Role of Panchakarma in Chronic Obstructive Pulmonary Disorder.

1. ROLE OF PANCHAKARMA IN
CHRONIC OBSTRUCTIVE
PULMONARY DISORDER

2. Chronic Obstructive Pulmonary Disease
• 1837 – Dr William Stokes Ist reported chronic bronchitis
• Named as Chronic Obstructive Lung Disease
• 1965 - Dr William Briscoe changed to COPD
• A chronic inflammatory lung disease that causes
obstructed airflow from the lungs
• Pulmonary disease (such as emphysema or chronic bronchitis) that is
characterized by chronic typically irreversible airway obstruction
resulting in a slowed rate of exhalation [Websters Med Dictionary]

3. How lungs are affected ?
Air into lungs via
trachea – bronchi-
bronchioles- alveoli
Air sacs have very thin walls that
expands and full of tiny blood vessels
(capillaries), exchange of O2 and CO2 into
blood takes place here.
COPD causes them to lose their elasticity and
over expand, which leaves some air trapped in
your lungs when you exhale + Inflammation result
In mucus production and narrowing air ways

4. Emphysema Chronic Bronchitis
This lung disease causes destruction of the fragile
walls and elastic fibers of the alveoli. Small airways
collapse when you exhale, impairing airflow out of
your lungs.
Bronchial tubes become inflamed and narrowed and
your lungs produce more mucus, which can further block
the narrowed tubes

5. COPD PATIENT CLASSIFCATION
PINK PUFFERS BLUE BLOATERS

6. SIGNS & SYMPTOMS
symptoms often don't appear until significant lung damage has occurred
• For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three
months a year for two consecutive years.
• Shortness of breath, especially during physical activities
• Wheezing
• Chest tightness
• Morning cough with phlegm
• A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
• Blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
• Swelling in ankles, feet or legs
EXPERIENCE EPISODES CALLED EXACERBATIONS, DURING WHICH THEIR SYMPTOMS BECOME
WORSE THAN USUAL DAY-TO-DAY VARIATION AND PERSIST FOR AT LEAST SEVERAL DAYS.

7. Risk factors
• Exposure to tobacco smoke
• People with asthma who smoke. The combination of asthma, a chronic
inflammatory airway disease, and smoking increases the risk of COPD even more
• Occupational exposure to dusts and chemicals
• Exposure to fumes from burning fuels
• Age. COPD develops slowly over years, so most people are at least 40 years old
when symptoms begin
• Genetics - The disease results from a genetic disorder that causes low levels of a
protein called alpha-1-antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and
secreted into the bloodstream to help protect the lungs

8. COMPLICATIONS
•Respiratory infections. People with COPD are more likely to catch colds, the flu
and pneumonia. Any respiratory infection can make it much more difficult to breathe
and could cause further damage to lung tissue. An annual flu vaccination and regular
vaccination against pneumococcal pneumonia can prevent some infections.
•Heart problems. COPD can increase your risk of heart disease, including heart
attack. Quitting smoking may reduce this risk.
•Lung cancer. People with COPD have a higher risk of developing lung cancer.
Quitting smoking may reduce this risk.
•High blood pressure in lung arteries. COPD may cause high blood pressure in
the arteries that bring blood to your lungs (pulmonary hypertension).
•Depression. Difficulty breathing can keep you from doing activities that you enjoy.
And dealing with serious illness can contribute to development of depression.

9. DIAGNOSIS
• Lung (pulmonary) function tests Measure the inflow and outflow of air. If lungs deliver enough
O2 to blood
 Spirometry is the most common lung function test – It can use for diagnosis (even before
symptoms appearing), to check the progress with treatment
 Other lung function tests include measurement of lung volumes, diffusing capacity and pulse
oximetry.
•Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can
also rule out other lung problems or heart failure.
•CT scan – to detect emphysema, lung Ca, benefit from surgery
•Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood
and removing carbon dioxide.
•Laboratory tests- Not effective in diagnosing COPD, but may find the cause of your sympotms. Eg. Aat
deficiency
SYMPTOMS GOES ON INCREASING ONLY

10. Samprapthi 1 &/OR 2
Smoking
Dust
Fumes
Occupational gases
Air pollution
Pranavaha srotas
Udakavaha srotas
Annavaha srotas
Infective cough
Dyspnoea
Anxious
Blushy
Thin appearance
NIDANA
- Agantuja
SROTOVAIGUNYA
- Sangam
- Vimargagamana
DOSHA KOPA
- VPK
• GENETIC
• AIRWAY
HYPERSENS
ITIVITY
NIDANA
-
NIJA
PRANAVAHA
SROTAS
UDAKAVAHA ,,
ANNAVAHA ,,
SROTOVAIGUN
YA
ATIPRAVRUTTI
VIMARGAGA
MANA
• RECURRENT
COUGH WITH
SPUTUM
• HYPOXIA
• OEDEMATOUS
• CYANOTIC
DOSHA
KOPA
VKP

