management of pranavaha srotas diseases “ayurvedic pulmonology”

8-1-2008 [email protected] 1

Management of Pranavaha srotas Diseases

“Ayurvedic Pulmonology”

Prof. Dr. K.Shiva Rama Prasad M.D (KC); MA, Ph.D (Jyotish) [email protected]


Thought of 2008

•

“Following western scientist blindly is not admissible. The information available should be used discriminatively to enrich the knowledge and adopted to the Indian territory and population”.

Dr. Manmohan

Singh, PM India


•

Life starts with breath •

Ends with breathlessness

•

The maintenance of life throughout life is maintained by Pranavaha

srotas

with its –

initiative points i.e. Hrudaya

–

Heart; Mahasrotas

-

Lungs and 10 Dhamani

LET -

Introduction


Pranavaha srotas

• mÉëÉhÉuÉWûÉÌlÉÌiÉ

mÉëÉhÉxÉÇ¥ÉÉMüuÉÉiÉuÉWûÉlÉÉqÉç

LiÉŠ mÉëÉhÉÉZrÉÌuÉÍzÉ¹xrÉxÉëÉåiÉ

– cÉUMü

ÌuÉqÉÉlÉ

5/8 cÉ¢ümÉÉÍhÉ

• mÉëÉhÉmÉuÉlÉ: mÉëÉhÉÉÌlÉsÉ: mÉëÉhÉÉÍ´ÉiÉÉå

uÉÉrÉÑËUÌiÉ– zÉÉ.xÉÇ.mÉÔ. 5/48 -AÉRûqÉssÉ

• Pranavaha Srotas is a vital input capability structure, maintaining the Life = Pranavata

• Prana is said as – Pavana / Anila – wind/ Air• Life sustenance relays on maintenance of

Oxygen – Ambara peeyusha and water in the body


Pranavaha Sroto Moola

• qÉÔsÉÍqÉÌiÉ

mÉëpÉuÉxjÉÉlÉqÉç

– cÉ.ÌuÉ.5/8 – cÉ¢ümÉÉÌlÉ• iÉ§É

mÉëÉhÉuÉWûÉlÉÉÇ

xÉëÉåiÉxÉÉÇ

WØûSrÉÇ

qÉÔsÉÇ

qÉWûÉxÉëÉåiÉ¶É

– cÉ.ÌuÉ.5/8

• iÉrÉÉåqÉÔïsÉÇ

WØûSrÉÇ

UxÉuÉÉÌWûlrÉ¶É

kÉqÉlrÉ: -

xÉÑ.zÉÉ.9/12

• Moola refers to developmental or generative place

• PVS have Hrudaya (Heart), Mahasrotas (trachea) and Rasavahini dhamani (pulmonary vessels) added by Susruta as originative places

• Technically any organ takes in and sends out is Hrudaya – either Heart or Lungs


Source of life•

The Prana is specific air breathed into the lungs during the act of inspiration.

•

The effect of indoor and outdoor air pollution on allergic disease has received considerable attention

•

Human is continuously under the influence of environmental changes subjected pollution.

•

Urbanized life style and industrialization etc. compound the problem.


Pranavata

xjÉÉlÉÇ

mÉëÉhÉxrÉ

qÉÔkÉÉåïU: MühPûÎeÉÀûÉxrÉlÉÉÍxÉMüÉ¹ÏuÉlÉ¤ÉuÉjÉÔªÉUμÉÉxÉÉWûÉUÉÌS MüqÉï

cÉ

– cÉ.ÍcÉ.28/6mÉëÉhÉÉå§ÉqÉÔkÉïaÉ: EU:MühPûcÉUÉå

oÉÑÎ®WØûSrÉåÎlSìrÉ

ÍcÉ¨É

SØMçüÌlÉ¹ÏuÉlÉ

¤ÉkÉÔªÉU

ÌlÉ:μÉÉxÉÉ³É

mÉëuÉåzÉM×üiÉç

– A.WØû.xÉÔ.12/

• Pranavata initiates impulse from Shirasa (Buddhi Hrudayendriya chittam – druk = aspect) travels through nose, tongue, pharynx, neck till Uras understood as – reticular formation form the Medulla oblongata with higher center connected especially “Respiratory center”

• Promotes expulsion of phlegm, gas and intake of air and food.


Vata

uÉÉ

aÉÌiÉaÉlkÉlÉrÉÉå

– xÉÑ.xÉÔ.21/5

• Vata defined as Gati – momentum = motor and Gandhana – sensory perceptional or said as information / knowledge transformation


Types of Evoked Potentials•

MOTOR = Gati =Measured from arm or leg muscle

•

VISUAL = Druk = Monocular visual stimulation with a checkerboard pattern is used to elicit visual evoked potentials, which are recorded from the midoccipital

region of the scalp. •

AUDITORY = Srotra = Monaural stimulation with repetitive clicks is used to elicit brainstem auditory evoked potentials, which are recorded at the vertex of the scalp.

•

SOMATOSENSORY = Gandhana = Electrical stimulation of a peripheral nerve is used to elicit the somatosensory

evoked potentials, which are

recorded over the scalp and spine.


Motor evoked potentials (MEP) = Vata Gati

•

Action potentials generated in the cortex travel down the pyramidal pathway to the muscles.

