Kaphaketuras kaphajakasa rs003-gdg

PREPARATION AND PHYSICO-CHEMICAL ANALYSIS OF

KAPHAKETU RASA

AND ITS CLINICAL EFFICACY ON KAPHAJA KASA

By

Ravikumar B. Pattanashetti.

Dissertation Submitted to the Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M.D.

In

RASASHASTRA

Under the guidance of Dr. Dilipkumar. B.M.D. (Rasashastra)

And co-guidance of

Dr. Girish N. Danappagoudar.M.D. (Rasashastra)

DEPARTMENT OF RASASHASTRA, POST GRADUATE STUDIES AND RESEARCH CENTER,

SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG – 582103.

2005

Ayurmitra

TAyComprehended

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

hereby declare that this dissertation / thesis entitled

“Preparation and Physico-Chemical analysis of Kaphaketu rasa and

its clinical efficacy on Kaphaja kasa” is a bonafide and genuine

research work carried out by me under the guidance of

Dr. Dilipkumar. B. M.D. (Rasashastra). Asst. Professor, Post graduate

department of Rasashastra and Co-guidance of Dr. Girish N.

Danappagoudar, M.D. (Rasashastra), Lecturer, Post graduate department of

Rasashastra.

I

Date: Place: Gadag Ravikumar B. Pattanshetti.

SHRI D. G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG.

POST GRADUATE DEPARTMENT OF RASASHASTRA

CERTIFICATE BY THE CO – GUIDE

his is to certify that the dissertation entitled “Preparation and

Physico - Chemical analysis of Kaphaketu rasa and its clinical

efficacy on Kaphaja kasa” is a bonafide research work done by

Ravikumar B. Pattanshetti in partial fulfillment of the requirement for

the degree of Ayurveda Vachaspathi. M.D. (Rasashastra).

T

Date:

Place: Gadag Dr. G. N. DanappagoudarM.D. (Rasashastra).

Lecturer,

Department of Rasashastra,

Post Graduate studies and research center

DGM Ayurvedic Medical College. Gadag

ENDORSEMENT BY THE H.O.D, PRINCIPAL OF THE

INSTITUTION

his is to certify that the dissertation entitled “Preparation and

Physico-Chemical analysis of Kaphaketu rasa and its clinical

efficacy on Kaphaja kasa” is a bonafide research work done

by Ravikumar B. Pattanshetti under the guidance of

Dr. Dilipkumar. B.M.D. (Rasashastra), Asst. Professor, Post graduate

department of Rasashastra and Co-guidance of Dr. Girish N.

Danappagoudar. M.D. (Rasashastra), Lecturer, Post graduate department of

Rasashastra.

T

Dr. M. C. Patil, M. D. (Ayu.) Dr. G. B. Patil. Professor and H. O. D. Principal, Post graduate Dept. of Rasashastra. DGMAMC,Gadag. DGMAMC, Gadag.

Date : Date:

Place: Gadag Place: Gadag

COPYRIGHT

Declaration by the candidate

herby 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.

I

Date:

Place: Gadag Ravikumar B. Pattanshetti

© Rajiv Gandhi University of health Sciences, Karnataka

Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa on Kaphaja kasa

Acknowledgement First and foremost, I salute almightily God who is omnipresent, omniscient and

omnipotent. He is the possessor of the ocean of knowledge and wisdom - to which I would like to

contribute a drop in the form of my dissertation. As it is said, each and every drop goes to make an

ocean, so this is my humble endeavor towards its goal of wisdom.

It gives me inexpressible pleasure to offer my sincere thanks to all those who have

rendered their wholehearted support, guidance and Co-operation in completing the thesis work.

My deep sense of gratification is due for my parents who are the architects of my career.

The culture, discipline and perseverance, which I could imbibe, is solely because of their

painstaking, upbringing and strong moral support.

I am extremely happy to express my deepest sense of gratitude to my beloved and respected

HOD and Prof. Dr. M. C. PatilMD.(Rasashastra) whose sympathetic, scholarly suggestions and

guidance at every step have inspired me not only to accomplish this work but in all aspects.

I express my deep gratitude to my respected guide Dr. Dilipkumar B. MD.( Rasashastra) for his

critical suggestions and expert guidance for the completion of thesis.

I am extremely grateful to my co-guide Dr. G. N. Danappagowdar,MD. (Rasashastra) under

whose guidance, inspiration, supervision and valuable suggestions, I have been able to complete

this research work.

Principal, Dr. G. B. Patil, D. G. Melmalgi Ayurvedic Medical College, Gadag, who’s

valuable suggestions during the course of my academic career has shown me the way of perfectness.

I convey my sincere gratitude to our beloved Principal.

It is Dr. S. H. Doddamani MD (Ayu) and Dr. Jagadish Mitti, MD (Rasashastra) who helped me in

every step of this thesis work and supplied the information’s wherever necessary. I will remember

their service with deep sense of gratitude for ever.

I take this opportunity to thank HOD’s, of other departments Dr.

VaradhacharyuluMD(Ayu), Dr. PurushothamacharyuluMD(Ayu) and Dr. G. V. MulgundMD(Ayu). For

their inspiration and valuable suggestions.

I am grateful to all the PG, teachers Dr. K. S. R. PrasadMD.(AYU), Dr.

ShivaramuduMD.(AYU), Dr. R. Y. ShettarMD.(AYU), Dr. Kuber SankMD.(AYU), Dr. Santosh

BelvadiMD.(AYU), Dr. MulkiPatil, Dr. Yasmin, MD.(AYU), Dr. Shashidhar NidagundiMD.(AYU), and

Dr. D. M. Patil MD.(AYU), for their valuable inputs and suggestions.

Acknowledgement - I


I extend my immense gratitude to Dr. R. K. Gacchinmath, Dr. G. S. Hiremath, Dr. S. A.

Patil, Dr. U. V. Purad, Dr. B. G. Swami, Dr. Paraddi and other teaching staff who helped during

my study.

I take this opportunity to thank Dr. Chandur, Lecturer J. T. Pharmacy College, Gadag,

who extended valuable support by conducting analytical procedures.

My sincere thanks are extended to Dr. Basavaraj SaraganachariMD.(AYU), for his

inspiration and valuable suggestions.

I would like to express my sincere thanks to Mr. V. M. Mundinamani, Librarian and

Asst. Librarian Mr. S. B. Sureban for providing valuable books in time throughout the study.

I am thankful to Mr. P. M. Nanadakumar, Statistician, who helped me in Statistical

Analysis.

I extend my sincere thanks to my seniors Dr. Srinivas Reddy, Dr. Hanumanth Gowda

and Dr. Shankar Gowda for their guidelines and timely rendered help.

I can not move further before thanking to my beloved friend Dr. Varsha who have shared

all the moments of joy and sorrow with me continuously during my Post Graduate studies.

I feel proud in expressing my sincere gratitude to my best friends Dr. Naganur, Dr.

Hosalli, Mr. Sanjeev, Mr. Mahantesh,, Smt. Manjula, Dr. Vinod, Dr. Mahadev, Dr. Gurav, Dr.

Pampanagowda, Dr. Seema. M. B., who not only helped me but stood by me during hours of stress

and dejection.

I take this moment to express my thanks to all my Post Graduate colleagues Dr.

Santhoji, Dr. Jaggal, Dr. V. S. Hiremath, Dr. Koteshwar, Dr. Joshi, Dr. Chetan and Junior

Colleagues Dr. Ganti, Dr. Pradeep, Dr. Sobagin,, Dr. Sasvihalli,, Dr. Teggi,, Dr. Sharanu, Dr.

Anand, Dr. Suvarna, Dr. Anitha, Dr. M. S. Hiremath, Dr. Lingareddi,, Dr. Vijay, Dr. Umesh,

Dr. Jagadish and Dr. Anand Doddamani.

I am very much thankful to my room mates Dr. Kalmath,, Dr. Nagaraj, Dr. Santosh,,

Dr. Venkareddi,, Dr. Jayaraj, Dr. Hugar, and Dr. Ramesh for their help and co-operation..

I am very much thankful to Raghu S. K. and Raju S. K., Net Nota Cyber Café, Gadag for

their timely help in typing and bringing out this computer print.

Last but not least, I thank to the patients who are pillars of my research work and to all

those names my memory fails to recollect.

Dr. Ravikumar B. Pattanashetti.

Acknowledgement - II


ABSTRACT

Background:

n Ayurvedic literature, the classification of the disease Kasa has been done

mainly on the basis of the nature of sputum. In Kaphaja Kasa patient expectorates

Bahula (copious), Snigdha (unctuous), Sandra (viscid) and Swetha (white) coloured

sputum. The reason for which is the hyper secretion of mucous in Pranavaha Srotas

(Respiratory system). Kaphaja Kasa is one among Pranavaha Srotodusti vyadhi.

Kaphaketu Rasa is a formulation which combats the Pranavaha Srotodusti vyadhis

(Respiratory disorders) especially Kaphaja Kasa. Hence this study has been

undertaken.

I

Objectives:

Preparation of Kaphaketu rasa

Physico – chemical analysis of Kaphaketu rasa.

To evaluate the clinical efficacy of Kaphaketu rasa in the selected cases of

Kaphaja kasa patients.

METHODS: Pharmaceutical Study:

Tankana Shodhana.

Shankha Shodhana and Marana According to Rasatarangini

Vatsanabha Shodhana

Analytical study : Kaphaketu rasa is subjected for Physico-chemical analysis like

Assay for Boron and Calcium, Acid insoluble ash, Loss on drying at 110oC, Loss on

ignition at 450oC, Organoleptic characters, Friability test, Disintegration time,

Weight variation, Size variation, pH study, Solubility t, Test for alkaloids etc.,

Acknowledgement - III


Clinical study : 30 patients of Kaphaja Kasa with confirmed diagnosis were selected

by Simple random technique. Subjective and Objective parameters were considered

for assessment.

Results : Kaphaketu rasa reducing signs and symptoms of Kaphaja Kasa which is

confirmed by the value of Subjective and Objective parameters has the statistical “p”

value < 0.001.

At the completion of study data was scrutinized and results were obtained by

statistically analyzing the data given to subjective and objective finding before and

after treatment. In this study it was observed and analyzed that, the effect of

“Kaphaketu rasa” was statistically significant and it is suggested that this formulation

has significant role in the management of Kaphaja Kasa.

Interpretation and Conclusion: The dravyas which are mentioned in Shodhana of

Vatsanabha and Shankha, neutralizes the toxic properties and converts them into

therapeutically effective form.

Shankha Marana: Ayurvedic Bhasama Pareeksha and modern physico-

chemical analysis are the confirmative tests for the complete formation of

bhasma and its genuinety.

The Bhavana dravya Ardraka helps in subsiding the disease and also enhance

the property of Kaphaketu rasa.

Anupana also takes role in subsiding the disease by helping quick absorption

of drugs.

Kaphaketu rasa is one of the best formulation for Kaphaja Kasa.

Key words: Kaphaketu rasa, Kaphaja kasa, Pranavaha srotas, Lungs, Chronic

bronchitis, Vati Kalpana, Tankana, Shankha, Vatsanabha, Pippali.

Acknowledgement - IV

Effect of Arohana Snehapana on Samedarakta

ABBREVIATIONS

R. T. Rasa Tarangini

A. P. Ayurveda Prakasha

R. S. S. Rasendra Sara Sangraha

R. A. Rasamrita

R. J. N. Rasa Jala Nidhi

Y. R Yogaratnakar

B. P. Bhava Prakasha

R. N. Raja Nighantu

D. N. Dhanvantari Nighantu

K. N. Kaideva Nighantu

Ma. Ni. Madanapala Nighantu

N. A. Nighantu Adarsha

S. N Shodala Nighantu

C.S. Charaka Samhita

S.S Sushruta Samhita

A.S. Astanga Sangraha

A.H. Astanga Hridaya

M. N Madhava Nidana

G. N. Gadha Nigraha

I.M.M Indian Materia Medica

Abbreviations- VII

Physico - Chemical Analysis & Efficacy of Kaphaketurasa in Kaphajakasa

List of Tables - VIII

LIST OF TABLES

Sl. No. Tables Pages 1 Showing the contents of kaphaketu rasa 5 2 Showing synonyms of Tankana 6 3 Showing the Tankana Shodhana according to different authors 9 4 Showing the Karma of Shudda Tankana according to different

authors 9

5 Showing the Rogaghnata of Shudda Tankana according to different authors

10

6 Showing synonyms of Shankha 14 7 Showing of Rogaghnata of Shankha 16 8 Showing synonyms of Pippali 19 9 Showing actions of Pippali 21 10 Showing Indications of Pippali 21 11 Showing Synonyms of Vatsanabha 23 12 Showing types of Vatsanabha 25 13 Vatsanabha shodhana according to different authors 26 14 Showing Pharamacological Properties of Ingredients of

Kaphaketurasa 30

15 Showing the Samanya nidana of Kasa 42 16 Showing the Poorvaroopa of kasa 43 17 Showing roopa of Kaphaja kasa according to different Acharyas 44 18 Showing interrelation between Lakshanas and Dosha, Vikalpa,

Dushya, Srotas and Sthana in Kaphaja Kasa 47

19 Showing quantity of Tankana before and after Shodhana 67 20 Showing quantity of Shankha before and after Shodhana 69 21 Showing quantity of Shankha Before and After Marana 71 22 Showing Qty of Vatsanabha Before and After Shodhana 73 23 Showing Qty of Pippali Before and After Churnikarana 74 24 Showing Qty of Vatsanabha Before and After Churnikarana 75 25 Showing the Age Incidence 91 26 Showing the sex incidence 92 27 Showing the Religion 92 28 Showing Occupational Incidence 92 29 Showing socio – economical status of patients 93 30 Showing incidence of Habitat 93 31 Showing the chief complaints of the patients 94 32 Showing the incident of Chronic respiratory disorders in the family 94 33 Showing the condition of work place 95 34 Showing the incident of history of recurrent URTI 95 35 Showing the mode of on set of disease 96 36 Showing the course of the disease 96 37 Showing the periodicity of cough 96 38 Showing various types of sputum in cough 97 39 Showing the incidence of Aggravating factors 97 40 Showing incidence of smoking 98


List of Tables - IX

41 Showing food habits in patients 98 42 Showing consuming dominant rasa in food 99 43 Showing the incidence of Vyasana 99 44 Showing the incidence of Nidra 99 45 Showing the type of Agni of Kaphaja kasa patients 100 46 Showing type of Khosta 100 47 Showing exposure to any aggravating factors during working hours 100 48 Showing whether symptoms produced during working hours 101 49 Showing whether the symptoms reduce by change of place 101 50 Showing Prakruti of patients 101 51 Showing the Vyayam shakti of kaphaja kasa patients 101 52 Showing Aharashakti of Kaphaja kasa patients 102 53 Showing the Satmya of the Kaphaja kasa patients 102 54 Showing Satwa of Kaphaja kasa patients 102 55 Showing Sara of patients 102 56 Showing pramana of Kaphaja kasa patients 103 57 Showing the incidence by Samahana 103 58 Showing the effect of the disease over routine activities 103 59 Showing the observed symptoms of Pranavaha Srotas symptoms 103 60 Showing the observed symptoms of Rasavaha srotas symptoms 104 61 Showing the observed nidanas in Kaphaja kasa 104 62 Showing the observed purva roopas in Kaphaja kasa 104 63 Showing the number of patients with Kasa 105 64 Showing the number of patients with Nishteevana 105 65 Showing the number of patients with Uraha Vankshana