11. SWASA
• Tamaka swasa has lakshanika samyata with COPD , but Kapha pradhana vyadhi
• In COPD can see tridoshaja samprapthi hence better to manage in general Swasa chikitsa
line considering Amsamsa dosha and Rogi bala
• Swasa samprapthi – Uparodha to prana vata by pravrudha kapha
• Acc to Sus/U/51/48
श्वासहिक्कापरिगतं हिग्धै: स्वेदैरुपाचिेत्
आक्तं लवणतैलाभ्ां तैिस्य ग्रहिता कफ:
स्वस्िो हवलयनं याहत मारुतश्च प्रशाम्यहत
For gradhitha kapha do lavana thaila abhyanga – sweda. Do kapha vilayanam and vata
anulomana
• After swedana – Rasoudana – dhumapana
• Dhumapana yoga
- Manasila, devadaru, patraka, erandamula, laksha, guggulu – with sari
- Yava, madana ,Salaniryasa – with sarpi
- Turushka, sallaki, gugguluadi yoga – with sarpi

12. स्नेहबस्तिं विना क
े वित् ऊर्ध्व िाधश्च शोधनम् |
मृदु प्राणितािं श्रेष्ठिं श्वाविनामावदशस्ि वह || (Su/U/51/15)
Urdhwa sodhana – Vamana
Adha sodhana – Virechana Mrdu sodhana = apeedakaram
Sneha basthi – contraindicated due to avasthavasat
Snehana -1. Purana ghrita (> 10 yrs) processed with abhaya, hingu and bida
2. Saouvarchala, abhaya, bilva purana ghrita
3. Vidarigandha ghrita with pippali kalka Swasa kaso vyapohati
4. Ghrita added with panchalavana
5.Himsradi ghrita – arsa, gulma, atisara,kshayhara
6.Vasa ghrita – Pitta pradhana as seeta added with madhu
7.Srngyadi, Suvahadi, Sauvarchaladi, gopallavadi ghrita, taleesatamalkyadi ghrita – Sarva swasaharam param
In Dalhana Teeka – PV pradhana –ghrita and K taila is advised
9. Bhringarajarasa taila – K pradhana avastha, Shadpala ghrita – Vatika
Pandu roga and Sodha roga yogas are Swasa Kasahara
बलीयवि कफग्रत िमनिं िविरेिनम् |
Durbala and ruksha – do tarpana with mamsa rasa, aanupa, jangala and mesha (Sus)
• Vamana yoga- vata avirodhi wth pippali lavana madhuyuktam – produce sroto sudhi, vata anulomana , sukha swasa(A
H/Chi/)
• Utkleshakara ahara - Snigdha anupa rasa , dadyuttara, matsya with sngdha anna

13. • Virechana for adhmana udavartha tamaka assoctn Sukhoshna anulomaka with
saindhava amlaphala
• Dhumapana – Sesha doshaharana – saghritayava varthi, guggulvadi varthi, salaniryasa
etc
• Swedaniya/ Aswedaniya –SEKAM- Sukhoshna sita ksheera, UPANAHAM – utkarika over
ura: kanda
• Tamaka Swasa –
• Vegavastha
1. Snehana – Snigdhairadou - salvana sneha (Cha/Su/13/98) & Su/Chi/25/30
2. Swedana – Nadi/ sankara / prastara – Sroto vilayana of grathitha K
3. Utkleshakara ahara like dadhi,snidghodana, mamsarasa
4. Vamana – pippalichurna , saindhava lavana, madhu
5. Dhumapana visudha srotasam – haridra erandamula,manasila(Cha/Chi/17/77)
6. Virechana – tamake tu rechane – P sthana samudbhava, (adhoamasaya Cha/Su/20/18) sopha harana,
phuphusa sonitaja, Apana viagunya followed by prana , Udakavaha srotodushti janya kleda
7. Vasti only by YR & Vangasena but no snigdha bastis
8. Kabala and gandusha- kandasthana gata Kaphahara
• Avega avastha –
• Deepana pachana
• Vatanaulomana
• Balya - brmhana

