effect of shvasahara avaleha in the management of …

EFFECT OF SHVASAHARA AVALEHA IN THE

MANAGEMENT OF TAMAKA SHVASA IN CHILDREN

By

RAHUL CHOUGULE

Dissertation Submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE

KARNATAKA

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATI

M.D. (Ayu) In

KAUMARABHRITYA

Under the guidance of

Dr. SHAILAJA.U

M.D. (Ayu), Ph.D.,

H.O.D & PROFESSOR

Department of Kaumarabhritya

DEPARTMENT OF POST GRADUATE STUDIES IN KAUMARABHRITYA

SDM COLLEGE OF AYURVEDA AND HOSPITAL

HASSAN - 573 201

2011

DEPARTMENT OF POST - GRADUATE STUDIES

IN KAUMARABHRITYA

SHRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL

HASSAN - 573 201

Certificate

This is to certify that the Dissertation entitled “Effect of Shvasahara

Avaleha in the Management of TamakaShvasa in Children” is the bonafide

record of research work conducted by “Rahul Chougule” under my direct

supervision and guidance as a partial fulfillment for the award of the degree of

M.D. in Ayurveda - Kaumarabhritya.

The candidate has fulfilled all the requirements of ordinances laid down in

the prospectus of Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka for the award of Degree of Ayurveda Vachaspathi (MD Ayu.) in

Kaumarabhritya.

I am fully satisfied with his work and recommend this dissertation to be

forwarded for adjudication.

Date: Guide :

Place: HASSAN Dr. SHAILAJA U.

H.O.D. & PROFESSOR

Dept. of P. G. Studies in Kaumarabhritya,

S D M College of Ayurveda & Hospital, Hassan

DEPARTMENT OF POST GRADUATE STUDIES IN

KAUAMARABHRITYA

SHRI DHARMASTHALA MANJUNATHESHWARA

COLLEGE OF AYURVEDA & HOSPITAL

HASSAN – 573 201

(Affiliated to R.G.U.H.S, Karnataka, Bangalore)

ENDORSEMENT BY THE HOD AND HEAD OF THE INSTITUTION

This is to certify that the Dissertation entitled “Effect of Shvasahara

Avaleha in the Management of TamakaShvasa in Children” is the bonafide record

of research work conducted by “Rahul Chougule” under the guidance of Dr.Shailaja

U, H.O.D. and professor, Dept. of P. G. Studies In Kaumarabhritya, S D M College of

Ayurveda, Hassan.

Dr. Shailaja U. Dr. Prasanna N. Rao.

Prof.& H.O.D. Principal

Dept. of P. G. Studies in Kaumarabhritya S D M College of Ayurveda & Hospital,


Hassan

Prof. Gurdip Singh

Director, Post Graduate Studies


Date:

Place: HASSAN

Drug Review

Effect of Shvasahara Avaleha in the management of Tamaka Shvasa in childern. 71

SHVASAHARA AVALEHA

Pushkaramoola Agaru

Jeevanti Amlavetas

Bhoomyamalaki Tulasi

Drug Review


Hingu Ela

Madhu Shati

Shvasahara Avaleha

Observations


GRAPHS

Chart No.C-01 Chart No.C-02


Chart No.C-06

Chart No.C-05

Observations





Observations


Chart No. C-19

Discussion


Graph no.20 Effect of treatment

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation / thesis entitled “Effect of Shvasahara

Avaleha in the Management of TamakaShvasa in Children” is a bonafide and

genuine research work carried out by me under the guidance of Dr. Shailaja.U,

Professor and H.O.D., Dept. of P. G. Studies in Kaumarabhritya, S D M College of

Ayurveda and Hospital, Hassan.

Date: Signature of the candidate

Place: Hassan Rahul Chougule.

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall

have the rights to preserve, use and disseminate this dissertation/ thesis in print or

electronic format for academic/ research purpose.

Date: Signature of the candidate

Place: Hassan Rahul Chougule.

© Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGEMENT

My gratitude, which is the mother of all virtues and most capital of all duties,

has all there order and diligence to all those who graciously involved in this venture

of mine. There is much greatness of mind in acknowledging a good turn, as in doing

it.

I humbly, seek this opportunity to bow my head to the feet of almighty Lord

Dhanwantari, Lord Gomateshwara and Lord Mahaveer for showering their

blessings and empowering me to this eventful outcome without any impediments.

Words are not enough to express my gratitude and indebt to the sacrifices of my

beloved and respected parents Mr. Vijay Chougule, Smt. Surekha and my

grandfather Late Jaykumar Digraje who are the cause for me to take this noble

profession and shape me into what I am today.

I pay my respectful salutations to his Holiness Poojya Shri Veerendra

Hegadeji, founder father of SDMCA&H, Hassan and fountainhead of educational

movements, for his divine blessings in disguise and who has been kind enough to

provide me an opportunity to study and render my service in this esteemed institution.

My vocabulary falls short of suitable words to express my recondite sense of

indebtedness to my compassionate teacher Prof. Prasanna N. Rao, Principal, who

has been guiding force and instrumental in all the proceedings of my postgraduate

study and stood as an excellent encouraging stanchion in all strides in accomplishing

this meticulous effort.

It is beyond the reach of my language to inscribe the profound respect and

devotion towards affectionate Prof. Gurdip Singh. Director, P.G. Board of Studies,

for his constant support, timely guidance and valuable suggestions to get this work

done successfully.

The words are inadequate to express with profound reverence my heartiest

gratitude and indebtedness to my guide Dr. Shailaja U. H.O.D. Dept of

Kaumarabhritya for her untiring help, close and constant attention with constructive

and valuable suggestions at every steps of this work.

I am extremely grateful to Dr. Srinidhi K Acharya. Asst. professor, Dept. of

Kaumarabhritya, for his constant support and guidance during my thesis work.I am

very thankful to Dr.Basavaraj Ganti, Dr.Reena Kulkarni, Dr.Govind Sharma,

Dr.Suhaskumar Shetti, Dr. Sudhakar Powar, Dr.Prakash Hegade, Dr.Tripathi,

Dr.Praveen B.S. and Dept. of Rasashastra.

I am very much thankful to my colleagues Dr. Shital, Dr.Amol, Dr.Nikhil,

Dr.Sarita, my seniors Dr.Shwetha, Dr.Arthi, Dr.Rahul, Dr.Prasad, Dr.Pravin,

Dr.Sudarshan, Dr.Vishal Chougule, Dr.Purushottam, Dr.Abhijit, Dr.Shine,

Dr.Ragamala and juniors Dr.Rushikesh, Dr.Amal, Dr.Sharash, Dr.Radha,

Dr.Ambika, Dr.Arya, Dr.Prashant, Dr.Sharvari, Dr.Vishvendra for their support

and encouragement throughout the research work. I am also thankful to Dr.Pankaj,

Dr.Rudramuni, Dr.Sadanand, Dr.Niranjan, Dr.Brijesh, Dr.Mayank Jain & my

all classmates. I am also thankful to my younger brother Chakravarti and his wife

Madhuri, my sister-in-law Trupti Patil, cousin brothers Kiran, Chandrashekhar,

Milind and all my Chougule, Digraje and Patil family for their kind support. I am

also specialy thankful to my juniors Dr.Jyoti B., Dr.Pratibha Murthi, Dr.Niraja,

Dr.Sahana, Dr.Saraswati, Dr.Basaveshwari and all who helped me knowingly

and unknowingly.

I express my deep sense of gratitude to my wife Dr.Krupanjali Chougule for

supporting, blessing, careing and praying for my success in life.

Rahul Chougule.

LIST OF ABBREVIATIONS

Ka.Sa. - Kashyapa Samhita

Cha. - Charaka Samhita

Su. - Sushruta Samhita

A.S. - Astanga Samhita

A.H. - Astanga Hridaya

B.P. - Bhava Prakash

Y.R. - Yoga Ratnakara

M.N. - Madhava Nidana

G.N. - Gada Nigraha

C.D. - Chakradatta

Sha.Sa - Sharangadhara Samhita

Su. - Sutrasthana

Sha - Shareera Sthana

Ni - Nidana Sthana

Chi - Chikitsa Sthana

I - Indriya Sthana

Ka - Kalpa Sthana

Si - Siddi Sthana

U - Uttara tantra

Khi - Khila Sthana

AEC - Absolute cosinophitea count

TC - Total Count

DC - Differential count

ESR - Erythrocyte Sedimentation rate

PEFR - Peak Expiratory Flow Rate

T.B. - Text Book

T.S. - Tamaka Shwasa

S.C. - Shringyadi Choorna

E.I.A. - Exercise induced asthma

H.I.A. - Hyperventilation induced asthma

LTD4 - Leukotrine D4

PAF - Platelate activating factor

PGD2 - Prostaglandin D2

UTRI - Upper Respiratory Tract Infection

RSV - Respiratory Syncytial Virus

NB - Note before

J.M. - Jamnagar I.P.G.T.& R.A. Gujarat Ayurveda University

A.D. - Ahmedabad, Govt. Ayurvedic College, Gujarat Ayurvedic University

B.U. - Varanasi, Faculty of Ayurveda, IMS., Banaras Hindu University

L.K. - Lucknow, State Ayurvedic College, University of Lucknow

J.P. - National Institute of Ayurveda, Rajasthan University

U.D. - Udaipur M.M.M Government Ayurvedic Colege, Rajasthan University

T.R. - Trivendrum, Govt. Ayurvedic College, Kerala University,

Thiruvananthapuram

H.Y. - Hyderabad, Government Ayurvedic College, Hyderabad

B.L. - Bangalore, Govt. College of Indian Medicine

M.Y. - Mysore, Govt. College of Indian Medicine

R.P. - Raipur, Govt. Ayurvedic College, Pt. Ravishankar University, Raipur.

G.W. - Gwaliar, Government Ayurvedic College, Jiwaji University, Gwaliar

P.U - Puri Government Ayurvedic College

C.A. - Calcutta, Post Graduate Centre, University of Calcutta

P.L. - Patiala Government Ayurvedic College

P.N.T - Pune Tilak Ayurveda Mahavidyalaya, Poona University

Astanga Ayurveda Mahavidyala, Poona University

N.D. - Nanded Govt. Ayu. Mahavidyalaya, Dr. Babu Saheb Ambedkar

Marathwada Vidyapith

N.G. - Government Ayurvedic College, Nagpur.

N.S. - Shri. Ayurveda Mahavidyala, Nagpur

B.M. - K.G. Mittal Punarvasu Ayurveda Mahavidyala, Bombay.

INDEX

Sl. No Contents Page No.

1. INTRODUCTION 01

2. REVIEW OF LITERATURE 03

3. DRUG REVIEW 46

4. MATERIALS AND METHODS 73

5. OBSERVATIONS 76

6. RESULTS 87

7. DISCUSSION 93

8. SUMMERY & CONCLUSION 101

9. REFERENCES 104

10. BIBLIOGRAPHY 109

LIST OF TABLES

Sr. no Content Page

No.

1 Nidana of Shvasa 04

2 samprapti of Tamakashwasa 13

3 Poorvaropa of Shvasa 19

4 Roopa of Tamaka Shvasa 23

5 Differencial Diagnosis of Extrinsic and intrinsic Asthma 27

6 Vyavacchedaka Nidana of Tamakashvasa 30

7 Sapeksha Nidana of Shvasa 31

8 Assessment of Severity of Asthma 32

9 List of Shamanoushadhi for Shvasa 41

10 Pathya and Apathya for Shvasa 45

11 Age wise Distribution 76

12 Sex wise Distribution 76

13 Religion wise Distribution 76

14 Education Status 77

15 Age of onset 77

16 Aggravating factors 77

17 Incidence of associated disorders 78

18 family history of Asthma 78

19 Dietary Habit-wise distribution 78

20 Prakruti wise distribution 79

21 Sara wise distribution 79

22 Samhanana wise distribution 79

23 Satwa wise distribution 80

24 Pramana wise distribution 80

25 Vyayama Shakti wise distribution 80

26 Showing Ahara Shakti of Tamaka Shvasa patients 81

27 Showing of Agni of Tamaka Shvasa patient 81

28 Showing Nature of kosta 82

29 Ahara Sambandhi Nidana 82

30 Effect of Shvasahara Avaleha on Breathlessness 87

31 Effect of Shvasahara Avaleha on Wheezing 88

32 Effect of Shvasahara Avaleha on Cough 88

33 Effect of Shvasahara Avaleha on Sputum 88

34 Effect of Shvasahara Avaleha on Common Cold 89

35 Effect of Shvasahara Avaleha on Day Time Asthama 89

36 Effect of Shvasahara Avaleha on Night Time Asthama 89

37 Effect of Shvasahara Avaleha on Discomfort 90

38 Effect of Shvasahara Avaleha on Tightness of Chest 90

39 Effect of Shvasahara Avaleha on Chest Pain 90

40 Effect of Shvasahara Avaleha on Loss of Sleep 91

41 Effect of Shvasahara Avaleha on Impact on Activity 91

42 Effect of Shvasahara Avaleha on Palpitation 91

43 Effect of Shvasahara Avaleha on the Mean Respiratory Rate 91

44 Effect of Shvasahara Avaleha on Frequency of Attack 92

45 Effect of Shvasahara Avaleha on Duration of Symptoms 92

46 Effect of Shvasahara Avaleha on PEFR 92

LIST OF GRAPHS

Graphs Content Page No.

1 Age wise Distribution 83

2 Sex wise Distribution 83

3 Religion wise Distribution 83

4 Education Status 83

5 Age of onset 83

6 Aggravating factors 83

7 Incidence of associated disorders 84

8 Family history of Asthma 84

9 Dietary Habit-wise distribution 84

10 Prakruti wise distribution 84

11 Sara wise distribution 84

12 Samhanana wise distribution 84

13 Satwa wise distribution 85

14 Pramana wise distribution 85

15 Vyayama Shakti wise distribution 85

16 Showing Ahara Shakti of Tamaka Shvasa patients 85

17 Showing of Agni of Tamaka Shvasa patient 85

18 Showing Nature of kosta 85

19 Ahara Sambandhi Nidana 86

20 Effect of Treatment 99

List of Diagrams – Drugs which are used in study

No 01 Pushkaramula

71

No 02 Agaru

No 03 Jivanti

No 04 Tulasi

No 05 Bhoomyamalaki (Tamalaki)

No 06 Amlavetasa

No 07 Hingu

72

No.08 Ela

No09 Madhu

No10 Shati

No11 &12 Shvasahara Avaleha

INTRODUCTION

Introduction

Effect of Shvasahara Avaleha in the Management of Tamaka Shvasa in Children 1

.

INTRODUCTION

Tamaka Shvasa is one among the five varieties of Shvasa explained in almost

all the classics of Ayurveda, which is analogous with bronchial asthma mentioned in

modern medicine. Since centuries Tamaka Shvasa remained to be a challenging and

unremitting disease. In both sexes it may occur at any age. Tamaka Shvasa is one of

the chronic diseases of children, which causes a lot of worries to the patients as well

as parents. It affects school attendance, play works, school performance, day to day

activities and growth of the child.

Bronchial asthma in children is a worldwide problem having an incidence rate

of 10-15% in boys and 7-10% in girls. In general population, about 80% of children

begin to have symptoms before the age of 4-5 years and 10% starts wheezing for the

first time in the later childhood. Thus asthma is a chronic respiratory disease in

children which is increasing day by day due to the mode of life, dietetic changes,

pollution environmental variations and various stimuli like dust, cold air, smoke,

pollens, house dust mite, viral respiratory track infections etc. Childhood asthma is

highly variable and may differ from patient to patient, so needs much attention and

care.

The younger asthmatic child is often very troubled by cough especially at

night rather than flank wheezing. So the diagnosis is often given as bronchitis or

spastic bronchitis rather than asthma. Chronic nocturnal cough is one of the symptoms

of asthma children. The older children with asthma, typically has episodic attacks of

wheezing and breathlessness, usually worst at night or early morning and are often

accompanied by cough, but little or no sputum production. The attacks are separated

by symptoms free interval and duration attach varies from patient to patient.

The nature of attacks of asthma and the pattern of recurrence varies

considerably from child to child and this has an importance on treatment.

Shvasahara Mahakashaya(Dashemani), which is indicated for Shvasa Roga

includes ten drugs like Shati (Hedychium spicatium), Pushkaramula (Inula racemosa),

Amlavetasa (Garcinia pedunculata), Ela (Elettaria cardamomum), Hingu (Ferula

narthex), Agaru (Aqualaria agalocha), Surasa (Ocimum sanctum), Tamalaki

Introduction


(Phyllanthus urinaria), Jivanti (Ledtadenia reticulate) and Chanda (Angelica glauca).3

Out of these drugs Chanda is not available so remaining 9 drugs will be prepared in

the form of Avaleha as it is palatable and easy for administration in pediatric age

group.

In the present single group study 40 patients of Tamaka Shvasa were

selected from Out Patient Department & In patient Department of Kaumarbhritya,

S.D.M.C.A. & Hospital, Hassan. And Shvasahara Avaleha was administered for the

period of 1 month.

The study was planned under following headings.

1. Literary review

2. Drug review

3. Clinical study

4. Discussion

5. Summary and conclusion

In the present single group study Shvasahara Avaleha as a Shamana Chikitsa

provided significant relief in the symptoms of the children suffering from Tamaka

Shvasa.

REVIEW OF

LITERATURE

Review of Literature


REVIEW OF LITERATURE

Tamaka Shvasa is one of the five varites of Shvasa Roga, explained in almost all the

texts of Ayurveda.

Nirukti

The term „Tamaka-Shvasa‟ consists of two words „Tamaka‟ and „Shvasa‟.

„Tamyati tamuglanou kwip anunasikasya iti deerghahai Shvasagati pratibandhaka

Doshaha’.

The word „Tamaka‟ is derived from the dhatu (root) „Tamu – glanau’ with ‘kvip’

pratyaya (syllable). It means to choke, be suffocated, darkness.

„Tamyati iti Tamaka’ Tama eva Tamaka’ i.e. where Tama occurs that is Tamaka.

Tama means –Darkness

The word „Shvasa’ is derived from the dhatu „shvas’ with „ghai’ pratyaya.

‘Shvasti iti Shvasah’ it means to – breathe, by which the respiratory movements take

place.

The term Tamakashvasa is formed by Karmadharaya Samasa as

“Tamakascha asau Shvasascha Tamaka Shvasaha” It means difficulty in breathing,

which mainly occurs during night time.

Paribhasha

Sushruta defined Tamaka Shvasa as “Visheshad durdine tamyeti shvasha sa

Tamako matah”.

The attack of Shvasa with Tamah-pravesha occurs specially during Durdina.

No commentator has mentioned the meaning of the word Durdina. Acharya Caraka

explained that Tamaka Shvasa gets aggravated when one is exposed to cloudy

atmosphere, cold water, cold weather, and wind blowing from eastern direction,

Kapha aggravating food and regimen. Hence the above conditions can be correlated

with durdina.

Vijayarakshita the commentator of MadhavaNidana explained in Shvasa Roga

the expired air produces sound similar to the sound of blow of blacksmith.



NIDANA PANCHAKA

Tamaka Shvasa is one of the diseases where Nidana Parivarjana and Samprati

Vighatana play an important role.

NIDANA

The term Nidana refers to all the factors, which causes initiation and progress of the

disease. Various etiological factors can be studied under 4 conventioanal headings as

listed in Table-1 to 4.

Table-1

Ahara Sambandhi Nidana of Shvasa Mentioned in Ayurvedic Texts

Nidana C.S S.S A.S A.H Y.R B.P M.N G.N

A. Ahara Sambandhi

Sheetapana + + + + + + + +

Sheeta Ashana + + - - + + + +

Guru Bhojana + + - - + + + +

Abhishyandi Bhojana + + - - + + + +

Rooksha Bhojana + + - - + + + +

Vidahi ahara + + - - + + + +

Vistambi ahara + + - - + + + +

Adhyashana + + - - + + + +

Shleshmala ahara + - - - - - - -

Jalaja Mamsa + - - - - - - -

Anoopa Mamsa + - - - - - - -

Ama Ksheera + - - - - - - -

Shaluka + - - - - - - -

Dadhi + - - - - - - -

Masha + - - - - - - -

Nishpava + - - - - - - -

VishAmashana + + - - - - - -

Puinyaka + - - - - - - -

Tila Taila + - - - - - - -

Pista padartha + - - - - - - -

Amla padartha - + - - - - - -



Table-2

Vihara Sambandhi Nidana of Shvasa Mentioned in Ayurvedic Texts

Nidanas C.S S.S A.S A.H Y.R B.P M.N G.N

B.Vihara Sambadndhi

Vata Sevana + + + + + + + +

Raja Sevana + + + + + + + +

Dhomma Sevana + + + + + + + +

Vyayama + + + + + + + +

Vegadharana + + - - - - + +

Sheeta Sthana - + - - + + + +

Sheeta snana - + - - + + + +

Sheetashana - - - - + + - -

Atapa Sevana + + - - - - - -

Bhara vahana - + - - + + + +

AdwagAmana + - - - - - - +

Abhishyandi upachara + - - - - - - -

Dwandwa Sevana + - - - - - - -

Table-3

Avastha Sambandhi Nidana of Shvasa Mentioned in Ayurvedic Texts


C.Vyadhi/Avastha sambadhi Nidana

Pratishyaya + + - - - - - -

Kasa - + + + + - - -

Jvara + - + + + + + -

Chardi + - + + + - - -

Kshata kshaya + - - - - - - -

Atisara + - + + + + + -

Vishoochika + - - - - - - -

Vibandha + - - - - - - -

Dourbalya + - - - - - - -

Udavartha + - - - - - - -

Raktapitta + - - - - - - -

Anaha + - - - - - - -

Pandu + - + + + - - -

Rookshata + - - - - - - -

Apstarpana + + - - + + + -

Shuddi Atiyoga



Table-4

Agantuja Nidana of Shvasa Mentioned in Ayurvedic Texts


D. Agantuja

Marmaghata + + + + + - - -

Visha + - + + + - - -

Kantorasa Pratighata + - - - - - - -

Acharya Caraka explains that the child feeding on Atisnigdha breast milk

suffers from Tamaka Shvasa. Chakrapani commeting on the Nidanas of Shvasa had

grouped them into Vata Prakopaka gana and Kapha Prakopaka gana, which are as

follow:

VATA PRAKOPAKA NIDANA:

Sheetapana, sheetasnana, Sheeta Vata and similar Nidanas causes sheeta Guna

vriddhi of Vata, which may in term causes the Kshobha and Sankocha in the Srotas.

Ativyayama, Adhvagamana, Bharavahana and Atapa Sevana may cause Dhatu

Kshaya as well as Vata Prakopa.

KAPHA PRAKOPAKA NIDANA:

Sheeta Sthana, Sheetashana, Sheeta Snana, Sheeta Vata etc causes increase in

Sheeta Guna of Kapha resulting in KaphaVruddhii. Dadhi, Masha etc are Guru and

Picchila in nature so excessive consumption of these food materials causes Kapha

Vriddhii. Vishamashana, Adhyashana and Abhishyandhi Bhojana cause Agnimandya

with resultant production of Ama. The Ama having similar Gunas of Kapha causes

Kapha Vriddhii.

Asatmya in our classics has been defined as “Shareerena saha yat athmatam

vikritha roopatham na yathi that. Ethena yadupayuktam prakrita roopopaghathakam

bahavathi that Asatmyami” i.e. which doesn‟t suit to the body constitution. Raja and

Dhooma are well known to produce Tamaka Shvasa symptoms especially in children.

Raja includes pollen grains, smoke, dust particles, animal danders, feather wool and

fungal spores.