Sampoornmiva 106

66 Showing the number of patients with Quantity of Sputum (morning bout)

106

67 Showing the ESR before and after treatment 107 68 Showing the AEC, TC, DC values before and after treatment 108 69 Showing statistical analysis of subjective parameters 109 70 Showing statistical analysis of objective parameters 109 71 Showing the overall result 110


List of Tables - X

LIST OF MASTER CHARTS

Sl. No. Master chart Pages 1 Showing over all assessment of the response to “kaphaketu rasa”

based on assessment criteria. 111

2 Showing the Assessment of grading of parameters of “Clinical efficacy of Kaphaketu rasa in Kaphaja kasa

112

LIST OF FLOW CHARTS Sl. No. Flow Charts Pages

1 Illustrating the classification of Kasa according to different factors 40 2 Showing the samprapti of kaphajakasa 45 3 Showing Pathogenesis of Chronic Bronchitis 59

LIST OF GRAPHS

Sl. No. Graphs Pages 1 Showing the sex incidence 92 2 Showing socio – economical status of patients 93 3 Showing the condition of work place 95 4 Showing the incident of history of recurrent URTI 95 5 Showing the periodicity of cough 96 6 Showing the incidence of Aggravating factors 97 7 Showing incidence of smoking 98 8 Showing the overall result 110

LIST OF PHOTOGRAPHS

Sl. No. Photographs 1 Showing Tankana, Shankha Shodhana and Marana 2 Showing Vatsanabha, Pippali Churnikarana and final product

CONTENTS

INTRODUCTION 1- 3

OBJECTIVES 4

REVIEW OF LITERATURE 5 - 92

DRUG RIVIEW 5 - 34

HISTORICAL RIVIEW 8 - 32

NIRUKTI AND PARIBHASHA OF SNEHA 8 - 9

MAHA SNEHAS 11

CLASSIFICATION OF SNEHA AND SNEHANA 12 -18

SNEHANA YOGYAYOGYA 18 - 22

SNEHA PRAKARSHA KALA 22 - 23

SHODHANANGA SNEHANA VIDHI 23 - 32

KARMUKATA OF SHODHANANGA SNEHANA 33 - 38

MEDA 39 - 42

CONCEPT OF LIPIDS 43 - 68

SAMEDARAKTA AND HYPERLIPIDAEMIA 69 - 84

DRUG REVIEW 85 - 92

Contents - V

Methodology 64 - 90

Pharmaceutical Study 64 - 76

Analytical Study 77 - 84

Clinical Study 85 - 90

Results 91 - 112

Observations 91 - 104

Results 105 - 112

Discussion 113 -128

Conclusion 129 -130

Summary 131 -133

Bibliographic References 134 -150

Annexure

Contents - VI


Introduction - 1

yurvedic is a system of indigenous medicine which systematizes and applies

the knowledge about health and disease. Health is the supreme foundation of virtue,

wealth, enjoyment and salvation. Diseases are the destroyers of health, goodness and

even life itself.

In Ayurveda, Acharyas have explained different charyas in order to maintain

the health. The diseases are manifested mostly because of neglecting the laws of

nature. In this modern era, urbanization have paved way for many developments, but

the hazards caused by the same can not be ignored. Quality of life on earth is

deteriorating day by day due to pollution and urbanization.

Toxic substances liberated from the industries, inhalation of polluted air, in the

form of smoke etc is responsible for the disease of Pranavaha srotas (Respiratory

system). In Ayurveda the fundamental unit of living activity is said to be breathing,

one of basic activity of Pranavahasrotas is exchange of gases, 16 times per minute

making it one of the most vulnerable site for disease. The lungs with their greater

surface area (500 m2) are directly open to the external environment. Thus, structural,

functional or microbiological changes within the lungs can be closely related to

epidemiological, environmental, occupational, personal and social factors. Thus the

primary respiratory diseases are responsible for a major burden of morbidity and

ultimately death. As a result of dhuma & raja the main cause of Pranavaha sroto

dusthi have become unavoidable making Kasa the most common disease to the extent

of 60% of total disease being recorded.

Kaphaja kasa is one of the most common ailment afflicting Pranavaha srotas

(Respiratory system). This condition has been considered to be the cutting edge of

the doshic type of kasa, which if neglected or mismanaged, may result in poor

prognostic conditions such as Kshataja, Kshayaja Kasa and Tamaka swasa etc., which

A


Introduction - 2

are very difficult to manage. This shows the importance of early intervention of this

type of Kasa, is of paramount importance in the field of medicine. Till today it has

been a challenging pathological condition of the Respiratory system.

Modern medical science is using Bronchodilators, Expectorants and

Corticosteroids to manage Respiratory disorders which are causing many adverse

effects and suppressing the immunity.

In the meanwhile Ayurvedic treatment regimens have gained much

importance due to less adverse effects, but they are very time consuming. The

significance of Rasashastra and Bhaishajya Kalpana becomes evident in such a

situation. The branch deals with techniques for developing new formularies, which

are more potent and at the same time cost effective and also suitable to the

modernized life style.

Several Herbo-mineral preparations have been described in Rasashasta. These

combinations are mutually complimenting. The ingredients can enhance one or each

others absorption, assimilation, bio-availability, therapeutic activity etc. They may

also reduce one or each others adverse reactions, toxicities. To conclude the exact

Pharmacokinetics and Pharmacodyanamics of herbo-mineral complexes is very

laborious. To arrive at a particular conclusion, the facilities and the sophistication at

this level of research are inadequate.

Kaphaketu rasa is one among such a Herbo-mineral Khalvirasayana which is

having commonly available drugs in it and is cost effective too. Different varieties of

Kaphaketu rasa are explained in several Rasa texts with slight difference in their

ingredients. But in this present study which has been mentioned in the 24th chapter

Vishopavishadi Vijnaniya of Rasatarangini has been under taken.


Introduction - 3

There are so many yogas recommended for Kaphaja Kasa by looking it

physicians may get confused in which particular Avastha of the disease, these are to

be prescribed, so this present study is undertaken to confirm in what stage Kaphaketu

rasa is effective and its overall efficacy on Kaphaja Kasa.

The study also presents the observation of the incidents of factors associated

with a disease such as sex, age and social class of patient, occupation, past history of

recurrent upper respiratory tract infection, severity, chronicity of disease, course of

the disease and relation with smoking etc.

PLAN OF STUDY:

Introduction: Introducing the subjects putting emphasis on its importance

and necessity in the present time.

Review of Literature: The detailed classical Ayurvedic literature and relevant

modern literature about the drugs Tankana, Shankha,

Vastanabha, Pippali, and about the disease Kaphaja Kasa

were reviewed.

Pharmaceutical Study: In this, the method of preparation of Kaphaketu rasa and

various Pharmaceutical processing of ingredients of

Kaphaketu rasa was incorporated.

Analytical Study: This includes Physico-chemical analysis of Kaphaketu rasa.

Clinical Study: This includes Clinical evaluation of Kaphaja Kasa patients.

Discussion: In this, it has been tried to found out possible explanations

for its effects over observations, findings and results of

various studies.

Conclusion and Summary: In this part summary of whole study along with certain

conclusions drawn was presented.


The objectives of the study were as follows :

Preparation of Kaphaketu rasa.

Physico-chemical analysis of Kaphaketu rasa.

To evaluate the clinical efficacy of Kaphaketu rasa in the selected cases of


Objectives - 4

Preparation, Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa

DRUG REVIEW:

asa shastra is a branch of Ayurveda deals with drugs and efficacious

formulations, mode of preparation of different formulations under Khalvi rasayana,

Kupipakwa rasayana, Pottali rasayana and Parpati rasayana. The Kaphaketu rasa

comes under Khalvi rasayana.

R

Kaphaketu rasa is a Khalvirasayana with a unique Herbo-mineral

combinations of drugs to treat Kaphaja kasa. Even though the name suggests that it is

a ras preparation, it does not contain Rasa (Parada) as an ingredient. It was found

mentioned in various rasa shastra classics. We get more than one preparation in the

name of Kaphaketurasa.

The author of Bhaishajya ratnavali also explained Kaphaketu rasa with similar

ingredient but three bhavana of Ardraka swarasa, Vatis of gunja matra, Ardraka

swarasa as anupana1 and one more preparation in the name of Brihat Kaphaketu rasa2

was explained.

In Rasendra Sara Sangraha Kaphaketu rasa is explained under Kapharoga

Chikitsa3 and it has same ingredients as explained in Rasatarangini. The Kaphaketu

rasa mentioned under Karanaroga Chikista4 have ingreadients like Trikatu, Hijjala

beeja, Shankha Bhasma, Vatsanabha and it is found recommended in Karna puya,

Karna nada, Karna antaha shotha. For the present work, that which has been

mentioned in the 24th Chapter of Rasatarangini has been selected5.

CONTENTS OF KAPHAKETU RASA

Table No.1 showing the contents of kaphaketu rasa

Drug Botanical / Scientific Name Quantity Shoditha Tankana Borax 1 part Shankha Bhasma Calyx of Conch shell 1 part Shoditha Vatsanaha Aconitum ferox Wall 1 part Pippali Piper longum Linn 1 part Ardraka (Swarasa) (For Bhavana ) Zingiber officinale Rosc Q. S.

Drug Review - 5


TANKANA

Tankana is mentioned in all the Brahatrayees. It is one among ksharatraya and

Ksharapanchaka. In Rasendrasarasangraha6, Anandakanda7, Ayurveda prakasha8,

Tankana is included under uparasa varga. After 8th century A. D. it has been used as

an antidote of Vatsanabha in Rasashastra and used in Paradajaranakarma9.

Vernacular Name:10

Sanskrit : Tankana, Rasashodhana Telagu : Veligaramu

Hindi : Suhaga Tamil : Venkaram

English : Borax Marathi : Tankana Khara

Kannada : Biligara Gujarathi : Tankana Khara

Synonyms :

Table No. 2 Showing synonyms of Tankana 11, 12, 13

Synonyms R.T A.P R.S.S Tankana + Tanka + Tanga + Tangana + Dravaka + Tankana kshara + + Tanka kshara + Ranga kshara + Ranga + Rangada + Loha shodhana + Soubhagya + Sita kshara + Shweta kshara + Tankaka + Kshara raja + Dhatu dravaka + Karamana + Pachana + Dravi + Louha vishuddhi +

Drug Review - 6


Occurrence:

It occurs as natural deposit.Crude Borax is found in masses by evaporation of

water, on shores of dried lakes in India and Tibet. It is also obtained from the mud of

lakes surrounded by hills in Nepal and from Searle’s Lake in California14.

In Nepal, Iran, Puga etc., Tankana occurs as crystals and as crystalline cement

between sand grains around salt lakes. It occurs also as bedded deposits, inter layered

with sedimentary rock15.

Varieties:

Varieties of Tankana on the basis of appearance:16

Tankana

Sphatikabha (Alam like)

Gudaprabha (Jaggery like)

Pandura (Pale coloured)

Varities of Tankana on the basis of occurance:17

Tankana

Khanija Kritrima

Varities of Tankana on the basis of availability:18

Tankana

Sonari Choukiya

Rasajalanidhi mentioned two types of Tankana:19 Tankana

Pinda Shadama (Pale white Colour) (Pure White Colour)

Drug Review - 7


Evil effects of Ashuddha Tankana :20

The therapeutic use of Ashuddha Tankana causes vomiting and delusions

Grahayagrahyata :21

The Tankana which is clear, transparent, crystalline with bluish tinge is the

best.

Nirmalikarana :22

If Tankana is mixed with dust, sand etc, impurities, then it is subjected to

Nirmalikarana. Take 1 part of Tankana choorna, 24 parts of water(1:24), mix well

and fitter it. After some time, decant supernant water and subject it to teevragni till

water evaporates. Take down the patra when it is little bit wet in the bottom and dry

it. In this way Nirmalikarana is done. It is used in the place of Boric acid but after a

Shodhana only internal use can be done.

Necessity of Shodhana :23

• The impure Tankana causes complications like vomiting & delusions.

• If it is mixed with dust, sand etc., impurities,.

Shodhana :

Actually, grahya variety of Tankana does not contain any impurity except for

the water content of it, which can cause heaviness in the body after its intake.

Therefore, practically Tankana is merely fried over the stove and evaporating the

water content which is termed as Shodhana.

Drug Review - 8


Table No. 3 Showing the Tankana Shodhana according to different authors.24,25, 26,27,28,29,30, 31

Sl. No. Shodhana Process R. T. A. P. R. A R. J. N. R. S. S. Y. R. B. R. R. S. I. M. M.

1 Fried in a pan till it becomes flower like. + + - - - + - -

2 Fried on a iron pan. - - + - - - - - 3 Mixed with water, next

day decanted, filtered and heated on fire.

- - + + - - - -

4 Mixed with 24 parts of water filtered through cloth and boiled on intense fire when it becomes paste like removed from fire and dried.

+ - - - - - - -

5 Purifies by being steeped for a night in Kanjika and dried in sun

- - - - + - - +

6 i. Purified by being steeped for over night in Jambhiraswarasa

ii. By keeping it inside Gomaya

- - - - - - + -

Pharmacological properties:32

Rasa : katu

Guna : Rooksha, Teekshna, Usna, Sara

Veerya : Ushna

Vipaka : Amla

Doshagnata : Vatakaphashamaka

Table No. 4 Showing the Karma of Shudda Tankana according to different authors 33, 34, 35, 36 , 37, 38, 39

Sl. No. Karma R. T. A. P. R. A R J. N. R S. S. B.R.R. S. Y. R.

1 Hridya + + + - + - + 2 Vishagna + + + + + + + 3 Deepaka + + + + + - + 4 Balya + - + - + - - 5 Rojahpravarthaka /

Streepushpa janana + - + - + - - 6 Moodagarbhapravarthaka + - + - + - - 7 Shoolaghna - - - - - + - 8 Vatapittakara - - - + - - - 9 Dravani - - - - - + - 10 Bhedi - - - - - + -

Drug Review - 9


Table No. 5 Showing the Rogaghnata of Shudda Tankana according to different

authors : 40

Sl. No. Rogaghnata R. T. A. P. R. A R. J. N. R. N. B. R. R. S. Y. R.

1 Kasa + - + + + - - 2 Swasa + - + + + - - 3 Adhmana + - + - - - - 4 Vrana + - + - - - - 5 Gulma - - - - - + - 6 Shoola - - - - - + - 7 Jwara - - - - - + - 8 Visha - + - + - + + 9 Rajorodha - - - + - - - 10 Kshaya - - - - + - -

Matra : 1-2 ratti

Anupana : Madhu, Ghrita or according to disease

Yoga : Anand Bhairava rasa

Mruitunjaya rasa

Sarvangasundara rasa

Ardhanarishwara rasa

MODERN VIEW

Borax:

Tankana is identified as Borax and it is composed of Boric Acid and Soda.41 It

has a reputation as a germicide. It is primarily a bacteriostatic, not only used by the

medical profession in the form of ointments and irrigating solutions, but also the

compound become a common item in house hold cabinets and nurseries.42

Physical properties:43

Chemical composition - Na2B4O710H20.

Crystal structure - Monoclinic prisms, often dull on the surface or

Crystalline tough masses or in the form of translucent

irregular masses, on exposer to air it becomes opaque.

Drug Review - 10


Colour - White sometimes with blue or gray tinge

Streak - White

Solubility - Sparingly soluble in cold water more soluble in hot

water.

Hardness - 2 – 2.5

Sp – gravity - 1.71

It’s aqueous solutions show an alkaline reaction. When heated it gradually

looses its water of crystallization, swells up and finally becomes a fused glassy mass.

