INDIAN NONI AS A BOON INDIAN NONI AS A BOON FOR ASTHMA PATIENTSFOR ASTHMA PATIENTS

DR. BHABAGRAHI PATRIDR. BHABAGRAHI PATRIB.H.M.S., M.D. (HOM)B.H.M.S., M.D. (HOM)

P.G.D. D&N.M (Utkal University)P.G.D. D&N.M (Utkal University)

Dhabaleswar Homoeo Clinic & Research CentreDhabaleswar Homoeo Clinic & Research Centre

Ranihat Canal Road, Cuttack – 753 003, OrissaRanihat Canal Road, Cuttack – 753 003, Orissa

A CLINICAL TRAIL ON BRONCHIAL A CLINICAL TRAIL ON BRONCHIAL ASTHMAASTHMA

INTRODUCTIONINTRODUCTIONBronchial Asthma has long been recognized as Bronchial Asthma has long been recognized as an important global health problem affecting an important global health problem affecting almost all age group. almost all age group. A number of explanations have been proposed A number of explanations have been proposed including increased environmental pollution including increased environmental pollution from motor vehicles, growing from motor vehicles, growing industrialization, reduction on plant life on industrialization, reduction on plant life on forest areas, dietary changes with allergens to forest areas, dietary changes with allergens to cause Bronchial Asthma. cause Bronchial Asthma. Now a days it is considered that between Now a days it is considered that between 100-150 million people around the globe100-150 million people around the globeare suffering from this distress. are suffering from this distress.

Cont..Cont..Worldwide deaths from this condition have Worldwide deaths from this condition have reached over 1,80,000 annually. reached over 1,80,000 annually. Advantageously enough for all these positive Advantageously enough for all these positive factors, befitting answers could be provided by factors, befitting answers could be provided by Indian Noni. Indian Noni. Observing the positive effects of Indian Noni Observing the positive effects of Indian Noni on Bronchial Asthma many people are now on Bronchial Asthma many people are now taking interest to administer the same in taking interest to administer the same in different types of chronic diseases. different types of chronic diseases. Indian Noni is effective for such chronic Indian Noni is effective for such chronic diseases due to its high immuno-modulating diseases due to its high immuno-modulating power.power.

AIMS AND OBJECTIVESAIMS AND OBJECTIVES

Keeping in view the above facts, a Keeping in view the above facts, a clinical trial was conducted in my clinical trial was conducted in my

personal clinic to study the efficacy of personal clinic to study the efficacy of Indian Noni along with Homoeopathic Indian Noni along with Homoeopathic Medicine. In case of both chronic and Medicine. In case of both chronic and

acute exacerbations of Bronchial acute exacerbations of Bronchial Asthma.Asthma.

WHAT IS ASTHMAWHAT IS ASTHMAThe American Society Committee on 1962 defined Asthma as The American Society Committee on 1962 defined Asthma as “A disease characterized by an increased responsiveness of “A disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by the trachea and bronchi to various stimuli and manifested by widespread narrowing of the arrays that change in severity widespread narrowing of the arrays that change in severity either spontaneously or as a result of treatment.either spontaneously or as a result of treatment.Asthma is characterized by episodic, reversible Asthma is characterized by episodic, reversible Bronchospasm, resulting from an exaggerated Bronchospasm, resulting from an exaggerated bronchoconstrictor response to various stimuli (Robins).bronchoconstrictor response to various stimuli (Robins).However Bronchial Asthma is due to a specific antigen However Bronchial Asthma is due to a specific antigen antibody reaction (Type I immune Reaction – IgE mediated) antibody reaction (Type I immune Reaction – IgE mediated) resulting in the excitation of the Bronchial end organs. resulting in the excitation of the Bronchial end organs. Bronchial hyper responsiveness due to the allergens and the Bronchial hyper responsiveness due to the allergens and the mediators humoral like histamine and lucotrines cause mediators humoral like histamine and lucotrines cause following three facts.following three facts.Constriction of Bronchial smooth muscles.Constriction of Bronchial smooth muscles.Oedema of the mucous membrane.Oedema of the mucous membrane.Collection of mucous on the lumen.Collection of mucous on the lumen.

Asthma has traditionally been classified into two basic typesAsthma has traditionally been classified into two basic types

Extrinsic (intiated by IgE medicated

Intrinsic (Non immune mechanism, caused due to

Atopic asthma Occupational asthma (extrinsic non-atopic)

Bronchopulmonary aspergilloses

Ingestion of aspirin

Pulmonary infections

Cold Inhealed irritants

Stress Exercise

AETIOLOGYAETIOLOGYAsthma is a complex disorder involving automatic, Asthma is a complex disorder involving automatic,

immunologic, infectious, endocrine and psycogenic factor in immunologic, infectious, endocrine and psycogenic factor in varying degrees in different individuals as the causative index.varying degrees in different individuals as the causative index.