•

Surface electrodes placed on an arm or leg muscle are used to record the summed motor potentials. These potentials are larger and easier to record when the subject lightly contracts the corresponding muscle beforehand.

•

An abnormality of the MEP implies a lesion in the peripheral or central portion of the motor pathway.


Vata can be calculated in terms

impulse transportation time

CMCT (Central Motor Conduction

Time)

Fundamentals of Neurology1sted 2006.Thieme.3HA

XAP, Mumenthaler

/ Mattle, pp 59


Somatosensory evoked potentials (SSEP) = Vata Gandhana

•

When a repetitive electrical stimulus is applied to the skin, impulses are generated at the terminal sensory branch of a peripheral nerve and conducted centrally via the peripheral nerve, nerve root, posterior columns/ spinothalamic tract, medial lemniscus, and thalamocortical connections. A lesion at any point along this pathway can alter the evoked potentials, which are recorded first over Erb point (for the median n.) or the lumbar spine (for the tibial n.), and then through a scalp electrode in the parietal region on the side opposite the stimulation. An example of delayed conduction in the central somatosensory pathway is shown in Fig.


•

Fundamentals of Neurology1sted 2006.Thieme.3HA

XAP, Mumenthaler

/ Mattle, pp 58


Embryological appreciation of Pranavaha Srotas

• Puppusa develop from the blood froth

• Heart that bears the blood, build from blood and phlegm

• Anatomical relations are – from heart in the left lies the “Puppusa – Left lung” and on the right “Kloma – Right lung”

• zÉÉåÍhÉiÉTåülÉmÉëpÉuÉ: mÉÑmmÉÑxÉ: -

xÉÑ.zÉÉ.4/25• zÉÉåÍhÉiÉMüTümÉëxÉÉSeÉÇ

WØûSrÉÇ

– rÉSÉ´ÉrÉÉ

ÌWû

kÉqÉlrÉ: mÉëÉhÉuÉWûÉ: -

xÉÑ.zÉÉ

4/31• WØûSrÉxrÉ

AkÉÉå

uÉÉqÉiÉ: msÉÏWû

mÉÑmTÑüxÉ¶É; SÍ¤ÉhÉiÉÉå

rÉM×üiÉç

YsÉÉåqÉ

cÉåÌiÉ

YsÉÉåqÉÌiÉsÉMüqÉç

-xÉÑ.zÉÉ

4/31QûsWûhÉ


Development of Lung •

Lungs are the essential organs of respiration•

substance of the lung is of a light, porous, spongy texture; it floats in water, and crepitates when handled, owing to the presence of air in the alveoli; it is also highly elastic

•

Right (Kloma) and left (Puppusa) lung buds grow out behind the ducts of Cuvier

•

Each lung is invested by an exceedingly delicate serous membrane, the pleura

•

The lungs provide an alveolar surface area of approximately 40 m2 for gaseous exchange.

•

Each lung has: an apex which reaches above the sternal

end of the 1st

rib; a costovertebral surface which underlies the chest wall; a base overlying the diaphragm and a mediastinal surface which is moulded

to adjacent mediastinal

structures.


Physiological appreciation of Lung unit


Present day Understanding•

The entoderm

consists at first of flattened cells, which subsequently become columnar. It forms the epithelial lining of the whole of the digestive tube excepting part of the mouth (Asya) and pharynx (kanta) and the terminal part of the rectum (Pakwashaya) (which are lined by involutions of the ectoderm), the lining cells of all the glands which open into the digestive tube, including those of the liver and pancreas, the epithelium of the auditory tube and tympanic cavity (srotra), of the trachea, bronchi, and air cells of the lungs (Puppusa-Kloma), of the urinary bladder (Vasti) and part of the urethra, and that which lines the follicles of the thyroid gland and thymus.


Organ (Lung) Pathology

• Inflammatory Lung diseases • Interstitial Lung diseases • Infectious Lung diseases• Environmental Lung diseases • Obstructive Lung disease • Respiratory Insufficiency • Pulmonary manifestations of

systemic diseases • Pulmonary Vascular diseases• Neoplastic Lung diseases• Congenital Lung diseases• Developmental Lung diseases • Genetic Lung diseases • Pleural diseases • Apart from the above many

categories are placed in URT pathology

• Common bronchial and pulmonary diseases – exposure to infectious pathogens and/or air, including tobacco smoke, causes the disorders shown


Srotas Pathology

MÑüÌmÉiÉÉlÉÉÇ

ÌWû

SÉåwÉÉhÉÉÇ

zÉUÏUå

mÉËUkÉÉuÉiÉÉqÉçrÉ§É

xÉ…¡û: ZÉuÉæaÉÑhrÉÉSèurÉÉÍkÉxiÉ§ÉÉåmÉeÉÉrÉiÉå

– xÉÑ.xÉÔ.24/10 AÌiÉmÉëuÉ×Ì¨É: xÉ…¡ûÉå

uÉ

ÍxÉUÉhÉÉÇ

aÉëÎlkÉrÉÉåÅÌmÉ

uÉÉÌuÉqÉÉaÉïaÉqÉlÉÇ

cÉÉÌmÉ

xÉëÉåiÉxÉÉÇ

SÒÌ¹sÉ¤ÉhÉqÉç

–cÉ.ÌuÉ.5/24

Vitiated Dosha moving all the way in the body develops the disease where ever is obstructed in its channel -