Keeping it in sun, looses its transparency because of evaporation of water. It

is odourless, saline in taste efflorescent in dry air. Soluble in 25 parts of water and

insoluble in 90% Alcohol. It is soluble in 1% glycerin.44

Standard:45

Borax contains not less than 99% and not more than the equivalent of 103% of

Na2B4O710H20. Arsenic limit 5 parts per million, Led limit 5 parts per million,

complies also with limit tests for Chloride, Sulphate and Iron.

Preparation of Borax:46

Most of the Borax is prepared from the natural Borax of lake Borax or from

minerals like Colemanite (Ca2B60115H20), Boracite (2Mg3B8O15Mgcl2) etc.

In the preparation of Borax, minerals such as Colemaite are ground to a fine

powder and boiled with Sodium carbonate solution for three hours.

15 parts of minerals + 10 parts of Na2Co3 +60 parts of water.

2(2Cao,3B2O3)+3Na2Co3 = 3Caco3 +CaO +3Na2 B4O7

The solution is filtered and allowed to crystalline for 3 days in vats. Thus the

Borax is drained, broken up and packed in Kgs.

Drug Review - 11


Toxic effects:47

Acute poisoning of Borax poisoning begins with nausea, vomiting and

diarrhoea, regardless of the route of administration. The body temperature falls, and

an erythematous rash similar to that of scarlet fever develops. This is followed by

desquamation, not only in the areas of the rash but also of mucous membranes.

Absorption, Distribution and Excretion:

It is readily absorbed from the gastrointestinal tract, serous cavities and

inflammed skin. It does not penetrate the intact skin. Excretion is primarily by the

kidney; approximately 50% of a given dose is excreted within 24 hours. Relatively

large amounts are localized in the brain, liver and kidney.

Action:48

Diuretic, Emmengogue, Astringent, Antacid, Local sedative and Antiseptic.

Uses:49

1. It is used as germicide and primarly as a bacteriostatic

2. It is used in few commercial dermatological preparations, and also used as

ophthalmic ointment

3. Fiberglass for insulation and textiles.

4. Flame retardant for fabric and wood.

5. It is used as a flux in bronzing and in silvering.

6. It is also used in making enamel and in leather tanning.

Drug Review - 12


SHANKHA

Shankha is known to Indians since many days. Charaka explained shankha in

27th Chapter of Sutrasthana under Varishiya varga.50 Sushruta also explained it in

various places as a medicinal use. Rasarnavakar is the person who explained or

considered it under Shukla varga.

It is a molluscan species and it is also identified as sacred chank or conch. It is

large massive elegant shell with a fine pear shaped spire and a wide opening of mouth

which is prolonged into a narrow spout.

It has an external lustrous yellowish brown horny layer and beneath it has a

thick layer, chiefly formed of Calcium carbonate.51

Vernacular name: 52

Sans : Shankha Tamil : Sanka

English : Conch shell Telugu : Sehkham

Hindi : Shankh Kannada : Shankha

Bengali : Sankh

Chemical composition: Calcium carbonate (CaC03)

Source:53

Indian Ocean coasts. It is the outer covering of “Molluska group” of aquatic

animal which are seen in sea. It is collected from the sea, and put in boiling water.

The animal which is present inside dies and the outer portion is shanka, it is sold in

market.

Chanks are gregarious and exclusively marine animals occurring in large

numbers on muddy sand bottom Thirteen meters in depth in Tamil Nadu shores and

Andaman waters.

Drug Review - 13


Swaroopa : 54

The Shankha having Vrinta, Snigdha, Sukshma Mukha, Sundara, Nirmala and

Guru in nature is considered to be the best.

Characters:55

It is a porcelaneous shell of an oblang or conical form. The oblong form is

bulged in the middle and tapering at each end the conical variety is peculiar. The

upper portion is like corkscrew, twisted and tapering at the end. The base is broad,

the interior is hallow. The surface is hard & dull white colour. The upper surface is

highly tuberuleted, the under surface shining, very brittle and translucent.

Synonyms :

Table No. 6 Showing synonyms of Shankha 56, 57, 58, 59

Sl. No. Synonyms R. T. A. P. B. R. R. S. R. S. S. 1 Shankaka + - - - 2 Kambu + + + + 3 Trirekha + - - - 4 Samudraja + + + - 5 Sunada + - - - 6 Deerganada + - - - 7 Kamboja + - - - 8 Kshudra - + + - 9 Shankanaka - + + - 10 Pavana dhwani - - - + 11 Mahanada - - - + 12 Haripriya - - - +

Varieties:60

Two varieties of Shankha are mentioned in Ayurveda prakash. One is

Dakshinavartha and another Vamavartha. Dakshinavartha is said to be more sacred,

uttama and is widely used for medicinal purposes. Vamavartha is madhyama can also

be used for medicinal purposes. Fig. 5 Showing the types of Shankha

Shankha

Dakshinavartha Vamavartha

Drug Review - 14


Shodhana :61, 62, 63

The Shankha is made into pieces and these are tied into pottali and boiled in

Jambira Swarasa for 4 yamas ie., 12 hours approximately. After that pottali should

be removed and pieces should wash with hot water.

Jayanthi Swarasa Swedana

Dolayantra Δ 3 hours

Tanduliya drava 3 hours

Dolayantra Δ swedana

Kanji 3 hours

Dolayantra Pachana

Nimbukamla ½ Yama

Dolayantra Pachana Amla dravya +

Dolayantra

Kanji Δ Swedana

Marana of Shankha:64, 65, 66

Pieces of shuddha Shankha are dried well, then these are placed in sharava

samputa, after that sandibhandhana should be done. After complete drying it is

subjected to gajaputa. After obtaining from puta the backed pieces are powdered. It

is then given the Bhavana of Kumari Swarasa and once again subjected to gajaputa.

Such 2-3 putas yield good white bhasma of Shankha.

The pieces of Shodhita Shankha are put into the fire and subjected for

samyaga laghu puta till the they becomes bloomed.

One pala of Shankha, killed by being heated in a blind crucible is to be rubbed

by means of a rod with half a masha of Tankana and used in medicines.

Drug Review - 15


Pharmacological properties:67

Rasa : Katu rasa (Kshara)

Guna : Laghu, Hima

Veerya : Sheeta

Karma : Grahi, Balya, Vilekhana, Agnideepana, Vishagna, Varnya, Hridya.

Rogaghnata

Table No. 7 Showing of Rogaghnata of Shankha 68, 69, 70, 71, 72, 73

Rogaghnata R. T. A. P. R. S. S B. R. R. S R. N. Y. R. Amlapitta + - + - + - Grahani + + - + + + Parinama shoola + - - - - - Tarunya pidika + + - + - + Netrapushpahara - + - - + + Gulma - - + - - - Kapha Swasa - - + - - - Meha - - + - + - Udara shoola - - + - + -

MODERN VIEW

Calcium carbonate :

Calcium carbonate occurs in large quantities in nature as chalk, marble and

lime stone. However enough CaCO3 is absorbed to cause systemic and renal effects

but it has mainly considered to be the non systemic antacid.74

Absorption & Excretion:75

CaCO3 Ca+2 + CO3-2

H3O+ H2CO3 H20 + CO2

The calcium cations formed in reaction and present as the water soluble

calcium chloride salt can be either absorbed or precipitated as the insoluble calcium

phosphate salt in the intestine or as insoluble calcium soaps from the hydrolyzed

glycerides resulting from digested food. Calcium excretion varies directly with the

creatinine clearance.

Drug Review - 16


Preparation:76

It is obtained in the laboratory by the action of soluble carbonate on a calcium

salt or by passing CO2 through lime water.

CaCl2 + Na2CO3 CaCO3 + 2NaCl

Ca(OH)2 + CO2 CaCO3 + H2O

Untoward effects: 77

The constipating effects and chalky taste of Calcium carbonate are clinically

disadvantages, Belching occurs in same individuals the liberation of CO2. Nausea is

an occasional complaint, mere seriously infrequent instances of hyper calcimia with

alkalosis, caleinosis and azotemia occur during chronic Calcium carbonate usage.

Contraindications :

Patients with renal disease, history of calculi, gastrointestinal haemorrhage,

hypretension or dehydration and electrolyte imbalance due to excessive vomiting.

Properties :78

1. It is soluble in water containing Carbon dioxide forming calcium

bicarbonate. CaCO3 + H2O + CO2 Ca(HCO3)2

2. It is fine, white, odorless, tasteless, fluffy, microcrystalline powder which

is stable in air.

3. It is insoluble in alcohol, water and dissolves with effervescence in diluted

acetic, diluted hydrochloric and diluted nitric acids.

Uses :

1. It is used an Diuretic, Emmenogogue, Astringent, Antacid and Local

sedative and Antiseptic.

2. For the manufacture of lime.

3. As a flux in the smelting of ores.

4. In the preparation of tooth pastes and face powder.

Drug Review - 17


PIPPALI

Charaka and Shushruta have quoted pippali among the Dashemaniya gana. It

is quite interesting to know that Vagbhata did not mention it in any of his Vargas.

However he used it in therapeutics extensively.

Pippali should not be administered continuously for a long time without the

restrictions mentioned in Rasayana vidhi.79

Family : Piperaceae

Botanical name : Piper longum Linn.

Vernacular Names :80

Hindi : Pipala, Pimpli Malayalam : Tippali English : Long pepper

Punjab : Pipal

Telugu : Pippaller Nepal : Pipalmol Tamil : Pipli Kannada : Hippali Marathi : Pipali Gujathi : Pipara

Gana:

Charaka : Deepaniya81, Kanthya82, Asthapanopaga83, Shirovirechanopaga84,

sheetaprashamana85, Shula prashamana86, Kasahara87,

Hikkanigrahana88, Triptighna89.

Sushruta : Pippalyadi90, Amalakyadi91. Astanga sangrahakara also quoted

Pippali in Pippalyadi gana and Nyagrodhadi gana92.

Distribution and Habitat:93

This plant is indigenous to hotter parts of India like north-eastern and southern

India and Ceylon. It is found growing wild in the west coast and as undergrowth in

the evergreen forests of the Western Ghats from Konkan to Kerala.

Drug Review - 18


Synonyms:

Table No. 8 showing synonyms of Pippali 94, 95, 96, 97, 98, 99

Synonyms B. P. K. N. N. A. R. N. D. N. Ma. Ni.

Magadhi + + + + + + Shoundi + + - + + + Vaidehi + + + + - + Chapala + + + + + + Kana + + + + + - Krishna + + + + + - Upakulya + + - + + + Teekshna tandula + + + + + Magadha - - - - - + Vishwa - - - - - + Kola + - - + + - Kukara - - - + - - Katu beeja - - - + - - Korangi - - - + - - Tikta tandula - - - + - - Magadodbhava - - - + - - Ushana - - - + + -

Botanical Description:100, 101.

Piper longum is an aromatic glabrous under shrub, with erect or subscandent

nodose stem and slender branches.

Leaves: Simple, alternate, entire, glabrous, 5.9 cm x 3.5 cm, subaerte,

cordate at the base, seven veined that vary in shape and mode

of attachment even in the same plant.

Flowers: In pendulant spikes, straight, unisexual, spikes of small or

minute chamydeous densely or closely packed.

Male: Larger and slender,

Female: 1.3 – 2.5 cm x 4-5 mm diam. Flowering nearly throughout the

year.

Fruits: Very close clusters of small grayish green or darker grey beries,

when ripe yellowish orange in colour.

Drug Review - 19


External morphology of fruits: Fruits are small about 2-5 mm in diameter grayish green or

nearly blackish when ripe and are partially sunk in the fleshy

axis of the spike. The fruiting spikes are 2.5 to 3 cm long and

2.5 to 3.5 mm thick.

Chemical composition:102

It contains Essential oil, piperine, piplartine, piperlongurminie,

piperlonguminine, pipernonaline, pipercide, sesamin, - sitosterol, four aristolactams,

starch, fatty oil, gum caryophiline, mono and sequiterpenses etc.

Verities

Showing varities of Pippali

Sushruta & Charaka – Two types 103,104

Pippali Gajapippali

Classification of pippali on the basis of availability105

Pippali Gajapippali Simhali Vanapippali

Classification on the basis of availability in market 106

Choti Badi

Parts used : Fruit & root or the dried unripe fruits as well as root are used.

Dosage : Phala churna: ½ - 1 gm.

Pharmcologoical properties 107,108

Dried fruit Fresh fruit Rasa Katu Rasa Katu Guna Laghu, Snigdha Guna Guru, Snigdha Veerya Anushna Veerya Sheeta Vipaka Madhura Vipaka Madhura Doshagnata VataKaphahara

Drug Review - 20


Actions ;

Table No. 9 showing actions of Pippali

Actions D. N R. N N. A B. P. Ma. Ni K. N

Ruchya - - - - - + Sara - - - - - + Vrishya - + + + + + Rasauana + + + + + Deepani - + + + + + Pachani - - - - - + Hridhya - - - - - + Pittala - - - - - + Amadosha hara + - - - - - Rechani - - - + + + Sara - - - - - +

Infusion is stimulant carminative and alternative tonic more powerful than

black pepper, also aphrodisiac, diuretic, vormifuge and emenogogue. Externally

rubeficient root is stimulant109.

Indications: 110,111,112,113,114,115 Table No. 10 showing Indications of Pippali

Indications D. N R. N N. A B. P. Ma. Ni K. N Kasa - + + + + + Swasa - + + + + + Udara + - + + + + Jwara + + + + + + Kusta - - + + - - Meha - - + + - + Gulma - - + + + Arsha - - + + + Pliha - - + + + Trishna + - - - - - Krimi + - - - - - Kshaya - + - - - -

Pipper longum or piperine shows to posses bio aviablity enhancing activity

with various structurally and therapcutically diverse drugs. It may hypothesize that

piperine bioavaibility enhancing property may be attributed to increased absorption,

which may be due to alteration in membrane lipid dynamics and change in

confirmation of enzymes in the intestine.116

Drug Review - 21


VATSANABHA

Vatsanabha is known to Ayurvedic pharmacopoiea since very early times.

Among the Bhrihatrayees Charakra mentioned under “Sthavara vishas”.117 It is

described under 13 varieties of “Kanda vishas” by Sushruta.118 Vagbhata preferred

the name ‘Visha’ to denote Vatnsanabha and used in the treatment of Gandamala,

Kustha, Timira etc.119,

Sharangadhara and Bhavamishra delinated Vatsanabha in their texts while

almost all Nighantus mentioned it. Rajanighantu included it in the pancha mahavisha.

The utility of Vatsanabha definitely increased after the development of Rasa Shastra.

Aconite is one of the oldest known drugs and aconite is a Greek word meaning

arrow. The arrows were coated with this poison and used. It is of two different kinds

viz., poisonous and non – poisonous. Among the poisonous varieties both Aconitum

ferox and Aconitum chasmanthum are used as Vatsanabha in India.

Family : Ranunculaceae

Botanical Name : Aconitum ferox

Gana:

Charaka Samhita - Sthavara vishas

Sushruta samhita - Kanda vishas

Dhanvantari Nighantu - Mishraka varga

Bhavaprakash Nighantu - Dhatvadi varga

Raja Nigahantu - Pippalyadi varga

Kaidev Nighantu - Visha varga

Shodala Nighantu - Chandanadi varga

Drug Review - 22


Vernacular names:120

Hindi - Bachanag, mitha visha

English - Monks hood, aconite.

Kannada - Bachanag

Marathi - Bachanag

Telagu - Nabhi

Gujarathi - Basnag

Malayalam - Vatsanabhi

Punjabi - Mohari

Bengali - Kathvish

Assami - Vish.