Predisposing factors such as :Predisposing factors such as : HeredityHeredity Age – (Pediatric group most affected within 10 years of age)Age – (Pediatric group most affected within 10 years of age) Sex (Male : Female : : 2 : 1) within 10 year and equal on adults.Sex (Male : Female : : 2 : 1) within 10 year and equal on adults. Allergens – Food, Inhalants, Bacteria.Allergens – Food, Inhalants, Bacteria. Respiratory infections, pharmacologic stimulants, occupational Respiratory infections, pharmacologic stimulants, occupational

factors, exercise, climatic factors, low socio-economic status.factors, exercise, climatic factors, low socio-economic status. Passive smokingPassive smoking Air pollutionAir pollution Obesity are responsible for producing Bronchial Asthma.Obesity are responsible for producing Bronchial Asthma.

PATHOPHYSIOLOGYPATHOPHYSIOLOGY A number of causes have been postulated for the increased A number of causes have been postulated for the increased

airway reactivity of Asthma but basic mechanism remains airway reactivity of Asthma but basic mechanism remains unknown. unknown.

The most popular hypothesis at present is that of airway The most popular hypothesis at present is that of airway inflammation.inflammation.

Increased number of mast cell, epithelial cells, neutrophils, Increased number of mast cell, epithelial cells, neutrophils, oesinophils and lymphocytes have been found in the oesinophils and lymphocytes have been found in the bronchoalveolar lavage fluid of patient with asthma, as have a bronchoalveolar lavage fluid of patient with asthma, as have a variety of mediators. variety of mediators.

It is widely believed that the physiologic and clinical features of It is widely believed that the physiologic and clinical features of asthma derive from an interaction among the resident and asthma derive from an interaction among the resident and infiltrating inflammatory cells in the airways and the surface infiltrating inflammatory cells in the airways and the surface epithelium. epithelium.

The cells who have to play important roles are mastThe cells who have to play important roles are mastcells, eosinophils, macrophages, neutrophils andcells, eosinophils, macrophages, neutrophils andlymphocytes. lymphocytes.

Cont..Cont..The mediators released are histamine, bradykinin, The mediators released are histamine, bradykinin, leukotriens, platelet activating factors and leukotriens, platelet activating factors and prostaglandins they produce an intense, immediate prostaglandins they produce an intense, immediate inflammatory reaction involving bronchoconstriction, inflammatory reaction involving bronchoconstriction, vascular congestion an oedema formation. vascular congestion an oedema formation. The leukotriens may also account for the other The leukotriens may also account for the other pathophysiologic features of asthma e.g. increased pathophysiologic features of asthma e.g. increased mucus production and impaired mucocilliary transport.mucus production and impaired mucocilliary transport.In early reaction mast cells and cosinophils play an In early reaction mast cells and cosinophils play an important role like destroying the epithelium, which is important role like destroying the epithelium, which is then sloughed into the bronchial lumen in the form of then sloughed into the bronchial lumen in the form of Creole bodies. Such damages elicit the production of Creole bodies. Such damages elicit the production of cytokines leading to further inflammation.cytokines leading to further inflammation.

Cont..Cont..

Lymphocytes play a quiet important role in inflammatory Lymphocytes play a quiet important role in inflammatory response. response. They are present in increasing number in asthmatic They are present in increasing number in asthmatic airways and produce cytokines that activate the cell airways and produce cytokines that activate the cell mediated immunity as well as humoral immune responses. mediated immunity as well as humoral immune responses. Cytokines e.g. interleukin (IL2) and interferon (IFN) can Cytokines e.g. interleukin (IL2) and interferon (IFN) can promote the growth and differentiation of B cells and promote the growth and differentiation of B cells and activation of macrophages respectively. activation of macrophages respectively. The cytokine IL4 and IL5 stimulate B-cell growth and The cytokine IL4 and IL5 stimulate B-cell growth and immunoglobulin secretion and IL5 promotes casinophil immunoglobulin secretion and IL5 promotes casinophil proliferation, differentiation and activation by stimulation proliferation, differentiation and activation by stimulation of B lymphocytes (Humoral lympho), the antibody of B lymphocytes (Humoral lympho), the antibody formation against the allergens enhanced which formation against the allergens enhanced which subsequently reduces the hyper responsiveness of subsequently reduces the hyper responsiveness of tracheobronchial tree.tracheobronchial tree.