NIDANARTHAKARA ROGA:

Acharya Gangadhara in the context of Shvasa Nidana has commented that the

diseases like Jvara, Kasa, Pratishyaya, Pandu, Kshatakshaya, Raktapitta, Udavarta,

Visoochika, Visha etc. cause Shvasa. According to Sushruta Apastamba, Stanamoola,

and Stanarohita Marma and according to Vagbhata Siramarma, Vishalyaghna Marma

Viddha causes Shvasa. Out of these pratishyaya and Kasa are known to produce

Tamaka Shvasa.

It is explained that Pratishyaya is Nidanarthakasa Roga for Kasa and if Kasa is

not treated properly then it leads to Shvasa i.e. “Kasa Vruddhya Bhaveta Shvasah”.

PITTASTHANA DUSTIKARAKA NIDANA

Acharya Caraka has explained Shvasa as Pitta Sthana Samudbhava Vyadhi.

Vagbhata and Cakrapani have explained it as Amashaya Samudbhava Vyadhi. All

etiological factors including Agnimandyakaraka and Amotpadaka Nidanas may be

grouped under this heading. These factors affect Pitta-Sthana, which may result in

Agnimandya and Ama formation. It is explained that „Rogah sarve api mandagne‟ i.e.

all the diseases are produced by Mandagni. Agnimandya and Ama have a definite role

in initiation and severity of Tamaka Shvasa.

KHAVAIGUNYA KARAKA NIDANAS:

Acharya Sushruta had explained that the vitiated Doshas while traveling all

over body, settles where there is Khavaigunya and produces Vyadhi therein.Thus

Khavaigunya in Pranavaha Srotas may occur due to many factors which causes

vitiation of Dosha. Thus Khavaigunya in Pranavaha Srotas may occur directly due to

Agantu Karanas like Raja, Dhooma, SheetaVata Sevana etc. It is also explained that

Pratishyaya & Kasa are Nidanarthakara Rogas for Tamaka Shvasa. Thus

Khavaigunyakaraka Nidanas are important factors which are responsible for Tamaka

Shvasa. This Khavaigunya may be compared to bronchial hyperreactivity or airway

hyperresponsiveness.



PROBABLE CAUSE FOR RECURRENCE OF TAMAKA SHVASA:

Caraka explains that, even if a disease is cured, it may reoccur by minor form

of etiological factors, which is true especially in case of Tamaka Shvasa. Acharya

Caraka also explains that when a person becomes weak due to earlier diseases and the

channels for the manifestation of the disease (here Pranavaha Srotas) becomes

vulnerable for the same disease then recurrence of the disease occurs.

Cakrapani commenting on the word „margeekrute’ told that

„Vyadhipratibandhakataya margasadrushikrute‟ i.e. person may not become resistant

to that Vyadhi. Caraka substantiated his statement by giving a simily that, after the

main fire is extinguished, a small quantity of fire is enough to flare up the same.

This principle can be applied in Tamaka Shvasa also. Because once the child

gets Tamaka Shvasa (asthma), the Pranavaha Srotas (airways) is vulnerable for the

same disease, whenever the child is exposed to Nidanas i.e. etiological factors. This

can be compared to bronchial hyper-reactivity or airway hyperresponsiveness. In most

of the cases bronchial hyperreactivity in association with triggering factors, will be

the main cause for childhood asthma.

ETILOGOY OF ASTHMA:

Asthma is a complex disorder involving autonomic, immunologic, infectious,

endocrine and psychologic factors in varying degrees in different individuals. Thus

asthma is a result of multifactorial inheritance.

ALLERGY

Airway inflammation related to allergic processes is of fundamental

importance in asthma especially in childhood asthma. Here the problem is to detect

the specific allergens for a particular individual in the initiation and persistance of

asthma.



INHALED ALLERGENS

Most of the allergens that initiate asthma are inhaled allergens like pollen

grains, animal hairs, dander, feathers, dandruff, dust and smoke etc. Inhalation of

these allergens in the hypersensitive children leads to a biphasic response (early and

late reactions) ultimately causing bronchoconstriction.

FOOD ALLERGY (INGESTED ALLERGY)

Foods that have the highest potential to cause IgE mediated sensitivity are

fish, shellfish, peanuts, various nuts and seeds, egg, cow‟s milk, soya, wheat and corn.

Children with IgA deficiency have higher levels of antibodies to cow milk

proteins and of immune complexes containing milk antigens than do normal controls.

Cow milk allergy can contribute to gastro-intestinal reflux, especially associated with

diarrhoea or atopic dermatitis. Children with gastro-esophageal reflux and atopic

history are more succeptible for asthma.

Salfites can cause bronchoconstriction in some asthamatic patients and severe

life threatening airway obstruction in few.

Food additives like dyes (coloring agent) e.g. tartazine, flavouring agents

(MSG) and preservatives like metabilsulfite can induce bronchoconstriciton in

asthmatic children.

Various foods or food preparations, which can cause allergy, are listed below.

DIETARY SOURCES OF COW MILK:

Butter fried foods Chocolates

Biscuits Cookies

Bread Cream Sauces

Butter Cream Soups

Cakes Custard

Candy Fish fried in batter

Cereals Gravies

Yogurt Ice-cream

Cheese



DIETERY SOURCES OF EGG:

Baked goods Egg noodles

Baking mixes Ice cream

Batters Omelettes

Breakfast cereals Soups

Cake flours Malted cocoa drinks

Candy Cookies

Creamy fillings Custard

VIRAL INFECTIONS:

One of the important factors that triggers childhood asthma are viral infections

of respiratory tract with respiratory syncytial virus (RSV), parainfluenza virus,

influenza virus, and rhino virus. Probably viral infections damage the mucosal surface

and causes shedding of epithelium leading to mucosal oedema and more mucus

secretion.

One study reveals that viral infections accounts for some 80-85% of asthma

exacerbation in children aged 9-11yrs (Johson et.al.1995).

DIURNAL AND SEASONAL FACTORS

Children usually suffer from frequent nocturnal attacks and they will be

relatively well without symptoms during daytime.

Exercise

The commonest problem encountered in asthma management is exercise-

induced asthma. Because children are naturally for more active physically than adults

and they often take part in play works or competitive physical activities. The severity

of asthma depends upon climate of air breathed and exercise induced asthma (EIA) is

less where the air is warm and humid. EIA is seen less common after intermittent

exercise such as occurs in most group games as compared with continuous running

for 6-8 minutes. There fore swimming is best exercise for asthmatic children, as it

doesn‟t cause EIA because the air that the child breathes is relatively humid.



Physical exercise is seen as having aggrevating effects on the asthmatic

person.

It causes hyperventilation with consequent cooling and drying of bronchial

mucous and intern liberates bronchoconstricting mediators such as LTD.

SMOKING AND POLLUTION

In a child with hyper-reactive airways, environmental pollution especially

tobacco smoke can increase the incidence of lower respiratory tract disease and

provokes attacks of asthma.

It is interesting to note that the study of Targer et.al.1993; Stick et.al.1996,

demonstrated that in infants of mothers who smoke during pregnancy, had reduced

resting lung function and increased bronchial reactivity. A study revealed that

dampness in the house was significantly associated with incidence and severity of

asthma. (Williamson et.al.1997)

PSYCHOLOGICAL FACTORS:

Emotional factors can trigger symptoms in many asthmatic children.

Emotional stress operates through vagus, initiating bronchial smooth muscles to

contract. In these cases control over asthma is poor.

ENDOCRINE FACTORS:

Asthma may worsen in relation to menses especially in pre-menstrual period.

In some girls symptoms of asthma reduces after puberty. Thyrotoxicosis increases the

severity of asthma but the pathophysiology is yet unknown.

DRUGS:

Drugs such as aspirin, NSAID, tartarazine, -receptor antagonists, and

metabilsulphites can trigger an asthmatic attack.



GASTRO-OESOPHAGEAL REFLUX:

It has been recognised that gastro-oesophageal reflux can produce an increase

in bronchial reactivity (Wilson et.al, 1985; Vincent et.al. 1997) and may be

responsible for the very severe attacks of nocturnal asthma which occurs in some

children. This can be supported by the study reported that, in some infants antireflux

treatment has been accompanied by an improvement in lung function. (Eid et. al.

1994) In severe asthmatic children having severe and alarming nocturnal

exacerbations, the possibility of reflux should be investigated.

CONTRIBUTING FACTORS

Bronchial hyper-reactivity /Khavaigunyata

Bronchial hyper-responsiveness manifests itself as bronchoconstriction

following exercise, on natural exposure to strong odours on irritant fumes such as

sulphur dioxide, tobacco smoke or cold air.

This may be compared to Kha-vaigunya explained by Acharya Sushruta. The

vitiated Dosha‟s while moving all over the body settles where the khavaigunya is

present and produces Vyadhi there. When the airway is hyper-reactive (ie when

Khavaigunyata is present in Pranavaha Srotas) various known and unknown stimuli

(vitiated Dosha‟s settled in Pranavaha Srotas) cause bronchoconstriction

(Shvasakrichrata).

GENETIC FACTOR

It is acceptable that we cannot give answers for the questions like:-

1. Why the asthmatic airways are hyper-reactive.

2. Whether this is present since birth or acquired.

3. Why it seems to disappear during later childhood or puberty in most children

as they „grow out‟ of their asthma.

Study reported that there was a relatively high incidence of atopy and bronchial

hyper-reactivity amongst the totally healthy relatives of asthmatic children and

wheezy infant. A child with one affected parent has about a 25% risk of having

asthma; the risk increases to about 50% of both parents are asthmatic. It seems that



even in genetically predisposed children also some environmental factor(s) is needed

to activate them.

PRECIPITATING FACTORS IN ASTHMA /VYANJAKA NIDANA:

Respiratory symptoms in asthma may be precipitated or exacerbated by

various factors although in many cases, no precipitating factors may be recognized.

Other triggering factors which may produce wheezing are water over scalp or

inside nose, irritation of nasal mucous, sweets, some fruits like grapes etc. ice cold

items, non stop speech, loud prolonged laughing, exposure to cold air, closed and

crowed places & violent air flow (window seat while travelling).

SAMPRAPTI

The study of Samprapti helps in understanding how the disease has been

manifested after Nidana Sevana. Thus Samprapti deals with all the pathological

processes, which are responsible for clinical signs and symptoms of the disease. In

Ayurveda, much importance has been given for Samprapti Vighatana i.e. breaking the

pathological process. Because Chikitsa is mainly to disintegrate the Samprapti

(pathology) i.e. Samprapti Vighatana meva Chikitsa

Acharya Caraka explains that if the child is feeding on Atisnigdha breast milk,

his body channels (Srotas) are constantly smeared with aggrevated Kapha and the

chills gets Tamaka Shvasa etc diseases.

In the Charaka Samhita Chikitsa Sthana, Samprapti of Shvasa has been dealt

in three occasions.

1. Common Samprapti of Hikka and Shvasa.

2. Vishista Samprapti of Shvasa.

3. Samprapti of Tamaka Shvasa.

I. Common Samprapti of Hikka and Shvasa

It is explained that the (vitiated) Vata enters the Pranavaha Srotas (channels

carrying the vital breath) and this vitiated Vata affecting the Kapha which is situated

in Uras (chest) produces Hikka and Shvasa.



From the above explanation we can point out the Acharya Caraka‟s views as

1. Srotas affected is Pranavaha Srotas.

2. Vata and Kapha are primly involved Dosha‟s.

II. Vishista Samprapti of Shvasa

This Samprapti is common for all 5 types of Shvasa. Acharya Caraka

explained that the Kapha along with Vata obstructs the Srotas. This obstructed Vata

trying to overcome the obstruction moves in all directions resulting in Shvasa.

Here the term “Kapha purvaka” is commented by Cakrapani as „Kapha

Pradhana i.e. predominance of Kapha.45

Gangadhar opines it to be Kapha Samyukta

i.e. along with Kapha.

The term ‘Vishvagvrajati’ is commented by Cakrapani as ‘Sarvagvrajati’ i.e.

moves in all direction (inside the Pranavaha Srotas). But Gangadhara opines it to be

“Sarva shareera gacchati i.e. moves all over the body.46

Arunadatta commenting on

the same and uses the term “Urasthagagrahanam” i.e. it should be considered as

Uras. After observing the above explaination Gangadhar commentory seems to be

unacceptable and Cakrapani and Arunadatta opinions hold good.

Acharya Sushruta explains that the vitiated Prana Vata gets Urdhvagati and

combines with Kapha and produces Shvasa. Dalhana on the above verse comments

that Tamaka Shvasa is Kaphaprdhana Vyadhi.

Acharya Vagbhata explained that the Vata, which is obstructed by Kapha,

moves all over. This viatiated Vata further vitiates Prana, Udaka & Annavaha Srotas

and produces Shvasa in Uras which is considered as Amashaya Samudbhava Vyadhi.

Madhukoshakara has the same opinion as Cakrapani regarding the Vishista

Samprapti of Shvasa. Also he had explained as Pranavaha Sroto Avarodha is due to

Kaphavritha Vata.

Vagbhata has adopted the Samprapti of Caraka in different words but he has

considered the affliction of Annavaha and Udakavaha Srotas along with Pranavaha

Srotas. Even Cakrapani has considered the involvement of Annavaha and Udakavaha



III. Samprapti of Tamaka Shvasa

Srotas, but Gangadhar has clearly ruled out the involvement of Srotas other

than Pranavaha Srotas.

This Samprapti is explained for Tamaka Shvasa only because it is a

continuation of the previous Samprapti as it states “Pratilomam yada Vata”.

The Vata in Pratiloma Gati enters the Pranavaha Srotas and causes agitation of

Kapha and then enters Greeva and Shiras resulting in Greeva and Shirograha and

stimulates phlegm to cause peenasa (Coryza). Thus the obstructed Vata produces the

signs & symptoms of Tamakashvasa.

SAMPRAPTI GHATAKA

Dosha : Vata – PranaVata, UdanaVata

Kapha : Avalanbhaka Kapha

Dushya : Rasa

Agni : Jatharagni, rasadhatvagni

Ama : Jataragnimandhyajanya

Srotas : Pranavaha

Srotodusti : Sanga – Atipravritti

Udbhava Sthana: PittaSthana / Amashaya

Adhistana : Uras

Sanchara Sthana: Pranavaha Srotas

Vyakta Sthana: Uras

Rogamarga : Abhyantara

Due to multifactorial origin of Tamaka Shvasa, the Samprapti may differ from

patient to patient and varies according to the etiological factors. Thus common

Samprapti of Tamakashvasa can‟t be drawn due to its complexity. Eventhough, the

Samprapti of Tamakashvasa with regards to Kriyakalas can be studied in general as

fallow in two stages.



STAGE 1

In this stage physiological derangement takes place due to exposure to

etiological factors (Nidanas). It occurs in first three phases of Kriyakalas i.e.

Sanchaya, Prakopa and Prasara. The important manifestations are as fallows:

1. Vata Prakopa occurs due to Vata Vardhaka Nidana Sevana.

2. Kapha Prakopa occurs due to Kaphakara Nidana Sevana.

3. Pitta Sthana Dusti may occur due to Agnimandyakaraka and Amotpadaka

Nidanas.

4. The vitiated Doshas circulates all over the body.

5. Sthanika Doshas may be directly vitiated due to direct affliction of Pranavaha

Srotas due to Nidanas like Raja, Dhooma Sheeta Vayu etc.

Though the role of Kapha is predominant in obstruction of Pranavaha Srotas but it

is also motivated by Vata Dosha.

STAGE 2

In this stage physiological abnormality leads to the pathological

manifestations and then circulation to all over the body. This stage includes three

phases corresponding to the changes that take place in the last three phases of

Kriyakalas i.e. Sthana Sansraya, Vyakta and Bheda.

STHANA SAMSRAYA

In this stage, the Doshas, which are already aggrevated and circulating

throughout the body, settles in (Uras) Pranavaha Srotas where Khavaigunya is

present. Here Khavaigunya may be present since birth (Beeja Dosha, Prakriti) or

resulted due to aggrevated Doshas. Poorva Roopas will appear at this stage.

VYAKTI

The basic pathology is due to vitiation of Kapha and Vata in the Pranavaha

Srotas. Due to Kapha vitiation, excess Kapha Udeerana takes place, resulting in

obstruction of Vata marga in the Pranavaha Srotas. Acharya Caraka has given the

simily to explain this as, „when the flowing water is obstructed, first it collects and

breaks the obstruction leading to exceess flow of water suddenly,56

in the same way if



the free flowing Vata is obstructed by Kapha then it vitiates and causes damage to the

Srotas‟. The obstructed Vata moves in all direction.

BEDHAVASTHA:

If proper treatment is not done in the above stage, the pathological processes

already going on may worsen and Lakshanas may be produced according to

predominance of Doshas. If Vata is predominant Vatadhika, Kaphadhika if Kapha

predominate and if Pittanubandha is there praTamaka Lakshanas will be produced. If

neglected or due to improper or inadequate treatment, the Pranavaha Srotas and

Srotomoola may be affected resulting into complications in due course of time.

Figure-1

Showing schematic representation of samprapti of Tamakashwasa



PATHOLOGY OF ASTHMA:

It is now clearly established that the airway inflammation is the basic

pathology in all types of asthma. Airway epithelium damage is another characteristic

abnormality, which is not found in other diseases of airways. Pathology of extrinsic

and intrinsic asthma is different. Therefore these are separately explained below.

Pathology of Extrinsic Asthma or Allergic Asthma:

It is a type I hypersensitivity reaction. The basic sequence of events in

pathogenesis of type I hypersensitivity begins with the initial exposure of antigen

(also called as allergen). The allergen stimulates IgE production by B cells. Once IgE

is bound to the surface of mast cells the individual is primed to develop type I

hypersensitivity. Re exposure to the same antigen results in fixing of the antigen to

cell bound IgE, initiating a series of reactions which lead to the release of several

powerful mediators that are responsible for the clinical features of type I

hypersensitivity.

All allergens causes bronchoconstricition, mucosal edema, and mucus

secretion, which ultimately result in airway obstruction58

and variety of chemotaxic,

vasoactive and spasmogenic compounds take part in the pathogenesis of extrinsic

asthma.

PATHOLOGY OF INTRINSIC ASTHMA:

In intrinsic or non-atopic asthma the mechanism of bronchial inflammation

and hyper responsiveness is less understood.

In this type of asthma, perhaps there is a hereditary or acquired over activity of

the cholinergic (constrictor) response or reduced activity of the 2-adrenergic

(bronchodilator) pathway. But in majority of cases triggering mechanism is non-

immune in intrinsic asthma.



POORVA ROOPA:

Poorva Roopa denotes the symptoms that manifest before the actual or main

symptoms occur. They are manifested during the stage of Doshadushya

Sammurchana.

The Poorva Roopa of Shvasa collected from different texts are presented in

Table-5.

Table-5

Poorvaropa of Shvasa According to Ayurvedic Major Texts

Nidanas C.S S.S A.S A.H Y.R B.P M.N G.N

Anaha + + + + + + + +

Hridaya Peedana + + + + + + + +

Parshwa shoola + + + + - - - -

Asya Vairasya - + - - + + + +

Shankha Bhedha - - + + + + + +

Pranasya Vilomata + - + + - - - -

Shoola (udara) - - - - + + + +

Admana - - - - + + + +

Bhaktadvesha - + - - - - - -

Aruchi - + - - - - - -

ROOPA:

The symptoms which appear on the complete manifestation of a disease are

known as Roopa. Acharya Kashyapa explains that if the child, who has hot breath

from chest, is to be considered for having Shvasa. The symptoms of Tamaka Shvasa

by the various Ayurvedic texts are depicted in Table-6.



Table-6

Roopa of Tamaka Shvasa According to the Major Texts

Pranavaha Srotosambandhi

Lakshana

C.S S.S A.S A.H Y.R B.P M.N G.N

Gurguruka (Wheezing) + + + + + + + +

Shvasakrichrata (Dyspnea)

+

+

+

+

+

+

+

+

Kasa (Cough)

+

+

+

+

+

+

+

+

Prana peedana

(Discomfort in chest)

+

-

+

+

+

+

+

+

Peenas/ Pratishyaya (Coryza)

+

+

+

+

+

+

+

+

Ateeva teevra Vegam cha

Shvasam (Increased rate of

respiration)

+

-

+

+

+

+

+

+

MuhuShvasa (Gets frequent

attacks of dyspnea)

+

+

+

+

+

+

+

+

Kantodhwansa

(Throat irritation)

+

-

+

+

+

+

+

+

Pramoham kasamanas-Cha

(Fainting during excessive

cough)

+

-

+

+

+

+

+

+

Krichrat shaknote bhashitam

(Difficulty in speaking)

+

-

-

-

+

+

+

+

Shayanasya Shvasa peedita

(Dyspnea increases in lying down

posture)

+

+

+

+

+

+

+

+



Pranavaha Srotosambandhi

Lakshanas C.S S.S A.S A.H Y.R B.P M.N G.N

Aseena Labhate Soukhyam

(comfortable in sitting position)

+

+

+

+

+

+

+

+

Parshwe tasyavagrahnati

shayanasya sameeranah

(Discomfart in sides of chest in

lying down posture)

+

-

+

+

+

+

+

+

Shleshmanam Amuchyamane

brusham bhavathi dukitha (Distress

increases when unable to

expectorate)

+

+

+

+

+

+

+

+

Tasyeva vimokshante

muhurtham labhate sukham

(Gets relief after expectoration)

+

+

+

+

+

+

+

+

Meghambusheeta pragvatai

shleshmalaisch abhivardhate

(Attacks gets aggravated

during cloudy weather after

consuming cold water,

exposure to cold air, eastern

wind and when resorts Kapha

aggravating food and regimen)

+

-

+

+

+

+

+

+

17.Ghoshen mahat - + - - - - - -



Sarvadaihika Lakshanas C.S S.S A.S A.H Y.R B.P M.N G.N

BrushAmatiman

(Maximum distress) + - + + + + + +

Sushkasyata

(Dryness of mouth)

+ - + + + + + +

Latatena swidyata

(Sweating in forehead)

+ + + + + + + +

Uchritaksha (wide opened eyes) + - + + + + + +

Sannirudhyati (Immobilised) + - - - + + + +

Na labhate nidra

(Distrubed sleep)

+ - - - + + + +

parshwa peeda

(Pain in the sides of chest)

- - + + - - - -

Pratamyati

(Loss of consciousness)

+ + + + + + + +

Ushna abhinandana

(Likes to take hot things)

+ - + + + + + +

rishna (Thirst) - + + + - - - -

Vamathu (Vomiting) - + - - - - - -

Vepatu (Tremours) - - + + - - -

Aruchi (Tastelessness) - + + + - - - -

Trastyate (Frightened) - - - - - - - -

Annadvit (aversion to food) - + - - - - - -

CLINICAL FEATURES OF TAMAKA SHVASA/ASTHMA:

Common signs and symptoms include bouts of cough especially more in night,

dyspnea, tachypnea wheezing and use of accessory muscles of respiration.

Ghurghuruka (wheezing) is due to Pranavaha sroto avarodha by Kapha. Excess

Kapha Udeerana (secretion) takes place resulting in Sroto Avarodha. Pitta Sthana

Dustikaraka Nidanas may cause Agnimandya and Ama which inturn does Rasa Dusti.



This results in Kapha Vriddhi in Pranavaha Srotas. As Sroto Avarodha is one of the

Rasa Dustipradoshaja Roga61

and Sashabdhata is an important Lakshana of Pranavaha

Sroto Dusti, it ultimately produces Ghurghuruka Shabda

Shvasa Krichrata (dyspnea) is due to Pranavaha Sroto Sankocha and

Avarodha. Due to Vatakara Nidanas Vata Prakopa takes place in Pranavaha Srotas,

and being obstructed by Kapha, it further vitiated and moves in all directions.