Synonyms:

Table No. 11 showing Synonyms of Vatsanabha 121, 122, 123, 124, 125

Synonyms D. N. R. N. B. P. N. A. B.R.R.S

Amruta + + Visha + + + + + Ugra + + Mahoushada + + Garala + + + + + Marana + + Naga + + Stokaka + + Pranaharaka + + Kshweda + + +

Distribution and Habitat:126

It grows in Eastern temperate and sub alpine regions of the Himalayas,

Eastward of Kumaon, Nepal, Kashmir & Sikkim.

Drug Review - 23


Botanical Description :127

It is a erect perennial herb, stem erect with or without a slender hypogenous

base.

Leaves : Scattered, distant, excepting the lowest 2-3 which are usually

decayed at the time of flowering up to seven glabrous or the upper

most very sparingly hairy.

Petioles : Slender, the lower are upto 25 cm long and much dialted at the

base, upper most very short.

Inflorescence : A loose raceme, 10-25 cm long often with slender, erect, few

flowered additional branches from the leafy base.

Seeds : Obovoid to obopyramidal, 2.6-3 mm long, winged along the

rhaphe, transversely lamellae undulate on the faces, lamellae

undulate.

Chemical constituents:128

Roots contain toxic alkaloids, pseudoaconitine along with bikhaconitine,

chasma conitine, indaconitrine, verotroyl pseudaconitine and diacetyl

pseudoaconitine.

Four lipoalkaloids viz liposeudo aconitine, lipoyanaconitine, lipoindaconitine

and lipbikhaconitine and four acorine viz. vertroylpseudaconine, anisoylyunaconine,

benzyolindaconine and veratroylbikhaconine are also reported.

Varities:

I. Sushruta quoted about four varieties of Vatsanabha. Rasa vagbhata and

Yogaratnakara have elaborated four varieties, the colour and properties of

each varieties are given129

Drug Review - 24


Table No. 12 Showing types of Vatsanabha

Sl. No. Bheda Varna Guna

1 Brahmana Pandu Rasayana 2 Kshatriya Rakta Dehapushtikara 3 Vaishya Peeta Kushtaghna 4 Shudra Krishna Dhatu karma

II. In Rasatarangini only three varities are described on the basic of colour.130

1. Krishna (Blakish)

2. Kapisha (Browinsh yellow)

3. Pandu varna (yellowish grey)

They are considered as superior to each other in the same order.

III. According to Ayurveda prakasha two varities 131

1. Shukla 2. Krishna

Among these two Krishna variety is having property of Laghu and Ashukari.

It is used Roganashanartha, Parada jaranartha and as Rasayana.

Identification:132

Rasavagbhata mentioned certain characteristics for identification. Vatsanabha

having pandura Varna (yellowish grey colour). Its roots are similar to navel of calf

and is not more than five angulis in length and circumference is 1-2.5 angulis they are

Sthula (bulky tuber), Snigdha (smooth), Guru (heavy in weight), Nava (newly

harvested), Phala pakanta grahya (collected after fruits have dried up), Kitadi

abhakshita (not affected by insects). In Bhavapraksha133 it is mentioned that its leaves

and root resemble the leaves of sindhuvara and navel of the calf respectively.

Shodhana:

The impure form of Vatsanabha may produce Daha, Moha, Hridgati Rodhana

and Marana eventually.134 Therefore purification is essential135.

Drug Review - 25


Table No. 13 Vatsanabha shodhana according to different authors.136-137-138-139-140

Sl. No. Shodhana process R. T. R. A. D.G.V Y. R. R. J. N

1 Kept in cow’s urine in strong sunlight for 3 days

+ + - - +

2 Swedana in Ajadugdha for 1 yama

+ + - - -

3 Swedana in Surabhi payas (cows milk) for 1 or 2 yama

+ + - + -

4 Kept in cow’s urine for 3 days then Swedana in a cow’s milk or goat’s milk for 3 hrs

- - + + -

5 Swedana in dolayantra containing Triphala kashaya and Aja ksheera

- - - - +

6 Swedana in dolayantra containing cow’s urine.

- - - - +

Contraindications: 141

• Vatsanabha should not be used in rainy season and on the cloudy days.

• It is contraindicated in Krodhi, Pitta predominant, Klibya, Kings, when feeling

hungry or thirsty, Bhrama, Sun stroke, after walking for long distance,

pregnant women, children, old age, emaciated individuals, marma rogas etc.,

• Sleep during day time, exposure to fire and heat are also forbidden.

• Diet restricted rich in pungent, sour and salt tastes.

Toxic effects: 142

The toxic effects of Vatsanabha viz, Greevasthambha, peeta vin mutra netratva

(deep yellowish discolouration of stools, urine and conjunctiva). The other toxic

effects are Twak vikara, Vepathu, Daha, Phenodgama, Jadata and Marana.

Drug Review - 26


Anti-dotes: 143

Over dosage with Vatsanabha may produce the above symptoms. Different

anti-dotes have been mentioned for the management.

• Tankana (Borax) is considered to be the main antidote. Usually equal quantity

of Vatsanabha and Tankana are recommended to nullify toxic effects of it144.

If Tankana is not available maricha may be used in a double the quantity of

Vasthanabha.

• Cow’s ghee is considered as one of the best anti-dotes for Vasthanabha. 145

Modern View: 146

Most of the aconite varities are found to be poisnous. The main active

principal resulting in toxic effects is aconitine. The symptoms of poisoning occur

immediately or within a few minutes after consumption of root. First, buring

sensation is experienced from moth to stomach followed by tingling and numbness

oin the mouth, tongue and pharynx. This is followed by salivation, nausea, vomiting

and diarrhea. Later, dryness of mouth and the patients will be unable to swallow.

Other symptoms include head ache, giddiness, pallor, profused sweating, sub-

normal temperature, weakness of limbs, inability to stand or walk, cramps and

convulasions may also occur.

The pupils contract and dilate alternately, but remain dialted at the later stage.

Dimness of vision and diplopia may cusue. The pluse becomes slow, feeble and

irregular. Blood pressure will be low and the patients complain of breathlessness.

Finally death may occur due to paralysis of heart or respiratory centres or even both.

Treatment:

• Gastric lavage with warm water and weak solution of potassium

permanaganate.

Drug Review - 27


• Powerderd charcoal to diminish solubility.

• Atropine 0.5-1 mg.

• Artificial respiration may also be useful

Collection : The collection of root is preferred during winter.

Part used : Root

Dosage : 1/8th ratti i.e, 15mg approximately or 60 – 125 mg.

Fatal dose : 1-2 gm of root.

Fatal period : 3-6 hours.

Pharmacological properties: 147

Rasa : Madhura

Guna : Laghu, ruksha, teekshana, vyavayi, vikashi

Virya : Ushna

Vipaka : Madhura

Doshagnata : Tridosha shamaka, especially Vatakapha shamaka

Action : Yogavahi, Shoola prashamaka, Mootrala, Balya, Rasayana,

Madakari. 148

Vatsanabha has Diaphoretic, Diuretic, Antidiabetic, Antiphlogistic

and Antipyretic action. 149

Uses : Jwara, Swasa, Kasa, Bhagandhara, Aganimandya, Gulma, Pandu,

Vrana, Arsha and Vatarakta. 150

Drug Review - 28


ARDRAKA

Family : Zingiberaceae

Kula : Ardraka Kula

Synonyms: 151

Sringaver Gulma moola Katubhadra Moolajam Ardrika Kandalam Anupajam

Chemical composition : 152

Volatile oil, starch, fat, protein, fibre, inorganic, material, residual

moisture, an acrid resinous matter phenolic kentones of oleoresins.

Parts used : Rhizome

Dosage : Ardraka Swarasa 5-10 ml

Pharmacological Properties: 153

Rasa : Katu

Guna : Guru, Rooksha, Teekshna

Veerya : Ushna

Vipaka : Katu

Doshagnata : Kaphavata Shamaka

Action : Agnideepaka, Ruchya, Jihwa kantha vishodhaka, Kasa Swasahara

Uses : It is useful in Agnimandya, Swasa, Kasa, Jalodara, Sheeta pitta etc.,

Drug Review - 29


Table No. 14 showing Pharamacological Properties of Ingredients of

Kaphaketurasa

Ingredient Rasa Guna Veerya Vipaka Doshaghnata Karma

Tankana Katu Rooksha,

Teekshna

Ushna Katu Vatakaphahara Jwarahara,

Depana,

Stavaravishnapaha,

Ruchya

Shankha Katu Laghu,

Hima

Anushna Pittahara Vilekhana, Grahi,

Depana, Balya

Pippali Katu Laghu,

Snigdha,

Teekshna

Ushna Madhura Vatakaphahara Deepana,

Rasayana, Vrishya

Vatsanabha Madhura Laghu,

Rooksha,

Teekshna,

Vyavayi,

Vikashi

Ushna Madhura Vatakaphahara Rasayana,

Madakari,

Swedajanana,

Grahi, Balya.

Ardraka Katu Rooksha,

Guru

Ushna Madhura Vatakapahara Deepana, Pachana,

Anulomana,

Amadoshahara

Drug Review - 30


JAMBEERA

Family : Rutaceae

Latin : Citrus limon

Synonyms : Danta Shata, Jambala, Jamba.

Habit : Northern India, cultivated in countries like Inida, spain, Italy, Australia

California etc.,

Macroscopic character: 154

Colour : Fresh outer surface, bright green yellow, internally white.

Dried : Outer surface is yellow and inner surface pithy white.

Odour : Strong, fragnant, aromatic and Characteristic.

Taste : Aromatic, bitter.

Chemical constituents :

Volatile oil, hesperiden, pectin, calcium oxalate and bitter substances,

Limonene, citral, geranyl acetate and terpineol.


Rasa : Amla

Guna : Guru, Teekshna

Veerya : Ushna

Vipaka : Amla

Doshagnata : Vatashlesma Shamaka

Uses : Kasa, Hritpida, Shoola, Chardi, Trishna, Ashyavairashya,

Agnimandya, Krimgna, Swasa. It is a carminative and stimulant

and oil is used as perfuming and flavouring agent.

Drug Review - 31


KUMARI

Family : Lilliaceae

Latin : Aloe vera

Synonyms :

Picha sambhruta Kshara boodesh

Bala Vishala

Habit : North Africa, India, China.

Chemical constituents: 156

Crystals of Aloin glueosides present in Aloe vera are the active principles.

Other than this it contains volatile oil and resin.


Rasa : Katu

Guna : Guru, Snigdha, Picchila

Veerya : Sheeta

Vipaka : Tikta

Doshagnata : Kaphapittahara

Uses : Gulma, Pliha, Kaphajwara, Visphota, Vishahara, Kustagna, Swasa,

Pittaja kasa. Aloe is used as a purgative effect is mainly on colon.

Drug Review - 32


GOMUTRA

Gomutra is used as medicine since good old days. Acharyas have prescribed

the treatment for various diseases, by the use of cow’s urine. Charaka has prescribed

Gomutra in Katuskanda in Charaka chikitsasthana158 and sustruta shirovireechana

adhyaya. 159

Urine of animals like, Sheep, Goat, Cow, Buffalow, Elephant, Camel, Horse,

Ass, Ox, and Human are used as medicine. In these cows urine contains ammonia in

concentrated form, is frequently used for purification of drugs and minerals.

Sanskrit : Mutra

Hindi : Pesab

English : Urine.

Synonyms : Gomutra, Gojala, Goambu, Godrava160.

Pharmacological Properties:

Rasa : Katu, Tikta, Kashaya, Madhura, Lavana.

Guna : Teekshna, Ushna, Laghu

Veerya : Ushna

Vipaka : Katu

Doshagnata : Kaphavata shamaka, pitta prakopa

Uses : Internally as laxative, diuretic, and used in the preparations of

various medicines like Punarnava mandura, Marichadi tail etc., it is

also recommended by Chakradatta as a vechicle for castor oil given

as purgative. 161

Drug Review - 33


MADHU

Synonyms :

Madhu Makshika vanta Maakshika Varativanta Kshaudra Bhringavanta Saaraga Pushparasodhbhava

Varieties : 162

Habitat :

Maakshika Chaatra Bhramara Ardya Kshaudra Aouddhalaka Pautika Daala

Some dwell in forests and build their home (hive) attached to the branches of

tall trees, some build them inside the crevices of the trees.

Composition : 163

Dextrose, Levulose, Wax, volatile oils, proteids, mucilage, colouring matter,

formic acid, some other substances contained are pollen dust, ethesealoil, various

phosphates, lime, Iron etc.,


Rasa : Madhura, Kashaya

Guna : Laghu, Rooksha, Sookshma

Veerya : Sheeta

Vipaka : Katu, Madhura

Doshaghnata : Kaphapitta Shamaka

Action : Yogavahi, Chakshushya, Deepaka, Swarya, Krimighna,

Vranashodhaka, Vranaropaka and Vatakara.

Uses : It is useful in Raktapitta, Kasa, Swasa, Prameha, Krimi, Kusta,

Arsha, Atisara, and also as anupana in many diseases.

Drug Review - 34


PRANAVAHA SROTAS

Kaphaja kasa is a disease of Pranava srotas. Therefore detailed anatomy and

physiology of Pranavha srotas is essential to know the disease in detail. The word

‘prana is derived from Sanskrit root ‘An’ with a prefix ‘pran’ means to breath, to live.

Chakrapani had clearly stated that this srotas is related to a special “Vayu” called

prana”. The word ‘Prana’ of Pranavata srotas should not be misunderstood as

pranavata one of the five subdivisions of vata. The act of respiration is one of the

function of Pranavata but the function of pranvaha srotas is only respiration.

According to Charaka the moola of Pranvaha srotas is hridaya and maha

srotas165. Based on the explaination of Chakarapani the Pranavaha srotas is concerned

with the visishta vayu known as prana, the puppusa have to be accepted as the moola

of this srotas. The Mahasrotas associated with puppusa is the trachea, its two

branches, bronchi further branching to bronchioles. All these structures participate in

the act of respiration. The reference from Charaka samhita seen to indicated only the

external respiration comprising of inspiration & expiration with the absorbtion of

visishta pranavayu and removal of the carbon dioxide from the body as whole. Due to

dhatukshaya, vegasandharana, raukshya, vyayaama, kshudita causes the dushti of

pranavaha srotas.

Pranavaha srotodusthi lakshanas:- The Pranavaha srotodusthi lakshanas indicates

the changes in the respiration. They are Atisrishtam, Atibaddam, Kupitam, Alpalpam,

Abhikshanam, Sashabdam, Sashoola166. Injury to Pranavaha Srotas produces the

symptoms like Akroshana, Vinamana, Mohana, Bhramana, Vepana and Maranam.

Kasa is a symptom in almost all diseases caused by the vitiation of Pranavaha srotas.

Kasaroga, Swasaroga, Hikkaroga & Rajayakshma are the diseases caused by the

vitiation of the Pranavaha srotas.

Disease Review - 35


HISTORICAL REVIEW

Description of Kasa in different eras:

It would be quite judicious to review the reference of Kasa which is available

from vedic period to modern period167.

VEDA KALA:

Kasa has been mentioned as a disease in Atharvana veda where in, the

synonyms and management have been described. There are some Mantras (Hymns)

to be recited to get rid of the disease Kasa. Earlier to this, in Rigveda there are few

references are available for Kasa and its management.

PURANA KALA:

Garuda purana - contains detailed reference of Abhrata Kasa, Vatasa Kasa

and Sumna Kasa & its management.

SAMHITA KALA:

We get an elaborate description of the disease, symptoms, its etiology,

pathogenesis, complications and its treatment in different samhitas.

