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Tamaka swasa kc033gdg
Tamaka swasa kc033gdg
Tamaka swasa kc033gdg
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EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI …

EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI
IN THE MANAGEMENT OF TAMAKA SWASA By KALMATH. BASAYYA. LINGAYYA, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  • 1. EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATIIN THE MANAGEMENT OF TAMAKA SWASA By KALMATH. BASAYYA. LINGAYYA Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. V. Varadacharyulu M.D. (Ayu) (Osm) Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish) Department of Kayachikitsa Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2003-2006
  • 2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OFARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKASWASA” is a bonafide research work done by KALMATH. BASAYYA. LINGAYYA inpartial fulfillment of the requirement for the post graduation degree of “AyurvedaVachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,Bangalore, Karnataka.Dr. Shiva Rama Prasad Kethamakka Dr. V. VARADACHARYULU M.D. (Ayu) (Osm) M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish) GuideCo- Guide Professor & HODProfessor in Kayachikitsa Dept. of KayachikitsaDGMAMC, PGS&RC, Gadag PGS&RCDate: Date:Place: Gadag Place: Gadag
  • 3. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 Endorsement by the H.O.D, principal/ head of the institution This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OFARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKASWASA” is a bonafide research work done by KALMATH. BASAYYA. LINGAYYA underthe guidance of Dr. V. VARADACHARYULU, M.D. (Ayu) (Osm), Professor & HOD andDr. Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D](Jyotish), Professor in Kayachikitsa Co- Guidance, in partial fulfillment of the requirement forthe post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under RajeevGandhi University of Health Sciences, Bangalore, Karnataka.. (Dr. V. Varadacharyulu) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place:
  • 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled EVALUATION OF THEEFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OFTAMAKA SWASA is a bonafide and genuine research work carried out by me under theguidance of Dr.V.Varadacharyulu M.D.(Ayu) and Dr. Shiva Rama PrasadKethamakka, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)], Professor in Kayachikitsa Co-Guidance, DGMAMC, PGS&RC, Gadag.DatePlace KALMATH. BASAYYA. LINGAYYA
  • 5. Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis in print orelectronic format for the academic / research purpose.DatePlace KALMATH. BASAYYA. LINGAYYA© Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. Acknowledgement I express my deep gratitude to my Guide Dr. V.V.Varadacharyulu M.D. (Ayu)Goldmedalist, professor and H.O.D and my Co-guide, Dr. Shiva Rama PrasadKethamakka, M.D.(Ayu),M.A.Ph.D., Professor, PG Dept, Kayachikitsa for their time totime help and critical suggestions associated with expert guidance at the completion ofthis dissertation. I express my obligation to my beloved principal Dr.G.B.Patil, for hisencouragement as well as providing all necessary facilities for this research work. Iextend my gratitude to Dr. R.V.Shettar, M.D, lecturer, Dept. of KC (PG), Sri NandaKumar, Statistician and Librarian Sri Mundinamani, and assistant Sureban for theirencouragement, as well as timely suggestions at this research work. I express my acknowledgement to my parents who are responsible for myexistence and success Smt Basamma and Shri Lingayya along with my relatives who arehelpful to me at each and every step of development. I extend my gratitude to Dr. G.Purushottamacharyulu, Dr.M.C.Patil, Dr.Mulgund, Dr. G.S. Hiremath, Dr.P.Shivaramudu, Dr.S.H.Doddamani, Dr.G.Danappagoudar, Dr. S.N.Belawadi, Dr.J.Mitti, Dr.Nidugundi, Dr. Samudri, Dr.Kubersankh.who helped me time to time. I extend my gratitude to my U.G. Teachers Dr. B.G. Swami, Dr. C.S. Hiremath,Dr. S.A. Patil, Dr. R.K. Gacchinamath, Dr. V.M. Malagoudar, Dr. V.M. Sajjanar, and Dr.
  • 7. U. V. Purad, who gave support and inspiration during my studies. I grateful to my teacherDr. S.B. Govindappanavar,Asst. Registrar, RGUHS, Bangalore. I would like to mention the support and inspiration provided by professor S. B.Shetter Rtd. Principal, Professor Mallikarjun,Rtd. Principal, Shri. V.B. Shetter, Prof.Siddu yapalparavi, Shri. Basavaraj Ganavari, and Shri. Shyamsundar Rao.. I express my sincere thanks to my colleagues and friends, Ratnakumar, Mouli,Aswin, Uday Kumar, Venkareddi, , Hugar, Jayraj, Swami, Ganti, Pradeep, Sajjan,Ashok,, Shiba, Jigulur, Umesh, G.G.Patil, Sarvi, Subin, sathish, Febin, Joshi, Shyju,Shajil, Renjith, Srinivasa Reddy, Ravi, Pattanashetti, Koteshwar, V.S. Hiremath, SantoshYadahalli, Santoji, Jaggal, Suvarna, Lingaraddi, Suresh Hakkandi, Manjunath Akki,Anand, Payapagoudar, Sharanu, Anita, Sobagin, Meenakshi, Inamdar, Sunitha and otherP.G. Scholars for their support. I acknowledge my patients for their whole hearted consent to participate in thisclinical trial. I express my thanks to all the persons who have helped me directly andindirectly with apologies for my inability to identify them individually. (B.L. Kalmath)
  • 8. Abstract E VA L U A T I O N O F TH E EF F I C AC Y O F A RDH E DA SH E M AN I Y A S W A S A H A R A VA TI I N T H E M A N A G E M E N T O F T A M AK A S W A S A By KALMATH. BASAYYA. LINGAYYATamaka Swasa vis-à-vis bronchial asthma patients were diagnosed on the basis ofsymptomatology explained by Bruhatrayee (subjective parameter) and objectiveparameters fixed on contemporary scientific descriptions and parameters. Out of the 67patients of Tamaka Swasa 65 (97.01%) were undertaken for the study. The remaining 50(76.93%) patients of Tamaka Swasa fulfilling the criteria of diagnosis and inclusivecriteria were included in the study. Hindu religion patients were more (92%) recorded.Out of the symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patientsinitially are relieved 58%. Another symptom found for all patients is Ghurgurukatwam isrelieved for the 50% of patients in the study. Kasa a symptom appeared for 47 patientsinitially relived 61.7% in the study. 39 patients of Urahpeeda corrected at the end ofstudy by 58.97%. Greevashirasangraha (16 patients) and Kantodhwamsham (12 patients)are the other two symptoms of assessment got relief with 43.75 and 58.33 percentagesrespectively. At the Objective Parameters assessment in Tamaka Swasa in the study ofArdhedashemaniya Swasaharavati five objective parameters are assessed are enlisted inthe table 43. The result in the study ascertains the best activity of the ArdhedashemaniyaSwasaharavati over the Tamaka Swasa vis-à-vis Asthma. After through study of theentire parameters and materials available for the assessment of results it was drawn aconclusion of results as - 27 (54%) well responded, 11 (22%) moderately responded, 7(14%) poorly responded and 5 (10%) patients not responded and the 12 patientsdiscontinued in the study, were not considered for the result declaration.Ardhedashemaniya Swasaharavati is very economic safe and effective drug hence it canbe employed in all cases of Tamaka Swasa and it can be used as preventive type ofmedication. This Ardhedashemaniya Swasaharavati is new therapeutic option foroptimizing the asthma control. PEFR, BHT, TS, BA, CS, SS, AH, AS, MN, Lung Function Test,
  • 9. Contents of EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASAHARAVATI IN THE MANAGEMENT OF TAMAKA SWASA By KALMATH. BASAYYA. LINGAYYAChapter Content Pages 1 Introduction 1 to 9 2 Objectives 10 to 13 3 Review of literature 14 to 87 4 Methods 88 to 100 5 Results 101 to 151 6 Discussion 152 to 174 7 Conclusion 175 to 175 8 Summary 176 to 179 9 Bibliographic References I to IX 10 Annex – Case sheet 1 to 6 -1-
  • 10. Tables of E VA L U A T I O N O F TH E EF F I C AC Y O F A RDH E DA SH E M AN I Y A S W A S A H A R A VA TI I N T H E M A N A G E M E N T O F T A M AK A S W A S A By KALMATH. BASAYYA. LINGAYYASN Title of Table Page Number1 Showing Nidana of Swasa / Tamaka Swasa 362 Showing Poorvaroopa of Shwasa Roga: 603 Shows lakshanas of Tamaka Swasa 654 Vyavacchedaka Nidana in Tamaka Swasa 675 Showing Pathya in Tamaka Swasa 786 Showing Apathya Aahara in Tamaka Swasa 797 Showing Apathya Vihara in Tamaka Swasa 808 Pharmacological properties of Ardhedashemaniya Swasaharavati 879 Demographic Data 10210 Distribution of patients by Age- gender 10411 Result of Ardhedashemaniya Swasaharavati in trail patients by 105 Age12 Distribution of patients by Gender in Tamaka Swasa 10613 Distribution of patients by Religion and gender identification 10814 Result Distribution of patients by Religion 10915 Distribution of patients by occupation 11016 Distribution of patients by Economic status 11217 Distribution of patients by diet in Tamaka Swasa 11318 Distribution of patients by presenting complaints 11519 Presenting Associated features 11620 Distribution of patients by Mode of on set 11821 Distribution of patients by course 11922 Distribution of patients by frequency 12023 Distribution of patients by duration of attack 12124 Distribution of patients by periodicity 122 -2-
  • 11. 25 Distribution of patients by preceding factors 12326 Distribution of patients by aggravating factors 12427 Distribution of patients by comfort posture 12528 Distribution of patients by Dosha Kshaya lakshana 12629 Distribution of patients by Dosha vruddhi Prakruti 12730 Distribution of patients by Ahara Nidana 12831 Distribution of patients by Vihara Nidana 12932 Distribution of patients by Anya / Vyadhi Avasta sambandha 130 Nidana33 Distribution of patients by Srotas 13034 Distribution of patients by Poorva Roopa 13135 Distribution of patients by Chief complaints and Associated 132 complaints36 Distribution of patients by History of present illness 13337 Distribution of patients by Dosha Vruddhi Lakshana 13538 Distribution of patients by Dosha Kshaya Lakshana 13639 Distribution of patients by Ahara Nidana 13840 Distribution of patients by Vihara Nidana 13941 Distribution of patients by Anyavyadhi avasta sambandhi 14042 Subjective parameters assessment in Tamaka Swasa 14243 Objective Parameters assessment in Tamaka Swasa 14344 Cumulative effect in percentages obtained through subjective and 146 objective Parameters for Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis bronchial Asthma45 Result of Ardhedashemaniya Swasaharavati in Tamaka Swasa 14746 Statistical analysis of Objective parameters 14847 Statistical analysis of Subjective parameters 14948 Objective parameters Baseline comparison in Ardhedashemaniya 150 Swasaharavati in TS -3-
  • 12. Figures and Photos of E VA L U A T I O N O F TH E EF F I C AC Y O F A RDH E DA SH E M AN I Y A S W A S A H A R A VA TI I N T H E M A N A G E M E N T O F T A M AK A S W A S A By KALMATH. BASAYYA. LINGAYYASN Title of Figures and photos Page Number1 Upper and Lower Respiratory System 202 The Bronchi and Lobules of the Lung 213 Gross Anatomy of the Lungs 234 The Bronchi and Lobules of the Lung 255 Pressure changes during inhalation and exhalation 296 Ageing and the decline in Respiratory performance 317 Schematic representation of Tamaka Swasa Samprapti 518 Cross section of the lung in Tamaka Swasa i.e. Asthma 589 Ingredients of Ardhedashemaniya Swasaharavati 8110 Distribution of patients by Age – Gender 10411 Result of Ardhedashemaniya Swasaharavati in trail patients by 105 Age12 Distribution of patients by Gender in Tamaka Swasa 10613 Result Distribution of patients by Gender in Tamaka Swasa 10714 Distribution of patients by religion in Tamaka Swasa 10815 Result Distribution of patients by Religion in Tamaka Swasa 10916 Distribution of patients by Occupation 11017 Result of patients by occupation in Tamaka Swasa 11118 Result Distribution of patients by Economic status 11219 Distribution of patients by diet in Tamaka Swasa 11320 Result Distribution of patients by diet in Tamaka Swasa 114 -4-
  • 13. 21 Distribution of patients by presenting complaints 11522 Distribution of patients by Associated features of Tamaka Swasa 11723 Distribution of patients by Mode of on set 11824 Distribution of patients by course 11925 Depicting the frequency episodes in Tamaka Swasa 12126 Depicting the duration of attack in Tamaka Swasa 12227 Depicting the periodicity in Tamaka Swasa 12328 Depicting the preceding factors in Tamaka Swasa 12429 Depicting the aggravating factors in Tamaka Swasa 12530 Depicting the comfort posture in Tamaka Swasa 12631 Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa 148 -5-
  • 14. Chapter 1 Introduction From childhood as children we play with the conditions and are exposed to dustmites, fungi, and other allergens as a part of game or unnoticing. Human bodies producechemicals known as antibodies and there by the immunity is enriched. But the sameallergens concurs any individual common problem is respiratory tract infection along withdifficulty in respiration. The function of antibodies in the body is to fight off the invasion ofmaterials from the environment. However, the release of antibodies also inflames thebronchi and bronchioles. The more often a child is exposed to allergens, the more serious theresponse becomes. This condition is known as atopy i.e. “A genetically determined state ofhypersensitivity to environmental allergens. Type I allergic reaction is associated with theIgE antibody and a group of diseases, principally asthma, hay fever, and atopic dermatitis”,is thought to occur in anywhere from 30 to 50 percent of the general population. The lungs, which are exposed to the external environment needs a protectionespecially in the “World of Heat and Dust”. The human body is continuously under theinfluence of environmental changes subjected to environmental pollution. Our urbanized lifestyle and industrialization etc. compound the problem. As a result of smoke (dhooma) anddust (raja) Pranavaha srotodusti occurs, and terminates into the disease Tamaka Swasa otherwise Asthma 1.Atmospheric pollution The effect of indoor and outdoor air pollution on allergic disease has receivedconsiderable attention. Environmental pollutants have been reported to contribute to the Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 1
  • 15. prevalence of allergic disease, the precipitation of allergic symptoms, and their intensity(Ollier & Davies, 1994). Both epidemiological and experimental studies have demonstratedthat a variety of atmospheric substances including sulfur dioxide (SO) 2, nitrogen dioxide(NO2), ozone (O3) and particles influence the induction and elicitation phases of theallergic response. Effects have included adjuvant activity for allergen-specific IgEproduction, modulation of mediator release from inflammatory cells, and irritant effectson effector organs of the allergic response 2. The question of whether environmental factors may be involved in the observedincrease in the prevalence of allergy is a matter of controversy 3. There is no doubt thatpollutants such as suspended particles, automobile exhaust, ozone, sulfur dioxide and nitricoxides can be measured in rather high concentrations in the air of many countries that showan increasing prevalence of atopic diseases. However, some of these pollutants, like sulfurdioxide, have shown a decrease in air concentrations during the last decades. In a controlled prospective trial comparing different living areas with variousdegrees of air pollution in western and eastern Germany, striking differences were shownwith regard to the prevalence of respiratory atopic diseases, with higher values for westerncompared to East-Germany 4. In contrast to atopic respiratory diseases, there was a trend tohigher prevalence rates of atopic eczema in eastern Germany. In the same study there wasevidence of an increased risk of developing atopic eczema after exposure to natural allergens 5.as well as air pollutants from outdoor and indoor sources These observations made noware affirmed long back in Ayurveda. A common condition of transportation in flights or working as crew in them isproblematic for people those have respiratory problem. This situation is stated form Oxford Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 2
  • 16. Textbook of Medicine as “People with respiratory disease (Asthma) often have difficulty inassessing its true severity and aircrew with the condition may fly unaware of how severe itis. Exacerbations of asthma are often precipitated by upper respiratory infections. If such anexacerbation occurs when the aircrew member is overseas, there is considerable pressure onthe individual to fly; alternatively, serious disruption of flight scheduling may result. Anacute episode of asthma in flight is likely to interfere seriously with the flying task and hasbeen reported to result in loss of control of the aircraft. Aircrews with very mild, intermittentasthma requiring only occasional treatment are fit to fly. Those with more continuoussymptoms requiring regular suppressive medication, inhaled steroids, or cromoglycate are fitfor restricted licensing provided their asthma is well controlled. Those whose symptomspersist in spite of medication or who have very reactive airways with unexpected attacks areunfit to fly”. Living cells need energy for maintenance, growth, defense, and replication. Our cellsobtain that energy through aerobic mechanisms that require oxygen and produce carbondioxide. Many aquatic organisms can obtain oxygen and excrete carbon dioxide by diffusionacross the surface of the skin or in specialized structures, such as the gills of a fish. Sucharrangements are poorly suited for life on land, because the exchange surfaces must be verythin and relatively delicate to permit rapid diffusion. In air, the exposed membranescollapse, evaporation and dehydration reduce blood volume, and the delicate surfacesbecome vulnerable to attack by pathogenic organisms. Our respiratory exchange surfaces arejust as delicate as those of an aquatic organism, but they are confined to the inside of thelungs-in a warm, moist, protected environment. Under these conditions, diffusion can occurbetween the air and the blood 6. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 3
  • 17. It is a fact that the mentions of Charaka, that the Air as a fundamental unit ofexternal environment is a unique factor of biological activity providing the strength andconsciousness becomes a criteria of living activity through respiration 7. Pranavata andApanavata are responsible for breathing out and breathing in, which is an important day today experiences of life 8. Pranavaha Srotas, the origin is Hrudaya as well as Mahasrotas. Chakrapanicommenting on this stated that a special air known as Prana is related intimately to thisSrotas 9. Therefore, it is clear that the specific air known as Prana is breathed into therespiratory system during the act of inspiration. The normalcy of Pranavata suggests healthin the body 10, 11, 12. The abnormality of respiration indicates disease, and its cessation marks 13, 14, 15death . This unique sign of life is affected in the disease Tamaka Swasa 16. And this 17Pranavata vikaruti lead to the Swasa if it is neglects. This leads to the emergencycondition, 18 later on death. Tamaka Swasa is a disease, characterized by Swasa kricchata, Ghurghurakatwa,Kasa, Peenasa etc., with patient feels as if entering darkness. During the paroxysm which isdue to where on holy association of Vata with Kapha obstructing the passages of Pranavataleads to excitement of Vata to produce upward movement or abnormal expiratory dyspnoea.Which vary in severity and frequency from person to person is in an individual, they mayoccur from hour to hour and day to day. Bronchial asthma is a disease. Characterized by variable air flow obstruction, air wayinflammation and bronchial hyper responsiveness, the disease manifests wide variations onair way obstruction over a short period of time until recently, bronchospasm was considered Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 4
  • 18. cardinal feature of asthma but now in addition to bronchospasm, air way inflammation isrecognized as an essential component of the disease 19.Need and significance of the study The world health organization estimated in 1998 that asthma affect 155 millionpeople world wide, based on data collected in epidemiological studies in more than 80countries. Asthma rate has increased significantly in recent decade which is increased 50%every decade 20 worldwide, deaths from this condition have reached over 180,000 annually.Asthma is not just a public problem for developed countries. In developing countries,however, the incidence of the disease varies greatly. India has an estimated 15-20 millionasthmatics.Economic burden Mortality due to asthma is not comparable in size to the day to day effects of thedisease. Although largely avoidable, asthma tends to occur in epidemics and affects youngpeople. The human and economic burden associated with this condition is severe. Worldwide the economic costs associated with asthma are estimated to exceed those of TB and orAIDS combined 21. Above mentioned all points shows its severity of incidence and prevalence rate iscrucial that we should gain more insight into its causation and management. WHOrecognizes asthma as a disease of major health, public health importance and plays a uniquerole in the co-ordination of international efforts against the disease. The international action is needed to stimulate research into the causes of asthma, todevelop new control strategies and treatment techniques and develop and implement anoptimal strategy for its management and prevention increase public awareness of the disease Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 5
  • 19. Drugs The management of asthma is two fold, i.e. pharmacological and nonpharmacological. First one includes the bronchodilators, anti inflammatory corticosteroids,and anti histamines. Inflammatory is the now target of therapy and the role of inhaled.Corticosteroids have been formerly established in long term therapy. NAEP 1991 suggestsminimizing the toxicities of oral steroids. Non-pharmacological is the education 22. The goal of asthma treatment has shifted from symptom relief to disease control thiscan be achieved through usage of prophylactic category of medicaments. Asthma is considered to increase direct and indirect medical expenditures. So reducethe cost of treatment also to prevent the disease. Ayurveda suggest the cost effectivemanagement from different treatment modalities. Sequential administration of the snehana, swedana,shodhana, dhumapana, shamana,Rasayana, diet etc., line of treatment forms the complete treatment of Tamaka Swasaexpounded in the Ayurvedic literature 23. Among these procedure shamana line of treatment that includes oral administrationof medicines is of utmost importance as the administration is very easy and also effective. Plenty of research works have been carried out in relation to shaman treatment asdirected in Ayurveda and their therapeutic effect is proved. Many more herbal combinationsare described on Ayurveda, and therapeutic effect in is yet to be explored. Ardhedashemaniya Swasaharavati is one such herbal combination, includes the shati,puskaramula, bhumyamalaki, amlavetasa and tulasi. Which were taken from DashemaneeyaSwasahara gana of Charaka Samhita in Shadvirechanashatasritadhyaya 24. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 6
  • 20. The efficacy of Dhashemaneeya Swasahara dravyas are still to be proved by modernresearch methods. By looking at the individual herbal constituents, (easy availability in themarket cost effective all the drugs which suit for disintegration of pathology of TS) itappears that this combination should be very effective in combating the attack of TamakaSwasa. Therefore the present work is planned to evaluation and efficacy ofArdhedashemaniya Swasaharavati in the management of Tamaka Swasa (bronchial asthma)REVIEW OF PREVIOUS WORKS: 1. 1962, Haridra Vigyanam - Action of Haridra on Tamaka Shwasa and Eosinophilia - Singh Rajpal, G.A.U., Jamnagar 2. 1971, Dhatoor Multwaka Swarasa Bhavita Kajjali on Tamaka Shwasa Roga - Patel K. K., G.A.U., Jamnagar 3. 1974, Arkapatri Swarasa Bhavita Rasasindoor in Tamaka Shwasa - Somanandon G. G.A.U., Jamnagar 4. 1976, Bharangi Nagarayoh Kalkam Tamakae - Sharma D. P. G.A.U., Jamnagar 5. 1979, Study of effect of Shwasahar Kwath during acute attack of Tamaka Shwasa and Dipaniya Kwatha during interval of attack.- Mehata P. S. G.A.U., Jamnagar 6. 1981, Tamaka Shwasa Men Bharangiguda Ki Karmukata –Sharma C. B., N. I. A. 7. 1982, Tamaka Shwasa Ki Shastrokta Chikitsa - Pathade C. N. G.A.U., Jamnagar 8. 1983, A comparative study of Bhumyamalaki and Kapittha in the management of Tamaka Shwasa - Thaker L. V. G.A.U., Jamnagar 9. 1984 - A study of Dhumapana with its clinical evaluation on tamaka shwasa” - by Dr.Hariprakash. H. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 7
  • 21. 10. 1984, Studies on the Samprapti of Tamaka Shwasaroga and its management with Katuki Vati and Gojihvadighanavati - Tamboli P. K. G.A.U., Jamnagar11. 1985, A Clinical study on the systemic effect of Vamana Karma W.S.R. to Tamaka Shwasa - Kabra P. R. G.A.U., Jamnagar12. 1986, Astasanskarita Evam Samanya Shodhita Parada Se Nirmita Shwasakuthara Rasa Ka Tamaka Shwasa Roga Par Tulanatmaka Adhyayana. - Modh K. G. G.A.U., Jamnagar13. 1987, Clinical management of Tamaka Shwasa with reference to its attack - Singhald A. K. G.A.U., Jamnagar14. 1988, Comparative study of media in the preparation of Tamra Bhasma W.S.R. to Tamaka Shwasa. - Vododkar D. S. G.A.U., Jamnagar15. 1988, Studies on Mutrala Dravya W.S.R. to Tamaka Shwasa - Chara R. K. G.A.U., Jamnagar16. 1989, A Critical study on Shati W.S.R. to Tamaka Shwasa - Suthar R. D. G.A.U., Jamnagar17. 1991, Role of Virechana and Rasayana in the prevention and cure of Tamaka Shwasa - Modh K. G. G.A.U., Jamnagar18. 1993 - Study on Tamaka Shwasa - by Dr. Saraswati. H.19. 1994, A clinical study of Ginger and Guda in the management of Nija Swayathu and Tamaka Shwasa - Shah V. V. G.A.U., Jamnagar20. 1995, A clinical study on standardization of Vamana Karma W.S.R. to its effect on respiratory function tests in the patients of Tamaka Shwasa - Patnayaka Krishna. G.A.U., Jamnagar Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 8
  • 22. 21. 1995-Tamaka Swasa with Gouripashana - by Dr. Jayaraj. R.22. 1998 - The role of Rasayana in tamaka shwasa with special reference to the effect of Bharangiharitaki avalehya - by Dr. Ashok. M. Iti. .23. 1999 - A study on the role of upavasa in the management of tamaka Swasa by Dr. K. Ajithanarthindra24. 2000- Evaluate the efficacy of Manashiladi dhoomayoga on tamaka shwasa by Dr.Prasanna. N. Mogasale25. 2001, A comparative and pharmaco-clinical study of vasarishta and vasakasava in the management of Shwasa, Dr. Kulkarni Shailaja.26. 2001, A Comprehensive study of Katphala (Myrica esculenta Buch - Ham.) with special reference to Tamaka shwasa - Jaram Singh G.A.U., Jamnagar27. 2001 - The Evaluation of the effect of Padmapatradi yoga in Tamaka Swasa, R.D.Suresh. RGUHS, Bangalore28. 2002, A comprehensive study of Plant Acalypha indica. Linn. And efficacy in Tamaka Shwasa - Asmita Shinde. G.A.U., Jamnagar29. 2002, Clinical Study on the effect of Pippalyavaleha and Virecana karma in the Management of Tamaka Shwasa - Sangeetha G.A.U., Jamnagar Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Introduction 9
  • 23. Chapter – 2 Objectives of Study The present study intended to focus on the disease evaluation i.e., Tamaka Swasavis-à-vis. Bronchial asthma and the management with Ardhedashemaniya Swasaharavatiused as a shamanaoushadi. The Dashemaniya Swasahara gana is mentioned in shadvirechana shatasritadhyaof Charaka Samhita Sutrasthana. Among ten drugs we have selected five drugs, whichare prepared into choorna form then subjected to same dravya kwath bhavana three times,finally made it in vati which weighing about 500 mg for this vati we named it asArdhedashemaniya Swasaharavati. Hypothetically this has the best therapeutic efficacyon the Tamaka Swasa vis-à-vis bronchial asthma. In this regard the objectives proposed in the study are discussed under theheadings.1) To assess the effect of selected Ardhedashemaniya compound in Tamaka Swasa The condition Tamaka Swasa characterized by recurrent attacks of Swasakricchrata, and ghurgurakatwa along with other symptoms like – 1. Kasa (cough) 2. Duhkhena Kapha nissaranam (Expectoration) 3. Peenasa (Coryza) 4. Kruchrena bhasate (Dysphonoea) 5. Kantodhwamsham (Hoarseness of voice) 6. Greevashirasangraha (Headache & Stiffness) Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives 10
  • 24. 7. Urah Peeda (Chest Pain) 8. Shayane Swasa peedita (Discomfort at supine), etc. Tamaka Swasa and its management through various methods are possible viz.Ahhyanga Swedana, Virechana, Vamana, Dhoomapana, Shamana, Kapha nissarana,srotomardavatu, Vata kaphahar Kapha vilayana, kasagnee, bruhamana effects will bevery effective in combating the Tamaka Swasa. Considering the same theArdhedashemaniya compound having almost all of these therapeutic effects is opted forthis study. Administrating of Ardhedashemaniya compound in this disease may be helpful asShodhana and Shamana types of effect, which supports the Shodhana and Shamanaprinciples of treatment of Tamaka Swasa. As the disease is episodic therefore, distinctplanning of the treatment is required during the attack and in between the attacks.Liquefaction and elimination of sleshma sheet anchor of the treatment. There by thusremoves the obstructing (Snehana Swedana followed dhomapana) shleshma from thePranavaha Srotas, and allowing the free movement of Pranavata. This gives relief in the symptoms of Swasa kricchrata, preventing the attacksremoving the khavaigunyata and improving the resistance of the disease. So, the Ardhedashemaniya compound comprises the Vata Kapha pacificationeffect in nature and by which it reduces the recurrent attacks of breathlessness, andwheezing and features and its duration along with frequency and nature of the disease. The effect of Ardhedashemaniya compound in Tamaka Swasa is evaluated bymeans of studying the subjective parameters such as Swasa kricchrata, and Ghrgurukatwa Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives 11
  • 25. (wheeze) etc., with specified parameters in comparison to that of baseline data to that offinal data. The understanding of the study from base line data to the final data differencesafter the drug administration to the patients those who are included by preset parametersof exclusion and inclusion criteria.2) To assess the lung functions (Peak Expiratory Flow Rate) improvement byArdhedashemaniya compound in Tamaka Swasa Tamaka Swasa vis-à-vis bronchial asthma is characterized by spastic contractionof the smooth muscle on the bronchiole, which causes extremely difficult breathing. Thisis due to localized edema in the walls of the small bronchioles as well secretion of thickmucus in to the bronchiolar lumens and spasm of the bronchiolar smooth muscletherefore air way resistance increases greatly. The bronchiolar diameter becomes more reduced during expiration than duringinspiration in Tamaka Swasa (Bronchial Asthma) because the increased intrapulmonarypressure during expiratory effort compresses the out sides of the bronchioles. Because thebronchioles are already partially occluded, further occlusion resulting from the externalpressure creates especially severe obstruction during expiration. So the Tamaka Swasapatient usually can inspire quite adequately but has great difficulty expiring. The functional residual capacity and the residual volume of the lung becomegreatly increased during the asthmatic attack because of the difficulty in expiring air fromthe lungs. The clinical measurements show great reduced maximum expiratory rate andtimed expiratory volume. So in this study the lung function assessment is recorded with Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives 12
  • 26. the help of Peak Expiratory Flow Rate. The readings are taken before the administrationof the drug and every 15 days once, after the treatment schedule and follow up. The Peak Expiratory Flow Rate or a lung function test is done to document theseverity of air flow obstruction and to establish bronchodilator responsiveness. Themeasurement of Peak Expiratory Flow Rate is useful for monitoring and assessingvariations in lung function and providing information about allergies and environmentalfactors or asthma triggers. The drug Ardhedashemaniya compound hypothetically stated that it improves thelung function, because the individual drugs of Ardhedashemaniya are having antiinflammatory. Bronchodilator, expectorant, anti histamine, anti viral, etc., propertiesthere by disintegrates the pathology of Tamaka Swasa. By these actions the drug which reduces the functional residual capacity andresidual volume of the lung and improves the expiratory effort all these should beassessed by Peak Expiratory Flow Rate. This can be understood that when using Peak Expiratory Flow Rate measurement(lung function assessment) to judge response to treatment or severity of exacerbation. It isuseful to compare the measurement to patient base line. This base line is usually regardedas the norm or personal (Best Peak Expiratory Flow Rate) for the individual patient. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Objectives 13
  • 27. Chapter -3 Literary review Most of the times Tamaka Swasa (asthma) guidelines of recommendations andassessing Swasa complications with their control according to a series of criteria based onsymptoms and pulmonary function is difficult. Swasa treatment should aim at minimizingTamaka Swasa symptoms, rescue bronchodilator needs, and exacerbations, while optimizingpulmonary function. Many methods for assessing airway inflammation non-invasively havebeen developed, but they are not currently integrated into the assessment of asthma controlglobally. Studies or surveys on asthma generally use an "all or none" approach or a strictlyqualitative evaluation of asthma control, without specific quantification of its magnitude ordegree compared with optimal goals. Other means of assessing these parameters includeevaluating or scoring each separate component of asthma control and comparing the effectsof treatment or interventions on these specific parameters. In current practice of Ayurveda, however, both patients and physicians assess Swasacontrol globally, although there is no simple, practical method for truly quantifying it. Thismay contribute to an overestimate of the adequacy of asthma control by the Ayurvedicphysician, and even more so by the patient, and may consequently contribute to the poorasthma control observed in the asthmatic population. Quantification of control with tools such as the validated questionnaire developed byresearchers has been welcomed, providing a most interesting way to assess asthma control.However, busy clinicians may not have the time or personnel required for administering suchquestionnaires, and the scoring system used may not necessarily be meaningful to the Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 14
