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ROLE OF VIRECHANA AND KANTAKARYAVALEHA IN THE MANAGEMENT OF TAMAKA SHVASA IN CHILDREN, By RAHUL PATIL, DEPARTMENT OF POST GRADUATE STUDIES IN KAUMARABHRITYA SDM COLLEGE OF AYURVEDA AND HOSPITAL ...

ROLE OF VIRECHANA AND KANTAKARYAVALEHA IN THE MANAGEMENT OF TAMAKA SHVASA IN CHILDREN, By RAHUL PATIL, DEPARTMENT OF POST GRADUATE STUDIES IN KAUMARABHRITYA SDM COLLEGE OF AYURVEDA AND HOSPITAL HASSAN

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    Tamaka shvasa kantakari-kb Tamaka shvasa kantakari-kb Document Transcript

    • ROLE OF VIRECHANA AND KANTAKARYAVALEHA IN THE MANAGEMENT OF TAMAKA SHVASA IN CHILDREN By RAHUL PATIL Dissertation Submitted to the RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATI M.D. (Ay.) In KAUMARABHRITYA Under the guidance of Dr. SHAILAJA.U M.D. (Ay.), Ph.D., H.O.D & PROFESSOR Department of KaumarabhrityaDEPARTMENT OF POST GRADUATE STUDIES IN KAUMARABHRITYA SDM COLLEGE OF AYURVEDA AND HOSPITAL HASSAN - 573 201 2010
    • DEPARTMENT OF POST - GRADUATE STUDIES IN KAUMARABHRITYA SHRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA & HOSPITAL HASSAN - 573 201 Certificate This is to certify that the Dissertation entitled “Role of Virechana and Kantakaryavaleha in the Management of TamakaShvasa in Children” is the bonafide record of research work conducted by “Rahul Patil” under my direct supervision and guidance as a partial fulfillment for the award of the degree of M.D. in Ayurveda - Kaumarabhritya. The candidate has fulfilled all the requirements of ordinances laid down in the prospectus of Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka for the award of Degree of Ayurveda Vachaspathi (MD Ayu.) in Kaumarabhritya. I am fully satisfied with his work and recommend this dissertation to be forwarded for adjudication.Date: Guide :Place: HASSAN Dr. SHAILAJA U. H.O.D. & PROESSOR Dept. of P. G. Studies in Kaumarabhritya, S D M College of Ayurveda & Hospital, Hassan
    • DEPARTMENT OF POST GRADUATE STUDIES IN KAUAMARABHRITYA SHRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF AYURVEDA & HOSPITAL HASSAN – 573 201 (Affiliated to R.G.U.H.S, Karnataka, Bangalore) ENDORSEMENT BY THE HOD AND HEAD OF THE INSTITUTION This is to certify that the Dissertation entitled “Role ofVirechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children” is the bonafide record of research workconducted by “Rahul Patil” under the guidance of Dr.Shailaja U,H.O.D. and professor, Dept. of P. G. Studies In Kaumarabhritya, S D MCollege of Ayurveda, Hassan.Dr. Shailaja U. Dr. Prasanna N. Rao.Prof.& H.O.D. PrincipalDept. of P. G. Studies in Kaumarabhritya S D M College of Ayurveda & Hospital,S D M College of Ayurveda & Hospital, HassanHassan Prof. Gurdip Singh Director, Post Graduate Studies S D M College of Ayurveda & Hospital, HassanDate:Place: HASSAN
    • RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “Role of Virechanaand Kantakaryavaleha in the Management of TamakaShvasa inChildren”is a bonafide and genuine research work carried out by me under theguidance of Dr. Shailaja.U, M.D. (Ay.), Ph.D., Professor and H.O.D., Dept. of P. G.Studies in Kaumarabhritya, S D M College of Ayurveda and Hospital, Hassan.Date: Signature of the candidatePlace: Hassan Rahul Patil
    • COPYRIGHT DECLARATION BY THE CANDIDATEI hereby declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for academic/research purpose.Date: Signature of the candidatePlace: Hassan Rahul Patil © Rajiv Gandhi University of Health Sciences, Karnataka
    • ACKNOWLEDGEMENTMy gratitude, which is the mother of all virtues and most capital of all duties, has allthere order and diligence to all those who graciously involved in this venture ofmine. There is much greatness of mind in acknowledging a good turn, as in doing it.I humbly, seek this opportunity to bow my head to the feet of almighty LordDhanwantari for showering their blessings and empowering me to this eventfuloutcome without any impediments.Words are not enough to express my gratitude and indebt to the sacrifices of mybeloved and respected parents Mr. Jagdish Patil and Smt. Shobha who are the causefor me to take this noble profession and shape me into what I am today.I pay my respectful salutations to his Holiness Poojya Shri Veerendra Heggadeji,founder father of SDMCA&H, Hassan and fountainhead of educational movements,for his divine blessings in disguise and who has been kind enough to provide me anopportunity to study and render my service in this esteemed institution.My vocabulary falls short of suitable words to express my recondite sense ofindebtedness to my compassionate teacher Prof. Prasanna N. Rao, Principal, whohas been guiding force and instrumental in all the proceedings of my postgraduatestudy and stood as an excellent encouraging stanchion in all strides in accomplishingthis meticulous effort.It is beyond the reach of my language to inscribe the profound respect and devotiontowards affectionate Prof. Gurdip Singh. Director, P.G. Board of Studies, for his
    • constant support, timely guidance and valuable suggestions to get this work donesuccessfully. The words are inadequate to express with profound reverence my heartiestgratitude and indebtedness to my guide Dr. Shailaja U H.O.D. Dept ofKaumarabhritya for her untiring help, close and constant attention with constructiveand valuable suggestions at every steps of this work. I am extremely grateful to Dr. Srinidhi K Acharya Asst. professor, Dept. ofKaumarabhritya, for his constant support and guidance during my thesis work.I am very much thankful to my colleagues Dr. Shwetha, Dr.Aarthi, Dr.Praveen,Dr.Prasad my seniors and junior for their support and encouragement throughoutthe research work. I am also thankful to Dr.Ramya, Dr.Drishya, Dr.Sunil, Dr.Ketan,Dr. Maheshwar, Dr. Jyotirmoy, Dr. Gautam & my all classmates for their kindsupport.I express my deep sense of gratitude to my brother Mr. Bhushan Patil forsupporting, blessing and praying for my success in life. Rahul Patil
    • LIST OF ABBREVIATIONSKa.Sa.- Kashyapa SamhitaCha. - Charaka SamhitaSu. - Sushruta SamhitaA.S. - Astanga SamhitaA.H. - Astanga HridayaB.P. - Bhava PrakashY.R. - Yoga RatnakaraM.N. - Madhava NidanaG.N. - Gada NigrahaC.D. - ChakradattaSha.Sa - Sharangadhara SamhitaSu. - SutrasthanaSha - Shareera SthanaNi - Nidana SthanaChi - Chikitsa SthanaI - Indriya SthanaKa - Kalpa SthanaSi - Siddi SthanaU - Uttara tantraKhi - Khila SthanaAEC - Absolute cosinophitea count
    • TC - Total CountDC - Differential countESR - Erythrocyte Sedimentation ratePEFR - Peak Expiratory Flow RateT.B. - Text BookT.S. - Tamaka ShwasaS.C. - Shringyadi ChoornaE.I.A. - Exercise induced asthmaH.I.A. - Hyperventilation induced asthmaLTD4 - Leukotrine D4PAF - Platelate activating factorPGD2 - Prostaglandin D2UTRI - Upper Respiratory Tract InfectionRSV - Respiratory Syncytial VirusNB - Note beforeJ.M. - Jamnagar I.P.G.T.& R.A. Gujarat Ayurveda UniversityA.D. - Ahmedabad, Govt. Ayurvedic College, Gujarat Ayurvedic UniversityB.U. - Varanasi, Faculty of Ayurveda, IMS., Banaras Hindu UniversityL.K. - Lucknow, State Ayurvedic College, University of LucknowJ.P. - National Institute of Ayurveda, Rajasthan UniversityU.D. - Udaipur M.M.M Government Ayurvedic Colege, Rajasthan UniversityT.R. - Trivendrum, Govt. Ayurvedic College, Kerala University, Thiruvananthapuram
    • H.Y. - Hyderabad, Government Ayurvedic College, HyderabadB.L. - Bangalore, Govt. College of Indian MedicineM.Y. - Mysore, Govt. College of Indian MedicineR.P. - Raipur, Govt. Ayurvedic College, Pt. Ravishankar University, Raipur.G.W. - Gwaliar, Government Ayurvedic College, Jiwaji University, GwaliarP.U - Puri Government Ayurvedic CollegeC.A. - Calcutta, Post Graduate Centre, University of CalcuttaP.L. - Patiala Government Ayurvedic CollegeP.N.T - Pune Tilak Ayurveda Mahavidyalaya, Poona University Astanga Ayurveda Mahavidyala, Poona UniversityN.D. - Nanded Govt. Ayu. Mahavidyalaya, Dr. Babu Saheb Ambedkar Marathwada VidyapithN.G. - Government Ayurvedic College, Nagpur.N.S. - Shri. Ayurveda Mahavidyala, NagpurB.M. - K.G. Mittal Punarvasu Ayurveda Mahavidyala, Bombay.
    • INDEXSl. No Contents Page No. 1. INTRODUCTION 01 2. REVIEW OF LITERATURE 03 3. DRUG REVIEW 54 4. MATERIALS AND METHODS 75 5. OBSERVATIONS 79 6. RESULTS 85 7. DISCUSSION 103 8. SUMMERY & CONCLUSION 115 9. REFERENCES 118 10. BIBLIOGRAPHY 123
    • LIST OF TABLESSr. no Content Page No.No 1 Nidana of Shvasa 04No 2 samprapti of Tamakashwasa 20No 3 Poorvaropa of Shvasa 22No 4 Roopa of Tamaka Shvasa 23No 5 Differencial Diagnosis of Extrinsic and intrinsic Asthma 30No 6 Vyavacchedaka Nidana of Tamakashvasa 33No 7 Sapeksha Nidana of Shvasa 34No 8 Assessment of Severity of Asthma 35No 9 List of Shamanoushadhi for Shvasa 45No 10 Pathya and Apathya for Shvasa 49No 11 Age wise Distribution 79No 12 Sex wise Distribution 79No 13 Religion wise Distribution 79No 14 Education Status 80No 15 Age of onset 80No 16 Aggravating factors 80No 17 Incidence of associated disorders 81No 18 family history of Asthma 81No 19 Dietary Habit-wise distribution 81No 20 Prakruti wise distribution 82
    • No 21 Sara wise distribution 82No 22 Samhanana wise distribution 82No 23 Satwa wise distribution 83No 24 Pramana wise distribution 83No 25 Vyayama Shakti wise distribution 83No 26 Showing Ahara Shakti of Tamaka Shvasa patients 84No 27 Showing of Agni of Tamaka Shvasa patient 84No 28 Showing Nature of kosta 84No 29 Effect of Kantakaryavaleha after Virechana on Dyspnoea 85No 30 Effect of Kantakaryavaleha after Virechana on Wheezing 86No 31 Effect of Kantakaryavaleha with Virechana on Cough 86No 32 Effect of Kantakaryavaleha with Virechana on Sputum 86No 33 Effect of Kantakaryavaleha with Virechana on Sneezing 87 Effect of Kantakaryavaleha with Virechana on CommonNo 34 87 Cold Effect of Kantakaryavaleha with Virechana on Day TimeNo 35 87 Asthama Effect of Kantakaryavaleha with Virechana on Night TimeNo 36 88 AsthamaNo 37 Effect of Kantakaryavaleha with Virechana on Discomfort 88 Effect of Kantakaryavaleha with Virechana on Tightness ofNo 38 88 ChestNo 39 Effect of Kantakaryavaleha with Virechana on Chest Pain 89 Effect of Kantakaryavaleha with Virechana on Loss ofNo 40 89 SleepNo 41 Effect of Kantakaryavaleha after Virechana on PEFR 89 Effect of Kantakaryavaleha with Virechana on Impact onNo 42 90 ActivityNo 43 Effect of Kantakaryavaleha with Virechana on Palpitation 90
    • Effect of Kantakaryavaleha with Virechana on the MeanNo 44 90 Respiratory Rate Effect of Kantakaryavaleha with Virechana on FrequencyNo 45 91 of Attack Effect of Kantakaryavaleha with Virechana on Duration ofNo 46 91 SymptomsNo 47 Effect of Kantakaryavaleha on Dyspnoea 92No 48 Effect of Kantakaryavaleha on Wheezing 92No 49 Effect of Kantakaryavaleha on Cough 92No 50 Effect of Kantakaryavaleha on Sputum 93No 51 Effect of Kantakaryavaleha on Sneezing 93No 52 Effect of Kantakaryavaleha on Common Cold 93No 53 Effect of Kantakaryavaleha on Day Time Asthama 95No 54 Effect of Kantakaryavaleha on Night Time Asthama 95No 55 Effect of Kantakaryavaleha on Discomfort 95No 56 Effect of Kantakaryavaleha on Tightness of Chest 96No 57 Effect of Kantakaryavaleha on Chest Pain 96No 58 Effect of Kantakaryavaleha on Loss of Sleep 96No 59 Effect of Kantakaryavaleha on PEFR 98No 60 Effect of Kantakaryavaleha on Impact on Activity 98No 61 Effect of Kantakaryavaleha on Palpitation 98No 62 Effect of Kantakaryavaleha on the Mean Respiratory Rate 99No 63 Effect of Kantakaryavaleha on Frequency of Attack 99No 64 Effect of Kantakaryavaleha on Duration of Symptoms 99No 65 comparison of effect of treatment 101
    • LIST OF GRAPHSGraphs Content Page No.No 01 Effect of therapies on Dyspnoea 94No 02 Effect of therapies on Wheezing 94No 03 Effect of therapies on Cough 94No 04 Effect of therapies on Sputum 94No 05 Effect of therapies on Sneezing 94No 06 Effect of therapies on Common Cold 94No 07 Effect of therapies on Day Time Asthama 97No 08 Effect of therapies on Night Time Asthama 97No 09 Effect of therapies on Discomfort 97No 10 Effect of therapies on Tightness of Chest 97No 11 Effect of therapies on Chest Pain 97No 12 Effect of therapies on Loss of Sleep 97No 13 Effect of therapies on PEFR 100No 14 Effect of therapies on Impact on Activity 100No 15 Effect of therapies on Palpitation 100No 16 Effect of therapies on the Mean Respiratory Rate 100No 17 Effect of therapies on Frequency of Attack 100No 18 Effect of therapies on Duration of Symptoms 100No 19 comparison of effect of treatment 102
    • List of Diagrams – Drugs which are used in studyNo 01 KantakariNo 02 GuduchiNo 03 ChitrakaNo 04 MustaNo 05 Maricha 73No 06 KarkatasringiNo 07 RasnaNo 08 SathiNo 09 KantakaryavalehaNo 10 TrivritNo 11 VidangaNo 12 PippaliNo 13 Moorchita Ghrita 74No 14 HaritakiNo 15 BibhitakiNo 16 Amalaki
    • Introduction INTRODUCTION Tamaka Shvasa is one among the five varieties of Shvasa explained in almost .all the classics of Ayurveda, which is analogous with bronchial asthma mentioned inmodern medicine. Since centuries TAMAka Shvasa remained to be a challenging andunremitting disease. In both sexes it may occur at any age. Tamaka Shvasa is one ofthe chronic diseases of children, which causes a lot of worries to the patients as wellas parents. It affects school attendance, play works, school performance, day to dayactivities and growth of the child. Bronchial asthma in children is a worldwide problem having an incidence rateof 10-15% in boys and 7-10% in girls. In general population, about 80% of childrenbegin to have symptoms before the age of 4-5 years and 10% starts wheezing for thefirst time in the later childhood. Thus asthma is a chronic respiratory disease inchildren which is increasing day by day due to the mode of life, dietetic changes,pollution environmental variations and various stimuli like dust, cold air, smoke,pollens, house dust mite, viral respiratory track infections etc. Childhood asthma ishighly variable and may differ from patient to patient, so needs much attention andcare. The younger asthmatic child is often very troubled by cough especially atnight rather than flank wheezing. So the diagnosis is often given as bronchitis orspastic bronchitis rather than asthma. Chronic nocturnal cough is one of thesymptoms of asthma children. The older children with asthma, typically has episodicattacks of wheezing and breathlessness, usually worst at night or early morning andare often accompanied by cough, but little or no sputum production. The attacks areseparated by symptoms free interval and duration attach varies from patient to patient. Page 1Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Introduction The nature of attacks of asthma and the pattern of recurrence variesconsiderably from child to child and this has an importance on treatment. Virechana is explained as best treatment in Tamakashvasa i.e. TamaketuVirechanam. As the disease in Pittasthana Samudbhava, Virechana may help a lot.Caraka explains that according to disease, Bheshaja should be used in reduced dosageand in mild form for children. Adopting the same principles, Mridu Virechana withTrivrutta can be administered to children, which does not cause much discomfort tothem.2a Generally it is seen in practice that only Virechana may not cure the diseaseand some Shamana Yoga has to be given. Bhavaprakasha has indicatedKantakaryavaleha to manage Shvasa Raga. Moreover the medicine is palatable &sweet in taste, hence can be administered to children easily.3 In the present clinical study patients were divided into 2 groups. Total 60patients were completed the clinical study with 15 patients in each group. Group Apatients were admitted in S.D.M. C.A & H Hassan and Virechana therapyadministered followed by Kantakaryavaleha for Shamana Chikitsa. In groups Bpatients only Kantakaryavaleha was administered. The study was planned under following headings. 1. Literary review 2. Drug review 3. Clinical study 4. Discussion 5. Summary and conclusionIn the present clinical study Virechana followed by Kantakaryavaleha as a ShamanaChikitsa provided better relief in relieving the symptoms of Tamaka Shvasa. Page 2Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review REVIEW OF LITERATURETamaka Shvasa is one of the five varites of Shvasa Roga, explained in almost all theclassics of Ayurveda.NiruktiThe term „Tamaka-Shvasa‟ consists of two words „Tamaka‟ and „Shvasa‟.„Tamyati tamuglanou kwip anunasikasya iti deerghahai Shvasagati pratibandhakaDoshaha’.1The word „Tamaka‟ is derived from the dhatu (root) „Tamu – glanau’ with ‘kvip’pratyaya (syllable). It means to choke, be suffocated, darkness.1„Tamyati iti Tamaka’ Tama eva Tamaka’ i.e. where Tama occurs is Tamaka.2Tama means –Darkness 2a The word „Shvasa‟ is derived from the dhatu „shvas‟ with „ghai‟ pratyaya.„Shvasti iti Shvasah‟ it means to – breathe, by which the respiratory movements takeplace.3 The term Tamakashvasa is formed by Karmadharaya Samasa as “Tamakaschaasau Shvasascha Tamaka Shvasaha” It means difficulty in breathing, which mainlyoccurs during night time.Paribhasha Sushruta defined Tamaka Shvasa as “Visheshad durdine tamyeti shwasha saTamako matah”.4 The attack of Shvasa with Tamapravesha occurs specially during Durdina. Nocommentator has mentioned the meaning of the word Durdina. Acharya Carakaexplained that Tamaka Shvasa gets aggravated when one is exposed to cloudyatmosphere, cold water, cold weather, and wind blowing from eastern direction, Page 3Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewKapha aggravating food and regimen.5 Hence the above conditions can be correlatedwith durdina. Vijayarakshita the commentator of MadhavaNidana explained in Shvasa Rogathe expired air produces sound similar to the sound of blow of blacksmith.6NIDANA PANCHAKATamaka Shvasa is one of the diseases where Nidana Parivarjana and SampratiVighatana play an important role.NIDANAThe term Nidana refers to all the factors, which causes initiation and progress of thedisease. Various etiological factors can be studied under 4 conventioanal headings aslisted in Table-1. Table-1 AAhara sambandhi Nidana of Shvasa Mentioned in Ayurvedic Texts A. M. G. Nidana C.S S.S A.S Y.R B.P H N N A. Ahara Sambandhi Sheetapana + + + + + + + + Sheeta Ashana + + - - + + + + Guru Bhojana + + - - + + + + Abhishyandi Bhojana + + - - + + + + Rooksha Bhojana + + - - + + + + Vidahi ahara + + - - + + + + Vistambi ahara + + - - + + + + Adhyashana + + - - + + + + Shleshmala ahara + - - - - - - - Jalaja Mamsa + - - - - - - - Anoopa Mamsa + - - - - - - - Ama Ksheera + - - - - - - - Shaluka + - - - - - - - Dadhi + - - - - - - - Masha + - - - - - - - Nishpava + - - - - - - - VishAmashana + + - - - - - - Puinyaka + - - - - - - - Tila Taila + - - - - - - - Pista padartha + - - - - - - - Amla padartha - + - - - - - - Page 4Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table 1 BVihara sambandhi Nidana of Shvasa Mentioned in Ayurvedic Texts A. M. G.Nidanas C.S S.S A.S Y.R B.P H N NB.Vihara SambadndhiVata Sevana + + + + + + + +Raja Sevana + + + + + + + +Dhomma Sevana + + + + + + + +VyayAma + + + + + + + +Vegadharana + + - - - - + +Sheeta Sthana - + - - + + + +Sheeta snana - + - - + + + +Sheetashana - - - - + + - -Atapa Sevana + + - - - - - -Bhara vahana - + - - + + + +AdwagAmana + - - - - - - +Abhishyandi upachara + - - - - - - -Dwandwa Sevana + - - - - - - - Table 1 CAvastha sambandhi Nidana of Shvasa Mentioned in Ayurvedic Texts A. M. G.Nidana C.S S.S A.S Y.R B.P H N NC.Vyadhi/Avastha sambadhi NidanaPratishyaya + + - - - - - -Kasa - + + + + - - -Jwara + - + + + + + -Chardi + - + + + - - -Kshata kshaya + - - - - - - -Atisara + - + + + + + -Vishoochika + - - - - - - -Vibandha + - - - - - - -Dourbalya + - - - - - - -Udavartha + - - - - - - -Raktapitta + - - - - - - -Anaha + - - - - - - -Pandu + - + + + - - -Rookshata + - - - - - - -Apstarpana + + - - + + + -Shuddi Atiyoga Page 5Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table 1 DAgantu karaka Nidana of Shvasa Mentioned in Ayurvedic Texts A. M. G. Nidana C.S S.S A.S Y.R B.P H N N D. Agantu Karaka Marmaghata + + + + + - - - Visha + - + + + - - - Kantorasa Pratighata + - - - - - - - Acharya Caraka explains that the child feeding on Atisnigdha breast milksuffers from Tamaka Shvasa. Chakrapani commeting on the Nidanas of Shvasa hadgrouped them into Vata Prakopaka gana and Kapha Prakopaka gana, 15, which can bestudied as fallows:VATA PRAKOPAKA NIDANA Sheetapana, sheetasnana, sheeta Vata and similar Nidanas causes sheetaGunavriddhi of Vata, which may in term causes the Kshobha and Sankocha in the Srotas. Ativyayama, Adhvagamana, Bharavahana and Atapa Sevana may cause DhatuKshaya as well as Vata Prakopa.KAPHA PRAKOPAKA NIDANA SheetaSthana, Sheetasana, Sheetasnana, Sheeta Vata etc causes increase inSheeta Guna of Kapha resulting in KaphaVruddhii. Dadhi, Masha etc are Guru andPicchila in nature so excessive consumption of these food materials causes KaphaVriddhii. Vishamashana, Adhyashana and Abhishyandhi Bhojana cause Agnimandyawith resultant production of Ama. The Ama having similar Gunas of Kapha causesKapha Vriddhii. Page 6Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Asatmya in our classics has been defined as “Shareerena saha yat athmatamvikritha roopatham na yathi that. Ethena yadupayuktam prakrita roopopaghathakambahavathi that Asatmyami”16 i.e. which doesn‟t suit to the body constitution. Raja andDhooma are well known to produce Tamaka Shvasa symptoms especially in children.These can be taken as pollen grains, smoke, dust particles, animal danders, featherwool and fungal spores.NIDANARTHAKARA ROGAS Acharya Gangadhara in the context of Shvasa Nidana has commented that thediseases like jvara, Kasa, Pratishyaya, Pandu, Kshatakshaya, Raktapitta, Udavarta,Visoochika, Visha etc. cause Shvasa.17 According to Sushruta Apasthamba,Sthanamoola, and Sthanarohita Marma18 and according to Vagbhata Siramarma,Vishalyagna Marma Viddha causes Shvasa.19 Out of these pratishyaya and kasa areknown to produce Tamaka Shvasa. It is explained that Pratishyaya is Nidanarthakasa Roga for Kasa and if Kasa isnot treated properly then it leads to Shvasa i.e. “Kasa Vruddhya Bhaveta Shvasah”.20PITTASTHANA DUSTIKARAKA NIDANA Acharya Caraka has explained Shvasa as Pitta Sthana Samudbava Vyadhi. 