Atipravrutti = Excited / hyper functional activity – HypercapniaSanga = Acute/chronic obstructive disorders - AsthmaVimargagamana = Abnormal passage / infiltration or

diverticular of srotas content – pulmonary fistulaSira-Granthi = vascular / abnormal mass tissue – makes the

extra luminal compression – Malignant Tumor


Pranavaha srotodusti Hetu

¤ÉrÉÉiÉç

xÉÇkÉÉUhÉÉSìÉæ¤rÉÉiÉç

urÉÉrÉÉqÉÉiÉç

¤ÉÑÍkÉiÉxrÉ

cÉ

– mÉëÉhÉuÉÉÌWûÌlÉ

SÒwrÉÎliÉ

xÉëÉåiÉÉÇxrÉlrÉÉæ¶É

SÉÂhÉÉæ:

– cÉUMü

ÌuÉqÉÉlÉ

5/10

Dhatu kshaya (wasting)Vega sandharana (natural urges suppression) Rooksha padartha sevana (indulgence in dry food) Vyayama (excessive physical exertion) Kshudhita (excessive hunger) Anya daruna (other health violations pertained to PVS)


Pranavaha srotodusti Lakshana

AÌiÉxÉ×¹qÉÌiÉoÉ®Ç

MÑüÌmÉiÉqÉsmÉÉsmÉqÉpÉÏ¤hÉÇ

uÉÉ xÉzÉoSzÉÔsÉqÉÑcduÉxÉliÉÇ

SØwOèuÉÉ

mÉëÉhuÉWûÉlrÉxrÉ

xÉëÉåiÉÉÇÍxÉ

mÉëSÒ¹ÉlÉÏÌiÉ

ÌuÉ±ÉiÉç

– cÉUMü

ÌuÉqÉÉlÉ

5/8

Atisrustam (too long respiration)Atibaddham (restricted respiration)Kupitam (agitated respiration)Alpalpam (shallow / short respiration)Abhikshanam (frequent/ increased/ repeated respiration)Sashabdam (stertrous respiration)Sashoola (painful respiration)


Pranavaha sroto Abhighata Lakshana

iÉ§É

ÌuÉ®xrÉÉ¢üÉåzÉlÉ

ÌuÉlÉqÉlÉ

qÉÉåWlÉ

pÉëqÉlÉ

uÉåmÉlÉÉÌlÉ

qÉUhÉÇ uÉÉ

pÉuÉÌiÉ

– xÉÑ

zÉÉ

9/12û

Akroshana (loud grooming)Vinamana (deformation of the thoracic region)Mohana (loss of consciousness)Bhramana (illusion / giddiness)Vepana (tremors)Marana (death)


SYMPTOMS•

Cough = A sudden explosive forcing of air through the glottis,

occurring immediately on opening the previously closed glottis, and

excited by mechanical or chemical irritation of the trachea or bronchi,

or by pressure from adjacent structures.

•

Wheeze = A whistling, squeaking, musical, or puffing sound made by

air passing through the fauces, glottis, or narrowed tracheobronchial

airways in difficult breathing.

•

Dyspnea = Shortness of breath, a subjective difficulty or distress in

breathing, usually associated with disease of the heart or lungs;

occurs normally during intense physical exertion or at high altitude.


SYMPTOMS•

Stridor = A high-pitched, noisy respiration, like the blowing of the

wind; a sign of respiratory obstruction, especially in the trachea or

larynx.

•

Hoarseness voice , Chest pain, Haemoptysis

•

Cyanosis = A dark bluish or purplish coloration of the skin and

mucous membrane due to deficient oxygenation of the blood, evident

when reduced hemoglobin in the blood exceeds 5 g per 100 ml.

•

Clubbing = A condition affecting the fingers and toes in which

proliferation of distal tissues, especially the nail-beds, results in

thickening and widening of the extremities of the digits; the nails are

abnormally curved and shiny.


Krichra swasa (Dyspnoea) cardinal symptom of Pranavaha srotodusti

euÉUWØûSìÉåaÉU£üÌmÉ¨ÉeÉsÉÉåSUqÉåSÉåUÉåaÉzÉÉååjÉAÌiÉxÉÉUmÉëqÉåWû

(qÉkÉÑqÉåWû)aÉsÉaÉlQûaÉÑsqÉAÉl§ÉuÉ×Î®zÉÔsÉ

Common disease with Dyspnoea are -


Symptoms of Importance qÉÂiÉ: mÉëÉhÉuÉÉWûÏÌlÉ xÉëÉåiÉÉÇxrÉÉÌuÉzrÉ

MÑümrÉÌiÉ

– EU:xjÉ

MüTüqÉÑ®ÕrÉ ÌWû‚üÉμÉxÉÉlÉç

MüUÉåÌiÉ

xÉ;

- cÉ ÍcÉ17/17rÉ: mÉëÉhÉuÉÉÌWûÌlÉ

xÉëÉåiÉÇxrÉluÉåÌiÉ

iÉålÉ

μÉÉxÉ: mÉëÌiÉzrÉÉrÉ¶É

eÉÉrÉiÉå

–

cÉ

ÌlÉ

6/4

SwarabhedaUrah shoolaKasaRaktasteevanaHikkaSwasaPratishyaya


Examination of PVS ailment

General Examination Vital data

Systemic ExaminationInspectionPalpation PercussionAuscultation

Instrumental Examination Imaging PEFRetc,


PVS Diagnostic Instruments Pulmonary Function TestingPulmonary Exercise testing Pleural / Pulmonary pathology diagnostic

procedures Pulmonary Imaging Pre operative evaluation & diagnostic

procedures

Haematological

and biochemical tests

•

Haemoglobin, to detect the presence of anaemia

or polycythaemia

•

Packed cell volume (secondary polycythaemia

occurs with chronic hypoxia)

•

routine biochemistry (often disturbed in carcinoma and infection).