  • 28. practitioner and the patient. But for a researcher amount of literature and derived questions,through understanding of Samprapti (pathogenesis) is valuable for the further scopes ofdevelopment in the field.HISTORICAL REVIEWPREVEDIC AND VEDIC PERIOD: The available literatures of Pre-vedic and Vedic period reveal that the physiology ofrespiration, the role of Prana in respiration, the concept of Apanavata are mentioned at anumber of occasions. Akin to the present understanding in Rigveda, the word Prana is coined 25to describe the act of respiration. Some of the references like Pranadvayu jayate , 26ayumapranaha reveal the same. In Yajurveda also, the process of respiration, the act ofinspiration, the effort of expiration and involvement of Prana Vayu in respiration are 27 28elaborated. Few to mention here are - vatam pranena nasike pranasya apyathatvam .Further, in Atharvaveda, the word Matarishwa is coined to denote the Pranavayu. Theconcept of respiration and the role of Pranavayu in respiration is also clearly described in the 29last treatise among the Vedas. vatoprana ucyata - this is one of the lines from theAtharvaveda revealing the Prana Vayu and the concept of respiration.UPANISHATH KALA: The act of inspiration and expiration is mentioned as the prime physical sign of life inAmanaskopanishath. Further, the opinion of absence of respiration suggesting the death isalso described. The line from this Upanishad goes like this - svasocchvasatmaka prana 30 andavasocchusa hinastu niscitam muktaevasaha In Brhadaranyakopanishath the Prana is referred by the names Angirasa and Ayusya.The function of controlling the body mechanisms are attributed to Prana Vayu in this book. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 15
  • 29. In the Chandogyopanishath, the Prana has been named as Angeera and Brhaspati. The role ofPrana in nourishing the body is elaborated here 31. The diseased conditions of Pranavaha srotas that includes Hikka, Shwasa and Kasaare described and the role of deranged Vata in its causation is explained in YogaChudamanyam. The organ of respiration is compared to the bird Crane; the two wings of the birdrepresenting the organ of respiration, the trunk indicating the heart, and the neck of the birdsymbolically expressing the wind pipe are discussed in detail in Hamsopanishath.SAMHITA PERIOD: Charaka Samhita: The detailed description of Swasa and its five varieties are found in 17th chapter of Chikitsa. The elaborate explanation of etiological factors, pathogenesis, premonitory symptoms, clinical manifestations as well as complete radical treatment of Swasa is given here. Pratamaka and Santamaka Swasa, the variant forms of Tamaka Swasa are also described in Charaka Samhita 32. Susruta Samhita: The whole description of Swasa roga, its types and the treatment is available in Susruta Samhita 33. Bhela Samhita: Swasa as a symptom is mentioned in Bhela Samhita. In the form of complication of many disorders Shwasa is described in this treatise 34. Harita Samhita: Etiopathogenesis, line of treatment and dietetics of Kasa Roga are described at full length in Harita Samhita. The relevant descriptions are available in the 12th chapter of third Sthana of this work; where in Swasa is not available 35. Kasyapa Samhita: In Khila Sthana, the brief description of Swasa Roga with its treatment is described along with Kasa Roga 36. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 16
  • 30. Ashtanga Hridaya and Ashtanga Sangraha: In both Nidana Sthana and Chikitsa Sthana the relevant description of Swasa Roga is available in these books 37. Madhava Nidana: 12th chapter deals with the diagnostic aspect of the Swasa Roga in this book of Madhava Nidana 38.MEDIEVAL PERIOD: Chakradatta: Chakrapanidatta’s description of Swasa Roga available in this book is in accordance with the Brihatrayi. His treatise describes Swasa Chikitsa in the 12th chapter along with Hikka Roga 39. Arunadatta: Arunadutta commentator, in his commentary titled Sarvangasundara on Ashtanga Hridaya, Arunadatta has mentioned the etiological factors of Swasa and has opined the predominant involvement of Kapha Dosha in the etiopathogenesis of Swasa Roga 40. Kalyanakaraka: The description of herbo-mineral combinations that may be prescribed in patients suffering from Swasa Roga is unique in this text book. Ayurvedarasayana: Indu discuss the aggravated Kapha as the cause of Swasa. Bhavaprakasha and Yogaratnakara: Both these works describe the Swasa Roga at full length and this is in accordance with the description available in Brihatrayi 41, 42.Nirukti of Tamaka Swasa The word Tamaka Swasa (TS) is composed of two words. They are Tamaka and Swasa. The word ‘Tamaka’ is derived from the dhatu (root) “Tamaka glanu” with “Kwip” pratyaya. It means; to choke, darkness, be suffocated 43. It is also defined as “Tamyati Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 17
  • 31. iti Tamaka”- “tama eva Tamaka” in Shabdakalpadruma, which means dark curtains i.e. ‘tama’ occurs, in Tamaka Swasa 44. The word ‘Swasa’ is derived from the dhatu “Swas” with “gahs” pratyaya. It means to breathe 45 The word Tamaka Swasa means difficulty in breathing; which occurs mainly during night hours. Tamaka Swasa vis-à-vis Bronchial Asthma is a condition of the lungs in which there is widespread narrowing of airways, varying over short periods of time either spontaneously or as a result of treatment, due in varying degrees to contraction (spasm) of smooth muscle, edema of the mucosa, and mucus in the lumen of the bronchi and bronchioles; these changes are caused by the local release of spasmogens and vasoactive substances (e.g., histamine, or certain leukotrienes or prostaglandins) in the course of an allergic process 46.Paribhasha of Tamaka Swasa The attack of Swasa with tamapravesha which occurs specially during durdina is called as Tamaka Swasa. i.e. “Visheshyaddurdine tammyethi Swasa ha sa tamako mataha” 47. Vijayarakshita the commentator of Madhavanidana explained as “Swasastu bastrikadmana samavatordwa gamitha”. I.e. sounds similar to the sound of bellow of blacksmith 48. 49 50 Dalhana and Chakrapani commented Tamah praveshana which refers to the darkness or black curtains in front of the eyes. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 18
  • 32. The features or the clinical picture of TS; looks identical with the features of Bronchial Asthma (BA) and resembles for a greater extent.Definition The American thoracic society defined BA as a clinical syndrome characterized byincreased responsiveness of the trachio-bronchial tree to a variety of stimuli, which ismanifested physiologically by generalized airway obstruction which varies in severity overshort periods of time either spontaneously or as a result of treatment 51. In current medical diagnosis and treatment 1999- Asthma is defined as a chronicinflammatory disorder of the airway. Airway inflammation contributes to airway hyperresponsiveness, airflow limitation, respiratory symptoms (which include recurrent episodesof wheeze, breathlessness, chest tightness and cough particularly during the night and earlymorning). The word “asthma” is derived from Greek, which means hard drawn breath orpanting. Asthma is a disease of airways i.e., characterized by increased responsiveness of thetrachea bronchial tree to a multiplicity of stimuli. Asthma is manifested physiologically by awide spread narrowing of air-passages, and clinically dysponea, cough and wheezing, it is anepisodic disease. Its prevalence, is a very common disorder and it is estimated that 4-5% ofthe world population 52.Relevant information from ShareeraRespiratory System The respiratory system is responsible for supplying oxygen to the blood andexpelling waste gases, of which carbon dioxide is the primary constituent, from the body.The upper structures of the respiratory system are combined with the sensory organs of smell Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 19
  • 33. and taste (in the nasal cavity and the mouth) and the digestive system (from the oral cavity tothe pharynx). At the pharynx, the specialized respiratory organs diverge into the airway.The larynx, or voice box, is located at the head of the trachea, or windpipe. The tracheaextends down to the bronchi which branch off at the tracheal bifurcation to enter the hilus ofthe left or right lung. The lungs contain the narrower passageways, or bronchioles, whichcarry air to the functional unit of the lungs, the alveoli. There, in the thousands of tinyalveolar chambers, oxygen is transferred through the membrane of the alveolar walls to theblood cells in the capillaries within. Likewise, waste gases diffuse out of the blood cells intothe air in the alveoli, to be expelled upon exhalation. The Diaphragm, a large, thin musclebelow the lungs, and the inter-costal and abdominal muscles are responsible for contractingand expanding the thoracic cavity to effect respiration. The ribs serve as a structural supportfor the whole thoracic arrangement, and pleural membranes help provide lubrication for therespiratory organs so that they are not chafed during respiration. Figure -1 Upper and Lower Respiratory System Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 20
  • 34. Trachea The trachea, or windpipe, is the upper section of the airway, separated from thepharynx by the larynx. It is composed of ribbed cartilage which extends about four inchesdown to the bronchi of the lungs. Resting flatly against the esophagus, the trachea canextend slightly during swallowing, breathing, or bending the neck. It is lined with a mucouslayer and cilia which help to filter out dust. The constant action of these cilia carry mucousand debris upward into the pharynx, where upon it is swallowed. When the upper trachea orpharynx become blocked so as to cut off the airway, as from swelling of the tissues, a smallincision is made in the throat and into the trachea, in an operation called a tracheotomy,which allows air to pass into the windpipe. Figure -2 The Bronchi and Lobules of the Lung Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 21
  • 35. Bronchus The bronchi are the tubes which carry air from the trachea to the inner recesses of thelungs, where it can transfer oxygen to the blood in small air sacs called alveoli. Two mainbronchi, the right and left bronchus, branch off of the low end of the trachea in what is calledthe tracheal bifurcation. One bronchus extends into each of the right and left lung. Thebronchi continue to divide into smaller passageways, called bronchioles, forming a tree-likenetwork of branches which extends throughout the spongy lung tissue. The exterior of thebronchi are composed of elastic, cartilaginous fibers and feature annular reinforcements ofsmooth muscle tissue. The bronchi are able to expand during inspiration, to allow the lungsto expand, and contract during expiration as air is exhaled.Upper Lobe The right and left lung feature fissures divide the overall structures into smallerlobes. The left lung (the bodys left, the viewers right) has one horizontal fissure whichdivides it into two lobes (upper and lower). The right lung has one horizontal fissure and oneoblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Becauseof this third lobe, the right lung is larger than the left, extending further down in theabdominal cavity. The right and left lung are each enclosed in a pleural sac and are separatedby the mediastinum, a membrane which extends from the vertebral column in back to thesternum in front.Middle Lobe The right and left lung feature fissures divide the overall structures into smallerlobes. The left lung (the bodys left, the viewers right) has one horizontal fissure whichdivides it into two lobes (upper and lower). The right lung has one horizontal fissure and one Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 22
  • 36. oblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Becauseof this third lobe, the right lung is larger than the left, extending further down in theabdominal cavity. The right and left lung are each enclosed in a pleural sac and are separatedby the mediastinum, a membrane which extends from the vertebral column in back to thesternum in front. Figure - 3 Gross Anatomy of the Lungs Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 23
  • 37. Lower Lobe The right and left lung feature fissures divide the overall structures into smallerlobes. The left lung (the bodys left, the viewers right) has one horizontal fissure whichdivides it into two lobes (upper and lower). The right lung has one horizontal fissure and oneoblique fissure, dividing the right lung into three lobes (upper, middle, and lower). Becauseof this third lobe, the right lung is larger than the left, extending further down in theabdominal cavity. The right and left lung are each enclosed in a pleural sac and are separatedby the mediastinum, a membrane which extends from the vertebral column in back to thesternum in front.Alveoli The alveoli are the tiny sacs at the ends (or "leaves") on the bronchial tree. Eachsmall bronchiole divides into half a dozen or so alveolar ducts, which are the narrow inletsinto alveolar sacs. Each alveolar duct subdivides, leading into three or more alveolar sacs.Each large alveolar sac is like a grape cluster which contains ten or more alveoli. Because themembrane separating the alveolus and the capillary network which carries blood over them isvery thin and semi-permeable, oxygen can transfer from the air into the blood cells within thecapillaries. Likewise, carbon dioxide and other waste gases can transfer out of the blood andinto the air to be exhaled from the lungs. The alveoli are particularly susceptible to infection,as they provide bacteria and viruses a perfect place to grow. This accounts for the tendencyfor a chest cold or other lung problem to advance into pneumonia and pneumonitis, bothpotentially dangerous conditions in which the innermost parts of the lungs become infectedand inflamed, diminishing air flow and oxygen transport. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 24
  • 38. Figure - 4 The Bronchi and Lobules of the LungFUNCTIONS OF THE RESPIRATORY SYSTEMThe respiratory system has five basic functions: 1. Providing an extensive area for gas exchange between the air and the circulating blood. 2. Moving air to and from the exchange surfaces of the lungs. 3. Protecting respiratory surfaces from dehydration, temperature changes, or other environmental variations and defending the respiratory system and other tissues from invasion by pathogens. 4. Producing sounds involved in speaking, singing, and nonverbal communication. 5. Providing olfactory sensations to the CNS from the olfactory epithelium in the superior portions of the nasal cavity. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 25
  • 39. In addition, the capillaries of the lungs indirectly assist in the regulation of bloodvolume and blood pressure, through the conversion of angiotensin I to angiotensin II 53.Tamaka Swasa vis-à-vis Asthma Asthma affects an estimated 3-6 percent of the population. There are several forms ofasthma, but each is characterized by unusually sensitive and irritable conductingpassageways. In many cases, the trigger appears to be an immediate hypersensitivity reactionto an allergen in the inspired air. Drug reactions, air pollution, chronic respiratory infections,exercise, or emotional stress can also induce an asthmatic attack in sensitive individuals. The most obvious and potentially dangerous symptoms include - (1) The constriction of smooth muscles all along the bronchial tree, (2) Edema and swelling of the mucosa of the respiratory passageways, and (3) Accelerated production of mucus. The combination makes breathing very difficult. Exhalation is affected more thaninhalation; the narrowed passageways often collapse before exhalation is completed.Although mucus production increases, mucus transport slows, and fluids accumulate alongthe passageways. Coughing and wheezing then develop. The broncho-constriction and mucusproduction occurs in a few minutes, in response to the release of histamine andprostaglandins by mast cells. The activated mast cells also release interleukins, leukotrienes,and platelet-activating factors. As a result, over a period of hours, neutrophils and eosinophilsmigrate into the area. The area then becomes inflamed, further reducing airflow anddamaging respiratory tissues. Because the inflammation compounds the problem,antihistamines alone are often unable to control a severe asthmatic attack. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 26
  • 40. When a severe attack occurs, it reduces the functional capabilities of the respiratorysystem. Peripheral tissues gradually become oxygen starved, a condition that can prove fatal.Asthma fatalities have been increasing in recent years.Pulmonary Lobules The connective tissues of the root of each lung extend into the lungs parenchyma.The fibrous partitions, or trabeculae, contain elastic fibers, smooth muscles, and lymphaticvessels. The trabeculae branch repeatedly, dividing the lobes into ever smaller compartments.The branches of the conducting passageways, pulmonary vessels, and nerves of the lungsfollow these trabeculae. The finest partitions or interlobular septa (septum, a wall) divide the lung intopulmonary lobules, each supplied by branches of the pulmonary arteries, pulmonary veins,and respiratory passageways. The connective tissues of the septa are in turn continuous withthose of the visceral pleura, the serous membrane covering the lungs.RESPIRATORY PHYSIOLOGY The general term respiration refers to two integrated processes: external respirationand internal respiration. The precise definitions of these terms vary from reference toreference. In this discussion, external respiration includes all the processes involved in theexchange of oxygen and carbon dioxide between the interstitial fluids of the body and theexternal environment. The goal of external respiration, and the primary function of therespiratory system, is to meet the respiratory demands of living cells. Internal respiration isthe absorption of oxygen and the release of carbon dioxide by those cells. We shall considerthe biochemical pathways responsible for oxygen consumption and carbon dioxidegeneration by mitochondria, often called cellular respiration. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 27
  • 41. Our discussion of respiratory physiology focuses on four integrated steps involved inexternal respiration: 1. Pulmonary ventilation, or breathing, which involves the physical movement of air into and out of the lungs. 2. Gas diffusion across the respiratory membrane between the alveolar air spaces and the alveolar capillaries. 3. The storage and transport of oxygen and carbon dioxide between the alveolar capillaries and capillary beds in other tissues. 4. The exchange of dissolved gases between the blood and the interstitial fluids. Abnormalities affecting any one of these steps will ultimately affect the gasconcentrations of the interstitial fluids and thereby cellular activities as well. If the oxygencontent declines, the affected tissues will become oxygen-starved. Hypoxia, or low tissueoxygen levels, places severe limits on the metabolic activities of the affected area. Forexample, the effects of coronary ischemia result from chronic hypoxia affecting cardiacmuscle cells. If the supply of oxygen is cut off completely, the condition of anoxia is results.Anoxia kills cells very quickly. Much of the damage caused by strokes and heart attacks isthe result of localized anoxia.Respiratory ReflexesThe activities of the respiratory centers are modified by sensory information from: 1. Chemo-receptors sensitive to the PCO2, pH, and/or PO2 of the blood or CSF. 2. Changes in blood pressure in the aorta or carotid sinuses. 3. Stretch receptors that respond to changes in the volume of the lungs. 4. Irritating physical or chemical stimuli in the nasal cavity, larynx, or bronchial tree. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 28
  • 42. 5. Other sensations, including pain, changes in body temperature, and abnormal visceral sensations. Information from these receptors alters the pattern of respiration. The inducedchanges have been called respiratory reflexes. Figure – 5 Pressure changes during inhalation and exhalationHypercapnia and Hypocapnia Hypercapnia is an increase in the PCO2 of arterial blood. The central response tohypercapnia is triggered by the stimulation of chemo-receptors in the carotid and aorticbodies and reinforced by stimulation of CNS chemo-receptors. Carbon dioxide crosses theblood-brain barrier quite rapidly, so a rise in arterial PCO2 almost immediately elevates CSF Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 29
  • 43. CO2 levels, lowering the pH of the CSF and stimulating the chemoreceptive neurons of themedulla oblongata. These receptors stimulate respiratory centers to increase the rate and depth ofrespiration. Breathing becomes more rapid, and more air moves into and out of lungs witheach breath. Because more air moves into and out of the alveoli each minute, alveolarconcentrations of carbon dioxide de-cline, accelerating the diffusion of carbon dioxide fromthe alveolar capillaries. Thus homeostasis is restored. If the rate and depth of respiration exceed the demands for oxygen delivery andcarbon dioxide removal, the condition of hyperventilation exists. Hyperventilation willgradually lead to hypocapnia, an abnormally low PCO2. If the arterial PCO2 drops belownormal levels, chemoreceptor activity decreases and the respiratory rate fall. This situationcontinues until the PCO2 returns to normal and homeostasis is restored. The most common cause of hypercapnia is hypoventilation. In hypoventilation, therespiratory rate remains abnormally low and is insufficient to meet the demands for normaloxygen delivery and carbon dioxide removal. Carbon dioxide then accumulates in the blood.AGING AND THE RESPIRATORY SYSTEM Many factors interact to reduce the efficiency of the respiratory system in elderlyindividuals. Three examples are - 1. As age increases, elastic tissue deteriorates throughout the body. This deterioration reduces the compliance of the lungs, lowering the vital capacity. 2. Chest movements are restricted by arthritic changes in the rib articulations and by decreased flexibility at the costal cartilages. The stiffening and reduction in chest Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 30
  • 44. movement effectively limit the respiratory minute volume. This restriction contributes to the reduction in exercise performance and capabilities with increasing age. 3. Some degree of emphysema is normally found in individuals over age 50. However, the extent varies widely with the lifetime exposure to cigarette smoke and other respiratory irritants. The respiratory performance of individuals who have never smoked with individuals who have smoked for varying periods of time. After through discussion of the concern organ anatomical and physiological perceptions it is relevant to understand the Tamaka Swasa vis-à-vis Asthma from the classical Ayurvedic texts and also of modern parlance 54. Figure – 6 Ageing and the decline in Respiratory performancePRANAVAHA SROTAS Tamaka Swasa is a disease of Pranavaha Srotas. Therefore detailed Anatomy andPhysiology of Pranavaha Srotas (Respiratory system) is essential to study the disease indetail. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 31
  • 45. Chakrapani had clearly stated that this Srotas is related to a special "Vata" called 55“prana . Adhamalla, the commentator of Sharangadhara Samhita had also explained that 56Pranavata is the Vayu in which the life is located . The word "prana" is derived from theSanskrit root "An" with a prefix "Pra". "An" means to breathe, to live 57. The word "prana"of Pranavaha Srotas should not be misunderstood as Pranavata, one of the five subdivisions 58of Vata. The act of respiration is one of the functions of Pranavata but the function ofPranavaha Srotas is only respiration. According to Charaka, the moola (source or origin) of Pranavaha Srotas is Hridaya andmaha srota 59. (The word Moola here indicates that the organs mentioned as moolas of srotasare capable of bestowing strength and efficacy or even influences that particular srotas). But 60Sushruta considered hridaya and rasavahini dhamanis as the moola . A patantara wasmentioned in the Nirnayasagar press of Susruta Samhita as "Pranavahini dhanianya" insteadof "rasavahini dhamanis". Here the word "Hridaya" requires explanations. This word is derived from threeSanskrit roots "Hri", "Da" and "ya", which respectively mean Harana, Dana and Ayana.These three words respectively mean receipt, giving away and moving for the continuousactivity to execute the two earlier functions. The word Ayana" indicates path, way orthrough which movement of materials takes place. Therefore it is evident that thedesignation "hridaya" denotes only the functional aspect of an organ but not its anatomicallocation. The anatomical identity can be decided only on the basis of the substance / materialconveyed by it. In the light of the above-mentioned definition and other explanations, there are certainorgans, which can qualify for the designation of "Hridaya of these, three are important. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 32
  • 46. 1. Pupphusam or a lung, which takes in and gives out the air by continuously functioning/ moving for the vital respiratory act. 2. Hridaya (or thoracic heart), which receives and ejects the blood (Rasa- Rakta complex) by continuous contractions and relaxations for the maintenance of the circulation to perform the preenana and jeevana kriyas to the body tissues. 3. The manas or mind, located in the Mastishka, receiving the information about the indriyarthas from the sense organs and giving out the instructions of the Buddhi regarding the requisite action to the karmendriyas or other musculature. This action of the Manas correlate, the functions of the cognitive and connective organs. These are the other organs that qualify to be designated as "Hridaya". But theanatomical identification is mainly based on the substance dealt by that organ. Based on the 61explanation of Chakrapani that the pranavaha Srotas is concerned with the visishta vayuknown as Prana, the puppusha have to be accepted as the moola of these srotases. The word"Mahasrotas", which according to Charaka is one of the two moolas of pranavahasrotases,indicates that it is a large tube and large in diameter. As the "Pranavata” is a corporeal substance, the mahasrotas should be a patentstructure (but not Koshta). Therefore the mahasrotas associated with pupphusa (lungs) is thetrachea, its two branches, bronchi and their further branching into bronchioles to the alveoli.All these structures participate in the act of respiration (the movement of the visishta Vata).Charaka seems to indicate what Sharangadhara opined is that only the external respirationcomprising of inspiration and expiration with the absorption of visishta Prana vayu (oxygen)and removal of the carbon dioxide from the body as a whole 62. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 33
  • 47. The internal or tissue respiration consisting of the gaseous exchange between the cellsand their fluid medium is equally important for the jeevanakriya. Susruta seemed to haveindicated this aspect by stating that the Hridaya (in this context, the thoracic heart) andRasavahini dhamanis are the moolas of the Pranavaha srotases. These two moolas requiresome explanation.Nidana Panchaka of Tamaka Swasa An attempt has been made to review the Nidana panchaka of Tamaka Swasa, thoseare Nidana, Samprapti, poorvaroopa, roopa, upashaya, and Chikitsa from various classicaltexts and contemporary explanation regarding the (Asthma) aetiology, pathophysiology ofthe Bronchial Asthma (Tamaka Swasa) also be reviewed from various texts and recentjournals website for better understand the disease aspect as well as treatment aspect of theTamaka Swasa.Nidana of Tamaka Swasa The disease of Tamaka Swasa has its own etiological factors and Nidanottara karanasCharaka has claimed. A single etiological factor may produce a single disease or many 63etiological factors may produce the single disease contemporary sciences also reveals thebronchial asthma is heterogeneous disease 64. Various Authors of Ayurvedic texts 65 to 69 havebeen mentioned the general etiological factors of the Swasa which are also considered for theTamaka Swasa. But aggravating factors like meghambu(rainy season) sheeta sthana(coldplace) and preceding factors like peenasa (common cold) kasa(cough) are clearly explained 70, 71in the pathology of Tamaka Swasa . Nidana (etiological factors) are classified into 72mainly two groups . The general etiological factors of Swasa roga also divide into twocategories, viz. – Bahya and Abhyantara. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 34
  • 48. Bahya karana like raja sevena vayu sevana, (acharajanya) karana considered asaharajanya. Abhyantara Karana are also responsible for the cause of Swasa such as – AmaDosha, Vibandha, Rooksha bhojana, etc. Chakrapani has classified Nidana of Swasa under three categories 73. 1. Vataprokopaku gana - The Aetiological factors which vitiate the Vata Dosha are grouped ex.-raja sevana dhumapana 2. Kapha prokopaka gana - The Aetiological factors which vitiate the Kapha Dosha are grouped ex-nishpava, mash 3. Agnimandhya karaka and Ama utpadaka Nidana are also grouped. Agnimadyakara nidanas are for diminish the Agni there by Ama takes place. The most of the disease are due to Ama dosha only i.e. amay. Ex-Ama ksheer Jalaja Mamsa 74. Other classification has been made fewer than four headings 75, Ahara sambandi, Vihara sambandi, Nidanarthakara and Agantu sambani.1. Ahara sambandi nidanas – in this category the etiological factors related to food, drinks are grouped. Example: sheeta jala sevan, sheeta ashana (intake of cold foods) etc 76.2. Vihara sambandi nidanas – in this category the etiological factors like external activities of person exposed to vayu sevan, shetasthan are grouped.3. Nidanarthakara (avastha sambhandhi) – the different physiological and pathological conditions which play a very important role in manifestation of Tamaka Swasa. Ex- pandu, kasa, atisara, pratisyaya jwara etc 77.4. Agantu nidanas – in this classification injuries and trauma related factors are mentioned 78 79 ex-marmaghata, like stanarohita , stanamoola apasthamba, Sirama –vishalyagna marma. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 35
  • 49. Like wise again grouped under three headings – 1) Asatmendriyartha samyoga, 2) Parinama and 3) PrajnaparadhaASATMENDRIYARTHA SAMYOGA In Tamaka Swasa asatmendriyartha plays an important role in the causation ofTamaka Swasa. Mainly Ghranendriya, Rasanendriya and Sparsanendriya and their samyogawith Asatmyaartha will precipitate Tamaka Swasa immediately. Affect of allergy and atopyhas discussed in modern science as Aetiological factors. Nidana of Tamaka Swasa like raja,dhuma sevana, anoopa mamsa sevana may be considered in this category.PRAJNAPARADHA Either conscious or unconscious indulgence in harmful activities causes disease.These prajnaparadha like atimaithun, atyadhika padayatra, adhika vyayam will cause TamakaSwasa.PARINAMA Parinama means the effect of climatic condition. This is very well observed thatparoxysmal attacks of Tamaka Swasa during specific time and season. Example: night,winter season, cloudy climate and rainy season. Table No: 1 Showing Nidana of Swasa / Tamaka Swasa Factors CS 80 SS 81 AH 82 AS 83 MN 84 Vata-Prakopa Ahara Rukshanna - Ununctuous food + + - - + Visamashana - Irregular food habit + + - - + Adhyashana - Habit of eating frequently - + - - - Anasana - Observation of fast for long - + - - + Dvandvatiyoga - Mutually contradicting + - - - - foods Sheetashana - Cold foods - + - - + Visha – Poison + + - - + Sheetapana - Cold drinks - + - - + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 36
  • 50. Pitta-Prakopa AharaTilataila - Gingely oil + - - - -Vidahi - Food causing burning sensation + + - - +Katu -Spicy food - - - + -Usna - Hot food - - - + -Amla - Sour - - + - -Lavana - Salt - - + + - Kapha-Prakopa AharaNispava - Dolichos lablab + - - - -Masa - Vigna radiatus + - - - -Pistanna – Pastries + - - - -Saluka - Rhizome of lotus + - - - -Guru dravyas - Heavy food + + - - +Jalajamamsa - Meat of aquatic animals + - - - -Anupa mamsa - Meat of marshy animals + - - - -Dadhi – Curds + - - - -Amaksira - Unboiled milk + - - - -Utkleda - Kaphakara food + + - - +Vistambhi + + - - + Vata-Prakopa ViharaRajas - Dust / Pollen + + + + +Dhuma - Smoke + + + + +Vata - Cold breeze + + + + +Sheeta Sthana - Cold places + + - - +Sheeta ambu - Cold water + + + + +Ativyayama - Excessive exercises + + - - +Gramya dharma - Excessive sexual + - - - +intercoursesApatarpana - Emaciating techniques + - + - +Shuddhi Atiyoga - Excessive purification + + - - +Kantha/Urah pratighata - Injury to + - - - +throat/chestBharakarshita - Emaciation due to lifting + + - - +heavy weightsAdhwahata - Excessive walking + + - - +Karmahata - Excessive-work + + - - +Veganirodha - Suppression of urges - - - + -Abhighata - Injury - + + + -Marmabhighata–Injury to vital structures + - - - + Pitta-Prakopa ViharaUsna – Hot - - - + - Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 37
  • 51. Kapha -Prakopa Vihara Abhishyandi Upacara - Administration of + - - - + substances which obstruct the channels Divasvapna - Day sleeping - - - - - Vataja-Vyadhi / Avastha Sambandhi Nidana Anaha + - - - - Dourbalya + - - - - Atisara + - - - + Kshaya - + - - - Ksataksaya + - - - - Udavarta + - - - - Visucika + - - - - Panduroga + + + + - Visa Sevana + + + + - Vibandha + - - - - Pittaja Vyadhi / Avastha Sambandhi Nidana Rakta pitta + - - - - Jwara + - - - + Kaphaja Vyadhi / Avastha Sambandhi Nidana Kasa - - + + - Amapradosa - + - - - Chardi + - + + - Pratisyaya + - - - - Amatisara - - + + -Aetiology of Asthma Aetiological factors of asthma are of two types. Some factors called inducing factorscan set initial development of asthma, whereas some other factors provoke an episode inpredisposed individuals suffering from asthma and these are called provoking or triggerfactors 85. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 38
  • 52. 1) INDUCING FACTORS Genetic factors are important to determine why asthma occurs in a particularindividual. Asthma occurs more commonly in relatives of atopic individuals and thereforeatopy has been recognized as an important risk factor for developing asthma. A distinct gene 86.for atopy on chromosome 11q has been identified The frequent clinical observation thatasthma runs in families has been supported by many more formal investigations 87. The genetics of production of total serum IgE have studied. In such studiesconsideration has to be given to the following factors since each has been shown to effect ofIgE levels allergic exposure, parasitic infection age, gender, and smoking. A correlation wasfound between the total serum IgE of parents and children, suggesting the involvement ofone or more genes. However agreement on the model of inheritance blocking linkage of locifor total serum IgE and BHx to chromosome has been reported 88. A gene for IgE responsewith maternal inheritance was identified at chromosome. High level of IgE in cord blood 89appears to be strong indicator of subsequent development of atopic disease . Further it islikely that different genes and different environmental factors contribute to asthma indifferent populations. The chromosome 5 contains a 1l-4 gene cluster, which is closely linkedinheritance of an increased IgE response and to increased bronchial asthma 90.2) PROVOKING FACTORSa) Atopy and allergy The association between asthma and allergy has long been recognized. It has beenreported that 75 to 85 percent of patients with asthma have positive immediate skin reactionsto common inhalant allergens. There are at least 6 major evidences to prove that asthma isdue to exposure to allergens. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 39