21Vagbhata and Cakrapani have explained it as Amashaya Samydbhava Vyadhi. 22 Alletiological factors including Agnimandyakaraka and Amotpadaka Nidanas may begrouped under this heading. These factors affect PittaSthana, which may result inAgnimandya and Ama formation. It is explained that „Rogah sarve api mandagnow‟i.e. all the diseases are produced by Mandagni. Agnimandya and Ama have a definiterole in initiation and severity of Tamaka Shvasa. Page 7Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewKHAVAIGUNYA KARAKA NIDANAS Acharya Sushruta had explained that the vitiated Doshas while traveling allover body, settles where there is Khavaigunya and produces Vyadhi there.23 ThusKhavaigunya in Pranavaha Srotas may occur due to many factors which causesvitiation of Doshas. Thus Khavaigunya in Pranavaha Srotas may occur directly due toAgantu Karanas like Raja, Dhooma, SheetaVata Sevana etc. It is also explained thatPratishyaya & Kasa are Nidanarthakara Rogas for Tamaka Shvasa. ThusKhavaigunyakaraka Nidanas are important factors which are responsible for TamakaShvasa. This Khavaigunya may be compared to bronchial hyperreactivity or airwayhyperresponsiveness.PROBABLE CAUSE FOR RECURRENCE OF TAMAKA SHVASA Caraka explains that, even if a disease is cured, it may reoccur by minor formof etiological factors, 24 which is true especially in case of Tamaka Shvasa. AcharyaCaraka also explained that when a person becomes weak due to earlier diseases andthe channels for the manifestation of the disease (here Pranavaha Srotas) becomesvulnerable for the same disease.25 Cakrapani commenting on the word „margeekrute‟ told that„Vyadhipratibandhakataya margasadrushikrute‟ i.e. person may not become resistantto that Vyadhi.25a Caraka substantiated his statement by giving a simily that, after themain fire is extinguished, a small quantity of fire is enough to flare up the same. This principle can be applied in Tamaka Shvasa also. Because once the childgets Tamaka Shvasa (asthma), the Pranavaha Srotas (airways) is vulnerable for thesame disease, whenever the child is exposed to Nidanas i.e. etiological factors. Thiscan be compared to bronchial hyper-reactivity or airway hyperresponsiveness. In Page 8Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Reviewmost of the cases bronchial hyperreactivity in association with triggering factors, willbe the main cause for childhood asthma.ETILOGOY OF ASTHMAAsthma is a complex disorder involving autonomic, immunologic, infectious,endocrine and psychologic factors in varying degrees in different individuals. Thusasthma is a result of multifactorial inheritance.ALLERGY Airway inflammation related to allergic processes is of fundamentalimportance in asthma especially in childhood asthma. Here the problem is to detectthe specific allergens for a particular individual in the initiation and persistance ofasthma.INHALED ALLERGENS Most of the allergens that initiate asthma are inhaled allergens like pollengrains, animal hairs, dander, feathers, dandruff, dust and smoke etc. Inhalation ofthese allergens in the hypersensitive children leads to a biphasic response (early andlate reactions) ultimately causing bronchoconstriction.26FOOD ALLERGY (INGESTED ALLERGY) Foods that have the highest potential to cause IgE mediated sensitivity arefish, shellfish, peanuts, various nuts and seeds, egg, cow‟s milk, soya, wheat and corn. Children with IgA deficiency have higher levels of antibodies to cow milkproteins and of immune complexes containing milk antigens than do normal controls.Cow milk allergy can contribute to gastro-intestinal reflux, especially associated with Page 9Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Reviewdiarrhoea or atopic dermatitis. Children with gastro-esophageal reflux and atopichistory are more succeptible for asthma.27 Salfites can cause bronchoconstriction in some asthAmatic patients and severelife threatening airway obstruction in few.28 Food additives like dyes (coloring agent) e.g. tartazine, flavouring agents(MSG) and preservatives like metabilsulfite can induce bronchoconstriciton inasthmatic children.28 Various foods or food preparations, which can cause allergy, are listedbelow.29DIETARY SOURCES OF COW MILKButter fried foods ChocolatesBiscuits CookiesBread Cream SaucesButter Cream SoupsCakes CustardCandy Fish fried in batterCereals GraviesYogurt Ice-creamCheeseDIETERY SOURCES OF EGGBaked goods Egg noodlesBaking mixes Ice creamBatters OmelettesBreakfast cereals SoupsCake flours Malted cocoa drinksCandy CookiesCreamy fillings Custard Page 10Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewVIRAL INFECTIONS One of the important factors that triggers childhood asthma are viral infectionsof respiratory tract with respiratory syncytial virus (RSV), parainfluenza virus,influenza virus, and rhino virus. Probably viral infections damage the mucosal surfaceand causes shedding of epithelium leading to mucosal oedema and more mucussecretion.30 One study reveals that viral infections accounts for some 80-85% of asthmaexacerbation in children aged 9-11yrs (Johson et.al.1995).31DIURNAL AND SEASONAL FACTORS Children usually suffer from frequent nocturnal attacks and they will berelatively well without symptoms during daytime.Exercise The commonest problem encountered in asthma management is exercise-induced asthma. Because children are naturally for more active physically than adultsand they often take part in play works or competitive physical activities. The severityof asthma depends upon climate of air breathed and exercise induced asthma (EIA) isless where the air is warm and humid. EIA is seen less common after intermittentexercise such as occurs in most group games as compared with continuous runningfor 6-8 minutes. There fore swimming is best exercise for asthmatic children, as itdoesn‟t cause EIA because the air that the child breathes is relatively humid. Physical exercise is seen as having four effects on the asthmatic person.32 It causes hyperventilation with consequent cooling and drying of bronchialmucous and intern liberates bronchoconstricting mediators such as LTD4. Page 11Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewSMOKING AND POLLUTION In a child with hyper-reactive airways, environmental pollution especiallytobacco smoke can increase the incidence of lower respiratory tract disease andprovokes attacks of asthma. It is interesting to note that the study of Targer et.al.1993; Stick et.al.1996,demonstrated that in infants of mothers who smoke during pregnancy, had reducedresting lung function and increased bronchial reactivity. A study revealed thatdampness in the house was significantly associated with incidence and severity ofasthma. (Williamson et.al.1997) 33PSYCHOLOGICAL FACTORS Emotional factors can trigger symptoms in many asthmatic children.34Emotional stress operates through vagus, initiating bronchial smooth muscles tocontract.35 In these cases control over asthma is poor.ENDOCRINE FACTORS Asthma may worsen in relation to menses especially in pre-menstrual period.In some girls symptoms of asthma reduces after puberty. Thyrotoxicosis increases theseverity of asthma but the pathophysiology is yet unknown.34DRUGS: Drugs such as aspirin, NSAID, tartarazine, -receptor antagonists, andmetabilsulphites can trigger an asthmatic attack. Page 12Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewGASTRO-OESOPHAGEAL REFLUX It has been recognised that gastro-oesophageal reflux can produce an increasein bronchial reactivity (Wilson et.al, 1985; Vincent et.al. 1997) and may beresponsible for the very severe attacks of nocturnal asthma which occurs in somechildren. This can be supported by the study reported that, in some infants antirefluxtreatment has been accompanied by an improvement in lung function. (Eid et. al.1994) In severe asthmatic children having severe and alarming nocturnalexacerbations, the possibility of reflux should be investigated.36CONTRIBUTING FACTORSBronchial hyper-reactivity /Khavaigunyata Bronchial hyper-responsiveness manifests itself as bronchoconstrictionfollowing exercise, on natural exposure to strong odours on irritant fumes such assulphur dioxide, tobacco smoke or cold air.37 This may be compared to Kha-vaigunya explained by Acharya Sushruta. Thevitiated Dosha‟s while moving all over the body settles where the khavaigunya ispresent and produces Vyadhi there.31 When the airway is hyper-reactive (ie whenKhavaigunyata is present in Pranavaha Srotas) various known and unknown stimuli(vitiated Dosha‟s settled in Pranavaha Srotas) cause bronchoconstriction(Shvasakrichrata).GENETIC FACTOR It is acceptable that we cannot give answers for the questions like:- 1. Why the asthmatic airways are hyper-reactive. 2. Whether this is present since birth or acquired. Page 13Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review 3. Why it seems to disappear during later childhood or puberty in most children as they „grow out‟ of their asthma. Study reported that there was a relatively high incidence of atopy and bronchialhyper-reactivity amongst the totally healthy relatives of asthmatic children andwheezy infant. A child with one affected parent has about a 25% risk of havingasthma; the risk increases to about 50% of both parents are asthmatic.39 It seems thateven in genetically predisposed children also some environmental factor(s) is neededto activate them.PRECIPITATING FACTORS IN ASTHMA /VYANJAKA NIDANA Respiratory symptoms in asthma may be precipitated or exacerbated byvarious factors although in many cases, no precipitating factors may be recognized. Other triggering factors which may produce wheezing are water over scalp orinside nose, irritation of nasal mucous, sweets, some fruits like grapes etc. ice colditems, non stop speech, loud prolonged laughing, exposure to cold air, closed andcrowed places & violent air flow (window seat while travelling). 40SAMPRAPTI The study of Samprapti helps in understanding how the disease has beenmanifested after Nidana Sevana. Thus Samprapti deals with all the pathologicalprocesses, which are responsible for clinical signs and symptoms of the disease. InAyurveda, much importance has been given for Samprapti Vighatana i.e. breaking thepathological process. Because Chikitsa is mainly to disintegrate the Samprapti(pathology) i.e. Samprapti Vighatana meva Chikitsa41 Page 14Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Acharya Caraka explains that if the child is feeding on Atisnigdha breast milk,his body channels (Srotas) are constantly smeared with aggrevated Kapha and thechills gets Tamaka Shvasa etc diseases.42 In the Charaka Samhita Chikitsa Sthana, Samprapti of Shvasa has been dealtin three occasions. 1. Common Samprapti of Hikka and Shvasa. 2. Vishista Samprapti of Shvasa. 3. Samprapti of Tamaka Shvasa. I. Common Samprapti of Hikka and Shvasa It is explained that the (vitiated) Vata enters the Pranavaha Srotas (channelscarrying the vital breath) and this vitiated Vata affecting the Kapha which is situatedin Uras (chest) produces Hikka and Shvasa.43From the above explanation we can point out the Acharya Caraka‟s views as 1. Srotas affected is Pranavaha Srotas. 2. Vata and Kapha are primly involved Dosha‟s. II. Vishista Samprapti of Shvasa This Samprapti is common for all 5 types of Shvasa. Acharya Carakaexplained that the Kapha along with Vata obstructs the Srotas. This obstructed Vatatrying to overcome the obstruction moves in all directions resulting in Shvasa.44 Here the term “Kapha purvaka” is commented by Cakrapani as „Kaphapradhana ie predominance of Kapha.45 Gangadhar opines it to be Kapha samyukta i.e.along with Kapha.46 Page 15Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review The term ‘Vishwagwrajati’ is commented by Cakrapani as ‘Sarvagwrajati’ i.e.moves in all direction.45 (inside the Pranavaha Srotas). But Gangadhara opines it to be“Sarva shareera gacchati i.e. moves all over the body.46 Arunadatta commenting onthe same uses the term “Urasthagagrahanam” i.e. it should be considered as Uras.After observing the above explaination Gangadhar commentory seems to beunacceptable and Cakrapani and Arunadatta opinions hold good. Acharya Sushruta explains that the vitiated Prana Vata gets Urdhwagati andcombines with Kapha and produces Shvasa.48 Dalhana on the above verse commentsthat Tamaka Shvasa is Kaphaprdhana Vyadhi.49 Acharya Vagbhata explained that the Vata, which is obstructed by Kapha,moves all over. This viatiated Vata further vitiates Prana, Udaka & Annavaha Srotasand produces Shvasa in Uras which is considered as Amashaya samudbhavaVyadhi.50 Madhukoshakara has the same opinion as Cakrapani regarding the VishistaSamprapti of Shvasa. Also he had explained as Pranavaha Sroto Avarodha is due toKaphavritha Vata.51 Vagbhata has mentioned the Samprapti of Caraka in different words but hehas considered the affliction of Annavaha and Udakavaha Srotas along withPranavaha Srotas.52 Even Cakrapani has considered the involvement of Annavaha andUdakavaha Srotas53, but Gangadhar has clearly ruled out the involvement of Srotasother than Pranavaha Srotas.54 Page 16Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewIII. Samprapti of Tamaka Shvasa This Samprapti is explained for Tamaka Shvasa only because it is acontinuation of the previous Samprapti as it states “Pratilomam yada Vata”. The Vata in Pratiloma Gati enters the Pranavaha Srotas and causes agitation ofKapha and then enters Greeva and Shiras resulting in Greeva and Shirograha andstimulates phlegm to cause peenasa (Coryza). Thus the obstructed Vata produces thesigns & symptoms of Tamakashvasa.55SAMPRAPTI GHATAKADosha: Vata – PranaVata, UdanaVataKapha: Avalanbhaka KaphaDushya: RasaAgni: Jatharagni, rasadhatvagniAma: JataragnimandhyajanyaSrotas: PranavahaSrotodusti: Sanga – AtipravrittiUdbhava Sthana: PittaSthana / AmashayaAdhistana: UrasSanchara Sthana: Pranavaha SrotasVyakta Sthana: UrasRogamarga: Abhyantara Due to multifactorial origin of Tamaka Shvasa, the Samprapti may differ frompatient to patient and varies according to the etiological factors. Thus commonSamprapti of Tamakashvasa can‟t be drawn due to its complexity. Eventhough, the Page 17Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewSamprapti of Tamakashvasa with regards to Kriyakalas can be studied in general asfallow in two stages.STAGE 1 In this stage physiological derangement takes place due to exposure toetiological factors (Nidanas). It occurs in first three phases of Kriyakalas i.e.Sanchaya, Prakopa and Prasara. The important manifestations are as fallows: 1. Vata Prakopa occurs due to Vata Vardhaka Nidana Sevana. 2. Kapha Prakopa occurs due to Kaphakara Nidana Sevana. 3. Pitta Sthana Dusti may occur due to Agnimandyakaraka and Amotpadaka Nidanas. 4. The vitiated Doshas circulates all over the body. 5. Sthanika Doshas may be directly vitiated due to direct affliction of Pranavaha Srotas due to Nidanas like Raja, Dhooma Sheeta Vayu etc. Though the role of Kapha is predominant in obstruction of Pranavaha Srotas but itis also motivated by Vata Dosha.STAGE 2 In this stage physiological abnormality leads to the pathologicalmanifestations and then circulation to all over the body. This stage includes threephases corresponding to the changes that take place in the last three phases ofKriyakalas i.e. Sthana Sansraya, Vyakta and Bheda.STHANA SAMSRAYA In this stage, the Doshas, which are already aggrevated and circulatingthroughout the body, settles in (Uras) Pranavaha Srotas where Khavaigunya is Page 18Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Reviewpresent. Here Khavaigunya may be present since birth (Beeja Dosha, Prakriti) orresulted due to aggrevated Doshas. Poorva Roopas will appear at this stage.VYAKTI The basic pathology is due to vitiation of Kapha and Vata in the PranavahaSrotas. Due to Kapha vitiation, excess Kapha Udeerana takes place, resulting inobstruction of Vata marga in the Pranavaha Srotas. Acharya Caraka has given thesimily to explain this as, „when the flowing water is obstructed, first it collects andbreaks the obstruction leading to exceess flow of water suddenly,56 in the same way ifthe free flowing Vata is obstructed by Kapha then it vitiates and causes damage to theSrotas‟. The obstructed Vata moves in all direction.BEDHAVASTHA If proper treatment is not done in the above stage, the pathological processesalready going on may worsen and Lakshanas may be produced according topredominance of Doshas. If Vata is predominant Vatadhika, Kaphadhika if Kaphapredominate and if Pittanubandha is there praTamaka Lakshanas will be produced. Ifneglected or due to improper or inadequate treatment, the Pranavaha Srotas andSrotomoola may be affected resulting into complications in due course of time. Page 19Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table No. 2 Showing schematic representation of samprapti of TamakashwasaPATHOLOGY OF ASTHMA It is now clearly established that the airway inflammation is the basicpathology in all types of asthma. Airway epithelium damage is another characteristicabnormality, which is not found in other diseases of airways. Pathology of extrinsicand intrinsic asthma is different. Therefore these are separately explained below. Page 20Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewPathology of Extrinsic Asthma or Allergic Asthma It is a type I hypersensitivity reaction. The basic sequence of events inpathogenesis of type I hypersensitivity begins with the initial exposure of antigen(also called as allergen). The allergen stimulates IgE production by B cells. Once IgEis bound to the surface of mast cells the individual is primed to develop type Ihypersensitivity. Re exposure to the same antigen results in fixing of the antigen tocell bound IgE, initiating a series of reactions which lead to the release of severalpowerful mediators that are responsible for the clinical features of type Ihypersensitivity.57 All allergens causes bronchoconstricition, mucosal edema, and mucussecretion, which ultimately result in airway obstruction58 and variety of chemotaxic,vasoactive and spasmogenic compounds take part in the pathogenesis of extrinsicasthma.59PATHOLOGY OF INTRINSIC ASTHMA In intrinsic or non-atopic asthma the mechanism of bronchial inflammationand hyper responsiveness is less understood. In this type of asthma, perhaps there is a hereditary or acquired over activityof the cholinergic (constrictor) response or reduced activity of the 2-adrenergic(bronchodilator) pathway. But in majority of cases triggering mechanism is non-immune in intrinsic asthma. Page 21Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewPOORVA ROOPA Poorva roopa denotes the symptoms that manifest before the actual or mainsymptoms occur. They are manifested during the stage of DoshadushyaSammurchana. The poorva roopa of Shvasa collected from different texts are presented inTable-3. Table-3 Poorvaropa of Shvasa According to Ayurvedic Major TextsNidanas C.S S.S A.S A.H Y.R B.P M.N G.NAnaha + + + + + + + +Hridaya Peedana + + + + + + + +Parshwa shoola + + + + - - - -Asya Vairasya - + - - + + + +Shankha Bhedha - - + + + + + +Pranasya Vilomata + - + + - - - -Shoola (udara) - - - - + + + +Admana - - - - + + + +Bhaktadwesha - + - - - - - -Aruchi - + - - - - - -ROOPA The symptom of a disease or the characteristic manifestations, which appearsduring the course of a disease, is known as Roopa. Acharya Kashyapa explains that ifthe child, who has hot breath from chest, is to be considered for having Shvasa. Page 22Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table-4 Roopa of Tamaka Shvasa According to the Major TextsPranavaha Srotosambandhi C.S S.S A.S A.H Y.R B.P M.N G.NLakshanaGurguruka (Wheezing) + + + + + + + +Shvasakrichrata (Dyspnea) + + + + + + + +Kasa (Cough) + + + + + + + +Prana peedana(Discomfort in chest) + - + + + + + +Peenas/ Pratishyaya (Coryza) + + + + + + + +Ateeva teevra Vegam chaShvasam (Increased rate of + - + + + + + +respiration)MuhuShvasa (Gets frequentattacks of dyspnea) + + + + + + + +Kantodhwansa(Throat irritation) + - + + + + + +Pramoham kasamanas-Cha(Fainting during excessive + - + + + + + +cough)Krichrat shaknote bhashitam(Difficulty in speaking) + - - - + + + +Shayanasya Shvasa peedita(Dyspnea increases in lying down + + + + + + + +posture)Pranavaha Srotosambandhi C.S S.S A.S A.H Y.R B.P M.N G.NLakshanasAseena Labhate Soukhyam + + + + + + + +(comfortable in sitting position)Parshwe tasyavagrahnatishayanasya sameeranah + - + + + + + +(Discomfart in sides of chest inlying down posture)Shleshmanam