•

B-type natriuretic

peptide may be a useful test to distinguish cardiac from non-cardiac breathlessness. A rapid bedside test is available but is not yet in routine clinical use.

•

D-dimer

can be measured to detect intravascular coagulation. A negative test makes pulmonary embolism very unlikely.

Sputum •

yellowish green indicates inflammation (infection or allergy)

•

the presence of blood suggests neoplasm or pulmonary infarct

•

Microbiological studies (Gram stain and culture) are not helpful in upper respiratory tract infections or in acute or chronic bronchitis. They are of value in:

•

pneumonia •

the diagnosis of tuberculosis (Ziehl-Neelsen

or auramine-

phenol stains)

•

unusual clinical problems •

Aspergillus lung disease.


Pulmonary Function Testing•

STATIC LUNG VOLUMES

•

Gas Dilution Techniques

•

Plethysmography•

Radiographic Total Lung Capacity

•

Spirometry•

Peak Expiratory Flow and Peak Flow Meters

Respiratory function tests and exercise tests

Vitalograph spirometer

Micro Medical Micro Loop and Micro Lab spirometers


Pulmonary Exercise testing•

Clinical integrative cardiorespiratory

exercise testing is

the ability to assess oxygen uptake (VO2

) from measurements of ventilation and respired gas concentrations as Fick's

relationship

•

Where VE

is ventilation, K is a constant, VCO2

is CO2production, and D is dead space volume flow (VD ×respiratory rate). The linkage of CO2

and VD

to ventilatory demand is clear. These factors represent the metabolic

rate and the fraction of wasted ventilation. Ventilation is tightly linked to CO2

rather than to O2

. •

Anaerobic (Lactate) Threshold = At a certain work intensity, usually about 50% of the individual VO2max

, lactic acid starts to accumulate in the muscles and in the blood at a faster rate, and this metabolic level can be detected from measurements of gas exchange.


Pleural/Pulmonary pathology diagnostic procedures

•

Thoracentesis•

Pleural Fluid Analysis

•

Pleural Biopsy•

Open Pleural Biopsy

•

Thoracoscopy


Pulmonary Imaging•

Standard plain X-Ray PA & Lateral/ Apical Lordotic

Films

•

Chest Fluoroscopy•

COMPUTED TOMOGRAPHY

•

NUCLEAR IMAGING OF THE THORAX

•

PULMONARY ANGIOGRAPHY•

MAGNETIC RESONANCE IMAGING

•

INTERVENTIONAL PROCEDURES -

percutaneous

biopsy

Five important internal tissue types may be easily identified on CT or MRI scans:1. Gas (cavitation)2. Low-density material (lipid)3. High-density material (hemorrhage)4. Intermediate-density material (soft tissue)5. Calcification


Pre operative evaluation & diagnostic procedures

•

Atelectasis

= Collapse of an expanded lung •

Shunting with Hypoxemia

•

Factors Predisposing to Postoperative Pneumonia

•

Impaired Transport of Mucus•

Aspiration•

Pre-existing Lung Infection•

Impaired Coughing•

Respiratory Failure•

Pulmonary Embolism


• Inflammation – infection, Rhinitis (coryza), Allergy, laryngitis, Tracheitis, bronchitis, bronchiectasis, bronchial asthma extrinsic/ intrinsic, emphysema, lung collapse, pneumonia, lung abscess, TB, Anthracosis, silicosis, asbestosis, fibrosis,

• Environmental• Tumors – epithelial, connective tissue; benign/

malignant, Acinus (primary lobule) / secondary lobule, macropahse

• Respiration – insufficiency, Atelectasis (Collapse of an expanded lung), gas exchange supply /demand

• Pulmonary vascular• Pulmonary plural

Types of diseases in PVS

PROTECTIVE AGENTS IN THE EPITHELIAL LUNG FLUID

•

Defensins•

Secretory

lactoperoxidase

A2

•

Lactoperoxidase•

IgA

•

Lysozyme•

Lactoferrin

•

Surfactant proteins (collectins) •

Antiproteinases:

•

α1-antiproteinase, secretory leucocyte

protease inhibitor (SLPI),

elafin•

Antioxidants: glutathione

•

Alveolar macrophages. Scanning electron micrograph showing alveolar macrophages (arrow) patrolling the alveolar spaces of the lung

Methodical approach to diagnose


Examination of PVS

• MåüÍcÉcNûUÏUÉmÉaÉiÉÉÈ

vÉoSÉÈ

xrÉÑxiÉ§É

´ÉÉå§ÉåhÉ

mÉUÏ¤ÉåiÉçcÉ.ÌuÉ. 4/7

Auscultation of the PVS is most important

• uÉhÉï

xÉÇxjÉÉlÉ

mÉëqÉÉhÉÉcNûÉrÉÉÈ

vÉUÏUmÉëM×üÌiÉÌuÉMüÉUÉæ, cÉ¤ÉëÑUçuÉæwÉÌrÉMüÉÍhÉ

rÉÉÌlÉ cÉÉlrÉÉlrÉÑ£üÉÌlÉ

iÉÉÌlÉ

cÉ¤ÉÑwÉÉ

mÉUÏ¤ÉåiÉ

| cÉ. ÌuÉ. 4/7

The colour changes viz. Cyanosis, because O2 deprivation or Anemia is noticed as generalized symptom. The edema – shotha is observed and conformed by sparsha.