Sankocha has been explained as one of the Lakshana of vitiated Vata thus vitiated

Vata causes the Pranavaha Sroto Sankocha leading to Shvasakrichrata.

Peenasa and Kasa are important symptoms especially in children. The

obstructed Vata moving in Pratiloma Gati causes Greeva and Shiragraha and produces

peenasa.then child gets bouts of cough (Kasa) and faintig occurs when frequency of

cough is increased (Pramoham Kasamanascha).

Many children having no symptoms during day time, often gets up in the

middle of the night or early morning with either a classical wheezing (nocturnal

dyspnea) or a severe bout of cough (nocturnal cough). Frequency and severity of

cough increases gradually along with wheezing. It is sometimes difficult for the

parents to accept that the nocturnal cough is a manifestation of asthma. Child may be

presented with only cough without wheezing or wheezing without cough. But the

younger asthmatic child is often troublesome due to nocturnal cough rather than

dyspnea.

Ateeva Teevra Vega Shvasa i.e. increased rate of respiration may indicate the

severity of Vata vitiation. Murda (head) is main seat for Prana Vata and uras for

Udana Vata. Impairement in the functions of Prana Vata and Udana Vata may lead to

Ateeva Teevra Vega Shvasam. Here it is also important to recall that Atisristam and

Kupita are Pranavaha Sroto Dusti Lakshana.

When the lungs become overinflated, the stretch receptors activate an appropriate

feedback response that „switches off‟ the inspiratory ramp and thus stops further

inspiration. This is called the Hering-Breuer inflation reflex. This reflex also increases

the rate of respiration.



Krichrat shaknoti bhashitam i.e. difficulty in speaking may be due to involvement

of Udana Vata. Vak Pravritti is one of the important fuction of Udana Vata and

vitiation of Udana Vata may cause difficulty in speaking. Due to increased rate of

respiration and expiratory difficulty child will be having difficulty in speaking.

Parshve tasyagrahnati i.e. discomfort in the sides of chest may be due to excess

and laborious work of respiration especially intercostal muscles.

Pramoham kasmanascha i.e. fainting during excessive cough might be due to

severe bronchoconstriction (which is not able to generate wheezing sound) and

hypoxia. This leads to less oxygen supply to brain which causes fainting in children.

Prana peedana is due to respiratory distress/ discomfort in the chest because of

Shvasakrichrata.

When airway is obstructed by mucus plug, the child gets maximum distress

(brushAmatiman). The distress increases when the child is unable to expectorate it

(shleshmanam amuchyAmane brusham bhavati dukhita) and gets relief after

expectoration of sputum (tasyeva vimokshante muhurtam labhate sukham).

Abdominal pain (udara shoola) is common particularly in younger children.

Vomiting (Vamathu) is common which may give temporary relief of symptoms.

Children can‟t expectorate sputum, instead they swallow it. During vomiting due to

contraction of diaphragm and intercostal muscles, the intrathoracic pressure increases

which may help in expulsion of sputum from airways.

By Ushnopachara Kapha gets liquefied causing its easy expectoration and the

patient thus likes to take ushnopachara (ushnabhinandana).

Aruchi (tastelessness), annadvit (aversion to food) and Vamathu (vomiting) may

be due to involvement of Annavaha Srotas along with Pranavaha Srotas.

Tamaka Shvasa gets aggrevated during cloudy atmosphere, cold weather, after

exposure to cold air, eastern wind and Kapha aggrevating food & regimen. All these

factors may act as precipitating factors for attacks of asthma.



Na labhate nidra i.e. unable to get sleep is due to Pranavaha Sroto Avarodha and

difficulty in breathing. Usually in younger children sleep is disturbed by nocturnal

cough rather than wheezing and in older children cough with frank wheezing disturbs

the sleep.

With severe airway obstruction, child has difficulty in walking (sannirudyate) or

even talking (Krichrat shaknoti bhashitam), child may assume a hunched over tripod

like sitting position that makes it easier to breathe (Aseena Labhate sukham). Because

sleeping in supine position increases dyspnea (Shayansya Shvasa peedita). Many

children complain both inspiratory and expiratory difficulty. In severe cases there will

be respiratory distress (brushAmatiman) and child may sweat profusely (lalatena

swidyate). Low-grade fever (Jvara) may develop due to infection or enormous work

of breathing.

Suskasyata and trishna indicates involvement of Udakavaha Srotas. During

severe attack, child may get thirst due to excess water loss through evoparation from

lungs and low intake of foods & fluids during attacks.

Pratamyati

(loss of consciousness), uchritaksha (wide opened eye),

brushAmartiman (distress), vepatu (tremors) and sannirudyati (immobilised) etc signs

and symptoms indicates the severity of disease and the child in this condition needs

urgent and immediate prompt treatment.

A barrel shaped chest deformity is a sign of chronic unremitting airway

obstruction of severe asthma.

UPASHAYA AND ANUPASHAYA

A judicious application of Aushadhi, Ahara and Vihara, when produces relief

in the symptoms that is called as Upashatya and when it aggravates the symptoms it is

called Anupashaya. It is a trial and error treatment.

In Tamaka Shvasa, the Upashaya and Anuashaya have been explained while

mentioning the Lakshanas of the diseas, which are as fallows:

Upashaya:

1. Tamaka Shvasa patients always desire for warm substances and surroundings.

2. Respiratory distress will be relieved in sitting posture (tripod posture)



Anupashaya:

1. Respiratory distress increases in lying down posture.

2. Shvasakrichrata & Kasa with expectoration aggravates during cloudy weather, cold

season, intake of cold substances cold weather especially eastern wind, durdina and

night or early morning.

VARIANTS OF TAMAKA SHVASA:

In Ayurveda Tamaka Shvasa has been classified on the basis of Pitta Dosha

association, two variants have been explained viz. Pratamaka and Sansamaka.

1. Pratamaka

If Tamaka Shvasa is associated with Jvara and Moorcha then it is called as

PraTamaka. It occurs due to Udavarta, Raja Sevana, Ajeerna, Klinnakaya and

Vegadharana.

2. Santamaka

In this variety patient complaints of darkness around him and feels as if sinking in

darkness. It aggravates severely in Tama ie darkness (or night) and subsides by

Sheetopachara.

Acharya Gangadhara opines that these two are not Bhedhas of Tamaka Shvasa

rather are stages of the same.

In modern science asthma is mainly classified into 3 types.

1) Extrinsic or allergic (or atopic) asthma

2) Intrinsic asthma

3) Mixed variety

The differences between extrinsic and intrinsic asthma are shown in Table-7.



Table-7. Differencial Diagnosis of Extrinsic and intrinsic Asthma

Extrinsic Intrinsic

Immune reaction type I hypersensitivity Non immune abnormal autonomic

regulations of airways

Family history of hypersensitivity is

common

No family history of hypersensitivity

Usually starts in childhood Starts in adult life

Proceeded by infantile eczema and

hypersensitivity of food

No evidence of atopy

Predisposition to form IgE antibodies IgE antibodies may be found but no

particular predisposition

Recognizable allergens like pollen

dandruff, house dust mite etc

No recognizable allergens

Attacks often diminish in later years Attacks increases in severity as years pass

Chronic bronchitis seldom develops Associated with nasal polyp‟s chronic

bronchitis

Emphysema unusual Emphysema commonly develops

No drug sensitivity Drug sensitivity may develop

(aspirin, penicillin etc)

Increased levels of IgE found in serum Normal level of IgE in serum

Positive response to skin provocation

test

Negative response to skin provocation test

LABORATORY INVESTIGATION:

Only on the basis of laboratory investigations it is very difficult to establish

the diagnosis of asthma. Following are the laboratory findings.

1) Blood eosinophilia more than 250-400 cells/cmm is usual.

2) Eosiniophilia is seen in the sputum sample.

3) Asthmatic sputum is grossly tenacious, rubbery & whitish.

4) Serum protein and immunoglobulin concentrations are generally normal in

asthma; expect that IgE levels may be increased.



Bronchial Reactivity Testing:

Tests of bronchial reactivity can be a major importance in making the

diagnosis, when the diagnosis is uncertain and evaluating the severity of asthma.

Bronchial provocation by inhalation has now been widely performed in children using

either methacholine or histamine as the challenge. Children with asthma generally

respond abnormally to exercise, methacholine and adenosine 5- monophasphate

(AMP) challenges while those with other types of chronic lung disease often respond

abnormally to methacholine but not to exercise or AMP (Avital.et.al.1995). This may

be helpful in differential diagnosis of the child with chronic airway obstruction. When

the baseline pulmonary function is abnormal, instead of methacholine provocation

testing, response to bronchodilator therapy is more appropriate.

Exercise Testing:

Running for 1-2 minutes causes bronchodilation but prolonged running causes

bronchoconstrion in children suffering from asthma.

Chest Radiograph:

If the child is presented with acute severe asthma, chest radiograph is

necessary to exclude the other possible diagnosis or complications such as atelactesis

or pneumonia or mediastenal emphysema. Lung markings are commonly increased in

asthma.

During exacerbations if the child is presented with fever, tachypnea

>60beats/min, tachycardia 160beats/min, localised rales or wheezing or decreased

breath sounds or suspected for pneumothorax, in these conditions chest radiograph is

necessary.

Immunological Tests:

Skin testing or the measurement of specific IgE levels is of limited value in

most children with asthma. If a strong reaction is obtained to a specific allergen, it is

only significant when the child has a history of wheezing on contact with the allergen.

Determination of specific IgE with these testing is useful in identifying the

environmental allergens. But Shapiro and Anderson 1998 reported that none of these

unconventional tests (in vitro allergy diagnostic tests) have been shown to be of any

real diagnostic value.



Pulmonary Function Testing:

Testing of lung function useful for management of asthma and in the

evaluation of children in whom asthma is suspected. Above 6yrs aged children can

undergo spirometry and in younger children peak flow meter is helpful. If the PEFR

nor FEV, measured before and after aerosol therapy shows a 10% increase then it is

strongly suggestive of asthma. PEFR can be measured at home 2-3 times/day with the

mini Wright peak flow meter that provides an objective evidence for degree of airway

obstruction. Diurnal variability more than 30% indicates increased bronchial

responsiveness and worsening of asthma with increased susceptibility to airway

obstruction



Table-8

Vyavacchedaka Nidana of Tamakashvasa

Symptoms Tamaka

Shvasa

Maha

Shvasa

Urdhwa

Shvasa

Chinna

Shvasa

Kshudra

Shvasa

Shvasa

Ateeva

teevra

Vega

UchaihiShva

sati

Deergam

Shvasati

UrdwamShva

sati

Shvasati

vichinnam

Rooksha

ayasodbh

ava

Shvasa

Shabda Gururaka Matta

Vrishabhavat _ _ _

Concious-

ness Pramoha

Pranasta

Gyanavignan

a

Pramoha Murcha _

Netra Uchritaksh

a

Vibrantaloch

an &

Vivrataksha

UchaihiShvas

ati

&Vibrantaks

ha

Viplutaksha

Raktaikaloch

ana

_

Shoola Parshwa

Shoola _ Vedanartha Marmacheda

No

indriya

vyatha

Vak

Krichrat

Shaknoti

Bhashitam

Vishirnavak _ Pralapana _

Asya Vishuskasy

a _ Shuskasya

Pari

shuskasya _

Sweda Latata

sweda _ _ _ _

Miscellane

ous

Badda

mutra

varcha

_ Arati Anaha,

vivarna

Precipitat

ed by

vyayAma

& ahara

no much

distress

Sadhyasadh

ata

Yapya/sad

hya Asadhya Asadhya Asadhya Sadhya

Table-9



Sapeksha Nidana of Shvasa

Symptoms Tamaka Shvasa Kshataja Kasa Rajayakshma

Shvasa Swasa with teevra

Vega is the

partyathma Lakshana

One of the

symptoms

One of the symptoms

of ekadasha roopa

rajayakshma

Kasa Present Initially dry Present

Steevana

Kruchra steevana

Rakthayuktha

Piohila, visra,

bahala, naritha,

swetha, peetha varna

rasa steevana, some

times raktha yukta

Jvara Absent Present Present

Dhatu shoshana A late feature Late feature Present

Shabda Ghurguraka ParaVata

koojana

-

Shoola Parshva shoola Vedana in kanta

pradesha

Parshvashoola shira

shoola

Sadhya Yapya Yapya Sarva roopayuktha is

asadhya

Nidana Kapha and Vata

vardaka Nidanas or

marmaghata or

Nidanarthakara Rogas

Kshata on uras Vegavarodha,

dhatukshaya, sahasa

vishAmashan

DIAGNOSIS:

Recurrent episodes of coughing and wheezing especially, if aggravated or

triggered by exercise, viral infection or inhaled allergens are highly suggestive of

asthma. Persistent cough without wheezing is also suggestive of asthma in children,

which may be erroneously diagnosed as „allergic cough‟, or „allergic bronchitis‟ or

„wheezy bronchitis‟ or „chronic bronchitis‟. Pulmonary function testing before and

after administration of methacholine or a bronchodilator or before and after exercise

may help to establish the diagnosis of asthma.



Table-10

Assessment of Severity of Asthma in Children

Based on Mild Moderate Severe

Frequency/Month <One episode >One episode 4 episodes

Duration of Symptoms Brief for hours Prolonged

2-3days

Almost continuous

Activities

-Eating

-Sleep disturbance

-Playing

-School absenteeism

- Normal

- Nil

- Able

- Nil

- Solids

- At times

- Restricted

- Occasional

- Liquids

- Frequent

- Not able

- Frequent

Hospitalisation Rare Occasional Frequent

PEFR 60-80%

Predicted

40-60% Predicted 40%

Chest x-ray Normal Hyperairation Emphysema

UPADRAVA OF TAMAKASHVASA:

Trishna has been mentioned as the upadrava of Shvasa and this type of

Trishna is called as Aupasargika Trishna. No reference is available regarding the

other Upadrava of Tamaka Shvasa.

ARISHTA LAKSHANA:

Arista Lakshanas are the indicative of definite death thus indicating the fatal

prognosis of the patient. Arista Lakshanas of Tamakashvasa have not been explained

in any classics but Arista Lakshanas of Shvasa have been explained in the classics,

which are as follow:

1. Patient presenting with deergha and Hrisva Nihshvasa.

2. Passage of Grathita mootra and pureesha associated with Agnisada.

3. Shvasa complicated with Atisara, Jvara, Hikka, Chardi, Medrashotha and

Andashotha.

4. Shvasa with jvara Chardi, Trishna, Atisara and Shopha.



SADHYA-ASADHYATA:

Sadyasadhayata gives the clear picture of curability of the disease i.e. whether

the disease is curable, incurable or difficult to cure. It depends upon so many factors

like nature of disease, severity of disease, Vaya, Prakruti, Bala of patient etc.

o According to Charaka it is Yapya ie difficult to cure. If it is in Navavastha

(early stage) then it is Sadhya.

o Also Charaka says Tamaka Shvasa is curable in strong persons when the

symptoms are not manifested fully.

o According to Sushruta it is Kastasadhya, but Asadhya in Durbala Rogi (weak

patient).

o Dalhana commenting on the above version says that it is Asdhya when it is

associated with Jvara, Moorcha and others.

o According to Vagbhata it is Yapya. But says if it is treated in the begining and

patient is strong (Balina) then Tamaka Shvasa is Sadhya.

o When Maha, Chinna, Urdhva Shvasa Lakshanas appear in Tamaka Shvasa

then it is considered to be Asdhya.

YAPYATA OF TAMAKA SHVASA IN CHIDREN

Generally Tamaka Shvasa is said to be Yapya disorder i.e. relieved till

medicine is taken. In other words Yapya means sustained only by the medicines, thus

difficult to cure. It is Sadhya in early stages and in strong patients and if it is not

associated with other complications. The disease becomes Asadhya in Durbala

patients.

It is explained that in Balyavastha Kapha is predominant Dosha and childhood

diseases caused by Kapha naturally take a serious turn. So children are most

succeptible for Kaphaja diseases like Pratishyaya, Kasa and Shvasa. Dalhana has

explained that Tamaka Shvasa is Kaphabhuyista Vyadhi i.e. Kapha predominant

disease. Therefore the diseases like Tamaka Shvasa occurring in Kapha predominant

age (childhood) may be difficult to cure.



PROGNOSIS

The prognosis for young asthmatic children is generally good. In majority of

children there will be occasional attacks of mild to moderate severity. But a minority

of children experience severe intractable asthma usually perennial rather than

seasonal.

The prognosis is also poor in those with a diagnosis of asthma, of which about

50% are still wheezing at age of 10yrs. (Park et. al. 1986)

CHIKITSA VIVECHANA

After reviewing the literature about Tamaka Shvasa Nidana, Samprapti,

Roopa, Sadhyasadhyata etc, it became clear that there is vitiation of Kapha & Vata

and Tamaka Shvasa is Pittasthana (Amashaya) Samudbhava Vyadhi102

. Therefore our

treatment should be aimed to pacify the vitiated Vata and Kapha Dosha along with

Nidana Parivarjana.

Acharya Charaka has given the guidance for better management of Tamaka

Shvasa i.e Shodhana followed by Shamana Chikitsa, should be done in Balavana and

Kaphadika patients, whereas Shamana and Tarpana should be done in Durbala and

Vatadhika patients.

Here the question arises, whether the same treatment can be adopted in

children? For that it is better to review the literatures about the line of treatment in

case of children.

PRINCIPLES OF TREATMENT IN CHILDREN:

Acharya Kashyapa explains that for children neither Shoshana (desiccation)

nor Ati-samshodhana (excerssive cleaning) and Raktamokshana (blood letting) are

benefical. They should be treated with oral medications, ointments etc. In children

Vata, Pitta and Kapha are similar as like adults but they are in less quantity.

The similar explanation is given by the Acharya Charaka in Chikitsa Sthana

i.e. Dosha, Dushya, Mala, and diseases present in children are same as like adults but

the dosage will be less compared to adults.



Vagbhata accepting the above opinion, says that the Dosha, Dushya, diseases

such as fever etc. and methods of treatment are the same in both children and adults

whereas the dosages (of medicines or therapies) are minimum for children since they

are of tender aged and having small body. Madhavakara also explains the same

regarding treatment of children.

SHODHANA IN CHILDREN:

Acharya Charaka explains that after observing the Mrudutva (tenderness) and

Paratantrata (dependency) and in those children, who are unable to speak and act, one

should not advice for Vamana etc. treatment. But according to disease, Bheshaja

(medicines or therapies) should be used in reduced doses.

Chakrapani explains that Balas (children) are of two types i.e. Svatantra and

paratantra. In paratantra (dependant) children Vamana etc should not be administered

where as in independent children who can act and speak, Vamana etc therapies should

be administered in Mrudu form.

Vegakaleena Chikistsa of Shvasa (Acute Management):

Snehana and Svedana (Oleation & Sudation)

To the person having Shvasa (i.e. at acute condition) Bahya Snehana (external

application of oil) should be done with Lavana Taila and Nadi or Prastara or Sankara

Sveda with Snigdha Dravya.

By this Grathita Kapha (tenacious sputum) present in Pranavaha Srotas

(respiratory tract) undergoes Vilayana (liquification) thus Srotomardavata takes place

resulting in Vatanulomana. Thus respiratory tract becomes clear for easy passage of

air.

Above process is compared as the ice on the mountain dissolves after exposure

to sun, in the same way Grathita Kapha dissolves after Svedana procedure.

In Vatadlika Snigdha Sveda, in Kaphadika Rooska Sveda and in combination

of Kapha and Vata, Sadharana (general) Svedana can be adopted.

Svedana is contraindicated in Pitta Prakruti persons, and in persons suffering

from Pittaja disorders, Madhumeha, Kshuda, Trishna, Shosha (emaciation) Rosha

(anger), Kamala, Udara Roga, Karshya, Bhrushagni (voracious appetite) etc.



Charaka includes Rooksha and Ksheena Dhatubala (diminished Dhatubala)

persons in the list of contraindicated for Svedana.

In such Patients‟ Mrudu Sveda for Uras and Kantha Pradesha can be done by

doing Snehaseka with Sharkara or by Utkarika mixed with sugar or by Upanaha.

Soon after Svedana, Snigdha Anna along with Dadhi, Matsya, Mansarasa or

Shookara Rasa should be given which does the Shleshma Vruddhii.

VAMANA

Once there is Shleshma Vruddhii, Vamana should be performed by giving a

combination of Pippali, Madhu and Saindhava, but it should be Vata Avirodhi.

For the term Vata Avirodhi, Chakrapani opines that „it rules out the use of

Ruksha and Teekshna Vamaka drvyas,‟ indicating the need of Mrudu Vamana.

Gangadhar opines that Vatahara Vamana dravya have to be used along the above said

drugs. Astanga Hridaya states that there should not be aggrevation of Vata by

Vamana.

By this liquefied Kapha which is present in Pranavaha Srotas comes out by

Urdhva Marga. After Kapha Nirharana, Srotavishuddhi takes place leading to free

movement of Vata in the Srotas.

DOOMAPANA:

After Vamana for expulsion of the avashista Kapha (to remove remained

sputum), Dhoomapana with Haridra Manashiladi Yoga etc should be given.

Here it is interesting to note that Acharya Charaka has not mentioned the

routine classical Vamana procedure for the management of acute attack. Instead of

Abhyantara Snehapana, he has advised Bahya Snehana. After proper Svedana,

Shleshmavriddhikara Ahara and Vamana should be done.

Here we can conclude that the above said therapy is for Vegakallena Chikitsa

of Tamaka Shvasa. Because classical method of Vamana is not followed, here instead

of it, acute management of Shvasa is explained, as there will be less time to do all

those procedures.



GENERAL LINE OF TREATMENT IN TAMAKA SHVASA:

As it is an episodic disease and Yapya it is difficult to cure. So before starting

the treatment, special attention has to be given, for detail examination of the children,

to know Rogibala and Rogabala.

The general line of treatment is Nidana Parivarjana, SanShodhana and

Shamshamana.

NIDANA PARIVARJANA

Nidana, Dosha and Dushya are the essential factors in the of disease process.

Anubandha and Ananubandhya of these three factors influence in the ocurence of

signs and symptoms of disease. That is why acharya Charaka has given much

importance for the Nidana Parivarjana in Hikka and Shvasa Roga.

It is said that if the

person suffering from the Shvasa wants the healthy condition (Arogya) he must avoid

the Nidana factors.

Acharya Sushruta stressing for the Nidana parivarjana explained as

“sankshepatah kriyayogo Nidana parivarjanam”. However but avoiding the causitive

factors may be difficult in children because they are more susceptible for allergens,

upper respiratory tract infections, dust and exercise during play works and many are

allergic to variety of foods etc. Avoiding these causative factors may reduce

frequency of attacks in children. As the Tamaka Shvasa is Yapya in nature, proper

advises should be given to both children and parents regarding the Nidana

Parivarjana.

AVOIDANCE OF TRIGGERS / AGGREVATORS

PHYSICAL FACTORS:

The physical factors, which can cause symptoms in asthmatic children, are

exercise, strong smell, cold air, changes in weather etc. In majority of cases the

patient or parents easily identify these factors. For the better management of asthmatic

children, it is necessary to avoid the exposure to these factors.



ALLERGENS:

Aero-allerges are important triggers of attack in most allergic asthmatics. The

child may get severe disease if the child had been exposed to allergen within first year

of life. Most of the allergens include dust, mites, moulds, pollens and animal proteins.

Now house dust mite (dead or alive) claimed to be the important cause for nocturnal

symptoms. Particular care should be taken for the children who are having family

history of allergy, because these children are susceptible for allergic disorders.

Therefore avoidance of allergens plays an important role.