  • 53. 1. Most people with asthma are atopic, which can be measured by skin tests or with measurements of specific IgE.2. Challenge with allergens in atopic asthmatics increases the severity of the disease.3. Occupational asthma is known to be caused by allergens and sensitisers4. It has been shown that subjects with apparently intrinsic asthma have higher levels of circulating IgE than the non-asthmatic population.5. Improvement in the symptomatology occurs on allergen withdrawal which proves the causal relationship between the two.6. Population studies have clearly demonstrated association between atopy and asthma 91. Taken together these facts are strong evidence for the role of atopy in asthma. Themost important are house dust mites, grass pollens, animal proteins, and moulds. Dandersfrom these animals like dog, cats, horses, and other pet animals contribute greatly to theallergenic components of house dust 92.b) Food and drinks Atopic asthmatics may occasionally notice that their symptoms are provoked by certainfoods or drinks. The foods most frequently suspected are milk, eggs, fish, cereals, nuts and 93chocolates, but very many others have been described . Indians are reported to be more 94sensitive and broncho-constrict to Ice and cola drinks . Food preservatives also provokesattacks of asthma, such as benzoates, sodium nitrate and sodium metabisulphite, anti-oxidants, the yellow food colorings agents such as tartrazine 95. Food allergies are common triggers for asthma and their symptoms are provoked bycertain foods. The allergens are compared with asatmya sevana in Ayurveda. These factors Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 40
  • 54. are discussed under Asatmendriyartha samyoga Nidana. Our Acharyas have mentioneddhuma, raja, jalaja and anoopa mamsa sevena etc are inducing asthma.c) Infection The observations have suggested that viral infections may be intimately involved in thedevelopment of asthma. The viral respiratory illnesses may produce their effect by causingepithelial damage, producing specific immunoglobulin IgE antibodies directed againstrespiratory viral antigens and enhancing mediator release. Interestingly in recent years, it isalso observed that some infections are protective of bronchial asthma. Viral or bacterialinfections during the first three years of life may serve a protective function against thedevelopment of allergic disease. Multiple Infections occur during the first few years of life,high concentrations of these Th 1 Cytokines could inhibit the release of Th 2 Cytokines, there 96by turning the mucosal immune response away from allergen sensitization . The virusesusually responsible are influenza, rhinovirus, and respiratory syncytial virus, together withbacterium Mycoplasma pneumonia 97. The role of infections in causation of Tamaka swasa isnot mentioned but effects of viral infections like kasa, prathishyaya, jwara have mentioned asNidana of Tamaka Swasa are also included in Nidanarthakara roga Karanas 98. 99d) Drug About 5 to 20 percent of adults with asthma will experience severe and even fatalexacerbations of broncho-constriction after ingestion of aspirin or NSAIDS. Although theexact mechanism is not known, it is non-immunologic and probably depends on inhibition ofcyclooxygenase. Other drugs include beta-blocker drugs; eye drop preparations of this classlike nadolol drugs can also induce asthma. Recently inhaled verapamil, a calcium channelblocker has been reported to induce severe bronchospasm in mild asthma. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 41
  • 55. e) Exercise Exercise induced asthma" is often used to describe the asthma of persons in whomexercise is the predominant or even the only identified trigger to air flow obstruction.Exercise induced broncho-constriction is one manifestation of the asthmatic diathesis;untreated EIA can limit and disrupt normal life. Airway narrowing develops within 2 to 3 minutes after cessation of exercise. Itgenerally reaches its peak about 5 to 10 minutes after cessation of activity and usually 100resolves spontaneously in the next 30 to 90 minutes or with bronchodilators . A rapidchange to warm, moist air post exercise tends to worsen the development of airflowobstructions 101. In contrast to asthma in general, EIA is due to smooth muscle contraction. The keyaspects of the triggering stimulus are the level of ventilation during exercise and thetemperature / water content of the inspired air 102. To reduce / avoid EIA, avoidance of cold /dry environment is preferable. The role of exercise (Vyayama) is well recognized inAyurveda.f) Occupational factors With increased industrialization, simple chemicals and organic compounds have beenused more often with a consequent increase in new respiratory hazards, particularlyoccupational asthma. Over 250 agents have been recognized to cause occupational asthma103 . Occupations like veterinarians, laboratory workers, formers, processing, pharmaceuticals,painter, and hospital workers are more prone for occupational asthma 104. Occupational asthma can be mediated by any of the several mechanisms. Theyinclude, reflex vagal broncho-constriction in response to an irritant effect on specific Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 42
  • 56. receptors, inflammatory broncho-constriction secondary to toxic concentration of gases or byimmunologic mechanisms 105. Typically, the symptoms initially occur towards the end of theworking day and in the evening, and are relieved at weekends and on holiday 106. Some of the aetiological factors mentioned under vihara category can be incorporatedwith occupational factors mentioned by modern literature. They are sheetastana,bharavahanam, adhwagamana, etc.g) Rhinitis & Sinusitis A possible relation between sinusitis and activation of asthma has been postulatedrecently. It is also likely that nasal and sinus pathology can aggravate asthma, particularly ifthere is uncontrolled drainage of mucoid or muco-purulent material down the nasopharynxwhere it can contribute to cough and irritability of larynx. It is now being appreciated that allergic rhinitis and bronchial asthma are consideredas one air way, and one disease 107. It is estimated that 60 to 70 percent of patients who haveasthma have also co-existing allergic rhinitis. Traditional therapies originally indicated forallergic rhinitis and asthma are being reassessed to explore their potential utility in both thesecondition 108. These Nidana are well recognized by our Acharyas. They have mentioned Pratishyayaand Peenasa like rogas. They have predisposing or sometimes accompanying with theTamaka Swasa.h) Gastro-esophageal reflux (GOR) 109, 110 Two separate mechanisms are involved in the gastro-esophageal reflux and asthma relationship - Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 43
  • 57. i) Reflex vagal broncho- constriction occur secondary to stimulation of sensory nerve fibres in the lower oesophagus. This mechanism is supported by the findings that acid infusion of the oesophagus in asthmatic patients leads to increased airway resistance that rapidly reverses with antacids. ii) The second proposed mechanism is micro-aspiration, a high prevalencerate of hiatus hernia and gastroesophageal reflux in patients with bronchial asthma A number of reports are available in medical literature on the relationship between gastro esophageal reflux and pulmonary disease. In Ayurveda, the disease is being 111 mentioned as Amashaya (pittastana) samudbhava and findings also support this explanation. i) Psychological factors 112 There has been a great deal of controversy regarding the cause and effect relationshipof asthma and psychological factors. Many of patients with asthma acknowledge thatexacerbations are provoked by psychological events, such as shock, excitement,bereavement, depression. Other psychological problems like recent family loss, disruption,recent unemployment, and schizophrenia. Occasionally, psychological illness, familydisputes or marital disharmony may be major factors in the aetiology of intractable asthma.Definite emotional factors are not mentioned in the nidanas of Swasa. But their role indisease development is well approved by Ayurveda. The above mentioned nidanas mainlyvitiate Vata which has important role in Tamaka Swasa.j) Pollution 113 Pollution with particulate matter adds to the allergenicity of aeroallergens. Passivesmoking is known to be a risk factor. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 44
  • 58. SAMPRAPTI OF TAMAKA SWASA Samprapti is a process from Dosha-vaishamya up to the manifestationof disease Study of Samprapti is very important, because it is mentioned as Samprapti 114vighatanameva Chikitsa" i.e., the disintegration of Samprapti completes the treatment .Samprapti explains the complete disease process which starts immediately after Nidanasevana, by the way the Dosha vitiated and where by vitiating doosya leading to Dosha -doosya sammurchana, producing a disease. It includes the explanation about thederangement of Dosha and pathological changes that takes place in the disease process andalso mode of manifestation of clinical features.SAMANYA SAMPRAPTI Vata located in the Uras after afflicting the Pranavaha Srotas, get aggravated andstimulates Kapha which is located in uras 115. It is observed that, 1. The Dosha-involved are Vata and Kapha. 2. Srotas involved is Pranavaha Srotas. 3. Vata is the main factor. Again Samprapti explained as, the disease originate from the Pittastana, and arecaused by simultaneous aggravation of Kapha and Vata. They adversely affect the Hridayaand all the Rasadi Dhatu. Here the disease originate from Pittastana, here implies Amashaya,where the disease originate. Both Vata and Kapha simultaneously aggravated. Hrudaya andrasadi dhatu are also affected in this disease. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 45
  • 59. VISISTA SAMPRAPTI OF SWASA The visista Samprapti of Tamaka Swasa says, Vata predominantly associated withKapha, obstructs the Srotas, the obstructed Vata trying to overcome the obstruction andmoves in all direction, resulting the disease i.e., Swasa 116. In the above reference in first line the word Kapha purvaka has been used.Chakrapani says it means Kapha pradhana i.e. predominance of Kapha. Also here Srotasword being said. The commentator considered the pranavaha and udakavaha srotas 117involvements in this disease . In second line "vishug vrajati" is being used. For thisGangadhara opines that "sarva shareera gacchati." Chakrapani says the meaning of this wordis "Sarvata gacchati" i.e., moves in all direction. It is better to considered movement in chestonly 118. In short it can be summarizes like - 1. Mainly Pranavaha srotas gets obstructed by Kapha, by which Vata aggravated due to srotosanga. Also vitiation of Udakavaha and Annavaha Srotas are to be considered. 2. Kapha Dosha is predominant. 3. Vata moves all over the chest resulting in Swasa.SAMPRAPTI PARTICULARLY RELATED TO TAMAKA SWASA Vata moving in the reverse direction pervades the Srotas (channel) afflicts the shira andgriva, and stimulates Kapha causes Tamaka Swasa Vyadhi 119. Vagbhata has mentioned Samprapti of Tamaka Swasa similar to that of Charaka, but hehas directly mentioned the vitiation of Pranavaha, Annavaha and Udhakavaha Srotas 120. The Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 46
  • 60. disease originates from Amashaya. Susruta states that the deranged Vata attains urdwa gati and along with Kapha produces Swasa. It is almost similar to that of Charakas explanation. It is more acceptable almost in all cases Pranavaha and Udakavaha Srotas are involved,but in rare cases involvement of Annavaha Srotas is also seen. The disease originates fromAmashaya, and Annavaha Srotas moola is Amashaya. In all cases in vitiated states themoola stanas of Srotas are also vitiated. The udbhava stana Amashaya still needs more explanation. Water loss throughrespiration is common, and vitiated Udakavaha Srotas symptoms are appeared in this disease. Thus the Samprapti of Tamaka Swasa is complex one. It can be summarized as follows, in first three Kriyakala i.e. Sanchaya, Prakopa and Prasara. The physiological derangement takes place due to exposure to aetiological factors (Nidana sevana). These three levels occur in doshic level only. Here the doshic general symptoms appear i.e. Dosha Sanchaya or Dosha prakopa lakshanas in Tamaka Swasa, 1. Vata prakopa (dushti) occurs due to vatika Nidana sevana 2. Kapha prakopa (dushti) occurs due to Kaphakara Nidana 3. Agnimandya and subsequently Ama utpatti occurs due to Agnimandyakara Nidana and as sequele to dosha prakopa. Samprapti explained, indicate that both Vata, Kapha are mainly involved, though Kapha is predominant in obstruction of Pranavaha Srotas where by causing Vata prakopa. In later stages the physiological derangements leads to pathological manifestations. These three Kriyakalas more gravies because Vyadhi vinischaya, Vyadhi lakshanas, Vyadhi avasta (prognosis) are being done. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 47
  • 61. Stana samshraya in Tamaka Swasa Here the predromal symptoms of Tamaka Swasa are manifested. In this stage thedoshas which are already aggravated and circulating throughout the body affects the tissuesof pranavaha srotas, where the khavaigunya occurs. This Khavaigunya better understoodwith modern science prevalence. Due to stana samshraya of doshas in Pranavaha Srotas getsobstructed (srotosanga) and Vata moves in all directions.Vyakta in Tamaka Swasa The sroto sanga due to Kapha and Ama Dosha in Pranavaha Srotas causes vimargagaman of Pranavata; where by the lakshanas of Tamaka Swasa will be manifested.Bhedavastha in Tamaka Swasa The pathological process which is already ongoing in a patient reaches this stage ifthe patients suffer from long time or uncontrolled disease. In long term permanentirreversible air flow obstruction takes place in affected Dhatu and Srotas, also affectsrotomoolas, as a result complication arises in this stage.Obstructive phenomena in Pranavaha Srotas: By the influence of etiological factors there occurs independent vitiation of Pranavataas well as Kapha Dosha. The morbid Pranavata, by virtue of its Ruksa, Sita and Kharaqualities tends to harden and narrow the Pranavaha Srotas. This narrowing as well as 121hardening hinders the free passage of Pranavata in the Pranavaha Srotas . In CharakaSamhita, this aspect of pathogenesis is explained while dealing with the therapeutics. In thiscontext it is said that Srotomardava Chikitsa has to be done by way of Snehana and Swedanato reduce the obstruction 122. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 48
  • 62. Stiffness of the Pranavaha Srotas is not the only cause of obstruction. Quite similar tothe other Srotas, secretion of the Kapha is the natural process. In Tamaka Swasa there occursabnormal secretion and accumulation of Kapha in the Pranavaha Srotas obstructing it. Thisobstruction prevents smooth and free flow of Prana Vata causing the Prana Vilomata theprime pathology of Tamaka Swasa. The obstruction and the resultant Prana Vilomata resultsin turbulent breathing causing audible wheezing. This is the cardinal symptom of TamakaSwasa. Rapid breathing is another effect of obstruction in the Pranavaha Srotas as opined inCharaka Samhita. In an adult normal person the rate of respiration is said as 15 per minute. Inpatients suffering from Tamaka Swasa this may go up to 40 per minute. Another effect of obstruction in the Pranavaha Srotas is the Kantha Gurghuraka. TheSleshma accumulated in the Kantha region obstructing the Pranavayu causes bubbling andthe resultant sound is Kantha Gurghuraka 123. Samprapti Ghatakas of Tamaka Swasa Dosha Pranavata, Udanavata, Avalambhakakapha, Pachakapitta Dushya Rasa Agni Jataragni, Rasadhatwagni. Ama Jataragnijanya and dhatwagnijanya. Srotas Pranavaha srotas directly, indirectly Udakavaha, Annavaha and Rasavaha Srotas. Srotodusti prakara Sanga, vimargagamana. Udbhava sthana Amasaya (Stomach). Sanchara Pranavaha srotas. Adhistana Uras, Pranavaha srotas. Vyakta sthana Uras (lungs). Roga marga Abhyantara Vyadhi swabhava Chirakari (chronic). Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 49
  • 63. Physiological Swasa has two components and are named as Praswasa and Niswasa.The ability of the Swasa may be improved by specific pulmonary exercise. This is popularlyknown as Pranayama. The assessment of chest expansion, which is approximately 4 to 5 cmroughly, expresses the ventilatory capacity. Further the understanding of the Pranayama 124gives way to think about the ventilation capacities. The following lines give thedescription of the same. The maximum amount of air that may be inhaled is known as Puraka. This refers to vitalcapacity and the spirometric evaluation of FVC quantifies the Puraka. In a normal individualFVC may reach up to 3000 ml. Inhaled air is then held for a maximum period with nomovement of inhalation and exhalation and this is known as Kumbhaka. This may be easilyquantified by the breath holding time. In a normal adult the average breath holding time isestimated as 50 to 70 seconds. Further this may be improved by another 20 seconds bypracticing pulmonary exercise. Further exhaling with maximum force is known as Recaka. The capacity of theRecaka can be evaluated by the spirometry. By assessing the FVC, FEV1 one can quantifythe Recaka. More over the 40 mm test and the expiratory blast test also quantify the capacity 125of Recaka activity . Further the distance covered by the exhaling air during Recakaexercise is told as 12 Angula. And this is appreciated by the movement of insects that comealong the way of exhaling air. The same in the present day is quantified by the Snider’s test. In Tamaka Swasa, as there is obstruction in the Pranavaha Srotas, there will bereduction in the ventilatory capacity affecting the Puraka, Kumbhaka and Recaka. Reductionin these ventilarory capacities can be understood by assessing FVC, FEV1, PEF and FVC /FEV1. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 50
  • 64. Figure – 7 Schematic representation of Tamaka Swasa Samprapti NIDANA SEVANASANCHAYA AGNIMANDYA DOSHA DUSHTI (Vata & Kapha dusti) AMARASOTPATTIPRAKOPA MALAROOPA KAPHAPRASARA PARIBHRAMANA PRATILOMAGATI OF VATA PRANAVAHA SROTOGAMANA KAPHA makes AVARANA to PRANAVATA STHANASANSHRAYA PRANA try to overcome the AVARANA VYAKTAVASTHA SWASA (swasavarodha, shwasativriddhi, Ghurghurkam etc.) Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 51
  • 65. PATHOPHYSIOLOGY OF BRONCHIAL ASTHMA The hallmark of the disease is the air flow obstruction. Most of asthma is of allergicorigin. It is viewed as sum of three features, i.The early asthmatic reaction (EAR) ii.The late asthmatic reaction (LAR) and iii.Bronchial hyper-responsiveness, with varying contribution from each. Three factors narrow airway caliber to limit the flow. 1) Airway smooth muscle contraction 2) Gland and epithelial secretions and exudation into the airway lumen, and 3) Inflammatory oedema and vasodilatation (hyperemia).EARLY ASTHMATIC REACTION (EAR) In atopic persons, an early response, this begins at 15 minutes and characterised bysmooth muscle contraction, exudation of plasma, and mucous production. This reaches its peak in about 30 minutes and resolves within 90 to 180 minutes. Thisearly reaction is IgE dependent and is the result of IgE binding to the mast cells by its Fcportion and to specific antigens by its F(ab) portion.This results in the release of preformedand newly generated mediators.This early responce is being accounted for by the release ofhistamine 126.LATE ASTHMATIC REACTION (LAR) AND BRONCHIAL HYPERREACTIVITY (BHR) The LAR is also characterized by the release of inflammatory mediators into the samefluids. However, during this phase there is striking infiltration of inflammatory cells withactivation of these cells which include eosinophils, neutrophils and lymphocytes. This LAR Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 52
  • 66. is thought to be a primary mechanism responsible for airway (bronchial hyperresponsiveness. The BHR is an exaggerated branchocontriction of smooth muscles and airwaynarrowing on exposure to small quantity of nonallergic stimulant that usually does notprovoke such a reaction in normal subjects. The BAL fluid from these subjects containsincreased eosinophils, eosinophilic cationic protein, CD4+ T lymphocytes, macrophages,monocytes, basophils and neutrophils. Mucosal oedema and vasodilatation are the importantcomponents of airway obstruction during the LAR. Bronchial asthma is now established as an inflammatory disease of the airwaysassociated with inflammatory cell infiltration, epithelial damage, and sub epithelial fibrosis.Presence of increased number of eosinophils in the sputum and peripheral blood of patientswith bronchial asthma has been known for many years. It is also reported subsequently thateosinophils and mast cells increase quantitatively during exacerbations of asthma 127.INFLAMMATORY CELLS IN ASTHMAMAST CELLS Normal human respiratory tract contains large numbers of mast cells beneath thebronchial epithelium and alveolar walls. Increased numbers of mast cells and histamine (aproduct of mast cells) have been found in broncho-alveolar lavage fluid obtained from thepatients with bronchial asthma. These cells are derived from CD3 4-+ positive cells in thebone marrow. A large number of biologically active molecules, both preformed i.e.,histamine, proteases and newly synthesized are released from the mast cell-during theallergic reaction when its high affinity, IgE receptors are cross-linked with antigen. All mastcells have secretary granules that contain large amounts of histamine, proteoglycans, heparin, Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 53
  • 67. and proteases. These preformed substances are exocytosed from the cell after immunologicactivation. The mast cells play an important role in the development of LAR in addition toits primary role in EAR.EOSINOPHILS 128 Eosinophils development is dependent on T-cell function. The IL-5 specificallystimulates eosinophil differentiation. They have receptors for IgG, IgA and IgE on their cellsurface. These cells are able to produce many mediators that are responsible for thedisordered airway function characteristic of asthma. These substances includes, Plateletactivating factor, LTB4, LTC4, PGE2,15-HETE, Oxygen radicals, four cytotoxic proteinsMBP,ECP,EPO, EDN. All these mediators are released by activated eosinophils. The release of these mediatorsresults in bronchoconstriction, epithelial damage and recruitment and priming of otherinflammatory cells. Another molecule present in the eosinophils is the CharcotLeydoncrystal protein that possesses lysophospholipase activity.LYMPHOCYTES 129 The production of IgE by B lymphocytes, there are a number of evidences to provethat these cells play important roles in this disease. i. T lymphocytes secrete lymphokines, IL-4, and interferon -y that closely regulate IgE ii. production by B lymphocytes, while IL-4 stimulates, inter feron-7 inhibits lgE synthesis, iii. T Cells are attracted to the bronchial mucosal surface to the site of inflammation by specific receptors both on themselves and on the mucosal capillary and endothelial venules. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 54
  • 68. MONOCYTES AND MACROPHAGES A subpopulaton of peripheral blood monocytes and alveolar macrophages are IgEreceptor positive. The macrophage IgE receptor (IgEFcR) has a low affinity for IgEcompared to that of the mast cell. It has been demonstrated that active macrophages arepresent at the air surface interface of human airways as well as in alveoli. Therefore, it ispossible that these cells interact with inhaled allergen.BASOPHILS Basophils are histamine releasing cells in the late phase reaction of asthma unlikemast cells, which release histamine in the early phase reaction.ADHESION MOLECULES Adhesion molecules are considered to be important in the causation of airwayinflammation although the specific mechanism is still under investigation.INFLAMMATORY MEDIATORS IN ASTHMALEUKOTRIENES Their involvement principally in bronchial asthma includes severe airway obstruction,i.e., bronchoconstriction, oedema and increased secretion of bronchial mucus from sub-mucosal gland secretion. The recent development and usefulness of leukotriene receptorantagonists and synthesis inhibitors in bronchial asthma further emphasizes the role of thisleukotriene in the pathogenesis of this condition.MAST CELL PROTEASES As much as 70% of the weight of mast cell consists of proteases that areenzymatically active at neutral pH. There cells express a complex array of proteases which Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 55
  • 69. consist of serine proteases, tryptases and chymase. These enzymes regulate neuropeptideregulation in the airways, smooth muscle contraction and submucosal gland secretion.HISTAMINE Histamine induces broncho-constriction, increases epithelial and vascularpermeability, and increases the secretion of mucous glycoproteins.PROSTAGLANDINS PGD2 and PGF2(x are very potent broncho-constrictor agents.PLATELET ACTIVATING FACTOR (PAF) PAF has attracted attention as an important mediator of bronchial asthma. It is animportant mediator involved in the bronchial hyper responsiveness in addition to havingaction of bronchial construction, stimulation of eosinophil and eodsinophil accumulation inthe airway induction of airway micro-vascular leakage and oedema and increased airwaysecretions.BRADYKININ It also important inflammatory mediator, bradykinin mediates its effect, through BKIand BK2 receptors.NITRIC OXIDE In patient with bronchial asthma the peak or mixed expired NO is about 50% higher.Expired concentrations of NO reflect the inflammatory microenvironment of the asthmaticairway wall.NEUROPEPTIDES IN ASTHMA There is increasing evidence that abnormal neurogenic mechanisms andneuropeptides contributing in the pathophysiology of bronchial asthma. Autonomic nerves Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 56
  • 70. regulate airways smooth muscle tone, mucous secretion, blood flow, vascular permeabilityand migration and release of inflammatory cells. Neuropeptides are small aminoacidcomponents that are localized to neurons. Neuropeptides such as VIP (Vasoactive intestinalpeptide)has been identified in various inflammatory cells including eosinophits, mast cells,and mononuclear and polymorpho nuclear leucocytes. Once release peptides act as either ofneurotransmitters, hormones or mediators. Their widespread distribution and differentphysiological effects make neuropeptides excellent candidates to play important roles inasthma.Pathology of Asthma The morphologic changes in asthma have been described principally in patients dyingof status asthmatics, but it appears that the pathology in non-fatal cases is similar. Grossly the lungs are over distended because of overinflation. The most strikingmacroscopic finding is occlusion of bronchi and bronchioles by the thick tenacious mucousplugs. Histologically the mucous plugs contain whorls of shed epithelium, which give rise tothe well known Curschmann-spirals. Numerous Eosinophils and Charcot Leyden crystals arepresent; the latter are collections of crystalloid made up of Eosinophilic membrane protein. The other characters are - 1) Thickening of the basement membrane of the bronchial epithelium. 2) Oedema and an inflammatory infiltrate in the bronchial walls with a prominence ofEosinophils which form 5 to 10% of the cellular infiltrate. 3) An increase in size of the sub mucosal glands, 4) Hypertrophy of the bronchial wall muscle, a reflection of prolonged bronchoconstriction. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 57
  • 71. Though the Samprapti of Tamaka Swasa is inadequate to explain in some aspects ofphysiological and pathological manifestation, starts due to Nidana sevan to diseasedevelopment. The knowledge helps in poorva roopa, roopa, Chikitsa and Vyadhi vinischaya.The analysis pathophysiology of Tamaka Swasa, found that Ayurveda emphasized thePranavaha Srotas, where as modern science pointed out bronchiols and other inflammatorycells and mediators. Figure – 8 Cross section of the lung in Tamaka Swasa i.e. AsthmaPOORVA-ROOPA The poorva roopa defined as the premonitory symptoms, which appears immediately aftersthana samshraya. In this stage of clinical manifestation of the disease premonitory featuresare of two types. The poorva roopa of Tamaka Swasa are due to Vata Kapha prakopa,Agnimandya and Ama. The vitiated Kapha and Vata Dosha first settled in Amashaya and Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 58
  • 72. produce symptoms like adhmana, anaha, arati, bhaktadwesa. It may persist for long periodbefore the manifestation of Tamaka Swasa. As Dosha lodged in Pranavaha Srotas TamakaSwasa is manifested with episodic attacks. Between the attacks patient may be free fromsymptoms of respiratory illness. Before each attack some premonitory symptoms like parshwashoola, pranavilomata and shankanistoda are manifested. The premonitory symptoms are visista type; hence they persist during attack also. In modern science, premonitory symptoms are not mentioned but some of preceding symptoms which are explained in clinical presentation of asthma can be interpreted as premonitory symptoms. Most patients will complain of the onset of an attack of bronchial asthma following allergic pharangitis in the form of sore throat, pain in the throat, itching, sneezing, running nose or a blocked nose. Viral infection of upper airways is another important preceding event in many patients of bronchial asthma. Further allergic rhinitis has been recognized as a risk factor for asthma. The study of poorva roopa helps in early detection of diseases; appropriate treatment can be started immediately and succeeded in preventing the disease or at least to minimizing its severity 130. To sum up, the vitiated Doshas stemming out from the Adhoamasaya circulates in theUras, Kantha and Siras. Consequently, these Doshas getting localized in the PranavahaSrotas produces symptoms like Parshva Shoola, Hridaya Peedana and Prana Vilomata, beforethe actual onset of breathlessness. The poorva roopa are explained by different authors arelisted in table following. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 59
  • 73. Table No. 2 Showing Poorvaroopa of Shwasa RogaSymptoms C.S 131 S.S132 A.H 133 M.N 134Anaha – distension of abdomen + + + +Adhmana – fullness of the abdomen - - - +Arati – restlessness - + - -Bhaktadwesa – aversion to take food - + - -Vadanasya vairasya – abnormal taste in the mouth - + - -Parshwa shoola – pain in the sides of the chest + + + +Peedanam hridayasya – tightness of the chest + + + +Pranasya vilomata – obstruction to expiration + - + +Shankha nistoda – temporal headache - - + +Roopa (Lakshana) of Tamaka Swasa In our classics there are number of symptoms being explained but it does not mean thatall the symptoms are to be present in every patient, for some patients very few symptomsmay be present but some are with many symptoms. The symptomatology can be rearrangedaccording to severity of the symptoms. In modern science, clinical presentations of bronchial asthma are heterogeneous, fallinginto every age group from infancy to old age, and the spectrum of signs and symptomsvarious in degree of severity from patient to patient, as well as within each patient, overtime.Detailed clinical history taking is very important in clinical diagnosis of bronchial asthma.The pattern of symptoms may be perennial, seasonal, or perennial with seasonalexacerbations. The symptomatology is generally episodic, although may be continuous orcontinuous with acute exacerbation 135. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 60
  • 74. Out of symptoms of Tamaka Swasa mentioned in the table, ati-teerva vega Swasa,ghurghur shabda, kasa, shleesma are the direct manifestation of the disease process hence,they considered to be main symptoms of Tamaka Swasa. In modern science, the usual symptom includes cough, wheezing, shortness of breath, 136chest tightness and modest degree of sputum production . Ghurghurka (wheezing) occursdue to avarodha in Pranavaha Srotas due to Kapha. A wheeze is generated by vibration inthe wall of an airway on the point of closer due to smooth muscle contraction (sankocha) 137.The srotorodha is one of the important manifestations of Samprapti of Tamaka Swasa. But inmodern science it is, often said - that entire wheeze is not asthma, because of the followingreason. Presence of rhonchi is a characteristic finding in asthma and will be present in mostpatients. However neither its presence nor absences will confirm or exclude bronchialasthma. Rhonchi may be heard in many other condition including chronic bronchitis,pulmonary oedema, bronchial stenosis, foreign body aspiration, upper airway obstruction andpulmonary emboli 138. Swasa is produced due to obstruction in Pranavaha Srotas. In normal circumstancesone is not aware of respiration. Here the patient finds difficulty to breath and increased inrate of respiration to compensate oxygen requirement. Dyspnoea can be due to obstruction tothe flow of air into and out of the lungs; Atiteerva vega Swasa is the pratyatma lakshana ofTamaka Swasa. Kasa (cough) is also one of the important symptoms of Tamaka Swasa. It is due toirritation in the airways (Pranavaha Srotas) and also it is an effort to expel the Kapha(sputum) secreted in the airways. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 61
  • 75. Greeva - shiraso- urasa sangraham these due to over inflation of the lungs and patientfeels a sort of discomfort or ache or pain in the bilateral sides of the chesta 139. Some symptoms are very peculiar to a particular disease; there existence confirmed thediagnoses and these are called pratyatma lakshanas of that particular disease. In our classicsthere is no direct reference of pratyatma lakshanas of Tamaka Swasa. As already mentionedabove in comparison with modern science, usual symptoms of asthma are considered to bepratyatma lakshanas of Tamaka Swasa. Rest of the features of Tamaka Swasa includes the explanation of the above saidfeatures, their effects and complications. Other symptoms are associated with upperrespiratory track infection. Kastena-shlesma nisharanam i.e. difficulty in expectoration, caused due to the overinflated lung, with both large and small airways being filled with plugs comprising of amixture of mucus, serum proteins, inflammatory cells and cell debris 140 . After the expulsionof sputum patients feel relief i.e., shlesma vimokshanthe sukham. This is because ofexpectoration, the plugging of the airways cleared off and make easy for respiration. Patientlikes hot things i.e., ushnam abhinandate. The hot things help in liquefying the plug(sputum) and become easy to expectorate. Shayanasya Swasa peeditha i.e., dyspnoea increases in lying down posture. This is dueto lying down position, the diaphragm is raised and reducing the lungs volume. Thesecretion in the lungs tends to obstruct the airways in this position. Shayanasya sameerinaparswe avagrihnati, this is due to intercostals are put into maximum efforts to compensate thediaphragmatic breathing which is ineffective due to tense diaphragm. As a result patientfeels a sort of griping sensation in the sides of the chest. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 62