• xmÉzÉïÇ

cÉ

mÉÉÍhÉlÉÉ

mÉëM×üÌiÉ

ÌuÉM×üÌiÉrÉÑ£üqÉç|| cÉ. ÌuÉ. 4/7


Areas of examination •

Major Points–

Shape of the chest

–

Tracheal position–

Apical position

–

Respiratory movement•

Additional Points–

Spine

–

Shape & contour of chest–

Pulsations

–

Veins–

Respiratory sounds like

•

cough, wheeze, stridor, grunt

Ayurvedic

• lÉÉQûÏ

= zsÉåwqÉåMüÉxÉå

ÎxjÉUÉ

qÉlSÉ

μÉÉxÉå

iÉÏuÉëaÉÌiÉpÉïuÉåiÉç

– UÉuÉhÉlÉÉÌQû

• qÉÔ§ÉÇ

= oÉ®qÉÔ§ÉÇ

/ AsmÉqÉÔ§ÉqÉç

MåüÍcÉiÉç

EwhÉqÉÔ§ÉqÉç• qÉsÉqÉç

= oÉ®uÉcÉïxÉç

• ÎeÉÀûÉ

= zsÉåwqÉÉuÉ×iÉ

qÉÑZÉ

/ sÉåmÉ

/ ÌlÉUÉSìï

ÎeÉÀûÉ

/ÌuÉzÉÑwMüÉxrÉ

• zÉoS

= ÌuÉzÉÏhÉïuÉÉMçü

/ xÉzÉoS

EcduÉÉxÉ• xmÉzÉï

= SåWû

zÉÏiÉ

xmÉzÉï

/ mÉëlÉ¹¥ÉÉlÉqÉç

• SØMçü

= iÉqÉÉåpÉÉuÉÇ

/ ÌuÉpÉëÉliÉsÉÉåcÉlÉqÉç

/ FkuÉïSØÌ¹

/ • AÉM×üÌiÉ

= SÏlÉ

/ AÉxÉÏlÉÉå

sÉpÉiÉå

xÉÑZÉÇ

Diagnostic tools

Management principles

•

Methods of Management –

Eliminative

–

Suppressive –

Palliative

–

Reductive •

Should under go either Volatile or Stable medicament management

•

Internal Environment –

Ushna

vs

Sheeta

–

Snigdha

vs

Rooksha•

Lung Disease is Suggested as Sheeta-Rooksha

Vyadhi requires Ushna-Snigdha

chikitsa


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MüxÉlÉÉiMüÉxÉ

EcrÉiÉå

– cÉ. ÍcÉ

18/6-8

MüÉxÉ

Cough reflex


Acute Bronchitis ICD 10 = J20 & J21

•

Include:•

bronchitis: · NOS, in those under l5 years of age· acute and subacute (with): · bronchospasm· fibrinous· membranous· purulent · septic· tracheitis

•

tracheobronchitis, acute

Exclude:•

bronchitis: · NOS, in those 15 years of age and above ( J40) · allergic NOS ( J45.0) · chronic: · NOS ( J42) · mucopurulent ( J41.1) · obstructive ( J44.-) · simple ( J41.0)

•

tracheobronchitis: · NOS ( J40) · chronic ( J42) · chronic obstructive ( J44.-)