The detailed description of Kasa is seen in Charaka samhita, where in its

bhedas, description of individual nidana of five varieties of Kasa, Samprapti,

Lakshanas, Sadhyasadhyata and Chikitsa have been mentioned. Chakrapani datta, a

renowned commentator of Charaka Samhita has commented on the description of

kasa169.

Sushruta mentioned Kasa not only as a disease entity, but also as symptom.He

also explained its Bhedas, individual Lakshanas, Samprapti and Chikitsa169.

The Kasa has been classified into eight varieties along with detailed

description of the disease & treatment aspect by Hareeta170. Reference of Kasa is also

Disease Review - 36


found in Kashyapa samhita in the context of Urhogata roga as one of its

complication171.

MADYAMA KALA

Vriddha vagbhata in 400 AD, given detailed description of Kasa its Nidana,

Bheda, Samprapti, Lakshana, Sadhyasadhyata and Chikitsa172

Arunadatta and Indu the commentators of Ashtanga Hridaya and Ashtanga

Sangraha has commented on Kasa173.

In 800AD Madhavakara has described the nidana aspect of Kasa in his treatise

Madhavanidana. Vijayarakshita and Shri Kanthadatta have commented on it174.

Description of Kasa is also found in Gadanigraha175, Rajanighantu176,.

Sharangadhara (14th Century A. D.)177 Bhava mishra (15th Century A. D.)178 has also

described Kasa and its management. Numerous references can be seen in

Yogaratnakar 179 , Rasaratna samucchaya180 etc.

ADHUNIKA KALA

Description of Kasa, its line of treatment with therapeutic measures to control

Kasa, important yogas for Kaphaja Kasa are explained in Yogaratnakar, Bhaishajya

Ratnawali 181 in 19th century. Almost all the 20th century authors like vaidya Yadavaji

Trikamji, Acharya Vidhyadhara shukla, Shivacharana Dhyani, Kaviraja Ramaraksha

Pathak have described the disease kasa under the heading of Pranavaha srotodhusti

vikara.

UTPATTI, PARIBHASHA & PARYAYA

In ayurveda Kasa is explained as a separate disease entity with the explanation

of specific nidana panchaka and treatment. The Kasa which is produced by

predominantly vitiated Kapha is called as Kaphaja Kasa.

Disease Review - 37


UTPATTI:

Kaphaja Kasa consists of two words “Kapha” and “Kasa”. The word Kapha is

derived from the root Ke, meaning Shirasi Kena Jalena va palathi, that which is

produced in the Shiras and nourished by jala182.

The Synonym Shleshma which is used frequently, as the term Kapha, is

derived from the root “Shlish alingane” meaning of Shlish being to embrace or to

keep together183.

Three derivations are available for the word Kasa in “Shabda anushasana of

Panini”.

1. One more derivation of the term Kasa is from the root Kasi, which means gati

and shasanayoti. The meaning of two words being movement and

punishment184.

2. Second derivation is from the root Kas, the meaning of Kas is gatou,

movement. Commentator Chakrapani derived the word Kasa from the root

kas and meaning of Kas is gati Shatanayoti, means falling movement185.

3. The word Kasa is masculine gender and taken from the root Kasri, meaning

“Shabda Katsanyam” i.e., “unpleasant sound”.

Commentator Gangadhara used Kasri dhatu for derivation of Kasa. Meaning

of it is kushabda, bhinna swara, broken sound186.

NIRUKTI:

The term kapha has been defined as “Kena jalena phalathi ithi kapha”. That is

to say Kapha is the product of water187.

Charaka has defined kasa as “Shushka va sa kapho va kasanath kasaha” means

release of obstructed vayu resulting in the production of abnormal sound in the

process which may be productive or dry188.

Disease Review - 38


Sushruta defines kasa as “it is the disease associated with a typical sound that

of sound obtained from broken bronze vessel” 189. Dalhana commented over this as

while expelling of dusta prana vayu it makes sound ‘saghosha’ called as kasa190.

In Madhukosa commentary kasa is defined as “Kasati shirokanthat urdhva

gachati vyariti” means in which upward movement of vayu even above kantha and

shira pradesha191.

Definition of Cough:

• A sudden explosive forcing of air through the glottis by an effect to expel

mucous or the forigen matter from the bronchial tubes or larynx.

• To free air through the glottis by series of expiratory efforts.

PARYAYAS :

Paryaya of kasa mentioned in Atharnava veda are Kasaha,Kasa & Kasika

Kasika - means it is a roga vishesha, which produces a peculiar sound i.e. kas

shabda192.

BHEDAS :

Starting from “Garuda purana”, all Acharyas of Brihatrayees,Laghutrayees,

Yogaratnakara, Gadanigraha & Bhelasamhita opined that there are only five types of

kasa as

1. Vataja Kasa 2. Pittaja Kasa 3. Kaphaja Kasa

4. Kshataja Kasa 5. Kshayaja Kasa

Depending upon the nature of kasa it can be classified into two important

varieties193

1. Ardra kasa (Kaphaja Kasa).

2. Shushka kasa (Vataja kasa)

Disease Review - 39


Flow Char No. 1 illustrating the classification of Kasa according to different

factors

KASA BHEDA

According to According to According to According to Karma Bheda Dosha Bheda Nature of Kasa sadhyasadhyata

Nija Agunthaja Shushka Ardra Sadhya Asadhya

According to different Acharyas According to Hareeta197

Vataja Kasa194 195 196 Vataja Kasa

Pittaja Kasa Pittaja Kasa

Kaphaja Kasa Kaphaja Kasa

Kshayaja kasa Vatapittaja Kasa

Kshataja kasa Shleshma pittaja Kasa

Raktaja Kasa

Kshayaja Kasa

Disease Review - 40


NIDANA

Kasa is the most commonest disease of Pranavaha srotodushti vikara. Nidana

for manifestation of Kasa is categorized broadly into two main divisions.

1. General causative factor (samanya nidana)

2. Specific causative factor (vishesha nidana)

General etiological factors are responsible for the manifestation of all varieties

of the Kasa where as specific etiological factors are responsible for the specific

variety of Kasa.

Acharya Charaka is the only author who has mentioned separate etiological

factors for different varities of Kasa. Rest of the authors viz . Sushruta, Vagbhata,

Bhavamishra, Madhavakara, Yogaratnakara have explained general nidana for all

varieties of kasa .

For better understanding nidanas of Kasa, can be broadly classified into two

groups.

Aharaja nidana

Rooksha ahara sevana Atikashaya rasa aharasevana

Atisheethahara sevana Alpa Ahara sevana

Katu, Ushna Amla ahara atisevana. Guru, snigdha, madhura ahara atisevana

Bhojyanam Vimargagamana

Viharaja nidana

Dhooma sevana Atisamsarga of surya & agni

Raja Sevana Diva swapna

Shrama Alpa cheshtana

Vegavarodha Vega udeerna

Ratrijagarana

Disease Review - 41


Kaphaja kasa vishesha nidana:

The Nidanas like Guru, Abhishyandi, Madhura, Picchila, Snigdha ahara

sevana, Ratrijagarana, Diwaswapna, Himasnana and Madyapana198

Table No. 15 Showing the Samanya nidana of Kasa199 200 201 202 203

Nidana S.S B.P M.N Y.R G.NDhumopaghatha + + + + + Raja sevana + + + + + Shrama + + + + + Bhojanasya vimargagamana + + + + + Vegavarodha + + + + + Hasya, Prahasya - - - - - Anila Sannirodha - - - - - Vega Udeerana - - - - - Ratri Jagarana - - - - - Diva Swapna - - - - - Dhatukshayakaraka nidana - - - - - Avarana - - - - - Rukshanna Shevana + + + + + Atiushna guru ahar sevana - - - - - Asatmya, Katu, Amla, Lavana, Sheeta Snigdha, Utkledi ahara sevana

- - - - -

Following are the commentaries available for Nidana

Dhumopagata- the smoke which causes damage on entering nose & mouth

Rajasevana – The dust which enters nose & mouth.

Bhojana vimargagamana- when the food is consumed hastly followed by fast and

forceful diglutation causes vimarga gamana of bhojana.

Utkledi – The kledatwa produced in Rakta and Mamsa.

Disease Review - 42


POORVA ROOPA:

As no specific poorva roopa are mentioned, general Poorva roopas

explained in the context of Kasa can be considered.

They are as follows:

1. Shuka purnagala

2. Kanthe Kandu

3. Bhojyanama avarodha

4. Aruchi

Apart from these Sushruta has mentioned few more poorva roopas like

Swashabdha vaishamya, Agnisada, Gala talu lepa.

Table No. 16 showing the Poorvaroopa of kasa204 205 206 207 208 209 210

Poorvaroopa C. S. S. S. A. S. A. H. M. N. B. P. G. N.

Shukapurna gala + - + + + + +

Shukapurna asya + - - - + + +

Kanthe kandu + + + + + + +

Bhojyanam

avarodha

+ + - - + + +

Galatalu lepa - + - - + - -

Arochaka - + + + + - -

Agnisada - + - - + - -

Hridaya aswasthata - - + - - - -

Asya vairasya - - + - - - -

Disease Review - 43


ROOPA

Roopa is the stage of pathogenesis where in manifestation of the symptoms are

produced due to dosha dushya sammurchana that is vyaktavastha.

Table No. 17 Roopa of Kaphaja kasa according to different Acharyas 211 212 213 214 215 216 217

Roopa C.S S.S A.S A.H M.N B.P G.N

Buhula, Madhura, Snigdha, Ghana + - - - - - -

Sandra - + - - + + +

Bahula, Ghana, Snigdha Sweta - - + + - - -

Ghana, bahula - - - - - - -

Grathita - - - - - - -

Kapha poorna deha

Uraha vankshana sampoornmiva + - - - - - -

Rasamano hi ruk vaksha + - - - - - -

Uro alpa rujatwa - - + - - - -

Hridaya stimita - - + - - - -

Swara bheda - - - - - - -

Pinasa + - + - - - -

Utklesha + - - - - - -

Chardi + - + - - - -

Aruchi + + + - + - +

Ashya madhuryatha + - - - - - -

Shira shoola - + - - + - +

Mandagni + - - - - - -

Gourava + + + - + - +

Jadhyata - - - - - - -

Angasada - + - - - - -

Romaharsha + - + - - - -

Mukhalepa - + - - - - -

Kanthe kandu - - - - - - +

Disease Review - 44


Flow Chart No. 2 Showing the samprapti of kaphajakasa218

Khavaigunya

Utpadaka Nidana Nidanarthakara

roga Kapha prakopaka

nidana

Khavaigunya

Kapha Vriddhi

Amarasa

Agnimandya

Prakupita kapha Dusta rasadhatu

Malarupi kapha vriddhi

Sanga

Vata avarodha

Vata prakopaka karana

Vata vimarga gamana

Kaphaja kasa

Disease Review - 45


SAMPRAPTI GHATAKA:

The importance of the knowledge of the pathogenic process is to break the

sammurchana of dosha and dushya. Along with dosha and dushya rest of the

samprapti ghataka’s like agni, ama, srotas etc., also having role in the manifestation

and progress of the disease. For the break down of the samprapti, a clear knowledge

about the various ghatakas are important. The samprapti ghataka of kaphaja kasa are

as follows

Dosha - Kapha, vata

Dushya - Rasa

Agni - Jatharagni mandya,

- Rasadhatwagni mandya

Ama - Jatharagni mandhya janya

Udbhavasthana - Amashaya

Sancharasthana - Rasayani

Adhishtana - Uras

Srotas - Pranavaha, Rasavaha

Dustiprakara - Sanga

Vyadhi marga - Abhyantara

Disease Review - 46


Table No. 18 showing interrelation between Lakshanas and Dosha, Vikalpa,

Dushya, Srotas and Sthana in Kaphaja Kasa.

Lakshanas Dosha Vikalpa Dushya Srotas Sthana

1 Kapha stivana K Drv R P Uras

2 Kasamano hi ruk vaksha V Kar R P Uras

3 Uro alpa rujathwam V Kar R P Uras

4 Hridaya stimita K Sheeta G R P Uras

5 Uraha vankshana

sampoorn miva

K Kar R P Uras

6 Kanthe kandu K Kar R P Uras

7 Swara bheda K Drv R R Kanta

8 Peenasa K Drv R P Nasa

9 Mukhalepa K Picchila G R A Mukha

10 Utklesha K Kar R A Amashaya

11 Chardi K Drv R A Amashaya

12 Ashyamadhurya K Drv R A Mukha

13 Shirashula V Kar R A Shiras

14 Mandagni K Manda G R A Amashaya

15 Gourav K Guru G R R Sarvasharira

16 Angasada V Manda G R R Sarvasharira

17 Romaharsha V Sheeta G R R Sarvasharira

18 Kledata K Snigdha G R R Sarvasharira

Note :

V = Vata K = Kapha R = Rasa,

P = Pranavaha A = Annavaha Drv = Dravyataha

Kar = Karmataha G = Gunataha

Disease Review - 47


UPASHAYA AND ANUPASHAYA:

In classics there is no direct reference about Upashaya and Anupashaya of

kaphaja kasa. Acharya Charaka had mentioned the drugs which are having Katu,

Ruksha and Ushna quality and Kaphahara properties to be admistered in kaphaja kasa.

In Kaphaja kasa if pitta dosha is associated then tikta rasa drayas will act as Upashaya

219.

The substances which are having Guru, Snigdha, Abhishandhi and Madhura

rasa act as Anupashaya. Diva swapana also act as Anupashaya.

UPADRAVA:

According to Charaka if Kaphaja Kasa is associated with pitta dosha, then

Tamakaswasa would occur220.

Upadravas are the complications produced at the end stage of diseases. For

Kaphaja kasa no specific upadravas have been explained in classics. In Ashtanga

hridaya221, Yogaratnakara222 and Bhavaprakasha223, general Upadravas for Kasa roga

has been explained i.e if Kasa is neglected then it gives rise to Shwasa, Kshaya,

Jwara,Chardi, Arochaka,Swarabheda,Peenasa, Yakshma like disorders. So it should

never be neglected and should be treated at an earliest.

SADHYASADHYATA:

Most of the authors of Ayurveda have described the Sadhyasadhyata of kasa

according to the variety, chronicity of disease, age and strength of the patient.

According to Acharya Charaka224 and Vagbhata225, the kasa that is manifested

by single dosha is sadhya. The kasa if it is manifested due to involvement of two or

more doshas, kshataja, kshayaja Kasa and all varities of Kasa in an aged person are

yapya.

Disease Review - 48


According to Yogaratnakara226 any variety of Kasa which is recently

manifested is sadhya, only when chikista chatushpada holds good. If patient

expectorate puyayukta, aruna, shyava, harita, peeta, neela coloured sputum and

associated with complications like Shwasa, Kshaya, Vamana and Swarabanga then

such Kasa is said to be incurable.

ARISHTA LAKSHANA:227

When Kasa patient spits large quantity of Kapha, having the colour of blue,

yellow or red, suggests the definite sign of death.

If kasa patient is with mamsakshina, balakshina and if he develops

romaharsha, shotha, sandramutrata and jwara is asadhya, and ends in death. 228

In a Kasarogi, where extreme dhatukshaya and Balakshaya are seen and if this

patient gets temptation during noon hours and along with this, if dreadful

cough is present then it is an arishta lakshana.

A persistent vomiting in a kasarogi is a definite sign of death.

If Kasarogi develops Atisara, Jwara, Hikka, Chardi and Shotha in medra and

vrushana, then patient is sure to die.