  • 76. Aasenolabhate soukhyam i.e., due to sitting position diaphragm is lowered andsecretion of airways will not obstruct the airways completely. There will be more space forgaseous exchange. Hence patient feels relatively comfortable in this position. Kricchena bhashate i.e., dysphonoea, during episodic attack of Tamaka Swasa patientcan hardly speak anything. This is due to dyspnoea and also due to tenacious mucous may becoated in the throat including vocal cords. Nalabhate nidra i.e. Anidra Patients does not get proper sleep. This is due tocharacteristic attacks of dyspnoea during night hours (Nocturnal attacks). This is because oflowest level of serum adrenalise and cortisol and highest levels of histamine during night 141hours could be responsible for nocturnal episodes in asthmatic individua . Also changesthe body temperature i.e. lowering of temperature and increased accumulation of secretion inthe respiratory track during sleep may be additional factors. The symptoms aggravatesduring cloudy weather, after consuming cold water etc., these factors increase Vata andKapha by their sheeth guna leading to increased obstruction i.e., in other way increasesbroncho-constriction 142. If the disease becomes severe certain ominous features will be developed, the patientmay go into syncope during the bouts of coughing i.e., pramoham kashamanascha. In caseincreased respiratory distress i.e., pratamyati, patient becomes motionless i.e., sannirudyate,some times patient may develop loss of consciousness i.e. pramoham. The patient developthe wide opening of the eyes i.e., Ucchita akshata, sweating of the forehead i.e., lalata sweda,dryness of mouth due to air hunger i.e., vishukasyata, excessive thurst i.e., trishna, tremorsi.e. kampa, malaise i.e., angamarda. Patient takes short breaths and puts all his efforts in Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 63
  • 77. breathing i.e., muhurswasa mushuschaiva avadhamyate. Also sometimes patient is presentwith jwara (fever) this is because of upper respiratory infection or viral infection. All patients with bronchial asthma are at risk of developing severe asthma attack,which places them at risk of developing respiratory failure. These disorders refer to as statusasthmatics. In most cases, severe life threatening asthma develops against a background ofpoorly controlled disease. All features above discussed can be compared to status asthmatics and complicationsof asthma in modern science. However in 10 % to 20% of cases fatal or near fatal asthma,the onset appears to be sudden and unexpected, such episode are called "sudden asphyxiaasthma". Acute severe asthma said to "run to type" meaning there by, if hypercapniadevelops during one severe attack i.e. likely reverse in subsequent episodes 143. The clinical features of status asthmaticus include increased breathlessness, cough,wheezing, and chest tightness. The patient is typically anxious, breathless, fatigued, sittingupright in bed and is preoccupied with task of breathing. Clinical signs include tachypnoea,tachycardia, hyper inflated lungs, wheeze, use of accessory muscles pulses paradoxus and 144diaphoresis . The clinical features which are mentioned included severe or fatal asthmawith complication of bronchial asthma. Hypoxia results in the manifestation of features liketachycardia, sweating, wide pulses, pressure and cyanosis. Lakshana Table is followed. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 64
  • 78. Table No. 3 Shows lakshanas of Tamaka SwasaSL Vega Kaleena Lakshanas Cs SS AH YR BP MNNo1 Ghur-Ghur Shabda (Wheezing) + + + + + +2 Ati-Teerva Vega Swasa (Acute dyspnoea) + + + + + +3 Kasa (Cough) + + + + + +4 Muhur-Swasa(Rapid Inspiration) + - I + + -+ +5 Greeva-Shiraso-Urasa Sangraham (Pain/stiffness + + + + + + in head, neck and chest)6 Kastena-Shlesma Nihsarnam (Difficult + + + + + + Expectoration)7 Shleshma-Vimokshanthe Sukham (Relief after + + + + +- Expectoration) +8 Ushnam-Abhinandate (Liking hot things) + - + + +9 Shayanasya-Swasa Peeditha, Aseena Labhate- + + + + + + Soukhyam (Discomfort in lying down posture, comfortable in sitting posture)10 Shayanasya Sameerana Parshve Grahnati + - + + + + (Discomfort in sides of the chest on lying down posture)11 Kricchen-Bhasate (Dysphonoea) + - - + + +12 Na-Labhate Nidra (Sleeplessness) + - - + + +13 Megha, Ambu, Sheeta, Pragrath, Shlesmadalancha + - + + + + Pravradati (Increase after exposure to cloudy whether, cold water, Kaph-kara ahara)14 Pramoham Kashamanascha (Fainting during + - + + + + cough) 115 Pratamyati (feels much distressed) + + + + + +16 Sannirudyathi (Steady voluntary movements) + - + + +17 Uchita Akshata (Wide-open eyes) + - + + + +18 Lalata Sweda (Sweety forehead) + + + + + +19 Vishu Kasyata (Dryness of mouth) + + + + +20 Trishna (Excessive thirst) + + - - -21 Kampha (Tremors) + - + - - -22 Anqamarda (Malaise) + + - - - -23 Mushira avadhamyati (Puts all efforts to breath) + - + + + +24 Jwara (Fever) + - +25 Pratishyaya (Coryza + - + + + +26 Brashamartha (Maximum distress) + - + + + +27 Aruchi (Anorexia) - + +28 Kantaddvamsha (Hoarseness of voice) + + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 65
  • 79. VYAVACCHEDAKA NIDANA (differential diagnosis) While making diagnosis of Tamaka Swasa the following diseases which are havingsimilar symptamatology haves to be excluded. They are other types of Swasa roga andkaphajakasa. Features are shown in the table 145.Kaphaja kasa In kaphajakasa mandagni, aruchi, chardi, peenas, uthklesha, gourava, romharsha,madurya in mouth. snigda, nistevana kapha, samprapti in uras. According to modern science,the following diseases should be differentiated from bronchial asthma 146. i.Chronic bronchitis ii.Pulmonary emphysema iii.Congestive heart failure iv.Pulmonary embolism v.Mechanical obstruction of the airways vi.Pulmonary infiltrations with eosinophilia vii.Cough due to drugs (Beta-blockers, AIE inhibitors)The signs and symptoms of the disease are 147 1) Chronic Bronchitis: The clinical signs are persistent cough productive of copious sputum. For many years, no other respiratory functional impairment present. But eventually dyspnoea on exertion develops. Cyanosis and hemoptysis are present. X- rays shows the features of increased bronchovascular markings. 2) Pulmonary emphysema: Increasing breathlessness with wheezing but no cough or sputum. Chest is barrel shaped, percussion note hyper-resonant. Auscultatory finding is slowing of forced expiration. X-rays shows hyper-translucency, low flat diaphragm. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 66
  • 80. 3) Congestive heart failure: Weakness, fatigue, oedema, restlessness, insomnia, cough, dyspnoea, orthopnoea, anorexia, nausea. Signs raised JVP, liver enlargement, peripheral cyanosis. 4) Pulmonary embolism: Sever chest pain, dyspnoea, shock, elevation of temperature, increased level of serum, lactic, dehydrogenase. X-rays shows pulmonary infarct, as a wedge shaped infiltrate. TABLE No - 4 Vyavacchedaka Nidana in Tamaka SwasaSymptoms Tamak-Swasa Maha-Swasa Urdwa Swasa Chinna-Swasa Kshudra SwasaSwasa Ateerva vega Uchaiti Deergam Vichhinnam Rooksha Urdhwam ayaasodbhavaShabda Ghurgurukatw Matta vrisha am bhavatConscious Pramoha Pranas Pramoha Murchaness Hta jnanavignanceNetra Uchritaksha Vibrantalocha Urdhvadrishti Viplutaksha, na and raktaika vibrantaksa lochanaShoola Parshwa Vedanartha Marmachedha No shoola rugarditha indriyavyatha pralapaVak Kricchena Vishirna vak Pralapana bhasateAsya Vishu kasyate Shuskasya ParishuskasyaSweda Lalata swedaSadya Yapya/sadya Asadya Asadya Asadya SadyaasadyathaUpadrava of Tamaka Swasa Upadarava are the complications of a disease occur at the end of stage of disease. Anobservational finding in symptomatology of Tamaka Swasa includes upadrava even. We canconsider hridaya vikriti as one of upadrava because hridaya is moola of Pranavaha Srotas.The complications of bronchial asthma are pneumothorax, pneumomediastinum, Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 67
  • 81. subcutaneous emphyseam, pneumopericardium, myocardial infarction, mucus plugging,atelectassis, electrolyte imbalance, dehydration, myopathy, lactic acidosys, and hypoxic braininjury etc.Arista lakshanas Arista Lakshanas are the features or symptoms which occur just before death. In otherwords they are the definite signs towards death. This Swasa is also fatal because all thepatients at the end will suffer from Swasa. As Tamaka swasa has been said as sadhya in itsinitial stages to take up for the treatment, the Arista lakshanas all to be examined. Thepatient presenting with deergha uchwasa and hriswa nishwasa are the arista lakshanas of 148Tamaka Swasa . The swasa complicated with atisara, jwara, hikka, chardi, medrashotha 149and shotha are said to be arista lakshanas . The swasa with jwara, chardi, trishna, atisara, 150and shopha are said to be arista lakshana . The colour of the skin is also changed to bluedue to Swasa, which is explained in varna context of arista. This can be explained as thecentral and peripheral cyanosis, which is manifested in the superficial skin and mucousmembrane due to hypoxemia.Sadhyasadhyata Ayurveda is advised to assess the prognosis i.e., Sadhyasadhyata of the disease beforestarting the treatment. For the sadhyasadhyata of Tamaka Swasa, Charaka has said it is 151yapya, but it becomes sadhya only in its early stages . Also said, it is sadhya, when itssigns and symptoms are not fully manifested and if the patient is strong 152. Susruta has said 153that Tamaka swasa is kastasadhya but becomes asadhya in durbala rogi . According tovagbhata Tamaka swasa is yapya but can be sadhya if it is treated in the beginning and if itoccurs in strong person 154. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 68
  • 82. In modern science mentioned, it was long believed that the prognosis for asthmaoriginating in infancy or childhood was good, and that in most patients the symptoms wouldresolve by the age of puberty. In fact an asthma symptom persists in 30 to 80 % of adultpatients. Although epidemiological studies have shown a fair chance of either remission orreduction in asthma symptoms between the ages of 10 and 20 years, no definite informationis available about progression of asthma through childhood and adolescence. The assessment of sadya- asadyatha is very important to physician to undertake patientfor the treatment. If a patient come to physician in his later stages i.e., worsened conditionsof a disease, a wise physician should not take for treatment. With sadhyaasadyatha physiciancan convenience the patients and their relatives about the prognosis of the disease. Herepatient education important in such yapya disease. This makes the patients co-operation withphysician for long term treatment.UPASHAYA – Factors relieving the severity of disease – Asino labhate saukhyam (sitting posture gives relief). Shleshma vimokshe sukham (expectoration of kapha gives relief). Ushnabhinandati (liking toward hot things).ANUPASHAYA – Factors aggravating the severity of the disease – Sheeta pana (cold drinks). Sheeta vata (cold weather). Guru bhojana (heavy eatables). Vyayama (exercise). Shayane shwasavriddhi (sleeping or lying down intensify shwasa). Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 69
  • 83. Chikitsa in Tamaka Swasa The effective treatment of Tamaka Swasa can not be unified, as the pathologyinvolves multiple varying factors. Vitiated Vata and Kapha Dosha stemming out from thePitta Sthana, afflicting the Rasa Dhatu in the Pranavaha Srotas produces the illness.Therefore, the procedures aimed at the rectification of the imbalances of Vata Dosha, as wellas Kapha Dosha forms the sheet anchor of treatment of Tamaka Swasa which is individuallyquite opposite. Thus, the unique pathogenesis poses complexity in planning the treatment.The final treatment planned should pacify the Vata as well as Kapha Dosha effectively,simultaneously not causing any further addition to the imbalance of Vata and Kapha Dosha.With the due consideration of this, following principles of treatment are advocated in theAyurvedic classics. 1. Abhyanga and Swedana –Application of the oil over the chest followed by sudation. 2. Vamana – Therapeutic emesis 3. Dhoomapana – Therapeutic inhalation of the smoke from the burning herbs 4. Virechana Karma – Therapeutic purgation 5. Pratisyaya Chikitsa – Treatment of rhinitis 6. Kasaroga Chikitsa – Treatment of Kasaroga 7. Vatahara Chikitsa – Elimination of vitiated Vata Dosha 8. Kaphahara Chikitsa – Pacification of vitiated Kapha Dosha. 9. Manasa Dosha Chikitsa –Correction of emotional disturbances 10. Kapha Vilayana Chikitsa –Liquification of the sputum 11. Srotomardavakara Chikitsa – Softening of the channels of respiration 12. Kaphanissaraka Chikitsa – Expectoration of sputum 13. Kasaghna Chikitsa – Treatment of cough 14. Rasayana Chikitsa – Rejuvenating the Pranavaha Srotas and body Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 70
  • 84. Judicial employment of these therapeutic procedures brings about maximum relief tothe patient suffering from Tamaka Swasa. The details of these procedures are given in thefollowing paragraphs.Abhyanga and Swedana: Treatment of Tamaka Swasa differs both during the attack and in between the attacks.During the episode of Tamaka Swasa, the Dosha are in a state of provocation and contrary tothis, in between the attacks the Doshas are silent and are not apparent, thus demandingdifferent treatment. To make it more clear, the treatment is planned during the attack tonegate the effect of Samprapti. In contrast to this, in between the attacks, the treatment isplanned to prevent the initiation of new Samprapti thereby, forming the complete treatmentof Tamaka Swasa 155. Pranavilomata is a pathological event during an episode of Tamaka Swasa and is saidto be due to the tenacious Kapha obstructing the passage of Pranavata. Bringing it out byliquefying the sputum is the principle and first treatment of this condition. This can beachieved by Abhyanga and Swedana over the chest thereby allowing the free passage ofPranavata. Charaka has prescribed application of oil added with rock salt over the chestfollowed by sudation in the form of Nadi, Prastara or Sankara Sweda 156.Vamana Karma: The Clinical presentation in patients suffering from Tamaka Shwasa is not uniform.Some patients present with symptoms suggestive of dominant Vata Dosha and arecharacterized mostly by dry cough and prominent wheezing. In such patients, VamanaKarma is not the ideal choice. Yet, other patients present with symptoms suggestive ofdominance of Kapha Dosha, which is characterized by paroxysmal productive cough, where Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 71
  • 85. the sputum is tenacious, bouts of distressing paroxysmal cough brings out small amounts ofsticky sputum and this is associated with breathlessness. In such patients, with thepredominant vitiation of Kapha Dosha, Vamana Karma is most ideal. This renders clarity ofthe Pranavaha Srotas and thereby allowing free passage of the Pranavata. The procedure of Vamana Karma is advisable only in patients who are physicallystrong and can tolerate the strain of Vamana Karma. The mild form of Vamana is alwaysadvisable in all patients of Tamaka Swasa and it can be repeated during every attack 157. In children, spontaneous vomiting is a natural defense mechanism that clears thepassage of respiratory tract. Here, act of vomiting along with emptying the stomach, alsoincludes forced expiration that clears the respiratory passage. After subjecting the patient to Abhyanga and Nadi Sweda over the chest, in theevening, the patient is allowed to take the food that provocateur the Kapha Dosha - likemeals with curds or fish. This Kaphotkleshana procedure renders easy elimination of theKapha Dosha by the Vamana procedure, which is carried out on the immediate next day, inthe morning hours 158.Dhoomapana: This is another procedure also aimed at eliminating the Kapha Dosha from the Srotas.Dhoomapana is advised after the Vamana karma and it eliminates some amount of KaphaDosha that is still left out after the Vamana karma. Or else, if the minimum Kapha Dosha inthe Srotas as in Vata dominant cases or in cases of milder attacks, Dhoomapana may beperformed alone without prior Vamana karma. Further, in debilitated patients, whereputrefactive procedure is not possible, Dhoomapana alone helps in the elimination of Kapha Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 72
  • 86. Dosha. Added to this, the drugs used in Dhoomapana also reduces spasm or stiffness ofPranavaha Srotas bringing about Srotomardavata that ensures free passage of Vata Dosha. Improvement from the respiratory distress can be spontaneously seen, asexpectoration is improved and made easy. Also, it produces broncho-dilatation, bringingmaximum relief to the patient. Here, the medicines are directly delivered into the system andhence response is prompt and immediate. The procedure is akin to the inhalers prescribed bythe modern counterparts. Procedure can be repeated regularly depending upon the 159requirement . Occasionally, due to irritant cough, breathlessness may worsen in somepatient. This is mostly seen if the patient cannot smoke smoothly, and is especially true infemales and children.Virechana Karma: Abnormal response of patients for simple factors like dust is said to be due toKhavaigunyata of the Pranavaha Srotas. In the modern counterpart, this is described ashypersensitivity or allergy of the respiratory system. This may be said as Khavaigunyata, orelse called as Asatmyata or even may be named as faulty Vyadhikshamatva. And the fact isthat, the patient unfavorably responds to simple factors like dust, atmospheric change, orfood. The friendly environment in which the patient has to live becomes hostile to him and islike the enemy of the patient. The interaction in such a situation between the patient and theenvironment is just like the two mirrors facing each other. The mirrors facing each otherproduce infinite number of images and quite similar to this, the patient suffers frominnumerable attacks of Tamaka Swasa. The answer for such a nature of illness is Virechana karma and Rasayana Chikitsa.Charaka pronounced this as “Tamake Tu Virechanam” 160. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 73
  • 87. The Virechana procedure may not be of much use during the attack of TamakaSwasa. But when employed in between the attack, prevents the attacks of Swasa, reduces itsseverity, minimizes the duration of illness. Even in some patients, this procedure incombination with Rasayana Chikitsa brings about complete cure. After Virechana, Samasarjana Karma is advised for about 3 to 5 days. By thisprocedure, Doshas in Tamaka Swasa get eliminated, as is told in the classics, Doshasstemming out from Pitta Sthana is best eliminated by Virechana procedure. It is worthmentioning here that, Vata Dosha is the predominant Dosha involved in the Samprapti ofTamaka Swasa. Virechana normalizes the course of Vata Dosha and thus helps in thereversal of the Vilomagati of Pranavata. Distension of the abdomen, constipation and suchother symptoms may be associated in some patients and these symptoms are best treated bythis procedure.Pratishyayahara Chikitsa: Charaka opines that, Pratishyaya is a cause of Tamaka Swasa. Sneezing, runningnose, stuffiness of the nose are the prominent symptoms that associates Tamaka Swasa. In atypical attack, the patient develops these upper respiratory tract symptoms. Within hours,following this, the patient develops wheezing. This chronological order of symptommanifestation is more suggestive of Pratishyaya Roga as the cause of Tamaka Swasa. In suchpatients, along with other medicines of Tamaka Swasa, the Pratishyayahara Chikitsa shouldbe adopted. By this planning of the treatment, one can draw maximum favorable results 161.Kasa Roga Chikitsa: Kasa Roga is another disease said to predispose Tamaka Swasa. The clinical course inthis case, could be the initial development of productive cough, with or without manifestation Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 74
  • 88. of fever. Characteristically, sputum is muco-purulent or yellowish. Within a day or two,breathlessness and wheezing follows. This unique evolution of symptoms is very muchindicative of Kasa Roga, precipitating Tamaka Swasa. Therefore, addition of treatment ofKasa Roga in patients of Tamaka Swasa is thus justified 162.Vatahara Chikitsa: Vata Dosha as well as Kapha Doshas is invariably involved in the pathogenesis ofTamaka Swasa. But relative dominance and accordingly the clinical picture of these twodoshas may vary in individual patients. Minimal cough, when present, mostly dry,insignificant amount of sputum, prominent breathlessness and wheezing, all are suggestive ofdominance of Vata Dosha. In such case, Tamaka Swasa Chikitsa should mainly includemeasures to pacify the Vata Dosha to get best results 163.Kaphahara Chikitsa: In patients of Tamaka Swasa, relative dominance of Kapha Dosha is characterized byparoxysmal productive cough with profuse whitish sputum. Associated breathlessness iscomparatively lesser than the Vata dominant variety. In such a clinical state, measures topacify the Kapha Dosha are a better approach in the treatment of Tamaka Swasa 164.Manasa Dosha Chikitsa: Patients’ expression of anxiety may not be in the eyes, face or their activity, but itmay be through the Pranavaha srotas in the form of Swasa. The absolute cause is related tothe mind but its reflection is through the Pranavaha srotas. In such clinical presentation,additions of Manasa Dosha Chikitsa are more beneficial 165. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 75
  • 89. Kapha vilayana Chikitsa: Tenacious sputum is most distressing to the patients of Tamaka Swasa. Hereexhausting bouts of paroxysmal cough, fail to bring out rubbery sputum. In such patients,typical sound of productive cough is diagnostic. Liquefaction of the sputum by oraladministration of specific medicines brings more comfort to the patients 166.Srotomardavakara Chikitsa: Stiffness, constriction or to say spasm is responsible for the breathlessness and themusical sounds in patients of Tamaka Swasa. Charaka has advised SrotomardavakaraChikitsa to relieve the detrimental effect of Vata Dosha 167.Kaphanissaraka Chikitsa: Effective removal of Sleshma secreted in the Pranavaha Srotas forms the principaltreatment of Tamaka Swasa. Symptomatic approach with expectorant treatment is desiredwhen the mucoid sputum is disturbing 168.Kasa Laksanika Chikitsa: Exhausting dry cough is observed in most of the patients of Tamaka Swasa. Here, therespiratory tract secretions are minimal but the irritation in the throat is most disturbing. It istrue that bouts of irritant cough leads to worsening of breathlessness. In these conditions,Kasaghna Chikitsa minimizes the suffering of breathlessness, thus improving the totalefficiency of the treatment 169.Brimhana and Rasayana Chikitsa The difference in response to atmospheric changes in a normal person, in contrast topatients of Tamaka Swasa, where in atmospheric changes reflects as disease in patients issaid to be due to Khavaigunyata, an abnormality of the Pranavaha Srotas. This can be Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 76
  • 90. rectified by Vyadhihara Rasayana. This Rasayana treatment is much helpful to reduce thefurther attacks of Asthma. Also, in due course, improves the defense mechanism ofPranavaha Srotas, reduces the tendency of abnormal reaction to simple factors in thesurrounding. Further, in the long run, this disease causes emaciation of the body. This can becorrected by the Brimhana Chikitsa. This adds to the benefit 170. To sum up, sequential administration of Abhyanga and Swedana over the chest, dietincreasing the tendency of Kapha to get eliminated, Vamana, Dhoomapana followed byShamana Chikitsa is the sheet anchor of treatment of Tamaka Swasa during an episode.Virechana followed by Vyadhihara Rasayana and Brimhana Chikitsa forms the idealtreatment in between the attack. These procedures are very much efficacious in remitting thesymptoms as well as preventing the attack of Tamaka Swasa. Vatahara Chikitsa, KaphaharaChikitsa, Pratishyayahara Chikitsa, Kasaroga Chikitsa, Manasa Dosha Chikitsa,Kaphavilayana Chikitsa, Kaphanissaraka Chikitsa, Srotomardavakara Chikitsa, andKasaghna Chikitsa are the principles of Shamana treatment.Pathya – Apathya in Tamaka Swasa A number of predisposing factors initiate an attack of Tamaka Swasa or may worsenthe episode, if the patients are already in the symptomatic phase. As discussed earlier, in apatient who has reduced immune mechanism of the Pranavaha Srotas, which is described asKhavaigunyata or Asathmyata, exacerbation or else initiation of an attack of the Swasa, islikely. Hence, understanding of Pathya as well as Apathya gains importance both inpreventing as well as planning the treatment. Mainly the factors that influence the balance ofVata and Kapha Dosha are either Pathya or Apathya as per their role in pacifying or else Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 77
  • 91. aggravating these Doshas respectively. Following table depicts the list of Pathya andApathya factors in Tamaka Swasa. Table No.5 Showing Pathya in Tamaka Swasa Pathya Ahara C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175Shaali Dhanya Purana Shali + - - + + Tandula - - - + +Vrihi Dhanya Shashtika + - + + +Shooka Dhanya Yava + - + + + Godhuma + - + + +Shimbi Mudga + - + - - Kulatha - - + + +Shakha Varga Guduchi + - - + + Patola - - - + + Vartaka - - + + + Rasona - - - + + Bimbi - - - + + Vastuka - - - - + Moolaka + - + - + Potaki - - - - + Shigru + - - - - Kasamarda + - - - -Mamsa Varga Janghala - - - + + Shasha - - - + + Titira - - - + + Bhuka - - - + + Lava - - - + + Dhanva - - - + + Shuka - - - + + Mruga Dwija - - - + +Phala Varga Jambira - - - + + Draksha + + - + + Mathulunga + + + - + Amalaka + + + - - Bilwa + + + - -Madhya Varga Sura - + - + + Varuni - - + - -Madhu Varga Madhu + + + + +Mootra Varga Gomutra - - - - +Dugdha Varga Aja Kshira - - - + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 78
  • 92. C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175Ghrita Varga Purana sarpi - + - + + Ajasarpi - - - + +Krtanna Varga Yusha + - + - - Yavagu + - - - - Peya + - + - - Sathu - - + - - Varuni - - + - -Pathya Vihara Virechana + - - + + Swedana + - - + + Dhoomapana + - - + + Prachardana - - - + + Swapanam - - - + + Diva Table No.6 Showing Apathya Aahara in Tamaka Swasa Apathya C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175Shimbi Nishpava + - - + -Dhanya Masha + - - + - Thila + - - - - Sarshapa - - - + +Shaaka Kanda - - - + +VargaMamsa Jalaja + - - - -Varga Anupa + - - - + Pishita + - - - - Matsya - - - + +Dadhi Dadhi + - - - -VargaKshira Kshira + - - + +Varga Mahisha Kshira + - - - -Grita Mahisha Gritha - - - + +VargaKrtanna Tailabhrsta - - - - +Varga Nishpava Pistanna + - - - - Pinyaka + - - - - Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 79
  • 93. Table No.7 Showing Apathya Vihara in Tamaka Swasa C .S.171 S .S. 172 A .H. 173 Y.R. 174 B.R. 175 Sheeta Snana + + + - - Raja + + + + + Dhooma + + + + + Anila + + + + + Vyayama Karma + + - - - Bhara - + - - + Adhwa - + - - + Vegaghata - + - - - Apatharpana + + - - - Rakta srava - - - - - Pragvata - - - - - Marmaghata + - + + + Sooryatapa - - - - + Daurbalya + - - - - Aanaha + - - - - Abhighata - + - - - Strigamana - + - - - Vegavarodha- - + - - - Mootra, Udgara, Chardi, Trushna, Kasa In a nut shell, the factors that help in maintenance of normalcy of Vata Dosha andKapha Dosha, both during the symptomatic and asymptomatic period are considered asPathya. Added to this, the factors that favour the normal physiological functioning ofPranavaha Srotas, is popularly known by the name Pathya. In contrast to this, the factorseither related to food or behavior that can affect the balance of the Vata and Kapha Doshasare regarded as Apathya. Any factor that has detrimental effect on the Pranavaha Srotas islisted as Apathya. Strict observation of the Pathya and Apathya prevents an episode of theillness in patients who are asymptomatic. Likewise, Pathya and Apathya have great influencein modifying the severity of the illness during the acute attack of breathlessness. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 80
  • 94. Figure - 9
  • 95. Drug Review The pharmaco dynamics and kinetics of the individual herbs of composition“Ardhedashemaniya Swasaharavati” is very efficacious result in hypothesis are studiedfrom various contexts of textual references from different Samhita of Ayurveda andreviewed to found with its relevance to the present day study 176Trial Drugs composition 177, 178, 179, 180 The combination will be equal parts of Ardhedashemaniya Swasaharavati is asfollows. 1. Shati : Hedychium spicatum 2. Pushkaramool : Inula recemosa 3. Amlavetas : Garcinia pedunculata 4. Tulasi : Ocimum sanctum 5. Bhumyamalaki : Phyllanthus urinaria All the herbs will be identified and collected from local area. GoodManufacturing Practice will be followed for preparation of vati. The individual details ofthe composition are as under.1) Shati (Hedychium spicatum – Zingiberaceae)Description: Woodland, Sunny Edge, By Walls, By South Wall, By West Wall, Forest 181clearings, shrubberies, 1800 - 2800 meters , Perennial growing to 1.5m by 0.7m. It ishardy to zone 8 and is frost tender. It is in flower in October. The scented flowers arehermaphrodite (have both male and female organs). We rate it 1 out of 5 for usefulness. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 81
  • 96. The plant prefers light (sandy), medium (loamy) and heavy (clay) soils. The plant prefersacid, neutral and basic (alkaline) soils. It cannot grow in the shade. It requires moist soil.Actions & Uses: Carminative; Digestive; Emmenagogue; Expectorant; Stimulant;Stomachic; Tonic; Vasodilator. The rootstock is carminative, emmenagogue, expectorant,stimulant, stomachic and tonic. It is useful in the treatment of liver complaints, and is also 182used in treating vomiting, diarrhoea, inflammation, pains and snake bite and a wide 183.range of references and details of research into the plants chemistry It is digestive,stomachic and vasodilator. It is used in the treatment of indigestion and poor circulation 184.due to thickening of the blood The rootstock yields 4% essential oil. This oil, whichhas a scent somewhat like hyacinths, is so powerful that a single drop will render clotheshighly perfumed for a considerable period. The dried root is burnt as incense and notable 185anti histamine activity . Rhizomes possess anti-inflammatory and analgesic activity.The anti-inflammatory activity was localised mainly in the hexane fraction from whichone of the pure active constituents, hedychenone has been isolated. The analgesic activitywas more prominent in the benzene fraction. Some other minor active constituents arealso present which may contribute to the total activity of the rhizomes.2) Pushkarmoola (Inula racemosa - Compositae family)Part used: Roots, Root powderDescription: Pushkaramoola grows in the hilly regions in the northwestern Himalayas.The plant is a stout herb about 150 cms tall. It bears a large inflorescence in a racemosearrangement. The stem is grooved and very hairy. Leaves are elliptical, large (46 cms)and have long petioles. The fruits are 4 mm long and bearded with long hairs. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 82
  • 97. Chemical constituents: On extraction of the plant with hexane and isolation, thecompounds obtained are dihydroisoalantolactone, isoalantolac-tone and alantolactone 186.Alantolacton, Isoalantolactone, Dihydroalantolactone, Dihydroisoalantolactone, Betasitosterol, Daucosterol, Inunolide are found in Pushkarmoola.Actions & Uses: The extract showed potent, anti-inflammatory, antipyretic andantispasmodic effect against bronchial spasm induced by histamine,5-hydroxytryptamine,and various plant pollens Zea mays, Helioptelia & and Acacia Arabica 187. The essential oil of 1 racemosa was tested for antibacterial and anti- fungalactivity. It is moderately effective against S. aureus, Ps aeruginosa, B.subtillis, mildly 188against E. coli and B. anthracis . Alantolactone and isoalantolactone exhibitedantidermatophytic activity. Antifungal activity of these two compounds against two ring-worm fungi was comparable to that of Nystatin but inferior to that of Amphotericin B 189. In Ayurvedic practice, it is mainly used as an expectorant and bronchodilator. Ithas been used in the treatment of tuberculosis and topically in the treatment of skindiseases 190. It is used for cardiovascular system, angina, and dyspnoea. Animals given Inula had smaller increases in SGOT, LDH, CPK, CAMP, cortisol, 191pyruvate, lactate, and glucose than those in an untreated control group . 200 patientswith ischemic heart disease were used in the trial. Twenty-five percent of the subjects hadno chest pain, and patients experiencing dyspnea fell from 80 percent at the beginning of 192the study to 32 percent . In another trial, all subjects had improvement in ST-segmentdepression on ECG. However, the improvement was greater for those who were givenPushkaramoola 193. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 83
  • 98. 3) Amlavetasa 194 (Garcinia pedunculata - Roxburgh) Indian RhubarbDescription: Yields a yellow fruit having an acidulous taste and it is 20 meters height,leaves 15-30 cms in length, androcium is bigger than gynaeciumChemical constituents: Anthraquinone derivatives such as chrysophanic acid(=chrysophanol), emodin, aloe-emodin, rhein & physcion, with their O-glycosides suchas glucorhein, chrysophanein, glucoemodin; sennosides A-E, reidin C & others. Tannins;Action and Uses: Amlavetas is stomachic, bitter, tonic, cathartic. Purgative, alterative,hemostatic, antipyretic, anthelmintic, stomachic, bitter tonic, cathartic, laxative, atonicindigestion Constipation (with fevers, ulcers, infections), diarrhea, Pitta dysentery,jaundice, liver disorders. Rhubarb Root has a purgative action for use in the treatment ofconstipation, but also has an astringent effect following this. It therefore has a trulycleansing action upon the gut, removing debris and then astringing with antisepticproperties as well.4) Tulasi (Ocimum Sanctum – Labiatae) BasilParts Used: Leaf, Herb, PanchangaChemical constituents: Volatile oils (up to 28 percent methyl cinnamate)Description: An annual plant found wild in the tropical and subtropical regions of theworld. The bushy stem grows to 1 to 2 feet high. The toothed leaves are often purplishhued. The flowers vary in color from white to red, sometimes with a tinge of purple,appear from June to September. The plant emits a spicy scent when bruised.Actions and Uses: Antispasmodic, appetizer, carminative, galactagogue, stomachic,demulcent and expectorant along with anti viral property. The tea made from the leavesof the basil plant is used for nausea, gas pains, and dysentery. Tea made with basil and Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 84
  • 99. peppercorns is a folk remedy to reduce fever. Basil is antispasmodic, appetizer,carminative, galactagogue, and stomachic. Basil is vary useful for ailments affectingstomach and the related organs. It is used for stomach cramps, gastric catarrh, vomiting,intestinal catarrh, constipation, and enteritis. It had been sometimes used for whoopingcough as an antispasmodic. It is Antibacterial, antiseptic, antispasmodic, diaphoretic,febrifuge, nervine. Used in Coughs, colds, fevers, headaches, lung problems, abdominaldistention, absorption, arthritis, colon (air excess), memory, nasal congestion, nervetissue strengthening, purifies the air; sinus congestion, clears the lungs, heart tonic; itfrees ozone from suns rays and oxygenates the body, cleanses and clears the brain andnerves; relieves depression and the effects of poisons; difficult urination, prevents theaccumulation of fat in the body (especially for women after menopause), obstinate skindiseases, arthritis, rheumatism, first stages of many .cancers, builds the immune system.Tulsi contains trace mineral copper (organic form), needed to absorb iron.5) Bhumyamalaki (Phyllanthus niruri)Parts Used: Leaves, root, whole plantDescription: Bhumyamalaki is a perennial herb found in Central and Southern India, toSri Lanka. It can grow to 12-24 inches in height and blooms with many yellow flowers.All parts of the plant are employed therapeutically.Chemical constituents: Phyllanthus primarily contains lignans (e.g., phyllanthine andhypophyllanthine), alkaloids, and bioflavonoids (e.g., quercetin). While it remainsunknown as to which of these ingredients has an anti-viral effect, research shows that thisherb acts primarily on the liver. This action in the liver confirms its historical use as aremedy for jaundice. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 85