ICD-9CM CODES = 466.0 Acute bronchites


Chronic Bronchitis


Bronchiectasis


Kasa Chikitsa sutra

qÉÑWÒûqÉÑïWÒûÌuÉïwÉcNûÌSïÌWïûkqÉÉiÉ×Oèû

μÉÉxÉMüÍxÉwÉÑ

– A.WØû. xÉÔ. 13/-MåüuÉsÉÉÌlÉsÉÇ

MüÉxÉÇ

xlÉåWæûUÉSÉæmÉÉcÉUåiÉç

– A WØû

ÍcÉ

3/1

mÉæÌ¨ÉMåü

xÉMüTåü

MüÉxÉå

uÉqÉlÉÇ

xÉÌmÉïwÉÉ

ÌWûiÉÇ

– cÉ. ÍcÉ. 18/83mÉëcNûkÉïlÉÇ

MürÉÍzÉUÉåÌuÉUåMüÉxiÉjÉæuÉ

kÉÔqÉÉ: MüuÉsÉaÉëWû¶É

EwhÉ¶É

sÉåWûÉ: MüOÒûMüÉ

ÌlÉWûliÉÑ: MüTÇü

ÌuÉzÉåwÉåhÉ

MüTüzÉÉåwÉhÉÇ

cÉ

– xÉÑ.E.52/28MüÉxÉqÉÉirÉÌrÉMÇü

qÉiuÉÉ

¤ÉiÉeÉÇ

iuÉUrÉÉ

eÉrÉåiÉç

qÉkÉÑUæeÉÏïuÉlÉÏrÉæ¶É

oÉsÉqÉÉÇxÉÌuÉuÉkÉïlÉæ: -

cÉ

ÍcÉ

18/138SÏmÉlÉÇ

oÉ×ÇWûhÉqÉåuÉÉSÉæ

MÑürÉÉïSalÉå¶É

SÏmÉlÉqÉç

urÉirÉÉxÉÉiÉç

¤ÉrÉMüÉÍxÉprÉÉå

oÉsrÉÇ

xÉuÉïÇ

ÌWûiÉÇ

pÉuÉåiÉç

– cÉ. ÍcÉ

18/187AaêrÉ

– ÌuÉSÎaSMüÉ

-

MülOûMüËU

(Solanum xanthocarpum)

MüxÉWûU

uÉaÉï

:-

SìÉ¤ÉpÉrÉÉqÉsÉMü

ÌmÉmmÉsÉÏSÒUÉsÉpÉÉ

zÉ×…¡ûÏMühOûMüËUMüÉ uÉ×¶ÉÏUmÉÑlÉlÉïuÉÉiÉÉqÉsÉYrÉÉ

CÌiÉ

SzÉåqÉÉÌlÉ

MüxÉ

WûUÉÍhÉ

pÉuÉÎliÉ

– cÉ. xÉÔ.4/16

A total 1238 compounds for treating Kasa in Ayurveda

342 Rasa aushadhi•

Talisadi

churna

–

srungyadi

churna

•

Abhraka

bhasma

–

Shrungi

bhasma•

Trijatakadi

vati –

Lavangadi

vati

•

Dashamoolarista

–

Vasarista•

Amrutaprasha

ghruta

–

Vasa

ghruta

•

Vasakantakari

Avaleha

–

Agastya

Rasayanam•

Mahalaxmivilasa

Ras

-

Agni kumara ras

•

Hemagarbha

pottali

–

Hemabhra

sindhura

- Swarnamalivi

vasantam

Kasa Yoga

•

Kadaliphala yoga = kadali + Maricha (Basava Rajiya)

•

Swarna Bhupati Ras = Sarva Kasaharam (Vaidya chintamani)


Hikka- Swasa

u“MNˇÁ≈ƒÁÃ

“zoÏ

-

uƒtÁu“TÏªuƒ…bu©ßøqÁuß…ÆuãtßÁz\å{: @

∆yoúÁåÁ∆åÀsÁå∫\ÁzáÓ™ÁoúÁuå¬{: @@1@@

√ÆÁÆÁ™Nˇ™îßÁ∫ÁÜƒƒzTÁVÁoÁúoúîm{: @

u“MNˇÁ

≈ƒÁÃ≈Y

NˇÁÃ≈Y

åwmÁÊ

Ã™Ïú\ÁÆoz

@@2@@

• Ahara = Vidahi, Vistambhi, Abhishyandi, Vidruddha, Vishamashana, Amapardosha, Anaha,

• Guna = Guru, Rooksha, sheeta• Bahya = rajas, Dhooma, Atapa, anila, • Other = Vyayama, Bharadhwa, Vegarodha, Apatarpana,

Gramyadharma, Dourbalya, Marmabhighata, Shodana viparyaya,

• Nidanarthakara roga = Atisara, Jwara, Chardi, Peenasa, Urahkshata, Raktapitta, Udavarta, Vishuchi, Alasaka, Pandu, Visha


Swasa

≈ƒÁÃ

Ã©ú¿Áuõo

-

ÆtÁ

Ã¿ÁzoÁÊuÃ

ÃÊªÜÆ

™Áªo: Nˇ¢ˇúÓƒîNˇ: @

uƒ…ƒSƒ¿\uo

ÃÊªt‚áÀotÁ

≈ƒÁÃÁå‚

Nˇ∫Ázuo

Ã: @@17@@Nidana

Vata • Prana vaha,

Udana vaha, Annavaha Srotoroodha

Kapha Ruddhopagamana = obliterated by it self


Tamaka swasa•

Normalcy of Pranavata suggests health in the body, abnormality indicates disease

•

Pranavata and Prana vikruti leads to the Swasa, which is an emergency condition, leads to death even.

•

WHO 1998 estimates asthma as 155 millions which increases 50% every decade worldwide.

•

India has an estimated 15-20 million asthmatics.•

Tamaka - is derived from “Tamyati iti Tamaka”- means; to choke, darkness, be suffocated.

•

Dalhana and Chakrapani commented Tamah praveshana which refers to the darkness or black curtains in front of the eyes.


Tamaka Swasa Nidana•

Either Bahya or Abhyantara Nidana (etiological factors) cause Bronchial asthma which is heterogeneous disease.

•

Aggravating factors like meghambu(rainy season) sheeta sthana(cold place) and preceding factors like peenasa (common cold) kasa(cough) are clearly explained in the pathology of Tamaka Swasa.