14. Rajayakshma/Sosha
• Saahasadi nidana sevana ––Urakshata-Srotomukha sangam/srotomukha ativivritatwa (Sus)–tridoshaja kopa
• Sahasadi nidanaa – srotorodha – rakta kshaya – dhatupaka – VPK kopa - Rajayakshma.
• Lakshnas like Vahnisadana , deha sadana, asnato api balakshaya, padasopha, swasa, kasa, sonita darsana , bhinna varna
(Sus) Jarjanorasa , kapha shteevanam, ura sula (Cha)
स्थिरावदिर्व विद्धेन घृतेनाजाविक
े न ि |
वस्नग्धस्य मृदु कतवव्यमूर्ध्ं िाधश्च शोधनम्||
आथिापनिं तिा कायं वशरिश्च विरेिनम् |(Su/U/41/32)
• Snehana – Sneha Sweda - Vamana – Virechana (Sramsana)
………… Sasneham yanna karshanam ……………
• Sthiradi ghrita/Vidaryadi dravya processed in aja or avika ghrita snehapana
• Mrdu sodhana – Vamana/ Virechana/ NB and Sirorechana (mrdu – yat karshanam na bhavati)
• For rechana – srotorodha – plihodarokta – Shadpala ghrita, Udaroktha – haritaki churna prastha, gavye payasi
maha vrksa ksheeram , chavya citraka danti ativishadi yoga
• Samsarjana – yava, godhuma, saali, mamsa rasa of jangala
• After attaining druda agni and nivrutopadrava do brmhana
• Brmhana snehapana – Grdhradaya mamsa ghrita – soshapaha kshoudra kana sameta
• Utsadana – turagandha yava punarnava

15. • Swedana – vatottara vata use atrakadi Sankara sweda
• Nadisweda – parswaarthi – Kseera (V), sneha aranaala anupamamsa, or panchamuli kashaya
• Vamana – Madanapippal, ksheera , madhukena/ rasena and
• Samsarjana with Laghvanna deepana yava godhuma seedhu arishta etc
• Navana yoga – Prapoundarika, madhuka, pippali, ksheera sarpi nasya – Shira parswa amsa
sulaghnam Kasa Swasa nibarhanam (Cha)
• Aalepana – Sira parswa amsa sula – Satapushpa kushta, chandana with ghrita (Cha/Chi/8)
• Pradeha with guggulu chandana ghrita etc (Cha)
• RASAYANA – Ela ajamoda,amalaka abhayaadi with ghrita, sitopala, vamsalochana, madhu into
lehya –Medhyam, swasam hanti swarabheda kasa hritsula pliha gulma grahani gada
• Nagabala rasayana with ksheera take as pippali rasayana , silajatu rasayana
• Agasthya haritaki (Cha/chi/18/57) Kasa, Swasa, Kshaya, Hrdroga
• Pippali rasayana (Cha/chi/1/3/32-35) – Pippali with kisumka kshara bhavitha ghrita bharjitha
taken with madhu- Kasa Swasa Kshaya Sosha ……
• Chayavanaparasha (Cha/Chi/1/63) Kasa,swasa
• Upacharet aatmavantam deeptagnimakrsham navam – Jitendriyam (Satvavajayam)
• Pathya – Udaravishaya , gurvadi archna , rudramantra
• Apathya – Krodha, shoka, asuya, striyam tyajet

16. Conclusion
सवेषां बृंिणेह्यल्पश्शक
ृ श्च प्रायशो भवेत्
नात्यिं शमने अपायो भृशो शक
ृ च्च कशशने
शमनै बृम्हणैश्चातो भूहयष्ठं तानुपाचिेत्
कास श्वासक्षय छहदश हिध्माश्चान्योन्य भेषजै : (A H/Chi/4/55-56)
Brmhana produce Alpa vyapad but manageable
But Sodhana produce vatakopa – apayi
Hence both brmhana and langhana need to be wisely administered

17. Research Papers
• Yoga-based pulmonary rehabilitation for the management of dyspnoea in coal miners
with chronic obstructive pulmonary disease: A randomized controlled trial.
doi: 10.1016/j.jaim.2015.12.001 Shows improvement in dyspnoea, fatigue, PR, Peripheral O2
saturation by Pranayama, Asanas, Counselling ,Meditation
• Efficacy of Vasadi syrup and Shawasaghna Dhuma in the patients of COPD(Shwasa Roga),
doi: 10.4103/0974-8520.68204 , Subjectively and Spirometric criteria significant improvement.
Contents of Shwasaghna dhuma: Yavakuta churna of seeds of Kantakari, Dry leaves of Dhatura,
Ajowan, Khurasani ajowan, Kalmishora, Haridra and Bhanga in equal parts- ref Anubhuta yoga
from bhaishajya ratnavali