A person suffering from kasa, when exhibits associated diseases like Jwara,

Vamana, Trishna, Atisara and Shopha, then it is definite sign of death.

When Kasarogi exhibits the prodromal symptoms like Koshta shula, Hikka

and Chardi the death is sure.

Disease Review - 49


VYAVACHEDAKA NIDANA:229

Before confirming the diagnosis of Kaphaja kasa it has to be differentiated

from other diseases which mimic some specific symptoms of Kaphaja kasa. Kasa

associated with kapha shteevana is presenting symptom of Kaphaja kasa, which is

also seen in other disorders like Vataja kasa, Pittaja kasa, Kshataja kasa, Kshayaja

kasa and Rajayakshma. So it is necessary to differentiate kaphaja kasa from the above

said disorders.

Vataja Kasa:

The cardinal feature of Vataja kasa is dry cough. But in some condition

patient expectorates small quantity of sputum with difficulty. Along with this

Urashoola, Parshva shoola, Mukha shuskata are present. These symptoms are absent

in Kaphaja kasa, so it can be ruled out.

Pittaja Kasa :

The cardinal feature of Pittaja kasa is peeta kaphashteevanayukta kasa. Jwara

is another important lakshana. Along with these pitta vriddhi lakshanas like Trishna,

Daha, Urodhoomayana are present. In kaphaja kasa these symptoms are absent so it

can be ruled out.

Kshatasa kasa:

The cardinal feature of Kshataja kasa is shonitayukta kaphastheevana.

Urahashoola is the another important symptom. The nature of pain is pricking type,

tenderness in Uras, Jwara, Shwasa and Paaraavata eva kujana are associated

symptoms. As these symptoms are absent in kaphaja kasa. So differentiated.

Disease Review - 50


Kshayaja Kasa:

The cardinal feature of Kshayaja Kasa is durghanda, harita, rakta and puyaukta

kaphashteevana. The patient is Krisha and is associated with Jwara, Urahashula,

Irregular bowel habits. So the absence of these symptoms in Kaphaja kasa, rules out

the disease.

Rajayakshma230:

The nature of shteevana in Rajayakshma is Picchila, Bahula and colour is

harita, sweta or peeta. The samanya lakshana of Rajayakshma are Amsaparshwa

abhitapa, Karapada santapa and Jwara, which are not present in Kaphaja kasa. So

differentiated.

CHIKITSA:231, 232

Following are the principles treatment of Kaphaja Rasa :

If the person is strong, Vamana is the first line of treatment. After that, the

drugs which are having katu, ruksha, ushna and kaphakara properties to be

administered, yavanna is diet in such patients.

Depending upon the condition Vamana, Virechana, Shirovirechana,

Vairechanika dhumapana and Kavalagraha are the line of treatment.The drugs

which are having Katu and Kaphahara properties which especially make

vishoshana of kapha are useful. Commenting on this Dalhana has explained

that the drugs which are laghu, ruksha and bhojana in little quantity act as

vishoshana.

Acharya Charaka explains Virukshana is the main principle in Ardra kasa.

According to Yogaratnakara, Vamana and Langhana are the two main

principles of treatment of Kaphaja kasa. After that, yusha prepared with yava

and katu tikta dravya is to be administered.

Disease Review - 51


PATHYA AND APATHYA:233, 234

Treatment procedure for any disease without the diet will not be complete.

The diet and drugs, which are favourable to the body and mind and do not produce

any adverse effects are considered as Pathya and opposite to it are Apathya.

In Brihatrayee there is no direct references about Pathya and Apathya. There

is direct mentioning of Pathya and Apathya in Yogaratnakara and in Bhaishajya

ratnavali.

PATHYA:

Ahara Suka danya varga - Shastikashali, Yava, Laja ,Godhuma Shamidhanya varga - Mudga,Kulatha Masha Mamsarasa varga - Gramya mamsa,Jangala mamsa. Gorasa varga - Ksheera, Gritha,Takra Jalavarga - Ushnajala Phalavarga - Bimbi ,Bijapura Madhu varga - Madhu Ikshu varga - Guda padartha Taila varga - Tila taila, sarshapataila,Bilvataila Sthavara varga - Jivanthi ,Gostani, Maricha, Shunti, Mulaka

Balamula, Kasamarda, Yusha with Kulatha and Mulaka, Laghu anna

APATHYA:

Ahara

Rasa : Madhura rasa

Guna : Snigdha, Guru,Pichila

Anna : Pistanna ,Payasa

Vihara : Maithuna,Dhumasevana.

Disease Review - 52


ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM 235

Structures of the respiratory system:

Respiratory organs include the nose, pharynx, trachea, bronchi and lungs.

They act with cardiovascular system to supply oxygen (O2) and remove carbon

dioxide (CO2) from the blood.

Nose : The external portion of the nose is made of cartilage and skin and is lined with

mucous membrane. Openings to the exterior are the external nares. The internal

portion of the nose communicates with the Paranasal sinuses and Nasopharynx

through the internal nares. The nasal cavity is divided by septum. The anterior

portion of the cavity is called the vestibule. The nose warms, moistens and filters air

and function in olfaction and speech.

Pharynx : The pharynx is a muscular tube lined by a mucous membrane. The

anatomic regions are the Nasopharynx, Oropharynx and Laryngeopharynx. The

Nasopharynx functions in respiration. The Oropharynx and Laryngeopharynx

function both in digestion and respiration.

Larynx : The Larynx (voice box) is a passage that connects the Pharynx with the

Trachea. It contains the thyroid cartilage (Adam’s apple), the epiglottis, which

prevents food from entering the Larynx; the cricoid cartilage, which connects the

Larynx and Trachea and the paired Arytenoids, Corniculate and Cuneiform cartilages.

The Larynx contains vocal folds, which produce sound as they vibrate.

Trachea : The Trachea (wind pipe) extends from the Larynx to the primary Bronchi.

It is composed of C- Shaped rings of cartilage and smooth muscle and is lined with

pseudostratified ciliated epithilium. Two methods of obstruction in the airways are

tracheotomy and intubation.

Disease Review - 53


Bronchi : The Bronchial tree consists of the Trachea, Primary Bronchi, Secondary

bronchi, Tertiary bronchi, Bronchioles and Terminal Bronchioles. Walls of bronchi

contain rings of cartilage. Walls of bronchioles contain plates of decreasing cartilage

and increasing smooth musles.

Lungs : Lungs are paired organs in the thoracic cavity. The pleural membrance

encloses them. The parietal pleura is the superficial layer that covers the thoracic

cavity of the lungs. The visceral pleura is the deep layer that covers the lungs. The

right lung has three lobes separated by two fissures and depression, the cardiac notch

secondary branch supply segments of lung tissue called brancho pulmonary segments.

Each broncho pulmonary segment consists of lobules, which contain

lymphatics, arterioles, venules, terminal bronchioles, respiratory bronchioles, alveolar

ducts, alveolar sacs and alveoli. Alveolar walls consist of type I alveolar cells type II

alveolar cells and alveloar macrophages. Gas exchanges occurs across the alveolar –

capillary (respiratory) membrance.

Pulmonary ventilation

Pulmonary ventilation, or breathing, consists of inspiration and expiration.

The movement of air into and out of the lungs depends on pressure changes governed

in part by Boyle’s law, which states that the volume of a gas varies inversely with

pressure, assuming that temperature is constant. Inspiration occurs when alveolar

pressure falls below atmospheric pressure. Contraction of the diaphragm and external

intercostals muscles increases the size of the thorax. Thus decreasing then

intrapleural pressure so that the lungs expand. Expansion of the lungs decreases

alveolar pressure so that air moves along the pressure gradient from the atmosphere

into the lungs. During forced inspiration, accessory muscles of inspiration are also

used.

Disease Review - 54


Expiration occurs when alveolar pressure is higher than atmospheric pressure.

Relaxation of the diaphragm and external intercostals muscles results in elastic recoil

of the chest wall and lungs. Which increases intrapleural pressure. Lung volume

decreases, and alveolar pressure increase. So that air moves from the lungs to the

atmosphere. Forced expiration employs contraction of the internal intercostals and

abdominal muscles. Normal quiet breathing is termed as “Euponea”. Other patterns

are costal breathing and diaphragmatic breathing. Modified respiratory movements

such as coughing, sneezing, singing, yawning, crying, laughing and hiccough are used

to express emotions and to clear the airways.

EXCHANGE OF OXYGEN AND CARBON DIOXIDE

External respiration and internal respiration:

In internal and external respiration, O2 and CO2 diffuse from areas of their

higher partial pressures. External (pulmonary) respiration is the exchange of gases

between alveoli and pulmonary blood capillaries. It depends on partial pressure

differences, a large surface area for gas exchange and a small membrane and the rate

of airflow into and out of the lungs. Internal (tissue) respiration is the exchange of

gases between tissue blood capillaries and tissue cells.

Control of respiration: The respiratory centre consists of medullary rhythmicity

area, pneumotaxic area, and aphneustic area. The inspiratory area has an intrinsic

excitability (auto rhythimicity) that sets the basic rhythm of respiration. The

pneuotaxic and apneustic areas coordinate the transition between inspiration and

expiration. Respiration may be modified by a number of factors, including cortical

influences; the inflation reflex, chemical stimuli, such as O2 and CO2 and H+ levels,

neural changes due to movement blood pressure changes, the limbic system

temperature, pain and irritatin to the airways.

Disease Review - 55


CHRONIC BRONCHITIS 236

Chronic bronchitis is a clinical disorder charecterised by productive cough due

to excessive mucus secretion in the bronchial treenot caused by local

bronchopulmonary disease on most of the days for atleast three months of the year,

for atleast two consecutive years. Both sexes and all ages may be affected but it is

most frequent in middle aged men.

EPIDEMIOLOGY237

Chronic bronchitis is a common Respiratory disease. These has been

increasing evidence in recent years of a relatively high prevalence in developing

countries. Prevalence rates for Chronic bronchitis in the age group 40 – 64 yrs in men

was 17% and in women 8%.

Chronic bronchitis is the fourth leading cause of death in the United States and

is the only one of the 10 leading causes of death for which mortalility rate is still

raising.

Mortality rate is much higher in males than females, and increase with

increasing urbanization. The highest mortality is in the winter. Cigarette smoking is

the most important factor associated with the occurrence of mucous hyperscerection

and air flow obstructive diseases.

Patients with Bronchitis are more likely to have a family history of chest

diseases and the hereditary tendency being stronger in female than in male patients.

There is higher prevalence of Chronic bronchitis among persons with a lower

socioeconomic status and in those with a history of low birth weight.

Disease Review - 56


AETIOLOGY238

Chronic bronchitis develops in response to the long continued action of

various types of irritants on the bronchial mucosa. The most important of these is

tobacco smoking, but others include dust, smoke and fumes occurring as specific

occupational hazards or as part of a general atmospheric pollution in industrial cities

and towns. Infection is sometimes a precipitating factor in the onset of Chronic

bronchitis but its role is in aggravating the established condition.

Smoking:

Smoking is the most common single factor leading to Chronic bronchitis.

Cigarette smokers have about 10 times risk than non smokers, of dying from Chronic

bronchitis. It has been predominantly related to the inhalation of tobacco smoke and is

more prevalent among chain smokers

Air pollution:

Air pollution may be domestic, urban or occupational. In comparing with

smoking, urban air pollution is less harmful, Dust exposure at work has been

considered as an important etilogical factor of respiratory diseases. Exposure to dust

of vegetable origin appears more likely to cause Chronic bronchitis than exposure to

most mineral dusts.

Infection :

Most of the times viral infection is responsible for exacerbation of Chronic

bronchitis. The frequency of lower respiratory tract infection is much higher in a

person who is recurrently suffering from cold.

Disease Review - 57


Hereditary:

Recent studies have shown that relatives of Chronic bronchitis subjects have a

higher prevalence of Bronchitis. But the underlying defect that constitutes genetic

predisposing is unknown.

Excerbation:

Patients with Chronic bronchitis often relate excerbations of their disease to

climatic factors. Particularly extreme varitations in humidity and temperature.

PATHOGENESIS239

The aetiological factors induce some pathological conditions in the

trachiobronchial tree. There are two sets of factors which are important in the genesis

of Chronic bronchitis.

1. Chronic irritation by inhaled substances.

2. Microbiologic infections.

Cigarette smoking remains the paramount influence over Chronic bronchitis.

The hallmark and earliest feature of Chronic bronchitis is hyperserection of

mucus, which starts in the large airways and is associated with hypertrophy of

the submucosal glands in the trachea and bronchi. These changes contributes

excessive mucus production but not to airway obstruction.

If Chronic bronchitis persists there is also an increase in the number of goblet

cells in the surface epithelium of large bronchi and a marked increase in goblet

cells of small bronchi and bronchioles. It is this excessive mucus production

by goblet cells in small airways that contributes to airway obstruction.

It is thus possible that airway irritants cause mucus hypersecretion by

stimulation of neurohormonal pathways.

Disease Review - 58


The alterations in the small airways of the lung (small bronchi and

bronchioles, less than 2 to 3 mm in diameter) are the physiologically important

and perhaps earliest manifestations of chronic airway obstruction.

Histological studies in the lungs of smokers disclose goblet cell metaplasia

with mucous plugging of bronchiolar lumen, clustering of pigmented alveolar

macrophages, inflammatory infiltration and fibrosis of the bronchiolar wall.

The role of infection appears to be secondary. cigarette smoke probably

predisposes to infection in more than one way,.It interfere with ciliary action

of the respiratory epithelium, may cause direct damage to airway epithelium

and inhibits the ability of bronchial and alvealor leukocytes to clear

bacteria.Virus can also cause exacerbations of Chronic bronchitis.

CLINICAL FEATURES240

The main symptoms of Chronic bronchitis are cough, expectoration and

dyspnoea

Symptoms of Chronic bronchitis:

Cough : Constant or paroxysmal, worse in winter or on exposure to cold

winds or sudden change in temperature.

Expectoration : Variable, may be little, thin and mucoid or thick or frothy, mucoid

and sticky. May become mucopurulent during attacks of acute

bronchitis in winter.

Dyspnoea : In advanced cases, breathing becomes quick and wheezing present

even at rest.

Fever : Absent except in acute exacerbation.

Haemoptysis : Ususally in the form of streaks.

Disease Review - 59


Signs of Chronic bronchitis :

Build-Usually short & stocky

Cyanosis rarely with clubbing.

Signs of airway obstruction, prolonged expiration, contraction of

expiratory muscles of respiration, pursing of lips during expiration &

jugular venous distension during expiration due to excessive swings of

intrathoracic pressure.

Widespread rhonchi of variable pitch usually most marked in expiration.

Crepitations at lung bases in patients with excessive bronchial secretions.

Both wheezing and crepitations may be altered in character by coughing.

TREATMENT241

It is found that one clinical form of Chronic bronchitis can transform into

another. Long standing simple Chronic bronchitis convert into Mucopurulent

bronchitis if infection joins.So the treatment of Chronic bronchitis in the early stages

is necessary.

Steps in management:

Smoking cessation

Avoidance of atmospheric pollution

Bronchodilators

Expectorants and mucolytics

Antibiotics and Corticosteroids

COMPLICATIONS242

Preumotharax may occur following a bout of cough.

Respiratory failure and chronic cor-pulmonale are end stage complications.

The incidence of lung cancer is also higher.

Disease Review - 60


Complications are directly connected with infections, Pneumonia,

Bronchiectasis, Bronchospasm and Asthama.

Complications connected with evolution of Bronchitis are Lung emphysema,

diffuse fibrosis, Pulmonary failure and development of right ventricular

failure.