Amuchyamanebrusham bhavathi dukitha (Distress + + + + + + + +increases when unable toexpectorate)Tasyeva vimokshantemuhurtham labhate sukham + + + + + + + +(Gets relief after expectoration) Page 23Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewMeghambusheeta pragvataishleshmalaisch abhivardhate + - + + + + + +(Attacks gets aggravatedduring cloudy weather afterconsuming cold water,exposure to cold air, easternwind and when resorts Kaphaaggravating food and regimen)17.Ghoshen mahat - + - - - - - -Sarvadaihika Lakshanas C.S S.S A.S A.H Y.R B.P M.N G.NBrushAmatiman + - + + + + + +(Maximum distress)Sushkasyata + - + + + + + +(Dryness of mouth)Latatena swidyata + + + + + + + +(Sweating in forehead)Uchritaksha (wide opened eyes) + - + + + + + +Sannirudhyati (Immobilised) + - - - + + + +Na labhate nidra + - - - + + + +(Distrubed sleep)parshwa peeda - - + + - - - -(Pain in the sides of chest)Pratamyati + + + + + + + +(Loss of consciousness)Ushna abhinandana + - + + + + + +(Likes to take hot things)rishna (Thirst) - + + + - - - -Vamathu (Vomiting) - + - - - - - -Vepatu (Tremours) - - + + - - -Aruchi (Tastelessness) - + + + - - - -Trastyate (Frightened) - - - - - - - -Annadvit (aversion to food) - + - - - - - -CLINICAL FEATURES OF TAMAKA SHVASA/ASTHMA Common signs and symptoms include bouts of cough especially more innight, dyspnea, tachypnea wheezing and use of accessory muscles of respiration. Page 24Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Ghurghuruka (wheezing) is due to Pranavaha sroto avarodha by Kapha.60Excess Kapha Udeerana (secretion) takes place resulting in Sroto Avarodha. PittaSthana Dustikaraka Nidanas may cause Agnimandya and Ama which in tern doesRasa Dusti. This results in Kapha Vriddhi in Pranavaha Srotas. As Sroto Avarodha isone of the Rasa Dustipradoshaja Roga61 and Sashabdhata is an important Lakshana ofPranavaha Sroto Dusti, 62 it ultimately produces Gurguruka Shabda Shvasa Krichrata (dyspnea) is due to Pranavaha Sroto Sankocha andAvarodha. Due to Vatakara Nidanas Vata Prakopa takes place in Pranavaha Srotas,and being obstructed by Kapha, it further vitiated and moves in all directions.Sankocha has been explained as one of the Lakshana of vitiated Vata63 thus vitiatedVata causes the Pranavaha Sroto Sankocha leading to Shvasakrichrata. Peenasa and Kasa are important symptoms especially in children. Theobstructed Vata moving in Pratiloma Gati causes Greeva and Shiragraha andproduces peenasa.then child gets bouts of cough (Kasa) and faintig occurs whenfrequency of cough is increased (Pramoham Kasamanascha). Many children having no symptoms during day time, often gets up in themiddle of the night or early morning with either a classical wheezing (Nocturnaldyspnea) or a severe bout of cough (Nocturnal cough). Frequency and severity ofcough increases gradually along with wheezing. It is sometimes difficult for theparents to accept that the nocturnal cough is a manifestation of asthma. Child may bepresented with only cough without wheezing or wheezing without cough. But theyounger asthmatic child is often troublesome due to nocturnal cough rather thandyspnea. Page 25Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Ateeva Teevra Vega64 Shvasa i.e. increased rate of respiration may indicatethe severity of Vata vitiation. Murda (head) is main seat for Prana Vata65 and uras forUdana Vata.66 Impairement in the functions of Prana Vata and Udana Vata may leadto Ateeva Teevra Vega Shvasam. Here it is also important to recall that Atisristamand Kupita are Pranavaha Sroto Dusti Lakshana.67 When the lungs become overinflated, the stretch receptors activate an appropriatefeedback response that „switches off‟ the inspiratory ramp and thus stops furtherinspiration. This is called the Hering-Breuer inflation reflex. This reflex alsoincreases the rate of respiration.68 Krichrat shaknoti bhashitam69 i.e. difficulty in speaking may be due toinvolvement of Udana Vata. Vak Pravritti is one of the important fuction of UdanaVata66 and vitiation of Udana Vata may cause difficulty in speaking. Due to increasedrate of respiration and expiratory difficulty child will be having difficulty in speaking. Parshve tasyagrahnati i.e. discomfort in the sides of chest may be due to excessand laborious work of respiration especially intercostal muscles. Pramoham kasmanascha71 i.e. fainting during excessive cough might be due tosevere bronchoconstriction (which is not able to generate wheezing sound) andhypoxia. This leads to less oxygen supply to brain which causes fainting in children. Prana peedana64 is due to respiratory distress/ discomfort in the chest because ofShvasakrichrata. When airway is obstructed by mucus plug, the child gets maximum distress(brushAmatiman72). The distress increases when the child is unable to expectorate it Page 26Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review(shleshmanam amuchyAmane brusham bhavati dukhita73) and gets relief afterexpectoration of sputum (tasyeva vimokshante muhurtam labhate sukham73). Abdominal pain (udara shoola) is common particularly in younger children.Vomiting (Vamathu80) is common which may give temporary relief of symptoms.Children can‟t expectorate sputum, instead they swallow it. During vomiting due tocontraction of diaphragm and intercostal muscles, the intrathoracic pressure increaseswhich may help in expulsion of sputum from airways. By Ushnopachara Kapha gets liquefied causing its easy expectoration and thepatient thus likes to take ushnopachara (ushnabhinandana70). Aruchi78 (tastelessness), annadvit81 (aversion to food) and Vamathu (vomiting)may be due to involvement of Annavaha Srotas along with Pranavaha Srotas. Tamaka Shvasa gets aggrevated during cloudy atmosphere, cold weather, afterexposure to cold air, eastern wind and Kapha aggrevating food & regimen.74 All thesefactors may act as precipitating factors for attacks of asthma. Na labhate nidra75 i.e. unable to get sleep is due to Pranavaha Sroto Avarodhaand difficulty in breathing. Usually in younger children sleep is disturbed bynocturnal cough rather than wheezing and in older children cough with frankwheezing disturbs the sleep. With severe airway obstruction, child has difficulty in walking (sannirudyate71) oreven talking (Krichrat shaknoti bhashitam75), child may assume a hunched overtripod like sitting position that makes it easier to breathe (Aseena Labhate sukham70).Because sleeping in supine position increases dyspnea (Shayansya Shvasa peedita76). Page 27Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewMany children complain both inspiratory and expiratory difficulty. In severe casesthere will be respiratory distress (brushAmatiman) and child may sweat profusely(lalatena swidyate77). Low-grade fever (Jvara) may develop due to infection orenormous work of breathing. Suskasyata76 and trishna78 indicates involvement of udakavaha Srotas. Duringsevere attack, child may get thirst due to excess water loss through evoparation fromlungs and low intake of foods & fluids during attacks. Pratamyati71 (loss of consciousness), uchritaksha76 (wide opened eye),brushAmartiman (distress), vepatu79 (tremors) and sannirudyati (immobilised) etcsigns and symptoms indicates the severity of disease and the child in this conditionneeds urgent and immediate prompt treatment. A barrel shaped chest deformity is a sign of chronic unremitting airwayobstruction of severe asthma.UPASHAYA AND ANUPASHAYAA judicious application of Aushadhi, Ahara and Vihara, when produces relief in thesymptoms that is called as Upashatya when it aggravates the symptoms it is calledanupashaya. It is a trial and error treatment. 82 In Tamaka Shvasa, the Upashaya and Anuashaya have been explained whilementioning the Lakshanas of the disease. These are as fallows.Upashaya: 1. Tamaka Shvasa patients always desire for warm substances and surroundings.70 2. Respiratory distress will be relieved in sitting posture.70 (Tripod posture) Page 28Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewAnupashaya:1. Respiratory distress increases in lying down posture.832. Shvasakrichrata & kasa with expectoration will be aggravated during cloudyweather, cold season, intake of cold substances cold weather especially eastern wind,durdina and night or early morning.74VARIANTS OF TAMAKA SHVASA In Ayurveda Tamaka Shvasa has not been classified. On the basis of PittaDosha association two variants have been explained viz. Pratamaka and Sansamaka. 1. Pratamaka If Tamaka Shvasa is associated with Jvara and Moorcha then it is called asPraTamaka. It occurs due to Udavarta, Raja Sevana, Ajeerna, Klinnakaya andVegadharana.84 2. SantamakaIn this patient complaints of darkness around him and feels as if sinking in darkness.It aggravates severely in Tama ie darkness (or night) and subsides bySheetopachara.85 Acharya Gangadhara opines that these two are not bhedhas of Tamaka Shvasarather are stages of the same.86 In modern science asthma is mainly classified into 3 types. 1) Extrinsic or allergic (or atopic) asthma 2) Intrinsic asthma 3) Mixed variety Page 29Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewThe differences between extrinsic and intrinsic asthma are shown in Table-5. Table-5 Differencial Diagnosis of Extrinsic and intrinsic AsthmaExtrinsic IntrinsicImmune reaction type I Non immune abnormal autonomic regulationshypersensitivity of airwaysFamily history of hypersensitivity No family history of hypersensitivityis commonUsually starts in childhood Starts in adult lifeProceeded by infantile eczema and No evidence of atopyhypersensitivity of foodPredisposition to form IgE IgE antibodies may be found but no particularantibodies predispositionRecognizable allergens like pollen No recognizable allergensdandruff, house dust mite etcAttacks often diminish in later Attacks increases in severity as years passyearsChronic bronchitis seldom Associated with nasal polyp‟s chronicdevelops bronchitisEmphysema unusual Emphysema commonly developsNo drug sensitivity Drug sensitivity may develop (aspirin, penicillin etc)Increased levels of IgE found in Normal level of IgE in serumserumPositive response to skin Negative response to skin provocation testprovocation testLABORATORY INVESTIGATION Only on the basis of laboratory investigations it is very difficult to establishthe diagnosis of asthma. Following are the laboratory findings. 1) Blood eosinophilia more than 250-400 cells/mm is usual. 2) Eosiniophilia is seen in the sputum sample. 3) Asthmatic sputum is grossly tenacious, rubbery & whitish. 4) Serum protein and immunoglobulin concentrations are generally normal in asthma; expect that IgE levels may be increased.87 Page 30Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewBronchial Reactivity Testing Tests of bronchial reactivity can be a major importance in making thediagnosis, when the diagnosis is uncertain and evaluating the severity of asthma.Bronchial provocation by inhalation has now been widely performed in children usingeither methacholine or histamine as the challenge. Children with asthma generallyrespond abnormally to exercise, methacholine and adenosine 5- monophasphate(AMP) challenges while those with other types of chronic lung disease often respondabnormally to methacholine but not to exercise or AMP (Avital.et.al.1995). This maybe helpful in differential diagnosis of the child with chronic airway obstruction. Whenthe baseline pulmonary function is abnormal, instead of methacholine provocationtesting, response to bronchodilator therapy is more appropriate.Exercise Testing Running for 1-2 minutes causes bronchodilation but prolonged running causesbronchoconstrion in children suffering from asthma.Chest Radiograph If the child is presented with acute severe asthma, chest radiograph isnecessary to exclude the other possible diagnosis or complications such as atelactesisor pneumonia or mediastenal emphysema. Lung markings are commonly increased inasthma. During exacerbations if the child is presented with fever, tachypnea>60beats/min, tachycardia 160beats/min, localised rales or wheezing or decreasedbreath sounds or suspected for pneumothorax, in these conditions chest radiograph isnecessary. Page 31Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewImmunological Tests Skin testing or the measurement of specific IgE levels is of limited value inmost children with asthma. If a strong reaction is obtained to a specific allergen, it isonly significant when the child has a history of wheezing on contact with the allergen.Determination of specific IgE with these testing is useful in identifying theenvironmental allergens. But Shapiro and Anderson 1998 reported that none of theseunconventional tests (in vitro allergy diagnostic tests) have been shown to be of anyreal diagnostic value.Pulmonary Function Testing Testing of lung function useful for management of asthma and in theevaluation of children in whom asthma is suspected. Above 6yrs aged children canundergo spirometry and in younger children peak flow meter is helpful. If the PEFRor FEV, measured before and after aerosol therapy shows a 10% increase then it isstrongly suggestive of asthma. PEFR can be measured at home 2-3 times/day with themini Wright peak flow meter that provides an objective evidence for degree of airwayobstruction. Diurnal variability more than 30% indicates increased bronchialresponsiveness and worsening of asthma with increased susceptibility to airwayobstruction. Page 32Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table-6 Vyavacchedaka Nidana of Tamakashvasa Tamaka Maha Urdhwa Chinna KshudraSymptoms Shvasa Shvasa Shvasa Shvasa Shvasa Deergam Rooksha Ateeva UchaihiShva Shvasati Shvasati ayasodbh Shvasa teevra sati UrdwamShva vichinnam ava Vega sati Shvasa Matta Shabda Gururaka _ _ _ Vrishabhavat PranastaConcious- Pramoha Gyanavignan Pramoha Murcha _ ness a UchaihiShvas Vibrantaloch Viplutaksha Uchritaksh ati Netra an & Raktaikaloch _ a &Vibrantaks Vivrataksha ana ha No Parshwa Shoola _ Vedanartha Marmacheda indriya Shoola vyatha Krichrat Vak Shaknoti Vishirnavak _ Pralapana _ Bhashitam Vishuskasy Pari Asya _ Shuskasya _ a shuskasya Latata Sweda _ _ _ _ sweda Precipitat ed by BaddaMiscellane Anaha, vyayAma mutra _ Arati ous vivarna & ahara varcha no much distressSadhyasadh Yapya/sad Asadhya Asadhya Asadhya Sadhya ata hya Page 33Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table-7 Sapeksha Nidana of ShvasaSymptoms Tamaka Shvasa Kshataja Kasa RajayakshmaShvasa Swasa with teevra One of the One of the Vega is the symptoms symptoms of partyathma Lakshana ekadasha roopa rajayakshmaKasa Present Initially dry Present Piohila, visra,Steevana Kruchra steevana Rakthayuktha bahala, naritha, swetha, peetha varna rasa steevana, some times raktha yuktaJvara Absent Present PresentDhatu shoshana A late feature Late feature PresentShabda Ghurguraka ParaVata - koojanaShoola Parshva shoola Vedana in kanta Parshvashoola shira pradesha shoolaSadhya Yapya Yapya Sarva roopayuktha is asadhyaNidana Kapha and Vata Kshata on uras Vegavarodha, vardaka Nidanas or dhatukshaya, sahasa marmaghata or vishAmashan Nidanarthakara RogasDIAGNOSIS Recurrent episodes of coughing and wheezing especially, if aggravated ortriggered by exercise, viral infection or inhaled allergens are highly suggestive ofasthma. Persistent cough without wheezing is also suggestive of asthma in children,which may be erroneously diagnosed as „allergic cough‟, or „allergic bronchitis‟ or„wheezy bronchitis‟ or „chronic bronchitis‟. Pulmonary function testing before andafter administration of methacholine or a bronchodilator or before and after exercisemay help to establish the diagnosis of asthma.87 Page 34Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table-8Assessment of Severity of Asthma in Children88Based on Mild Moderate SevereFrequency/Month <One episode >One episode 4 episodesDuration of Symptoms Brief for hours Prolonged Almost continuous 2-3daysActivities-Eating - Normal - Solids - Liquids-Sleep disturbance - Nil - At times - Frequent-Playing - Able - Restricted - Not able-School absenteeism - Nil - Occasional - FrequentHospitalisation Rare Occasional FrequentPEFR 60-80% 40-60% Predicted 40% PredictedChest x-ray Normal Hyperairation EmphysemaUPADRAVA OF TAMAKASHVASA Trishna has been mentioned as the upadrava of Shvasa and this type ofTrishna is called as Aupasargika Trishna.89 No reference is available regarding theother Upadrava of Tamaka Shvasa.ARISHTA LAKSHANA Arista Lakshanas occurs just before death indicating the fatal prognosis of thepatient. Arista Lakshanas of Tamakashvasa have not been explained in any classics.Arista Lakshanas of Shvasa have been explained in the classics, which are as follow: 1. Patient presenting with deegra and hriswa niShvasa.90 2. Passage of grathita mootra and pureesha associated with agnisada.91 3. Shvasa complicated with atisara, jwara, Hikka, chardi, medrashotha and andashotha.92 4. Shvasa with jwara chardi, trishna, atisara and shopha.93 Page 35Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewSADHYA-ASADHYATA Sadyasadhayata gives the clear picture of curability of the disease i.e. whetherthe disease is curable, incurable or difficult to cure. It depends upon so many factorslike nature of disease, severity of disease, Vaya, Prakruti, Bala of patient etc. o According to Charaka it is Yapya ie difficult to cure. If it is in Navavastha (early stage) then it is Sadhya.94 o Also Charaka says Tamaka Shvasa is curable in strong persons when the symptoms are not manifested fully.95 o According to Sushruta it is Kastasadhya, but Asadhya in Durbala Rogi (weak patient).96 o Dalhana commenting on the above version says that it is Asdhya when it is associated with Jwvara, Moorcha and others.97 o According to Vagbhata it is Yapya. But says if it is treated in the begining and patient is strong (Balina) then Tamaka Shvasa is Sadhya.98 o When Maha, Chinna, Urdhva Shvasa Lakshanas appear in Tamaka Shvasa then it is considered to be Asdhya.99YAPYATA OF TAMAKA SHVASA IN CHIDREN Generally Tamaka Shvasa is said to be Yapya disorder74 i.e. difficult to cure.It is Sadhya in early stages and in strong patients and if it is not associated with othercomplications. The disease becomes Asadya in Durbala patients. It is explained that in Balyavastha Kapha is predominant Dosha and childhooddiseases caused by Kapha naturally take a serious turn.100 So children are mostsucceptible for Kaphaja diseases like Pratishyaya, Kasa and Shvasa. Dalhana hasexplained that Tamaka Shvasa is Kaphabhuyista Vyadhi i.e. Kapha predominantdisease. Therefore the diseases like Tamaka Shvasa occurring in Kapha predominantage (childhood) may be difficult to cure. Page 36Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewPROGNOSIS The prognosis for young asthmatic children is generally good. In majority ofchildren there will be occasional attacks of mild to moderate severity. But a minorityof children experience severe intractable asthma usually perennial rather thanseasonal. The prognosis is also poor in those with a diagnosis of asthma, of which about50% are still wheezing at age of 10yrs. (Park et. al. 1986)101CHIKITSA VIVECHANA After reviewing the literature about Tamaka Shvasa Nidana, Samprapti,Roopa, Sadhyasadhyata etc, it became clear that there is vitiation of Kapha & Vataand Tamaka Shvasa is Pittasthana (Amashaya) Samudbhava Vyadhi102. Therefore ourtreatment should be aimed to pacify the vitiated Vata and Kapha Dosha along withNidana Parivarjana. Acharya Charaka has given the guidance for better management of TamakaShvasa i.e Shodhana followed by Shamana Chikitsa, should be done in Balavana andKaphadika patients, whereas Shamana and Tarpana should be done in Durbala andVatadhika patients.103 Here the question arises, whether the same treatment can be adopted inchildren? For that it is better to review the literatures about the line of treatment incase of children.PRINCIPLES OF TREATMENT IN CHILDREN Acharya Kashyapa explains that for children neither Shoshana (desiccation)nor AtisamShodhana (excerssive cleaning) and Raktamokshana (blood letting) are Page 37Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Reviewbenefical. They should be treated with oral medications, ointments etc. 104 In childrenVata, Pitta and Kapha are similar as like adults but they are in less quantity. 105 The similar explanation is given by the Acharya Charaka in Chikitsa Sthanai.e. Dosha, Dushya, Mala, and diseases present in children are same as like adults butthe dosage will be less compared to adults. 106 Vagbhata accepting the above opinion, says that the Dosha, Dushya, diseasessuch as fever etc. and methods of treatment are the same in both children and adultswhereas the dosages (of medicines or therapies) are minimum for children since theyare of tender aged and having small body. 107Madhavakara also explains the same regarding treatment of children. 108SHODHANA IN CHILDREN Acharya Charaka explains that after observing the Mrudutva (tenderness) andParatantrata (dependency) and in those children, who are unable to speak and act, oneshould not advice for Vamana etc. treatment. But according to disease, Bheshaja(medicines or therapies) should be used in reduced doses. 