8-1-2008 [email protected] 61Tamaka Swasa

o™Nˇ≈ƒÁÃ

-

ú¿uo¬Áz™Ê

ÆtÁ

ƒÁÆÏ: Ã¿ÁzoÁÊuÃ

ú¿uoú˘oz

@

T¿yƒÁÊ

u∆∫≈Y

ÃÊTw—Æ≈¬z…™ÁmÊÃ™ÏtyÆîÊ

Y @@27@@

Nˇ∫Ázuo

úyåÃÊ

ozå

ªt‚áÁz

VÏVîÏ∫NÊˇ

osÁ

@

EoyƒÊ

oyƒ¿ƒzTÊ

Y ≈ƒÁÃÊ

ú¿Ámú¿úygNˇ™‚

@@28@@

ú¿oÁ©Æuo

Ã ƒzTzå

ow…Æoz

ÃuãåªÜÆoz

@

ú¿™Áz“Ê

NˇÁÃ™Áå≈Y

Ã TXZuo

™ÏÛ™ÏîÛ: @@29@@

≈¬{…™lÆ™ÏXÆ™Áåz

oÏ

ßw∆Ê

ßƒuo

tÏ:uQo: @

oÀÆ{ƒ Y uƒ™ÁzqÁãoz ™Ï˜oîÊ ¬ßoz ÃÏQ™‚ @@30@@

osÁDÀÆÁzt‚ÜƒÊÃoz

Nˇle: NwˇXZ~ÁXZMåÁzuo

ßÁu oÏ™‚

@

å

YÁuú

¬ßoz

uå¸ÁÊ

∆ÆÁå: ≈ƒÁÃúyugo: @@31@@

úÁ≈ƒzî

oÀÆÁƒTw—mÁuo

∆ÆÁåÀÆ

Ã™y∫m: @

EÁÃyåÁz ¬ßoz ÃÁ{PÆ™Ï…mÊ Y{ƒÁußåãtuo @@32@@

GuXZ~oÁqÁz

¬¬Ábzå

uÀƒ˘oÁ

ßw∆™Áuoî™Áå‚

@

uƒ∆Ï…NˇÁÀÆÁz

™Ï“Ï: ≈ƒÁÃÁz

™ÏÛ≈YƒÁƒá©Æoz

@@33@@

™zVÁ©§Ï∆yoú¿ÁSƒÁo{: ≈¬z…™¬{≈Yuƒƒáîoz

@

Ã ÆÁõÆÀo™Nˇ: ≈ƒÁÃ: ÃÁÜÆÁz

ƒÁ

ÀÆÁãåƒÁzunso: @@34@@

•

Asthma is defined as intermittent, reversible airway obstruction in association with increased nonspecific bronchial reactivity. These physiologic changes are now known to exist in the context of airway inflammation. The addition of inflammation to the definition has shifted the understanding of asthma from a disease of airway nerves and smooth muscle to one that identifies inflammation as the driving force for the symptoms associated with the disease. This realization has led to a dramatic shift in the treatment of the disease in the past 10 years.


Nidana Sevana (Diet, Regimen & Climate)

Vatadushti Kaphadushti

Agnimandhya

Ama

Kapha vridhi Rasadushti

Pranavaha Sroto Avarodha

Vimarga gamana Sanga of Pranavata

Kloma Nalika Shaka

Tamaka Shwasa


Asthma


J45-Asthma Excludes:acute severe asthma ( J46) chronic asthmatic (obstructive) bronchitis ( J44.-) chronic obstructive asthma ( J44.-) eosinophilic asthma ( J82) lung diseases due to external agents ( J60-J70) status asthmaticus ( J46)

J45.0 Predominantly allergic asthmaAllergic: · bronchitis NOS · rhinitis with asthma Atopic asthma Extrinsic allergic asthma Hay fever with asthma