PROGNOSIS:243

Most favourable prognosis is in cases with simple Chronic bronchitis. In rest

of the varieties complete recovery is hardly possible. The least favourable prognosis

is in Obstructive Chronic bronchitis and with complications.

PREVENTION:

Avoidance of smoking, adequate control of atmospheric pollution in industry.

Use of ideal cooking fuel and prompt treatment of recurrent bronchopulmanory

infections help in the prevention of this disease. Even in established cases,

implementation of these measures helps in preventing further deterioration of lung

function.

DIFFERENTIAL DIAGNOSIS:244

Simple and recurrent mucopurulent Chronic bronchitis is by definition, a

diagnosis based on exclusion of other pathologies. In non smokers presenting with

chronic cough, a specific cause can often be identified. So the following possibilities

should be considered.

Pulmonary Tuberculosis

Mucopurulent Chronic bronchitis

Obstructive Chronic bronchitis

Bronchiectasis

Bronchogenic Carcinoma

Disease Review - 61


INVESTIGATIONS:245

During the initial stage of Chronic bronchitis the laboratory and instrumental

findings can be normal. But these findings can become very informative at certain

stages of Chronic bronchitis. They are used to reveal complications, to determine the

activity of inflammation, to differentiate the disease from the other diseases with

similar clinical symptoms.

Sputum examination:

The sputum is usually mucoid and frothy and becomes mucopurulent or

purulent during acute exacerbations. Sputum culture and sensitivity helps in

management.

Blood examinations:

The White cell count may be raised. In the acute phase, indices are

moderately increased and leucocyte counts are moderately high, Eosinophilia is

possible. It usually suggests allergic lesions.

Urine:

Routine urine examinations are also in normal limits.

Chest X-ray:

Most of the cases of Chronic bronchitis are having normal posterior anterior

chest radiograph. In same patients PA view X-ray of the chest shows over inflation

with increased brochiovascular markings, suggestive of thickening of bronchi.

Disease Review - 62


Flow Chart No.3 Showing Pathogenesis of Chronic Bronchitis

Recurrent R. T. I. Smoking Atmospheric

Pullution

Irritation in Bronchial Tree

Stimulation of Secretion

Metaplasia of epithelium

Loss of ciliated epithelium

Retension of secretion (chronic bronchitis)

Serous gland hyperplasia

Infection

Inflammation of mucosa

Inflammation of mucasa

Broncho spasm

Spread of infection to distal bronchi

Collapse of small brochi

Obstruction

Disease Review - 63


Methodology was studied mainly under three headings

I. Pharmaceutical Study

II. Analytical Study

III Clinical Study

I. PHARMACEUTICAL STUDY:

Pharmaceutical study consists of identification, selection, processing of raw

drugs and preparation of Kaphaketu rasa.

Preparation of medicines involves various processes like Shodhana, Marana in

accordance with physical, chemical and pharmacological properties of the drug and its

clinical purpose.

In Rasashastra texts, we get more than one preparation in the name of

Kaphaketu rasa in different contexts, with variation of ingredients. In this particular

study which has been mentioned in the context of Vishopavishadi vijnaniya

chaturvinshastarang of Rasatarangini has been selected.

The following ingredients and equipments are necessary for this study.

Vatsanabha Tankana Shankha

Pippali Ardraka

Equipments like Mortar, Pestle, Ulukalayantra, Spatula, Vessels, Cloth etc.,

Pharmaceutical Study - 64


METHOD OF PREPARATION:

The method of preparation of Kaphaketu rasa is done under these steps.

1 Identification & collection of raw drugs.

2 Tankana Shodhana

3 Shankha Shodhana

4 Shankha Marana

5 Vatsanabha Shodhana

6 Pippali choornikarana

7. Vatsanabha churnikarana

8 Ardraka swarasa

9. Mixing of Ingredients

10. Preparation of Kaphaketu rasa.

Date of commencement of practical : 16/08/2004

Date of completion of practical : 18/09/2004

1. IDENTIFICATION AND COLLECTION OF RAW DRUGS.

The identification and collection of raw drugs are necessary because without

these we can’t assure the quality of formulations. So this section of study deals with

Identification and collection of raw drugs of Kaphaketu rasa.



Date of commencement : 16 /08 /2004

Date of completion :17 / 08/ 2004

The local herbo – mineral drug shop dealer was requested to get the particular

or good quality of raw drugs and those were certified by the concerned departments

with their classical grahya and agrahya lakshanas.

In Ayurveda certain drugs will cause adverse effects or will be with less

therapeutic effect, if administered in impure state. So proper purification is necessary

to combat the probable adverse effects by reducing its toxicity.

2. TANKANA SHODHANA :

Date of commencement : 19/08/2004

Date of completion : 19/08/2004

Reference : Rasatarangini 13 / 77 -78.

Materials: Dravya Mana Tankana 300 gms

Iron pan, Stove, Khalvayantra etc.

Method of purification:

300 gms of ashuddha Tankana was taken in a clean and dry Khalva yantra

and pounded well to prepare fine powder.

Each time about 5 gms of fine powder of Tankana was taken in an iron pan

and fried under mild fire.



Initially it liquefies and on continuous heating it turned into white opaque

substance due to evaporation of water.

The frying was continued until Tankana get completely bloomed and

disappearance of sounds like crepitations.

The product thus obtained was taken out and allowed to cool itself then

powdered and preserved in an air tight glass container.

Observations :

During frying, initially it liquefied and then it produced sounds like

crepitation.

The Tankana after frying become bloomed and turned into white

opaque substance.

The weight of the Tankana was reduced after frying due to evaporation

of water content. i.e reduced to almost half of its initial weight.

Precautions :

To avoid loss wide pan should be used. Each time small quantity of

Tankana powder is used to avoid spilling out of material.

It should be fried under mild fire.

Results :

Table No. 19 Showing quantity of Tankana before and after Shodhana

Dravya Before Shodhana (in gms) After shodhana (in gms) Loss

Tankana 300 170 130



3. SHODHANA OF SHANKHA



Reference : Rasatarangini 12 / 7.

Materials :

Dravya Mana Shankha 210 gms Jambira nimbu swarasa Yathavashyaka

Dolayantra, Stove, Cloth, Iron rod, thread, Ulukala Yantra etc.


The extracted Jambira nimbu swarasa was kept ready.

210 gms of Shankha was taken and made into small pieces.

The pieces of Shankha were tied in cloth and Pottali was prepared.

The Pottali was immersed in Dolayantra with the help of iron rod

containing Jambira nimbu swarasa.

The Dolayantra was subjected for heating on mild fire which was

maintained throughout.

Required amount of Jambira nimbu swarasa was added frequently in

Dolayantra to avoid burning of drug.

The procedure was continued for three hours.

Then Pottali was taken out from Dolayantra and the Shankha pieces were

thoroughly washed with hot water.

The pieces of Shankha were dried well.



Observations:

After few minutes of heating the Jambira nimbu swarasa started to

over flow.

The colour change of the Shankha pieces to white was observed.

Precautions:

The Pottali was immersed in Dolayantra in such a manner that, it should

not touch the patra on any side and whole drug should be in contact with

liquid.

Mild fire was maintained through out.

To avoid overflow of swarasa, small quantity of swarasa was added

frequently.

Results :

Table No. 20 Showing quantity of Shankha before and after Shodhana

Dravya Before Shodhana (in gms)

After Shodhana (in gms) Loss

Shankha 210 200 10

4. MARANA OF SHANKHA



Reference : Rasatarangini 12 / 17 -19.



Materials :

Dravya Mana Shankha 200 gms Kumari Swarasa Yathavashyaka

Khalvayantra, Ulukalayantra, Sharava samputas,Mud, Cloth, etc.,

Method of Marana:

The dried Shodhita Shankha pieces were taken and put into the sharava

and was closed by another Sharava.

Sandhi bandhana was done with the cloth smeared with mud and dried

well.

The pit was digged measuring 30 angulas in length, breadth and height.

700 vanopalas were kept in the pit and sharava samputa was placed over it.

Again 300 vanopalas were kept over the Sharava samputa.

Then subjected to Gaja puta by igniting the fire.

After swanga sheeta the sharava was taken outside and smeared mud was

removed carefully.

Then the pieces of Shankha were powdered well and Kumari Swarasa

bhavana was given and chakrikas were prepared and dried.

Once again these chakrikas were subjected to Gajaputa as explained

above.

As it did not passed Bhasma pareeksha, it was once again subjected to

Gajaputa for the third time, where it attained the Samyak Bhasma laxanas.

Sharavasamputa was removed and chakrikas were powdered well and kept

in air tight container.



Observations :

After first Gajaputa, Shankha pieces colour changed to Gray colour.

After second Gajaputa, Shankha pieces colour changed to Grayish white.

After third Gajaputa, Shankha pieces colour changed to white

Essential Bhasma pareekshas were observed like Rekha purnata,Uttama

etc.after third Gajaputa.

Precautions :

Sandhi bandhana should be done properly.

Chakrikas were prepared and kept in Sharava before subjecting to Gaja

puta.

Gajaputa should be given until it should pass the essential Bhasma

pareeksha.

Results :

Table No. 21 Showing quantity of Shankha Before and After Marana

Before Marana Gaja putas After Marana Loss 200 gms 1st Gaja puta 192 gms 8 gms

2nd Gaja puta 178 gms 14 gms 3rd Gaja puta 160 gms 18 gms

Total weight loss after marana 40 gms



5. VATSANABHA SHODHANA



Reference : Rasa tarangini 24 / 77-78.

Equipments : Ulakalayantra, Vessel, Cloth etc.,

Ingredients and quantity :

Dravya Mana

Vatsanabha 250 gms

Gomootra Yathavashyaka


250 gms of roots of Vatsanabha were taken and made into small pieces

and washed well to remove the impurities (external).

The pieces of Vatsanabha were tied in cloth and Pottali was prepared.

This pottali was kept in a clean wide mouthed vessel. Gomutra was added,

till the Vatsanabha gets completely immersed in it. This vessel is kept

under sunlight whole day.

Next day the previous Gomutra was removed and fresh Gomutra was

added and kept under sunlight. This process was repeated for three days.

Then Vatsanabha pieces were washed with hot water and the outer layer

was removed.

The pieces of Vatsanabha were dried under sunlight.



Observations:

After soaking in Gomutra it became soft and colour of Gomutra changed to

dark brown.

After drying Vatsanabha became black in colour.

The Vatsanabha pieces becomes mrudu after shodhana. Tingling sensation

was not felt after Shodhana. After peeling of outer layer it had pandura varna

inside.

Precautions:

Daily Gomutra should be replaced and fresh Gomutra must be used.

A clean wide mouthed vessel was used to avoid over flow of Gomutra.

Initially pounding should be done slowly to avoid loss of material.

Test for Vatsanabha Shodhana :

It becomes so soft as it can be pierced by a pin. It does not produce tingling or

numbness when kept over the tongue.

Results :

Table No. 22 Showing Qty of Vatsanabha Before and After Shodhana

Dravya Before Shodhana (in gms)

After Shodhana (in gms) Loss Observations

Vatsanabha 250 180 70 Colour-Gray Smell -Gomutra gandha. Touch-Fine Taste-Tikta



6. PIPPALI CHURNIKARANA



Materials :

Dravya Mana Pippali 250 gms

Ulukhala yantra,Cloth. etc

Method of preparation:

The Grahya 250 gms of pippali churnikarana was done in Ulukalayantra and

sieved through cloth and stored in clean air tight bottle.

Observations:

Pippali converts into brown coloured fine powder.

Result :

Table No. 23 Showing Qty of Pippali Before and After Churnikarana

Dravya Before

Churnikarana (in gms)

After Churnikarana

(in gms) Loss Observations

Pippali 250 190 60 Colour-Dark green

Smell -Aromatic.

Touch-Fine

Taste-Pungent



7. VATSANABHA CHURNIKARANA



Materials :

Dravya Mana Vatsanabha 250 gms

Ulukhala yantra,Cloth. etc

Method of preparation:

The Grahya 250 gms of Vatsanabha churnikarana was done in Ulukalayantra

and sieved through cloth and stored in clean air tight bottle.

Observations:

Vatsanabha converts into Gray coloured fine powder.

Precautions:

Vatsanabha should be dried properly before churnikarana.

Result:

Table No. 24 Showing Qty of Vatsanabha Before and After Churnikarana

Dravya Before Churnikarana (in gms)

After Churnikarana (in gms) Loss

Vatsanabha 180 160 20



8. PREPARATION OF ARDRAKA SWARASA

1kg of Ardraka was thoroughly washed with water to remove the mud from it.

Outer skin was removed cut into pieces and crushed well. This Ardraka kalka was

squeezed well using clean cloth to get swarasa. This is used for bhavana process.

Dravya Dravyamana Ardraka 1 kg

Total quantity of Swarasa expressed from 1 kg of Ardraka is 600ml

9. MIXING OF INGREDIENTS

150 gms of each powdered Shodhita Vatsanabha, Tankana, Shankha &

Pippali were taken in Khalva yantra, mixed thoroughly.

Result : Total quantity of dravyas obtained after mixing : 600 gms

10. PREPARATION OF KAPHAKETU RASA:

Date of commencement: 18/09/2004 Date of completion : 18/09/2004

Materials : Dravya Dravyamana

Shodhita Vatsanabha 150 gms Shodhita Tankana 150 gms Pippali Choorna 150 gms Shankha Bhasma 150 gms Ardraka Swarasa Yathavashyaka

Method: The whole mixture was kept in Khalvayantra, Adraka swarasa was

added to it and mixed with the powder using a spatula till the powder becomes

sufficiently wet. Mardana was done till consistency obtained so that vatis can be

prepared out of it. Then vatis of ½ ratti (62.5 mg) each were prepared.

Result: 630 gms of Kaphaketu rasa was obtained.


Physico – Chemical Analysis & Efficacy of Kaphaketu rasa in Kaphaja kasa

II. ANALYTICAL STUDY

To know the marker components, physico chemical properties and to identify

the composition of products, the analysis of the drug according to the modern

parameters is necessary. Though, Ayurveda is having its unique analytical approach

towards drugs. But in present era there is a necessity of understanding a drug based on

modern methodology of analysis also. In this section of the study, we have tried to

give the inferences for the analysis.

The study was done at Ministry of mines and Indian Bureau of mines,

Bangalore, K. L. E. Society’s College of Pharmacy, Gadag and Bangalore test house,

Bangalore.

The study has been divided into two parts

1. Physical Analysis 2. Chemical Analysis

1. PHYSICAL ANALYSIS

a) Organoleptic characters

Colour - Ash gray

Smell - Faint odour

Touch - Smooth

b) Analysis

Determination of Disintegration time:

Procedure: One pill was introduced into each tube of the Disintegration

Apparatus. Disc was added to each tube. The assembly was suspended in a

beaker containing water at 37oC and apparatus was operated. The time was

noted down with the help of a stop clock. The time taken for all the tablets to

disintegrate completely is disintegration time.

Disintegration time = 19 minutes.

Analytical Study - 77


Determination of PH value

Procedure : the PH value of the sample was determined by a Digital pH

Meter. One percent solution was prepared, as the sample was dry solid in the

form of pills. The pills was powdered. One gram of the sample was weighed

accurately and dissolved in 100 ml of water and pH was noted in the Digital

pH meter.

pH 1% solution = 9.90

Loss on drying:

Procedure : Digest pure quartz sand that passes through No. 40 and 60 sieves

with hydrochloric acid, wash acid free, dry and ignite preserved in a stopped

bottle.

Place 25-30 gms prepared sand and short glass rod in a nickel or

stainless steel dish about 55ml diameter and 40 mm deep filtered with cover.