RECOMMENDATIONS FOR REDUCING ALLERGEN:

o The humidity in houses should be minimised by good ventilation.

o All the bedding (mattresses, pillow etc) which is washable should be washed

regularly with hot water.

o Pillow and bed is to be covered with mite proof covers.

o Woollen clothing‟s and bedding are better to avoid because they may harbour

dust and house dust mite. Carpets in the bedroom are better to remove.

o Whenever practical, bedding should be exposed to the sun which kills mites.

[

Tamaka Shvasa patients can be grossly divided into two categories.

1. Kaphadhika and Balavana

2. Durbala and Vatadhika.

In the first category Shodhana can be adopted and Shamana in the later where as

Nidana Parivarjana is mandatory in both categories.

SAMSHODHANA:

Great importance has been given for the Shodhana Karma in the management

of Shvasa, which helps in eliminating the vitiated Doshas from the body. Vamana,

Virechana and Nasya are advised to adopt for Tamaka Shvasa Chikitsa.

DEEPANA AND PACHANA:

It is said that “Rogah sarve api managanow”. Agnimandya and Ama play an

important role in the production of Tamaka Shvasa. Hence in order to normalize the

Agni and to remove Ama, Deepana and Pachana should be given first.



POORVA KARMA

Abhyantara Snehapana should be done with judicious use of medicated ghee or oil till

the Samyaka Snigdha Lakshanas appear. Then Abhyanga and Svedana should be

done. VishrAma kala should be decided according to Shodhana (Vamana /

Virechana).

VAMANA

Dalhana commentator of Sushruta says that “Shleshmabhuyistha Tamakah” i.

e. Tamaka Shvasa is Kapha predominant disease. Hence Vamana will be helpful for

the patients. Vamana should be done in balavana (having good strength) and

Kaphadhika (having more Kapha) patients and it is also indicated in patients suffering

from the Kasa and Svarabhanga.

VIRECHANA

After Vamana, Virechana should be administered in Balavana and Kaphadhika

patients, and it should be followed by Pathya Ahara, Vihara, Dhoomapana, Leha and

Shamana Chikitsa. In Tamaka Shvasa Patients‟ virechana should be given with

Vatashleshmahara Dravyas.

According to Vagbhata, in cases of Adhmana, Udavarta and Tamaka Shvasa

first Anulomana should be done with rice-mess mixed with Matulunga, Amlavetasa,

Hingu, Pilu and Bida. Then Virechana with drugs mixed with Saindhava and any sour

fruit followed by warm water should be administered.

SHAMANA CHIKITSA:

Shamana involves the usage of a strict Pathya, Dhoomapana, Leha etc. Kshara

Leha‟s should be used only when there is Kaphadhikya, which is obstructing the

Pranavara Srotas.

Tarpana should be done with Sneha, Yusha and Mamsa Rasa along with

Vatanashaka drugs, in cases like Vatadhika, Durbala, Bala and Vriddha (aged).

Drugs, foods and drinks having ushna Guna, which acts as Kapha Vatagna and

Vatanulomana, should be administered to the Tamaka Shvasa patient.

The vitiated Doshas can be treated with following methods of treatments.



1. Vatakara and Kaphahara Chikitsa

2. Kaphakara and Vatahara Chikitsa

3. Single sided treatments like Kaphahara but Vatakara or Vatahara but

Kaphakara should not be done in any cases.

4. Out of all the Vatahara treatment is better.

In all cases of Shvasa if Brimhana is done, then the Shvasa becomes Prataha

Sukhasadhya even though it is associated with Upadravas.

In the same if Shamana treatment is adopted then it is always Sukhasadhya for

treatment.

If Karshana treatment is adopted, then Shvasa Roga becomes Asadhya for

treatment.

Brinhana is not a complete treatment so it should be done with Shamana Chikitsa

but Karshana therapy should not be advised especially in case of children.

TREATMENT ACCORDING DOSHA PREDOMINANCE:

In Vatapittanubandhi Suvarchala Svarasa, milk, ghee and Trikatu Choorna are

to be taken along with anupana of Shali Odana.

In Kaphapittanubandhi patients, Shirisha Pushpa Svarasa or Saptaparna

Svarasa along with Pippali and Madhu should be administered.

In Kaphadhika patients, if Kapha is obstructing the Pranavaha Srotas then

Kshara Lehas like Ashwagandha Kshara along with honey & ghee etc should be

administered.

Various Shamana Aushadhi‟s described in the classics are listed in Table-9

ANUPANA:

According to the disease the Anupana has been mentioned in Yogaratnakara.

For Shvasa Brimhadadi and Shunthi is Anupana



Table-11

List of Shamana- Aushadhi for Shvasa

Name of Yogas C.S S.S A.H A.S B.P Y.R B.R

Svarasa, kalka, kvatna,

ksheerapaka

Rambha pushpadi kalka - - - + - - -

Shireesha pushpadi kalka - - - + - - -

Saptaparsna swarasa - - - + - - -

Shireesha swarasa - - - + - - -

Kapittha swarasa - - + - - - -

Dashamoola kwatha + - - - - - -

Devadaru kwatha + - - + - + -

Kulatta dashamooladi kwatha - - - + - - -

Vyaghradi ksahaya - - - + - - -

Dashamoola kashaya - - - + - - -

Dashamoola pushkara kwatha - - - - + - -

Bibheetaki kashsya - - - - + - -

Shringyadi kwatha - - - - + - -

Kulattadi kashaya - - - - - + -

Bharangi nagara kwatha - - - - - + -

Panchamula ksheerapaka - - - - - - -

Vaidya vilasa kwatha - - - - - + -

Vaidya jeevana kwatha - - + - - + -

Shankaaka kwatha - - + - - + -

Choorna

Sauvarchaladi choorna + - - - - - -

Shatyadi choorna + - - - - - -

Muktadi choorna + - - - - - -

Saptachadasyetyadi choorna - + - - - - -

Draksha hareetakyadi choorna - + - - - - -

Shringyadi yoga shata choorna - - - - - - +

Haridradi choorna - + - - + - +

Jeevanthyadi dviGunasharkara

choorna

- - + - - - -

Shatydi astha sharkara choorna - - + - - - -

Kushmandamoola choorna - - - - + - +




MahaKaphaladi choorna - - - - + - -

Hingwadi choorna - - - + - - -

Krishnadi choorna - - - - - - +

Shrigyadi choorna - - - - - + +

Shuntyadi choorna - - - - - + -

Markatee choorna - - - - - + -

Gudadi choorna - - - - - + -

Indravarni kadi choorna - - - - - - +

Pippalyadi choorna - - - + - - -

Avaleha

Timirasyetyadi lehya - + - - - - -

Pippaliphaladi lehya - - + - - - -

Gorajadi lehya - - + - - - -

Charuchpanchmradimashree lehya - - + - - - -

Ashwagandhramurva lehya - - + - - - -

Shathvadi lehya - - + - - - -

Paushkara pippali lehya - - + - - - -

Gaurkadi lehya - - + - - - -

Dhatryadi lehya - - + - - - -

Pathyadi lehya - - + - - - -

Koladi lehya - - + - - - -

Gudadi lehya - - + - - - -

Sithopaladi lehya - - + + - - -

Haridradi lehya - - - - - - +

Bharangyadi lehya - - - - - - +

Magdhikavaleha - - - - - - +

Bharargi guda - - - - - + -

Asava

Pathadyasava + - - - - - -

Kanakasava + - - - - + -

Ghritha-Taila

Dashamooladi ghritha + - - - - - -

Tejovahatyadi ghtitha + - + - - + -

Manashiladi ghritha + - - - - - -

Sauvarchaladi gritha - + - - - - -

Himsra vidangaiyadi ghritha - + - - - - -

Dashamoola ghritha - - + - - - -




Karjoorodi ghritha - - + - - - -

Jeevantyadi ghritha - - + - - - -

Stanya siddha gritha - - + - - - -

Kanadi ghrtiha - - + - - - -

Jeevaneeya ghrtiha - - + - - - -

Ardhasarshara ghritha - - + - - - -

Ardhasalavana ghritha - - + - - - -

Dhanvantaradi ghritha - - - + - - -

Sathyadi ghritha - - - - - - +

Shringe guda ghritha - + - - - - -

Purana ghritha + - - - - - -

Bringaraja vagityadi taila - + - - - - -

Guda sharshapa taila - - - + - - -

Dhumayoga

Haridradi dhumayoga + - + - - - -

Sarjarasadi dhumyoga + - - - - - -

Shyonakadi dhumyoga + - - - - - -

Padmakadi dhumyoga + - + - - - -

Yovachoorna dhumyoga + - + - - - -

Goshringadi dhumyoga + - + - - - -

Manshiladi dhumyoga - + - - - - -

Yavadi dhumyoga - + - - - - -

Sringabaladi dhumyoga - + - - - - -

Tarushasallaketyadi dhumyoga - + - - - - -

Madhuchistadi dhumyoga - - + + - - -

Agaru dhumyoga - - + + - - -

Chandana dhumyoga - - + + - - -

Harina khuradi dhumyoga - - + + - - -

Guggulu dhumyoga - - + + - - -

Manashila dhumyoga - - + + - - -

Shala niryasa dhumyoga - - + + - - -

Dhatturaphaladi dhumyoga - - + - - - +

Vati, Rasayoga, LohaBhasma

Shvasa kuthura rasa - - - - + + +

Shvasa bhairava rasa - - - - - - +

Nagarjunabhra rasa - - - - - - +




Sooryavarto rasa - - - - - - +

Brihat mriganka rasa - - - - - - +

Damreshwarabhra vati - - - - - - +

Maha swasadi lauha - - - - - - +

Pippatyadya lauha - - - - - - +

Mayoora piccha bhasAma - - - - - - +

Vijaya vati - - - - - - +

Nasya yoga

Lasahoona muladi nasya - - + + - - -

Guda nagara nasya - - + + - - -

Makshikavishatudi nasya - - + + - - -

Anya

Arkankuraibhravitannmityadi

tandula

- + - - - - -

Kola majjamithyadi tandula - + - - - - -

Nidigdhikadi yoga + - - - - - -

Hingwadi dravya prayoga + - - - - - -

Bilvadi patra rasa - - - - - - +

Bharangi sharkara - - - - - - +

Gandhaka prayoga - - - - - - +

Bibitaka prayoga - - - - - - +

Gudadraka prayoga - - - - - - +

PATHYA AND APATHYA:

Along with Nidana parivarjana and Chikitsa, proper dietetic and seasonal

regimens are necessary things to be followed. By that one can prevent the attacks of

Tamaka Shvasa. Seasonal variations and climatic & atmospheric changes will always

complicate the management of Tamaka Shvasa where nothing can be much expected.

But dietetics and mode of life can be adopted according to the disease. Thus pathya

helps in getting a healthy life. Various patya patyas explained in our classics are listed

in Table-12.



Table-12

Pathya and Apathya for Shvasa

Pathya Apathya

Aharaja Y.R B.R Aharaja Y.R B.R

Rakta shali + + Rooksha anna pana + +

Kulattha - - Sheetanna pana + +

Godhooma + + Guru anna pana + +

Yava + + Vidahi anna pana - +

Tandula + + Vishtambi padartha

Puratana sarpi + - Sevana - +

Madhu + + Mahisha Dugdha + +

Aja paya + + Masha - +

Sura + + Kanda + +

Patola + + Sarshapa + +

Varthaka + + Dushta ambu + +

Rasona + + Tailabrishta nishpava - +

Bimbi phaia + + Sheshmakaraka ahara - +

Jambeera + + Anupana - +

Tanduleeya + + Mamsa varga

Vastuka + + Anupa mamsa - +

Jeevanthi - + Matsya + +

KAmala moola - + Viharaja

KaphaVata nashaka + + Mootra Vegavarodha + +

Annapana Udgar Vegavarodha + +

Poothika - + Chardi veghavarodha + +

Matulunga - + Trisna veghavarodha + +

Ushnajala + + Kasa veghavarodha + +

Shasha mamsa + + Adwagamana - +

Ahita bhuk - + Bharavahana - +

Lava + + PoorvaVata + +

Daksha + + Dantadhavana + +

Shuka + + Srama + +

Dhavadvijamriga + + Kama - +

Aushadhi Varga Upacharaja

Draksha + + Raktamokshana + +

Ela + + Nasya + +

Trikatu - + Basti + +

Gomutra + +

Kantakari + +

Vamana + +

Swrdana + +

Dhoomapana + +

DRUG REVIEW

Drug Review


DRUG REVIEW

Ayurveda considers Oushadha as one of the four essential components for

maintaining health. The drug which is rich in pharmacological activities, which could

be made into various forms of medicaments, having specific therapeutic action and

available in plenty are praised by the legendaries of science. Ample of references are

available in the classics regarding the wonders a good drug can produce as well as the

ill effects an improper drug can create. The combinations of medicines described in

the textbooks of Ayurveda are the products of thorough analysis and clinical trials.

Many of them indicated in the context of various disorders are able to work both in

the curative as well as preventive perspective.

Acharya Charaka says in Charaka Samhita and seeks to achieve first

promotion and preservation of health, strength and longevity in the Swasthya.

Acharya Charaka says that if one who known‟s the uses and actins of herbs though

not acquainted with their forms may be called a knower of science what need be said

of physician who has knowledge of herbs in all their respect. He is the best physician

who due reference to clime and season and who applies it only after examining each

and every patient daily.

Of that this is the text that is of such and such nature of quality of such

efficacy is born of such a country or region, of such a season either eliminates or

allays such and such Doshas and if there be any medication in similar manner should

it also be examined.

Shvasahara Mahakashaya- which is indicated for Shvasa Roga

includes ten drugs like-

Shati (Hedychium spicatium),

Pushkaramula (Inula racemosa),

Amlavetasa (Garcinia pedunculata),

Ela (Elettaria cardamomum),

Hingu (Ferula narthex),

Agaru(Aqualaria agalocha),

Surasa(Ocimum sanctum),

Drug Review


Tamalaki(Phyllanthus urinaria),

Jivanti (Ledtadenia reticulate),

Chanda (Angelica glauca).

Out of these drugs Chanda is not available so remaining 9 drugs will be prepared in

the form of avaleha as it is palatable and easy for administration in pediatric age

group.

By keeping this in mind, this study is undertaken to evaluate the role

of Shvasahara Avaleha in the management of Tamaka Shvasa of pediatric age

patients.

Preparation of Drugs:

Preparation is the process performed to modify the natural properties of

substance. That process again is that which modifies radically the properties of

substance.

By skillfully carrying out synthetic and analytical procedures on drugs by time

factors by pharmaceutical processes even a small dose of a drug may be made to

produce powerful action and a big dose of medication may be made to produce a very

mild result.

Avaleha is modified form of Panchavidha Kashaya Kalpana to make the

availability of the drug material throughout the year, long shelf life, good taste,

elegant look and pleasant smell, produce quick action with low doses. Despite this,

Avaleha Kalpana has its own specific qualities for the Tridosha, capacity to reach

every and every Srotas quick action, palatability, ability to reach each and every

Srotas, capacity to remove the obstruction, make there utility in the different diseases

or different stages of disease.

To know the bio-pharmaceutics, Drugs having Vata Kaphahara, Ushna and

Vatanulomana properties are prescribed. Hence, for present study Shvasahara

Avaleha which is having Kaphahara and Shvasa-Kasahara property has been selected.

Drugs which are available easily, having low cost and can be used safely are selected

and compound preparation in the form of Avaleha has been prepared. Along with this

Acharya mentioned to use Avaleha Kalpana in the Shvasa as mentioned below.

Drug Review


Acharya Vagbhata advices to use the Kashaya, Avaleha in the Anutklesshta

Kapha. While, Acharya Charaka corroborated the use of Avaleha in the Kapha

Pradhan Avastha. Avaleha is intended for internal administration and it is a semisolid

preparation of drugs by the addition of sugar or jaggery and boiled with prescribed

liquid such as decoctions or juices etc. of different drugs. It can be consumed along

with some Anupana. Avaleha can be considered as an Upakalpana of Kwatha since

Acharya Sharangadhara has given utmost importance to Kwatha in his scriptures. In

present era Avaleha is gaining rapid importance. Because it‟s easily consumable,

having good taste and also possesses dietetic values. It can be compared with

confections, electuaries, and conserves of British Pharmacopoeia. Metabolism and

absorption of this dosage form starts from the mouth itself because of the presence of

more quantity of sweetening agents like glucose, fructose etc. Avaleha‟s acceptance is

more when compared to other variety of Ayurvedic Dosage forms.

Administration of Drugs:

He is the best of physicians who knows the art of combination as well as the

systematic administration of these preparations single group in internally.

Dose: The art of prescription depends on the knowledge of according to age of dosage

and time and on this art, in term depends success; hence the skillful physician stands

ever superior to those possessing merely a theoretical knowledge of drugs.

Shvasahara Avaleha for 3yrs to 8yrs- 5gm.

Shvasahara Avaleha for 9yrs to 12yrs- 10gm

HINGU

Hingu consists of oleo-gum-resin obtained from rhizomes and roots of Ferula foetida

Regel., Ferula narthex Bioss,and other species of Ferula (Fam. Umbelliferae), a

perennial herb, occurring in Persia and Afghanistan, resin collected after making

incisions at the upper part of tap root of more than five year old plants by scrapping in

March, April, just before flowering, whole process repeated many times, after one or

two days or after a few weeks when it gets hardened.

Drug Review


SYNONYMS

Sanskrit : Ramaha, Sahasravedhi

Assamese : Hin

Bengali : Hing

English : Asfoetida

Gujrati : Hing, Vagharni

Hindi : Hing, Hingda

Kannada : Hing, Ingu

Kashmiri : Eng

Malayalam : Kayam

Marathi : Hing, Hira, Hing

Oriya : Hengu, Hingu

Punjabi : Hing

Tamil : Perungayam

Telugu : Inguva

Urdu : Hitleet, Hing

DESCRIPTION

a) Macroscopic

Rounded, flattened or masses of agglutinated tears, greyish-white to dull

yellow, mostly 12-25 mm in diameter, freshly exposed surface, yellowish and

translucent or milky white, opaque, slowly becoming pink, red, finally reddish brown,

odour, strong, characteristic and persistent, taste, bitter and acrid.

IDENTITY, PURITY AND STRENGTH

Identification

(I) Freshly broken surface when touched with sulphuric acid a bright red or

reddishbrown colour is produced, changing to violet when acid washed off with

water.

(II) Boil 0.2 g with 2 ml Hydrochloric acid for about 1 minute, cool, dilute with an

equal volume of water, and filter into 3 ml of dilute solution of Ammonia,

fluorescence is produced.

Drug Review


Absence of colophony resin:-Triturate 1 g with 10 ml of Light Petroleum (b.p. 40°-

60°) for 2 minutes, filter into a test tube and add to the filtrate 10 ml of a fresh 0.5 per

cent w/v aqueous solution of copper acetate, shake well and allow the liquids to

separate, petroleum layer does not show any green colour, indicating absence of

colophony resin.


Foreign matter Not more than 2 per cent, Appendix 2.2.2.

Total Ash Not more than 15 per cent, Appendix 2.2.3.

Acid-insoluble ash Not more than 3 per cent, Appendix 2.2.4.

Alcohol-soluble extractive Not less than 50 per cent, Appendix 2.2.6.

Water-soluble extractive Not less than 50 per cent, Appendix 2.2.7.

ASSAY

Place about 5 g accurately weighed, in a small beaker furnished with a glass rod,

and tared add 50 ml of Alcohol (90 per cent), and boil gently. Filter the hot solution

through a tared filter paper and boil the residue with further quantities of Alcohol (90

percent); unitl all soluble matter is removed, using the glass rod to disintegrate the

soluble matter. Wash the filter paper with hot alcohol (90 per cent) transfer the paper

to the beaker, dry the 100°, and weigh. The- residue weighs not more than 50 per cent

of the original sample taken.

CONSTITUENTS - Essential oil, gum and resin.

PROPERTIES AND ACTION

Rasa : Katu

Guna : Tikshna

Virya : Ushna

Vipaka : Katu

Karma : Anulomana, Dipana, Hrudya, Krumighna, Pachana, Ruchya,

Vatakaphaprashamana.

IMPORTANT FORMULATIONS - Hingvashtaka Churna, Hingvadi Churna,

Hinguvachadi Churna.

Drug Review


THERAPEUTIC USES - Shularoga, Adhmana, Gulma, Hrudroga, Krumiroga,

Udararoga, Agnimandya, Anaha

DOSE - 125-500 mg of the drug.

PUSHKARAMOOLA

Pushkara consists of dried root of Inula racemosa Hook. f. (Fam. Asteraceae), a

stout herb, 0.5 to 1.5 m high, mostly found in Western Himalayas upto 2600 m.

SYNONYMS

Sanskrit : Kashmira, Pushkara

Assamese : Pohakarmul, Puskar

Bengali : Pushkara, Pushkaramula

English : Orris Root

Gujrati : Pushkarmula

Hindi : Pohakar Mul

Kannada : Pushkara Moola

Kashmiri : --

Malayalam : Puskara

Marathi : Pokhar Mool

Oriya : Puskara

Punjabi : Pokhar Mool

Tamil : Pushkarmulam

Telugu : Pushkara Mulamu

Urdu : --

DESCRIPTION

a) Macroscopic

Root available in cut pieces, upto about 15 cm long and 0.5 to 2.0 cm in dia.;

Cylindrical, straight or somewhat curved; surface rough due to longitudinal striations

and cracks, scars of lateral rootlets and rhytidoma present, externally brownish-grey

and internally yellowish-brown; fracture, short and smooth; odour, camphoraceous

and aromatic; taste, bitter and camphoraceous.

Drug Review


b) Microscopic

Mature root shows a wavy outline due to development of rhytidoma; cork

composed of 8 to 12 layers of thick-walled, tangentially elongated, rectangular cells,

some filled with reddish-brown contents; secondary cortex 1 or 2 layers or absent;

secondary phloem consists of sieve elements and parenchyma having secretory

cavities and traversed by medullary rays; cambium not distinct; wood occupies bulk

of root consisting of vessels, tracheids, fibres, parenchyma, secretory cavities and

medullary rays; vessel have reticulate thickenings, a few fibres occur in small patches

adjacent to vessels and abundant in xylem parenchyma, thin-walled; a few small

tracheids; parenchyma in general contain granular, slightly yellowish or colourless

inulin granules and also a few yellowish oil globules; starch grains either absent or

very rarely seen in cortical and ray cells; yellowish resinous masses present in

secretory canals.

Powder - Reddish-brown; under microscope shows fragments of cork cells, vessels,

fibres and parenchyma cells containing tannin and inulin.




Acid-insoluble ash Not more than 0.6 per cent, Appendix 2.2.4.

Alcohol-soluble extract Not less than 10 per cent, Appendix 2.2.6.

Water-soluble extract Not less than 20 per cent, Appendix 2.2.7.

T.L.C.

T.L.C. of alcoholic extract on Silica gel 'G' plate using Benzene: Ethylacetate

(9:1) shows on exposure to Iodine vapour nine spots at Rf. 0.23, 0.28, 0.34, 0.39,

0.48,0.51, 0.64, 0.73 and 0.94 (all yellow). On spraying with Vanillin-Sulphuric acid

reagent and heating the plate for about ten minutes at 105o C eight spots appear at Rf.

0.11, 0.28, 0.34, 0.39, 0.48, 0.64, 0.73 and 0.94 (all violet).

Drug Review


CONSTITUENTS - Essential oil


Rasa : Katu, Tikta

Guna : Laghu

Virya : Ushna

Vipaka : Katu

Karma : Kaphavatajit

IMPORTANT FORMULATIONS - Kankayana Gutika, Kumaryasava,

Mahanarayana Taila, Manasamitravaaka, Dashamularishta, Lodhrasava, Rasnadi

Kvatha Churna

THERAPEUTIC USES - Aruchi, Adhmana, Hikka, Jvara, Kasa, Shvasa,

Parsvashula, Ardita, Pandu

DOSE - 1-3 gm of the drug in powder form.