J45.1 Nonallergic asthmaIdiosyncratic asthma Intrinsic nonallergic asthma

J45.8 Mixed asthmaCombination of conditions listed in J45.0 and J45.1

J45.9 Asthma, unspecifiedAsthmatic bronchitis NOS Late-onset asthma

J46 Status asthmaticus = Acute severe asthma


Areas of management interest in Tamaka Swasa

Swasahara

Deepaneya & Hrudya

Kasahara

Parshwashoolahara

Shothahara

Swasa / Tamaka swasa Chikitsa • MüÉUhÉ

xjÉÉlÉ

qÉÔsÉæYrÉÉSåMüqÉåuÉ

ÍcÉÌMüÎixÉiÉqÉç

– cxÉç.ÍcÉ.17/70

• xlÉåWûuÉÎxiÉÇ

ÌuÉlÉÉ

MåüÍcÉSÕ²ïcÉÉkÉ¶É

zÉÉåkÉlÉqÉç

qÉ×SÒmÉëÉhÉuÉiÉÉÇ

´Éå¹Ç μÉÉÍzÉlÉÉqÉÉÌSzÉÎliÉ

– xÉÑ.E.51/15

• rÉ²ÌmÉ

μÉÉxÉå

xlÉåWûuÉÎxiÉ

mÉëÉÍgÉÌwÉ®: -

QûsWûhÉ• iÉmÉïrÉåSåuÉ

zÉqÉlÉæ: xlÉåWûrÉÔwÉUxÉÉÌSÍpÉ: -

cÉ. ÍcÉ. 17/90

• rÉÎiMÇüÍcÉiÉç

MüTüuÉÉiÉblÉqÉÑwhÉÇ

uÉÉiÉÉlÉÑsÉÉåqÉlÉqÉç• pÉåwÉeÉÇ

mÉÉlÉqÉ³ÉÇ

uÉÉ

iÉÎ®iÉÇ

μÉÉxÉÌWûÌ‚ülÉå

– cÉ. ÍcÉ. 17/147

• xÉuÉåïwÉÉÇ

oÉ×ÇWûhÉÉå½smÉ: zÉYrÉ¶É

mÉëÉrÉzÉÉåpÉuÉåiÉç

-

-

-iÉxqÉÉcNÒû®ÉlÉ

zÉÑ®ÉÇ¶É

zÉqÉlÉæoÉ×ïÇWûhÉæUÌmÉ

– cÉ.ÍcÉ. 17/149-150

• mÉÉhQÒûUÉåaÉåwÉÑ

zÉÉåkÉåwÉÑ

LrÉÉåaÉÉ: xÉqmÉëMüÐÌiÉïiÉÉ: • μÉÉxÉMüÉxÉÉmÉWûliÉåÅÌmÉ

MüxÉblÉÉrÉåcÉ

MüÐÌiÉïiÉÉ

– xÉÑ.E. 51/43-44

• ÌuÉUåcÉlÉ

xuÉåSlÉ

kÉÔqÉëmÉÉlÉ

mÉëcNûSïlÉÉÌlÉ

xuÉmÉlÉÇÌSuÉÉlÉç

– uÉæ±ÍcÉliÉÉqÉÍhÉ


Swasa yogaKarpuradi chrna (SY)Shatyadi churna (VC)

Vidangadi churna (VC)Shrungyadi churna

Dashamoola katutrayadi kwathaVasadi kwatha

VasaghrutaTrushana ghruta

Talisa ghrutaBharngi guda haritaki (VC)

Abhraka bhasmaSwasa kuthara ras

Swasakasa chintamaniSwasa kaleshwara ras (VC)

Sameerapannaga rasRasamanikya

Aswagandha ksharaMayurapincha bhasma

•

962 yogas for Swasa Hikka Chikitsa •

102 Ghruta yoga •

283 rasa yoga

•

Vasa•

Pushkaramoola•

Bharangi•

Kantakari•

Sunthi – Haritaki (BR)•

Gandhaka + Maricha (BR)

Vasa

Ghruta yoga

• oÉëÍ¼

bÉ×iÉ• aÉÑSÕcrÉÉÌS

bÉ×iÉ

• aÉÑaaÉÑsÉÑmÉÇcÉÌiÉ£üMüqÉç

bÉ×iÉ• aÉÑaaÉÑsÉÑ

ÌiÉ£üMü

bÉ×iÉ

• MülOûMüÉËU

bÉ×iÉ• sÉzÉÑlÉ

bÉ×iÉ

• ÌlÉÇoÉÉÌS

bÉ×iÉ• ÍxÉÇWûÉqÉ×iÉ

bÉ×iÉ

• qÉWûÉMÔüwqÉÉlQûMü

bÉ×iÉ• iÉÉÍVûxÉÉÌS

bÉ×iÉ

• uÉÉxÉÉ

bÉ×iÉ• ÌuÉSÉËU

bÉ×iÉ

Panchatikta

ghruruta

of Yogaratnakara

has Vasa

and Pushkaramoola

that are swasahara

and the Brumhana -

Ghruta

pÉUÎlaÉ bÉ×iÉ

rÉÉåaÉ

cÉÇaÉåËU

bÉ×iÉMülOûMüÉËU

bÉ×iÉ

MÑüÍsÉjÉwÉOèTüsÉ

bÉ×iÉlÉÉaÉUÉ±Ç

bÉ×iÉ

mÉÇcÉaÉurÉÇ

bÉ×iÉAqÉ×iÉmÉëÉzÉ

bÉ×iÉ

kÉluÉliÉUÇ

bÉ×iÉoÉ×WûiÉç

MülOûMüÉËU

bÉ×iÉ

Pushkara

Moola Ghruta

Yoga

MülOûMüËU

bÉ×iÉmÉlcÉÌiÉ£ü

bÉ×iÉ

SzÉqÉÔsÉ

bÉ×iÉmÉlcÉaÉurÉÇ

bÉ×iÉ

zÉPûÉ±Ç

bÉ×iÉμÉSl·íÉÌS

bÉ×iÉ

kÉluÉliÉUÇ

bÉ×iÉiÉåeÉÉåuÉirÉÉÌS

bÉ×iÉ

uÉ×WûMülOûMüÉËU

bÉ×iÉ

Tamaka Swasahara rasa Aushadhi

• ¤ÉrÉMÑüsÉÉliÉMü

UxÉ• sÉbÉÑÍzÉuÉ

aÉÑÌOû

• ÍzÉsÉÎeÉiÉÑ

uÉÌOûMü• xÉÔrÉïmÉëpÉ

aÉÑÌOûMü

Points to observe at PVS Management•

Transport of oxygen and carbon dioxide (Ambara peeyusha)

•

Regulation of Acid base balance (Niramleekarana – Nirlavaneekarana)

•

Control of breathing (Kumbhaka – Rechaka Pranayama)

•

Regulating the water balance in the body (Ambu)


Note This is

Not an end But a big start !

•

Dr. K. Shiva Rama Prasad•

[email protected]

management of pranavaha srotas diseases “ayurvedic pulmonology”

Health & Medicine