Cont..Cont..Clinical featuresClinical features Shortness of breath.Shortness of breath. WheezingWheezing CoughCough Pain in abdomen in young childrenPain in abdomen in young children Profuse SweatProfuse Sweat Symptoms of respiratory allergy.Symptoms of respiratory allergy.

On Auscultatron, Ronchi and Crepitation in On Auscultatron, Ronchi and Crepitation in lungs field was found.lungs field was found.

DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA

Recurrent episodes of wheezing and Recurrent episodes of wheezing and cough.cough.

Appearance of allergic state.Appearance of allergic state.

On auscultation – Rhonchi + On auscultation – Rhonchi + crepitition + in lung fieldcrepitition + in lung field

LABORATORY LABORATORY DIAGNOSISDIAGNOSIS

Blood investigationBlood investigation

D.C., T.L.C., E.S.R. and D.C., T.L.C., E.S.R. and radiology of chest, radiology of chest,

pulmonary function test.pulmonary function test.

MATERIAL & METHODMATERIAL & METHODA clinical study was carried out at Dhabaleswar A clinical study was carried out at Dhabaleswar Homoeo Clinic and Research Centre, Cuttack, Homoeo Clinic and Research Centre, Cuttack, Orissa for a period of 4 months.Orissa for a period of 4 months.20 cases of Bronchial Asthma were screened out 20 cases of Bronchial Asthma were screened out from the above private clinics for the study.from the above private clinics for the study.A uniform schema of case taking was maintained A uniform schema of case taking was maintained for level of the patients by one standardized case for level of the patients by one standardized case taking format which was prepared strictly taking format which was prepared strictly according to Homoepathic methods of case taking according to Homoepathic methods of case taking with an emphasis to different aspect of Bronchial with an emphasis to different aspect of Bronchial Asthma. Asthma. Indian Noni was administered to 10 patients along Indian Noni was administered to 10 patients along with Homeopathic medicines and 10 patients were with Homeopathic medicines and 10 patients were administered only with Homeopathic medicines.administered only with Homeopathic medicines.

EVALUATION OF PARAMETERSEVALUATION OF PARAMETERSFor clinical evaluation, preferred For clinical evaluation, preferred parameters areparameters are

Marked improvement-patient feels Marked improvement-patient feels completely well with no recurrences of completely well with no recurrences of Asthmatic attach.Asthmatic attach.

Moderate improvement-patients feels well Moderate improvement-patients feels well with recurrent attack.with recurrent attack.

No improvement-patient not feeling well.No improvement-patient not feeling well. Dropped out.Dropped out.

OBSERVATIONOBSERVATION20 patients of Bronchial Asthma were taken for clinical 20 patients of Bronchial Asthma were taken for clinical study. Indian Noni was administered to 10 patients along study. Indian Noni was administered to 10 patients along with Homeopathic Medicine and only Homoeopathic with Homeopathic Medicine and only Homoeopathic Medicine to other 10 patients.Medicine to other 10 patients.The results are shown in a tabular manner below.The results are shown in a tabular manner below.

GroupGroup Marked Marked improvementimprovement

Moderate Moderate improvementimprovement

No No improvementimprovement

Dropped Dropped outout

Total Total numbernumber

Indian Noni Indian Noni with with

Homoeopathic Homoeopathic MedicineMedicine

66 11 11 22 1010

Only Only Homoeopathic Homoeopathic

MedicineMedicine22 44 22 22 1010

0

2

4

6

8

10

Marked improved Moderateimproved

No Improved Dropped out Total Number

Indian Noni with Homoe. Medicine Only Homoe. Medicine

ANALYSISANALYSIS‘‘Morinda Citrifolia’ – a predominant ingredient of Indian Noni Morinda Citrifolia’ – a predominant ingredient of Indian Noni exhibits the following actions which controlled asthmatic attack exhibits the following actions which controlled asthmatic attack quickly.quickly. It stimulates IL1 and IL4 formation which subsequently helps for It stimulates IL1 and IL4 formation which subsequently helps for

the growth of B lymphocytes (Humoral lymphocytes) which the growth of B lymphocytes (Humoral lymphocytes) which ultimately responsible for the more antibody formation in blood ultimately responsible for the more antibody formation in blood against the infiltrating allergens so that reducing the rate of allergic against the infiltrating allergens so that reducing the rate of allergic reactions.reactions.

Antibacterial activity : It acts against Bacillus subtilis, Antibacterial activity : It acts against Bacillus subtilis, staphylococcus aureas, streptococcus, kilebsiella & pneucoccus by staphylococcus aureas, streptococcus, kilebsiella & pneucoccus by reducing the further superadded infection of Bronchial tree and long reducing the further superadded infection of Bronchial tree and long field.field.