ELA

Ela consists seeds of dried fruits of Elettaria cardamomum (Linn.) Maton and

its varieties (Fam. Zingiberaceae), a stout large perennial herb, growing naturally in

moist forests of Western Ghats up to 1500 m, also cultivated in many other parts of

south India at an elevation from 750-1500m.

SYNONYMS

Sanskrit : Truti, Ela

Assamese : Sarooplaachi

Bengali : Chota elaich

English : Cardamom

Gujrati : Elchi, Elachi, Elayachi

Hindi : Choti Ilayachi

Kannada : Elakki, Sanna Yalakki

Kashmiri : Kath

Malayalam : Elam, Chittelam

Marathi : Velloda, Lahanveldoda, Velchi

Oriya : Chotaa leicha, Alaicha

Drug Review


Punjabi : Illachi, Chhoti Lachi

Tamil : Siruelam

Telugu : Chinne Elakulu, Sanna Elakulu

Urdu : Heel Khurd

DESCRIPTION

a) Macroscopic

Fruit - 1-2 cm long ovoid or oblong and more or less three sided with rounded,

angles, greenish to pale-buff or yellowish in colour, base rounded or with the remains

of pedicle, apex shortly beaked, surface almost smooth or with slight longitudinal

Striations, small trilocular fruit, each containing about 15-20 seeds in a row of

doubles, adhering together to form compact mass.

Seed-dark brown to black, about 4 mm long and 3 mm broad, irregularly angular,

transversely wrinkled but not pitted, with a longitudinal channel containing raphe,

enclosed in a colourless, membranous aril, odour, strongly aromatic, taste,

characteristic.

b) Microscopic

Transverse section of seed shows flattened, aril, thin-walled parenchymatous

cells, testa with outer epidermis of thick-walled, narrow, elongated cells, followed by

a layer of collapsed parenchyma, becoming 2 or 3 layered in the region of raphe,

composed of large, thin-walled rectangular cells containing volatile oil, a band of 2 or

3 layers of parenchyma and an inner epidermis of thin-walled, flattened cells, inner

integument 2 layered, an outer palisade sclerenchyma with yellow to reddish-brown

beaker shaped cells, 20 μ long in radial direction and 12 μ wide, thickened on inner

and anticlinal walls, each cell with a small bowl shaped lumen containing a warty

nodule of silica and an inner epidermis of flattened cells, peri sperm cells thin-walled,

packed with minute rounded polyhedral starch grains, about 1-2 to 4-6 μ in diameter

and containing 1-7 small prismatic crystals of calcium oxalate, about 10-20 μ long,

endosperm of thinwalled parenchyma containing protein as a granular hyaline mass in

each cell, embryo, of small thin-walled cells containing aleurone grains, starch absent

in endosperm land embryo, fibres sclerenchymatous, large vessels present in pericarp.

Drug Review



Foreign matter Not more than Nil per cent, Appendix 2.2.2.





Volatile oil Not less than 4 per cent, Appendix 2.2.10

CONSTITUENTS - Essential oil.


Rasa : Madhura, Katu

Guna : Laghu

Virya : Shita

Vipaka : Madhura

Karma : Anulomana, Depana, Hrudya, Mutrala, Rochana

IMPORTANT FORMULATIONS - Eladi Modaka, Eladi Churna, Sitopaladi

Churna

THERAPEUTIC USES - Aruchi, Shvasa, Chardi, Kasa, Mutrakrucchra

DOSE - 250-500 mg of the drug in powder form.

TULASÌ

Tulasi consists of dried whole plant of Ocimum sanctum Linn. (Fam. Lamiaceae);

An erect, 30 - 60 cm high, much branched, annual herb, found throughout the country.

SYNONYMS

Sanskrit : Surasa¸Krishnatulasi, Bana Tulasi

Assamese : Tulasi

Bengali : Tulasi

English : Holy Basil

Gujrati : Tulasi, Tulsi

Hindi : Tulasi

Kannada : Tulasi, Shree Tulasi, Vishnu Tulasi

Kashmiri : --

Malayalam : Tulasi, Tulasa

Drug Review


Marathi : Tulas

Oriya : --

Punjabi : Tulasi

Tamil : Tulasi, Thulasi, Thiru Theezai

Telugu : Tulasi

Urdu : Raihan, Tulsi

DESCRIPTION

a) Macroscopic

Root - Thin, wiry, branched, hairy, soft, blackish-brown externally and pale. violet

internally.

Stem - Erect, herbaceous, woody, branched; hairy, sub quadrangular, externally

purplish-brown to black, internally cream, coloured; fracture, fibrous in bark and short

in xylem; odour faintly aromatic.

Leaf - 2.5 - 5 cm long 1.6 - 3.2 cm wide, elliptic oblong, obtuse or acute, entire or

serrate, pubescent on both sides; petiole thin, about 1.5-3 cm long hairy; odour,

aromatic; taste, characteristic.

Flower - Purplish or crimson coloured, small in close whorls; bracts about 3 mm long

and broad, pedicels longer than calyx, slender, pubescent; calyx ovoid or campanulate

3-4 mm bilipped, upper lip broadly obovate or suborbicular, shortly apiculate, lower

lip longer than upper having four mucronate teeth, lateral two short and central two

largest; corolla about 4 mm long, pubescent; odour, aromatic; taste, pungent.

Fruit - A group of 4 nutlets, each with one seed, enclosed in an enlarged,

membranous, veined calyx, nutlets sub-globose or broadly elliptic, slightly

compressed, nearly smooth; pale brown or reddish with small black marking at the

place of attachment to the thalamus; odour, aromatic; taste, pungent.

Seed - Rounded to oval; brown, mucilaginous when soaked in water, 0.1 cm long,

Slightly notched at the base; no odour; taste, pungent, slightly mucilaginous.

b) Microscopic

Root - Shows a single layered epidermis followed by cortex, consisting of seven or

more layers of rectangular, round to oval polygonal, thin-walled, parenchymatous

Drug Review


cells, filled with brown content, inner layers of cortex devoid of contents; phloem

consisting of sieve elements, thin-walled, rectangular parenchyma cells and scattered

groups of fibres, found scattered in phloem; xylem consists of vessels, tracheids,

fibres and parenchyma; vessels pitted; fibre tracheides, long, pitted with pointed ends;

fibres thick walled and with pointed ends.

Stem - Shows a single layered epidermis with uniseriate, multicellular covering

trichomes having 5-6 cells, occasionally a few cells collapsed; cortex consists of 10 or

more layers of thin-walled, rectangular, parenchymatous cells; phloem consists of

sieve elements, thin-walled, rectangular parenchyma cells and fibres; fibres found

scattered mostly throughout phloem, in groups and rarely in singles; xylem occupies

major portion of stem consisting of vessels, tracheids fibres and parenchyma; vessels

pitted; fibres with pointed ends; centre occupied by nan-ow pith consisting of round to

oval, thin-walled, parenchymatous cells.

Leaf-

Petiole - shows somewhat cordate outline, consisting of single layered epidermis

composed of thin-walled, oval cells having a number of covering and glandular

trichomes; covering trichomes multicellular 1-8 celled long, rarely slightly reflexed at

tip; glandular trichomes short, sessile with 1-2 celled stalk and 2-8 celled

balloonshaped head, measuring 22-27 in dia; epidermis followed by 1 or 2 layers and

2 or 3 layers of thin-walled, elongated, parenchyma cells towards upper and lower

surfaces respectively; three vascular bundles situated centrally, middle one larger than

other two; xylem surrounded by phloem.

Midrib - epidermis, trichomes and vascular bundles similar to those of petiole except

cortical layers reduced towards apical region.

Lamina - epidermis and trichomes similar to those of petiole; both anomocytic and

diacytic type of stomata present on both surfaces, slightly raised above the level of

epidermis; palisade single layered followed by 4-6 layers of closely packed spongy

parenchyma with chloroplast and oleo-resin; stomatal index 10-12-15 on upper

surface and 14 - 15 - 16 on lower surface; palisade ratio 3.8; vein islet number31 - 35.

Powder - Greenish: shows thin-walled, parenchymatous cells, a few containing

reddishbrown contents, unicellular and rnulticellular-trichomes either entire or in

Drug Review


pieces; thinwalled fibres, xylem vessels with pitted thickenings, fragments of

epidermal cells insurface view having irregular shape, oil globules, rounded to oval,

simple as well ascompound starch grains having 2-5 components, measuring 3-17 μ in

diameter.







T.L.C.

T.L.C. of Tulasi oil obtained by stem distillation is carried out on Silica gel 'G'

plate using Toluene : Ethylacetate (93:7) Tulasi oil is diluted in chloroform-toluene

(1:10). Eugenol to be applied as standard also diluted in 130 ratio and 10 μl of each to

be applied in band form. After running distance of 10 cm the plate is air drying for 15

minutes and than kept in the over for 2 to 5 minutes. On cooling spray, in thoroughly

vanillin- Sulphuric acid reagent and heat the plate at 110° C for 5 - 1- minutes under

Observation. Record Rf. values of eugenol and caryophyllence. Eugenol (orange

brown) approx. Rf. value 0.7, caryophyllence (reddish violet) runs to solvent front.

CONSTITUENTS - Essential Oil.


Rasa : Katu, Tikta, Kashaya

Guna : Laghu, Ruksha, Ùshna

Virya : Ushna

Vipaka : Katu

Karma : Dipana, Hrudya, Kaphahara, Ruchya, Vatahara, Pittavardhina,

Durgandhihara.

IMPORTANT FORMULATIONS - Tribhuvanakirti Rasa, Muktapanchamruta

Rasa, Muktadi Mahanjana, Manasamitra Vataka

Drug Review


THERAPEUTIC USES - Ashmari, Shvasa, Chardi, Hikka, Kasa, Krumiroga,

Kushtha, Netraroga, Parva shula

DOSE - 1-3 ml of the drug in juice form.

1-2 g of the drug in powder form (seed).

SHATI

Shati consists of sliced, dried rhizomes of Hedychium spicatum Ham.ex Smith

(Fam. Zingiberaceae), a perennial rhizomatous herb, measuring upto 1 m occurs in

parts of western and central regions of sub-tropical Himalayas at an altitude of 1500-

2000 m, grows abundantly in Kumaon and Punjab.

SYNONYMS

Sanskrit : Shati, Gandhamulika

Assamese : Katuri, Sati

Bengali : Shati, Kachri

English : Spiked ginger lily

Gujrati : Kapurkachri, Kapurkachali

Hindi : Kapurkachri

Kannada : Goul Kachora, Seenakachora, Kachora

Kashmiri : Kapoorkachara

Malayalam : Katcholam, Katchooram

Marathi : Kapurakachari, Gablakachari

Oriya : Gandhasunthi

Punjabi : Kachur, Kachoor

Tamil : Poolankizangu Kichili Kizongu

Telugu : Gandha Kachuralu

Urdu : --

DESCRIPTION

a) Macroscopic

Rhizomes 15-20 cm long, 20-25 mm in diameter, externally yellowish-brown

hut changed to dark brown on storage, drug available in pieces of 2.5 cm diameter,

edge of each piece is covered by a rough reddish-brown layer marked with numerous

scars and circular rings, rudiments of root-lets visible, odour, camphoraceous, taste,

bitter.

Drug Review


b) Microscopic

Transverse section of rhizome shows an outermost thick layer of suberised,

dark brown cells of outer cork consisting of 10-15 or more layers of irregular

parenchymatous cells, inner cork consisting of a few layered light brown, rectangular,

radially arranged cells followed by a wide zone of cortex, 30-40 cells thick, some

cortical cells filled with flattened and oval-oblong starch grains, numerous oleo-resin

cells also found in this region which have suberised walls containing green-yellow oil,

a thin endodermal layer present beneath cortex, central cylinder distinguished by

presence of peripheral plexus of irregular congested vascular bundles with poorly

developed mechanical tissues, vascular bundles scattered irregularly throughout

ground tissue, bundles closed and collateral possessing group of two or more xylem

elements, ground tissue composed of large parenchymatous cells with abundant starch

grains and oil.







CONSTITUENTS - Essential oil.


Rasa : Katu, Tikta, Kashaya

Guna : Laghu, Ùshna

Virya : Ushna

Vipaka : Katu

Karma : Shulahara, Grahi, Kaphavataghna, Mukhashodhana

IMPORTANT FORMULATIONS - Agastyaharitaki Rasayana, Shatyadi Churna

THERAPEUTIC USES - Shula, Shvasa, Chardi, Kasa, Kandu, Mukharoga

DOSE - 1-3 g of the drug in powder form.

Drug Review


TAMALAKI

Tamalaki consists of root, stem and leaf of Phyllanthus fraternus Webst. Syn.

Phyllanthus niruri Hook. F. non Linn. (Fam. Euphorbiaceae), an annual herb, 20-60

cm high, found in Central and Southern India extending to Ceylon.

SYNONYMS

Sanskrit : Mahidhatrika, Bhumyamalaki, Bahuphala

Assamese : Bhuin Amla

Bengali : Bhumamla, Bhumi amalaki

English : --

Gujrati : Bhoi Amali, Bhony amari, Bhonyamali

Hindi : Bhui Amala

Kannada : Nelanelli

Kashmiri : Kath

Malayalam : Kizanelli, Keezhanelli, Ajjhada

Marathi : Bhuiawali

Oriya : Bhuin Amla

Punjabi : Lodhar

Tamil : Kizhukai nelli, Kizanelli

Telugu : Nela usirika

DESCRIPTION

a) Macroscopic

Root-small, 2.5-11 .0 cm long. Nearly straight, gradually tapering, with a number

of fibrous secondary and tertiary roots, external surface light brown, fracture, short.

Stem-Slender, gabrous, light brown, cylindrical, 20-75 cm long, branching

profusetowards upper region bearing 5-10 pairs of leaves, internode, 1-3.5 cm long,

odour, indistinct, taste, slightly bitter.

Leaf-compound and leaf-let arranged in two rows with a rachis, alternate, opposite

and decussate almost sessile, stipulate, oblong, entire, upto 1.5 cm long and 0.5 cm

wide, greenish-brown in colour, odour, indistinct, taste, slightly bitter

Drug Review


b) Microscopic

Root-transverse section shows, 4-6 layers of cork consisting of thin-walled,

rectangular, tangentially elongated and radially arranged cells, filled With reddish-

brown content, secondary cortex consists of 8-10 layers of thin-walled, tangentially

elongated parenchymatous cells, secondary phloem narrow consisting of sieve

elements, phloem parenchyma and traversed by narrow phloem rays, secondary xylem

represented by a broad zone of tissues, composed of vessels, tracheids, fibres and

parenchyma, all elements being thick-walled and lignified having simple pits, xylem

rays uniseriate. Stem-transverse section shows, a single layered epidermis composed

of thick-walled, flattened, tangentially elongated cells, older stem shows 4-5 layers of

cork, composed of thin-walled, tabular, tangentially elongated and radially arranged

cells, filled With reddish-brown content, cortex composed of 4-6 layers of oval,

tangentially elongated, thin-walled, parenchymatous cells, some cortical cells filled

with yellowish-brown content, endodermis quite distinct, pericycle represented by a

discontinuous ring, composed of several tangentially elongated strands of lignified

fibres with thick walls and narrow lumen, secondary phloem narrow, composed of

sieve elements, dispersed in mass of phloem parenchyma, secondary xylem composed

of vessels, fibres, parenchyma and traversed by numerous uniseriate rays, vessels

mostly simple pitted, a few show spiral thickenings, fibres narrow elongated, with

narrow or sometimes blunt ends with simple pits, centre, occupied by a pith composed

of thin-walled, circular to oval parenchymatous cells, occasionally cluster crystals of

calcium oxalate present in parenchymatous cells of ground tissue.

Leaf-transverse section of leaf shows, a biconvex outline, epidermis on either side,

single layered covered externally by a thick cuticle, a palisade layer present beneath

upper epidermis, intercepted by a few parenchymatous cells in the middle, meristele

composed of small strands of xylem towards upper surface and phloem towards lower

surface, rest of tissue of leaf composed of thin-walled, parenchymatous cells some

having cluster crystals of calcium oxalate, lamina shows a dorsiventral structure,

mesophyll differentiated into palisade and spongy parenchyma, epidermis on either

side composed of thin-wa1led, tangentially elongated cells, covered externally by a

thick cuticle, anisocytic type stomata present on both epidermises, palisade single

Drug Review


layered, mesophyll composed of 3-5 layers of loosely arranged cells having a number

of veins traversed in this region, a few cluster crystals of calcium oxalate present in

spongy parenchyma.

Powder-Powder of the drug, brown coloured, under microscope shows, fragments of

cork cells, vessels and fibres.







CONSTITUENTS - Phyllanthin.


Rasa : Madhura, Tikta, Kashaya

Guna : Laghu, Ruksha

Virya : Shita

Vipaka : Madhura

Karma : Mutrala, Rochana, Dahanashini, Pittashamaka

IMPORTANT FORMULATIONS - Chyavanaprasha, Citraka Haritaki,

Madhuyashtyadi Taila, Pippalyddi Ghrita, Satavariguda

THERAPEUTIC USES - Amlapitta, Kasa, Kshaya, Kushtha, Pandu, Prameha,

Trusha, Kshata, Mutraroga.

DOSE - 10-20 ml of the drug in juice form.

3-6 of the drug in powder form.

AGARU

Agaru consists of dried heart wood of Aquilaria agallocha Roxb. (Fam.

Thymelacaceae), a large evergreen tree, distributed in North East part of the country.

SYNONYMS

Sanskrit : Aguru, Lauha, K¤mija

Drug Review


Assamese : Agaru

Bengali : Agaru, Agarkashtha, Agar Chandan

English : Eagle Wood

Gujrati : Agar

Hindi : Agar

Kannada : Krishna Agaru

Kashmiri : --

Malayalam : Akil

Marathi : Agar

Oriya : --

Punjabi : Ooda, ooda, pharsi

Tamil : Akil kattai

Telugu : Agaru

Urdu : Ood Hindi, Agar

DESCRIPTION

a) Macroscopic

Drug available in cut pieces, dark brown to nearly black; fracture, hard; no

Characteristic smell and taste.

b) Microscopic

Shows mostly uniseriate sometimes biseriate xylem rays; vessels isolated

having simple pitted thickening and filled with dark brown contents; xylem fibres

short having narrow lumen occupying a major portion of wood; xylem parenchyma

less in number and simple pitted; included phloem tissues in pockets partially

disorganised, leaving large circular or oval holes, containing collapsed and broken

tissues.

Powder - Dark brown; shows numerous aseptate fibres, simple pitted vessels with

dark brown contents.



Total Ash Not more than 13 per cent, Appenix 2.2.3.


Drug Review




T.L.C.

T.L.C. of the alcoholic extract on Silica gel 'G' plate using Toluene:

Ethylacetate (9:1) shows in visible light two spots at Rf. 0.17 and 0.27 (both light

brown). Under U.V. (366 nm) five fluorescent zones appear at Rf. 0.17, 0.27, 0.36,

0.57 and 0.80 (all blue). On exposure to Iodine vapour eight spots appear at Rf. 0.05,

0.11, 0.15, 0.24, 0.33, 0.57, 0.73 and 0.80 (all yellow). On spraying with Vanillin-

Sulphuric acid reagent and after heating the plate for ten minutes at 105°C five spots

appear at Rf. 0.13, 0.18, 0.25, 0.37 and 0.59 (all violet).

CONSTITUENTS - Essential Oil


Rasa : Katu, Tikta

Guna : Laghu, Snigdha, Tikshna

Virya : Ushna

Vipaka : Katu

Karma : Shirovirechana, Kaphahara, Pittalam, Tvachya, Vatahara

IMPORTANT FORMULATIONS - Madhukasava, Mrudvikasava, Karpuradyarka,

Chyavanaprasha Avaleha, Anu Taila,

Candanadi Taila,Khadiradi Gutika, Shvasahara

Kashaya Churna, Guduchyadi Taila.

THERAPEUTIC USES - Akshiroga, Shvasa, Karna Roga, Kushtha, Visha.

DOSE - 1-3gms

JIVANTI

Jivanti consist of dried roots of Leptadenia reticulate W. & A. (Fam.Asclepiadaceae),

a much branched twining shrub, distributed throughout the plains of india, along

hedges.

SYNONYMS: Jivanti, Shakashreshtha, jivani.

REGIONAL LANGUAGE NAMES

Drug Review


Bengali : Jiwanti

English : Cork Swallow-wort

Gugrati : Dodee

Hindi : Dodi Shak, Jivanti

Malyalam : Atapatiyan

Marathi : Kheerakhodi, Kharkhoda

Tamil : Palalkkodi

Telagu : palatige, Mukkutummudu

DESCRIPTION

a)Macroscopic

Roots cylindrical, 5 to 7 cm in length and 1to 3 cm in thickness, surface light

brown to grayish brown with longitudinal wrinkles, fracture, tough, fractured surface

creamish and horny, odour and taste indistinct.

b)Microscopic

Root shows cork consisting of rectangular and tangentially elongated cell,

phellogen 1 to 2 layered, phelloderm consists of thin walled parenchyma cells,with

group of stone cells and fibres scattered in the central and lower regions, phloem

made up of of sieve tubes, companion cells, parenchyma, fibres and stone cells

present in outer phloem region, stonecells medullary rays, groups of fibres and stone

cells present in outer phloem region, stone cells are about 60 micron in length and 20

micron in width, fibres are upto 1300 micron in length, xylem represented by vessels,

tracheids, fibres, parenchyma, interxylary phloem and uni to multi seriare medullary

rays, all xylem elements except interxylary phloem thick walled and lignified, vessels

drum shaped or elongated with bordered pits or bifurcated ends present in some of the

parenchyma cells of phlom and phelloderm.

Powder- Powder shows rectangular to polygonal stone cells, vessels with bordered

pits or scalariform thickening, border pitted tracheids, fibres with tapering or

bifurcated ends, thick walled parenchyma cells with simple pits and thin walled

parenchyma cells rosettes of calcium oxalate crystals.

Drug Review



Foreign matter Not more than 2 percent, Appendix2.2.2

Total ash Not more than 14 percent, Appendix2.2.3

Acid-insoluble ash Not more than 1.5percent, Appendix2.2.4

Alcohol-soluble extractive Not more than 5 percent, Appendix2.2.7

Water-soluble extractive Not more than 3 percent, Appendix2.2.8

T.L.C.

T.L.C. of alcoholic extracts on precoated silica gel „G‟ plate using chloroform:

Methanol:water(4:3:1) as mobile phase and when seen under UV 254 nm shows spots

at R 0.01, 0.21,0.26(all blue), 0.54, and 0.75 (both white).

CONSTITUENTS – Hentriacontanol, Alfa and Beta-amyrin, stigmasterol, Beta-

sitosterol and flavonoids-diosmetin and luteolin.


Rasa : Madhura, Kashaya.

Guna : Laghu, Snigdha.

Virya : Shita

Vipaka : Madhura

Karma : Rasayana, Balya, Chakshushya, Grahi, Vrushya, Brimhana,

Stanyajanana, Vishaghna, Tridoshahara.

IMPORTANT FORMULATION- Chyanaprash, Brahmarasayana, Amrutaprasha

ghrita, Ashoka ghrita, Brihatmashataila, Manasamitravataka, Shvasahara

Kashayachurna, Guduchyadi taila.