  • 100. Actions and Uses: Bhumyamalaki is having various actions based on the properties. Allthe parts are used in different disorders. Used as Kapha Pitta Shamaka Vatakrit, it isYakrit uttejaka, Deepana, Pachana, Anulomana, Ruchikaraka, Balya, Puranatisara hara.,Rakta shodhaka, Sthambhaka, Pandu Rakta Pitta hara Atiraktasravahara., Swasaghna,Kshaya roga hara., Mutrala., Putradayaka, Garbhasaya shodhahara., Vishama jwaraghna,Niyatakalika Jwara Pratibandhaka and is also Vishahara, Nidrakaraka, Kshathapaha,Netra roga hara.Preparation of the Ardhedashemaniya Swasaharavati All the drugs of this vati are well identified with the help of taxonomist anddravya guna experts. The alaphashuska drugs are taken, than processed in to churna formand messed into the fine cloth (vastragalitha). It is well documented that bhavansincreases the potency of the drugs, the effect of the kwathas also superimposed over thecomposition. The kwatha is prepared from these drugs only. And three bhavanas wasgiven. Then it is made in the form of vati weighing about 500mg.Advantages to prepare in the form of vati 1. they are easy to carry 2. they are easy to swallow 3. patient cannot experience unpleasant taste 4. they donot require any measurement dose 5. an accurate amount of medicament and prolonged stability to medicament 6. The in compatibility of medicaments and their deterioration due to environmental factors. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 86
  • 101. Table – 8 Pharmacological properties of Ardhedashemaniya SwasaharavatiName and Part used Gana Rasa Guna Veerya Vipaka Doshagnat DoseLatin name ha in gmShati Kanda Swasahara, Katu, Tikta, Laghu, Ushna Katu Kapha 1-3(hedychim spicatum) hikkahara kasaya tikshna Vata haraPushkara moola Moola Swasahara Tikta, katu Laghu, Ushna Katu Kapha 1-3(inula recemosa) tikshna VataAmlavetasa Phala Swasa hara Amla Laghu, Ushna Amla Kapha 1-3(garcinenia ,deepaneya, ruksha, Vatapedenculata) hrudya tikshnaTulasi Patra, pushpa, Swasa hara Katu, Tikta Laghu, Ushna Katu Kapha 1-3(ocimum sanctum) beja, moola ruksha VataBhumyamalaki Panchanga Swasa hara, Tikta, Laghu, Seeta Madhura Kapha 3-6(phyllantus niruri) kasa hara kasaya, ruksha pita madhura Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Literary review 87
  • 102. Chapter – 4 Methods The clinical study is based on the classical explanations with scientific welldesigned research protocols, which enumerates the patient before to administrate the trialdrug to after effects in comparison.Criteria for selecting drugs 1. The above mentioned drugs, which are taken from the Dashemaniya Swasa hara gana of Charaka Samhita. 2. The pharmacological actions of the individual drugs are swasahara, hikka nigraha, kasaharas which are mentioned in different gana/varga 3. The trial drug, Ardhedashemaniya Swasaharavati is selected according to the pharmacological action and properties of individual drugs. 4. Ardhedashemaniya Swasaharavati is purely herbal, they are cheaper and easily available as in the local market 5. Ardhedashemaniya Swasaharavati is very easy to process and vati making 6. Ardhedashemaniya Swasaharavati is very easy to dispense. 7. Among the ten drugs mentioned only five are selected in the study by considering the following facts – In different contexts the texts referred these group of herbs are potent All of these are considered for multi dimensional actions Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 88
  • 103. All these yields results not only to Swasa but also to the Parshwa shoola, Kasa, etc, which are associative of Tamaka Swasa The said combination is hypothetically effective in reversal of Samprapti i.e. the patho-physiological normalcy inductionCriteria for quantity of the drug All the drugs which are selected and taken from Dasheminiya gana haspharmacological action against Swasa with therapeutic effects which are the equitant so itis considered to under take in equal quantity of the Ardhedashemaniya Swasaharavatiingredients.Methods followed in trail1) Method of Research design The trail is an observational clinical study. In this Patients were taken inrandomized selection.2) Posology of Trial drug 195 3 gm/day in divided dose or 6 vati per day in divided dose – flexible accrogabala3) Anupana of Trial drug Hot water because it is pathya 196 for Tamaka Swasa4) Study duration of Trial drug Ardhedashemaniya Swasaharavati observational clinical trial study was conductedfor 30 days. The medicine was dispensed for 15 days to all patients and advised to reportfor every 15 days interval, asked to note the nature, frequency and other symptoms of theirdisease and noted during their visits. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 89
  • 104. 5) Follow up of Trial drug Ardhedashemaniya Swasaharavati trail offered a further follow up 15 days wasdone. The effect of yoga was analyzed according to clinical and functional response beforeand after the treatment with 15 days intervals is compared to that of follow up data. Infurther the final declaration of the trail drug effect and result is done on the basis of thefollow up data.6) Source of data of Trial drug The data was collected from the patients suffering from Tamaka Swasa in the OPDof post graduation and research center DGM Ayurvedic medical college Gadag. Themethod of the present study consists of following headings. a) selection of the patient b) examination of the patient c) criteria of assessmenta) Selection of the patient Patients of Tamaka Swasa (bronchial asthma) fulfilling the criteria of diagnosiswere selected in the present study. Patients were distributed randomly for the study, basedon present inclusion and exclusion criteria. Patients were excluded, as they arediscontinuous at the treatment or unable to fulfill the study design. i) Inclusion criteria Patients with symptoms of Tamaka Swasa are included with classical symptoms enumerated at the classical texts under the lime light of contemporary medical context. The symptoms of inclusion are as under. Teevra vega Swasa (Dyspnoea) Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 90
  • 105. Kasa (cough) Duhkhena Kapha nissaranam (Expectoration) Ghurghuratwam (Wheezing) Peenasa (Coryza) Kruchrena bhasate (Dysphonoea) Kantodhwamsham (Hoarseness of voice) Greevashirasangraha (Headache & Stiffness) Urah Peeda (Chest Pain) Shayane Swasa peedita (Discomfort at supine)ii) Exclusion criteria Patients other than exclusion criteria are included in the study ofArdhedashemaniya Swasaharavati trail. The specified exclusions are as under withtheir causes. i. Patients with infective disease and status asthmatics cases are excluded – as the superseded infection hampers the study and misleads. ii. Patients with other systemic disease and status asthmatics cases are excluded - as the drug effect could not be assessed specifically relevant symptoms and possible misleads are suggestive of exclusion. iii. Patients below 15 years are excluded from the study – as the children are exposed recurrently to the dust at play and not possible to under take response as they are subjected for growth. iv. Patients above 65 years are excluded from the study – these elderly are subjected for degeneration thus excluded from study. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 91
  • 106. v. Patients undertaking medication – intervenes the effect of the trail drug, so such additive medications are prohibited in the study. vi. Pregnant and lactating women are also excluded from the study – as the placental barrier components may be there in the compound which may harmful, even though Ayurvedic herbals are safe in this part as a routine Pregnant and lactating women are excluded from the study.b) Examination of the patient Patient through examination is necessary to obtain clear picture of disease and alsothe effect of trail drug - Ardhedashemaniya Swasaharavati. For that the following methodsare obtained in the study.b-1) Physical signs of asthmatic patients – A. During attack – 197 i. On Inspection – Accessory muscles e.g. sternomastoid, scalenus and pectorals are in continual action to aid breathing. Barrel shape chest is common with prolonged expiration Jugular vein is distended With each short breath there is marked sucking in of “supra clavicular hallows”. The lips, cheeks and nail beds and later the skin as a whole becomes cyanosed in severe conditions ii. On palpation – Expansion of chest diminished. Vocal frematus diminished. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 92
  • 107. iii. On percussion – Note the hyper resonant, especially after many attacks, emphysema also supervenes. iv. On auscultation – The inspiratory effort is shortened and may hardly be audible. Expiration prolonged with rapid inspiration High – pitched musical rhonchi with prolonged expiration replaces the normal vesicular murmurs. Expiration phase is unduly prolonged and wheezy In severe asthma airflow may be insufficient to produce rhonchi and a silent chest is an ominous (arishta) sign B. Between attacks – There are usually no physical signs between attacks except in patients with chronicasthma, who are seldom without rhonchi. Prolonged asthma in elder may be complicatedwith emphysema, but severe asthma starting in childhood usually causes ‘pigeon chest’deformity.b-2) Diagnosis measurements The signs and symptoms of Tamaka Swasa mentioned in Ayurveda and modernscience were the main basis of diagnosis and criteria for assessing the response to thetreatment. Assessments of results were made according to clinical and functionalimprovement observed in the study. Clinical assessment was made on the body change inthe severity of the symptoms and for clinical assessment symptoms viz. Swasakricchata,kasa, dukhena kapha nissaranam, ghurguratwam, Uraha peeda and shayaneswasapeedit, Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 93
  • 108. which are allotted grades according to their severity or to that of normalcy. The grades arefollowed as under.Swasa kricchrata 0 – Normal - no symptoms 1 – Mild – breathless with activity, frequency 1 to 2 times/week 2 – Moderate – breathless with talking, frequency 2 to 4 times/week 3 – Severe – breathless at rest, frequency 4 to 6 times/week, limited activityKasa 0 – Normal - no cough 1 – Mild - morning bouts or after exercise - don’t disturb work 2 – Moderate - continuous cough during day and morning disturbing work 3 – Severe - continuous and night cough disturb activitiesdukhen kapha 0 – Normal - no phlegmnissaranu 1 – Mild - less than 2.5 ml/day without pain 2 – Moderate - 2.5 ml to 15 ml/day with mild pain 3 – Severe - 15 to 25 ml/day with painGhurghurtwam 0 – Normal - no wheezing 1 – Mild - moderate wheezing at mid to end respiration, brief, not more than 1 to 2 times/week 2 – Moderate - loud wheeze through out expiration, not more than 2 to 4 times/week 3 – Severe - loud inspiration and expiration wheeze, more than 4 to 6 times/weekPeenasa 0 – Normal - no common cold & cough 1 – Mild - initially present or occasionally 2 – Moderate - continuous day with cough 3 – Severe - continuous day and nightKrucchana 0 – Normal - difficult to speakbhasate 1 – Mild - able to speak in sentences 2 – Moderate - able to speak in phrases 3 – Severe - able to speak in wordsKantodwamsa 0 – Normal - no hoarseness of voice 1 – Mild - 0 or 1 bout while speaking sentence 2 – Moderate - 1 or 2 bout while speaking phrase 3 – Severe - associated with words and phraseGreeva shira 0 – Normal – no symptomssamgrah 1 – Mild - occasionally 2 – Moderate - 1 to 2 times in a week. 3 – Severe - 2 to 4 times or oftenUraha peeda 0 – Normal - no chest tightness 1 – Mild - able to tolerate the tight or pain 2 – Moderate - Persists during cough + mild differs 3 – Severe - feels difficulty to tolerate pain and tightness Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 94
  • 109. Shayanasy 0 – Normal – no discomfortSwasa peedita 1 – Mild - < 1 or 2 time/month 2 – Moderate - 2 time/week 3 – Severe - > 3 or frequently Functional assessments like Peak Expiratory Flow Rate, Breath Holding Time areconsidered in the study along with Absolute Eosinophilic Count to know the effect oftherapy on Eosinophilic activity in the study. The functional units of these parameters aretaken to consideration according to their normal values.Grade 0 No symptoms of Swasa - AsthmaGrade 1 Mild – the patients of mild asthma are defined as those with one or more of the following – Brief wheezing no more often than 1 – times/week Exacerabations of cough Breathless with activity Infrequent nocturnal cough Nocturnal asthma < 1-2times/month PEER> 80% of base line data (when asymptomatic) predicted variability < 20%Grade 2 Moderate asthma – Symptoms 1-2 times/week exacerbation that may as 1-several days occasional emergency care PEER 60-80% of base line 20-30% variabilityGrade 3 Severe asthma Daily wheezing limited activity level exacerbations that are often severe frequent nocturnal symptoms hospitalization 1 or 2 times/1 year or emergency PEER < 60% of base line/predicted variability >30% The Swasa vis-à-vis bronchial asthma can be defined as mild, moderate and severebased on the disease symptoms. This enables the clinician to put the disease in a specifiedcategory for the overall assessment of asthma patient. As the severity of bronchial asthma, 198defined by the national asthma education program (NAEP) expert panels of 1991 is as Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 95
  • 110. below mentioned is considered in the present study. The characteristics are generalized andas the asthma is highly variable with these characters may overlap some times.b-3) Assessment measures and Laboratory-investigations The following investigations are under taken to fulfill the criteria of inclusions andexclusions. The effective parameters which are considered for the assessment are as under.a) Breath holding time (BHT) Breath holding time (BHT) 199 is a simple test which can provide useful informationin health and disease of the lungs. Breath in can be held for variable period of time bydifferent individuals depending upon the functional states of lungs development ofrespiratory muscles practice, age, and sex. The normal BHT after deep inspiration mayvary from 40 seconds to over a minute. The BHT decreases in many diseases such aschronic bronchitis emphysema, asthma, etc.Procedure: Ask the patient to take a deep breath and count the time in secondsb) Peak expiratory flow rate 200 In any lung disease such as asthma patients, PEFR values are decreased. ThisPEFR measurement has many benefits in clinical medicine. It provides simple,quantitative and reproducible measures of airway obstruction. PEFR has a very goodcorrelation with FEVI. This simple objective measurement of lung function helps detectingearly deterioration of lung function. Measurement of PEFR is valuable in medical care settings to, asses the severity ofasthma as a basis for making treatment decisions, for increasing or decreasing themedicaments. It monitors response to therapy during an acute exacerbation. With this we Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 96
  • 111. can diagnose exercise induced asthma. To asses the overall success of ant therapyconcerned to lung function, the PEFR is more useful. The Wright’s peak flow meter, introduced in 1959 is a simple, portable device usedfor measuring the ventilatory function of lungs. This instrument measures the maximumflow rate or peak flow rate, which is achieved during a single forced expiration. Thisestimation is useful in distinguishing reversible (asthma) from irreversible (emphysema)disease. The peak flow meter, which measures PEER is of special value cases of asthmawhere the effectiveness of the treatment with bronchodilatory can be quickly evaluated.Procedure Step 1) ask patient to hold the PEFR in position Step 2) let the patient take a deep breath in Step 3) patient keep the PEFR instrument in the mouth with out any leakage of air from sides in to the flow meter with a sharp blast Step 4) the movement of the needle on the dial indicates the PEER in liters/minute, which is to be noted Taken 3 readings at one minute intervals and recorded the average of higherreadings brought to the needle back to zero by pressing the button located near the mouthpiece normal. Range of PEFR is 350-500liters/minute.c) Erythrocytes sedimentation rate 201 Erythrocytes sedimentation rate is measures in the graduated tubes underWestergren’s method (pipette method). This facilitates to understand possible presence oforganic disease or to follow the course of the disease. It is universally accepted that it is agood prognostic method in clinical laboratory. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 97
  • 112. Procedure: Steps 1) draw the sufficient blood sample from patient vein Step 2) add anti coagulant to the blood Steps 3) suck the blood in to the ESR tube Step 4) note the point of sedimentation on graduated tubed) Hemoglobin % 202 The hemoglobin content of whole blood is reported in terms of grams of Hb per 100ml of whole blood (g/dl). Normal ranges are 14-18 g/dl in males and 12-16 g/dl in females.Hemoglobin is responsible for the cells ability to transport oxygen and carbon dioxide.This is estimated with the Shali’s method in general, which will show the Hb% in grams/dl.e) Absolute Eosinophilic count 203 Eosinophils attack objects that have already been coated with antibodies. They arephagocytic cells and will engulf antibody-marked bacteria, protozoa, or cellular debris.However, their primary mode of attack involves the exocytosis of toxic compounds,including nitric oxide and cytotoxic enzymes, onto the surface of their targets. Eosinophilsare important in the defense against large multicellular parasites, such as flukes or parasiticworms, and they increase in number dramatically during a parasitic infection. Because theyare also sensitive to circulating allergens (materials that trigger allergies), eosinophilsincrease in number during allergic reactions as well. Eosinophils are also attracted to sitesof injury, where they release enzymes that reduce the degree of inflammation and controlits spread to adjacent tissues. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 98
  • 113. This test is being done to all the patients before and after the treatment. To study theeffect of Ardhedashemaniya Swasaharavati on Eosinophils, considering normal range ofEosinophils in peripheral blood as up to 250 cells, the AEC examination is performed. The following are investigations were done prior to the study according to the needeither to make an exclusion or inclusion in to the study, which are commonly undertakenfor the lung disease. a) Blood TC & DC b) Radiological X-ray of chest (if necessary) and c) Sputum examination (if necessary)c) Criteria of assessment Over all assessment of results are done considering the cumulative subjective and objective parameters assessments. As the disease is not totally curable in the scheduled time span of the study, the grades of assessment made for the results declaration are as follows - 1. Not responded – i. Patient not at all relieved with symptoms or ii. PEER was not shown any improvement iii. BHT not improved iv. AEC not shown any significant reduction v. not responded to the treatment by any means 2. Poor responded – i. Incomplete Symptomatic relief for the patient, ii. PEFR ≥ 150 L/min Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods 99
  • 114. iii. BHT > 10 sec iv. AEC reduced but not in normal limits3. Moderately responded – i. Symptomatic relief for the patient is witnessed ii. Relived with symptoms, while medicine is continued iii. Shown PEFR improvements with the PEER ≥ 250 to 350 L/ min iv. BHT ≥ 20 sec v. AEC comes back in to normal limits vi. Moderate symptoms within follow up schedule4. Well responded i. Patient relieved with symptoms after discontinuous of medicine even in follow up schedule ii. No further attacks reported even after exposure to aggravating factors iii. Peak expiratory flow rate shows ≥ 350 L/min iv. BHT comes to normal limits i.e. 40 sec v. AEC reduces to normal limits Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa – Methods100
  • 115. CHAPTER-5 RESULTS Present study registers 65 patients, out of 135 approached patients. Thepercentages of patients undertaken from the scrutinised are 48.14%. Out 135 patients, 67(49.62%) were Tamaka Swasa patients and the rest of 68 (50.38%) patients were havingrespiratory tract problem but not a condition of Tamaka Swasa. Out of the 67 patients ofTamaka Swasa 65 (97.01%) patients were undertaken for the study. Out of 65 patients 15(23.07%) patients were discontinued hence their data has not been included in theassessment. The remaining 50 (76.93%) patients of Tamaka Swasa viz. BronchialAsthma, fulfilling the criteria of diagnosis and inclusive criteria were included in thestudy. Peak Expiratory Flow Rate (PEFR) and Breath Holding Time (BHT) areconsidered as an objective for the inclusion in the present study. All the patients were examined before and after the trail, according to the casesheet format given in the annex. Both the subjective and objective criteria were recorded.The data recorded are presented under the following headings. A. Demographic data B. Evaluating disease Data C. Result of the Ardhedashemaniya Swasaharavati in Tamaka Swasa and D. Statistical analysis of the subjective (clinical) and objective parametersA) Demographic data: The details of Age, Gender, Religion, and Occupation etc. of the 50 patients are asfollows. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results101
  • 116. Table – 9 Demographic DataSN OPD Age Gender Religion Occupation Economical Food habits Result status1 5154 32 M Hindu Active High middle Mixed Diet WR2 5285 38 F Hindu Sedentary High middle Vegetarian WR3 5395 55 M Hindu Active Middle Vegetarian MR4 5402 48 F Hindu Active High middle Mixed Diet WR5 5541 50 M Muslim Labor Poor Mixed Diet WR6 5642 34 M Hindu Sedentary High middle Vegetarian WR7 5648 24 F Hindu Active High middle Vegetarian WR8 18 53 F Muslim Active Middle Mixed Diet NR9 45 50 M Hindu Active Middle Vegetarian MR10 63 18 F Hindu Labor Poor Mixed Diet MR11 201 58 M Hindu Active Middle Mixed Diet WR12 812 55 F Hindu Active Middle Vegetarian PR13 527 27 M Hindu Active High middle Mixed Diet WR14 530 22 M Hindu Active High middle Vegetarian WR15 562 53 F Hindu Active Middle Vegetarian NR16 566 33 M Hindu Active High middle Vegetarian WR17 572 23 M Hindu Labor Poor Vegetarian WR18 605 50 M Hindu Active Middle Vegetarian MR19 606 50 M Hindu Sedentary High middle Mixed Diet NR20 611 24 M Hindu Active Middle Mixed Diet WR21 624 60 M Hindu Active Middle Vegetarian PR22 626 35 M Hindu Labor Middle Mixed Diet WR23 676 24 M Hindu Active High middle Mixed Diet MR24 677 45 M Hindu Active Middle Vegetarian PR25 681 19 M Hindu Active High middle Vegetarian WR26 748 42 F Hindu Active High middle Mixed Diet WR27 749 45 M Hindu Active Middle Vegetarian WR28 774 21 F Hindu Active High middle Vegetarian WR29 775 50 F Hindu Sedentary High middle Vegetarian MR30 955 50 M Hindu Active Middle Vegetarian PR31 994 22 M Hindu Active Middle Mixed Diet WR32 995 24 F Hindu Active Middle Vegetarian WR33 1001 15 F Hindu Active High middle Vegetarian WR34 1497 48 F Hindu Active Middle Vegetarian PR35 1498 51 F Hindu Active Middle Vegetarian MR36 2210 50 F Hindu Active Middle Vegetarian PR37 2310 45 M Hindu Active Middle Vegetarian WR Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results102
  • 117. 38 2283 45 M Muslim Labor Poor Mixed Diet WR39 2332 40 M Hindu Active Middle Mixed Diet WR40 2333 45 F Muslim Labor Poor Mixed Diet MR41 2334 38 M Hindu Active Middle Vegetarian WR42 2381 39 F Hindu Active High middle Vegetarian MR43 2380 26 M Hindu Active Middle Mixed Diet WR44 2398 50 F Hindu Labor Poor Mixed Diet PR45 2399 55 M Hindu Labor Poor Mixed Diet MR46 2433 47 M Hindu Active Middle Vegetarian MR47 2481 56 M Hindu Active High middle Vegetarian NR48 2493 46 F Hindu Labor Poor Vegetarian WR49 2494 52 M Hindu Active Middle Vegetarian NR50 2541 52 M Hindu Labor Poor Vegetarian WR F = Female, M = Male, WR = Well Responded, MR = Moderately Responded, PR = Poor Responded, NR = Not Respond,A1) distribution of patients by AgeAge – gender distributions Observation and Results: An interval of 10 has considered from the ages 15 to 65 as discussed in themethods. In the study it is revealed that Tamaka Swasa is continued from the ages of 15onwards and as the age advances the samples are settled with Tamaka Swasa. At theolder age group of 55-65 only 3 (6%) patients are reported. Where in 45-55 and 35-45age groups reported with 20 (40%) and 10 (20%) patients in each group respectively. 15-25 age group reported with the 11 (22%) patients with the symptoms of Tamaka Swasavis-à-vis Asthma. It is interested to note that the active age group patients of 25-35 agegroups reported only 6 (12%) patients. The tabulations are depicted as under. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results103
  • 118. Table- 10 Distribution of patients by Age- genderAge Male patients Female patients Total patients Number % Number % Number %15 -25 6 12 5 10 11 2225- 35 6 12 0 0 6 1235 – 45 6 12 4 8 10 2045 – 55 10 20 10 20 20 4055 – 65 3 6 0 0 3 6Total 31 19 50 Graph – 10 Distribution of patients by Age – Gender DISTRIBUTION OF PATIENTS BY AGE - GENDER 0 55 – 65 3 10 45 – 55 10 4 35 – 45 6 0 25- 35 6 5 15 -25 6 0 2 4 6 8 10 15 -25 25- 35 35 – 45 45 – 55 55 – 65 Female 5 0 4 10 0 Male 6 6 6 10 3 Here in this study an attempt is made to understand the male female responses tothe management with respect to that of the age groups. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results104
  • 119. Table- 11 Result of Ardhedashemaniya Swasaharavati in trail patients by Age Total no of Responded Responded Responded Responded Moderate patientsAge Poor Well Not % % % % %15 -25 11 22 9 18 2 4 0 0 0 025- 35 6 12 6 12 0 0 0 0 0 035 – 45 10 20 7 14 2 4 1 2 0 045 – 55 20 40 4 8 7 14 5 10 4 855 – 65 3 6 1 2 0 0 1 2 1 2Total 50 100 27 54 11 22 7 14 5 10 Graph – 11 Result of Ardhedashemaniya Swasaharavati in trail patients by Age Result of Ardhedashemaniya Well Responded Swasaharavati in trail patients by Age 10 9 Moderate 9 Responded Poor Responded 8 7 7 7 Not Responded 6 6 5 5 4 4 4 3 2 2 2 1 1 11 1 0 0 0 0 00 0 0 15 -25 25- 35 35 – 45 45 – 55 55 – 65 Observations of well-responded group has 9 (18%) patients in the 15-25 interval, 6 (12%)patients in 25-35 interval, 7 (14%) patients in 35-45 interval, 4 (8%) patients in 45-55 interval andone (2%) patient in the interval of 55-65. Out of the moderately responded group it is found that 7(14%) patients out of 11 patients are from 45-55 age groups. At the category of poor responded Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results105
  • 120. out of 7 patients 5 (10%) are from the same group i.e. 45-55 age groups. The rest of thepercentages and patients results are tabulated in the table number 11. The observation of thisstudy suggests that the Tamaka Swasa effects to that of 45-55 and 15-25 ages. The pictorialrepresentation is as above.A2) Distribution of patients by Gender Table- 12 Distribution of patients by Gender in Tamaka Swasa Total no of Responded Responded Responded Responded Moderate patientsGender Poor Well Not % % % % %Male 31 62 18 36 6 12 3 6 3 6Female 19 38 9 18 5 10 4 8 2 4Total 50 100 27 54 11 22 7 14 5 10 Graph - 12 Distribution of patients by Gender in Tamaka Swasa Female Male 38.00% 62.00% Distribution of patients by Gender in Tamaka Swasa Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results106
  • 121. The male female ratio in the study is approximately 2:1 patients. The percentageof the distribution does not show any gender differentiation to get this respiratory diseasein specific, except a small lean towards male population. The observations are 31 Patientsi.e. (62%) male and 19 patients i.e. (38%) were female. Graph - 13 Result Distribution of patients by Gender in Tamaka Swasa Not Responded 2 Poor Responded 4 Female Moderate Responded 5 Well Responded 9 3 3 Male 6 18 0 5 10 15 20 Result of patients by Gender in Tamaka SwasaA3) distribution of patients by Religion For the convenience of the study, the religion groups are noted as Hindu, Muslim,Christian and Others. The maximum number of patients are noticed from the Hinducommunity as the ratio of community at the study area is more i.e. 46 (92%) along withMuslim patients 4 (8%). At the results observed, out of 46 (92%) of Hindu patients, 26(52%) patients Well responded, 9 (18%) patients moderately responded, 7 (14%) Patientsresponded poor and 4 (8%) patients not responded. On the other hand the resultsobserved at Muslim community are, out of 4 (8%), 2 patients fall under the category of Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results107
  • 122. well responded and one each in moderately responded and not responded respectively.The tabulation and graphical representation is as under. Table- 13 Distribution of patients by Religion and gender identificationReligion Male patients Female patients Total patients Number % Number % Number % Hindu 29 58 17 34 46 92 Muslim 2 4 2 4 4 8Christian 0 0 0 0 0 0 Others 0 0 0 0 0 0 Total 31 62 19 38 50 100 Graph – 14 Distribution of patients by religion in Tamaka Swasa Muslim Christian Others 0.00% 8.00% Hindu 0.00% 92.00% Distribution of patients by religion in Tamaka Swasa Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results108
  • 123. Table- 14 Result Distribution of patients by Religion Total no of Responded Responded Responded Responded Moderate patientsReligion Poor Well Not % % % % % Hindu 46 92 26 52 9 18 7 14 4 8 Muslim 4 8 2 4 1 2 0 0 1 2 Christian 0 0 0 0 0 0 0 0 0 0 Others 0 0 0 0 0 0 0 0 0 0 Total 50 100 27 54 11 22 7 14 5 10 Graph - 15 Result Distribution of patients by Religion in Tamaka Swasa 0 Others 0 0 Not Responded 0 Poor Responded 0 Moderate Responded Christian 0 0 Well Responded 0 1 Muslim 0 1 2 4 Hindu 7 9 26 0 5 10 15 20 25 30 Result Distribution of patients by Religion in Tamaka Swasa Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results109
  • 124. A4) Distribution of patients by Occupation Table- 15 Distribution of patients by occupation Total no of Responded Responded Responded Responded Moderate patientsOccupation Poor Well Not % % % % %Sedentary 4 8 2 4 1 2 0 0 1 2Active 36 72 19 38 7 14 6 12 4 8Labour 10 20 6 12 3 6 1 2 0 0Total 50 100 27 54 11 22 7 14 5 10 Graph - 16 Distribution of patients by Occupation Labour Sedentary Active 20.00% 8.00% 72.00% PATIENTS BY OCCUPATION At the results observed, out of 4 (8%) of sedentary patients, 2 (4%) patients wellresponded, 1 (2%) patient moderately responded and 1 (2%) patient not responded to thetreatment. At the active group, out of 36 (72%) patients, 19 (38%) patients wellresponded, 7 (14%) patients moderately responded, 4 (8%) patients not responded and 6 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results110
  • 125. (12%) patients poorly responded. At the results are observed, out of 10 (20%) of Labour,6 (12%) patients well responded, 3 (12%) patients moderately responded and 1 (2%)patient poorly responded to the Ardhedashemaniya Swasaharavati. The pictorialrepresentation is as follows. Graph – 17 Result of patients by occupation in Tamaka Swasa Not Responded 0 Poor Responded Labour 1 3 Moderate Responded 6 Well Responded 4 Active 6 7 19 1 Sedentary 0 1 2 0 5 10 15 20 Result of patients by occupation in Tamaka SwasaA5) Distribution of patients by economic status At the results observed, out of 9 (18%) of poor patients, 5 (10%) patients are wellresponded, 3 (6%) patients are moderately responded, 1 (2%) patient is poorly respondedand no patient is not responded. Out of 24 (48%) of Middle class patients, 10 (20%)patients are well responded, 5 (10%) patients moderately responded, 6 (12%) patientspoorly responded and 3 (6%) patients are not responded. From higher middle class 17(34%) patients reported and out of them 12 (24%) patients are well responded, 3 (6%)patients moderately responded and 2 (4%) patients are not responded. No patients are Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results111
  • 126. reported from the higher class of classification. The tabulation and pictorial graph isexpressed as here. Table- 16 Distribution of patients by Economic status Total no of Responded Responded Responded Responded Moderate patients Economic Poor Well Not % status % % % %Poor 9 18 5 10 3 6 1 2 0 0Middle 24 48 10 20 5 10 6 12 3 6Higher Middle 17 34 12 24 3 6 0 0 2 4Higher 0 0 0 0 0 0 0 0 0 0Total 50 100 27 54 11 22 7 14 5 10 Graph- 18 Result Distribution of patients by Economic status 14 12 12 10 10 8 6 6 5 5 4 3 3 3 2 2 1 0 0 0 0 0 0 0 Poor Middle Higher Middle Higher Result by economical status Patients Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results112
  • 127. A6) Distribution of patients by diet Table- 17 Distribution of patients by diet in Tamaka Swasa Total no of Responded Responded Responded Responded Moderate patientsAge Poor Well Not % % % % %Vegetarian 29 58 16 32 6 12 4 8 3 6Mixed diet 21 42 11 22 5 10 3 6 2 4Total 50 100 27 54 11 22 7 14 5 10 The vegetarian and mixed diet ratio in the study is approximately 1:1 patients.The percentage of the distribution does not show any diet differentiation to get thisrespiratory disease in specific, except a small lean towards vegetarian population. Theobservations are 29 Patients i.e. (58%) vegetarian and 21 patients i.e. (42%) were mixeddiet practitioners. Graph - 19 Distribution of patients by diet in Tamaka Swasa Vegetarian Mixed diet 58.00% 42.00% Distribution of patients by diet in Tamaka Swasa Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results113
  • 128. Graph - 20 Result Distribution of patients by diet in Tamaka Swasa Not Responded Poor Responded 2 Moderate Responded 3 Well Responded Mixed diet 5 11 3 4 Vegetarian 6 16 0 2 4 6 8 10 12 14 16 18 Result of patients by Gender in Tamaka Swasa As the results observed, out of 29 (58%) vegetarians, 16 (32%) patients wellresponse, 6 (12%) patients moderately responded, 4 (8%) patients poorly responded and 3(6%0 patients not responded to the management. As the results observed in mixed dietpopulation, out of 21 (42%), 11 (22%) patient well response, 5 (10%) patients moderatelyresponded, 3 (6%) patients poorly responded and 2 (4%) patients not responded to thetreatment.B) Data related to the disease.B1) Distribution of patients by presenting complaints As the above table explains about the different symptoms evaluated at the studyunder the heading of Tamaka Swasa vis-à-vis Bronchial Asthma with the presentingcomplaints are foot forth here. The first and fore most complaint in Tamaka Swasa isTeevra vega Swasa – Swasa Kruchrata (Dyspnonea) and Ghurghuratwam (Wheezing). Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results114