109 Chakrapani explains that Balas (children) are of two types i.e. Svatantra andparatantra. In paratantra (dependant) children Vamana etc should not be administeredwhere as in independent children who can act and speak, Vamana etc therapies shouldbe administered in Mrudu form. 110Vegakaleena Chikistsa of Shvasa (Acute Management)Snehana and Svedana (Oleation & Sudation)To the person having Shvasa (i.e. at acute condition) Bahya Snehana (externalapplication of oil) should be done with Lavana Taila and Nadi or Prastara or SankaraSveda with Snigdha Dravya. 111 Page 38Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review By this Grathita Kapha (tenacious sputum) present in Pranavaha Srotas(respiratory tract) undergoes Vilayana (liquification) thus Srotomardavata takes placeresulting in Vatanulomana. 112 Thus respiratory tract becomes clear for easy passageof air. Above process is compared as the ice on the mountain dissolves afterexposure to sun, in the same way Grathita Kapha dissolves after Svedana procedure.113 In Vatadlika Snigdha Sveda, in Kaphadika Rooska Sveda and in combinationof Kapha and Vata, Sadharana (general) Svedana can be adopted. 114 Svedana is contraindicated in Pitta Prakruti persons, and in persons sufferingfrom Pittaja disorders, Madhumeha, Kshuda, Trishna, Shosha (emaciation) Rosha(anger), Kamala, Udara Roga, Karshya, Bhrushagni (voracious appetite) etc. 115 Charaka includes Rooksha and Ksheena Dhatubala (diminished Dhatubala)persons in the list of contraindicated for Svedana. 116 In such Patients‟ Mrudu Sveda for Uras and Kantha Pradesha can be done bydoing Snehaseka with Sharkara or by Utkarika mixed with sugar or by Upanaha. 117 Soon after Svedana, Snigdha Anna along with Dadhi, Matsya, Mansarasa orShookara Rasa should be given which does the Shleshma Vruddhii. 118VAMANA Once there is Shleshma Vruddhii, Vamana should be performed by giving acombination of Pippali, Madhu and Saindhava, but it should be Vata Avirodhi. 119 For the term Vata Avirodhi, Chakrapani opines that „it rules out the use ofRuksha and Teekshna Vamaka drvyas,‟ indicating the need of Mrudu Vamana.Gangadhar opines that Vatahara Vamana dravya have to be used along the above said Page 39Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Reviewdrugs. Astanga Hridaya states that there should not be aggrevation of Vata byVamana. 120 By this liquefied Kapha which is present in Pranavaha Srotas comes out byUrdhva Marga. After Kapha Nirharana, Srotavishuddhi takes place leading to freemovement of Vata in the Srotas. 121DOOMAPANA After Vamana for expulsion of the avashista Kapha (to remove remainedsputum), Dhoomapana with Haridra Manashiladi Yoga etc should be given. 122 Here it is interesting to note that Acharya Charaka has not mentioned theroutine classical Vamana procedure for the management of acute attack. Instead ofAbhyantara Snehapana, he has advised Bahya Snehana. After proper Svedana,Shleshmavriddhikara Ahara and Vamana should be done. Here we can conclude that the above said therapy is for Vegakallena Chikitsaof Tamaka Shvasa. Because classical method of Vamana is not followed, here insteadof it, acute management of Shvasa is explained, as there will be less time to do allthose procedures.GENERAL LINE OF TREATMENT IN TAMAKA SHVASA: As it is an episodic disease and Yapya it is difficult to cure. So before startingthe treatment, special attention has to be given, for detail examination of the children,to know Rogibala and Rogabala. The general line of treatment is Nidana Parivarjana, SanShodhana andShamshamana. Page 40Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewNIDANA PARIVARJANA Nidana, Dosha and Dushya are the essential factors in the of disease process.Anubandha and Ananubandhya of these three factors influence in the ocurence of 123signs and symptoms of disease. That is why acharya Charaka has given muchimportance for the Nidana Parivarjana in Hikka and Shvasa Roga. It is said that if theperson suffering from the Shvasa wants the healthy condition (Arogya) he must avoidthe Nidana factors. 124 Acharya Sushruta stressing for the Nidana parivarjana explained as 125“sankshepatah kriyayogo Nidana parivarjanam”. However but avoiding thecausitive factors may be difficult in children because they are more susceptible forallergens, upper respiratory tract infections, dust and exercise during play works andmany are allergic to variety of foods etc. Avoiding these causative factors may reducefrequency of attacks in children. As the Tamaka Shvasa is Yapya in nature, properadvises should be given to both children and parents regarding the NidanaParivarjana.AVOIDANCE OF TRIGGERS / AGGREVATORS126PHYSICAL FACTORS: The physical factors, which can cause symptoms in asthmatic children, areexercise, strong smell, cold air, changes in weather etc. In majority of cases thepatient or parents easily identify these factors. For the better management ofasthmatic children, it is necessary to avoid the exposure to these factors.ALLERGENS: Aero-allerges are important triggers of attack in most allergic asthmatics. Thechild may get severe disease if the child had been exposed to allergen within first yearof life. Most of the allergens include dust, mites, moulds, pollens and animal proteins. Page 41Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewNow house dust mite (dead or alive) claimed to be the important cause for nocturnalsymptoms. Particular care should be taken for the children who are having familyhistory of allergy, because these children are susceptible for allergic disorders.Therefore avoidance of allergens plays an important role.RECOMMENDATIONS FOR REDUCING ALLERGEN o The humidity in houses should be minimised by good ventilation. o All the bedding (mattresses, pillow etc) which is washable should be washed regularly with hot water. o Pillow and bed is to be covered with mite proof covers. o Woollen clothing‟s and bedding are better to avoid because they may harbour dust and house dust mite. Carpets in the bedroom are better to remove. o Whenever practical, bedding should be exposed to the sun which kills mites. 127RHINITIS / SINUSITIS: When the child is having repeated attacks of rhinitis or sinusitis or otitis then aprompt treatment should be advocated. Always enquiry is must to know the history ofnasal obstruction, sneezing, snoring, night cough, interrupted sleep and gastric reflux(heartburn). If present, then best solution would be avoidance of causative factors andadequate treatment of these conditions.Tamaka Shvasa patients can be grossly divided into two categories. 1. Kaphadhika and Balavana 2. Durbala and Vatadhika. 128 Page 42Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review In the first category Shodhana can be adopted and Shamana in the later where asNidana Parivarjana is mandatory in both categories.SAMSHODHANA Great importance has been given for the Shodhana Karma in the managementof Shvasa, which helps in eliminating the vitiated Doshas from the body. Vamana,Virechana and Nasya are advised to adopt for Tamaka Shvasa Chikitsa.DEEPANA AND PACHANA It is said that “Rogah sarve api managanow”. 129 Agnimandya and Ama playan important role in the production of Tamaka Shvasa. Hence in order to normalizethe Agni and to remove Ama, Deepana and Pachana should be given first. 130POORVA KARMAAbhyantara Snehapana should be done with judicious use of medicated ghee or oil tillthe Samyaka Snigdha Lakshanas appear. Then Abhyanga and Svedana should bedone. VishrAma kala should be decided according to Shodhana (Vamana /Virechana).VAMANA Dalhana commentator of Sushruta says that “Shleshmabhuyistha Tamakah” 49i.e. Tamaka Shvasa is Kapha predominant disease. Hence Vamana will be helpful forthe patients. Vamana should be done in balavana (having good strength) andKaphadhika (having more Kapha) patients131 and it is also indicated in patientssuffering from the Kasa and Svarabhanga. 132 Page 43Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewVIRECHANA After vamana virechana should be administered in Balavana and Kaphadikapatients, and it should be followed by Pathya Ahara, Vihara, Dhoomapana, Leha andShamana Chikitsa. In Tamaka Shvasa Patients‟ virechana should be given withVatashleshmahara Dravyas. 132 According to Vagbhata, in cases of Adhmana, Udavarta and Tamaka Shvasafirst Anulomana should be done with rice-mess mixed with Matulunga, Amlavetasa,Hingu, Pilu and Bida. Then Virechana with drugs mixed with Saindhava and any sourfruit followed by warm water should be administered. 133SHAMANA CHIKITSA Shamana involves the usage of a strict Pathya, Dhoomapana, Leha etc. KsharaLeha‟s should be used only when there is Kaphadhikya, which is obstructing thePranavara Srotas. Tarpana should be done with Sneha, Yusha and Mamsa Rasa along withVatanashaka drugs, in cases like Vatadhika, Durbala, Bala and Vriddha (aged). 128 Drugs, foods and drinks having ushna Guna, which acts as Kapha Vatagnaand Vatanulomana, should be administered to the Tamaka Shvasa patient. 134 The vitiated Doshas can be treated with following methods of treatments. 1. Vatakara and Kaphahara Chikitsa 2. Kaphakara and Vatahara Chikitsa 3. Single sided treatments like Kaphahara but Vatakara Vatahara but Kaphakara should not be done in any cases. 4. Out of all the Vatahara treatment is better. 135 In all cases of Shvasa if Brimhana is done, then the Shvasa becomes PratahaSukhasadhya even though it is associated with Upadravas. Page 44Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review In the same if Shamana treatment is adopted then it is always Sukhasadhya fortreatment. If Karshana treatment is adopted, then Shvasa Roga becomes Asadhya fortreatment. 136 Brinhana is not a complete treatment so it should be done with Shamana Chikitsabut Karshana therapy should not be advised especially in case of children.TREATMENT ACCORDING DOSHA PREDOMINANCE In Vatapittanubandhi Suvarchala Svarasa, milk, ghee and Trikatu Choorna areto be taken along with anupana of Shali Odana. 137 In Kaphapittanubandhi patients, Shirisha Pushpa Svarasa or SaptaparnaSvarasa along with Pippali and Madhu should be administered. 138 In Kaphadhika patients, if Kapha is obstructing the Pranavaha Srotas thenKshara Lehas like Ashwagandha Kshara along with honey & ghee etc should beadministered. 139 Various Shamana Aushadhi‟s described in the classics are listed in Table-9ANUPANA: According to the disease the Anupana has been mentioned in Yogaratnakara.For Shvasa Brimhadadi and Shunthi is Anupana Page 45Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table-9 List of Shamanoushadhi for ShvasaName of Yogas C.S S.S A. A.S B.P Y.R. B.R HSvarasa, kalka, kvatna,ksheerapakaRambha pushpadi kalka - - - + - - -Shireesha pushpadi kalka - - - + - - -Saptaparsna swarasa - - - + - - -Shireesha swarasa - - - + - - -Kapittha swarasa - - + - - - -Dashamoola kwatha + - - - - - -Devadaru kwatha + - - + - + -Kulatta dashamooladi kwatha - - - + - - -Vyaghradi ksahaya - - - + - - -Dashamoola kashaya - - - + - - -Dashamoola pushkara kwatha - - - - + - -Bibheetaki kashsya - - - - + - -Shringyadi kwatha - - - - + - -Kulattadi kashaya - - - - - + -Bharangi nagara kwatha - - - - - + -Panchamula ksheerapaka - - - - - - -Vaidya vilasa kwatha - - - - - + -Vaidya jeevana kwatha - - + - - + -Shankaaka kwatha - - + - - + -ChoornaSauvarchaladi choorna + - - - - - -Shatyadi choorna + - - - - - -Muktadi choorna + - - - - - -Saptachadasyetyadi choorna - + - - - - -Draksha hareetakyadi choorna - + - - - - -Shringyadi yoga shata choorna - - - - - - +Haridradi choorna - + - - + - +Jeevanthyadi dviGunasharkara - - + - - - -choornaShatydi astha sharkara choorna - - + - - - -Kushmandamoola choorna - - - - + - + Page 46Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewName of Yogas C.S S.S A. A.S B.P Y.R. B.R HMahaKaphaladi choorna - - - - + - -Hingwadi choorna - - - + - - -Krishnadi choorna - - - - - - +Shrigyadi choorna - - - - - + +Shuntyadi choorna - - - - - + -Markatee choorna - - - - - + -Gudadi choorna - - - - - + -Indravarni kadi choorna - - - - - - +Pippalyadi choorna - - - + - - -AvalehaTimirasyetyadi lehya - + - - - - -Pippaliphaladi lehya - - + - - - -Gorajadi lehya - - + - - - -Charuchpanchmradimashree lehya - - + - - - -Ashwagandhramurva lehya - - + - - - -Shathvadi lehya - - + - - - -Paushkara pippali lehya - - + - - - -Gaurkadi lehya - - + - - - -Dhatryadi lehya - - + - - - -Pathyadi lehya - - + - - - -Koladi lehya - - + - - - -Gudadi lehya - - + - - - -Sithopaladi lehya - - + + - - -Haridradi lehya - - - - - - +Bharangyadi lehya - - - - - - +Magdhikavaleha - - - - - - +Bharargi guda - - - - - + -AsavaPathadyasava + - - - - - -Kanakasava + - - - - + -Ghritha-TailaDashamooladi ghritha + - - - - - -Tejovahatyadi ghtitha + - + - - + -Manashiladi ghritha + - - - - - -Sauvarchaladi gritha - + - - - - -Himsra vidangaiyadi ghritha - + - - - - -Dashamoola ghritha - - + - - - - Page 47Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewName of Yogas C.S S.S A. A.S B.P Y.R. B.R HKarjoorodi ghritha - - + - - - -Jeevantyadi ghritha - - + - - - -Stanya siddha gritha - - + - - - -Kanadi ghrtiha - - + - - - -Jeevaneeya ghrtiha - - + - - - -Ardhasarshara ghritha - - + - - - -Ardhasalavana ghritha - - + - - - -Dhanvantaradi ghritha - - - + - - -Sathyadi ghritha - - - - - - +Shringe guda ghritha - + - - - - -Purana ghritha + - - - - - -Bringaraja vagityadi taila - + - - - - -Guda sharshapa taila - - - + - - -DhumayogaHaridradi dhumayoga + - + - - - -Sarjarasadi dhumyoga + - - - - - -Shyonakadi dhumyoga + - - - - - -Padmakadi dhumyoga + - + - - - -Yovachoorna dhumyoga + - + - - - -Goshringadi dhumyoga + - + - - - -Manshiladi dhumyoga - + - - - - -Yavadi dhumyoga - + - - - - -Sringabaladi dhumyoga - + - - - - -Tarushasallaketyadi dhumyoga - + - - - - -Madhuchistadi dhumyoga - - + + - - -Agaru dhumyoga - - + + - - -Chandana dhumyoga - - + + - - -Harina khuradi dhumyoga - - + + - - -Guggulu dhumyoga - - + + - - -Manashila dhumyoga - - + + - - -Shala niryasa dhumyoga - - + + - - -Dhatturaphaladi dhumyoga - - + - - - +Vati, Rasayoga, LohaBhasmaShvasa kuthura rasa - - - - + + +Shvasa bhairava rasa - - - - - - +Nagarjunabhra rasa - - - - - - + Page 48Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Name of Yogas C.S S.S A. A.S B.P Y.R. B.R H Sooryavarto rasa - - - - - - + Brihat mriganka rasa - - - - - - + Damreshwarabhra vati - - - - - - + Maha swasadi lauha - - - - - - + Pippatyadya lauha - - - - - - + Mayoora piccha bhasAma - - - - - - + Vijaya vati - - - - - - + Nasya yoga Lasahoona muladi nasya - - + + - - - Guda nagara nasya - - + + - - - Makshikavishatudi nasya - - + + - - - Anya Arkankuraibhravitannmityadi - + - - - - - tandula Kola majjamithyadi tandula - + - - - - - Nidigdhikadi yoga + - - - - - - Hingwadi dravya prayoga + - - - - - - Bilvadi patra rasa - - - - - - + Bharangi sharkara - - - - - - + Gandhaka prayoga - - - - - - + Bibitaka prayoga - - - - - - + Gudadraka prayoga - - - - - - +PATHYA AND APATHYA Along with Nidana parivarjana and Chikitsa, proper dietetic and seasonalregimens are necessary things to be followed. By that one can prevent the attacks ofTamaka Shvasa. Seasonal variations and climatic & atmospheric changes will alwayscomplicate the management of Tamaka Shvasa where nothing can be much expected.But dietetics and mode of life can be adopted according to the disease. Thus pathyahelps in getting a healthy life. Various patya patyas explained in our classics are listedin Table-10. Page 49Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Table-10 Pathya and Apathya for Shvasa.140Pathya Apathya Aharaja Y.R B.R Aharaja Y.R B.R Rakta shali + + Rooksha anna pana + + Kulattha - - Sheetanna pana + + Godhooma + + Guru anna pana + + Yava + + Vidahi anna pana - + Tandula + + Vishtambi padartha Puratana sarpi + - Sevana - + Madhu + + Mahisha Dugdha + + Aja paya + + Masha - + Sura + + Kanda + + Patola + + Sarshapa + + Varthaka + + Dushta ambu + + Rasona + + Tailabrishta nishpava - + Bimbi phaia + + Sheshmakaraka ahara - + Jambeera + + Anupana - + Tanduleeya + + Mamsa varga Vastuka + + Anupa mamsa - + Jeevanthi - + Matsya + + KAmala moola - + Viharaja KaphaVata nashaka + + Mootra Vegavarodha + + Annapana Udgar Vegavarodha + + Poothika - + Chardi veghavarodha + + Matulunga - + Trisna veghavarodha + + Ushnajala + + Kasa veghavarodha + + Shasha mamsa + + Adwagamana - + Ahita bhuk - + Bharavahana - + Lava + + PoorvaVata + + Daksha + + Dantadhavana + + Shuka + + Srama + + Dhavadvijamriga + + Kama - + Aushadhi Varga Upacharaja Draksha + + Raktamokshana + + Ela + + Nasya + + Trikatu - + Basti + + Gomutra + + Kantakari + + Vamana + + Swrdana + + Dhoomapana + + Page 50Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewVIRECHANA IN CHILDREN Virechana in children is an important topic which needs more research work.Along with the Shamana whether the children needs Virechana like therapies or not,if needed what are the indications and contraindications etc. are the matters to bediscussed. In classics, age for contraindication of Virechana and what type ofvirechana should be adopted on the basis of age is not much clear. In general AcharyaCaraka, Sushruta and Vagbhata have contraindicated for Virechana in children. If the child gets afflicted with any disease, it should be properly diagnosed,with due regard to the specific nature of the etiology, premonitory symptoms, signsand symptoms and upashaya of the disease. Simultaneously characteristic features ofthe patient, drugs, locality, season and physical constitution of the child should beexamined. Thereafter administering therapies, which are sweet, soft, light, fregrant,cold and propitious, should treat him. Such types of therapies are wholesome forchildren and produce everlasting effects. 141 Acharya Kashyapa had explained that the Vata, Pitta and Kapha present inchildren are same as in adults. The difference between both is that they are in lessquantity, as the physic is small. Therefore the physician with his own understandinguses less quantity of diet, drinks and drugs according to the Dehagni(metabolic/digestive) and age. 142 A similar explaination is given by Acharya Charaka i.e. Dosha, Dushya,Malas and diseases present in children are same as like adults but the Bheshaja(medicines or therapies) Matra should be less compared to adults.109 Page 51Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary Review Vagbhata accepting the above opinion, says that Doshas, Dushyas, diseaseslike fever etc. and method of treatment are the same in both children and adultswhereas the dosages (of medicine or therapies) are minimum for children, since theyare tender and having small physical constitution. 107 Madhavakara had also expressed the same opinion regarding treatment ofchildren. 108 Acharya Caraka had given clear option regarding the Vamana, Virechana likeShodhana therapies in children, saying that after observing the Mrudutva(tenderness), Paratantrata (dependancy) and inability to speack and act, one shouldnot advice for Vamana etc treatments. But according to the disease, Bheshaja(medicnes or therapies) should be used in reduced dosage in mild form for children.109 Cakrapani commenting on the above said that, children are of two types viz.those who are independent (Svatantra) and others who are dependent upon others(Paratantra). In dependent children Vamana etc procedures should not beadministered. If the child is independent (Svatantra i.e. who can speak and act)Vamana etc. therapies should be administered only in mild (Mrudu) form. 110 Acharya Kashyapa had explained that for children neither Shoshan(desiccation) nor AtisanShodhana (excessive cleaning) and Rakta Mokshana (bloodletting) is beneficial. 143 This line of treatment is adaptable in infantile age group. By observing all the Acharyas opinion it is clear that drastic therapies likeVamana and Virechana should not be administered in children. But according to ageand disease condition, the same can be adopted in mild form, because the Doshas, Page 52Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Literary ReviewDushyas and Malas etc, basic body constitutions are same as in adults. Even thoughmany diseases differ from adult‟s disorders, some of the similar diseases like Jvara,Kasa and Shvasa should be appropriately treated with proper drugs and therapies. In this regard, Acharyas have clear idea of treatment of children saying thattreatment should be done appropriate to the Dosha, Roga, Udreka (of Dosha or 144symptoms) after determining the nature of the habitat season etc. In AstangaSangraha and Astanga Hridaya, it is explained that, diseases of children should betreated with the medicines (drugs or therapies) which are mild and which don‟tproduce discomfort to the children. If needed only Virechana like therapies should beadministered, otherwise such therapies should be avoided in case of children. 145 Adopting the same principles of classics, whenever Svatantra children are inneed of Virechana therapy, Mrudu Virechana can be administered which doesn‟tcause much discomfort to them. 146 Trivritta is praised to be best for Mrudu Virechaka. Bhavaprakashexplained that Aragwadha is Sransana, Kostha Pitta-Kaphahara and Kostha-Shuddikara.147 Acharya Caraka had explained that Trivritta can be given for virechanaespecially for Sukumara and Bala. As it is Mrudu, it will not produce any problems.148 12 different Trivritta Yogas have been explained in Trivritta-Kalpadhyayaespecially for children149. As it is having Sransana property, hence it expels out theMalas from the Kostha without doing their Paka. 150 Page 53Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review DRUG REVIEWHere in this chapter attempt has been made to review the drugs used in themanagement of Tamakashvasa. Murchita ghrita was used for Arohana Snehapana andTrivrit leha was used for Virechana. Kantakaryavaleha was used for shamanachikista in Group A & Group B The following are the drugs used in the study. 