THERAPEUTIC USES – Atisara(diarrhea), Daha(burning sensation), Jvara(fever),

Kashaya(pthisis), Kasa(cough), Shosha(emaciation), Mukharoga(disease of mouth),

Naktandhya(Night blindness), Netraroga(diseases of the eye), Raktapitta(bleeding

disorder), Trushna(thirst), Urahkshata(pulmonary cavitation), Vrana(ulcer).

DOSE – Churna (powder): 3 to 6 gm

Drug Review


HONEY

Ayurvedic properties:

Rasa : Madhura, Kshaya.

Guna : Ruksha, Laghu, Sukshma,

Veerya : Sheeta.

Vipaka : Katu.

Doshaghnta : Kapha nasaka.

Honey is a sweet and viscous fluid produced by bees and other insects from

the nectar of flowers. The definition of honey stipulates a pure product that does not

allow for the addition of any other substances. This includes, but is not limited to,

water or other sweeteners. Honey is significantly sweeter than table sugar and has

attractive chemical properties for baking.

Liquid honey does not spoil. Because of its high sugar concentration, it kill

bacteria by plasmolysis. Natural air bone yeasts can not become active in it because

the moisture content is too low. Natural, raw honey varies from14% to 18% moisture

content. As long as the moisture content remains under

18%, virtually no organism can successfully multiply to significant amounts in

honey.

Composition of Honey:

Honey is a mixture of sugars, water and other compounds. The specific

composition of any batch of honey will depend largely on the mixture of flowers

consumed by the bees that produced the honey. Honey has a density of about

1500 kg / m3.

Typical Honey Analysis: Fructose 38

Glucose 31%

Sucrose 1%

Water 17

Other sugars 9% (Maltose, Malaritose)

Ash 0.17%

Honey is available in four forms:

1. Extracted honey

2. Comb honey

Drug Review


3. Chunk honey

4. Creamed honey

Uses: The main uses of honey are in cooking, confectionary etc. Because honey is

hygroscopic (drawing moisture from the air), a small quantity of honey added to a

pastry recipe will retard the staling process. Raw honey also contains enzyme that

help in its digestion, and several antioxidants.

Honey is used in folk medicine and apitherapy and is an excellent natural

preservative. All the Acharya has considered it as one of the best Yogvahi the reason

for this because honey is made up of nectar of differentFlowers.

IKSHU

Family: Poaceae

Synonyms:

Sanskrit : Iksu

English : Sugarcane

Constituents : Sucrose.

Properties and Actions:

Rasa : Madhura

Guna : Guru, Sara, Snigdha

Virya : Shita

Vipaka : Madhura

Karma : Brmhana, Balya, Kaphahara, Pittahara, Vatahara,

Vrsya, Mutrala

Important Formulations: Bala Taila.

Therapeutic Uses : Raktapitta, Mutra Ksaya.

Dose : 200 - 400 ml in the juice form.

GHEE

Classical name : Avi, Sarpi, Aajy

Vernacular Name : Gujrati –Ghee,

Hindi-Ghee,

Drug Review


English -Clarified butter.

Ayurvedic properties:

Rasa : Madhur

Guna : Guru, Snigdha & Sara.

Virya : Sheet

Vipaka : Madhur

Doshaghnata: Vata-Pitta Shamaka.

Fresh - Pandu, Kamala, Netra Rogahara

Stored- Unamada, Apasmara, Kusthhara In general Agnivardhaka,

Vrishya, Medhavardhaka, Chakshukshya, Vayasthapak,

Rasayana.

Chemical constituents: Cow ghee generally contains

Moisture 14.4%

Fat 32.4%

Protein 36.0%

Lactose 12.0%

Ash 5.2%

Major constituent:

1) Triglyceride

2) Unsaponifiable Matter (Soluble in Fat): Vit. A, beta carotene, Xanthophylls,

Lycopene, alpho tocopherol, Sterols - Vit. D, cholesterol, cholesterol esters, 7-

dehydro- cholesterol, Ergosterol, Lanosterol, Vit. K, Hydrocarbons: Squalene

Trace Constituents:

Diglycerids, Monoglycerides, Phospholipids, Proteins, Lactose

Free acids:

Water soluble like formic, acetic, propionic and lactic acids, fatty acid like buturic,

caproic, oleic etc.Fat breakdown products like fat hydroperoxide, free aldehydes and

ketones, lactones, Minerals like calcium, Magnesium, Copper, Iron etc.

MATERIALS AND METHODS

Material & Methods


MATERIAL AND METHODS

OBJECTIVES OF THE STUDY

To evaluate the effect of Shvasa-Hara Avaleha in management of Tamak Shvasa

in children

SOURCE OF DATA

40 Patients selected from Out Patient Department & In patient Department of

Kaumarbhritya, S.D.M.C.A. & Hospital, Hassan. Diagnosed patients of Tamaka

Shvasa taken for the study by using special proforma prepared for screening.

METHOD OF COLLECTION OF DATA

Patients who fulfilled the diagnostic and inclusion criteria were selected for the study.

DIAGNOSTIC CRITERIA

The diagnosis was mainly be based on Lakshana of Tamaka Shvasa described

in Ayurvedic classics. Diagnosis was be confirmed by the ICD 10 (International

Classification of Disease) criteria for the diagnosis of bronchial asthma. This criterion

includes Episodes or chronic wheezing, dyspnea, cough, feeling tightness in the chest,

prolonged expiration & diffuse wheezing on physical exertion, limitation of airflow

on pulmonary function testing or positive Broncho provocation challenge test.

INCLUSION CRITERIA

1) Patients suffering from Tamakashvasa between age group of 3 to 12 years were

included in the study.

2) Patients were selected irrespective of sex, religion, occupation, socio economic

status.

EXCLUSION CRITERIA

1) Patients suffering from other types of Shvasa were excluded from the study.

2) Patients with Pulmonary tuberculosis, COPD, Bronchiectasis & Tropical

eosinophilia or with any other systemic disorders were excluded.

3) Patients with acute or severe exacerbation & status asthmatics who require

immediate intervention were excluded.

Material & Methods


SINGLE GROUP STUDY

This is a single group study on patients of Tamaka Shvasa with Shvsahara

Avaleha for the period of 1 month.

Doses of Shvasahara Avaleha:

5 gm twice daily before food for 3 to 8 years of age

10 gm twice daily before food for 8 to 12 years of age

Duration of treatment was for a period of 1 month.

Follow up Study:

The patients were followed at the interval of 15 days for one month. i.e. patients

were assessed initially and at the end of 15 days and at the end of 1 month.

CRITERIA FOR ASSESSMENT OF THE EFFECT OF TREATMENT

For the purpose of assessment of treatment pre test & post test were made on –

Assessment criteria B.T. D.T. A.T.

Breathlessness

Audible wheezes

Cough

Sputum

Common cold

Day time asthma

Night time asthma

Discomfort

Tightness of chest

Chest pain

Loss of sleep

Impact on activity

Palpitation

Respiratory rate

Frequency of attack

Duration of symptoms

PEFR

Material & Methods


LABORATORY INVESTIGATIONS –

Blood routine exam: TLC, DLC, Hb, ESR.

Urine routine exam for Albumin, sugar and microscopic exam.

X ray chest.

Peak expiratory flow rate.

The severity of disease was assessed with the help of criteria for assessment of

severity,

which is given in following table –

GRADATION INDEX –

GRADE 0 1 2 3

Dyspnoea None ≤ 2 Attacks per

60 days

2-4 Attacks per

60 days

>4 Attacks per

60 days

Wheezing None Only at the time

of attack

Frequently Always present

Discomfort Not at all On running /

short exercise

On walking On all position

/Missed school

Cough Not at all Occasional

cough

Frequently Distressing

nature

Impact on

activity

None Dyspnoea with

lot of activity

Interferes with

moderate activity

Interferes with

any activity /

missed schools

Sleep Fine Sleep well,

slight wheeze or

cough

Awake 2-3 times

at night, wheeze,

cough

Awake most of

the night.

Frequency

of attack.

No attack < 1 Episode /

month

> 2 Episodes /

month.

> 4 Episodes /

month

Duration of

symptom.

No

symptom.

Brief for hours Prolonged for 2-3

days

Almost

continuous

PEFR

values

Normal >80% Of

predicted

50-80% Of

predicted

<50% Of

predicted

R.R. 18-

23/min

24-30/min 31-40/min >40/min

Palpitation Not at all On running /

short exercise

On walking On all position

/contineous

Chest pain Not at all On running /

short exercise

On walking/

caughing

contineous

Chest

tightness

Not at all mild moderate severe

Cold None Itching sensation Watery discharge Blocked nose

Sputum Normal

saliva

More secretion Thick whitish Thick yellow

OBSERVATIONS

Observations


OBSERVATIONS

The clinical trail was carried out on 40 patients of Tamaka Shvasa (bronchial

asthma). These patients were treated in a single group and were treated Shvasahara

Avaleha. The Nidanatmaka aspect of these 40 patients of Tamaka Shvasa is being

given hereunder and thereafter the effects of the therapies will be described.

Age: Age wise distribution of 40 patients of Tamaka Shvasa showed that maximum

i.e. 45.00% were in the age group of 3-8 years and remaining 55.00% were of 9-12

yrs age group (Table-C1 and Graph-C1).

Sex: Sex wise distribution of 40 patients of Tamaka Shvasa showed that 62.5% were

boys while 37.5% were girls (Table-C2).

Religion: Religion wise distribution of 40 patients of Tamaka Shvasa showed that

maximum i.e. 87.5% patients were Hindu, 7.5% patients were Muslim and 5%

patients were Jain (Table-C3).

Table-C1

Age wise Distribution of 40 Patients of Tamaka Shvasa

Age group (in yrs) Number of Patients Percentage

3-8 18 45.0

9-12 22 55.0

Table-C2

Sex wise Distribution of 40 Patients of Tamaka Shvasa

Sex Number of patients Percentage

Male 25 62.5

Female 15 37.5

Table-C3

Religion wise Distribution of 40 Patients of Tamaka Shvasa

Religion Number of patients Percentage

Hindu 35 87.5

Muslim 3 7.5

Jain 2 5.0

Observations


Education: Education wise distribution of 40 patients of Tamaka Shvasa showed that

35.0% patients were studying in higher primary school, 65.0% patients were studying

in primary school (table-C4)

Age of Onset: Age wise distribution of 40 patients of Tamaka Shvasa showed that

60% patients had onset of disease after 8years of age and 40% patients had onset of

Tamaka shvasa at the age of 3 years to 8 years (table C-5).

Aggravating Factors: Maximum number of Tamaka Shvasa patients i.e. 100% were

reported exposure to cold air, 85% patients were reported smoke, 90% patients were

reported dust, 10% patients were reported strong smell and 67.5% were reported

exercise as the main precipitating factor of disease (Table C-6)

Table-C4

Education Status Recorded in 40 Patients of Tamaka Shvasa

Education Number of patients Percentage

Primary school 26 65.0

Higher Primary school 14 35.0

Table C5

Age of Onset of Tamaka shvasa

Age of onset

(in yrs)

Number of patients

Percentage

3-8 16 40

9-12 24 60

Table –C6

Aggravating Factors Reported by 40 Patients of Tamaka Shvasa

Vihara Sambandhi Nidana Number of patients Percentage

Sheeta vayu 40 100.00

Raja sevana 36 90.00

Dhooma sevana 34 85.00

Smell 04 10.00

Exercise 27 67.50

Observations


Associated Disorders: Maximum number of patients i.e. 90% patients were reported

Kasa, 83% patients were reported Pratisyaya, 43% patients were reported Jwara, 6%

patients reported Pandu and Atisara as associated disease with Tamaka Shvasa (Table

C -7)

Family History of Asthma: Family history was reported in 65.00% patients and in

35.00% patients there was no family history of asthma (Table C-8).

Dietary Habit: Maximum i.e. 62.5% patients from mixed diet and only 37.5%

patients from vegetarian diet family were seen out of 40 patients (Table C-9).

Table C-7

Associated Disorders Recorded in Tamakashvasa Patients

Associated disorders Number of patients Percentage

Pratishyaya 25 83.33%

Kasa 27 90%

Jvara 13 43.33%

Pandu 02 6.67%

Atisara 02 6.67%

Table C -8

Family History of Asthma Recorded in 40 Tamakashvasa Patients

Family history of Asthma Number of patients Percentage

Present 26 65.00

Absent 14 35.00

Table C - 9

Dietary Habit Reported by 40 Tamakashvasa Patients

Number of patients Percentage

Vegetarian 13 32.50

Mixed 27 67.50

Observations


Prakruti: Out of 40 patients 40% were of Kapha Prakruti, 47.5% were of Kaphavata

Prakruti, 7.5% were of Vata Prakruti and 5% were of Vatapitta Prakruti. (Table C-10)

Sara: Out of 40 patients, 57.5% were of Madhyama Sara, 30% were of Avara Sara

and 12.5% were of Pravara Sara. (Table C-11)

Samhanana: Samhanana wise distribution of patients showed that out of 40 patients,

55% had Madhyama Samhanana, 32.50% had Avara Samhanana and 12.50% had

Pravara Samhanana (Table C-12)

Table C-10

Prakruti wise Distribution of 40 Tamakashvasa Patients

Prakruti Number of patients Percentage

Kapha 16 40.00

Kaphavata 19 47.50

Vata 3 7.50

Vata pitta 2 5.00

Table C-11

Sara wise Distribution of 40 Tamakashvasa Patients

Sara Number of patients Percentage

Pravara 5 12.50

Avara 12 30.00

Madhyama 23 57.50

Table C-12

Samhanana wise Distribution of 40 Tamakashvasa Patients

Samhanana Number of patients Percentage

Pravara 05 12.50

Avara 13 32.50

Madhyama 22 55.00

Satva: Satva wise distribution of patients showed that out of 40 patients, 47.50% had

Avara Satva, 15% had Pravara Satva and 37.50% had Madhyama Satva. (Table C-13)

Observations


Pramana: Pramana wise distribution of 40 Tamaka Shvasa patients showed that

55.00% were of Madhyama Pramana, 32.50% were of Avara Pramana and 12.50%

were of Pravara Pramana (Table C- 14)

Vyayama Shakti: Vyayama Shakti wise distribution of 40 Tamaka Shvasa patients

showed that 62.50% had Avara Vyayama Shakti and 32.50% had Madhyama

Vyayama Shakti and 5% patient showed Pravara Vyayama Shakti (Table C- 15)

Table C-13

Satva wise Distribution of 40 Tamakashvasa Patients

Satva Number of patients Percentage

Pravara 06 15.00

Avara 19 47.50

Madhyama 15 37.50

Table C- 14

Pramana wise Distribution of 40 Tamakashvasa Patients

Pramana Number of patients Percentage

Pravara 05 12.50

Avara 13 32.50

Madhyama 22 55.00

Table C-15

Vyayama Shakti Reported by 40 Tamakashvasa Patients

Vyayama Number of patients Percentage

Pravara 02 5.00

Avara 25 62.50

Madhyama 13 32.50

Ahara Shakti: Ahara Shakti wise distribution of 40 Tamaka Shvasa patients showed

that 62.5% had Avara Ahara Shakti and Madhyama Ahara Shakti was reported in

27.5% and 10% had Pravara Ahara Shakti. (Table C-16)

Observations


Agni: Agni Shakti wise distribution of 40 Tamaka Shvasa patients showed that

Mandagni was observed in 65.00%, Samagni was observed in 12.50% and

Vishamagni was observed in 22.50% patients. (Table C-17)

Koshtha: : Koshtha wise distribution of 40 Tamaka Shvasa patients showed,

Madhyama Koshtha in 30%, Mrudu Koshtha was noticed in 27.50%, and Krura

Koshtha was noticed in 42.50% patients of Tamaka Shvasa (Table C-18)

Ahara Sambandhi Nidana : Ahara Sambandhi Nidana in distribution of 40 Tamaka

Shvasa patients showed-Sheeta, Guru, Shleshmala pana in 60%,Ruksha Vidahi

Bhojana in 27.5%, Adhyasana and Vishamashana 72.5%, Ksheera and Dadhi pana in

37.5%, Madhur, Amla,Pishta Padartha in 65%, Jalaja and Anoop mamsa in 45% of

Tamaka Shvasa patients.(Table C-19)

Table C-16

Ahara Shakti Reported by 40 Tamaka Shvasa Patients

Ahara shakti Number of patients Percentage

Pravara 04 10.00

Avara 25 62.50

Madhyama 11 27.50

Table C-17

State of Agni Reported by 40 Tamaka Shvasa Patients

State of Agni Number of patients Percentage

Sama 05 12.50

Vishama 09 22.50

Manda 26 65.00

Observations


Table C-18

Nature of Koshtha Recorded in 40 Tamaka Shvasa Patients

Kosthha Number of patients Percentage

Mrudu 11 27.50

Madhyama 12 30.00

Krura 17 42.50

Table C-19

Ahara Sambandhi Nidana of Tamaka Shvasa

Ahara Sambandhi Nidana Number of Patients Percentage

Sheeta, Guru, Shleshmala pana 24 60%

Ruksha Vidahi Bhojana 11 27.5%

Adhyasana and Vishamashana 29 72.5%

Ksheera and Dadhi pana 15 37.5%

Madhur, Amla,Pishta Padartha 26 65%

Jalaja and Anoop mamsa 18 45%

RESULTS

Results


RESULTS

Effects of the Therapy

40 patients of Tamaka Shvasa were treated in single group. patients was given

Shvasahara Avaleha were given directly. The effects of the therapy are being

described below.

Single Group : Effects of Shvasahara Avaleha

40 patients of Tamaka Shvasa were administered Shvasahara Avaleha for one month.

The effects of this therapy on the signs and symptoms of the patients are being

presented here under the separate headings.

Effect of Shvasahara Avaleha on Brethlessness: Statistically highly significant

improvement (P<0.001) of 60% was observed in dyspnea as its initial score reduced

from 2.42 before to 0.88 after the treatment (Table-19R & Graph 1)

Table-20R

Effect of Shvasahara Avaleha on Brethlessness of 40 Tamaka Shvasa Patients

Mean

%relief

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.

(±) „t‟ P

2.05

1

51.2 0.71 0.11 9.3 <0.001

Effect of Shvasahara Avaleha on Wheezing: Statistically highly significant

improvement (P<0.001) of 59% was observed in wheezing as its initial score reduced

from 2.08 before to 0.85 after the treatment (Table-20R & Graph 2).

Results


Table-21R

Effect of Shvasahara Avaleha on Wheezing of 40 Tamaka Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

2.08 0.85 59.04 0.78 0.12 10.1 <0.001

Effect of Shvasahara Avaleha on Cough: Statistically highly significant

improvement (P<0.001) of 58.33% was observed in cough as its initial score reduced


Table-22R

Effect of Shvasahara Avaleha on Cough of 40 Tamaka Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

2.1

0.88

58.33 0.69 0.11 11.10 <0.001

Effect of Shvasahara Avaleha on Sputum: Statistically highly significant

improvement (P<0.001) of 52.9% was observed in sputum as its initial score reduced


Table-23R

Effect of Shvasahara Avaleha on Sputum of 40 Tamaka Shvasa Patients

Mean %improvement

Paired „t‟ test

B.T. A.T. S.D. S.E.M. „t‟ P

1.75

0.86

52.9 0.72 0.12 8.02 <0.001

Effect of Shvasahara Avaleha on Common cold: Statistically significant

improvement (P>0.001) of 54% was observed in common cold as its initial score

reduced from 0.73 before to 0.33after the treatment (Table-24R & Graph 6).

Results


Table-24R

Effect of Shvasahara Avaleha on Common cold of 40 Tamaka Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

0.73 0.33 54 0.73 0.12 8.02 >0.001

Effect of Shvasahara Avaleha on Day time onset of Asthma: Statistically

significant improvement (P<0.001) of 67% was observed in day time asthma as its

initial score reduced from 1.3 before to 0.75 after the treatment (Table-25R & Graph

7).

Table-25R

Effect of Shvasahara Avaleha on Day time onset of Asthma of 40 Tamaka Shvasa

Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

1.3 0.75 67 0.60 0.09 9.1 <0.001

Effect of Shvasahara Avaleha on Night Time Asthma: Statistically not significant

improvement (<0.001) of 68% was observed in night time asthma as its initial score

reduced from 2.13 before to 0.68 after the treatment (Table-26R & Graph 8).

Table-26R

Effect of Shvasahara Avaleha on Night time onset of asthma of 40 Tamaka

Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

2.13 0.68 68 0.71 0.11 12.84 <0.001

Effect of Shvasahara Avaleha on Discomfort: Statistically highly significant

improvement (P<0.001) of 59.4% was observed in discomfort as its initial score


Results


Table-27R

Effect of Shvasahara Avaleha on Discomfort of 40 Tamaka Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

1.73

0.7

59.4 0.8 0.13 7.5 <0.001

Effect of Shvasahara Avaleha on Tightness of Chest: Statistically significant

improvement (P>0.001) of 63.6% was observed in tightness of chest as its initial

score reduced from 1.85 before to 0.68 after the treatment (Table-28R & Graph 10).

Table-28R

Effect of Shvasahara Avaleha on Tightness of Chest of 40 Tamaka Shvasa

Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

1.85 0.68 63.6 0.68 0.11 11.01 P>0.001

Effect of Shvasahara Avaleha on Chest Pain: Statistically not significant

improvement (P><0.001) of 69% was observed in chest pain as its initial score


Table-29R

Effect of Shvasahara Avaleha on Chest Pain of 40 Tamaka Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

1.95 0.6 69 0.77 0.12 11.1 <0.001

Effect of Shvasahara Avaleha on Loss of Sleep: Statistically not significant

improvement (P<0.001) of 62% was observed in loss of sleep as its initial score


Results


Table-30R

Effect of Shvasahara Avaleha on Loss of Sleep of 40 Tamaka Shvasa Patients

Mean %improvement

Paired „t‟ test

B.T. A.T. S.D. S.E.M. „t‟ P

1.93 0.55 71.4 0.74 0.11 11.7 <0.001

Effect of Shvasahara Avaleha on Impact on Activity of Tamaka Shvasa: Initial

Impact on activity score of 1.78 significantly (P<0.001) reduced to 0.58 after the

treatment showing 67% relief (Table-14R & Graph-14).

Table-31R

Effect of Shvasahara Avaleha on Impact on Activity of Tamaka Shvasa

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

1.78 0.58 67 0.88 0.14 8.60 <0.001

Effect of Shvasahara Avaleha on Palpitation of Tamaka Shvasa: Initial Palpitation

score of 1.8 significantly (P <0.001) reduced to 0.4 after the treatment showing 76.7%

relief (Table-15R & Graph-15).

Table-32R

Effect of Shvasahara Avaleha on Palpitation of Tamaka Shvasa

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

1.8 0.4 76.7 0.63 0.1 14 <0.001

Effect of Shvasahara Avaleha on the Mean Respiratory Rate of Tamaka Shvasa:

Initial mean respiratory rate score of 2.08 significantly (P<0.001) reduced to 0.9 after

the treatment showing 55% relief (Table-16R & Graph-16).

Table-33R

Effect of Shvasahara Avaleha on Respiratory Rate of Tamaka Shvasa

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

2.08

0.9

55 0.58 0.57 12.5 <0.001

Results


Effect of Shvasahara Avaleha on Frequency of Attack of Tamaka Shvasa: Initial

Frequency of attack score of 2.05 significantly (P<0.001) reduced to 0.5 after the

treatment showing 74% relief (Table-17R & Graph-17).

Table-34R

Effect of Shvasahara Avaleha on Frequency of Attack of Tamaka Shvasa

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

2.05 0.5 74 0.75 0.11 12.85 <0.001

Effect of Shvasahara Avaleha on Duration of Symptoms of Tamaka Shvasa:

Initial Duration of symptoms score of 2.15 significantly (P<0.001) reduced to 0.65

after the treatment showing 69.77 % relief (Table-18R & Graph-18).