  • 129. Table- 18 Presenting complaints Patients %Teevra vega Swasa – swasa Kruchrata (Dyspnonea) 50 100Ghurghuratwam (Wheezing) 50 100Kasa (cough) 47 94Duhkhena Kapha nissaranam (Expectoration) 43 86Urah Peeda (Chest Pain) 39 78Shayane Swasa peedita (Discomfort at supine) 37 74Peenasa (Coryza) 33 66Kruchrena bhasate (Dysphonoea) 22 44Greevashirasangraha (Headache & Stiffness) 16 32Kantodhwamsham (Hoarseness of voice) 12 24 Graph – 21 Distribution of patients by presenting complaints Distribution by Presenting Complaints 60 Ghurghuratwam, Kasa (cough), 50 50 47 Shayane Swasa peedita 40 37 30 Kruchrena bhasate 22 Greeva shirasangraha 20 16 10 0 Peenasa Kanto swasa Kruchrata Duhkhena Kapha Urah Peeda 33 dhwamsham 50 nissaranam, 43 39 12 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results115
  • 130. All the patients in the study (100%) reported the above symptoms. The next mostcommon complaint is Kasa (cough) followed with Duhkhena Kapha nissaranam(Expectoration). Only 12 patients (24%) reported with the Kantodhwamsham(Hoarseness of voice). The other complaints such as Peenasa (Coryza) (33 patients –66%), Kruchrena bhasate (Dysphonoea) (22 patients – 44%), Greevashirasangraha(Headache & Stiffness) (16 patients – 32%), Urah Peeda (Chest Pain) (39 patients – 78%)and Shayane Swasa peedita (Discomfort at supine) (37 patients – 74%) are reported in thestudy. The tabulation and graphical representation is expressed above.B2) Distribution of patients by Associated features Table- 19 Presenting Associated features Patients Percentage Muhur Swasa (frequent respiration) 28 56 Anidra (disturbed sleep) 26 52 Angamarda (Malaise) 23 46 Vishukasyata (Dryness of mouth) 20 40 Aruchi (Anorexia) 18 36 Lalata sweda 16 32 Muhuchaiva dhamyati (puts all effort to breath) 15 30 Trushna (Thirst) 14 28 Jwara (fever) 8 16 Pratamyati or Bhrushamarta (distressed) 7 14 Kampa (Tremors) 5 10 Vamathu (nausea) 3 6 Pramoha (fainting) 0 0 As many as features are associated with the study Tamaka Swasa vis-à-visAsthma with the associated complaints are foot forth here. Many complaints of Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results116
  • 131. associative are not observed in the study. Muhur Swasa (frequent respiration), Anidra(disturbed sleep), Angamarda (Malaise), Vishukasyata (Dryness of mouth), Aruchi(Anorexia), Lalata sweda, Muhuchaiva dhamyati (puts all effort to breath), Trushna(Thirst), Jwara (fever), Pratamyati or Bhrushamarta (distressed), Kampa (Tremors),Vamathu (nausea) and Pramoha (fainting) are the associated listed below show theirinvolvement in the most frequently presented to the least along with the percentages. Graph –22 Distribution of patients by Associated features of Tamaka Swasa Distribution of patients by Associated features 30 Anidra 26 25 Vishukasyata 20 20 Lalata sweda, 16 Trushna 15 14 Pratamyati or 10 Bhrushamarta 7 Vamathu 5 3 0 Muhuchaiva Kampa Pramoha Muhur Swasa Angamarda Aruchi Jwara 23 18 dhamyati 5 0 28 8 15B3) Distribution of patients by mode of on set The modes of onset of the Tamaka Swasa vis-à-vis asthma results observed are asunder. Out of 38 (76%) of Gradual onset patients, 22 (44%) patients are well responded,8 (16%) patients are moderately responded and 6 (12%) patients poorly responded and 2(4%) patients are not responded. Out of 12 (24%) of sudden onset patients, 5 (10%) Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results117
  • 132. patients are well responded 3 (6%) patients are moderately responded, 1 (2%) patientspoorly responded and 3 (6%) patients not responded. Table- 20 DISTRIBUTION OF PATIENTS BY MODE OF ON SET Total no of Responded Responded Responded Responded ModerateOnset patients Poor Well Not % % % % %Gradual 38 76 22 44 8 16 6 12 2 4Sudden 12 24 5 10 3 6 1 2 3 6Total 50 100 27 54 11 22 7 14 5 10 Graph –23 Distribution of patients by Mode of on set Sudden 24.00% Gradual 76.00% PATIENTS BY MODE OF ON SET Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results118
  • 133. B4) Distribution of patients by course Table- 21 Distribution of patients by course Total no of Responded Responded Responded Responded Moderate patientscourse Poor Well Not % % % % %Episodic 30 60 20 40 7 14 2 4 1 2Continuous 11 22 4 8 1 2 3 6 3 6Initially 9 18 3 6 3 6 2 4 1 2episodicTotal 50 100 27 54 11 22 7 14 5 10 Graph – 24 Distribution of patients by course Initially episodic 18.00% Continuous Episodic 22.00% 60.00% PATIENTS BY COURSE The course distributions of the Tamaka Swasa vis-à-vis Asthma results areobserved as under. It classified under three headings as Episodic, Continuous and initially Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results119
  • 134. episodic. Out of 30 (60%) of Episodic course patients, 20 (40%) patients are wellresponded 7 (14.2%) patients are moderately responded, 2 (4%) patients are poorlyresponded and 1 (2%) patient is not responded. Out of 11 (22%) of Continuous coursepatients, 4 (8%) patients are well responded 1 (2%) patient are moderately responded, 3(6%) patients poorly responded and 3 (6%) patients not responded. Out of 9 (18%) ofinitially episodic course patients, 3 (6%) patients are well responded, 3 (6%) patients aremoderately responded, 2 (4%) patients are poorly responded and 1 (2%) patient is notresponded to the management. The graphical expression is as above.B5) Distribution of patients by frequency Table -22 Distribution of patients by frequency Total no of Responded Responded Responded Responded Moderate patientsFrequency Poor Well Not % % % % %Few Hours 14 28 4 8 2 4 5 10 3 6Few Days 27 54 15 30 8 16 2 4 2 4Few Weeks 9 18 8 16 1 2 0 0 0 0Total 50 100 27 54 11 22 7 14 5 10 The distributions of frequency are observed as much (27) patients with few daysinterval of frequency of episode. The graphical expression is as under. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results120
  • 135. Graph – 25 Depicting the frequency episodes in Tamaka Swasa Depicting the Frequency episodes in Tamaka Swasa 27 30 25 20 14 15 9 10 5 0 Few Hours Few Days Few WeeksB6) Distribution of patients by duration of attack Table -23 Distribution of patients by duration of attack Total no of Responded Responded Responded Responded Moderate patientsDuration of Poor Well Not %attack % % % %Continuous 10 20 5 10 1 2 2 4 2 4Intermittent 32 64 20 40 9 18 2 4 1 2Subsideswith 8 16 2 4 1 2 3 6 2 4medicineTotal 50 100 27 54 11 22 7 14 5 10 The distributions of duration observed in the study is as much as (32) patientswith intermittent duration of attack. The graphical expression is as under. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results121
  • 136. Graph – 26 Depicting the duration of attack in Tamaka Swasa Depicting the duration of attack in Tamaka Swasa 32 35 30 25 20 15 10 8 10 5 0 Continuous Intermittent Subsides with medicineB7) Distribution of patients by periodicity Table -24 Distribution of patients by periodicity Total no of Responded Responded Responded Responded Moderate patientsPeriodicity Poor Well Not % % % % %Seasonal 11 22 6 12 2 4 2 4 1 2Irregular 30 60 16 32 7 14 4 8 3 6Perennial 9 18 5 10 2 4 1 2 1 2Total 50 100 27 54 11 22 7 14 5 10 The distributions of duration observed in the study is as much as (30) patientswith irregular periodicity. The graphical expression is as under. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results122
  • 137. Graph – 27 Depicting the periodicity in Tamaka Swasa Depicting the periodicity in Tamaka Swasa 30 30 25 20 15 11 9 10 5 0 Seasonal Irregular PerennialB7) Distribution of patients by preceding factors Table -25 Distribution of patients by preceding factors Total no of Responded Responded Responded Responded ModeratePreceding patients Poor Well Notfactors % % % % %Cough 11 22 6 12 4 8 0 0 1 2Sneezing with 21 42 12 24 3 6 3 6 3 6coughSneezing,cough with 12 24 5 10 4 8 3 6 0 0nasal irritationNasal irritation 3 6 3 6 0 0 0 0 0 0with coughSneezing, 2 4 1 2 0 0 0 0 1 2Nasal irritationNasal irritation 1 2 0 0 0 0 1 2 0 0Total 50 100 27 54 11 22 7 14 5 10 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results123
  • 138. The distributions of duration observed in the study are as much as (21) patientswith Sneezing with cough followed with (11) patients of only cough. The graphicalexpression is as under. Graph – 28 Depicting the preceding factors in Tamaka Swasa Sneezing with cough, 21 Sneezing, cough 25 with nasal 20 irritation, Cough, 12 15 11 Nasal irritation with cough , 10 Sneezing, Nasal 3 irritation, 5 2 Nasal irritation ,1 0 Depicting the preceding factors in Tamaka SwasaB9) Distribution of patients by aggravating factors Table -26 Distribution of patients by aggravating factors Total no of Responded Responded Responded Responded ModerateAggravating patients Poor Well Notfactors % % % % %Dust 17 34 8 16 5 10 1 2 3 6Smoke 6 12 4 8 0 0 2 4 0 0Dust & smoke 27 54 15 30 6 12 4 8 2 4Total 50 100 27 54 11 22 7 14 5 10 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results124
  • 139. The distributions of duration observed in the study are as much as (27) patientswith dust and smoke followed with (17) patients of only dust. The graphical expression isas under. Graph – 29 Depicting the aggravating factors in Tamaka Swasa Dust_Smoke, 27 30 Cough, 25 11 20 Smoke, 15 6 10 5 0 Depicting the aggravating factors in Tamaka SwasaB10) Distribution of patients by comfort posture Table -27 Distribution of patients by comfort posture Total no of Responded Responded Responded Responded ModerateComfort patients Poor Well Notposture % % % % %Sitting 24 48 14 28 7 14 2 4 1 2Forward 5 10 3 6 0 0 2 4 0 0bendingSitting &Forward 21 42 10 20 4 8 3 6 4 8BendingTotal 50 100 27 54 11 22 7 14 5 10 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results125
  • 140. The distributions of duration observed in the study are as much as (24) patientsfelt comfort with sitting followed with (21) patients with Sitting and Forward Bending ofcomfort. The graphical expression is as under. Graph – 30 Depicting the comfort posture in Tamaka Swasa Sitting & Sitting, 24 Forward Forward bending, Bending, 21 25 5 20 15 10 5 0 Depicting the comfort Posture in Tamaka SwasaB11) Distribution of patients by Dosha Kshaya lakshana The Shareerika Prakruti distributions of the Tamaka Swasa vis-à-vis Asthmaobservations are as under. It classified under three headings as Vata, Pitta, Kapha, Table - 28Vata Pts % Pitta Pts % Kapha Pts %Angasada 4 8 Mandagni 23 46 Bhrama 0 0Alpabhashite Shareera Urah 0 0 32 64 0 0ahitam sheetatwam shoonyata ShiraChesta heenata 0 0 Prabha hani 0 0 0 0 soonyataVyamoha 0 0 Hridrava 0 0Sleshma Sandhi 0 0 0 0vruddhi saidhilya Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results126
  • 141. B12) Distribution of patients by Dosha vruddhi Prakruti Table- 29Vata Vruddhi Pts % Pitta Vruddhi Pts % Kapha Pts % Lakshana Lakshana Vruddhi LakshanaKarshya 17 34 Peeta 0 0 Agni sadana 23 46 mootrataKarshnya 19 38 Peetanetra 0 0 Praseka 18 34Ushna 38 76 0 0 20 40 Peetavit AlasyakamitwaKampa 5 10 Peetatwak 0 0 Swetangata 16 32Anaha 14 28 Adhikshudha 0 0 Sheetangata 32 64Shakrudgraha 12 24 Adhidaha 9 18 Gowrava 22 44Balabhrmsha 6 12 Slathangata 0 0Nidrabhramsha 26 52 Swasa 50 100Pralapa 0 0 Kasa 47 94Bhrama Atinidra Out of the Dosha Kshaya Angasada (4 pts) of Vata and Shareera sheetatwam ofPitta lakshana are observed. But at the Dosha vruddhi lakshana maximum of Kaphalakshana and the pratyatma niyata lakshana of the disease Swasa is observed 50 patientsalong with the Kasa of 47 patients. Nidra bhramsha (Vata) is observed with 26 patientsand ushna kamitwa for 38 patients. Anidra of Pitta and Nidra rahityata of Vata more orless mimic and are observed as 9 patients in the study. Sheetangata of Kapha symptom isobserved for the 32 patients along with gowrava (22) and swetangata (16) patients. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results127
  • 142. B13) Distribution of patients by Ahara Nidana Table -30 Vata Pts % Pitta Pts % Kapha Pts %Visamashana (V) 14 28 Tilataila (P) 0 0 Pistanna (K) 11 22Adhyashana (V) 12 24 Vidahi (P) 0 0 Nispava (K) 0 0Anasana (V) 5 10 Saluka (K) 0 0Sheetashana (V) 0 0 Guru dravyas (K) 40 80Visha (V) 0 0 Jalajamamsa (K) 7 14Sheetapana (V) 36 72 Anupamamsa (K) 17 34Rukshanna (V) 34 68 Abhishyandi (K) 41 82 Masa (K) 27 54 Dadhi (K) 39 78 Vistambhi (K) 5 10 Amaksira (K) 0 0 It is observed those 40 patients under take Guru dravyas, 41 patients Abhishyandipadartha, and 39 patients Dadhi, in their food, which is Kapha kara Ahara. Sheeta (36)and Rooksha (34) anna, which is Vata kara ahara consumed by patients also listed here.The percentage and the number of patients enrolled to the Ahara Nidana are tabulated inthe table – 30. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results128
  • 143. B14) Distribution of patients by Vihara Nidana Table -31 Vihara Pts % Vihara Pts %Rajas (V) 50 100 Abhighata (V) 0 0Vata (V) 50 100 Dhuma (V) 23 46Sheeta Sthana (V) 30 60 Apatarpana (V) 5 10Sheeta ambu (V) 0 0 Bharakarshita (V) 5 10Ativyayama (V) 11 22 Adhwahata (V) 20 40Kanthapratighata (V) 0 0 Urahpratighata (V) 0 0Karmahata (V) 6 12 Marmabhighata(V) 0 0Veganirodha (V) 9 18 Usna (P) 0 0Shuddhi Atiyoga (V) 0 0 Abhishyandi Upacara (K) 0 0Gramya dharma (V) 0 0 Divasvapna (K) 0 0 It is observed that exposure to rajas and Vata is common among all 50 patients ofthe study. Seta stnana, Dhooma, adwavata, Ati Vyayama, veganirodha, Karmahata,apatarpana and Bharakarshita Vihara Nidana took the place of aetiology is tabulated inthe table – 31.B15) Distribution of patients by Anya / Vyadhi Avasta sambandha Nidana Out of the other symptoms scrutinized, Vibandha, Anaha, Panduroga, Dourbalyaof Vata lakshana are found in the study. At the same time Kasa and Pratishyaya whichare of Kapha lakshana and also lakshana of Tamaka Swasa show remarkable listing. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results129
  • 144. Jwara, which is Pitta lakshana also found as one of the avasta sambandha Nidana here.The tabulation is as under. Table - 32 Distribution of patients by Anya / Vyadhi Avasta sambandha Nidana Lakshana pts % Lakshana pts % Lakshana pts % Ksataksaya 0 0 Atisara 0 0 Visucika 0 0Vata Udavarta 0 0 Vibandha 9 18 Panduroga 4 8 Kshaya 0 0 Anaha 11 22 Dourbalya 4 8 Rakta Pitta 0 0 Jwara 5 10Pitta Kasa 47 92 Amapradosa 0 0 Chardi 3 6Kapha Pratisyaya 28 56 Amatisara 0 0B16) Distribution of patients by Srotas Table – 33 Distribution of patients by Srotas Lakshana pts % Lakshana pts %Pranavaha Atisrustam 38 76 Ati badhdama 12 24 Kupitam 32 64 Abheekhnam 27 54 Alpalpa 38 76 Sashoolam 22 44Annavaha Aruchi 19 38 Ajeerna 14 28 Chardi 3 6 Anannabhilasha 2 4Udakavaha Jihwashosha 14 28 Talushosha 4 8 Ostashosha 11 22 Pipasa 14 28 The enlisted symptoms pertaining to that of the Srotas examination observationsare put forth here. The chief Srotas involved in the Tamaka Swasa is Pranavaha Srotas.Out of the vitiated symptoms of the Pranavaha Srotas almost all symptoms are observedhere and specifically Atisrusta and Alpalpa found for as many as 38 patients. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results130
  • 145. Involvement of the Annavaha Srotas could not be ruled out as it is the udbhava stana. Inthe Annavaha Srotas Aruchi and Ajeerna found for many. Udakavaha Srotas involvementis established by the Jihwa sosha and Pipasa complaints of the patients. There were nopatients with out having either of the vitiated symptoms of the three Srotas which are saidto have the pathological involvement in the study. The symptoms involved patients withpercentages shown in the table 34 above.B17) Distribution of patients by Poorva Roopa Table -34 Distribution of patients by Poorva Roopa Poorva Roopa Patients PercentageHrutpeeda 18 36Kshudra Swasa 15 30Shankha bheda 15 30Shoola 0 0Pranavilomata 28 56Vaktra vairasya 0 0Parshwashoola 26 52Vibandha 9 18Anaha 11 22Arati 24 48Bhakta dwesha 19 38Admana 0 0 Out of the many told poorva Roopa, Prana vilomata, Parshwa shoola, Arati,Hrutpeeda, shankha peeda and Kshudra Swasa are found to be more generalized. Thepatients at the later course of the treatment period were not expressed. The tabulatedsymptoms are depicted above in the table -34. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results131
  • 146. Table No-35 Distribution of patients by Chief complaints and Associated complaints Duhkhenakapha nissaranama Greeva shira samgraha Shayane swasa peedita Muhuchavsadamyati Kruchrena bhashita Kantodhwamsha Swasa kruchrata Lalata sweda Vishukasyati Muhurswasa Ghrguratwa Angamarda Urah peeda Pratamyati Vamathu Pramoha Trushna Peenasa Kampa Anidra Aruchi Jwara KasaSN OPD1 5154 + + + + + + + + + +2 5285 + + + + + + + + +3 5395 + + + + + + + + + + + + +4 5402 + + + + + + + + + + + + + + +5 5541 + + + + + + + + + + + + + + + + + + +6 5642 + + + + + + + + + +7 5648 + + + + + + + + + + + + + +8 18 + + + + + + + + + + + + + + + + + +9 45 + + + + + + + + + + + + + + +10 63 + + + + + + + + + + + + + + + +11 201 + + + + + + + + + + + +12 812 + + + + + + + + + +13 527 + + + + + + + +14 530 + + + + + + + + + +15 562 + + + + + + + + + + + +16 566 + + + +17 572 + + + + + + + + + +18 605 + + + + + + + + + +19 606 + + + + + + + + + +20 611 + + + + + + + +21 624 + + + + + + + + + + + + + + + +22 626 + + + + + + + + +23 676 + + + + + + + + + +24 677 + + + + + + + + + + + +25 681 + + + + + + +26 748 + + + + + + + + +27 749 + + + + + + + + + + + +28 774 + + + + + + + + +29 775 + + + + + + + + + + + + + + +30 955 + + + + + + + + + +31 994 + + + + + + + + + + + + +32 995 + + + + + + + + +33 1001 + + + + + + + + + + + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results132
  • 147. 34 1497 + + + + + + + + + +35 1498 + + + + + + + + + + +36 2210 + + + + + + + + + + +37 2310 + + + + + + + + + + + +38 2283 + + + + + + + + +39 2332 + + + + + + + + +40 2333 + + + + + + + + + + +41 2334 + + + + + + + + + +42 2381 + + + + + + + + + +43 2380 + + + + + + + +44 2398 + + + + + + + + + + +45 2399 + + + + + + + + + +46 2433 + + + + + + + +47 2481 + + + + + + + + + +48 2493 + + + + + + +49 2494 + + + + + + + + +50 2541 + + + + + + + Table No-36 Distribution of patients by History of present illness Aggravatin Periodicity Frequency Preceding posture at Duration of attack of attack g factors Mode of Comfort Sputum Course factors attack onsetSerial Number Subsides with medicine Forward bending Initially episodic OPD Nasal irritation Non purulent Intermittent Continuous Continuous Few weeks Few hours Few days Sneezing Standing Seasonal Episodic Irregular Purulent Perineal Gradual Sudden Pollens Smoke Cough Sitting Lying Dust Pets1 5154 + + + + + + + + + + +2 5285 + + + + + + + + + + +3 5395 + + + + + + + + +4 5402 + + + + + + + + + + +5 5541 + + + + + + + + + + + + +6 5642 + + + + + + + + + + +7 5648 + + + + + + + + + + +8 18 + + + + + + + + + + +9 45 + + + + + + + + + +10 63 + + + + + + + + + + +11 201 + + + + + + + + + + +12 812 + + + + + + + + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results133
  • 148. 13 527 + + + + + + + + + + +14 530 + + + + + + + + + + +15 562 + + + + + + + + + + + +16 566 + + + + + + + + + + +17 572 + + + + + + + + + + + +18 605 + + + + + + + + + + +19 606 + + + + + + + + + + + +20 611 + + + + + + + + + + + +21 624 + + + + + + + + + + +22 626 + + + + + + + + + + +23 676 + + + + + + + + +24 677 + + + + + + + + + + + +25 681 + + + + + + + + + + +26 748 + + + + + + + + + + +27 749 + + + + + + + + + + + +28 774 + + + + + + + + + + + +29 775 + + + + + + + + + +30 955 + + + + + + + + + + + +31 994 + + + + + + + + +32 995 + + + + + + + +33 1001 + + + + + + + + + + +34 1497 + + + + + + + + + + + + + +35 1498 + + + + + + + + + +36 2210 + + + + + + + + + + + +37 2310 + + + + + + + + + + +38 2283 + + + + + + + + +39 2332 + + + + + + + + + + +40 2333 + + + + + + + + + + + +41 2334 + + + + + + + + + + + +42 2381 + + + + + + + + + + +43 2380 + + + + + + + + + + + +44 2398 + + + + + + + + + +45 2399 + + + + + + + + + +46 2433 + + + + + + + + + + + + +47 2481 + + + + + + + + + +48 2493 + + + + + + + + + + +49 2494 + + + + + + + + +50 2541 + + + + + + + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results134
  • 149. Table - 37 Distribution of patients by Dosha Vruddhi Lakshana Pittavruddhi Vata vruddhi lakshana Kapha vruddhi lakshana lakshana Adhika kshudha Nidra bhramsha shakrut graham Peeta mootrata Usna kamitwa Balabhramsha SwetasngataS Sheetangata Agnisadana Slathangata Peeta netra Peeta twak OPD Karshnya Gowrava Ati daha Karshya Atinidra Bhrama Praseka Peta vit Pralapa Kampa AlasyaN Anaha Swasa Kasa 1 5154 + + + + + + + + + + + 2 5285 + + + + + + + + + + 3 5395 + + + + + + + 4 5402 + + + + + + + 5 5541 + + + + + + + + + + + 6 5642 + + + 7 5648 + + + + + + + + + + 8 18 + + + + + + 9 45 + + + + + +10 63 + + + + + + + + +11 201 + + + + + +12 812 + + + + + + + + + +13 527 + + +14 530 + + + + + +15 562 + + + + + +16 566 + + +17 572 + + + + + + + +18 605 + + + + + + + +19 606 + + + + + + + + +20 611 + + + + + + +21 624 + + + + + + +22 626 + + + + + +23 676 + + + + + + + + + + +24 677 + + + + + + + + + +25 681 + + + + + + +26 748 + + + + + + + + +27 749 + + + + + + + + +28 774 + + + + + +29 775 + + + + + + + + + + +30 955 + + + + + + + + + +31 994 + + +32 995 + + + + + + + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results135
  • 150. 33 1001 + + + + + + + +34 1497 + + + + + + + +35 1498 + + + + +36 2210 + + + + + + + + +37 2310 + + + + + + +38 2283 + + + + + + + + + + +39 2332 + + + + + +40 2333 + + + + + + +41 2334 + + +42 2381 + + + + + + + + + + + +43 2380 + + + + + +44 2398 + + + + + + + + + + + +45 2399 + + + + + + + +46 2433 + + + + + + + +47 2481 + + + + + + + +48 2493 + + + + + + + + +49 2494 + + + + +50 2541 + + + + + + + + + Table - 38 Distribution of patients by Dosha Kshaya Lakshana Pitta Kshaya Vata Kshaya lakshana Kapha Kshaya lakshana lakshana Alpa bhashite hitam Shleshma vruddhi Shareera sheetata Sandhi shaithilya Shira shoonyata Urah shoonyata Chesta heenataS Angasada Prabhahani OPD Mandagni Vyamoha Hrudrava BhramaN1 5154 + +2 5285 + +3 5395 + +4 54025 5541 + +6 56427 5648 + + +8 18 + +9 4510 63 + +11 201 + +12 812 + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results136
  • 151. 13 52714 530 + +15 562 + +16 56617 572 + +18 605 + +19 606 + +20 611 +21 62422 626 +23 676 + + +24 67725 681 + +26 748 +27 749 + +28 774 +29 775 + +30 955 + +31 99432 99533 100134 1497 + +35 1498 + +36 221037 2310 + +38 2283 + +39 2332 +40 2333 +41 233442 2381 + +43 238044 2398 + +45 239946 2433 + +47 2481 +48 2493 + +49 249450 2541 + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results137
  • 152. Table - 39 Distribution of patients by Ahara nidana Vata Pitta Kapha Anoopa mamsa Vishamashana Jalaja mamsa Ama ksheera Sheeta snana Abhishyandi Rookshanna Gurudravya Sheetapana Adhyasana Vistambhi Anashana Nishpava Shalooka Tila taila PistannaS Vidhahi Masha Dadhi Visha OPDN 1 5154 + + + + + + + + 2 5285 + + + + + + + + + 3 5395 + + + + + + 4 5402 + + + + + + + + + 5 5541 + + + + + + + + + + 6 5642 + + + + + + + + + 7 5648 + + + + + + + + + 8 18 + + + + + + + + 9 45 + + + + +10 63 + + + + + + + +11 201 + + + + + + + +12 812 + + + +13 527 + + + + + + +14 530 + + + + +15 562 + +16 566 + + + + +17 572 + + + +18 605 + + + + + +19 606 + + + + + + +20 611 + + + + +21 624 + + + + + +22 626 + + + + +23 676 + + + + + +24 677 + +25 681 + +26 748 + + + + + + + +27 749 + + + + +28 774 + + + + + +29 775 + + + + +30 955 + + + + + +31 994 + + + +32 995 + + + +33 1001 + + + + +34 1497 + + +35 1498 + + + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results138
  • 153. 36 2210 + + + +37 2310 + + + + + + +38 2283 + + + + +39 2332 + + + + +40 2333 + + + + + + +41 2334 + + +42 2381 + + + + + +43 2380 + + + + + + +44 2398 + + + + + +45 2399 + + + + +46 2433 + + + + +47 2481 + + + + +48 2493 + + + + + +49 2494 + + + + + +50 2541 + + + + + + Table - 40 Distribution of patients by Vihara Nidana Kantaparatighata Marmabhighata Urah pratighata Suddhi atiyoga Bharakarshata Gramadharma Veganirodha Diwaswapna Vayu sevana Ativyayama Abhshyandi Raja sevana Apatarpana Adhwahata Karmahata Abhighata uapachara DhoomaS OPDN 1 5154 + + + 2 5285 + + + + + + 3 5395 + + + + 4 5402 + + + + + + 5 5541 + + + + + + 6 5642 + + + 7 5648 + + + + + + + 8 18 + + + 9 45 + + + + +10 63 + + + + +11 201 + + +12 812 + +13 527 + +14 530 + +15 562 + + +16 566 + + + + +17 572 + + + + + +18 605 + + + + + + +19 606 + +20 611 + + +21 624 + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results139
  • 154. 22 626 + + + + +23 676 + + +24 677 + + +25 681 + +26 748 + +27 749 + + + + + +28 774 + + +29 775 + + + + + + +30 955 + +31 994 + + +32 995 + + + +33 1001 + +34 1497 + +35 1498 + + +36 2210 + + + +37 2310 + + + +38 2283 + + + + + +39 2332 + +40 2333 + + + +41 2334 + + + +42 2381 + + + +43 2380 + +44 2398 + + + + +45 2399 + + + +46 2433 + + + +47 2481 + + +48 2493 + + + +49 2494 + + + +50 2541 + + Table - 41 Distribution of patients by Anyavyadhi avasta sambandhi Amapradoshaj Kshata kshaya Pratishyaya Vishuchika Panduroga Dourbalya Raktapitta Amatisara Vibandha Udavarta a vyadhi Kshaya Chardi Anaha Jwara KasaS OPDN1 51542 5285 + +3 5395 +4 5402 + +5 5541 + +6 5642 +7 5648 + + + Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results140
  • 155. 8 18 + 9 45 +10 63 +11 20112 81213 52714 530 +15 56216 566 +17 572 +18 605 + +19 60620 61121 624 +22 62623 676 +24 677 +25 68126 748 +27 74928 774 +29 775 +30 95531 99432 995 +33 1001 +34 1497 + +35 149836 221037 2310 +38 228339 2332 +40 233341 2334 + +42 238143 238044 2398 +45 239946 2433 +47 248148 249349 249450 2541 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results141
  • 156. C) Result of the Ardhedashemaniya Swasaharavati in Tamaka Swasa vis-à-vis AsthmaC1) Assessment of Subjective parameters in Tamaka Swasa Table- 42 Subjective parameters assessment in Tamaka Swasa Presenting complaints relieved Patients Patients Patients Before After % % %Teevra vega Swasa 50 100 21 42 29 58(Dyspnonea)Kasa 47 94 18 36 29 61.7(cough)Duhkhena Kapha nissaranam 43 86 20 40 23 53.48(Expectoration)Ghurghuratwam 50 100 25 50 25 50(Wheezing)Peenasa 33 66 15 30 18 54.54(Coryza)Kruchrena bhasate 22 44 10 20 12 54.54(Dysphonoea)Kantodhwamsham 12 24 5 10 7 58.33(Hoarseness of voice)Greevashirasangraha 16 32 9 18 7 43.75(Headache & Stiffness)Urah Peeda 39 60 16 20 23 58.97(Chest Pain)Shayane Swasa peedita 37 70 14 28 23 59.45(Discomfort at supine)All the subjective parameters which are declared for the assessment of theArdhedashemaniya Swasaharavati are tabulated here in the table 42. Out of thesymptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patients initially arerelieved 58%. Another symptom found for all patients is Ghurgurukatwam is relieved forthe 50% of patients in the study. Kasa a symptom appeared for 47 patients initiallyrelived 61.7% in the study. Next best appeared symptom is Duhkhena Kapha nissaranam Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results142
  • 157. for the 43 patients noticed relieved for the 53.48% of patients. Shayane Swasa peedita isthe next symptom with 37 patients found corrected at the end by 59.45%. 39 patients ofUrahpeeda corrected at the end of study by 58.97%. Peenasa, a symptom of thePranavaha Srotas always found associated with the Tamaka Swasa found for 33 patientsgot through by the end with 54.54% of relief. Greevashirasangraha (16 patients) andKantodhwamsham (12 patients) are the other two symptoms of assessment got relief with43.75 and 58.33 percentages respectively. The tabulation is as expressed above.C2) Assessment of Objective Parameters in Tamaka Swasa At the Objective Parameters assessment in Tamaka Swasa in the study ofArdhedashemaniya Swasaharavati five objective parameters are assessed are enlisted inthe table 43. All these are of disease oriented and specific to assess theArdhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis Bronchial Asthma.The table is followed as under. Table - 43 Objective Parameters assessment in Tamaka Swasa Peak Erythrocyte AbsoluteS Breath Holding Exploratory Sedimentation Eosinophilic OPD CountN Time Flow Rate Rate Hemoglobin % Before After Before After Before After Before After Before After 1 5154 10 24 180 350 10 8 10 11 500 300 2 5285 8 20 150 360 10 10 9 10.2 450 250 3 5395 8 15 125 290 14 10 10.4 12 500 350 4 5402 10 20 200 380 8 6 9.6 10.4 450 250 5 5541 12 22 160 350 10 10 9.2 10 500 350 6 5642 12 20 180 370 10 8 12 12 550 350 7 5648 10 20 150 370 10 10 10.8 11.2 500 250 8 18 5 5 90 90 14 12 9.6 11 600 600 9 45 8 14 140 250 8 10 11.4 12.6 550 35010 63 10 18 125 250 10 6 9.4 10.4 550 30011 201 10 22 140 350 12 10 10 11.8 500 30012 812 8 12 120 160 12 8 11 12.2 550 450 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results143
  • 158. 13 527 12 25 180 360 10 10 12 13 500 25014 530 10 21 150 350 8 10 11.2 12 500 35015 562 6 6 80 80 12 14 10.4 11.8 650 60016 566 8 20 160 350 10 6 9 10.6 500 25017 572 10 20 180 380 7 10 12 12.8 550 35018 605 7 15 120 270 8 8 12 13 500 35019 606 5 6 70 80 14 12 10 10 600 60020 611 14 30 240 450 8 6 12.6 13 500 25021 624 6 10 100 160 10 10 12.8 12 550 45022 626 12 25 200 380 8 8 9.8 11 500 25023 676 8 15 145 320 6 10 11.2 12.4 500 35024 677 5 10 120 180 12 10 10 11 450 35025 681 10 22 160 380 10 8 11 12.6 500 25026 748 12 22 150 380 10 10 10.6 11 550 35027 749 14 30 180 400 10 8 11 12.4 500 25028 774 10 20 140 350 8 10 9.2 10.4 550 35029 775 8 14 120 280 8 8 8 9.6 500 35030 955 8 12 100 150 12 12 12 12.6 550 45031 994 10 18 170 360 10 5 10.6 11 500 25032 995 10 20 150 380 8 8 12 13 500 25033 1001 12 22 160 370 10 10 8 9 500 35034 1497 8 12 90 140 12 10 11.2 12 600 50035 1498 10 18 125 250 10 8 12.2 11.8 550 35036 2210 6 10 110 170 10 10 12 12 550 45037 2310 12 25 200 350 8 6 8.2 10.4 500 25038 2283 10 22 140 360 12 8 10 11.8 500 25039 2332 10 20 170 350 10 10 10.6 12 500 35040 2333 7 16 130 300 10 8 9 9.8 550 35041 2334 10 24 150 380 6 6 10.4 12.2 500 25042 2381 8 15 135 250 8 10 12.8 13.2 500 35043 2380 10 18 140 360 12 10 11.2 12.8 500 25044 2398 6 10 100 130 14 12 10.4 11 550 40045 2399 8 14 160 280 10 10 11 12.6 550 35046 2433 7 18 130 300 8 6 9.2 10.4 500 35047 2481 5 5 80 90 15 14 10 10 650 55048 2493 10 25 160 370 10 8 12 13.2 500 25049 2494 5 8 90 80 12 12 11 10.8 550 50050 2541 12 20 140 350 10 10 10 10.8 500 250 Total 452 875 7085 14490 504 459 529 575.8 26200 17350 Mean 9.04 17.5 141.7 289.8 10.08 9.18 10.58 11.51 524 347 SD 2.381 6.171 35.36 103.5 2.088 2.057 1.232 1.093 43.14 100.2 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results144
  • 159. Out of the assessments of objective parameters it is clearly understood that theBreath Holding Time (BHT) means are compared and observed that a lot of 8.46 suggeststhat the lung capacity is enriched. This is conformed by the second significant test PeakExpiratory Flow rate (PEFR). In the PEFR readings it is clear once again that thedifference is as wide as 148.1, almost more than 50% improvement. Oxygen is the mostessential to live and that is carried by the Red Blood Corpuscles and Haemoglobin. TheHb% in the blood are studied as one of the parameter has 0.93 variance of mean showsthat the drug even has the effect over the increasing the haemoglobin and RBC. The nextbest prognostic and also estimating objective parameter is the Erythrocyte SedimentationRate; record the marked decrease, which is a significant of disease regression, is 0.9difference to that of baseline data to the final data. As many as Pranavaha Srotassymptoms are seen along with the Tamaka Swasa needs the Absolute Eosinophilic Countas the parameter is studied here and observed that 177 mean AEC decrease.C3) Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa vis-à-vis Asthma The result in the study ascertains the best activity of the ArdhedashemaniyaSwasaharavati over the Tamaka Swasa vis-à-vis Asthma. For the convenience the resultsare grouped as four categories, viz. Well-Responded (WR), Moderately Responded(MR), Poorly Responded (PR) and Not-responded (NR). All these patients are studieswith the cumulative percentages obtained through subjective and objective Parameters isas under. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results145
  • 160. Table – 44Cumulative effect in percentages obtained through subjective and objective Parameters for Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-vis bronchial Asthma Duhkhenakaphanis Swasa Kruchrate Shayane swasa Ghrgurukatwa Percentage Urahpeeda saranam peedita Result PEFR Kasa Total ESR AEC BHTOPD5154 3 3 3 3 3 3 3 2 3 3 29 96.66 WR5285 3 3 3 3 3 3 3 2 3 3 29 96.66 WR5395 2 3 2 2 3 3 2 2 1 2 22 73.33 MR5402 3 3 3 3 3 3 3 2 3 3 29 96.66 WR5541 3 3 2 3 2 2 3 2 3 3 26 86.66 WR5642 3 3 3 3 3 3 3 2 3 3 29 96.66 WR5648 3 3 3 2 3 3 3 2 3 3 28 93.33 WR 18 0 0 0 0 0 0 0 1 0 0 1 3.33 NR 45 2 2 2 2 2 2 2 2 3 3 22 73.33 MR 63 2 3 2 2 3 2 2 1 3 1 21 70 MR 201 3 3 2 2 3 3 3 2 3 3 27 90 WR 812 1 0 1 1 3 3 1 1 2 1 14 46.66 PR 527 3 3 3 3 3 3 3 3 3 2 29 96.66 WR 530 3 3 3 2 3 3 3 2 3 2 27 90 WR 562 0 1 0 0 3 0 0 1 0 1 6 20 NR 566 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 572 3 3 2 2 3 3 3 2 3 2 26 86.66 WR 605 2 1 2 2 3 3 2 2 3 2 22 73.33 MR 606 0 0 1 0 0 0 1 0 1 0 3 10 NR 611 3 3 3 3 3 3 3 3 3 3 30 100 WR 624 1 0 1 1 0 0 1 1 3 1 9 30 PR 626 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 676 1 2 1 1 3 3 2 2 2 2 19 63.66 MR 677 1 1 0 1 3 2 1 1 2 1 14 46.66 PR 681 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 748 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 749 3 3 3 3 3 3 3 3 3 3 30 100 WR 774 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 775 2 1 1 2 3 1 2 2 3 2 19 63.33 MR 955 1 1 0 1 2 1 1 1 0 1 9 30 PR 994 3 3 3 3 3 3 3 2 2 3 28 93.33 WR 995 3 3 3 3 3 3 3 2 3 3 29 96.66 WR1001 3 3 3 3 3 3 3 2 3 2 28 93.33 WR1497 1 1 0 1 3 3 1 1 2 1 14 46.66 PR1498 2 1 2 1 3 3 2 2 3 2 21 70 MR2210 0 1 0 3 3 1 1 1 3 1 14 46.66 PR2310 3 3 3 3 3 3 3 2 3 3 29 96.66 WR Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results146
  • 161. 2283 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2332 3 3 3 3 3 3 3 2 3 2 28 93.33 WR 2333 2 2 2 2 2 3 2 2 3 2 22 73.33 MR 2334 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2381 1 2 2 1 2 1 2 2 3 2 18 60 MR 2380 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2398 1 1 1 0 3 0 1 2 1 1 11 36.66 PR 2399 2 2 2 2 2 3 2 2 2 2 21 70 MR 2433 2 3 2 3 1 3 2 2 2 2 22 73.33 MR 2481 0 0 0 0 0 0 0 0 0 1 1 3.33 NR 2493 3 3 3 3 3 3 3 2 3 3 29 96.66 WR 2494 0 1 0 0 0 0 0 1 0 1 3 10 NR 2541 3 3 3 3 3 3 3 2 3 3 29 96.66 WR As par the discussions made and the results observed in the study ofArdhedashemaniya Swasaharavati, the results are declared as under keeping the allsubjective and objective parameter developments in view. After through study of theentire parameters and materials available for the assessment of results it was drawn aconclusion of results as - 27 (54%) well responded, 11 (22%) moderately responded, 7(14%) poorly responded and 5 (10%) patients not responded and the 12 patientsdiscontinued in the study, were not considered for the result declaration. The tabulatedresult and pi-diagram graphical expression is as under. Table-45 Result of Ardhedashemaniya Swasaharavati in Tamaka Swasa Result Number of patients Percentage Well Responded 27 54 Moderately Responded 11 22 Poorly Responded 7 14 Not Responded 5 10 Total 50 100 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results147
  • 162. Graph – 31 Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa Results of Ardhedashemaniya Swasaharavati in Tamaka Swasa Poorly Responded 14.00% Not Responded 10.00% Moderately Well Responded Responded 54.00% 22.00%D) Statistical analysis of the Subjective and Objective parametersD1) Objective parameters Table – 46 Statistical analysis of Objective parameters Objective Mean SD SE Z-Value p-Value Significance Parameters PEFR 147.7 73.59 10.407 14.19 < 0.01 HS BHT 8.84 4.037 0.57 15.48 < 0.01 HS AEC 178.00 69.73 9.81 18.14 < 0.01 HS ESR 1.9 2.032 0.287 6.608 < 0.01 HS HS = Highly Significant Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results148