1. Moorchita Ghrita 2. Trivritta leha 3. Kantakaryavaleha 4. Trikatu Choorna MOORCHITA GHRITAPharmacological propertiesRasa - MadhuraGuna - Guru, Snigdha, MriduVeerya - SheetaVipaka - MadhuraPrabhava - MedhyaSamanya Karma:Vrishya, Agni-Kara, Chakshushya, Medhya, Lavanya, Kanti, Oja, Tejavriddhikara,Alakshmi, Papahara, Rakshoghna, Vayasthapaka, Balya, Pavitra, Aayushya,Sumangalya, Rasayana, Sugandha, Rochana, Smriti Vardhaka, Rasa, ShukraVardhaka . Page 54Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewRogaghnata:Visha, Unmada, Shosa, Jvara, Mada, Apasmara, Murchcha, Yoni shoola, Karnashoola, Shira shoola.Dosha karma : Vata-pitta Shamaka, Na cha Shleshma Vardhaka HARIDRAFamily - ZingiberaceaeSYNONYMS:Sanskrit: Rajani, Nisa, Nisi, Ratri, Ksanada, DosaEnglish: TurmericConstituents Essential oil and a coloring matter (curcumin).Properties and ActionRasa: Katu, TiktaGuna : RuksaVirya : UsnaVipaka : KatuKarma : Krimighna, Kushaghna, Varnya, Visaghna, Kaphapittanut, Pramehanashaka.Important Formulations: Haridra KhandaTherapeutic Uses: Pandu, Prameha, Vrana, Vishavikara, Kushtha, Tvagroga,shitapitta, PinasaDose: 1-3 g of the drug in powder form. Page 55Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review HARITAKIFamily: CombretaceaeSynonyms::Sanskrit: Abhaya, K¡yasth¡, Pathy¡, Vijay¡English : MyrobalanConstituents: Tannins, anthraquinones and polyphenolic compounds.Properties and Actions:Rasa: Madhura, Amla, Katu, Tikta, KashayaGuna: Laghu, RukshaVirya: UshnaVipaka: MadhuraKarma: Chakshushya, Depana, Hridya, Medhya, Sarvadoshaprashamana, Rasayana,AnulomanaImportant Formulations: Triphal¡ Churna, Triphal¡di Taila, Abhayarishta,AgastyaHaritaki Rasayana, Citraka Haritaki, Danti Haritaki, DashamulaHaritaki,Brahma Rasayana, Abhaya Lavana, Pathyadi LepaTherapeutic Uses: Shotha, Arsha, Aruci, Hridroga, Arsha, Pandu, Prameha,Udavarta, Vibandha, Jirnajwara, Visamajvara, Shiroroag, Tamakasvasa, Gulma,UdararogaDose: 3-6 g of the drug in powder form. Page 56Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review BIBHITAKAFamily: CombretaceaeSynonyms:Sanskrit : Vibhitaka, Aksa, AksakaEnglish : Beleric MyrobalanConstituents: Gallic acid, tannic acid and glycosides.Properties and Action:Rasa: KashayaGuna: Laghu, RukshaVirya: UshnaVipaka: MadhuraKarma: Chakshushya, Keshya, Kaphapittajit, Bhedaka, Kriminashana, ArshaharaImportant Formulations: Triphal¡ Churna, Triphal¡di Taila, LavangadiVatiTherapeutic Uses: Chardi, Arsha, Krimiroga, Vibandha, Svarabheda, NetrarogaDose: 3-6 g of the drug in powder from. AMALAKIFamily: EuphorbiaceaeSynonyms:Sanskrit: Amrataphala, amalaka, DhatriphalaEnglish: Emblic MyrobalanConstituents: Ascorbic acid and gallotannins.Properties and Actions: Page 57Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewRasa: Madhura, Amla, Katu, Tikta, KashayaGuna: Laghu, RukshaVirya: ShitaVipaka: MadhuraKarma: Chakshushya, Rasayana, TridoÀajit, V¤ÀyaImportant Formulations: Chyavanaprasha, Dh¡tr¢ Lauha, Dh¡try¡di Ghrita, Triphal¡Churna.Therapeutic Uses: Raktapitta, Amlapitta, Premeha, DahaDose: 3-6 g of the drug in powder form. MUSTAFamily: CyperaceaeSynonyms: -Sanskrit : Mustaka, VaridaEnglish : Nut GrassConstituents: Volatile OilProperties and Actions:Rasa : Katu, Tikta, KashayaGuna : Laghu, RukshaVirya : ShitaVipaka : KatuKarma : Shothahara, Depana, Grahi, Krimighna, Pachana, Vishaghna, Pittakaphahara,Sthoulyahara, Trishnanigraha, Tvakadoshahara, Jvaraghna Page 58Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewImportant Formulations: Mustakarishta, MustakadiKwatha, Ashokarishta,Mustakadi Churna, Mustakadi, Mustakadi Lehya.Therapeutic Uses: Agnim¡ndya, Ajirna, Trishna, Jvara, Sangrahani, Shvasa, Arsha,Mutrakriccha, Vamana, Sutikaroga, Atisara, Amavata, Krimiroga.DOSE: 3-6 g. (Powder); 20-30 ml. (Kvatha) TRIVRUTTA LEHA TRIVRITFamily: ConvolvulaceaeSYNONYMS: -Sanskrit: Syama, TribhandiEnglish: Terpeth Root, Indian JalapConstituents: Resinous Glycosides.Properties and Actions:Rasa: Madhura, Katu, Tikta, KashayaGuna: Laghu, Ruksha, TikshnaVirya: UshnaVipaka: KatuKarma: Kaphapittahara, Pittahara, V¡tala, Virecana, Sukhavirecanaka, JvaraharaImportant Formulations: Hrdyavirecana Leha, Ashwagandharishta, AvipattikaraChurna, Manibhadra Guda.Therapeutic Uses: Malabandha, Gulma, Udara Roga, Jvara, Shopha, Pandu, Pliha,Vrana, Krimi, Kushtha, Kandu.Dose: 1-3 g of the drug in powder form. Page 59Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review VIDANGAFamily: MyrsinaceaeSynonyms:Sanskrit: Jantughna, Krimighna, Vella, Krimihara, KrimiripuHindi: Vayavidanga, Bhabhiranga, BaberangConstituents: Benzoquinones, alkaloid (Christembine), tannin and essential oilProperties and Action:Rasa: Katu, TiktaGuna: Laghu, Ruksha, TikshnaVirya: UshnaVipaka : KatuKarma : Anulomana, Depana, Kriminashana, V¡takaph¡pahaImportant Formulations: Vidangarishta, Vidanga Lauha,Therapeutic Uses: Shula, Krimiroga, Udararoga, AdhmanaDose: 5-10 g of the drug in powder form. PIPPALIFamily: PiperaceaeSynonyms:Sanskrit : Magadhi, Granthika, PippalikaEnglish : Long PepperConstituents: Essential Oil and Alkaloids Page 60Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewProperties and Actions:Rasa : Madhura, Katu, TiktaGuna : Laghu, SnigdhaVirya : AnusnaVipaka : MadhuraKarma : Depana, Hridya, Kaphahara, Rucya, Tridoshahara, V¡tahara, varnya,Rasayana.Important Formulations: Amritarishta, Ayaskriti, Chyavanaprasha Avaleha,Ashwagandharishta, Kumaryasava, Candanasava, Kaishora Guggulu.Therapeutic Uses: Shula, Arsha, Gulma, Hikka, Arsha, Krimi, Kushtha, Pliha Roga,Prameha, Udara Roga, Amavata, Jvara.Dose: 1-3 gm. KANTAKARYAVALEHA KANTAKARIFamily: SolanaceaeSynonyms:Sanskrit: Vyaghri, Nidigdhika, Khudra, Kantakarika, Dhavani, Nidigdh¡, DusparsaEnglish: Febrifuge plantConstituents: Glucoalkaloids and sterols.Properties and Actions:Rasa: Katu, TiktaGuna : Laghu, RukshaVirya : Ushna Page 61Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewVipaka : KatuKarma : Shothahara, Depana, Pachana, Kanthya.Important Formulations: Kantakaryavaleha , Panchatiktaka Ghrita,Vyaghrahariyaki.Therapeutic Uses: Aruchi, Svasa, Jvara, Arsha, Pinasa, Svarabheda.Dose: 20-30 g of the drug for decoction. GUDUCHIFamily: MenispermaceaeSynonyms:Sanskrit: Amrtavalli, Amrita, Madhupar¸ Guducika, ChinnobhavaHindi: Giloe, GurchaConstituents: Terpenoids and alkaloids.Properties and Actions:Rasa: Tikta, KashayaGuna: LaghuVirya: UshnaVipaka: MadhuraKarma: Balya, Depana, Rasayana, Sangrahi, Tridosasamaka, Raktaodhaka,Jvaraghna.Important Formulations: Amrtarisa, Amrtottara Kwatha Churna, Guduci Taila,Guducyadi Churna, Guduchi Sattva.Therapeutic Uses: Jvara, Kushtha, Pandu, Prameha, Vatarakta, Kamala.Dose: 3-6 g of the drug in powder form[ 20-30 g of the drug for decoction. Page 62Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review CHITRAKAFamily: PlumbaginaceaeSynonyms:Sanskrit: Agni, Vahni, Jvalanakhya, Krsanu, Huasaa, Dahana, Hutabhuk, SikhiEnglish: Lead warConstituents: Plumbagin.Properties and Actions:Rasa: KatuGuna: Laghu, Ruksha, TikshnaVirya: UshnaVipaka: KatuKarma: Shothahara, Depana, Grahi, Pachana, Kaphav¡tahara, Arsohara,.Important Formulations: Citrakadi Vati, CitrakaHaritaki, Citrakadi ChurnaTherapeutic Uses: Agnimandya, Grahani Roga, Arsha, Udara shula.Dose: 1-2 g of the drug in powder form. CHAVYAFamily: PiperaceaeSynonyms:Sanskrit: CavikaEnglish: CubebConstituents: Alkaloids, Glycosides and Steroids. Page 63Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewPROPERTIES AND ACTIONRasa: KatuGuna: Laghu, Ruksha, TikshnaVirya: UshnaVipaka : KatuKarma : Bhedana, Depana, Kaphahara, Pachana, Recana, V¡taharaImportant Formulations: Pranada Gutika, Candramrta Rasa.Therapeutic Uses: Arsha, Anaha, Gulma, Krimi, Udara Roga, Pliha Roga.Dose: 1-2 g. of the drug in powder form. MUSTAFamily: CyperaceaeSynonyms:Sanskrit : Mustaka, VaridaEnglish : Nut GrassConstituents:- Volatile OilProperties and Actions:Rasa : Katu, Tikta, KashayaGuna : Laghu, RukshaVirya : ShitaVipaka : KatuKarma : Shothahara, Depana, Grahi, Krimighna, Pachana, Vishaghna, Pittakaphahara,Sthoulyahara, Trishnanigraha, Tvakadoshahara, Jvaraghna. Page 64Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewImportant Formulations: Mustakarishta, MustakadiKwatha, Ashokarishta,Mustakadi Churna, Mustakadi, Mustakadi Lehya, Dhamya Pancaka Kwatha Churna,Piyusavalli Rasa, Gulmakatanala Rasa, Mahalaksadi Taila, Sadangapaneeya.Therapeutic Uses: Agnim¡ndya, Ajirna, Trishna, Jvara, Sangrahani, Svasa, Arsha,Mutrakriccha, Vamana, Stanyavik¡ra, Sutikaroga, Atisara, Amavata, Krimiroga.Dose: 3-6 g. (Powder); 20-30 ml. (Kvatha). KARKATASRINGIFamily: AnacardiaceaeSynonyms:Sanskrit: Sringi, Visani, KarkataEnglish: Crabs clawConstituents: Essential oil, tannins and resinous matters.Properties and Actions:Rasa: Tikta, KashayaGuna : GuruVirya : UshnaVipaka : KatuKarma : Arshahara, Kaphapittahara,Important Formulations: Balachaturbhadrika ChurnaTherapeutic Uses: Aruchi, Svasa, Chardi, Hikka, Jvara, Arsha, KshayaDose: 3-6 g of the drug in powder form. Page 65Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review SHUNTHIFamily: ZinglberaceaeSynonyms:Sanskrit: Ausadha, Muhausadha, N¡gara, Visva, Visvabhesaja, Srngavera, V¡sva,VisvaushadhaEnglish: Ginger root, GingerConstituents: Essential oil, pungent Constituents (gingerol and shogaol), resinousmatter and starch.Properties and Actions:Rasa: KatuGuna: Laghu, SnigdhaVirya: UshnaVipaka: MadhuraKarma: Anulomana, Depana, Hridya, Pachana, V¡takaph¡paha, ËsmadoÀaharaImportant Formulations: Saubhagyashunthi, Trikau, Saubhagya Vati, VaisvanaraChurna.Therapeutic Uses: Agnim¡ndya, Svasa, Adhmana, Amavata, Pandu, Udararoga.Dose: 1-2 g of the drug in powder form. MARICAFamily: PiperaceaeSynonyms:Sanskrit : Vellaja, Krsna, UsanaEnglish: Black PepperConstituents: Alkaloids (Piperine, Chavicine, Piperidine, Piperetine) and EssentialOil. Page 66Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewProperties and Actions:Rasa: Katu, TiktaGuna: Laghu, Ruksha, TikshnaVirya: UshnaVipaka: KatuKarma: Sleshmahara, Dipana, Medohara, Pittakara, Rucya, Kaphavatajit V¡tahara,Chedana, Jantunasana, Chedi, Hridroga, V¡taroga.Important Formulations: Maricadi gutica, Maricadi Taila, TriKatu ChurnaTherapeutic Uses: Shvasa, Sula, Krimiroga, TvagrogaDose: 250 mg - 1 g. of the drug in powder form. PIPPALIMULAFamily: PiperaceaeSynonyms:Sanskrit : M¡gadhi, Granthik¡, PippalikaEnglish : Piper rootConstituents: Alkaloids (Piperine, Piperlongumine, Piperlonguminine etc), EssentialOils.Properties and Actions:Rasa : KatuGuna : Laghu, RukshaVirya : UshnaVipaka : Katu Page 67Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewKarma : Depana, Kaphahara, Pachana, Rucya, Vatahara, Vatanulomana,SulaprasamanaImportant Formulations: Pancakola Churna, DashamulaTaila, Dasamulapancakoladi Kwatha Churna.Therapeutic Uses: Anaha, Gulma, Krimiroga, Udararoga, VatarogaDose: 0.5 - 1g. of the drug in powder form. DHANVAYASAHFamily: ZygophyllaceaeSynonyms:Sanskrit: Duhsparsa, Duralambha, Dhanvyasakah, Virupa, Duralabha, UstrabhaksyaEnglish: Khorasan thornProperties and Actions:Rasa: Madhura, Katu, Tikta, KashayaGuna: Laghu, SaraVirya: ShitaVipaka: MadhuraKarma: Kaphahara, Medohara, Pittahara, V¡taharaImportant Formulations: Duralabhadi Kwatha, Duralabhadi Kashaya, RasnadiKwatha Churna (Mah¡), Tiktaka Ghrita, Usirasava,Kantakaryavaleha ,Mahapancagavya Ghrita, Dasamularista, PunarnavasavaTherapeutic Uses: Daha, Grahani, Gulma, Jvara, Arsha, Kushtha, Prameha,Raktapitta, V¡tarakta, Visarpa, Atisara, Visamajvara, Trsna, Moha, Murccha,Madaroga, Raktavikara, Bhrama, Chardi, Mutrghata.Dose: 5-10 g powder, 40-80 ml (Kvatha) Page 68Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug Review BHARANGIFamily: VerbenaceaeSynonyms:Sanskrit: Angaravalli, Brahmanayastik¡Hindi: BharangeeConstituents: SaponinsProperties and Action -Rasa : Katu, Tikta, KashayaGuna : Laghu, RukshaVirya : UshnaVipaka : KatuKarma: Depana, Kaphahara, Pachana, Rucya, V¡tahara, áw¡saharaImportant Formulations: Ayaskriti, Kanakasava, Dasamularista, Rasnadi KwathaCurna, Dhanvantara Ghrita, MahaVatagajankusa Rasa.Therapeutic Uses: Gulma, Jvara, Svasa, Arsha, Yaksma, Pinasa, Shotha, Hikka.Dose: 3-6 g. of powder; 10-20 g. of kwatha curna. RASNAFamily: AsteraceaeSynonyms:Sanskrit: Suvaha, Sugandha,YuktaHindi : Rayasan, Rayasana, RasnaConstituents: Flavonoids - Quercetin and Isorhamnetin. Page 69Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewProperties and Actions:Rasa: TiktaGuna: GuruVirya: UshnaVipaka: KatuKarma : Amapachana, KaphavataharaImportant Formulations: Dasamularista, Devadarvarista, Rasnadi Kwatha Churna.Therapeutic Uses: Shotha, Vatavyadhi, Svasa, Arsha, Jvara, Udararoga, Sidhma,Adhyavata, Amavata, VataraktaDose: 25-50 g. (Decoction). SHATIFamily: ZingiberaceaeSynonyms:Sanskrit : Sathi, GandhamulikaEnglish : Spiked ginger lilyConstituents: Essential oil.Properties and Actions:Rasa : Katu, Tikta, KashayaGuna : Laghu, TikshnaVirya : UshnaVipaka : KatuKarma : Sulahara, Grahi, Kaphavataghna, MukhasodhanaImportant Formulations: AgastyHaritakiRasayana, Satyadi Curna Page 70Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewTherapeutic Uses: Shula, Svasa, Chardi, Arsha, Kasa, MukharogaDose: 1-3 g of the drug in powder form. IKSHUFamily: PoaceaeSynonyms:Sanskrit: IksuEnglish: SugarcaneConstituents: Sucrose.Properties and Actions:Rasa: MadhuraGuna: Guru, Sara, SnigdhaVirya: ShitaVipaka: MadhuraKarma: Brmhana, Balya, Kaphahara, Pittahara, V¡tahara, Vrsya, MutralaImportant Formulations: Bala Taila.Therapeutic Uses: Raktapitta, Mutra Ksaya.Dose: 200 - 400 ml in the juice form. TILAFamily: PedaliaceaeSynonyms:Sanskrit: TilaEnglish: Sesame, Gingelly-oil Seeds Page 71Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewConstituents: Fixed OilProperties and Actions:Rasa: Madhura, Katu, Tikta, KashayaGuna: Vyavai, Guru, Snigdha, SuksmaVirya: UshnaVipaka: MadhuraKarma : Balya, Keshya, Pittala, Rasayana, Sangrahi, V¡taghna, Varnya, Vishaghna,Snehana, Svarka, Snehopaga, Kusthakara, Vitbardhaka, Mutrabandhaka,Medhavardhala, Agnivardhaka, Avasadakara¸akara, Kasa Vardhaka,Karnapalivardhaka, Kaphakopaka, Mrudurecaka.Important Formulations: Narasimha Churna, Jatiphaladya Curna, SamangadiChurna, Haridradi Lepa, Vrsya, Pupalika Yoga, Nagaradi Yoga, Tiladi Upanaha,Tiladi Yoga, Priyaladi Yoga, Mustadi Upanaha.Therapeutic Uses: Asmari, Aksiroga, Atisara, Amasula, Galaganda, Gulma, Hikka,Krimi, Ksaya, Kasa, Kushtha, Penasa, Pradara, Pravahika,Raktatisara, Svasa, Visarpa,Udvarta, Yonisula, Udara, Anaha, sirah sula, Parsva sula.Dose: Powder 5-10 gm/day. TRIKATU CHOORNA Ingredients of trikatu choorna and their brief description are given earlier. Page 72Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewKantalkaryavaleha01.Kantakari choorna 02.Guduchi Choorna 03.Chitraka Choorna04.Musta 05.Marica 06.Karkatsringi07.Rasna 08.Sathi 09.Kantakaryavaleha Page 73Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Drug ReviewTrivritta Leha :10.Trivrit 11.Vidanga 12.PippaliMoorchita Ghrita :13.Moorchita GhritaTrikatu Choorna :14.Haritaki 15.Bibhitaki 16.Amalaki Page 74Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Material and Methods MATERIAL AND METHODSOBJECTIVES OF THE STUDY 1) To study the role of Mrudu Virechana with Trivrutta leha followed by Shamana Chikitsa with Kantakaryavaleha. 2) To study the role of Shamana Chikitsa with Kantakaryavaleha. 3) Compare the effects of both the groups to ascertain as to which one is better in providing relief to the children suffering from Tamaka-Shvasa.SOURCE OF DATA Patients diagnosed as Tamakashvasa were included in the study. Patients wereselected from Kaumarabhritya out patient department & in patient department ofS.D.M.C.A. & hospital, Hassan.METHOD OF COLLECTION OF DATAPatients who fulfilled the diagnostic and inclusion criteria were selected for the study.DIAGNOSTIC CRIETERIA The diagnosis was mainly based on lakshanas of Tamakashvasa described inAyurvedic classics. The ICD 10 (international classification of disease) criteria is also taken forthe diagnosis of bronchial asthma. This criteria includes:- Episodes or chronicwheezing, dyspnea, cough, feeling a tightness in the chest; prolonged expiration &diffuse wheezing on physical exertion; limitation of airflow on pulmonary functiontesting or positive bronchoprovocation challenge test. Page 75Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Material and MethodsINCLUSION CRITERIA1) Patients suffering from Tamakashvasa between age group of 5 to 16 years wereincluded in the study.2) Patients were selected irrespective of sex, religion, occupation, socio economicstatus.EXCLUSION CRITERIA1) Patients suffering from other types of Shvasa were excluded from the study.2) Patients with Pulmonary tuberculosis, COPD, Bronchiectasis & Tropicaleosinophilia or with any other systemic disorders were excluded.3) Patients with acute or severe exacerbation & status asthmatics who requireimmediate intervention were excluded.GROUPING30 Patients were randomly divided in to two groups, each consisting of 15 patients.Group A The patients were admitted in S.D.M.C.A&H.Hassan for virechana chikitsa. Adetail case history was taken with the help of proforma prepared for the study.Virechana chikitsa was administerd with the following method. On the day of admission deepana pachana was started by administeringTrikatu Choorna 5 grams twice a day with warm water for 2 days then snehapana wasstarted with 20-30ml of Murchita ghrita. Arohana snehapana was followedaccordingly till samyaka snigdha laxanas appears.In between sneha Jeeryamana and jeerna laxamas were observed. Two days vishramakala was given and in this period patients were advised to take normal diet. After 2 Page 76Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Material and Methodsdays vishrama kala, on the next day Trivritta leha was given in the mornig on emptystomach for virechana purpose.After virechana, Kantakaryavaleha , was administered orally with the proper dosagetwice a day & before food as shamana chikitsa for a period of 1 month.Group BIn this group patients were treated with Kantakaryavaleha as a Shamana Chikitsa fora period of 1 month with following dosage –Doses of Kantakaryavaleha:3 gm twice daily before food for 5 to 10 years of age5 gm twice daily before food for 11 to 16 years of age Duration of treatment will be for a period of 1 month in each group.Follow up Study: The patients of both the group were followed at the interval of 15 days for onemonth. i.e. patients were assessed initially and at the end of 15 days and at the end of1 month.CRITERIA FOR ASSESSMENT OF TREATMENTFor the purpose of assessment of treatment pre test & post test were made on –Assessment criteria B.T. D.T. A.T.BreathlessnessAudible wheezesCoughSputumSneezingCommon coldDay time asthmaNight time asthmaDiscomfortTightness of chestChest painLoss of sleep Page 77Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Material and MethodsPEFRImpact on activityPalpitationCharacter of breathingFrequency of attackDuration of symptomsLABORATORY INVESTIGATIONS – Blood routine exam: TLC, DLC, Hb, ESR. Urine routine exam for Albumin, sugar and microscopic exam. X ray chest. Peak expiratory flow rate.The severity of disease was assessed with the help of criteria for assessment ofseverity, which is given in following table –GRADATION INDEX –GRADE 0 1 2 3Dyspnoea None ≤ 2 Attacks per 2-4 Attacks>4 Attacks per 60 days per 60 days 60 daysWheezing None Only at the Frequently Always time of attack presentDiscomfort Not at all On running / On walking On all short exercise positions /Missed schoolsCough Not at all Occasional Frequently Distressing cough natureImpact on None Dyspnoea with Interferes with Interferes withactivity lot of activity moderate any activity / activity missed schoolsSleep Fine Sleep well, Awake 2-3 Awake most of slight wheeze times at night, the night. or cough wheeze, coughFrequency of No attack < 1 Episode / > 2 Episodes / > 4 Episodes /attack. month month. monthDuration of No symptom. Brief for hours Prolonged for Almostsymptom. 