Table-35R

Effect of Shvasahara Avaleha on Duration of Symptoms of Tamaka Shvasa

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

2.15 0.65 69.77 0.72 0.11 13.25 <0.001

Effect of Shvasahara Avaleha on PEFR: Statistically highly significant

improvement (P<0.001) of 29% was observed in PEFR as its initial score reduced

from 149.0 before to 193.4 after the treatment (Table-31R & Graph 13)

Table-36R

Effect of Shvasahara Avaleha on PEFR of 40 Tamaka Shvasa Patients

Mean

%improvement

Paired „t‟ test

B.T. A.T. S.D. (±) S.E.M.

(±) „t‟ P

149.0 193.4 29% 23.19 5.18 8.56 <0.001

DISCUSSION

Discussion


DISCUSSION

Tamakashvasa is one among the chronic pulmonary disease, which resembles

with bronchial asthma in modern science. Etiopathology, clinical features and

prognosis almost resemble with asthma

Selected patients were catagorised under single group and Shvasahara Avaleha

was administered as a Shamana Chikitsa.

An observation of present study reveals that maximum number of Patients‟ i.e.

55% was between the age group of 9-12 years. Many of them were chronic patients. It

might be due to their early exposure to allergens.

It was observed that more numbers of patients were boys i.e. 62.5% and

37.5% were girls. Childhood asthma ratio between boys and girls is 2:1 as per the

study reports. Here the ratio coincides with previous research data.

Maximum number of patients i.e. 87.5% belonged to Hindu community. This

might be due to Hindu‟s residing here are more in number. Hence there is no research

significance.

Out of 40 cases taken for the study, 65% patients were having family history

of asthma; where as 35% had no family history of asthma. This study reveals that

more number of children had got asthma in the presence of hereditary factors. So,

they are more prone for attack of asthma. We can prevent Shvasa by giving Rasayana

Chikitsa by increasing Agni, Amapachana and maintaining proper Koshta in these

children before the onset of disease. And others who are not having family history

may suggest that allergens, viral infections and environmental factors etc. may play an

important role in childhood asthma.

In majority of children upper respiratory track infection symptoms were

present before commencing an asthmatic attack. This report corroborates with the

following study,

Viral infection accounts for some 80-85% of asthma exacerbations in children

aged 9-11 years (Johson et. al. 1995)

Viral infection is commonest provoking factors for asthma in young children.

Respiratory Syncytial Virus (RSV) can induce immunological changes in the host

(Wellirer et. al. 1979 – 1981)

Discussion


Rhinovirus infection and allergy to common inhalants was more in older children

(Duff et. al. 1993).

The incidence of cold air exposure(100%) induced asthma was reported in

maximum number of patients, where as exposure to smoke(85%), dust(90%),

exercise(67.5%),change of whether induced asthma were also reported.It was

observed by parents that, Cough and breathlessness was increases after exercise in

these cases. Almost all parents restricted their children for exercise in fear of

recurrence of symptoms.

Majority of patients were reported with the influence of Ahara in initiation of

Tamakashvasa symptoms. Especially banana, grapes, guava fruit, jackfruit were

reported as precipitating factors for Tamakashvasa. Ice creams, other cold items,

curd, cheese, oily foods and fried food materials were also reported as precipitating

in some of the asthmatic children. In all the patients (100%) influence of Ahara was

observed for precipitating the asthmatic attack.

It was somewhat difficult to assess the AharaShakti in the children because of

the variability in appetite and digestive capacity. However, only 10% had Pravara

AharaShakti. Majority of these patients was mild asthmatic. In this group, appetite

and digestive capacity was not much affected.

It was observed that majority of patients (62%) were having Avara Ahara

Shakti. Here it is important to note that majority of these patients were moderate and

severe asthmatic. This might be due to the nature of the disease, as it is a pittasthana

samudbhava vyadhi and increased Ama formation may be responsible for this

condition.

In majority of the patients (65%) mandagni was observed and Samagni was

observed in 12.5%.Majority of patients have mandagni was suffering from moderate

to severe asthma. The Samagni was observed in mild asthmatic children. This shows

the definite relation of Agnimandya and Ama with the severity of disease.

Ahara Sambandhi Nidana showed Sheeta, Guru, Shleshmala pana (60%),

Ruksha Vidahi Bhojana (27.5%), Adhyasana and Vishamashana (72.5%), Ksheera

and Dadhi pana (37.5%), Madhur, Amla, Pishta Padartha (65%), Jalaja and Anoop

mamsa in 45% of Tamaka Shvasa patients in the study.

Discussion


Most of the Vihara Sambandhi Nidanas described in classics were observed in

the asthmatic children. Especially Nidanas like Sheeta vayu Sevana (100%), Raja

Sevana (90%), Dhooma Sevana (85%), Vyayama (67.5%), Asatmya Sevana, Sheeta

Sthana and Sheeta Snana were reported as Vyanjaka Nidana for Tamakashvasa.

In all the children one or more of the above said Nidanas were acting as

allergens and cause for upper respiratory tract infections (Peenasa), cough (Kasa)

followed by dyspnea. This can also be justified by the observation made in the

present study that the Pratishyaya (in 25 Patients i.e.83.33%), Kasa (in 27 patients i.e.

90%) and Jwara (in 13 patients i.e. 43.33%) were the Nidanarthakara Rogas.

Sheeta Pana (cold water/drinks), sheeta Ashana (ice creams, fruits like

Banana, Sponge Guard, Watermelon, Jackfruit, Guava fruit etc) Shleshmala Ahara

(Curd, Cheese etc), Guru Bhojana, Abhishyandhi Bhojana and oily foods and fried

food were observed as Nidanas in present study. Above observation can be supported

by following statement.

In children food allergy may be presented as urticaria or asthma.

Most of the Poorvaroopa mentioned in the classics was not observed as

premonitory signs of Tamakashvasa. But the symptoms like Hridaya Peedana,

Pranasya Vilomata and Parshwa Shoola was observed during Roopavastha of

Tamakashvasa. Ajit 2000 G.C.I.M.Mysore reports similar observation.

Chief complaints of Tamakashvasa viz. Gurguruka, Shvasakrichrata, Kasa,

and Pranaprapeedana were observed in all the patients (100%). In majority of cases,

Kasa in the Nighttime (nocturnal cough) followed by Shvasakrichrata (nocturnal

dyspnea) was seen.

Peenasa (common cold), Kantodwansa (throat infection) and Kasa (cough)

were observed in 80-90% of children both before and after establishment of

Tamakashvasa Lakshanas.

Vamathu (vomitting) was reported in minimum number of cases and vomiting

relieved the symptoms to some extent in these children. Aruchi was noticed in most

of the cases especially during the episodic attacks. This observation indicates the role

of Agnimandya and Ama in the manifestation of Tamakashvasa.

Discussion


Discussion on results

40 patients of Tamaka Shvasa single group were received Shamana Chikitsa with

Shvasahara Avaleha in a dose as per age for a period of 1 month. The effects of

therapy are being discussed here under the heading of each parameter.

Effect on Breathlessness:

In this single group highly significant improvement is observed in reducing

Breathlessness (P<0.001), the treatment showed 60% improvement.Because of kapha-

vata hara property of drugs. So Shamana Chikitsa with Shvasahara Avaleha was

effective to control Breathlessness in Tamakashvasa.

Effect on Wheezing:

In this single group highly significant improvement is observed in reducing wheezing

(P<0.001), Ushna guna and Vata-kaphahara properties reduces the bronchospasm and

because of that wheezing reduced.The treatment showing 59.4% improvement. So,

Shamana Chikitsa with Shvasahara Avaleha was effective to control wheezing in

Tamakashvasa.

Effect on Cough:

In all the patients reducing caugh was found to be highly significant at the level of

P<0.001. Percentage of improvement in reduction of caugh among group is 58.33%.

Because of Kapha-Vatahara guna and reduction in throat irritation, this data shows

that percentage increase in mean reduction of caugh was high.

Effect on Sputum:

In this single groups highly significant improvement is observed in reducing sputum

(P<0.001) the treatment showed 54.4% improvement. Because of ushna, laghu,

ruksha guna reduces sputam. So Shvasahara Avaleha effective to control sputum in

Tamakashvasa.

Effect on Common Cold:

In this single groups highly significant improvement is observed in reducing comman

cold (P<0.001) because of ruksha, ushna, laghu gunas reduces the congestion of

respiratory tract. So, the treatment showed 54% improvement hence Shvasahara

Avaleha effective to control common cold in Tamakashvasa.

Discussion


Effect on Day Time onset of Asthma:

In all the patients reducing day time onset of asthma was found to be highly

significant at the level of P<0.001. Percentage of improvement in reduction of day

time asthma among group is 67% due to reduced caugh and dyspnea. This data shows

that percentage increase in mean reduction of day time asthma was high.

Effect on Night Time onset of Asthma:

In this study highly significant improvement is observed in reducing Night time

asthma (P<0.001) the treatment showed 68% improvement due to reduced caugh and

dyspnea.So,Shvasahara Avaleha effective to control Night time asthma in Shvasa.

Effect on Discomfort:

In all the patients reducing discomfort was found to be highly significant at the level

of P<0.001. Percentage of improvement in reduction of discomfort among group is

59.4% due to reduced caugh, breathlessness and chest tightness. This data shows that

percentage increase in reduction of discomfort was high.

Effect on Tightness of Chest:

In this single groups highly significant improvement is observed in reducing

Tightness of Chest (P<0.001) the treatment showed 63.6% improvement due to

reduced bronchospasm, kaphahara property of medicine. So Patients undergone

through Shamana Chikitsa with Shvasahara Avaleha effective to control Tightness of

chest in Tamakashvasa.

Effect on Chest Pain:

In this single group significant improvement is observed in reducing Chest Pain

(P<0.001) the treatment showed 69% improvement. Due to Vatashamaka property of

drug. So, Shvasahara Avaleha effective to control Chest Pain in Tamakashvasa.

Effect on Loss of Sleep:

In this single group highly significant improvement is observed in reducing Loss of

Sleep (P<0.001), the treatment showed 71.4% improvement because of decreased

caugh and dyspnea. So Patients‟ undergone through Shamana Chikitsa with

Shvasahara Avaleha effective to control Loss of Sleep in Tamakashvasa.

Discussion


Effect on Impact on Activity:

In this single group highly significant improvement is observed in reducing Impact on

Activity (P<0.001), the treatment showed 67% improvement. So Shamana Chikitsa

with Shvasahara Avaleha effective to control Impact on Activity in Tamakashvasa.

Effect on Palpitation:

In all the patients reducing palpitation was found to be highly significant at the level

of P<0.001. Percentage of improvement in reduction of palpitation among group is

76.7%. This data shows that percentage increase in reduction of palpitation was high.

Effect on Mean Respiratory Rate:

In this single group significant improvement is observed in reducing Mean

Respiratory Rate (P<0.001), the treatment showed 55% improvement. So, Shvasahara

Avaleha effective to control Mean Respiratory Rate in Tamakashvasa.

Effect on Frequency of Attack:

In this single group highly significant improvement is observed in reducing

Frequency of Attack (P<0.001), the treatment showed 74% improvement. So Patients

undergone through Shamana Chikitsa with Shvasahara Avaleha effective to control

Frequency of Attack in Tamakashvasa.

Effect on Duration of Symptoms:

In this single group highly significant improvement is observed in reducing Duration

of Symptom (P<0.001), the treatment showed 69.7% improvement. So Shamana

Chikitsa with Shvasahara Avaleha effective to control Duration of Symptom in

Tamakashvasa.

Effect on PEFR:

In all the patients Peak expiratory flow rate was found to be highly significant

(P<0.001). Improvement in PEFR among group is 29% due to brochodialatation and

increased intake of air. This data shows that percentage increase in mean PEFR.

Discussion


Effect of the Treatment:

On observing for improvement in all the parameters, it is clear that the

improvement was promissable. i.e. the patients who received therapy with Shvasahara

Avaleha, there was maximum reduction in number of attacks, duration of symptoms

and better increase in PEFR. Hence, it may be concluded that Shvasahara Avaleha is

potent in controling the Tamaka Shvasa in children to the maximum extent.

Shvasahara Avaleha appears work better; this may be due to rasayana and

Vyadhipratyanik action of drug. In this study the patients who received Shvasahara

Avaleha as a Shamana Chikitsa, Shvasahara Avaleha worked better after one month

of prolonged administration than the initial days.

This study shows that in Bahudoshavastha, patients with chronic history,

increased number of attacks, Shvasahara Avaleha shown good improvement but

complete cure of the disease is not attained. So, prolonged administration of

Shvasahara Avaleha is needed for complete samprapti vighatana of Tamaka shvasa.

Mode of Action:

In all the patients, appetite was increased after administration of Shvasahara

Avaleha. This might be due to the ingredients of Shvasahara Avaleha i.e. Hingu,

Bhumyamalaki, Tulasi, and Amlavetasa which are having Ushna, Tikshna guna.

Ushna Veerya and deepana, pachana, kasashwasahara and shleshmahara properties.

Hence, Shvasahara Avaleha administration might have increase Jatharagni and does

amapachana, thus helping in reducing the severity and attacks of tamakashvasa.

Shvasahara Avaleha was palatable, as no patients refused to take orally.

Shvasahara Avaleha is having Deepana Pachana, Kaphavatashamaka, Shvasa-

kasahara, Peenasahara and Parshwapeedahara properties. Thus Shvasahara Avaleha

might have reduced the Vitiated Vata and Kapha helped in reducing the symptoms of

Tamakashvasa.

SUMMERY & CONCLUSION

Summary and Conclusion


SUMMARY AND CONCLUSION

Tamakashvasa is a chronic disease of children, which has no bar of age, sex,

race and geographical distribution. It correlates closely with bronchial asthma

mentioned in modern medicine. It is a global health problem, which is increasing

since last three decades, both in developed and developing countries.

The etiological factors of Tamakashvasa are numerous. Most of the Nidanas

explained in the Ayurvedic classics were observed in children especially Ahara and

Vihara Sambandhi Nidanas like Viruddhahara, Guru-Shitahara, Raja, Dhooma etc and

Nidanarthakara Rogas like Pratishyaya, Kasa and Jwara.

Samprapti of Tamakashvasa is complex because of various known and

unknown etiological factors operating in the pathological process. Even though Kapha

and Vata both are vitiated; Kapha in the initial stage and Vata in the later stage has an

important role in the manifestation of Tamakashvasa. Dalhana has explained it as

Kapha predominant disease. Kapha Udeerana (mucus secretion) takes place leading to

Pranavaha Sroto Avarodha (airway obstruction) which is further responsible for the

clinical signs and symptoms of Tamakashvasa.

Most of the Roopas explained in the Ayurvedic classics were observed in

children also. The symptoms usually start with exposure to etiological factors.

Initially child is presented with viral respiratory tract infections (mainly rhinitis),

cough which increases gradually followed by wheezing. In younger children

nocturnal cough is an important symptom of childhood asthma.

Clinical evaluation for assessing the severity of disease is necessary for proper

diagnosis and treatment. Children are to be treated with Shamana Chikitsa using Vati,

Avleha, Choorna, Ghrita and Kashayas, which are easy for administration and

palatable. Virechana is considered as best therapy for Tamaka Shvasa. When ever

necessary Virechana, Vamana and Nasya should be adopted.

Generally it is seen in practice that only Virechana may not cure the disease

and some Shamana Yoga has to be given.Acharya Chraka has indicated Shvasahara

Mahakashaya (Dashemani) in the Sutrasthana to manage Shvasa Raga.So, that



Mahakashaya has prepaired in Avaleha form easy administration.. Moreover the

medicine is palatable & sweet in taste, hence can be administered to children

easily.Therefore this clinical study is planned to evaluate Effect of Shvasahara

Avaleha administered in the management of Tamakashvasa in children. The research

design was pre-test and post test design. Excluding the dropout cases, total 40 patients

were studied. For that all Single group, Shamana Chikitsa with Shvasahara Avaleha

was administerd. Investigations were done if necessary prior to the treatment to

exclude other diseases in all the groups. Clinical data was graded as per gradation

index of assessment criteria. Pre-test and post-test data was collected and taken for the

statistical analysis.

In the present study it is observed that, for all patients of Tamaka Shvasa

administered Shvasahara Avaleha found to be better.

Discussion was done mainly on observation and results. Observations

regarding the age incidence, sex incidence, family h/o asthma, and presence of URTI,

influence of Ahara, Vihara, Nidanarthakara Rogas, Prakriti, Vyayama Shakti, and

Ahara Shakti etc were discussed. Results of the clinical trails were also discussed.

Most of the Nidanas explained in Ayurvedic classics were acting as precipitating

or triggering factors especially Ahara-Vihara Sambhandi Nidanas like Vishamasana,

Gurusheeta bhojana, exposure to raja, Dhooma, Sheetavayu and Nidanarthakara

Rogas like Pratishyaya & Kasa.

Upper respiratory tract infections especially rhinitis was usually found

premonitory for development of Tamaka Shvasa in children. Pratisyaya is explained

in Poorvaroopa of Tamakashvasa. So in known patients of Tamakashvasa progress of

disease can be arrested with administration of drugs.

Samprapti of Tamaka Shvasa is complex, as various known/unknown, exogenous

or endogenous etiological factors are responsible for pathological process.

Shvasahara Avaleha appears work better after one month of prolonged

administration than the initial days.



Efffect of Shamana Chikitsa with Shvasahara Avaleha in the long-term

management in arresting Tamaka Shvasa was found to give better results.

In allergic symptoms like sneezing and common cold significant improvement

P<0.001 is seen in patients having shaman Chikitsa with Shvasahara Avaleha. This

may be suggestive of Shamana therapy is necessary to reduce symptoms associated

with allergy.

Shamana Chikitsa therapy by with Shvasahara Avaleha has given more additional

therapeutic effects and showed maximum improvement in all the parameters

of assessment criteria.

REFERENCES

Refferences


LIST OF REFERENCE

1. Apte dictionary

2. Shabdakalpadruma Part II pp 590

2a. Amarakosha, Amarasudha Commentary vanoushadhi varg 120

3. Shabdakalpadruma Part IV pp 178-179

4. Su. U. 51/8

5. Cha. Chi. 17/62

6. M.Ni. 12/12

7. Byod‟s Pathology pp. 871

8. Nelson Pediatrics Cha. 145 pp. 664

9. Ka. Sa. Su. 27/48.2-57.1

10. Ka. Sa. Ka.9/16

11. Nelson‟s Pediatrics Cha. 145 pp. 664

12. Achar‟s T.B. of pediatrics pp. 259 & Harison‟s Principles of Internal Medicine, Vol. II. pp.

1456

13. Nelson Pediatrics Cha. 145 pp. 664

14. IAP T.B. of Pediatrics pp.399-400

15. Chakrapani Cha Chi. 17/11-16

16. Cha. Sha. 1/127

17. Gangadhar on Cha. Chi. 17/4

18. Su. Sha. 6/25

19. A.H. Sha. 4/50 & 56

20. A.H. Ni 4/1, A.H. Ni. 3/38, A.S. Ni. 4/2

21. Cha. Chi. 17/8

22. Chakrapani on Cha. Chi. 17/8

23. Su. Su. 24/10

24. Cha. Chi. 30/337

25. Cha. Chi 30/328

25a. Chakrapani on Cha. Chi 30/328

26. T.B. of Pediatrics by O.P.Ghai pp. 283

27. Nelson Pediatrics Cha. 153, pp. 695

28. Nelson Pediatrics Cha. 153, pp. 696

29. N.Pediatrics Cha 153, pp. 696-697 Sources modified from Seinman HA: “Hidden” allergies in

foods. J. Allergy Clin. Immunal 98; 241, 1996

30. T.B. of Pediatrics by O.P. Ghai pp.284

31. Asthma, 4th Edition by T.J. H. Clark et. al., pp. 389, 390

Refferences


32. Asthma, 4th Edition by T.J. H. Clark et. al., pp. 74

33. Asthma, 4th Edition by T.J. H. Clark et. al., pp. 389

34. Nelson‟s T.B. of pediatrics Cha. 145 pp. 666

35. Essentials of Pediatrics by O.P. Ghai 284

36. Asthma by T.J.H. Clark pp. 392

37. Nelson‟s T.B. of Pediatrics Cha. 145, pp. 664

38. Su. Su 24/10

39. Nelson‟s T.B. of Pediatrics Cha. 145, pp. 664

40. Recent Advances in Pediatrics. Suraj Gupte, pp. 87

41. Su. U. 1/27

42. Cha. Chi 30/247-248

43. Cha. Chi. 17/7

44. Cha. Chi. 17/45

45. Cakrapani on Cha. Chi. 17/45

46. Gangadhara on Cha. Chi. 17/45

47. Arunadatta on A.H. Ni. 4/4 31/1

48. Su. U. 51/4

49. Dalhan on Su. U 51/4

50. A.H. Ni. 4/31/2

51. Madhava Nidana Likka Swasa Nidana cha 12/17

52. A.H. Ni 4/3


54. Gangadhara on Cha. Chi. 17/45

55. Cha. Chi. 17/55-56

56. Cha. Chi. 17/122

57. T.B. of Pathology by Robinson and Kuman, pp. 457

58. Essentials of Pediatrics by O.P.Ghai pp. 284

59. T.B. of Pathology R & K Cha. pp. 459

60. Cha. Chi 17/56

61. Cha. Su 28/10

62. Cha. Vi 5/7

63. Cha. Chi. 28/20

64. Cha. Chi. 17/56

65. A.H. Su. 12/4

66. A.H.Su. 12/5

67. Cha.i 5/7

68. T.B. of Medical Physiology by Gayton & Hall Cha 41 pp. 525-527

Refferences


69. Cha. Chi. 17/ 81/2

70. Cha. Chi. 17/60

71. Cha. Chi. 17/57

72. Cha. Chi. 17/61

73. Cha. Chi. 17/58

74. Cha. Chi. 17/62

75. Cha. Chi. 17/59

76. A.H. Ni. 4/8

77. Cha. Su 4/36

78. A.H. Ni. 4/7

79. A.H. Ni 4/9

80. Su. U. 51

81. Su. U. 51

82. M. Ni. 1/8

83. A.H. Ni 4/8

84. Cha. Chi. 17/63

85. Cha. Chi. 17/64

86. Gangadhara on Cha. Chi. 17/63-64

87. Nelson pediatrics chap. 143, pp. 666

88. IAP T.B. of Pediatrics pp. Assessment of severity of asthma

89. Cha. Chi. 22/17

90. Cha. I 8/15

91. Cha. I 6/11

92. Su. Su. 31/20

93. A.H. Sha 5/76

94. Cha. Chi. 17/12

95. Cha. Chi. 17/67

96. Su. U. 51/24

97. Dalhana on Su. U 51/24

98. A.H. Ni 4/10

99. Chakrapani on Cha Chi 17/67

100. Cha. Chi. 30/31

101. Asthma by T.J.H. Clark pp. 212, 213

102. Cha. Chi. 17/8

103. Cha. Chi. 17/89-90

104. Ka. Sa. Su. 27/661

105. Ka. Sa. Khi 3/117

Refferences


106. Cha. Chi. 30/282

107. A.H.U. 2/30

108. M. Ni 68/16

109. Cha. Chi. 30/283


111. Cha. Chi. 17/71

112. Cha. Chi. 17/72

113. Cha. Chi. 17/72

114. Ka. Sa. Su. 23/7

115. Ka. Sa. Su 23/19-20

116. Cha. Chi. 17/82

117. Cha. Chi. 17/83

118. Cha. Chi. 17/74

119. Cha. Chi. 17/75

120. A.H. Chi. 4/4

121. Cha. Chi. 17/76

122. Cha. Chi. 17/77-78

123. Cha. Ni. 4/4

124. Cha. Chi. 17/138

125. Su. U. 1/25

126. Asthma T.J.H. Clark pp 371

127. Devision‟s Principles of Medicine, pp. 337

128. Cha. Chi. 17/88

129. A.H. Ni. 12/1

130. A.H. Chi. 4/15

131. Cha. Chi. 17/89

132. Cha. Chi.17/121

133. A.H. Chi. 4/66-7

134. Cha. Chi.17/147

135. Cha. Chi. 17/148

136. Cha. Chi. 17/149

137. Cha. Chi. 17/113

138. Cha. Chi. 17/114

139. Cha. Chi. 17/117

140. Bhaishajya Ratnavali, 16/132-134 & Yogaratnakar Shvasa roga /65-68

141. Cha. Cha 8/63 – 64

142. Ka. Sa. Khi 3/117-118

Refferences


143. Ka. Sa. Su. 27/66

144. A.H.U. 2/29

145. A.H.U. ¼ and A.S.U. 1/52

146. Cha. Su. 25/40

147. Bhavaprakash, Part II. pp. 159

148. Cha. Ka 8/5

149. Cha. Kalpasthana 8th Chapter

150. Sharangadhara Poorva Khanda 4/4

BIBLIOGRAPHY

Bibliography


BIBLIOGRAPHY

1. Abhimanyu Kumar; Child health care in Ayurveda, 1st Edition, 1999, Sri

Satguru Publications, Delhi, pp. 158, 235, 238.