  • 163. D2) Subjective parameters Ardhedashemaniya Swasaharavati in Tamaka Swasa Table – 47 Statistical analysis of Subjective parameters significance Subjective Mean SD SE Z-Value p-Value parameters Teevra vega Swasa 1.58 0.731 0.103 15.33 < 0.01 HS (Dyspnonea) Kasa 1.4 0.832 0.117 11.88 < 0.01 HS (cough) Duhkhena Kapha nissaranam 1.18 0.774 0.109 10.77 < 0.01 HS (Expectoration) Ghurghuratwam 1.44 0.704 0.099 14.45 < 0.01 HS (Wheezing) Peenasa 0.68 0.74 0.104 6.49 < 0.01 HS (Coryza) Kruchrena bhasate 0.38 0.567 0.08 4.73 < 0.01 HS (Dysphonoea) Kantodhwamsham 0.16 0.42 0.05 2.68 < 0.01 HS (Hoarseness of voice) Greevashirasangraha 0.22 0.418 0.059 3.71 < 0.01 HS (Headache & Stiffness) Urah Peeda 0.68 0.767 0.108 6.263 < 0.01 HS (Chest Pain) Shayane Swasa peedita 0.58 0.537 0.076 7.623 < 0.01 HS (Discomfort at supine) HS = Highly Significant Individually all the parameters shows highly significance, as p value is <0.01. Butin the subjective parameters Swasakruchrata, Ghrgurukatwa, Kasa and Duhkhenakaphanissaranam shows highly significance than the Urahpeeda, Shanasya Swasa peedita(comparing Z values). In the objective parameters AEC, BHT and PEFR show high significance that theESR (by comparing Z value). The parameter PEFR shows more variation. The mean neteffect of AEC is more before and after treatment. The subjective parameter Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results149
  • 164. Swasakruchrata and Ghrgurukatwa, mean net effect is more. The parameter Kasa showsmore variation and the Shayanasya Swasa peedita show less variation (by comparingmean and SD). Here we assume that if sample size is more than or equal to 30 the samplingdistribution will follow normal distribution with specified mean and SD for respectiveparameters. As sample size is more that 30 we use the technique of paired t-test to find out theeffect of the drug before and after the treatment. Here instead of the t-table value we usedthe Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a large sample test to findthe p-value.D3) Objective parameters Baseline comparison Ardhedashemaniya Swasaharavati in TS Table -48 Objective parameters Baseline comparison in Ardhedashemaniya Swasaharavati in TS Parameters Mean SD SE Z-Value p-Value Significance PEFR BT 141.7 35.36 5.00 4.11 <0.01 HS µ o = 350 AT 289.8 103.53 14.64 BHT BT 9.04 2.38 0.36 25.8 <0.01 HS µ o = 40 AT 17.5 6.17 0.872 AEC BT 524 43.141 6.101 6.84 <0.01 HS µ o = 250 AT 347 100.2 14.17 ESR BT 10.08 2.088 0.295 2.82 <0.01 HS µ o = 10 AT 9.18 2.057 0.29 HS = Highly Significant Further the analysis is done by using large sample test with specified mean value.The parameter PEFR show high significance as p value is < 0.01 after the treatment. The Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results150
  • 165. population mean is 350 litres/ minute. The mean effect after the treatment is improvedwith more variance. The parameter BHT show high significance as p value is < 0.01 after thetreatment where the population mean is 40 seconds. The mean effect BHT after thetreatment is more than the before with more variance. The parameter AEC show high significance as p value < 0.01 after the treatmentfor population mean 250 cells / cubic millimetre. The mean value after the treatment isreduced than the before treatment with more variance which is towards normal. The parameter ESR show high significance as p value is < 0.01 after the treatmentwhere the population mean is 10 millimetre /hour. There is reduction in mean value ofESR after the treatment with less variance than the before treatment (by comparing meanand SD). Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Results151
  • 166. Chapter- 6 Discussion Tamaka Swasa is a chronic disease of Pranavaha Srotas and it is characterized bySwasa kricchrata or tevra vega Swasa, ghurghurakatwa, kasa, shayanasya Swasa peedita,uraha peeda, peenasa, etc with patient feels as if entering dark ness during the paroxysmwhich is due to where un holy association of Vata with Kapha obstructing the passage ofPranavata leads to a excitement of Vata to produce up ward movement or abnormalexpiratory dyspnoea. Which vary in severity and frequency from person to person is in anindividual they may occur from hour to hour and day to day. The entity of disease is wellknown to Ayurvedic word since the time immemorial. The well established detaildescription of aetio-pathogenesis and treatment is found in our Ayurvedic literature. The contemporary medical science also has a vast description of bronchial asthmaparallel to Tamaka Swasa earlier concept about bronchial asthma that is broncho spasticdisease have changed in recent years where as it is proved that it is an inflammatorydisease. The national asthma education program panel states that asthma is a complexsyndrome of reversible airway obstruction, airway inflammation and bronchial hyperirritability that occurs following exposure to stimuli such as allergens viral respiratoryinfections, vigorous exercise, cold air, cigarette smoke, and air pollutants. The acceptable definition of bronchial asthma is still remains elusive. And themeans of interaction are not understood by modern community. According to globalinitiative for asthma the working definitions of asthma is a chronic inflammatory disorderof the airways. In susceptible individuals this inflammation causes recurrent episodes of Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion152
  • 167. wheezing, breathlessness, chest tightness, and cough particularly at night or in the earlymorning. These symptoms are usually associated with widespread but variable airflowlimitation that is at least partly reversible either spontaneously or with treatment. Theinflammation also causes as associated with increased in airway responsiveness to averity of stimuli. The recent survey of the WHO reveals that 155 million people world wide andasthma has increased significantly i.e., 50% every decade. India has an estimated 15-20million asthmatics. The concept of Tamaka Swasa and concept of bronchial asthmaseems to quite similar to the description given by contemporary medical world. Theaetio-pathogenesis, aetiological factors symptoms, prognosis has been explained vividlyand these are all equivalent to the description of asthma giving by contemporary medicalscience. Ayurvedic authors has been clarified and its prognosis and its chronisity. Till today which is been truth and eternal modern world also has a same opinion regarding this,they stated that asthma cannot be cured but could control. Keeping the above fact in view it was decided to go through detailed availableAyurvedic literature. The Ardhedashemaniya Swasaharavati is a combination of 5 drugsout of 10 herbs told by Charaka swasahara gana from shad-vireechana shatasriteeyachapter. Discussion improves the knowledge and discussion with science becomes baseestablishment of the concept. Thus discussion is the most essential phase of any researchwork. Keeping this in view, the facts which have emerged from the study can be studiedin five ways. They are - Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion153
  • 168. 1. Discussion on demographic data 2. Discussion on disease Tamaka Swasa 3. Discussion on probable mode of action of Ardhedashemaniya Swasaharavati over subjective and objective parameters 4. Assessment of Ardhedashemaniya Swasaharavati over subjective and objective parameters 5. Limitations of the study 6. Recommendations1) Discussion on demographic data The efficacy of any drug can not be proved unless it is subjected to clinical trialsand analyzed statistically. The trial drug Ardhedashemaniya Swasaharavati is consideredfor the evaluation in Tamaka Swasa (bronchial asthma). The clinical study was conductedon 50 patients in a single group. In the foregone pages observations were madesystematically presented. These discussions will be done over respective data andobservations.a) Relevancy of Age and Gender Age is a factor of asserting the Dosha impact in the human. In this study the drugover different age groups of the patients were enumerated, ages taken from 15 years to65years and 10 years interval period was given in each group for study purpose.Maximum numbers of patients were observed in 45-55 years of age. The effect ofArdhedashemaniya Swasaharavati, over these patients i.e., 45-55 years out of 20 patients4 patients responded very well. But this is very less comparatively 15-25 age group out of11(22%) patients 9 (18%) responded well. It clearly shows that age factor also playsimportant role. 100% effect was observed in 25-35 age groups. It is observed that among Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion154
  • 169. 20 patients (40%) from 45-55 age groups male and female patients are equallydistributed. In this disease out of 50 patients 31 patients’ male, 19 patients were female.Out of 31male patients 18 patients responded well, where as in female out of 19, 9patients responded well.b) Relevancy of Religion Out of the 50 patients, 46 patients were Hindus and the rest 4 were Muslims. Thisis due to the increased dominance of Hindus in this area, where the trail is undertaken.Out of 46 patients 26 patients responded well. 9 patients were moderately responded. 7patients were poorly and 4 patients not responded. Among 4 Muslim patients 2 patientsresponded well and moderately 2 patients responded.c) Relevancy of Occupation It was observed that out of 50 patients 4 patients (8%) were leading sedentary lifestyle. 36 patients (72%) were active and rest 10 patients (20%) are labour. As the activityof a person is having a say on Tamaka Swasa and the labour people are more susceptiblefor asthma the observations made were supportive. The results of these major groupactive patients are for discussion, at this maximum out of 36 patients (72%) 19 patientswell responded to the treatment. By which prove the efficacy of Ardhedashemaniya withits properties against the disease.d) Relevancy of Socio-economical status In any research, a socio economic condition plays an important role. Some timesit could be one of the reasons. Here Tamaka Swasa is a condition corresponded to thehigh frequency of affect and prevalence, is based upon the food habits and living stylereferred to the socio economic conditions. Drugs may not be sufficient to fulfill the needs Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion155
  • 170. of diseased and need better food and life style also for the benefit of patients. Out of 50patients, 24 patients (48%) were belongs to the middle class. 17 patients (34%) werehigher middle and 9 patients (18%) poor class. It is very obvious that 12 patientsresponded well from the higher middle class and 10 patients from middle at the sametime. 2 patients from higher middle and 3 patients from middle not responded to thetreatment. It was noted that 9 patients were belongs to poor class among 9 patients, 5patients were responded well though they are poor but patient noticed that they followedgood regimen i.e. Pathya. This study shows that even though socio economical status hasmild impact over the disease but more importance should be given to be dietaryrestrictions and Pathya and Apathya.e) Food habits Out of 50 patients 29 patients (58%) were vegetarians 21 (42%) were consumingmixed diet. The percentage of the distributaries does not show any diet differentiation toget this disease, because verity of vegetables are allergens and some foods like fish, milk,eggs, yeasts, wheat, etc., are also responsible for the disease, this may be the reason,dietary regimens were less impact over the disease, the effect of drug responded well.The observations made in this study support the above view.2) Discussion on disease Tamaka Swasa The discussion on Tamaka Swasa vis-à-vis Asthma can be divided under 4 headings. i. Etiological considerations (Nidana) ii. Patho-physiological concepts (Samprapti) iii. Symptomatic evaluations (Lakshana) iv. Treatment concepts (Chikitsa) Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion156
  • 171. i) Etiological considerations Tamaka Swasa is a type of Swasa according to Charaka explained the etiologicalfactors in general. But Chakrapani commenting the Nidana of Swasa he has grouped likeVata prakopaka, Kapha prakopaka gana as Nidana of Tamaka Swasa. In Vata Kaphaprokopaka gana, sheeta vayu, sheeta sthana, sheeta jala sevana, all are having similarcharacter and causes gunatwa vriddhi of Vata Kapha Dosha. Vata Rooksha gana vriddhicause hardening of bronchial walls due to rooksha quality of diet and regimen. Theexcessive intake of above said factors like dadhi, masha, amakshera, etc., leads to Kaphavruddhi. The jalaja mamsa, etc., are also factors by which guru guna and picchila gunaincreased. Adhysana, vishamashana, causes agnimandya as a result Ama production takesplace. Ama and Kapha having similar character mix together causing blocking thebronchial airways. (srotosanga) dhatukshaya also leads to Vata prokopa in terms ofexcessive exercise and bharavahana. The out door and in door (vihar Nidana) allergens exposure have increasedasthma morbidity. Allergy can incriminated as asatmya in Ayurveda. Asatmya has beendefined as which is not accepted by the body allergy can defined as an aquiredhypersensitivity to a substance. Raja doohma are well known allergens which are capableof producing bronchospasm. Rajah can be compared dhooli, which is considered as dustanimal dander, pollen etc., dust and smoke causes bronchospasm by releasing themediators like histamine from mast cells. Certain foods cause allergies manifestations incertain individuals. Finally by summarizing all the etiological factors we can assume thatsome factors produce Dosha vruddhi some factors causes’ dushya dusti and reamingcauses the srotovaigunya. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion157
  • 172. ii) Discussion on patho-physiological concepts Tamaka Swasa Samprapti can be discussed according to Nidana. By the abovementioned Nidana, vitiated Vata enters to Pranavaha Srotas cause rookshyata, andkatinyata of the srotomarga resulting the srotosanga. The Vata exaggerated in PranavahaSrotas only due to srotosanga due to localized increase of Kapha. Because of obstructionin Pranavaha Srotas Vata changes its direction (vimarga gamana) results in sankocha.On the contrary modern science explained the above fact as follows. 1) Narrow airway caliber to limit the flow in airway by smooth muscle contractions 2) Gland and epithelial secretions and exudation in to the airway lumen and 3) Inflammatory oedema The involvement of Srotas in this disease is mainly the Pranavaha Srotas. But inthe poorva roopa the involvement of Annavaha Srotas and in severity of the disease theUdakavaha also involved. Ayurveda explained the symptoms related to Annavaha Srotaslike anaha, admana, parshawashoola, hritpeeda bhakta dwesha arati and vibhanda. It has been found that maximum patients suffer from agnimandya, giving raise toAma utpatti leading to faulty production of prasadarasa, and more production of malarupa Kapha leading to vitiation of Rasa vaha Srotas. The moola of Pranavaha Srotas ismahasrotas and hridaya. Ama Rasa produced in Amashaya produces dusti of PranavahaSrotas and Annavaha Srotas so symptoms of Annavaha are occurred. Modern scienceexplained the premonitory symptoms of respiratory system. (Pranavaha Srotas) likepharyngitis, sore throat, pain in the throat itching sneezing running nose, viral infection ofupper airway, nasal irritation etc., which is due to allergic manifestation and infection. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion158
  • 173. iii) Symptomatic evaluations The clinical presentation of Tamaka Swasa, are heterogeneous. The spectrum ofsigns and symptoms varies in degree of severity from patient to patient from child to oldage. Patients may be free from symptoms in between the attack. The vegakaleenasymptoms Swasa kricchruta or teevra vega Swasa, ghurguraktwa kasa, dukhena Kaphanissarana, uraha peeda. The pratiloma Vata gets obstructed by Kapha in Pranavaha Srotas. It causes theghurghura shabda. But contemporary science wheeze is not considered as confirmatorysign in asthma. Because wheeze can be heard from many others conditions includingchronic bronchitis, pulmonary oedema, bronchial stenosis, foreign body aspiration upperairway obstruction and pulmonary embolism, which is generated by vibration in the wallof an airway on the point of closer due to smooth muscle contraction. The next symptom is occurred due to obstruction caused by Kapha in the passageof Vata and an attempt is made for its expulsion and this is presented as kasa, where inrelief is felt by expulsion of shelshma i.e., shelsma vimokshante sukham. Some patientsexperience dry cough in the manifestation of asthma. Cough is reflux action which isproduced by the irritation of bronchial mucosa muhurswasa and alpalpa Swasa can occurdue to increase the rate of respiration to compensate the oxygen requirement becauseoxygen saturation is reduced in bronchial asthma. Parshwa shoola is due to over inflation of the lung due to shlesma vruddhi andpatient feels a sort of discomfort or ache, or pain in the bilateral sides of the chest. All thepatients of Tamaka Swasa are at risk of developing teevra Tamaka Swasa the symptomslike pratamyati (feels distress) pramoha (faint) kampa (tremors) these can occur in the Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion159
  • 174. acute stage indicating sudden asphyxic asthma, which is due to bronchospasm andimpaired oxygen supply to the brain and accumulation of carbolic acid in the bloodproducing respiratory acidosis. The sadhyasadyata is depending upon age and immuno-status. Ayurvedaemphasized asthma originating in childhood is sadhya, who is having strength (uttamabala) and alpakaleena naveena Vyadhi according to Charaka. Susruta stated that durbalapatients for bad prognosis. Vagbhata states that uttam rogibala is for good prognosis. The course of Tamaka Swasa is not uniform with periods of exacerbation andremission which varies from days to weeks to months to years. Therefore themanagement requires to continuous care approach to the symptoms.iv) Treatment concepts The management of Tamaka Swasa depends on the Dosha predominance andphysical stage of the patient. Therefore the treatment modalities classified according topatient like kaphadhika, vatadhika, balawana, and durbala. Vata and Kapha involve in thepathogenesis of Tamaka Swasa. So the treatment modalities depend upon state ofvitiation of Dosha in the disease process. The therapy which alleviates both the Doshashould be adopted. When both Dosha are aggravated in equal ratio but reverse modalitiesis followed when Dosha are involved in different ratio. The drugs which are Vatakaphagna vatanulomaka, properties should be used as shamanoushadhi depending uponbody strength treatment varies as karshan Chikitsa indicated for balavana and brumhanashamana treatment for durbala and vrudha patients. Our science has given more importance to the shodana therapy also. It is statedthat vamana should be done in Kapha predominant disease. Where as vireechana also Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion160
  • 175. indicated. For durbala and vatadhika patients’ shamana tarpana, mamsasevana, arementioned. Susruta stated that Nidana parivarjan is must in management of the disease. Stepwise approach is management of Tamaka Swasa can be designed depending upon theseverity of the disease condition quick relief medications quoted in acute symptoms bymeans of Nasya and dhomapana sadvrutta is power full to for helping the patients to gainmotivation and skill to control asthma3) Probable mode of action of Ardhedashemaniya Swasaharavati Ardhedashemaniya Swasaharavati is combinations of five drugs with propertiesare Vata kaphagna, laghu, ruksha, tikshna, ushna virya and vatanulomaka. Herbs areselected according to Charaka explanation. As disease is mainly Kapha vatatmaka in nature and agnimandya as its roots. Thedrugs are acting over these Dosha by their properties. The gunas of the drugs are laghu,teekshana, rooksha, which are antagonistic to the gunas of Kapha Dosha there by drugsare normalizing or super imposing the Kapha Dosha. The veerya of these drugs in ushnaexcept Bhumyamalaki, which is having Kapha pittahara property as the disease ispittasthana samudbhava. The veerya of these drugs is Ushna, where as that of Vata is Sheeta. These drugsare normalizing the prakopita Vata Dosha by veerya, and vitiated Pranavaha Srotas,which is corrected by all these drugs. As they are under the Swasa hara heading andkasahara hikkahara gana, Srotodusti other wise sanga, is relieved by Ushna properties ofdrugs and swasahara property. Adhistana is Amashaya is seat of Kapha (urdwa) and Pitta(adho) as the drugs are katu, Tikta kashaya Rasa pradhana for Kapha, and kashaya Tikta Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion161
  • 176. madhura rasapradhana, where by acting over the Pitta and madhura, and amla Rasapradhana where by acting over Vata Dosha and restoring the normal functioning ofAmashaya by these properties Samprapti vighatana is taking place. Also many clinical and experimental studies were being conducted on these drugseither single or in combination and showed their efficacy in Tamaka Swasa vis-à-visbronchial asthma treatment. Combined effect of all drugs with same properties may haveacted on the disease Tamaka Swasa and support Charaka explains the combination herbsprovides more sustained therapeutic effect than using individually. The pharmacologicalproperties pertained to that of the present research is enlisted here.Shati Swasa hara - (CSu 4/37), Hikka hara - (CSu 4/30), Shotha hara, Vedanastapana, Jwarahara, Kasa hara - (Kayadeva Nighantu – 1393),Pushkaramoola Swasa hara, Kasa hara, Hikka hara, Parshwa shoolahara - (CSu 20/40 & AS Su 30/2)Shophaghna , Panduhara – (Dhanvamtari Nighantu -154)Amlavetasa Bhedaneeya, Deepaneeya, Anulomaneeya, Vata shleshma hara – (AS Su 13/2, CSu 25/40, 27/ Phalavarga)Tulasi Hikka, Kasa Swasa hara, Parshwashoolahara, Kaphavataghna (CSu 27/169, SSu 46/all)Bhumyamalaki Kasahara (CSu 4/36), Kapha Pitta hara, Pandughna, Swasa hara, Trushna Daha nasha (Kayadeva NIghantu – 250) Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion162
  • 177. According to modern science, bronchial asthma is a chronic inflammatorydisorder in which many cells play a role like mast, Eosinophils, and T-lympocytes. Theinflammation also causes an associated increase in airway hyper-responsiveness tostimuli. The pharmacological therapy is needed to treat reversible air flow obstructionand airway hyper responsiveness. Medications include bronchodilators and anti-inflammatory agents and antihistamine inflammation is the now target of therapy. A recent research carried out on these drugs the pharmacological action of all thedrugs is as follows. 1. Shati – it is proved as a anti inflammatory analgesic, expectorant, extract has notably anti histamine activity and laxative vasodilator 2. Pushkaramoola – Anti-inflammatory, expectorant, analgesic, antipyretic, antispasmodic activity. (Effect against bronchial spasm induced by histamine, 5 hydroxy tryptamind and various plant pollens). So it is also having anti histamine activity anti bacterial, and anti fungal activity bronchodialator. 3. Amlavetasa – it is stomachic, bitter tonic, purgative and antipyretic, 4. Tulasi – Demulcent, expectorant, antipyretic antiviral (leaf extract) antispasmodic carminative, antibacterial and nervine tonic (nerve tissue strengthening) it frees oxygen from sun rays and oxygenates the body, which builds the immune system. 5. Bhumyamalaki – Anti viral (phyllunthes primarly contains eg. – phyllanthine and hypophyllanthine) alkoloids and bio flavonoids while it remains un known as to which of these ingredients has anti viral effect appetizer, digestive, laxative, carminative. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion163
  • 178. By above said pharmacological action may be these drugs acting in bronchialasthma. Mechanism of action of this Ardhedashemaniya Swasaharavati is not clear butthe drugs are known of their bronchodilator, anti inflammatory, antihistamine activityexpectorant. Antiviral, antibacterial analgesic etc., as explained above, here proposing thefollowing mechanism of action may be hypothetical presume they are -1. Mechanism of Bronchodilators a) By relaxing bronchial smooth muscle b) By reducing the bronchial hyperactivity c) Also by improving the respiratory functions by increasing the strength and reducing the fatigue of the respiratory muscle2) Anti inflammatory mechanism As the inflammation is the target of therapy, the pharmacological action i.e., anti-inflammatory action can be interpreted for these drugs. An acute anti inflammatory action medicated via inhibition of micro vascular leakage Prevention of the direct migration and activation of inflammatory cells Human airway smooth muscle cells express before receptor from the trachea to the terminal bronchioles. This drugs as function antagonists can prevent and reverse the effects of all bronco constriction, with substance like histamine and endothelies.3) Anti histamine Hyper-responsiveness of airways by histamine can be interpreted as Vataprokopa. The drugs probably acting as Vatahara other wise anti histamine property byreducing the hyper responsiveness of airways is substantiated. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion164
  • 179. These agents block the acute bronco constricting effect produced by inhaledhistamine. They have also bronchodilator action4) Immuno-modulatary mechanism As the recurrence of the disease is because of lessened immunity, thepharmacological action i.e., immunomodulatory can be interpreted by the combination ofthese drugs. i.e., synergetic action which is as follows. 1. Eliminates the toxic metabolites and pollutants. 2. Preventing recurrent infection expelling the damaged cells 3. Nourishes and maintains the cell life. 4. Encouraging growth of new cells. Above all explanation with comparative to contemporary medical science we triedto propose the probable mode of action of these drugs.4. Assessment of Ardhedashemaniya Swasaharavati over subjective and objectiveparametersa) Mode of action of Ardhedashemaniya Swasaharavati over subjective parameters 1. Teevra vega Swasa (Dyspnoea) Swasakrichrata: In this study 100% patients i.e., out of 50,50patients reported this complaint after the treatment 21 patients were not relieved completely. But severity and frequency attack were reduced. Rests of 29 (58%) patients are relieved by their symptoms within the follow up schedule. It was observed that maximum patients were belongs to mild and moderate degree of Swasa kricchrata. Above mentioned data clearly shows that there is an effect of Ardhedashemaniya Swasaharavati over this subjective parameter. This is due to Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion165
  • 180. the trial drug is having such qualities like bronchodilator, anti-inflammatory, anti histamine, demulcent – immuno-modulator effect, as the Swasa kricchrata is result of the broncho-constriction (srotosanga), hyper-responsiveness of the airway due to inflammation and other patho-physiological causes. Like increased secretion of bronchial mucus airway smooth muscle contraction, gland and epithelial secretions and exudation in the air way lumens etc.,2. Kasa (cough): In this study out of 50 patients 47 patients (74%) were given the history of cough. Out of 47 patients 29 patients (61.7%) were relieved by their symptom. Remaining 18 (36%) were not relieved but maximum patients migrates severe to mild degree of cough. Kasa is due to irritation in the Pranavaha Srotas and another cause it is an effort to expel the Kapha. (malaroopa) secreted in the Pranavaha Srotas. The trial drug is having antagonistic quality like expectorant immuno-modulator, demulcent by these action subsides the kasa. The effect of drug Ardhedashemaniya swasahara vati is proved on this subjective parameter.3. Duhkhena Kapha nissaranam (Expectoration): In this study out of 50 patients 43 patients were got difficult expectoration. This is due to the over inflated lung with both large and small airways being filled with plugs comprising mixer of mucus. The drug disintegrates this pathology by its demulcent bronchodilator and expectorant actions. The mucus plugs smoothened by its demulcent property. Then arrowed airway try to dilate by its bronchodilator action expels out by its expectorant property. By this mechanism plugging of airways cleared of and make easy for respiration. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion166
  • 181. Out of 43 patients 23 (46%) patients improved a lot 20 patients (40%) improved severe to moderate to mild degree of expectoration. This study shows the there is a drug effect over this subjective parameter.4. Ghurghuratwam (Wheezing): The study shows that 50% of patients responded well out of 50 patients 25 patients (50%) improved severe to moderate to mild. This ghurgurakatwa occurs due to avarodha in Pranavaha Srotas due to Kapha. A wheeze is generated by vibration in the wall of an airway on the point of closer due to smooth muscle contraction. The drug which clears the srotorodha by the virtue of its actions. Anti inflammatory bronchodilator expectorant thee by it may improves the mucociliary clearance. This study shows that there is a effect of Ardhedashemaniya Swasaharavati over this parameter.5. Peenasa (Coryza): In this study out of 50 patients (100%) 33 (66%) patients were suffering from this symptom considered one of the symptoms of Tamaka Swasa and it is also preceding factor of this disease. Which induces the allergen induced inflammation and it is also caused by viral infections and specific allergens. Out of 33 patients (66%) 18 patients (54.54%) improved a lot. remaining 15 patients were improved moderate to minima. The drug which may inhibit stimulation of IgE machinism there by prevents the hyper secretion and hyper responsiveness of the airways, by its immunomodulatory, anti histamine antiviral activity. The study shows that the effect of trial rug proved on this parameter6. Kruchrena bhasate (Dysphonoea): In this study out of 50 (100%) patients 22 (44%) patients were reported these symptoms. This is due to the dyspnoea, and also due to tenacious mucous may be coated in the throat including vocal cords. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion167
  • 182. This is relived by the drug which is smoothened the mucus and expels out by its properties. There by it clears the passage of the airways and subsides the symptom. Out of 22 patients (44%),10 patients (20%) were got minimal improvement where as 12 (24%) patients were got well response out of 22 patients at the end 54.54% got relived . this study shows that there is a effect of trial drug over this parameter.7. Kantodhwamsham (Hoarseness of voice): Out of 50 patients only 12(24%) patients were reported out of 12 patients 5 (10%) patients minimal improved and 7 patients responded well at the end 58.33% were relived from the symptom. This is the effect of obstruction on the Pranavaha Srotas is the kantadwamsam. The shlesma accumulated in the kanta region obstructing the Pranavata causes the bubbling and resultant sound in kanta Pradesh. The result which is achieved by the action of the trail drug which is having Kapha hara sroto mardavakar, expectorant, etc. qualities.8. Greevashirasangraha (Headache & Stiffness): Out of 50 only 16 patients were reported this symptom. Out of 16 (32%) patients 7 (43.75%) patients result at the end of treatment. These may due to over inflammation of the lungs and patient feels some sort of discomfort t or ache or pain. Which is relieved by the drug action i.e., antiinflammatory analgesic quality of drug taken care of this.9. Urah Peeda (Chest Pain): In this study out of 50 patients 39 patients were reported uraha peeda. This is because of over inflation of lungs and patient feels some sort of discomfort or ache or pain in the bilateral sides of the chest. The drug Ardhedashemaniya Swasaharavati acted very effectively on this parameter. The Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion168
  • 183. analgesic and antiinflammatory actions relieves the pain or ache, the bronchodilator and expectorant qualities clears the airway passage. The data shows that out of 39 patients 23 patients i.e., 58.97% were relieved from the chest pain. 16 patients were got minimal improvement. This study shows that there is an effect of trial drug over this parameter 10. Shayane Swasa peedita (Discomfort at supine): In this study out of 50 patients 37 (74%) patients were reported for this symptom. This is due to lying down position the diaphragm is raised and reducing the lung volume. It may occur at any time or during the attack or night time. If it is night time because of the lowest serum adrenaline and cortisol and highest level of histamine during night hours could be the responsible for nocturnal episodes of asthma. The trial drug improves lung volume by its bronchodilator and anti inflammatory and expectorant effect. The trial drug also having anti histamine activity there by it compensate the level of histamine may be the these action at the end of the study out of 37 patients 23 patients were relieved i.e. 59.45% and remaining 14 patients responded moderate to mild.b) Mode of action of Ardhedashemaniya Swasaharavati over objective parameters i. Breath Holding Time: Breathing can be held for variable period of time by different individuals upon the functional status of lungs, development of respiratory muscles. This BHT is a simple test which provides useful in formation in health and disease of the lung. In this study breath holding time were assessed before and after the treatment. All 50 patients breath holding time recorded, this is highly Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion169
  • 184. variable person to person for that purpose we made eight group of intervals each interval shows 5 seconds difference. It was observed that maximum patients i.e. 35 (70%) were belongs to 5-10 group of interval and 5 patients were belongs to 0-5 interval and 10 (20%) belongs to 10-15 intervals. This is because of there is a broncho constriction, and bronchioles already partially occluded and there is a increased functional residual capacity and residual volume of the lung. This is reason why patients can not hold the breath long time. After the completion of treatment schedule again BHT has been documented maximum patients were shows less than 20 or 20 seconds i.e. 16 (32%) patients. 13 (23%) were belongs to 20-25 seconds group of interval and only 2 (4%) patients in 25-30 seconds group of intervals. All these considered as markedly improvement comparatively before treatment. 10(20%) patients and 7(14%) patients were belongs to 10-15 group and 5-10 group intervals respectively. These 7(14%) patients and 2 (4%) were remains 5-10, 0-5 group of intervals respectively. This study shows that there is effect of the trail drug over this parameter.ii. Peak expiratory flow rate: The Wright peak flow meter which measures PEFR is of special value in cases of asthma where the effectiveness of the treatment with bronchodilator can be evaluated. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion170