2-3 days continuousPEFR values Normal >80% Of 50-80% Of <50% Of predicted predicted predicted Page 78Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Observation OBSERVATIONS The clinical trail was carried out on 30 patients of Tamaka Shvasa (bronchialasthma). These patients were treated in two groups each comprising of 15 patients.One group was treated with Kantakaryavaleha after performing Virechana while thepatients of second group were given only Kantakari Avaleha. The Nidanatmakaaspect of these 30 patients of Tamaka Shvasa is being given here under and thereafterthe effects of the therapies will be described.Age: Age wise distribution of 30 patients of Tamaka Shvasa showed that maximumi.e. 66.73% were in the age group of 11-16 years and remaining 33.3% were of 5-10yrs age group (Table-C1 and Graph-C1).Sex: Sex wise distribution of 30 patients of Tamaka Shvasa showed that 60% wereboys while 40% were girls (Table-C2).Religion: Religion wise distribution of 30 patients of Tamaka Shvasa showed thatmaximum i.e. 90% patients were Hindu, 6.7% patients were Muslim and 3.3%patients were Jain (Table-C3). Table-C1 Age wise Distribution of 30 Patients of Tamaka ShvasaAge group (in yrs) Number of Patients Percentage5-10 11 33.311-16 22 66.7 Table-C2 Sex wise Distribution of 30 Patients of Tamaka ShvasaSex Number of patients PercentageMale 18 60Female 12 40 Table-C3 Religion wise Distribution of 30 Patients of Tamaka ShvasaReligion Number of patients PercentageHindu 27 90Muslim 02 6.7Jain 01 3.3 Page 79Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ObservationEducation: Education wise distribution of 30 patients of Tamaka Shvasa showed that60.0% patients were studying in higher primary school, 40.0% patients were studyingin primary school. (table-C4)Age of onset: Age wise distribution of 30 patients of Tamaka Shvasa showed thatonset of disease were increased after eleventh year to sixteenth year 60% patientswere had onset after 11years of age and 40% patients had onset of Tamaka shvasa atthe age of 6 years to 10 years. (table C-5)Aggravating factors: Maximum number of Tamaka Shvasa patients i.e. 100% werereported exposure to cold air, 96% patients were reported smoke, 93% patients werereported dust, 10% patients were reported strong smell and 06% were reportedexercise as the main precipitating factor of disease. (table C-6) Table-C4 Education Status Recorded in 30 Patients of Tamaka ShvasaEducation Number of patients PercentagePrimary school 12 40.0Higher Primary school 18 60.0 Table C-5 Age of onset of Tamaka shvasa Age of onset Number of patients Percentage (in yrs) 6-10 12 40 11-16 18 60 Table –C 6 Aggravating factors Reported by 30 Patients of Tamaka ShvasaVihara sambandhi nidana Number of patients PercentageSheeta vayu 30 100.00Raja sevana 28 93.33Dhooma sevana 28 96.66Smell 03 10.00Exercise 28 93.33 Page 80Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ObservationIncidence of associated disorders: Maximum number of patients i.e. 90% patientswere reported Kasa, 83% patients were reported Pratisyaya, 43% patients werereported Jwara, 6% patients reported Pandu and Atisara as associated disease withTamaka Shvasa. (Table C -7)Family history of Asthma: Family history was reported in 66.66% patients and in33.67% patients there was no family history of asthma. (Table C-8 )Dietary Habit: Maximum i.e. 63.33% patients from mixed diet and only 36.67%patients from vegetarian diet family were seen out of 30 patients. (Table C-9) Table C-7 Showing the incidence of associated disorders in Tamakashvasa patientsAssociated disorders Number of patients PercentagePratishyaya 25 83.33%Kasa 27 90%Jwara 13 43.33%Pandu 02 6.67%Atisara 02 6.67% Table C -8 Showing the family history of AsthmaFamily history of Asthma Number of patients PercentagePresent 10 33.33Absent 20 66.67 Table C - 9 Dietary Habit-wise distribution of patients in present study Number of patients Percentagevegetarian 11 36.67Mixed 19 63.33 Page 81Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ObservationPrakruti: Out of 30 patients 63% were of kapha prakruti, 26.67% were of kaphavataprakruti, 6.67% were of vata prakruti and 3.33% were of vatapitta prakruti. (Table C-10)Sara: Out of 30 patients, 26 60.00% were of Madhyama sara, .67% were of Avarasara and 13.33% were of Pravara sara. (Table C-11)Samhanana: Samhanana wise distribution of patients showed that out of 30 patients,63.33% had madhyama samhanana, 26.67% had avara samhanana and 13.33% hadPravara samhanana. (Table C-12) Table C-10 Prakruti wise distribution of patientsPrakruti Number of patients PercentageKapha 19 63.33Kaphavata 8 26.67Vata 3 10.00Vata pitta 1 03.33 Table C-11 Sara wise distribution of patientsSara Number of patients PercentagePravara 04 13.33Avara 08 26.67Madhyama 18 60.00 Table C-12 Samhanana wise distribution of patientsSamhanana Number of patients PercentagePravara 04 13.33Avara 08 26.67Madhyama 18 63.33 Page 82Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ObservationSatwa: Satwa wise distribution of patients showed that out of 30 patients, 46.67%had avara satwa, 33.33% had Pravara satwa and 20.00% had madhyama satwa. (TableC-13)Pramana: Pramana wise distribution of 30 Tamaka Shvasa patients showed that63.34% were of Madhyama Pramana, 23.33% were of avara pramana and 13.33%were of Pravara pramana. (Table C- 14)Vyayama Shakti: Vyayama Shakti wise distribution of 30 Tamaka Shvasa patientsshowed that 60% had Avara Vyayama Shakti and 40% had Madhyama VyayamaShakti and no patient showed Pravara Vyayama Shakti. (Table C- 15) Table C-13 Satwa wise distribution of patientsSatwa Number of patients PercentagePravara 10 33.33Avara 14 46.67Madhyama 06 20.00 Table C- 14 Pramana wise distribution of patientsPramana Number of patients PercentagePravara 04 13.33Avara 07 23.33Madhyama 14 63.34 Table C-15 Vyayama Shakti wise distribution of patientsVyayama Number of patients PercentagePravara 00 00.00Avara 18 60.00Madhyama 12 40.00 Page 83Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ObservationAhara Shakti: Ahara Shakti wise distribution of 30 Tamaka Shvasa patients showedthat 56.67% had Avara Ahara Shakti and Madhyama Ahara Shakti was reported in33.33% and 10% had Pravara Ahara Shakti. (Table C-16)Agni: Agni Shakti wise distribution of 30 Tamaka Shvasa patients showed thatMandagni was observed in 66.67%, samagni was observed in 26.67% andVishamagni was observed in 6.66% patients. (Table C-17)Kosta: : Kosta wise distribution of 30 Tamaka Shvasa patients showed, MadhyamaKosta in 46.67%, Mrudu Kosta was noticed in 43.33%, and krura kosta was noticedin 10.00% patients of Tamaka Shvasa. (Table C-18) Table C-16 Showing Ahara Shakti of Tamaka Shvasa patientsAhara shakti Number of patients PercentagePravara 03 10.00Avara 17 56.67Madhyama 10 33.33 Table C-17 Showing of Agni of Tamaka Shvasa patientsState of Agni Number of patients PercentageSama 08 26.67Vishama 02 06.66Manda 20 66.67 Table C-18 Showing Nature of kosta of Tamaka Shvasa patientsKosta Number of patients PercentageMrudu 13 43.33Madhyama 14 46.67Krura 03 10.00 Page 84Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Results RESULTEffects of the Therapy30 patients of Tamaka Shvasa were treated in two group each comprising of 15patients. One group of the patients was given Kantakaryavaleha after performing theclassical Virechana, while the patients of the second group were given Kantakaridirectly. The effects of the therapies are being described group wise.Group A: Effects of Kantakaryavaleha after Performing Virechana15 patients of Tamaka Shvasa were first subjected to Deepana Pachana with TrikatuChoorna followed by internal Snehana and then Virechana was performed. Oncompletion of Samsarjana Krama Kantakaryavaleha was administered for one month.The effects of this therapy on the signs and symptoms of the patients are beingpresented here under the separate headings.Effect of Kantakaryavaleha with Virechana on Dyspnea: Initial dyspnoea score of3.08 significantly (P<0.001) reduced to 0.92 after the treatment showing 93% relief(Table-1R and Graph-1). Table-1R Effect of Kantakaryavaleha after Virechana on Dyspnoea of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 3.08 0.92 93 1.99 0.39 5.41 <0.001 Page 85Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha after Virechana on Wheezing: Initial wheezing scoreof 2.8 significantly (P<0.001) reduced to 0.2 after the treatment showing 92% relief(Table-2R & Graph-2). Table-2R Effect of Kantakaryavaleha after Virechana on Wheezing of Tamaka Shvasa Mean Paired ‘t’ test %improvement B.T. A.T. S.D. (±) S.E. (±) „t‟ P 2.8 0.2 92 0.63 0.16 15.9 <0.001Effect of Kantakaryavaleha with Virechana on Cough: Initial Cough score of 2.28significantly (P<0.001) reduced to 0.76 after the treatment showing 66% relief(Table-3R & Graph-3). Table-3R Effect of Kantakaryavaleha after Virechana on Cough of Tamaka Shvasa Mean Paired ‘t’ test %improvement B.T. A.T. S.D. S.E.M. „t‟ P 2.28 0.76 66 0.87 0.17 17.32 <0.001Effect of Kantakaryavaleha with Virechana on Sputum: Initial sputum score of2.04 significantly (P<0.001) reduced to 0.60 after the treatment showing 70.5% relief(Table-4R & Graph-4). Table-4R Effect of Kantakaryavaleha after Virechana on Sputum of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.04 0. 60 70.5 0.65 0.13 11.06 <0.001 Page 86Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha with Virechana on Sneezing: Initial Sneezing score of0.8 significantly (P<0.001) reduced to 0.2 after the treatment showing 75% relief(Table-5R & Graph-5). Table-5R Effect of Kantakaryavaleha after Virechana on Sneezing of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.8 0.2 75 0.50 0.13 4.5 <0.001Effect of Kantakaryavaleha with Virechana on Common Cold: Initial Commoncold score of 0.8 significantly (P<0.001) reduced to 0.06 after the treatment showing92.5% relief (Table-6R & Graph-6). Table-6R Effect of Kantakaryavaleha after Virechana on Common Cold of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.8 0.06 92.5 0.45 0.11 6.20 <0.001Effect of Kantakaryavaleha with Virechana on Day Time onset of Asthama:Initial Day time asthma asthma score of 0.66 significantly (P<0.001) reduced to 0.06after the treatment showing 90% relief (Table-7R & Graph-7). Table-7R Effect of Kantakaryavaleha after Virechana on Day time onset Asthma Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.66 0.066 90 0.50 0.130 4.5 <0.001 Page 87Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha with Virechana on Night Time onset of Asthama:Initial Night time asthma score of 0.73 significantly (P<0.001) reduced to 0.33 afterthe treatment showing 75% relief (Table-8R & Graph-8). Table-8R Effect of Kantakaryavaleha after Virechana on Night time onset of asthma of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.8 0.2 75 0.50 0.13 4.58 <0.001Effect of Kantakaryavaleha with Virechana on Discomfort of Tamaka Shvasa:Initial Discomfort score of 2.24 significantly (P<0.001) reduced to 0.88 after thetreatment showing 60% relief (Table-9R & Graph-9). Table-9R Effect of Kantakaryavaleha after Virechana on Discomfort of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.88 2.24 60 0.63 0.12 10.66 <0.001Effect of Kantakaryavaleha with Virechana on Tightness of Chest of TamakaShvasa: Initial Tightness of chest score of 0.6 significantly (P>0.001) reduced to 0.2after the treatment showing 66% relief (Table-10R & Graph-10). Table-10R Effect of Kantakaryavaleha after Virechana on Tightness of Chest of Tamaka Shvasa Mean Pared ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.6 0.2 66 0.50 0.13 3.05 P>0.001 Page 88Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha with Virechana on Chest Pain of Tamaka Shvasa:Initial Chest pain score of 0.33 not significantly (P>0.02) reduced to 0.06 after thetreatment showing 81% relief (Table-11R & Graph-11). Table-11R Effect of Kantakaryavaleha after Virechana on Chest Pain of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.33 0.06 81 0.45 0.11 2.25 >0.02Effect of Kantakaryavaleha with Virechana on Loss of Sleep of Tamaka Shvasa:Initial Loss of sleep score of 0.53 significantly (P<0.001) reduced to 0.13 after thetreatment showing 75% relief (Table-12R & Graph-12) Table-12REffect of Kantakaryavaleha after Virechana on Loss of Sleep of Tamaka Shvasa Mean Paired ‘t’ test %improvement B.T. A.T. S.D. S.E.M. „t‟ P 0.53 0.13 75 0.50 0.13 3.05 >0.001Effect of Kantakaryavaleha with Virechana on PEFR of Tamaka Shvasa: InitialPEFR score of 142 significantly (P<0.001) reduced to 201 after the treatment showing41% relief (Table-13R & Graph-13). Table-13R Effect of Kantakaryavaleha after Virechana on PEFR of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 142 201 41 29.99 6.70 8.83 <0.001 Page 89Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha with Virechana on Impact on Activity of TamakaShvasa: Initial Impact on activity score of 2.00 significantly (P<0.001) reduced to0.840 after the treatment showing 58% relief (Table-14R & Graph-14). Table-14R Effect of Kantakaryavaleha after Virechana on Effect on Impact on Activity of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.00 0.84 58 0.37 0.07 15.50 <0.001Effect of Kantakaryavaleha with Virechana on Palpitation of Tamaka Shvasa:Initial Palpitation score of 0.2 not significantly (P>0.05) reduced to 0.06 after thetreatment showing 70% relief (Table-15R & Graph-15). Table-15R Effect of Kantakaryavaleha after Virechana on Palpitation of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.2 0.06 70 0.35 0.09 1.46 >0.05Effect of Kantakaryavaleha with Virechana on the Mean Respiratory Rate ofTamaka Shvasa: Initial mean respiratory rate score of 23.73/ min significantly(P<0.001) reduced to 21.2/ min after the treatment showing 10% relief (Table-16R &Graph-16). Table-16R Effect of Kantakaryavaleha after Virechana on Respiratory Rate of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 23.73 21.2 10 1.92 0.49 5.10 <0.001 Page 90Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha with Virechana on Frequency of Attack of TamakaShvasa: Initial Frequency of attack score of 2.4 significantly (P<0.001) reduced to0.9 after the treatment showing 62% relief (Table-17R & Graph-17). Table-17REffect of Kantakaryavaleha after Virechana on Frequency of Attack of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.4 0.9 62 0.68 0.15 9.75 <0.001Effect of Kantakaryavaleha with Virechana on Duration of Symptoms ofTamaka Shvasa: Initial Duration of symptoms score of 2.5 significantly (P<0.001)reduced to 0.8 after the treatment showing 68% relief (Table-18R & Graph-18). Table-18R Effect of Kantakaryavaleha after Virechana on Duration of Symptoms of Tamaka Shvasa Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.5 0.8 68 0.65 0.14 11.57 <0.001Group B: Effects of Kantakaryavaleha without Performing Virechana15 patients of Tamaka Shvasa were directly administered Kantakaryavaleha for onemonth. The effects of this therapy on the signs and symptoms of the patients are beingpresented here under the separate headings. Page 91Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha on Dyspnea: Statistically highly significantimprovement (P<0.001) of 60% was observed in dyspnea as its initial score reducedfrom 2.42 before to 0.88 after the treatment (Table-19R & Graph 1) Table-19R Effect of Kantakaryavaleha on Dyspnoea of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %relief S.E. B.T. A.T. S.D. (±) „t‟ P (±) 2.42 0.88 60 0.64 0.12 12.12 <0.001Effect of Kantakaryavaleha on Wheezing: Statistically highly significantimprovement (P<0.001) of 79% was observed in wheezing as its initial score reducedfrom 2.53 before to 0.53 after the treatment (Table-20R & Graph 2). Table-20R Effect of Kantakaryavaleha on Wheezing of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.53 0.53 79 0.65 0.16 11.83 <0.001Effect of Kantakaryavaleha on Cough: Statistically highly significant improvement(P<0.001) of 55% was observed in cough as its initial score reduced from 2.23beforeto 1.0 after the treatment (Table-21R & Graph 3). Table-21R Effect of Kantakaryavaleha on Cough of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.23 1.00 55 0.51 0.10 11.20 <0.001 Page 92Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha on Sputum: Statistically highly significantimprovement (P<0.001) of 57% was observed in sputum as its initial score reducedfrom 2.26 before to 0.96 after the treatment (Table-22R & Graph 4). Table-22R Effect of Kantakaryavaleha on Sputum of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement B.T. A.T. S.D. S.E.M. „t‟ P 2.26 0.96 57 0.61 0.12 10.79 <0.001Effect of Kantakaryavaleha on Sneezing: Statistically not significant improvement(P<0.05) of 33% was observed in sneezing as its initial score reduced from 0.6 beforeto 0.4 after the treatment (Table-23R & Graph 5). Table-23R Effect of Kantakaryavaleha on Sneezing of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.6 0.4 33 0.41 0.10 1.87 <0.05Effect of Kantakaryavaleha on Common cold: Statistically significantimprovement (P>0.001) of 54% was observed in common cold as its initial scorereduced from 0.73 before to 0.33after the treatment (Table-24R & Graph 6). Table-24R Effect of Kantakaryavaleha on Common cold of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.733 0.33 54 0.50 0.13 3.05 >0.001 Page 93Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Results Graph-1 Graph-2Effect of Therapies on Dyspnea Effect of Therapies on Wheezing Graph-3 Graph-4Effect of Therapies on Cough Effect of Therapies on Sputum Graph-5 Graph-6Effect of Therapies on Sneezing Effect of Therapies on Common cold Page 94Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha on Day time onset of Asthma: Statistically significantimprovement (P<0.001) of 90% was observed in day time asthma as its initial scorereduced from 0.66 before to 0.06 after the treatment (Table-25R & Graph 7). Table-25REffect of Kantakaryavaleha on Day time onset of Asthma of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.66 0.06 90 0.50 0.13 4.5 <0.001Effect of Kantakaryavaleha on Night Time Asthma: Statistically not significantimprovement (P>0.02) of 50% was observed in night time asthma as its initial scorereduced from 0.53 before to 0.26 after the treatment (Table-26R & Graph 8). Table-26REffect of Kantakaryavaleha on Night time onset of asthma of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.53 0.26 50 0.45 0.11 2.25 >0.02Effect of Kantakaryavaleha on Discomfort: Statistically highly significantimprovement (P<0.001) of 60% was observed in discomfort as its initial scorereduced from 2.03 before to 0.80 after the treatment (Table-27R & Graph 9). Table-27R Effect of Kantakaryavaleha on Discomfort of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 2.03 0.80 60 0.43 0.08 14.60 <0.001 Page 95Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha on Tightness of Chest: Statistically significantimprovement (P>0.001) of 60% was observed in tightness of chest as its initial scorereduced from 0.66 before to 0.26 after the treatment (Table-28R & Graph 10). Table-28REffect of Kantakaryavaleha on Tightness of Chest of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.66 0.26 60 0.50 0.13 3.05 P>0.001Effect of Kantakaryavaleha on Chest Pain: Statistically not significantimprovement (P>0.05) of 50% was observed in chest pain as its initial score reducedfrom 0.4 before to 0.2 after the treatment (Table-29R & Graph 11). Table-29R Effect of Kantakaryavaleha on Chest Pain of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.4 0.2 50 0.41 0.10 1.87 >0.05Effect of Kantakaryavaleha on Loss of Sleep: Statistically not significantimprovement (P>0.01) of 62% was observed in loss of sleep as its initial scorereduced from 0.53 before to 0.2 after the treatment (Table-30R & Graph 12). Table-30 REffect of Kantakaryavaleha on Loss of Sleep of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement B.T. A.T. S.D. S.E.M. „t‟ P 0.533 0.2 62 0.48 0.12 2.64 >0.01 Page 96Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Results ` Graph-7 Graph-8Effect of Therapies on Day time Asthma Effect of Therapies on Night time asthma Graph-9 Graph-10Effect of Therapies on Discomfort Effect of Therapies on Tightness of Chest Graph-11 Graph12Effect of Therapies on Chest Pain Effect of Therapies on Loss of Sleep Page 97Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha on PEFR: Statistically highly significant improvement(P<0.001) of 29% was observed in PEFR as its initial score reduced from 149.0before to 193.4 after the treatment (Table-31R & Graph 13) Table-31 REffect of Kantakaryavaleha on PEFR of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 149.0 193.4 29 23.19 5.18 8.56 <0.001Effect of Kantakaryavaleha on Impact on Activity: Statistically highly significantimprovement (P<0.001) of 48% was observed in impact on activity as its initial scorereduced from 1.92 before to 1.00 after the treatment (Table-32R & Graph 14). Table-32REffect of Kantakaryavaleha on Impact on Activity of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 1.00 1.923 48 0.39 0.76 12.0 <0.001Effect of Kantakaryavaleha on Palpitation: Statistically not significantimprovement (P>0.05) of 50% was observed in palpitation as its initial score reducedfrom 0.4 before to 0.2 after the treatment (Table-33R & Graph 15). Table-33R Effect of Kantakaryavaleha on Palpitation of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 0.4 0.2 50 0.41 0.10 1.87 >0.05 Page 98Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsEffect of Kantakaryavaleha on Respiratory Rate: Statistically highly significantimprovement (P<0.001) of 6% was observed in Respiratory rate as its initial scorereduced from 23.46/ min before to 22/min after the treatment (Table-34R & Graph16). Table-34R Effect of Kantakaryavaleha on Respiratory Rate of 15 Tamaka Shvasa Patients Mean Paired ‘t’ test %improvement S.E.M. B.T. A.T. S.D. (±) „t‟ P (±) 23.46 22 6 1.18 0.30 4.78 <0.001Effect of Kantakaryavaleha on Frequency of Attack: Statistically highlysignificant improvement (P<0.001) of 53% was observed in frequency of attack as itsinitial score reduced from 2.05 before to 0.95 after the treatment (Table-35R & Graph17). Table-35R Effect of Kantakaryavaleha on Frequency of Attack of 15 Tamaka Shvasa PatientsMean %improvement Paired ‘t’ testB.T. A.T. S.D. (±) S.E.M. „t‟ P (±)2.05 0.95 53 0.96 0.21 5.8 <0.001Effect of Kantakaryavaleha on Duration of Symptoms: Statistically highlysignificant improvement (P<0.001) of 