Anti inflammatory activity : It reduces the airway inflammation by Anti inflammatory activity : It reduces the airway inflammation by producing anti-hista minergic factors.producing anti-hista minergic factors.

Antiviral Activity : Reduces the superadded infection.Antiviral Activity : Reduces the superadded infection. C.N.S. effect : Anti cholinergic effect :C.N.S. effect : Anti cholinergic effect : Producing bronchodilatation – Reducing asthmatic attack.Producing bronchodilatation – Reducing asthmatic attack.

CONCLUSIONCONCLUSIONA clinical trial was conducted upon 20 patients of Bronchial A clinical trial was conducted upon 20 patients of Bronchial Asthma. 10 patients were administered with Homoeopathic Asthma. 10 patients were administered with Homoeopathic Medicines + Indian Noni and other 10 patients with only Medicines + Indian Noni and other 10 patients with only Homoeopathic medicine.Homoeopathic medicine.It was observed that more no. of patients i.e., 6 patients of It was observed that more no. of patients i.e., 6 patients of Group – I exhibit marked improvement in comparison to 2 Group – I exhibit marked improvement in comparison to 2 patients of Group – II i.e., (patients with only Homoeopathic patients of Group – II i.e., (patients with only Homoeopathic Medicine). Medicine). Again the study reveals that the Homoeopathic Medicines + Again the study reveals that the Homoeopathic Medicines + Indian Noni gives very quick improvement in acute Indian Noni gives very quick improvement in acute exacerbations of Bronchial Asthma. So it may be concluded exacerbations of Bronchial Asthma. So it may be concluded from the clinical trial that administration of Homoeopathic from the clinical trial that administration of Homoeopathic Medicines along with Indian Noni produces better and quick Medicines along with Indian Noni produces better and quick result than only Homoeopathic Medicines.result than only Homoeopathic Medicines.Bronchial asthma is usually a chromic disease and attacks Bronchial asthma is usually a chromic disease and attacks are episodic. are episodic. Therefore to study the effect of Indian Nomi onTherefore to study the effect of Indian Nomi on

patients it requires much time.patients it requires much time.

Cont..Cont..That's why within last 4 months the effect of Indian Nomi in That's why within last 4 months the effect of Indian Nomi in acute excerbations was well studied and the result was quite acute excerbations was well studied and the result was quite positive, but the recurrence of episodes takes place though positive, but the recurrence of episodes takes place though the interval increased to some extent. the interval increased to some extent. In after 2 years of the clinical trial it can be concluded that In after 2 years of the clinical trial it can be concluded that whether adult bronchial asthma patients get permanent relief whether adult bronchial asthma patients get permanent relief or not. or not. The study required more time and more number of patients The study required more time and more number of patients to establish the positive effect of Indian Nomi. to establish the positive effect of Indian Nomi. May the Almighty shower this External Bliss upon this May the Almighty shower this External Bliss upon this product so that it can occupy a better position in the Health product so that it can occupy a better position in the Health map of the world.map of the world.Due to insufficiency of time and less number of cases it Due to insufficiency of time and less number of cases it becomes quite difficult to study the effect of Indian Noni becomes quite difficult to study the effect of Indian Noni upon adult asthma cases as regards permanent cure. upon adult asthma cases as regards permanent cure.

Sathyprakash Dash, 2+ yrs

S/O – Bishwaranjan Dash, Mundamala, Choudwar,

Cuttack, Orissa, : 9338482947

Srusti Mohapatra, 10 yrs

D/O – Suresh Ch. Mohapatra, Kapaleswar, Choudwar,

Cuttack, Orissa,

Chandan Rout, 23 yrs

Sikharpur, Upper Sahi,

Cuttack, Orissa

: 9338483662

Sarita Mishra, 25 yrs

Sankarpur, Cuttack, Orissa

: 0671- 2334759

Pratap Kr. Dalai , 26 yrs

Baragodia, Jagatpur,

Cuttack, Orissa

: 9861242919

Mamata Mishra, 39 yrs

Choudwar Girl’s High School, Choudwar, Cuttack, Orissa

: 9861390114

Sudhansu Samal, 49 yrs

Rahania, Balichandrapur,

Jajpur, Orissa

: 9937733566, 9861283839

Parbati Jena , 52 yrs

Qr. No. – 2R-81, Labour Tournment,

Charibatia, Cuttack, Orissa

: 9861067111

Umesh Ch. Patnaik, 70 yrs

Chauliaganja, Cuttack, Orissa

: 9861063269