  • 185. In this study the lung function assessment was recorded with helpof this measurement. The readings were taken before and after thetreatment for the analytical study purpose we made eight groups ofintervals each interval difference is 50 lit/minute. (The normal PEFR 350lit/minute. It was observed that maximum patients i.e., 24 (48%) were belongsto 100-150 group of intervals. 16 (32%) were observed in 150-200 groupof intervals 9 (18%) patients were belongs to 50-100 group of intervals.Only one patient was belongs to the 200-250 groups of intervals. These clinical measurements shows greatly reduced maximumexpiratory rate and timed expiratory volume. This is because of thefunctional residual capacity and residual volume of the lung becomesgreatly increased during the asthmatic attack there by the difficulty inexpiring air from the lung. The bronchial diameter becomes more reducedthan during expiration than during inspiration. This is because theincreased intrapulmonary pressure during expiratory effort compresses theout sides of the bronchioles. Because the bronchioles are already partiallyoccluded further occlusion resulting from the external pressure createsespecially severe obstruction during expiration. So the Tamaka Swasapatient usually can inspire quite adequately but great difficult expiration. After the treatment it is observed that maximum patients i.e., 17 (34%)patients were belongs to 350-400 group of intervals 9 (18%) patients andone patient belongs to 300-350 and > 400 group of intervals all theseArdhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion171
  • 186. shows markedly improvement. 7 (14%) patients and 4 (8%) patients were belongs to 250-300 and 200-250 group of intervals respectively and shows moderately responded. 3(6%) and 4(8%) patients were belongs to 100-150 and 150-200 group of intervals respectively and shows poorly responded. 5 (10%) patients not responded to the treatment. This study shows the lung function improvement. The drug Ardhedashemaniya Swasaharavati it improves the lung function. Ardhedashemaniya Swasaharavati acts as anti inflammatory, analgesic bronchodilator, expectorant. Anti histamine anti viral, antibacterial, demulcent, etc., there by it clears the broncho construction reduces the inflammation and airway hyper responsiveness. Thus it improves the bronchiolar diameter decreases the intrapulmonary pressure reduces the functional residual capacity and residual volume of the lung and improves the expiratory rate.iii. Erythrocytes Sedimentation Rate: This test is being done before and after treatment there are minimal changes in the values of ESR. This facilitates to understand the possible presence of organic disease or to follow the course of the disease. This is universally accepted that it gives prognostic value. So the effect of Ardhedashemaniya Swasaharavati has very less impact over the parameter.iv. Absolute Eosinophilic Count: this test is being done to all the patients before and after treatment. It was observed that maximum patients i.e., 27(54%) patients were belongs to 450-500 cells/ cu mm group of intervals. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion172
  • 187. 15 patients (30%) observed 500-550 cells/ cu mm group of intervals. 3 (6%) and 2 (4%) patients from 550-600 and >600 group of intervals respectively. Eosinophils are phagocytes particularly effective in the elimination of parasite. They also participate in hyper sensitivity reactions. Especially in lungs Eosinophils play an important role, in the asthmatic inflammatory reaction which is being characterized by cellular infiltration rich in activated Eosinophils increase in number during allergic reactions as well. After the treatment the maximum i.e., 19(38%) and 17 (34%) patients were belongs to 300-350 and 200-250 group of intervals respectively. 3 patients were belongs to 250 300 group of intervals and shows that thee is a markedly reduced the number of Eosinophils. 3 (6%) patients remain same 1 patient 500-550 and 1 (2%) from 350-400 cells/cu mm group of intervals. In this group minimal reduction of Eosinophils were seen. It is proved that the effect of Ardhedashemaniya Swasaharavati on Eosinophils.5) Statistical discussion of parameters Individually all the parameters shows highly significance, as p value is <0.01. Butin the subjective parameters Swasakruchrata, Ghrgurukatwa, Kasa and Duhkhenakaphanissaranam shows highly significance than the Urahpeeda, Shanasya Swasa peedita(comparing Z values). In the objective parameters AEC, BHT and PEFR show highsignificance that the ESR (by comparing Z value). The parameter PEFR shows morevariation. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion173
  • 188. Further the analysis is done by using large sample test with specified mean value.The mean effect of PEFR, BHT after the treatment is improved with more variance. Themean value of AEC after the treatment is reduced than the before treatment with morevariance which is towards normal. The parameter ESR show high significance as p valueis < 0.01 after the treatment where the reduction in mean value after the treatment is withless variance than the before treatment. As sample size is more that 30 we use the technique of paired t-test to find out theeffect of the drug before and after the treatment. Here instead of the t-table value we usedthe Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is a large sample test to findthe p-value.6) Limitations of the study – 1. The sample size was small to generalize the result 2. Drug is being a compound form it was difficult to draw its direct mode of action. 3. Samples are selected incidentally.7) Future scope for the further study Long standing administration can also suggested. Pharmaco-dynamics of these drugs should be tried in different level and also to study the effect of other inflammatory cells. To study its effect with the help of Spirometry Immunological study can be done by comparing IgG and IgE levels. Long standing administration can also be suggested. Muhur muhur Aushadhi sevana in Tamaka Swasa can be tried Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Discussion174
  • 189. Chapter – 7 Conclusion A close perusal of the observation and interference for that can be drawn to thefollowing conclusion. By studying literature Tamaka Swasa can be compared with bronchial asthma. The Ardhedashemaniya Swasaharavati is very effective in reducing the subjective parameters of this study. And statistically highly significant i.e., p- value < 0.01 Ardhedashemaniya Swasaharavati increasing the lung function i.e. the PEFR and BHT. Which are statistically highly significant i.e., p <0.01 There is no relationship between the therapeutic effect of Ardhedashemaniya Swasaharavati gender and economical status. The individual drugs of Ardhedashemaniya Swasaharavati are acting as a bronchodilator anti inflammatory anti histamine and immuno modulator and expectorant. Ardhedashemaniya Swasaharavati is very economic safe and effective drug hence it can be employed in all cases of Tamaka Swasa. It can be used as preventive type of medication This Ardhedashemaniya Swasaharavati is new therapeutic option for optimizing the asthma control. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Conclusion175
  • 190. Chapter – 8 SummaryThe W.H.O. recognizes Tamaka Swasa vis-à-vis Asthma as a disease of majorpublic health importance and plays a unique role. The international action isneeded to stimulate research into the causes of asthma to develop new controlstrategies and treatment techniques and develop an optimal strategy for itsmanagement and prevention which increases public awareness of this disease.Tamaka Swasa is selected for research study to arrive at a specific, economic,and more effective, without side effects in the management, also selected theresearch to find out a new therapeutic option for optimizing asthma control.Keeping in the mind to establish the effect of Shamana therapy i.e.,Ardhedashemaniya Swasaharavati on Tamaka Swasa (Bronchial asthma) isstudied here.Initially at the dissertation Historical review, Vyutpatti, Nurukti, Paribhasha,Nidana, Lakshana, Sadhyasadhaya, Chikitsa, and Pathypathya of the TamakaSwasa as well as the contemporary medical descriptions are detailed as paravailable information. About the components of the drug, latest researches onthese individual herbs are procured.The research design was a pre-test and post test with an observational study of50 cases incidentally selected for the study. Patients were diagnosed on thebasis of symptomatology explained by Bruhatrayee (subjective parameter) andobjective parameters fixed on contemporary scientific descriptions andparameters. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary176
  • 191. Out of the 67 patients of Tamaka Swasa 65 (97.01%) were undertaken for thestudy. Out of 65 patients 15 (23.07%) patients were discontinued hence theirdate has not been included in the assessment. The remaining 50 (76.93%)patients of Tamaka Swasa vis-à-vis bronchial asthma fulfilling the criteria ofdiagnosis and inclusive criteria were included in the study. PEFR and BHTare considered as an objective for the inclusion in the present study.In this study recorded observations were analyzed, it reveled that 62% weremales in 31 patients, 38% were female (19 patients and more number ofpatients were belongs to 45-55 age group i.e., 20 (40%) patients. Hindureligion patients were more (92%) recorded. More patients were belongs tomiddle economical status, the dietary distribution does not show anydifferentiation.All the subjective parameters which are declared for the assessment of theArdhedashemaniya Swasaharavati are tabulated here in the table 42. Out ofthe symptoms, Swasa kruchrata i.e. teevra vega Swasa is found for all patientsinitially are relieved 58%. Another symptom found for all patients isGhurgurukatwam is relieved for the 50% of patients in the study. Kasa asymptom appeared for 47 patients initially relived 61.7% in the study. Nextbest appeared symptom is Duhkhena Kapha nissaranam for the 43 patientsnoticed relieved for the 53.48% of patients. Shayane Swasa peedita is the nextsymptom with 37 patients found corrected at the end by 59.45%. 39 patientsof Urahpeeda corrected at the end of study by 58.97%. Peenasa, a symptom ofthe Pranavaha Srotas always found associated with the Tamaka Swasa found Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary177
  • 192. for 33 patients got through by the end with 54.54% of relief.Greevashirasangraha (16 patients) and Kantodhwamsham (12 patients) are theother two symptoms of assessment got relief with 43.75 and 58.33percentages respectively. The tabulation is as expressed above.At the Objective Parameters assessment in Tamaka Swasa in the study ofArdhedashemaniya Swasaharavati five objective parameters are assessed areenlisted in the table 43. All these are of disease oriented and specific to assessthe Ardhedashemaniya Swasaharavati over the Tamaka Swasa vis-à-visBronchial Asthma. The table is followed as under. The objective parameters,PEFR AEL, BHT, show high significance then the ESR, the PEFR showsmore variation. All are shows statistically high significance i.e., P value is<0.01.Out of the assessments of objective parameters it is clearly understood that theBreath Holding Time (BHT) means are compared and observed that a lot of8.46 suggests that the lung capacity is enriched. This is conformed by thesecond significant test Peak Expiratory Flow rate (PEFR). In the PEFRreadings it is clear once again that the difference is as wide as 148.1, almostmore than 50% improvement. Oxygen is the most essential to live and that iscarried by the Red Blood Corpuscles and Haemoglobin. The Hb% in theblood are studied as one of the parameter has 0.93 variance of mean showsthat the drug even has the effect over the increasing the haemoglobin andRBC. The next best prognostic and also estimating objective parameter is theErythrocyte Sedimentation Rate; record the marked decrease, which is a Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary178
  • 193. significant of disease regression, is 0.9 difference to that of baseline data tothe final data. As many as Pranavaha Srotas symptoms are seen along with theTamaka Swasa needs the Absolute Eosinophilic Count as the parameter isstudied here and observed that 177 mean AEC decrease.As sample size is more that 30 we use the technique of paired t-test to find outthe effect of the drug before and after the treatment. Here instead of the t-tablevalue we used the Z-table value {Z table at 5% = 1.96, 1% = 2.58}, which is alarge sample test to find the p-value.The result in the study ascertains the best activity of the ArdhedashemaniyaSwasaharavati over the Tamaka Swasa vis-à-vis Asthma. For the conveniencethe results are grouped as four categories, viz. Well-Responded (WR),Moderately Responded (MR), Poorly Responded (PR) and Not-responded(NR). All these patients are studies with the cumulative percentages obtainedthrough subjective and objective Parameters is as under.As par the discussions made and the results observed in the study ofArdhedashemaniya Swasaharavati, the results are declared as under keepingthe all subjective and objective parameter developments in view. Afterthrough study of the entire parameters and materials available for theassessment of results it was drawn a conclusion of results as - 27 (54%) wellresponded, 11 (22%) moderately responded, 7 (14%) poorly responded and 5(10%) patients not responded and the 12 patients discontinued in the study,were not considered for the result declaration. The tabulated result and pi-diagram graphical expression is as under. Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Summary179
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  • 201. 170) Satya Narayan Shastri, Charka Samhita Chikitsa 17/92, Chakrapani, 1st ed. 2001, Choukumbha Bharati Academy, Varanasi, pp 521171) Ibid, 17/47, pp 529172) Ambika Datta Shastri, Susruta Samhita Uttara 51/46-47, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p 381173) K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, 4/25, 2nd ed, 1996, Krishnadas Academy, Varanasi, pp 249174) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 1-8 sl, 5th ed, 1993, Choukumbha Sanskrit samsthan, Varanasi, pp 435-36175) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, 6th ed, 1981, Choukumbha Samskrut Pratistan, Varanasi, pp 339176) Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 2nd ed. Choukumbha Samskrut Samstan, Varanasi, 1983. pp 218-20177) P.V. Sharma, Dravya guna vignyana, Vol 2, Chukumba Bharati academy, Varanasi, 2001, pp 292-93,296-97,338-40,513-16,640-41.178) P.V.Sharma, Dhanvantri nighantu 1/60-61, 65-66, 2/93-94, 3/83-84, 4/45-46, Chukumba Sanskrit samsthana, Varanasi, 1982 pp 26, 27, 87, 129, 106.179) P.V.Sharma, Kaideva nighantu, 1/1392-93, 1320-22, 3192-24, 1551-55, 247-50, Chukumba orientalia, varnasi, 1979, pp 258, 244, 61, 633, 49180) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan, Bombay, 1996, pp 608,683,565,865,949181) Phillips. R. and Rix. M. Bulbs Pan Books 1989 ISBN 0-330-30253-1182) Chopra. R. N., Nayar. S. L. and Chopra. I. C. Glossary of Indian Medicinal Plants (Including the Supplement). Council of Scientific and Industrial Research, New Delhi. 1986183) Medicinal Plants of Nepal Dept. of Medicinal Plants. Nepal. 1993 - Terse details of the medicinal properties of Nepalese plants, including cultivated species and a few imported herbs.184) [Tsarong. Tsewang. J. Tibetan Medicinal Plants Tibetan Medical Publications, India 1994 ISBN 81-900489-0-2, A nice little pocket guide to the subject with photographs of 95 species and brief comments on their uses.185) Genders. R. Scented Flora of the World. Robert Hale. London. 1994 ISBN 0- 7090-5440-8, An excellent, comprehensive book on scented plants giving a few other plant uses and brief cultivation details. There are no illustrations.186) Purmhothaman, K. K. et al.: J. Res. Ind. Med. 7: 39 (1972)187) Singh, N. et al.: J. Res. Ind. Med. Yoga & Homeo. ll: 3 (1976)188) Mishra, S. H. et al.: ind. Drugs, p.141 (1979)189) Tripathi, V. D. et al.. Ind. J. Pharm. Sci. 40: 129 (1978)190) Kirtikar, K. M. and B. D. Basu: Indian Medicinal Plants, Bishen Singh Mahendrapal Singh, Dehradun (1985)191) Patel V, Banu N, Ojha JK, et al. Effect of indigenous drug (Pushkarmula) on experimentally induced myocardial infarction in rats. Act Nerv Super 1982; Suppl 3:387-394192) Singh RP, Singh R, Ram P, Batliwala PG. Use of Pushkar-Guggul, an indigenous antiischemic combination, in the management of ischemic heart disease. Int J Pharmacog 1993; 31:147-160 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References VIII
  • 202. 193) Tripathi SN, Upadhyaya BN, Guptha VK. Beneficial effect of Inula racemosa (Pushkarmoola) in angina pectoris: a preliminary report. Ind J Physiol Pharmac 1984; 28:73-75194) Botanical Magazine t., 1847. Of G. indica, Bentley and Trimen, Med. Plants, 32195) Sailaja srivatsava, Sharangadhara Samhita, Poorvakhanda, 6/1, 2nd ed, 1998, Choukumbha Orientalia, Varanasi, pp 173196) Ambika Datta Shastri, Susruta Samhita Uttara 45/39-40, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p 171197) Aspi F Golwal, Golwal Physical Diagnosis, 8th ed, 1999, Media Promotors and Publishers pvt. Ltd. Mumbai, pp 346 - 375198) NAEP, 1991, Guidelines for the diagnosis and management of asthma, www.niaid.nih.gov199) Ibid, www.niaid.nih,gov200) Siddarth B. Shaha ed, API Textbook of Medicine, 7th ed, 2003, The Association of physicians of India, Mumbai, pp 294201) Ramnik Sood, Medical Lab Technology, 4th ed, 1994, Jaypee Brothers, New Delhi, pp 194-95202) Ibid, pp 184-85203) Ibid, pp 234 Ardhedashemaniya Swasaharavati in the management of Tamaka Swasa - Bibliography References IX
  • 203. SPECIAL CASE SHEET FOR THE EVALUATION OF “ARDHEDASHEMANEEYA SWASAHARAVATI” IN TAMAKA `’SWASA POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) SHRI. D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAGGuide: Dr .V. Varadacharyulu Scholar:Co-Guide: Dr. K.S.R. Prasad B.L.Kalmath1) Name of the Patient Sl.No2) Sex Male Female OPD No3) Age Years IPD No4) Religion Hindu Muslim Christian Other5) Occupation Sedentary Active Labor6) Economical status Poor Middle Higher middle Higher class7) Address Pin8) Birth data Place of Birth AMDate Month Year Time Hours Minutes PM9) Selection Included Excluded10) Schedule dates Initiation completion11) Result Well Moderately Not Discontinued Responded Responded respondedINFORMED CONSENT I Son/Daughter/Wife of am exercising my free will, to participate in above study as a subject. I have been informed tomy satisfaction, by the attending physician the purpose of the clinical evaluation and nature ofthe drug treatment. I am also aware of my right to opt out of the treatment schedule, at anytime during the course of the treatment. Patients Signature If the patient have status Asthmatics or under modern medication or Pregnant and lactating women or of 3 years-chronic symptoms are excluded. 1
  • 204. 12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints Duration Remarks1 Teevra vega Swasa (Dyspnonea)2 Kasa (cough)3 Duhkhena Kapha nissaranam (Expectoration)4 Ghurghuratwam (Wheezing)5 Peenasa (Coryza)6 Kruchrena bhasate (Dysphonoea)7 Kantodhwamsham (Hoarseness of voice)8 Greevashirasangraha (Headache & Stiffness)9 Urah Peeda (Chest Pain)10 Shayane Swasa peedita (Discomfort at supine)13) ASSOCIATED COMPLAINTS Associated Complaints Duration Remarks1 Anidra (disturbed sleep)2 Pratamyati or Bhrushamarta (distressed)3 Aruchi (Anorexia)4 Vishukasyata (Dryness of mouth)5 Lalata sweda6 Trushna (Thirst)7 Angamarda (Malaise)8 Kampa (Tremors)9 Jwara (fever)10 Pramoha (fainting)11 Vamathu (nausea)12 Muhur Swasa (frequent respiration)13 Muhuchaiva dhamyati (puts all effort to breath)14) HISTORY OF PRESENT ILLNESSMode of onset - sudden / GradualCourse episodic/ continuous/ initially episodicFrequency of attack few hours / few days / few weeksDuration of attack continuous / intermittent / subsides with medicationMode of progress Typical / Rapid / Longtime non progressivePeriodicity seasonal / irregular / perennialPreceded by sneezing / nasal irritation/ coughSputum non purulent / purulentAggravating factors dust/ food/ smoke/ pets / pollensComfort posture at attack sitting/ lying/ standing/ forward bending15) Occupational History if any 2
  • 205. 16) PERSONAL HISTORYFood habits Vegetarian Mixed dietTaste preferred Sweet Sour Salty Pungent Bitter AstringentAgni Sama Vishama Manda TeekshnaKosta Mrudu Madhyama KruraNidra Day Night Sound DisturbedAddictions Tobacco Alcohol DrugsBowel habits Normal Loose ConstipatedMenstrual History Regular Irregular Amenorrhea MenopauseFamily history – Specify if any has the same diseaseTreatment Other system medications Bronchodialtorshistory Cortico steroids Other medicines RS Since how longHistory of past illness17) EXAMINATION(a) VitalsTemperature ºF Pulse / min Respiration rate / minHeight Cms Weight Kg Blood pressure mmHg(b) GeneralOedema Present Absent Icterus Present AbsentPallor Present Absent Cyanosis Present AbsentClubbing Present Absent Palpable Present Absent lymph nodes(c) Respiratory system Shape Normal / Kyphosis / Scoliosis/ Flattening/ over inflation Movement Normal / ReducedDarshana Resp. Rhythm Normal / Abnormal Respiration Thoracic/ Abdominal / Thoraco abdominal Accessory muscles Not involved / Involved / Inter coastal spaces Visible veins Absent / present Venous pulses Normal / Raised Tracheal position Centrally placed / DeviatedSparshana Pain / Tenderness Swelling Vocal fremitus Shape Symmetrical / Asymmetrical Lymph nodes Not palpable / palpable atAkotana Normal / Resonant / Hyper Resonant / Dull Type of breath Broncho-vesicular/ Vesicular / BronchialvanaShra Vocal resonance Normal / Increased/ Decreased/ Absent Resp. Sound Rales/ Ronchi/ Crepitating/ Plural Rub / 3
  • 206. (d) Dosha Examination (Ayurvedic)Desham (Deha) Bhumi Jangala Anupa Sadharana(a) Dosha Vata Pitta Kapha Vruddhi P e e ta K ar s h ya Ag ni s ada na m o o tr a ta K ar s hn ya P e e tan e tr a P r as eka U s h na k a mi t w a P e e ta v i t A l as ya K a mpa P e e ta tw ak S w e t ang a ta An aha Ad hiks hudh a Sh ee ta nga ta S h akr ud gr a ha A d hi dah a G ow r a v a B a la bhr msh a S l a th ang a ta N idr abhr ams ha Swas a P r a la pa K as a Bhrama Atinidra(b) Dosha Vata Pitta Kapha Kshaya Angasada Mandagni Bhrama Alpabhashite Shareera Urah ahitam sheetatwam shoonyata Shira Chesta heenata Prabha hani soonyata Vyamoha Hridrava Sandhi Sleshma vruddhi saidhilyaNadi V P K VP VK PK VPKPrakruti V P K VP VK PK VPKSara Pravara Avara MadhyamaSamhanana Susamhita Asamhita Madhyma samhitaPramana Height in Cms Weight in KgsSatmya Ekarasa Sarvarasa Ruksha SnehaSatwa Pravara Avara MadhyamaAhara Shakti Abhyavaharana JaranaVyayam Shakti Pravara Avara MadhyamaVaya Balya Yauvana Vardhakya Nadi Dosha Mutra Pravrutti Gati VarnaAstasthana Purnata Gandha Spandana Kathinya Jihwa Ardra Sushka Mala Sama Nirama Lepa Nirlepa Shabda Sparsha Sheeta Ushna Drik Akruti 4
  • 207. (e) Srotas Lakshana Status Lakshana StatusPranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa SashoolamAnnavaha Aruchi Ajeerna Chardi AnannabhilashaUdakavaha Jihwashosha Talushosha Ostashosha Pipasa18) Tamaka Swasa Nidana Visamashana (V) Tilataila (P) Pistanna (K) Masa (K) Adhyashana (V) Vidahi (P) Nispava (K) Dadhi (K) Anasana (V) Saluka (K) Vistambhi (K)Ahara Sheetashana (V) Guru dravyas (K) Amaksira (K) Visha (V) Jalajamamsa (K) Sheetapana (V) Anupa mamsa (K) Rukshanna (V) Abhishyandi (K) Rajas (V) Abhighata (V) Kanthapratighata (V) Urahpratighata (V) Vata (V) Dhuma (V) Karmahata (V) Marmabhighata(V)Vihara Sheeta Sthana (V) Apatarpana (V) Veganirodha (V) Usna (P) Sheeta ambu (V) Bharakarshita Shuddhi Atiyoga (V) Abhishyandi (V) Upacara (K) Ativyayama (V) Adhwahata (V) Gramya dharma (V) Divasvapna (K) Vata Ksataksaya Atisara VisucikaAnya / Vyadhi Avasta Udavarta Vibandha Panduroga sambandha Kshaya Anaha Dourbalya Pitta Rakta pitta Jwara Kapha Kasa Amapradosa Chardi Pratisyaya Amatisara19) Tamaka Swasa Poorvaroopa Poorvaroopa Status Poorvaroopa StatusHrutpeeda ParshwashoolaKshudra Swasa VibandhaShankha bheda AnahaShoola AratiPranavilomata Bhakta dweshaVaktra vairasya Admana 5
  • 208. 20) Tamaka Swasa Vikalpa Samprapti Santamaka PratamakaUdavarta JwaraRajaobhighata MoorchaAjeernaVata nirodha21) Upashaya and AnupashayaUpashaya Asheene labhate sowkhyam Sleshma vimokshante sukham Usnamchaivabhinandate Shayanasya sameerane parshwe ghrnnatiAnupashaya Shayanasya Swasa peedita Meghambu sheeta pragwata22) INVESTIGATIONS (Objective parameters)Investigations for screening Before AfterSputum examination (if necessary)Chest-X-Ray (if necessary)Objective parametersBreath holding time /sec /secPeak expiratory flow rate L/m L/mErythrocytes sedimentation rate mm/1st Hour mm/1st HourHemoglobin % Gm% Gm%Absolute eosinophilic count /cumm /cumm23) Treatment schedule of “ARDHEDASHEMANEEYA SWASAHARAVATI”Schedule Investigator’s observationDay 1Day 15Day 30Day 45(Final Follow up) 45th day Investigators Note: Signature of Guide Signature of Co-Guide Signature of Scholar (Dr .V. Varadacharyulu) (Dr. K. Shiva Rama Prasad) (B.L.Kalmath) 6
  • 209. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA BANGALORE Proforma for registration of subject for dissertation1) Name of the candidate and : KALMATH. BASAYYA.LINGAYYA address (in block letters) IRAKAL GADA POST KOPPAL TQ. DIST2) Name of the institute : Sri D.G. Melmalagi Ayurvedic Medical College, Post graduation & Research Centre, Gadag - 5821033) Course of study and subject : AYURVEDAVACHASPATHI (M.D.) KAYACHIKITSA4) Date of admission : October 20035) Title of the topic : EVALUATION OF THE EFFICACY OF ARDHEDASHEMANIYA SWASA HARA VATI IN THE MANAGEMENT OF TAMAKA SWASA6. Brief Review of Intended Work 6.1 Need for Study: The human body is continuously under the influence of environmental changessubjected to environmental pollution. Our urbanized life style and industrialization1 compoundthe problem. As a result of smoke and dust Pranavaha srotodushti occurs and terminates in to thediseases like Kasa, Swasa, Rajayakshma, etc. Among these Tamaka Swasa (BronchialAsthma) is very common disease of Pranavaha srotas2. The world health organization (WHO) estimated in 1998 that Asthma affects 155 millionpeople world wide, based on data collected in epidemiological studies in more than 80countries. These are estimating as Bronchial Asthma may affect as many as 300 million ofpopulation worldwide. Asthma rate has increased significantly in recent decade. The number of 1
  • 210. disability adjusted life years (DALYs) lost due to Asthma worldwide has been estimated at 15million per year. Asthma accounts for around 1% of all DALYs lost worldwide reflecting the highprevalence and severity of the disease. It is crucial that we should gain more insight in to itscausation and management3. Even though the scientific world has conducted extensive studies but couldn’t find a safeand effective medicine for this disease. Ayurveda treat this disease confidently and increase thequality of life in individuals and contributive several modalities of management. Amongst herbalcombination is said to be the best. Tamaka Swasa management has shifted from symptomaticrelief to disease control this can be achieved through usage of prophylactic category ofmedicaments. Asthma is considered to increase direct and indirect medical expenditures, so to reducethe cost of treatment also to prevent the disease. Ayurveda suggest cost effective managementof Tamak Swasa. To fulfill the ideology 5 herbs are selected from Swasa hara Dashemaniya ofCharaka as Ardhedashemaniya Yoga4.6.2 Review of Literature: The elaborated descriptions of Tamaka Swasa Nidana, Poorvaroopa, Roopa, 5,6,7Sadhya, Asadhyata and Chikitsa are reviewed from Bhruhatryees . The definition of TamakaSwasa enumerated in Susruta Samhita very well. Susruta 8 defined it as “ÌuÉvÉåwÉå SÒÌSïlÉå iÉÉqrÉÌiÉ xuÉÉxÉÉxÉ iÉqÉMüqÉiÉå” which means that the attack of Swasa with iÉqÉ:mÉëuÉåvÉ (Darkness) occurs speciallyduring Durdina. Durdina means or compared with aggravating season or climate “Vijayarakshita interpreted as it is a condition where the air is expired out by producing sound. Apart from above said references of Tamaka Swasa Laghutrayee references along withother classical references of Madhava nidana9, Yogaratnakar10, Bhavaprakasha 11 ,chakradatta12, Vangasen13, and Bhaishajya Ratnavali14 explained Tamaka Swasa disease andtreatment in detail. 2
  • 211. The etiology, pathology and the management of Bronchial asthma has been consideredas the Tamaka Swasa of the contemporary and reviewed from various texts of contemporarymedicine textbooks viz. Davidson’s TBM 15, Harrison’s TBM16, API text book of medicine17. The pharmaco dynamics and kinetics of the individual herbs of composition have veryefficacious result in hypothesis are studied from various contexts of textual references fromdifferent Samhita of Ayurveda and reviewed to found with its relevance to the present daystudy18.6.3 Objective of the Studies: - 1. To assess the effect of selected Dashemaniya compound in Tamaka Swasa 2. To assess the lung function’s improvement by Dashemaniya compound in Tamaka Swasa7. Material and Methods:7.1 Source of Data a. Patients: suffering from Tamaka Swasa will be selected from postgraduate Studies and research center, Dept of Kayachitsa OPD and IPD of DGM Ayurvedic Medical College & Hospital by Pre-set inclusion & exclusion criteria. b. Literary: Literary aspect of study will be collected from classical Âyurvedic texts and contemporary texts with updated recent medical journal. c. Trial Drugs19,20,21,22 : The combination will be equal parts of Ardhedashmaniya Swasahara yoga is as follows. 1. Shati : Hedychium spicatum 2. Pushkaramool : Inula recemosa 3. Amlavetas : Garcinia Pedunculata 4. Tulasi : Ocimum sanctum 5. Bhumyamalaki : Phyllanthus Urinaria All the herbs will be identified and purchased from local area. Good Manufacturing Practice will be followed for preparation of vati. 3
  • 212. 7.2 Method of collection of data:a. Study designs: Observational Clinical Studyb. Sample: Minimum 50 patients are taken in randomized selection.c. Exclusion Criteria: The following were the criteria to exclude the patients of Tamaka Swasafrom the study. 1. Patients with infective disease or other systemic disease and status Asthmatics cases are excluded. 2. Patients below 14 years & above 60 years are excluded from the study. 3. Patients undertaking modern medication are excluded. 4. Pregnant and lactating women are also excluded.d. Inclusion Criteria: 1. Patients other than exclusion criteria are included 2. Patients with symptoms of Tamaka Swasa are included a. Teevra vega Swasa (Dyspnonea) b. Kasa (cough) c. Duhkhena Kapha nissaranam (Expectoration) d. Ghurghuratwam (Wheezing) e. Peenasa (Coryza) f. Kruchrena bhasate (Dysphonoea) g. Kantodhwamsham (Hoarseness of voice) h. Greevashirasangraha (Headache & Stiffness) i. Urah Peeda (Chest Pain) j. Shayane Swasa peedita (Discomfort at supine) 4
  • 213. e. Criteria of Diagnosis: 1. The symptoms and signs of Tamaka Swasa mentioned in Ayurvedic texts in comparison with contemporary medical science 2. Objective parameters with relevance investigations mentioned in contemporary texts will be the basis of diagnosis.f. Posology : 3gm/day in divided doses/24 hrsg. Study Duration: 30 Daysh. Follow up : 15 daysi. Assessment of Result: Subjective and objective parameters of base line data to aftertreatment data comparison is done for the assessment of results. Results are assessed fromsubjective and objective parameters of pre declared.j. Subjective Parameters: a. Teevra vega Swasa (Dyspnonea) b. Kasa (cough) c. Duhkhena Kapha nissaranam (Expectoration) d. Ghurghuratwam (Wheezing) e. Peenasa (Coryza) f. Kruchrena bhasate (Dysphonoea) g. Kantodhwamsham (Hoarseness of voice) h. Greevashirasangraha (Headache & Stiffness) i. Urah Peeda (Chest Pain) j. Shayane Swasa peedita (Discomfort at supine)k. Objective Parameters 23 : 1. Peak expiratory flow rate. 2. Erythrocytes sedimentation rate. 3. Absolute eosinophilic count. 5
  • 214. l. Statistical assessment: The paired “t” test, unpaired “t” test and non-parametric test areused to test the hypothesis. If “P” < 0.05, the test is highly significant.7.3 Investigation for exclusion: 1. Sputum examination (if necessary) 2. Chest-X-Ray (if necessary)7.4 Ethical Clearance : Obtained, certificate enclosedReferences :1. Petersdorf R.G editor, Harison principles of internal medicine,Vol-2, 252 ch. 14th ed. India: Mcgraw Hill, New York, 1998.p 1419 to 1426.2. Satya Narayan Shastri, Charka Samhita Chikitsa 17/13, 17, 22nd ed. Choukumbha Bharati Academy, Varanasi, 1996. pp 509-103. http://www.globalburdenasthma.com,4. Ganga Sahay Pande ed, Charka Samhita Sutra 4/37, 2nd ed. Choukumbha Samskrut Samstan, Varanasi, 1983. pp 675. Ambika Datta Shastri, Susruta samhita Uttar Tantra 51/8, 13th edition, Choukumbha Sanskrit samsthana, Varnasi, 2000, p 3746. Satya Narayan Shastri, Charka Samhita Chikitsa 17/1-6, 55-62, 68-83, 121, 147-48, 155, 22nd ed. Choukumbha Bharati Academy, Varanasi, 1996. pp 508-5317. Ambika Datta Shastri, Susruta samhita Uttar Tantra 51/1-6, 8-10, 14-15, 13th edition, Choukumbha Sanskrit samsthana, Varnasi, 2000, p 372-3788. Srikanta Murty, Astanga Hrudayam Nidana 4/6-10, Chikitsa 4/1-51, 2nd ed, Chukumba orientalia, Varanasi, 1995, pp 38, 245-549. Shri Sudarshan Shastri ed, Madhava Nidana, Vol-1, 12/27-41, 15th ed, Madhukosh commentary, Chukumba Sanskrit samsthan, Varanasi, 1985, pp 290-30110. Vaidya Shri Laxmi Pathishastri ed, Yogaratnakara, Swasa Adhikara, 1-8 sloka, 5th edition, Chukumba Sanskrit samsthan, Varanasi, 1993, pp 427-37 6
  • 215. 11. Brahmsankar Misra, Bhava Prakash, 14th chapter, 5th edition, Chukumba orientalia, Varanasi, 1980, pp 150-16612. P.V.Sharma ed, Chakradatta, Hikkaswasa Chikitsa 12/1-30, 5th edition, Chukumba publishers, Varanasi, 1998, pp 149-15313. Shri Shaligramaj Vaishy, Vangasena, Swasa roga, 1-86, khemaraja shri Krishnadas prakashana, Mumbai, 1996, pp 265-7114. Ambikadatta Shastri, Bhaishajya Ratnavali, Hikka swasa Chikitsa, 16/1-139, 2nd ed, Chukumba Samskruta samstan, Varanasi, 1981, pp 329-33915. C.R.W Edwards ed, Davidson’s Principals and Practice of the medicine,6th chapter- Disease of Respiratory system, 17th edition, Churchil Living stone, Edinburg, 1995, pp 336-34416. Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th ed. India: Mcgraw Hill, New York, 1998.p 1419 -1426.17. G.S.Sainani ed, API text book of medicine, sec-6, 7th chapter, 6th edition, Association of physician of India, Mumbai, 1999, pp 226-3018. Ganga Sahay Pande ed, Charka Samhita Sutra 25/40, 2nd ed. Choukumbha Samskrut Samstan, Varanasi, 1983. pp 218-2019. P.V. Sharma, Dravya guna vignyana, Vol 2, Chukumba Bharati academy, Varanasi, 2001, pp 292-93,296-97,338-40,513-16,640-41.20. P.V.Sharma, Dhanvantri nighantu 1/60-61, 65-66, 2/93-94, 3/83-84, 4/45-46, Chukumba Sanskrit samsthana, Varanasi, 1982 pp 26, 27, 87, 129, 106.21. P.V.Sharma, Kaideva nighantu, 1/1392-93, 1320-22, 3192-24, 1551-55, 247-50, Chukumba orientalia, varnasi, 1979, pp 258, 244, 61, 633, 4922. K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan, Bombay, 1996, pp 608,683,565,865,94923. G.S.Sainani ed, API text book of medicine, sec-3, 2nd 3rd 4th chapters, 6th edition, Association of physician of India, Mumbai, 1999, pp 214-20 7
  • 216. 9. Signature of the Candidate: - KALMATH.B.L10. Remarks of the Guide11. Name and Designation11.1 Guide : Dr.V.VARADACHARYULU M.D.(Ayu) Professor and HOD P.G.S. & R.C.D.G.M.A.M.C. Gadag11.2 Signature :11.3 Co-Guide : Dr.SHIVA RAMA PRASAD KETHAMAKKA M A (Jyo) M.D.(K.C) (OSM) READER IN KAYACHIKISTA P.G.S & R.C. D.G.MA.M.C. Gadag.11.4 Signature :11.5 Head of the Department : Dr.V.VARADACHARYULU M.D.(Ayu) Professor and HOD P.G.S. & R.C.D.G.M.A.M.C. Gadag11.6 Signature :12 Remarks of Chairman & Principal:21.1 Signature : Dr. G.B. Patil Principal /CMO 8

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