66% was observed in duration of symptoms asits initial score reduced from 2.28 before to 0.76 after the treatment (Table-36R &Graph 18). Table-36R Effect of Kantakaryavaleha on Duration of Symptoms of 15 Tamaka Shvasa PatientsMean %improvement Paired ‘t’ testB.T. A.T. S.D. (±) S.E.M. „t‟ P (±)1.95 0.65 66 0.73 0.16 7.93 <0.001 Page 99Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Results Graph-13 Graph-14Effect of Therapies on PEFR Effect of Therapies on Impact on ActivityGraph-15 Graph-16 Effect of Therapies on Respiratory RateEffect of Therapies on Palpitation 24 23.73 23.46 23 22 22 21.2 21 BT AT 20 19 Group 1 Group 2 Graph-17 Graph-18Effect of Therapies on Frequency of Attack Effect of Therapies on Duration of Symptoms Page 100Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsThus the comparison of effect of treatment in all the parameters of assessment isshown in following table.Table no. 37R comparison of effect of treatmentAssessment criteria Group A Group B % of improvement % of improvementBreathlessness 93 60Audible wheezes 92 79Cough 66 50Sputum 70.5 57Sneezing 75 33Common cold 92.5 54Day time asthma 90 90Night time asthma 75 50Discomfort 60 60Tightness of chest 66 60Chest pain 81 50Loss of sleep 75 62PEFR 41 29Impact on activity 58 48Palpitation 70 50Respiratory rate 10 06Frequency of attack 62 53Duration of symptoms 68 66 Page 101Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • ResultsGraph no. 19 Comparison of effect of treatment Page 102Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussion DISCUSSION Tamakashvasa is one among the chronic pulmonary disease, which resembleswith bronchial asthma in modern science. Etiopathology, clinical features andprognosis almost resemble with asthma Selected patients were catagorised under two groups. Out of which, first groupof patients were administered with Mrudu Virechana followed by Kantakaryavaleha,in second group only Kantakaryavaleha was administered as a Shamana Chikitsa. An observation of present study reveals that maximum number of Patients‟ i.e.66.73% was between the age group of 11-16 years. Many of them were chronicpatients. It might be due to their early exposure to allergens. It was observed that more numbers of patients were boys i.e. 60% and 40%were girls. Childhood asthma ratio between boys and girls is 2:1 as per the studyreports. Here the ratio coincides with previous research data. Maximum number of patients i.e. 90% belonged to Hindu community. Thismight be due to Hindu‟s residing here are more in number. Hence there is no researchsignificance. Out of 30 cases taken for the study, 66.66% patients were having familyhistory of asthma; where as 33.37% had no family history of asthma. This studyreveals that more number of children had got asthma even in the presence ofhereditary factors and others who are not having family history may suggest thatallergens, viral infections and environmental factors etc. may plays an important rolein childhood asthma, instead with hereditary factors. In majority of children upper respiratory track infection symptoms werepresence before commencing an asthmatic attack. This report corroborates with thefollowing study, Page 103Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussion Viral infection accounts for some 80-85% of asthma exacerbations in children aged 9-11 years (Johson et. al. 1995) Viral infection is commonest provoking factors for asthma in young children. Respiratory Syncytial Virus (RSV) can induce immunological changes in the host (Wellirer et. al. 1979 – 1981) Rhinovirus infection and allergy to common inhalants was more in older children (Duff et. al. 1993). The incidence of cold air exposure induced asthma was reported in maximumnumber of patients. (100%) and exposure to smoke, dust, exercise induced asthmareported in 93% patients. Cough and breathlessness was reported after long runningor exercise in these cases. Almost all parents restricted their children for exercise infear of recurrence of symptoms. Majority of patients was reported to have influence of Ahara in initiation ofTamakashvasa symptoms. Especially banana, grapes, guava fruit, jackfruit werereported as precipitating factors for Tamakashvasa. Ice creams, other cold items,cured, cheese, oily foods and fried food materials were also reported as precipitatingin some of the asthmatic children. In all the patients (100%) influence of Ahara was observed for precipitatingthe asthmatic attack. This is due to the reason that, most of the children had exposureto cold air, dust, smoke, and weather changes. All the children showedhypersensitivity for one or more of the above said factors. It was somewhat difficult to assess the AharaShakti in the children because ofthe variability in appetite and digestive capacity. However, only 10% had PravaraAharaShakti. Majority of these patients was mild asthmatic. In this group, appetiteand digestive capacity was not much affected. Page 104Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussion It was observed that majority of patients (56.67%) were having Avara AharaShakti. Here it is important to note that majority of these patients were moderate andsevere asthmatic. This might be due to the nature of the disease, as it is a pittasthanasamudbhava vyadhi and increased Ama formation may be responsible for thecondition. In majority of the patients (66.67%) mandagni was observed and Samagni wasobserved in 08 patients (26.67%). Majority of patients having mandagni wassuffering from moderate to severe asthma. The Samagni was observed in mildasthmatic children. This shows the definite relation of Agnimandya and Ama withthe severity of disease. Most of the Vihara Sambandhi Nidanas described in classics were observed inthe asthmatic children. Especially Nidanas like Vayu Sevana, Raja Sevana, DhoomaSevana, Vyayama, Asatmya Sevana, Sheeta Sthana and Sheeta Snana were reportedas Vyanjaka Nidana for Tamakashvasa. In all the children one or more of the above said Nidanas were acting asallergens and cause for upper respiratory tract infections (Peenasa), cough (Kasa)followed by dyspnea. This can also be justified by the observation made in thepresent study that the Pratishyaya (in 25 Patients‟ i.e.83.33%), Kasa (in 27 patientsi.e. 90%) and Jwara (in 13 patients i.e. 43.33%) were the Nidanarthakara Rogas. The following studies are also supportive towards the above observations. Viral infection accounts for some 80-85% of asthma exacerbation in children aged 9-11 years (John et. al. 1995). Rhinovirus infection and allergy to common inhalants was common in older children (Duff et. al. 1993). Page 105Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussion RSV infection can induce immunological changes in the host. (Welliver et. al. 1981). Exposure to sulfur dioxide interacts with other stimuli such as exercise, to increase bronchial responsiveness. (Sheppard et. al. 1981; Roger et. al. 1985). Incidence of asthma and lower respiratory tract illness in children was more who were exposed to environmental tobacco smoke in home or day care centres (Martinez et. al. 1992, Chilmonczyk et. al. 1993, Holberg et. al. 1993). Ahara Sambamdhi Nidanas in the initiation of asthmatic symptoms wereobserved in majority of the cases. Sheeta Pana (cold water/drinks), sheeta Ashana (ice creams, fruits likeBanana, Sponge Guard, Watermelon Jackfruit, Guava fruit etc) Shleshmala Ahara(Curd, Cheese etc), Guru Bhojana, Abhishyandhi Bhojana and oily foods and friedfood materials were observed as Nidanas for Tamakashvasa Lakshanas. Aboveobservation can be supported by following statement. In children food allergy may be presented as urticaria or asthma. Most of the Poorvaroopa mentioned in the classics was not observed aspremonitory signs of Tamakashvasa. But the symptoms like Hridaya Peedana,Pranasya Vilomata and Parshwa Shoola was observed during Roopavastha ofTamakashvasa. Ajit 2000 G.C.I.M.Mysore reports similar observation. Chief complaints of Tamakashvasa viz. Gurguruka, Shvasakrichrata, Kasa,and Pranaprapeedana were observed in all the patients (100%). In majority of cases, Page 106Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • DiscussionKasa in the Nighttime (nocturnal cough) followed by Shvasakrichrata (nocturnaldyspnea) was seen. Peenasa (common cold), Kantodwansa (throat infection) and Kasa (cough)were observed in 80-90% of children both before and after establishment ofTamakashvasa Lakshanas. Vamathu (vomitting) was reported in minimum number of cases and vomitingrelieved the symptoms to some extent in these children. Aruchi was noticed in mostof the cases especially during the episodic attacks. This observation indicates the roleof Agnimandya and Ama in the manifestation of Tamakashvasa. Discussion on results30 patients of Tamaka Shvasa were randomly divided into 2 groups, viz group A andgroup B. The patients of group A received Virechana followed by Shamana Chikitsawith Kantakaryavaleha in a dose as per age for a period of 1 month and patients ingroup B received directly Kantakaryavaleha for a period of 1 month. The effects ofthese two therapies are being discussed here under the heading of each parameter.Effect on Dyspnea:In both the groups highly significant improvement P<0.001 was observed in reducingdyspnea, after the treatment showing 93% and 60% improvement in both groupsrespectively. So Virechana followed by Shamana Chikitsa and only Shamana Chikitsawas nearly equally effective to control dyspnea in Tamakashvasa.Effect on Wheezing:In both the groups highly significant improvement P<0.001 was observed in reducingwheezing, after the treatment showed 92% and 79% improvement in both groupsrespectively. So Patients‟ undergone Virechana therapies followed by ShamanaChikitsa and on the other hand patients who received only Shamana Chikitsa have Page 107Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussionshown nearly same improvement. So Virechana followed by Shamana Chikitsa andonly Shamana Chikitsa was equally effective to control wheezing in Tamakashvasa.Effect on Cough:In both the groups highly significant improvement P<0.001 was observed in reducingcough, after the treatment showing 66% and 55% improvement in both groupsrespectively. So Patients‟ undergone Virechana therapies followed by ShamanaChikitsa and on the other hand patients who received only Shamana Chikitsa haveshowed nearly same improvement.Effect on Sputum:In both the groups highly significant improvement P<0.001 was observed in reducingsputum, after the treatment showing 70% and 57% improvement in both groupsrespectively. So Patients‟ undergone Virechana therapy followed by ShamanaChikitsa and on the other hand patients who received only Shamana Chikitsaprovided nearly same improvement.Effect on Sneezing:In the group A highly significant improvement P<0.001 was observed in reducingsneezing, after the treatment showing 93% improvement but in group B statisticallynot significant improvement (P<0.05) was observed with the effect of 33%. Herepatients who undergone Shodhana therapy has provided significant improvementcompare to the patients who received only Shamana Chikitsa so Shodhana followedby Shamana was better treatment to control sneezing associated with Tamakashvasa.Effect on Common Cold:In both groups highly significant improvement P<0.001 was observed in reducingcommon cold, after the treatment showed 92% and 54% improvement in both groupsrespectively. Patients in group A has showed more improvement comparative to thepatients in group B. Page 108Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • DiscussionEffect on Day Time onset of Asthma:In both the groups highly significant improvement P<0.001 was observed in reducingday time onset of asthma, after the treatment showing 90% improvement in bothgroups. So Patients‟ undergone Virechana therapy followed by Shamana Chikitsa andon the other hand patients who received only Shamana Chikitsa was provided sameimprovement.Effect on Night Time onset of Asthma:In the group A highly significant improvement P<0.001 was observed in reducingnight time asthma, after the treatment showing 75% improvement but in group Bstatistically not significant improvement (P>0.02) was observed with the effect of50%. So Shodhana followed by Shamana Chikitsa was the better treatment to arrestnight time onset of asthma. Day time onset of attack of asthma is reduced in both groups but night timeasthma is reduced in only patients in group A. This study suggest that, in more severeform of disease along with Shodhana therapy prolonged Shamana therapy may beneeded to reduce night time attacks of asthma.Effect on Discomfort:In both the groups highly significant improvement P<0.001 was observed in reducingdiscomfort, after the treatment showed 60% relief in both groups. So both Virechanafollowed by Shamana Chikitsa and only Shamana Chikitsa was equally effective tocontrol discomfort in Tamakashvasa.Effect on Tightness of Chest:In both the groups highly significant improvement P<0.001 was observed in reducingtightness of chest, after the treatment showing 66% and 60% improvement in bothgroups respectively. So both Virechana followed by Shamana Chikitsa and only Page 109Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • DiscussionShamana Chikitsa was nearly equally effective to control tightness of chest inTamakashvasa.Effect on Chest Pain:In both the groups not significant improvement was observed in reducing chest pain,after the treatment showing 81% and 50% improvement in both groups respectively.Effect on Loss of Sleep:In the group A highly significant improvement P<0.001 was observed in reducingloss of sleep, after the treatment showed 75% relief but in group B statistically notsignificant improvement (P>0.01) was observed with the effect of 62%. Here patientundergone Virechana followed by Shamana Chikitsa has shown significantimprovement. So this study suggests that Shodhana followed by Shamana Chikitsawas better treatment for the symptom loss of sleep in Tamakashvasa.Effect on PEFR:In all the groups Peak expiratory flow rate was found to be highly significant at thelevel of P<0.001. Percentage of improvement in PEFR among group A, B was 41%and 29% respectively. This data shows that percentage increase in mean PEFR wasmuch high in group A when compared to group B. In both the groups significant improvement P<0.001 is seen in reducingbreathlessness, cough and wheezing, though improvement in group A patient is morecompared to group B patients. In allergic symptoms like sneezing and common cold significant improvementP<0.001 is seen only in patients having Virechana followed by Shamana Chikitsameans patients in group A has shown significant improvement. This may besuggestive of Shodhana therapy is necessary to reduce symptoms associated withallergy. Page 110Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • DiscussionEffect on Impact on Activity:In both the groups highly significant improvement P<0.001 was observed in reducingimpact on activity, after the treatment showing 58% and 48% relief in both groupsrespectively. So Virechana followed by Shamana Chikitsa and only Shamana Chikitsaare nearly equally effective to reduce impact on activity in Tamakashvasa.Effect on Palpitation:In both the groups satistically not significant improvement was observed in reducingchest pain, after the treatment showing 70% and 50% relief in both groupsrespectively.Effect on Mean Respiratory Rate:In both the groups highly significant improvement P<0.001 was observed in reducingmean respiratory rate, after the treatment showing 10% and 6% improvement in bothgroups respectively. So Virechana followed by Shamana Chikitsa and only ShamanaChikitsa are nearly equally effective to reduce mean respiratory rate inTamakashvasa.Effect on Frequency of Attack:Number of attacks per month was much reduced in group A whereas there was lessreduction in frequency of attacks in group B. Both in group A and group B „P‟ valuegives significant result at the level of P<0.001. However, in group A percentage ofreduction in frequency of attacks/month 62% was greater than group B 53%. Thisdata indicates that Shodhana followed by Shamana gives good results in reducing thefrequency of attacks in child suffering from Tamakashvasa.Effect on Duration of Symptoms:The relief from duration of symptoms, both in group A and group B the percentage ofimprovement was 68% and 66% respectively. The „P‟ value of both groups A & Bgives significant results at the level of P<0.001. Hence it may be assessed that both Page 111Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussionthe Shodhana and Shamana treatements in group A and group B patients, was showedmuch effectiveness in reducing the duration of symptoms.Comparison of the Effect: On observing the comparison data of all groups for improvement/ relief in allthe parameters, it is clear that the improvement/relief was better in group A. i.e. in thepatients who received Virechana therapy followed by Kantakari Avaleha, there wasmaximum reduction in number of attacks, duration of symptoms and better increasein PEFR was observed. Group B patients who were administered onlyKantakaryavaleha showed less improvement compared to group A. Hence it may beconcluded that Shodhana followed by Shamana is potent in controling the TamakaShvasa in children (childhood asthma) to the maximum extent. Kantakaryavaleha appears work better if given after Shodhana this may be dueto rasayana and Vyadhipratyanik action of drug. In the group of patients who receivedKantakaryavaleha without shodhana as a Shamana Chikitsa Kantakaryavalehaappears work better after one month of prolonged administration than in the initialdays. This study shows that in Bahudoshavastha, patients with chronic history,increased number of attacks Kantakaryavaleha with Shodhana has shown goodimprovement. Patients received only Kantakaryavaleha without Virechana has shownimprovement after 1 month of prolonged administration of Kantakaryavaleha. Thismay suggest that prolonged administration of Kantakaryavaleha is needed if givenwithout Shodhana therapy.Mode of Action: In all the patients of shodhan group, increase in appetite was observed afteradministration of trikatu choorna. This might be due to all the three ingredients oftrikatu choorna i.e. shunti, maricha and pippali are having deepana, pachana, Page 112Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussionkasashwasahara and shleshmahara, properties. Hence trikatu choorna administrationmight have reduced the formation of ama by increasing the jatharagni thus helping inreducing the severity and preventing attacks of tamakashwasa. Moorchita Ghrita, which was used for Arohana Snehapana purpose, helped inreducing the severity of the disease even in severe asthmatic children. AcharyaKashyapa explained that the administration of Ghrita suppresses the vitiated Vataand Pitta, prevents accumulation of Kapha and Produses energy and increasesJatharagni. . In majority of Patients‟ Samyaka Snigda Lakshanas were appeared on3rd or 4th day. During Snehapana Kala Jeeryamana, Jeerna Lakshanas and SamyakaSnidgha Lakshanas were clearly observed in patients of present study. Trivritta leha worked better in children as Mrudu Virechaka because nopatients showed any complications due to Virechana. In this study Trivritta leha wasgiven to attain Avara or Madhyama Shodhana. In majority of patients number ofVegas (purges) was in the range of 4-9. In two patients Vegas were less than four. Itwas observed that numbers of Vegas were largely depended on nature of Kosta(bowel) of individual patients. It was practically seen that children having KruraKosta purged less with Trivrit. The action of drug might be due to Trivritta is bestMrudu Virechaka and have Sransana, Kostagata KaphavatAhara andKostashuddhikara properties. As Trivritta is explained as virechaka Dravyas forchildren, it can be safely used for Virechana in children. Kantakaryavaleha was comparatively palatable as no patients refused to takeorally. Kantakaryavaleha is having Deepana Pachana, Kaphavatashamaka,Shvasakasahara, Peenasahara and Parshwapeedahara properties. ThusKantakaryavaleha might have reduced the Vitiated Vata and Kapha thus helped inreducing the symptoms of Tamakashvasa. Page 113Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Discussion The results of this thesis are very encouraging and it is hoped that it willstimulate the research workers in the field for studying effect of Kanatakaryavalehaand Virechana in Tamaka Shvasa. Page 114Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Summary and Conclusion SUMMARY AND CONCLUSION Tamakashvasa is a chronic disease of children, which has no bar of age, sex,race and geographical distribution. It correlates closely with bronchial asthmamentioned in modern medicine. It is a global health problem, which is increasingsince last three decades, both in developed and developing countries. The etiological factors of Tamakashvasa are numerous. Most of the Nidanasexplained in the Ayurvedic classics were observed in children especially ViharaSambandhi Nidanas like Raja, Dhooma etc and Nidanarthakara Rogas likePratishyaya, Kasa and Jwara. Samprapti of Tamakashvasa is complex because of various known andunknown etiological factors operating in the pathological process. Even thoughKapha and Vata both are vitiated; Kapha in the initial stage and Vata in the