2. Agnivesha (2001), Charakasamhita (Hindi Commentary by Vidyothini),

Volume I, Reprint 2001. Chaukamba Bharati Academy Publication, Varanasi,

pp. 571, 710, 712714, 728, 828. Part II, pp. 508-510, 515, 516, 517, 524, 525,

526, 527, 528-531.

3. Agnivesha (2000), Charakasamhita with English Translation by

Bhagwandasha R.K. Sharma), Volume IV, II Edition, Chowkamba Sanskrit

Series Office, Varanashi, pp. 117-125.

4. Ajitnathindra K. (1999), A study on the role of Upavasa in the management of

Tamakashvasa, GCIM, Mysore.

5. Annonymous, Yogaratnakara with Vaidyaprabha, Hindi Commentary, 1st

Edition, 1998. Edr. Dr. Indradevi Tripathi and Dr. Daya Shankar Tripathi,

Krishnadas Academy, Varanasi, pp. 340, 341, 342, 344.

6. Ananthanarayan R., Jayaram Panikar C.K., Text book of Microbiology, 5th

Edition, 1996, Orient Langmann Ltd., 160 Anna Salai, Madras, pp. 122 to 139.

7. Apte V.S. (1985), The Students Sanskrit English Dictionary, Shatilal Jain,

Delhi.

8. Arunadatta (1995), Astanga hridaya, Sarvanga Sundara Vyakya Edtr. Vaidya

H.P. Krishnadas Academy of Varanasi, pp. 472, 473, 474, 602-608, 783.

9. Ashok M.I. (1998) To role of Rasayana in Tamakashvasa with Special

reference to the effect of Bharangiharitaki avaleha, GCIM, Mysore.

10. Bhela; Bhela Samhita, Edtr. Sharma P.V., 1st Edition, 2000, Chaukambha

Vishwabharati, Varanasi.

11. Bhava Misra; Bhavaprakash Vidyotini, Hindi Commentary, First Edition

1993, Choukambha Sanskrit Sansthan, Varanasi, Part II, pp. 159 to 166.

12. Brahmanand Tripathi (1999), Astanga Hridaya, Nirmal Hindi Commentary, 1st

Edition, Edr. Bramhanand Tripathi, Chaukamba Sanskrit Pratisthana, Delhi,

pp. 455 to 458, 609 to 616.

Bibliography


13. Braunwald Harrison‟s Principle‟s of Internal Medicine, 15th

Edition, McGraw

Hill Medical Publications, Vol. II, pp. 1456-1462.

14. Bouchier A.D., Index of Differential Diagnosis, 13th

Edition, 1996, Editor, Ian

A.D. Boucher, Horald Ellis, Peter R. Fleming, Butterworth, Heinemann,

Linacsa House, Jordan Hill Oxford, pp. 163, 164.

15. Chakrapani (1994), Charakasamhita, Edition IV, Edtr.. Vaidya Jadavaji

Trikamji Acharya, Chaukamba Sanskriti Sansthan Publisher, Varanasi, pp.

533-539.

16. Christopher Halsett et. al., Devidson‟s Principles of Medicine, Edtr.

Christopher Halsett et.al,. 18th

Edition, 1999. Churchil Livingstone, U.K. pp.

326, 327, 328, 329, 330.

17. Chaudri, Concise Medical Physiology, 3rd

Edition, 2000, New Central Book

Agency, Calcutta, pp. 144, 145.

18. Dalhana, Sushruta Samhita, Nibandha Sangraha Sanskrit Commentary, Editor

Jadavaji Trikamaji Acharya, Reprint 1999. Chaukambha Surabharati

Prakashana, Varanasi, pp. 654, 655, 565, 657, 658.

19. Devendranath Misra, Koumarbhritya, 2002 Edition, Edtr. Devendranath

Misra, Choukambha Vidyabhavana, Varanasi, pp. 507, 508, 509.

20. Dwarakanath C., Introduction to Kayachikitsa, 3rd

Edition, 1996, Chaukamba

Orientalia, Varanasi, pp. 83 to 128.

21. Elizabeth K.E., Fundamentals of Pediatrics, 2nd

Edition, 2002, Paras

Publications, Hyderabad, pp. 268-278.

22. Gananath Sen, Siddanta Nidana, Part I, 5th

Edition, 1966, Chaukamba Sanskrit

Series Office, Varanasi.

23. Gangadhar, Charaka Samhita, Part IV, 1st Edition, 1999, Chaukamba

Orientalia, Varanasi, pp. 3002 to 3032.

24. Glenn. J., manual of Allergy and Immunology, 3rd

Edition, 1995. Editor Glenn

J.L., Thomas J. Fischer, Daniel C.A., pp. 41-50, 121-139.

25. Ghai. O.P. (1996), Essential Pediatrics, IV Edition, Interprint Publication,

New Delhi. Pp. 283, 284, 285, 286.

26. Govindadas, Bhaishajya Ratnavali, 13th

Edition, 1999. Editor Shashri R.D.,

Chaukamba Sanskrit Bhavana, Varanasi, pp. 329 to 339.

Bibliography


27. Hariprakash (1984), A study of Dhoomapana with its clinical evaluation on

Tamakashvasa, GCIM, Mysore

28. Indu (1980), Astanga Sangraha, Shashilekha Sanskrit Commentry, Editor

Athavale A.P. Shrimad Atreya Prakashana, Vol. I, pp. 359-362, Vol. II pp. 35-

39.

29. Jam Lissayer, Graham Clayden, Illustrated Text Book of Pediatrics, 2nd

Edition, 2001, An imprint of Hurcowt Publishers Limited, U.K. pp. 222, 223.

30. Jayaraj R. (1995), Management of TamakShvasa with Gouripashana, Dept. of

P.G. Studies in KC, G.C.I.M., Mysore.

31. Jagannath S. Surpure, Synopsis of Pediatrics Emergency Care, 1st Edition,

1993. Edr. Jagannath S. Surpure, Jaypee Brothers, P.B. No. 7193, New Delhi,

pp. 33, 34, 35, 36.

32. Jejjata (1941), Nirantara padavyabya (Charaka Samhita) II Part, II Edition,

Shri, Motilal Banarasidas, Lahore.

33. Kameshwara Rao C., Database of Medical Plants. 1st Edition, 2000. Published

by Karnataka State Council for Science and Technology, Bangalore.

34. Kasture H.S., Ayurvedeeya Panchakarma Vignana 5th

Edition, 1997. Shri

Bhaidyanath Ayurveda Bhavana Limited, Nagapur, pp. 295 to 371.

35. Kirtikar & Basu, Indian Medical Plants, 2nd

Edition, Editor Blatter E, Cailus

J.F., International Book Distributors,9/3 Rajapur Road, Dehradun.

36. Krupp, Current Medical Diagnosis and Treatment, 1985, Maruzen Asian

Edition, Editor Marcus Krupp Milton J.C. Devid Wedegar, distributed by

Maruzen Asia, 51 Ayer Rajah Cresent, # 06-09, Singapore 0513, pp. 127, 128,

129, 130.

37. Kulkarni P.H., Bronchial Asthma Care in Ayurveda and Holistic Systems, 2nd

Edition, 2001. Sri Satguru Publications, Delhi.

38. Madhavakar, Madhavanidana, Madhukosha Sanskrit Commentary with

Vidyotini Hindi Commentary Part II, Edtr. Prof. Yadunandana Upadhayaya.

25th

Edition, 1995, pp. 388, Part I 281, 289, 290, 291, 292, 293-301.

39. Mark R.D., CIMS 5 Minute Clinical Assist, 1st Indian Edition, 1996. Bio-Gard

Private Limited, Bangalore pp. 100, 101.

Bibliography


40. Monilial William, A Sanskrit English Dictionary, 5th

Edition, 1997 Motilal

Banarasidas Publishers Private Limited, Delhi. pp. 438, 1166.

41. Michael Swash; Hutchison‟s Clinical Methods, 12th

Edition, W.B. Saunders

Company Ltd., London, pp. 142 to164.

42. Meharban Singh, Clinical Methods in Pediatrics, Reprinted January 2002,

Sagar Publications, 72 Janapath Ved Mansion, New Delhi, 165 to 180.

43. Pandurang (2002) Comparative study of Vamana and Kunjali Karma in the

management of Tamakashvasa, GCIM, Mysore.

44. Prasanna N.M. (2000), Evaluate the efficacy of manasiladi dhoomayoga on

Tamakashvasa, GCIM, Mysore.

45. Partha Sarathy .A (2002), IAP Textbook of Pediatrics, II Edition, Jaypee

Brothers Medical Publishers (P) Ltd., New Delhi. pp. 399, 400, 401, 402, 403,

405.

46. Raja Radha Kanta Deva; Shabda Kalpadrum, 3rd

Edition, Chaukamba Sanskrit

Series Office, Varanasi, Part II, pp. 590, Part IV, pp. 178-179.

47. Robin & Kumar, Robins Pathology, 7th

Edition, 2003. Edtr. Robin, Kumar,

Cortan, Published by Hawvrt (India) Private Limited, New Delhi, pp. 455,

456, 457, 458.

48. Satoskar, R.S., Pharmacology and Pharmacotherapeutics, Revised 17th

Edition, 2002, Popular Prakashana, Mumbai, pp. 337-352.

49. Sainani G.S., API Text Book of Medicine, 5th

Edition, 1997, Published by

Association of Physicians of India, Bombay, 286, 287, 288, 289, 290.

50. Santosh Kumar A., Manual of Pediatrics Practice, 1st Edition, 2001, Paras

Publishing, Hyderabad.

51. Satya Gupta, Pediatrics, 3rd

Edition, 1996, Publicated by New Age

International Limited, India, pp. 359, 369.

52. Sharangadhara (2001), Sharangdhara Samhita (English Translated by

Srikantamurthi) IV Edition, Chaukhamba Orientalia, Varanasi, pp.17.

53. Sharma P.V. Chakradatta Edtr. P.V. Sharma, 2nd

Edition,1998, Chaukamba

Publishers, Varanasi, pp. 145, 146.

Bibliography


54. Suraj Gupte (1993), Recent Advances in Pediatrics, Vol. III, Jaypee Brothers

Medical Publishers (P) Ltd., New Delhi. pp. 85, 86, 87, 89, 90, 91, 100, 101,

102.

55. Shashri R.G. (1995), Vedo me Ayurveda Madana Mohanlal, Ayurvedic Trust,

Delhi, pp. 32, 79, 241, 259.

56. Shastry V.L.N.; Kaumarbhrityam, 1st Edition, 2003, Ramani Publications,

Andra Pradesh, pp. 198.

57. Sharma P.V., Dravya Guna Vijyana, Vol. I to IV, Edition 199, Chaukamba

Bharati Academy, Varanasi.

58. Shodala (1999), Gada Nigraha, Volume III, II Edition, Edr. Sri Gangasahaya

Pandeya, Chaukamba Samskrith Samsthana, Varanasi, pp. 357, 360-366, 371.

59. Sushruta, Sushruta Samhita Ayurveda TattvaSandipika, Hindi Commentary,

11th

Edition, 1997. Editor, Kaviraja Ambikadutta Shastri, Chaukamba Sanskrit

Bhavana, Part II, pp. 372 to382.

60. Taranatha Tarakavachaspati, Vachaspatyam, Volume VI, 3rd

Edition, 1970.

The Chowkhambha Sanskrit Series Office, Varanasi, Vol. VI. Pp (5159),

1291, Vol. IV, pp. 812.

61. Tiwari. P.V. (1996), Kashyapa samhita text book (English translation)

Varanasi, I Edition, Chaukamba Vishwa Bharathi Publications. pp. 54, 41, 74,

277, 446.

62. Vishwanathan J., Desai A.B., Achars Text Book of Pediatrics, 3rd

Edition,

Reprinted 1995, Orient Longman, Madras, 474-475.

63. Wayne Harris, Examination Pediatrics, First Indian Edition, 1993, Jaypee

Brothers, P.B. No. 7193, New Delhi, pp. 280 to 286.

ANNEXURE

Annexure


RESEARCH PROFORMA

DEPARTMENT OF KAUMARBHRITYA

S.D.M. COLLEGE OF AYURVEDA & HOSPITAL, HASSAN

Title: “EFFECT OF SHVASAHARA AVALEHA IN THE MANAGEMENT OF

TAMAKA SHVASA IN CHILDREN.”

Scholar: Dr. Rahul Vijay Chougule.

Guide: Dr. Shrinidhi K. Acharya.

PERSONAL HISTORY

Name of Patient: Age:

Sex: Address:

Religion: Ph.No.:

Education Blood Group:

D.O.B.- Domicial: Urban/

Rural

O.P.D No: I.P.D.No:

Ward/Bed No:

Socio-Economic Status- L/Lm/M/Um/U

Desha (Habitat): Jangala /Anupa /Sadharana

PRESENT HISTORY

Pradhana Vedana (Chief Complain With Duration)

Shvasa Kashtata (Dyspnoea)

Kasa (Cough)

Pinasa (Coryza)

Parshva Shulla (Chest Pain)

Annexure


Kapha Nisthivan (Expectoration)

Ruksha Kasa (Dry Cough)

Others

O.D. P. (ORIGIN, DURATION, PROGRESS)

1. Time of Onset:

2. Duration of Disease:

3. Frequency of Attack:

4. Duration of Attack:

5. Nature of Attacks: Paroxysmal/Continuous/Alternately

6. Time of Increased Intensity of Attack:

1) Morning 2) Evening

3) Night 4) Mid night

5) After meals. 6) After playing or

physical activity

Associated factors

1) Predisposing factors- Dust/Smoke/Smell/Exercise/Dietary habits/Sleep

deprivation

2) Modifying factors

3) relieving factors- Sitting posture/Change of climate/rest/fomentation/change of

place/ Rest/Dietary habits/ Expectoration/Drugs-

inhalers/Nebulization/Oral/Parentral bronchodilators/ Antibiotics/Others.

4)Other.

PAST HISTORY:

TREATMENT HISTORY:

DRUG SENSITIVITIES:

Annexure


Family History: Mother Father:

Asthma/RRTI/Koch’s/Eczema/Heart disease/Others.

Personal History:

Ahara (Diet)

1. Time of Each Feed

2. Nature of Feeding: Ask For Food/Eat At Regular Time/Forceful Feed/Refuse to

Eat

3. Diet: Veg./Non.veg

4. Diet Habit: Samashana/Vishamashana/Adhyashana/Anashana

5. Habitual Supplementary Drinks:

6. Frequency of Eating Out Side Home:

7. Affinities

8. Rasa Satmya:

9. Guna Satmya:

Kostha

1. Nature: Krura/Madhya/Mridu

2. Stool: Regular/Irregular/Formed/Unformed/Hard/Loose/Others

3. Frequency: -----------------Times/Day

4. H/O Defecations after Feeds: Yes/No

5. Others.

Mutra Pravriti (Urine)

1. Frequency: …………….Times/Day and ………….Times/Night.

2. Varna (Colour): Yellow/Red//Watery

3. Gandha (Smell):

4. H/O Shayyamutra (Bed Wetting): Y/N

5. Others:

VYASANA: Thumb Shucking/Pica/Nail Biting/Other

VYAYAMA (EXERCISE):

NIDRA (SLEEP):

1. Nature: Sound/Disturbed

Sleep With Open Mouth or Snoring

2. Duration:……………Hrs/Day

……………Hrs/Night.

HYGINE:

Annexure


PRENATAL HISTORY:

1. Regular Hospital Visits: Yes/No

2. History of Any Medication

3. Others.

BIRTH HISTORY

Delivery: Home/ Hospital

Born by : NVD/assisted/ LSCS with indication

Birth Weight:

IMMUNIZATION HISTORY (Proper/Improper)

1. BCG 4. Hepatitis 7. MMR

2. OOPV 5. Measles 8.

Booster.

3. DPT 6. Typhoid

GROWTH AND DEVELOPMENTAL HISTORY: Proper/Delayed

DEHABALA PARIKSHA

PRIKRITI:

Sharirika (Physical): V/P/K/VP/PK/KV/VPK

Manasika (Mentally): Satvika/Rajasika/Tamsika

SARA: Pravara/Madhyama/Avara

SAMHANANA: Pravara/Madhyama/Avara

PRAMANA: Pravara/Madhyama/Avara

Height………..cms H.C.……………….cms

Weight……………kg C.C……………….cms

SHATMYA: Madhura/Amla/Lavana/Tikta/Katu/Kashaya

ATURA SATVABALA PARIKSHA

Emotional Makeup: Anxiety/Tension/Depression/Anger/Irritable/Fear/Others

Behavior: Co-Operative/Non-Co-Operative/Active/Hyperactive/Shy/Out

Spoken/Other

Tolerance: Low/Madhyama/High

Relationship With: Siblings/Parents/Teachers/Friends/Other Persons

Satwa: Pravara/Madhyama/Avara

EXAMINATION

1. DARSHANA PARIKSHA (INSPECTION)

Upper Respiratory Passage

Nasal Polyps: Present/Absent

Nasal Septum: Normal/Deviated To Rt./Lt.

Shape of Chest: Normal/Barrel/Pigeon/Funnel/Others

Size of Chest: Normal/Increased/Decreased

Annexure


Movement of Chest: Normal/Restricted-Unilateral/Bilateral

Depth of Inspiration: Shallow/Deep/Normal

Depth of Expiration: Shallow/Deep/Normal

2. SPARSHA PARIKSHA (PALPATION)

Position Of Trachea: Central/Deviated To Rt./Lt.

Movement of Chest: Symmetrical/Asymmetrical

Apex Beat: Normal/Shifted

Localized Tenderness: Present/Absent

3. PERCUSSION FINDINGS

Resonant/Hyper Resonant/Tympanic/Dull/Woody

4. AUSCULTATION FINDINGS (SHRAVANA PARIKSHA)

Breath Sounds: Vesicular/Broncho-Vesicular/Bronchial

Types: Wheezing: Present/Absent

Rales: Fine/Course/Inspiratory/Expiratory

Rhonchi: Sibiliant/Sonorous/Polyphonic

Vocal Resonance: Increased /Decreased/Normal

Others.

VIKRITITAH PARIKSHA:

SROTASA PARIKSHA

1.PRANVAHA SROTAS:

Shwas:Atibadhdha/Kupita/Alpalpa/Abhikshsnam/Sashabda/Sashulam/Uchhus

ana/Parshvapidayuktam/Grivashirso Sangrahnam/Shvasavrodha/Kshavathu/

Parshwapi

dayuktam/Tivraveedanam/Veoathu/Vamana/Pinasa/Ghurghurkam/Pramoham/Ka

sa/

Kashtenshlesma Nirharanam/Krichchhena Bhashitam/Aashino labhate

Shaukhayama/

Uchichhtaksha/Muhurmuhur/Prapidaka/Rudhda/Mahaghoshavanta/Sakapha.

Vegativrata: Ati/Madhyama/Mridu

Rate of Resp.:…………../Min Type…

Associated Symptoms during Attacks

Upashaya: Aahara/Vihara/Aaushodka

Anupashaya: Aahara/Vihara/Aaushadha

Shvasavega Kala Prabhava

Kasa: Satata/Alpaalpa/Abhikshanam

Ruksa/Kapha Yuktam/Others

Vegativrata: Tivra/Madhyam/Manda

3. ANNAVAHA SROTASA

Annabhilasha/Aruchi/Avipaka/Chhardi

Agni:Sama/Vishama/Manda/Tikshna

Abhyavaran Shakti:Pravara/Madhyama/Avara

Jaran Shakti:Pravara/Madhyama/Avara

Ajirna/Ahara/Aatop/Shula/Others

Annexure


3: PURISHAVAHASHROTASA:

Atidrava/Atigrathita/Bahu/Krichchhena/Alpa/Sashabda/Sashula Malapravritti

Avriti (Frequency):………………Times/Day

Matra (Volume): Madhyama/Alpa/Bahu

Gandha(Smell): Normal/Durghandha

Varna (Colour): Shwtabha/Pitabha/Arunabha/Krushnabha/Raktabha

Svabhava (Nature): Sama/Nirama/Drava/Sarakta/Fenila

4. RASAVAHA SROTASA:

Heart Rate (Rhythm)……………../Min

LABORATORY INVESTIGATIONS:

1. BLOOD TEST REPORT

B.T. A.T.

Hb

TLC

DLC N

L

E

M

B

E.S.R.

Absolute Eiosinophil Count

B.T A.T.

Urine Routine

Micro

Peak Flow Metric: PEFR

X-Ray Chest

PURVA RUPA

Pranasya Vilomata

Bhaktadwesha

Arati

Shankha Bheda Nistoda

Adhmana

Parshva Shoola

Hridyasya Pidanama Other:

Annexure


PROGRESS REPORT OF CARDINAL SYMPTOMS

Sr.No. ASSESSMENT CRITERIA B.T. D.T.(15 Days)

A.T.(30 Days)

1 Breathlessness

2 Audible wheezes

3 Cough

4 Sputum

5 Common cold

6 Day time asthma

7 Night time asthma

8 Discomfort

9 Tightness of chest

10 Chest pain

11 Loss of sleep

12 PEFR

13 Impact on activity

14 Palpitation

15 Respiratory rate

16 Frequency of attack

17 Duration of symptoms

Guide H.O.D. Scholar

(Dr.Shrinidhi K. Acharya) (Dr.Shailaja U.) (Dr.Rahul Chougule.)

Annexure


GRADE 0 1 2 3

Dyspnoea None ≤ 2 Attacks per 60 days

2-4 Attacks per 60 days

>4 Attacks per 60 days

Wheezing None Only at the time of attack

Frequently Always present

Discomfort Not at all On running / short exercise

On walking On all positions /Missed schools

Cough Not at all Occasional cough

Frequently Distressing nature

Impact on activity

None Dyspnoea with lot of activity

Interferes with moderate activity

Interferes with any activity / missed schools

Sleep Fine Sleep well, slight wheeze or cough

Awake 2-3 times at night, wheeze, cough

Awake most of the night.

Frequency of attack.

No attack < 1 Episode / month

> 2 Episodes / month.

> 4 Episodes / month

Duration of symptom.

No symptom.

Brief for hours Prolonged for 2-3 days

Almost continuous

PEFR values Normal >80% Of predicted

50-80% Of predicted

<50% of predicted

effect of shvasahara avaleha in the management of …

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