later stagehas an important role in the manifestation of Tamakashvasa. Dalhana has explained itas Kapha predominant disease. Kapha Udeerana (mucus secretion) takes placeleading to Pranavaha Sroto Avarodha (airway obstruction) which is furtherresponsible for the clinical signs and symptoms of Tamakashvasa. Most of the Roopas explained in the Ayurvedic classics were observed inchildren also. The symptoms usually start with exposure to etiological factors.Initially child is presented with viral respiratory tract infections (mainly rhinitis),cough which increases gradually followed by wheezing. In younger childrennocturnal cough is an important symptom of childhood asthma. Clinical evaluation for assessing the severity of disease is necessary for properdiagnosis and treatment. Children are to be treated with Shamana Chikitsa using Vati,Avleha, Choorna, Ghrita and Kashayas, which are easy for administration and Page 115Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Summary and Conclusionpalatable. Virechana is considered as best therapy for Tamaka Shvasa. When evernecessary Virechana, Vamana and Nasya should be adopted. Generally it is seen in practice that only Virechana may not cure the diseaseand some Shamana Yoga has to be given. Bhavaprakasha has indicatedKantakaryavaleha to manage Shvasa Raga. Moreover the medicine is palatable &sweet in taste, hence can be administered to children easily.3Therefore this clinicalstudy is planned to evaluate the role of Kantakaryavaleha administered afterVirechana in the management of Tamakashvasa in children. The research design waspre-test and post test design. Excluding the dropout cases, total 30 patients werestudied. Group A patients administered Virechana with Trivritta Leha followed byKantakaryavaleha and group B patients Kantakaryavaleha alone was administerd.Investigations were done if necessary prior to the treatment to exclude other diseasesin all the groups. Clinical data was graded as per gradation index of assessmentcriteria. Pre-test and post-test data was collected and taken for the statistical analysis. In the present study it is observed that Group A patients administered withVirechana followed Kantakaryavaleha found to be better when compared to othergroup. Group B patients administered with Kantakaryavaleha alone, the results werefound to be almost equal to group results. However Virechana showed additionaltherapeutic efficacy when added to Shamana chikitsa. Discussion was done mainly on observation and results. Observationsregarding the age incidence, sex incidence, family h/o asthma, presence of URTI,influence of Ahara, Vihara, Nidanarthakara Rogas, Prakriti, Vyayama Shakti, andAhara Shakti etc were discussed. Results of the clinical trails and their comparisonwere also discussed. Page 116Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Summary and Conclusion Most of the Nidanas explained in Ayurvedic classics were acting as precipitatingor triggering factors especially Vihara Sambhandi Nidanas like exposure to raja,Dhooma, Sheetavayu and Nidanarthakara Rogas like Pratishyaya & Kasa. Upper respiratory tract infections especially rhinitis was usually foundpremonitory for development of Tamaka Shvasa in children. Pratisyaya is explainedin Poorvaroopa of Tamakashvasa so in known patients of Tamakashvasa progress ofdisease can be arrested with administration of drugs. Samprapti of Tamaka Shvasa is complex, as various known/unknown, exogenousor endogenous etiological factors are responsible for pathological process. Kantakaryavaleha appears work better after one month of prolongedadministration than in the initial days. Efffect of Shodhana in arresting Tamaka Shvasa was found to give better resultsthan only Shamana Chikitsa with Kantakaryavaleha in the long-term management. In allergic symptoms like sneezing and common cold significant improvementP<0.001 is seen only in patients having Virechana followed by shaman Chikitsameans patients in group A has shown significant improvement. This may besuggestive of Shodhana therapy is necessary to reduce symptoms associated withallergy. Virechana therapy followed by Shamana Chikitsa with Kantakaryavaleha hasgiven more additional therapeutic effects when compared to Shamana Chikitsa withthe same drug. In comparision study, group A patients administered with Virechanafollowed by Kantakaryavaleha showed maximum improvement in all the parametersof assessment criteria. Page 117Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • List of ReferencesLIST OF REFERENCE1. Apte dictionary2. Shabdakalpadruma Part II pp 5902a. Amarakosha, Amarasudha Commentary vanoushadhi varg 1203. Shabdakalpadruma Part IV pp 178-1794. Su. U. 51/85. Cha. Chi. 17/626. M.Ni. 12/127. Byod‟s Pathology pp. 8718. Nelson Pediatrics Cha. 145 pp. 6649. Ka. Sa. Su. 27/48.2-57.110. Ka. Sa. Ka.9/1611. Nelson‟s Pediatrics Cha. 145 pp. 66412. Achar‟s T.B. of pediatrics pp. 259 & Harison‟s Principles of Internal Medicine, Vol. II. pp. 145613. Nelson Pediatrics Cha. 145 pp. 66414. IAP T.B. of Pediatrics pp.399-40015. Chakrapani Cha Chi. 17/11-1616. Cha. Sha. 1/12717. Gangadhar on Cha. Chi. 17/418. Su. Sha. 6/2519. A.H. Sha. 4/50 & 5620. A.H. Ni 4/1, A.H. Ni. 3/38, A.S. Ni. 4/221. Cha. Chi. 17/822. Chakrapani on Cha. Chi. 17/823. Su. Su. 24/1024. Cha. Chi. 30/33725. Cha. Chi 30/32825a. Chakrapani on Cha. Chi 30/32826. T.B. of Pediatrics by O.P.Ghai pp. 28327. Nelson Pediatrics Cha. 153, pp. 69528. Nelson Pediatrics Cha. 153, pp. 696 Page 118Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • List of References29. N.Pediatrics Cha 153, pp. 696-697 Sources modified from Seinman HA: “Hidden” allergies in foods. J. Allergy Clin. Immunal 98; 241, 199630. T.B. of Pediatrics by O.P. Ghai pp.28431. Asthma, 4th Edition by T.J. H. Clark et. al., pp. 389, 39032. Asthma, 4th Edition by T.J. H. Clark et. al., pp. 7433. Asthma, 4th Edition by T.J. H. Clark et. al., pp. 38934. Nelson‟s T.B. of pediatrics Cha. 145 pp. 66635. Essentials of Pediatrics by O.P. Ghai 28436. Asthma by T.J.H. Clark pp. 39237. Nelson‟s T.B. of Pediatrics Cha. 145, pp. 66438. Su. Su 24/1039. Nelson‟s T.B. of Pediatrics Cha. 145, pp. 66440. Recent Advances in Pediatrics. Suraj Gupte, pp. 8741. Su. U. 1/2742. Cha. Chi 30/247-24843. Cha. Chi. 17/744. Cha. Chi. 17/4545. Cakrapani on Cha. Chi. 17/4546. Gangadhara on Cha. Chi. 17/4547. Arunadatta on A.H. Ni. 4/4 31/148. Su. U. 51/449. Dalhan on Su. U 51/450. A.H. Ni. 4/31/251. Madhava Nidana Likka Swasa Nidana cha 12/1752. A.H. Ni 4/353. Chakrapani on Cha. Chi. 17/4554. Gangadhara on Cha. Chi. 17/4555. Cha. Chi. 17/55-5656. Cha. Chi. 17/12257. T.B. of Pathology by Robinson and Kuman, pp. 45758. Essentials of Pediatrics by O.P.Ghai pp. 28459. T.B. of Pathology R & K Cha. pp. 459 Page 119Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • List of References60. Cha. Chi 17/5661. Cha. Su 28/1062. Cha. Vi 5/763. Cha. Chi. 28/2064. Cha. Chi. 17/5665. A.H. Su. 12/466. A.H.Su. 12/567. Cha.i 5/768. T.B. of Medical Physiology by Gayton & Hall Cha 41 pp. 525-52769. Cha. Chi. 17/ 81/270. Cha. Chi. 17/6071. Cha. Chi. 17/5772. Cha. Chi. 17/6173. Cha. Chi. 17/5874. Cha. Chi. 17/6275. Cha. Chi. 17/5976. A.H. Ni. 4/877. Cha. Chi. 17/6178. A.H. Ni. 4/779. A.H. Ni 4/980. Su. U. 5181. Su. U. 5182. M. Ni. 1/883. A.H. Ni 4/884. Cha. Chi. 17/6385. Cha. Chi. 17/6486. Gangadhara on Cha. Chi. 17/63-6487. Nelson pediatrics chap. 143, pp. 66688. IAP T.B. of Pediatrics pp. Assessment of severity of asthma89. Cha. Chi. 22/1790. Cha. I 8/1591. Cha. I 6/11 Page 120Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • List of References92. Su. Su. 31/2093. A.H. Sha 5/7694. Cha. Chi. 17/1295. Cha. Chi. 17/6796. Su. U. 51/2497. Dalhana on Su. U 51/2498. A.H. Ni 4/1099. Chakrapani on Cha Chi 17/67100. Cha. Chi. 30/31101. Asthma by T.J.H. Clark pp. 212, 213102. Cha. Chi. 17/8103. Cha. Chi. 17/89-90104. Ka. Sa. Su. 27/661105. Ka. Sa. Khi 3/117106. Cha. Chi. 30/282107. A.H.U. 2/30108. M. Ni 68/16109. Cha. Chi. 30/283110. Chakrapani on Cha. Chi. 30/283111. Cha. Chi. 17/71112. Cha. Chi. 17/72113. Cha. Chi. 17/72114. Ka. Sa. Su. 23/7115. Ka. Sa. Su 23/19-20116. Cha. Chi. 17/82117. Cha. Chi. 17/83118. Cha. Chi. 17/74119. Cha. Chi. 17/75120. A.H. Chi. 4/4121. Cha. Chi. 17/76122. Cha. Chi. 17/77-78123. Cha. Ni. 4/4 Page 121Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • List of References124. Cha. Chi. 17/138125. Su. U. 1/25126. Asthma T.J.H. Clark pp 371127. Devision‟s Principles of Medicine, pp. 337128. Cha. Chi. 17/88129. A.H. Ni. 12/1130. A.H. Chi. 4/15131. Cha. Chi. 17/89132. Cha. Chi.17/121133. A.H. Chi. 4/66-7134. Cha. Chi.17/147135. Cha. Chi. 17/148136. Cha. Chi. 17/149137. Cha. Chi. 17/113138. Cha. Chi. 17/114139. Cha. Chi. 17/117140. Bhaishajya Ratnavali, 16/132-134 & Yogaratnakar Shvasa roga /65-68141. Cha. Cha 8/63 – 64142. Ka. Sa. Khi 3/117-118143. Ka. Sa. Su. 27/66144. A.H.U. 2/29145. A.H.U. ¼ and A.S.U. 1/52146. Cha. Su. 25/40147. Bhavaprakash, Part II. pp. 159148. Cha. Ka 8/5149. Cha. Kalpasthana 8th Chapter150. Sharangadhara Poorva Khanda 4/4 Page 122Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
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    • Bibliography 20. Dwarakanath C., Introduction to Kayachikitsa, 3rd Edition, 1996, Chaukamba Orientalia, Varanasi, pp. 83 to 128. 21. Elizabeth K.E., Fundamentals of Pediatrics, 2nd Edition, 2002, Paras Publications, Hyderabad, pp. 268-278. 22. Gananath Sen, Siddanta Nidana, Part I, 5th Edition, 1966, Chaukamba Sanskrit Series Office, Varanasi. 23. Gangadhar, Charaka Samhita, Part IV, 1st Edition, 1999, Chaukamba Orientalia, Varanasi, pp. 3002 to 3032. 24. Glenn. J., manual of Allergy and Immunology, 3rd Edition, 1995. Editor Glenn J.L., Thomas J. Fischer, Daniel C.A., pp. 41-50, 121-139. 25. Ghai. O.P. (1996), Essential Pediatrics, IV Edition, Interprint Publication, New Delhi. Pp. 283, 284, 285, 286. 26. Govindadas, Bhaishajya Ratnavali, 13th Edition, 1999. Editor Shashri R.D., Chaukamba Sanskrit Bhavana, Varanasi, pp. 329 to 339. 27. Hariprakash (1984), A study of Dhoomapana with its clinical evaluation on Tamakashvasa, GCIM, Mysore 28. Indu (1980), Astanga Sangraha, Shashilekha Sanskrit Commentry, Editor Athavale A.P. Shrimad Atreya Prakashana, Vol. I, pp. 359-362, Vol. II pp. 35- 39. 29. Jam Lissayer, Graham Clayden, Illustrated Text Book of Pediatrics, 2nd Edition, 2001, An imprint of Hurcowt Publishers Limited, U.K. pp. 222, 223. 30. Jayaraj R. (1995), Management of TamakShvasa with Gouripashana, Dept. of P.G. Studies in KC, G.C.I.M., Mysore. Page 125Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Bibliography 31. Jagannath S. Surpure, Synopsis of Pediatrics Emergency Care, 1st Edition, 1993. Edr. Jagannath S. Surpure, Jaypee Brothers, P.B. No. 7193, New Delhi, pp. 33, 34, 35, 36. 32. Jejjata (1941), Nirantara padavyabya (Charaka Samhita) II Part, II Edition, Shri, Motilal Banarasidas, Lahore. 33. Kameshwara Rao C., Database of Medical Plants. 1st Edition, 2000. Published by Karnataka State Council for Science and Technology, Bangalore. 34. Kasture H.S., Ayurvedeeya Panchakarma Vignana 5th Edition, 1997. Shri Bhaidyanath Ayurveda Bhavana Limited, Nagapur, pp. 295 to 371. 35. Kirtikar & Basu, Indian Medical Plants, 2nd Edition, Editor Blatter E, Cailus J.F., International Book Distributors,9/3 Rajapur Road, Dehradun. 36. Krupp, Current Medical Diagnosis and Treatment, 1985, Maruzen Asian Edition, Editor Marcus Krupp Milton J.C. Devid Wedegar, distributed by Maruzen Asia, 51 Ayer Rajah Cresent, # 06-09, Singapore 0513, pp. 127, 128, 129, 130. 37. Kulkarni P.H., Bronchial Asthma Care in Ayurveda and Holistic Systems, 2 nd Edition, 2001. Sri Satguru Publications, Delhi. 38. Madhavakar, Madhavanidana, Madhukosha Sanskrit Commentary with Vidyotini Hindi Commentary Part II, Edtr. Prof. Yadunandana Upadhayaya. 25th Edition, 1995, pp. 388, Part I 281, 289, 290, 291, 292, 293-301. 39. Mark R.D., CIMS 5 Minute Clinical Assist, 1st Indian Edition, 1996. Bio-Gard Private Limited, Bangalore pp. 100, 101. 40. Monilial William, A Sanskrit English Dictionary, 5th Edition, 1997 Motilal Banarasidas Publishers Private Limited, Delhi. pp. 438, 1166. Page 126Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Bibliography 41. Michael Swash; Hutchison‟s Clinical Methods, 12th Edition, W.B. Saunders Company Ltd., London, pp. 142 to164. 42. Meharban Singh, Clinical Methods in Pediatrics, Reprinted January 2002, Sagar Publications, 72 Janapath Ved Mansion, New Delhi, 165 to 180. 43. Pandurang (2002) Comparative study of Vamana and Kunjali Karma in the management of Tamakashvasa, GCIM, Mysore. 44. Prasanna N.M. (2000), Evaluate the efficacy of manasiladi dhoomayoga on Tamakashvasa, GCIM, Mysore. 45. Partha Sarathy .A (2002), IAP Textbook of Pediatrics, II Edition, Jaypee Brothers Medical Publishers (P) Ltd., New Delhi. pp. 399, 400, 401, 402, 403, 405. 46. Raja Radha Kanta Deva; Shabda Kalpadrum, 3rd Edition, Chaukamba Sanskrit Series Office, Varanasi, Part II, pp. 590, Part IV, pp. 178-179. 47. Robin & Kumar, Robins Pathology, 7th Edition, 2003. Edtr. Robin, Kumar, Cortan, Published by Hawvrt (India) Private Limited, New Delhi, pp. 455, 456, 457, 458. 48. Satoskar, R.S., Pharmacology and Pharmacotherapeutics, Revised 17th Edition, 2002, Popular Prakashana, Mumbai, pp. 337-352. 49. Sainani G.S., API Text Book of Medicine, 5th Edition, 1997, Published by Association of Physicians of India, Bombay, 286, 287, 288, 289, 290. 50. Santosh Kumar A., Manual of Pediatrics Practice, 1st Edition, 2001, Paras Publishing, Hyderabad. 51. Satya Gupta, Pediatrics, 3rd Edition, 1996, Publicated by New Age International Limited, India, pp. 359, 369. Page 127Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Bibliography 52. Sharangadhara (2001), Sharangdhara Samhita (English Translated by Srikantamurthi) IV Edition, Chaukhamba Orientalia, Varanasi, pp.17. 53. Sharma P.V. Chakradatta Edtr. P.V. Sharma, 2nd Edition,1998, Chaukamba Publishers, Varanasi, pp. 145, 146. 54. Suraj Gupte (1993), Recent Advances in Pediatrics, Vol. III, Jaypee Brothers Medical Publishers (P) Ltd., New Delhi. pp. 85, 86, 87, 89, 90, 91, 100, 101, 102. 55. Shashri R.G. (1995), Vedo me Ayurveda Madana Mohanlal, Ayurvedic Trust, Delhi, pp. 32, 79, 241, 259. 56. Shastry V.L.N.; Kaumarbhrityam, 1st Edition, 2003, Ramani Publications, Andra Pradesh, pp. 198. 57. Sharma P.V., Dravya Guna Vijyana, Vol. I to IV, Edition 199, Chaukamba Bharati Academy, Varanasi. 58. Shodala (1999), Gada Nigraha, Volume III, II Edition, Edr. Sri Gangasahaya Pandeya, Chaukamba Samskrith Samsthana, Varanasi, pp. 357, 360-366, 371. 59. Sushruta, Sushruta Samhita Ayurveda TattvaSandipika, Hindi Commentary, 11th Edition, 1997. Editor, Kaviraja Ambikadutta Shastri, Chaukamba Sanskrit Bhavana, Part II, pp. 372 to382. 60. Taranatha Tarakavachaspati, Vachaspatyam, Volume VI, 3rd Edition, 1970. The Chowkhambha Sanskrit Series Office, Varanasi, Vol. VI. Pp (5159), 1291, Vol. IV, pp. 812. 61. Tiwari. P.V. (1996), Kashyapa samhita text book (English translation) Varanasi, I Edition, Chaukamba Vishwa Bharathi Publications. pp. 54, 41, 74, 277, 446. Page 128Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Bibliography 62. Vishwanathan J., Desai A.B., Achars Text Book of Pediatrics, 3rd Edition, Reprinted 1995, Orient Longman, Madras, 474-475. 63. Wayne Harris, Examination Pediatrics, First Indian Edition, 1993, Jaypee Brothers, P.B. No. 7193, New Delhi, pp. 280 to 286. Page 129Role of Virechana and Kantakaryavaleha in the Management ofTamakaShvasa in Children
    • Annexure Annexure RESEARCH PROFORMA DEPARTMENT OF KAUMARBHRITYA S.D.M. COLLEGE OF AYURVEDA & HOSPITAL, HASSANTitle : Role of Virechana and Kantakaryavaleha in the management of Tamaka Shvasa in childrenScholar : Guide :Name : Sl. No :Age : OPD No/IPD No.:Sex : Group:(A)V&K/(B)KReligion : Education :Address :D.O.Commencement of Treatment: Phone No:D.O.Completion of Treatment:Presenting complains: No Present Duration Interval of /Absent recurrence 1 Breathlessness Grade:0/1/2/3 2 Audible breath sounds Grade:0/1/2/3 3 Sneezing 4 Common cold 5 Cough Productive Non productive Grade:0/1/2/3 6 Fever Grade:mild/mod/severe 8 Sputum: Colour- Consistancy- Postural variation- 9 Discomfort during attack Grade:0/1/2/3
    • Annexure 10 Tightness of chest None/Mild/Mod/Sev 11 Loss of sleep Grade:0/1/2/3 12 Palpitation 13 Chest pain 14 Others(specify) Onset of first attack : Duration of attack : Frequency of attack : Any occasional variations: Aggravating factors : Smoke/Dust/Smell/Exercise/ Relieving factors : Rest/Fomentation/Change of place/ Change of climate/Dietary Habits/expectoration/ sitting posture/ Drugs /inhalers/Nebulization / Oral or Parenteral bronchodilators /Antibiotics/Other Mode of onset : Sudden/ Gradual / Episodic/Continuous/ Initially episodic followed by continuous attacks At Present : Time of occurrence : Early morning / Evening/ Day/ Night/ Day & Night/ No timing Periodicity : Seasonal/ Perennial/ Irregular Proceeded by : Sneezing/ Nasal irritation/ Nasal discharge/ Cough/ WheezeAssociated disorders: Pandu/Kasa/Atisara/KshayaFamily history: Asthma/RRTI/kochs/eczema/heart disease/otherPersonal History: a) Diet : Veg / Mixed b) Sleep : Sound / Disturbed c) Habits : d) Bowels : Normal/Constipated/Loose stools e) Micturation: Normal/Polyurea/Aneuria/Dysurea f) Immunization Status: BCG Measles Oral Polio Hepatitis B DPT OthersPoorva Chikitsa Vrittanta:H/O Hospitalization due to Asthma, Cough Present / Absent
    • AnnexureDrugs for Asthma –GENERAL EXAMINATION:General appearance : Comfortable/Sick looking/Tachypnea/Dyspnea/otherBuilt: Poor / Moderate / Well BuiltNourishment: Poor / Moderate / WellPulse : /min.B.P. : / mm. of Hg.Resp. rate : /min.Temperature : degree F.Height : cm.Pallor : Present / AbsentTongue : Dry / WetNails : Clubbing / Kylonychia / OthersLymphadenopathy : Present / AbsentOedema/ Puffiness :Cyanosis :SYSTEMIC EXAMINATIONRESPIRATORY SYSTEM A. Inspection (Darshana Pareeksha) i. Shape of chest : ii. Respiratory rate : iii. Respiratory rhythm : Regular / Irregular. iv. Character of breathing : Abdominothorasic / Thoraco abdominal v. Accessory muscles of Respiration & Alae nasi : Involved / Not involved movement during the attack vi. Audible wheeze : Present / Absent B. Palpation (Sparshana Pareeksha ) i. Trachea : Centrally placed / Deviated ii. Expansion : Symmetrical / Asymmetrical iii. Vocal fremitus : Normal / Decreased / Increased C. Percussion ( Akotana Pareeksha ) Percussion tone : Resonant/Hyperresonant/dull/Stony dull Areas : D. Auscultation ( Shabdha Pareeksha ) i. Type of breath sound : Normal: Vesicular Abnormal: Bronchial / Bronchovesicular ii. Added sounds : Present / Absent Wheeze / Crackles / Pleural friction rub Site :
    • Annexure iii. Vocal resonance site : Normal / Increased / DecreasedATUR BALA PRAMANA PAREEKSHA:1 Prakrutitaha Shareera V/P/K Manasa S/R/T2 Sarataha P/M/A3 Samhananataha P/M/A4 Satmyataha P/M/A5 Satvataha P/M/A6 Pramanataha P/M/A7 Vyayama shaktitaha P/M/A8 Ahara shaktitaha Abhyavaharana shakti P/M/A Jarana shakti P/M/A9 Agni Sama / Vishama / Manada / TeekshnaSrotas Pareeksha: 1. Pranavaha srotas : Wheezes/Slow & frequent respiration 2. Udakavaha Srotas: Jivhashosha/Talushosha/Kanthashosha/Pipasa 3. Annavaha Srotas: Aruchi/Avipaka/Chardi 4. Rasavaha Srotas: Ashraddha/Aasyavairasya/Arasadnyata /Angamarda/Jwara/MandagniHETU PAREEKSHA:Nidana:Poorvarupa:Roopa:Upashaya / Anupashaya:Samprapti:SAMPRAPTI GHATAKA:Dosha: Srotas:Dushya: Srotodusti Prakara:Agni: Sanchara Sthana: Vyakta Sthana: Roga marga:Desha: Jata – Samvridha – Vyadhita –Upadrava ( if any ) –Arista (if any ) –Sadhyasadhyata –PRAYOGASHALEYA PARTIKSHA:Routine Investigations: 1. Hematological examination- 2. Urine Examination- 3. PEFR – 4. X-Ray chest –
    • AnnexureTREATMENT: Group A: Snehapana with Murchita ghrita, Virechana with TrivruttaLeha, Sansarjana Karma, Shamana Chikitsa with Kantakaryavaleha inproper dose without Anupana. Group B: Shamana Chikitsa with Kantakaryavaleha in proper dosewithout Anupana. Doses of Kantakaryavaleha : 3gm twice daily before food for 5 to 10 yrs of age 5gm twice daily before food for 11 to 16 yrs of age Duration of treatment: 1 month in each groupASSESSEMENT CRITERIA –Assessment criteria B.T. D.T. A.T.BreathlessnessAudible wheezesCoughSputumSneezingCommon coldDay time asthmaNight time asthmaDiscomfortTightness of chestChest painLoss of sleepPEFRImpact on activityPalpitationRespiratory rateRespiratory rhythmCharacter of breathingFrequency of attackDuration of symptomsSignature of Guide / Co Guide Signature of Student
    • Annexure CLINICAL GRADING --GRADE 0 1 2 3 ≤ 2 Attacks per 2-4 Attacks per >4 Attacks per 60Dyspnoea None 60 days 60 days days Only at the timeWheezing None Frequently Always present of attack On running / On all positionsDiscomfort Not at all On walking short exercise /Missed schools OccasionalCough Not at all Frequently Distressing nature cough Interferes withImpact on Dyspnoea with Interferes with None any activity /activity lot of activity moderate activity missed schools Sleep well, Awake 2-3 times Awake most ofSleep Fine slight wheeze or at night, wheeze, the night. cough coughFrequency of < 1 Episode / > 2 Episodes / > 4 Episodes /attack. No attack month month. monthDuration of No Prolonged for 2- Almostsymptom. Brief for hours symptom. 3 days continuous >80% Of 50-80% Of <50% ofPEFR values Normal predicted predicted predicted