Dry thoroughly, cover dish, cool in desiccators. Drying gives yield about 1 gm

of dry matter, mix with a few ml of water and transfer quantitatively to the

dish containing prepared sand with aid of water. Mix the sample thoroughly

with the sand.

Dry at a temperature not more than 700 0C. Under pressure not more

than 50 mm of Hg. Making trail washing at 2 hours intervals towards end of

drying period until successive weighing should not differ by more than 2 mg.

Calculate the total solid form the loss of weight on drying.

Loss on drying at 110 0C : 12.09 %



Identification of Alkaloids:

System:

Silica Gel 60 F 254 Merck pre-coated plates.

Mobile phase:

Chloroform : Methanol (90:10)

Location reagent :

Dragendroff’s Reagent.

Procedure : Weigh about 2.0 grm of the sample into a separating flask. Add

about 20 ml water. Basify with dilute ammonia and extract with two

quantities 25 ml of Chloroform. Filter through anhydrous Sodium Sulphate.

Evaporate the chloroform layer to the residue obtained. Add about 1 ml of

Methanol. Shake well to dissolve and spot about 10 μl solution on the TLC

plate. Elute the plate with Mobile Phase to 3/4th of the plate. Dry the plate at

105oC and spray the plate with Dragendroff’s reagent. It alkaloids are present,

brownish red sports are obtained.

Brownish red spots were obtained in the sample solution.

Test for presence of Alkaloid : Present

Determination of total ash :

Procedure : Take about 2 gms accurately weighed, ground drug in a

previously traced silica dish, previously ignited and weighed. Scatter the

ground dry in a fine even layer on the bottom of the dish. Incinerate by

gradually increasing the heat not exceeding dull red heat (450oC) until free

from carbon. Cool and weigh. Calculate the percentage of ash with reference

to the air dried drug.

Total ash : 32.91%



Solubility test

Procedure : About one gram of the sample was weighed and dissolved in 10

ml of the solvents. When the sample did not dissolve, an excess of solvent by

10 ml quantity upto 100 ml was added and noted that the sample was sparingly

soluble in Chloroform (1 grm of sample in 100 ml chloroform) and slightly

soluble in water, 1 M Hydrochloric acid and alcohol (1 grm of sample in 600

ml of the solvent).

Solubility

Water : Slightly soluble

Chloroform : Sparingly soluble

1M Hydrochloric acid : Slightly soluble

Alcohol : Slightly soluble

Weight variation of tablets :

Procedure : The average weight is determined by weighing 20 tablets. The

tablets are also weighed for each case is calculated and expressed in

percentage. Not more than two of the tablets deviate from the average weight

by a greater percentage. No tablet deviate by more than that percentage.

If 20 tablets are not available 10 may be assessed for the

determination, not more than one which deviate from the average weight by

greater percentage.

Weight variation in percentage (n=10) = 8.10%



Hardness test:

If the finished vati is too hard, it may not disintegrate in the required

period of time and if the vati is too soft, it may not stand during packing and

transporting. Therefore, it is necessary to check hardness of tablets.

The tablets or vatis can be roughly determined by holding the Vati or

tablet in between the fingers of the hand and throwing it lightly on the floor.

If it does not break it indicates that the proper hardness has been obtained.

Procedure (Monsanto hardness test) : It is a small portable hardness tester,

which was manufactured and introduced by Monsanto Chemical Company. It

consists of a spring which can be compressed by moving the screw knob

forward.

The tablet to be tested is held between a fixed and a moving jaw and

reading of the indicator was adjusted to zero. The force applied to the edge of

the tablet is gradually increased by moving the screw knob forward until the

tablet breaks. The reading is noted from the scale which indicates the pressure

required in kg or lb to break the tablet. Hardness of 6 kg or more will produce

tablets of highly compact nature.

Hardness in Kg (n = 10) = 3.5 + 0.5

Friability:

Friability test is performed to evaluate the ability of the tablet to

withstand abrasion in packing, handling and transporting. The instrument

used for the this test is known as “Friability test apparatus”.

Procedure : It consists of a plastic chamber which is divided into two parts

and revolves at a speed of 25 rpm. A number of tablets are weighted and



placed in the tumbling chamber which is rotated for four minutes for 100

revolutions. During each revolution the tablets fall from a distance of 6

inches to undergo shock. After 100 revolution the tablets are again weighed

and loss in weigh indicates the friability. The acceptable limit of weight loss

should not be more than 0.8%.

Friability in percentage = 0.64 %

Determination of acid insoluble ash

Procedure : Boil the ash obtained in the process described under

determination of total ash for a minutes with 25 ml of dilute hydrochloric acid.

Collect the insoluble matter on an ashless filter paper. Wash with hot water

and ignite. Weigh it and calculate the percentage of acid insoluble ash with

reference to the air dried drug.

Acid insoluble ash in percentage = 1.31.

2. CHEMICAL ANALYSIS :

Qualitative reactions:

Borate :

The mixture obtained by the addition of sulphuric acid and alcohol

(95%) to a borate when ignited, burns with a flame tinged with green.

Calcium :

i) Solutions of calcium salts, when treated with ammonium carbonate

solution, yield a white precipitate which after boiling and cooling the

mixture, is insoluble in ammonium chloride solution.



ii) Solutions of calcium salts when treated with ammonium oxalate

solution, yield a white precipitate which is soluble in hydrochloric

acid and insoluble in acetic acid.

iii) Calcium salts, when moistured with hydrochloric acid and introduced

on a platinum wire into the flame of a Bunsen burner, give a brick

red colour to the flame.

Quantitative estimations:

Borate:

Weigh accurately 2 gm of the material and extract with distilled water

exhaustively. Made water extract in a 250 ml volumetric flask, Pipette out 25

ml of the solution and titrate with standard 0.1 NHCl using methyl orange as

indicator.

To another 25 ml of the solution, add the quantity of standard

hydrochloric acid determined in the previous titration. Cover the beaker or

conical flask with a clock glass or fisher beaker cover, heat to simmering

temperature here for 10 minutes to expel carbon dioxide (prolonged vigorous

boiling may cause loss of boric acid which is volatile in steam), cool the

solution to room temperature and adjust sufficient standard sodium hydroxide

solution to restore the transition colour of original indicator. Then introduce

about 2 gm of mannitol and shake until dissolved. Add a few drops of

phenolphthalein and titrate with standard 0.1 N carbonate free sodium

hydroxide to the first permanent faint pink colour. Add a further 0.5gm of

mannitol ; if the solution becomes colourless, add more standard sodium

hydroxide until the pink colour reappears. Repeat the process until the



addition of mannitol has no effect, up on the end point of both the titration

calculate the percentage of Na2B4C7 in the sample from the results.

Calcium:

i) In the absence of organic matter.

The sample is dissolved in dilute hydrochloric acid. The solution is

filtered and filtrate is made up to volume in a volumetric flask.

ii) In the presence of organic matter.

Ignite a suitable quantity of sample, accurately weighed, in a porcelain

crucible at 500 – 550oC until the residue is white or nearly so. Moisture with

5-10ml hydrochloric acid, boil for two minutes, evaporate to dryness and heat

on steam bath for 3 hours to render Sio2 insoluble. Moisture the residue with 5

ml of hydrochloric acid, boil for two minutes, add 50 ml of water, heat on the

water bath for a few minutes, filter and wash thoroughly (The residue may be

reserved if necessary for the determination of Sio2).


GOVERNMENT OF INDIA MINISTRY OF MINES

INDIAN BUREAU OF MINES REGIONAL ORE DRESSING LABORATORY

No. K – 23011/4/Chem/2001-2002Analy/Bng/OD BANGALORE, Date : 20.01.05 From: The Suptdg. Officer (Ore Dressing), Indian Bureau of Mines. To : Dr. R. B. Pattanashetti, Final M. D. D. G. M. Ayurvedic Medical College & Hospital Gadag. Kalasapur Road, Shivananda Nagar, Gadag – 582 103.

Sub : CHEMICAL ANALYSIS RESULTS OF AYURVEDIC SAMPLE (KAPHAKETU RASA) Ref : YOUR letter No. DGM / AMC / MD / 04-05/016 Dated : 11.10.2004

Sir, The chemical analysis results of above referred samples is given below as desired by you.

Value in percentage

Acid Insoluble Ca 1.31 5.34

Yours faithfully, (D. J. Tahalramani) Sr. Chemist For Suptdg. Officer (Ore Dressing) Indian Bureau of Mines Address : The Superintending Officer, Regional Ore Dressing Laboratory, Indian Bureau of Mines, 29, Industrial Suburb, 2nd Stage, Tumkur Road, Goruguntapalaya, BANGALORE – 560 022. Ph. No : 080 – 233 79 824, Fax. No. 080 – 23375360 / 23373287, E-mail : [email protected]


CLINICAL STUDY :

Ayurveda believes in the concept that every individual differ from each other.

Drug working in patients of particular disease may not be so effective in another

person of a same disease. Though kaphaketu rasa is claimed to be useful in

kaphajakasa, but in what type, in which avastha of patients and to what extent this

drug is effective is not confirmed. Hence the clinical evaluation and to assess the

therapeutic effect of Kaphaketu rasa in the management of Kaphaja kasa was studied.

Efficacy can be determined by finding out the difference between the baseline data

and assessment data.

The materials and methods of the present study consist of following headings.

1. Selection of patients

2. Research design, Source of data, Sampling method

3. Administration of drug

4. Study duration

5. Examination of patients

6. Parameters of assessment

7. Statistical analysis

1. SELECTION OF PATIENTS :

30 patients of Kaphaja kasa with confirmed diagnosis were selected out of 37

patients, of which 5 patients were discontinued, 2 patients were excluded due to their

age factor. Thus ultimately 30 patients of Kaphaja kasa were selected after screening

with inclusion and exclusion criteria.

Clinical Study - 85


a) Inclusion criteria

Patients between the age of 16 years and 60 year of either sex.

Patients with classical signs and symptoms of Kaphaja kasa were

considered for selection.

Patients were selected after the thorough clinical examination and

laboratory investigation.

b) Exclusion criteria

Patients with complication of Kasa i.e., Chronic obstructive Bronchitis,

Tuberculosis, Bronchiectasis, Lung abscess, pulmonary edema resulting

from cardiac & renal disease have been excluded.

Patients with severe form of other systemic disorders.

Pregnant women and lactating mothers.

c) Diagnostic criteria:

Diagnosis was made on the basis of symptamatology and laboratory

findings.

Presence of prominent feature ie., cough with expectoration (productive

cough).

Presence of three or more symptoms of Kaphaja kasa.

2) RESEARCH DESIGN, SOURCE OF DATA, SAMPLING METHOD :

a) Research Design:

The research design suited for this study is prospective randomized

clinical trial in a single group.

b) Source of data and sampling methods:

A total of 30 patients suffering from Kaphaja Kasa of either sex and

with an age group of 16 – 60 years were selected incidentally at random from

Clinical Study - 86


the special camps conducted at the post graduate out patient department of D.

G. M. Ayurvedic medical college and hospital, Gadag. The patients were

registered and treated as out patients for the present study with the help of a

special Proforma prepared for the study. The proforma is affixed in the

appendix of this dissertation.

c. Sample size : 30 patients of Kaphaja Kasa.

d. Posology : ½ ratti (62.5mg) of Kaphaketu rasa twice a day.

e. Anupana : Madhu

3. ADMINISTRATION OF DRUG:

The Kaphaketu rasa prepared in Department of Rasa Shastra DGMAMC,

Gadag was used for clinical study.

Route of administration: Kaphaketu rasa was administered orally.

4 STUDY DURATION:

The total duration of the study was 5 weeks. Patients were advised to visit the

hospital after every week to observe the changes. The assessment was made before

and after treatment.

Intervention:

The patients were assessed before and after treatment as per assessment

criteria.

The nature of the study was explained to the patients in detail and pretreatment

consent was taken.

The patients have rights to withdraw from the study at any time.

Patients data was maintained confidentially.

Clinical Study - 87


5. EXAMINATION OF THE PATIENTS:

It will be based on Dashavidha pareeksha. Each patient was examined in

terms of basic parameters such as.

Physical examination:

Size and shape of the chest, respiratory movements, rate, rhythm and type of

respiration, diaphragmatic movement. Enlarged lymph nodes, visible pulsation,

sternmastoid sign, position of apex thrust.

Patients were subjected to laboratory investigations:

Blood for - TC, DC, ESR - mandatory, Hb % - as required.

Sputum test for AFB - Only in suspected cases.

Radiogram of chest - only in suspected cases.

Urine routine – as required.

6. PARAMETERS OF ASSESSMENT:

The patients were examined, at the end of every week over a period of 36 days

that constituted total 5 assessments. Medicine was dispensed for 3 weeks. After that

2 visits for follow up. The changes observed in the subjective parameters i.e., signs

and symptoms were assessed by adopting suitable scoring method and the objective

parameters by adopting proper lab investigations.

• For the purpose of assessment the signs and symptoms were graded as follow

i) Kasa (cough) Grade

o No Complaints - 0

o Intermittent cough - 1

o Constant cough - 2

o Worsened cough - 3

Clinical Study - 88


ii. Nishteevana (Expectoration)

o No Expectoration - 0

o Thick expectoration - 1

o Mucoid & sticky expectoration - 2

o Mucopurulent - 3

iii. Uraha vankshana sampoornamiva

o No feeling of Heaviness - 0

o Heaviness relieved completely

With expectoration - 1

o Heaviness relieved slightly


o Heaviness not relieved with

Expectoration - 3

• Comparing the objective parameter values of Quantity of sputum, TC, DC,

ESR and AEC before and after treatment.

• Quantity of sputum was graded as below:

o No sputum - 0

o Less than 2.0ml - 1

o 2.0 – 4.9 ml - 2

o 5.0 to more ml - 3

Clinical Study - 89


OVERALL ASSESSMENT OF THE TREATMENT:

To assess the overall effect, results are classified into four groups as below.

Well responded:

i. Absence of all signs and symptoms.

ii. Total blood picture in normal range.

iii. After treatment no aggravation of symptoms after exposure to nidana.

Moderately responded

i. Absence of all signs and symptoms.

ii. Total blood picture reduced abnormality.

iii. After treatment no aggravation of symptoms after exposure to nidana.

Responded

i. Reduction in severity of signs and symptoms.

ii. Total blood picture in reduced abnormality.

iii. After treatment aggravation of symptoms after exposure to nidana.

Not responded

i. Reduction of severity of signs and symptoms is not specific.

ii. No reduction or increase in abnormality of total blood picture.

iii. After treatment aggravation of symptoms after exposure to nidana..

7. STATISTICAL ANALYSIS:

Statistical analysis was done for subjective and objective parameters

before and after treatment. Analysis was done by calculating Mean, Standard

Deviation (S.D), Standard Error (S.E), t-Value and P- Value at 0.001 level.

Clinical Study - 90


OBSERVATIONS:

In the present study 30 individuals were registered to evaluate the efficacy of

Kaphaketu Rasa in Kaphaja Kasa The prevalence of age, sex, socioeconomic status,

Vyayama Shakti etc. were observed. The observed datas recorded in proforma before

and after treatment were divided into three sections for better under standing.

SECTION I – DEMOGRAPHIC DATA

SECTION II – DATA RELATED TO DISEASE

SECTION III – DATA RELATED TO RESULTS.

SECTION I – DEMOGRAPHIC DATA:

DATA RELATED TO AGE INCIDENCE:

Table No. 25 Showing the Age Incidence

Age Group (in Years) No. of Patients Percentage

16-25 5 16.66

26-35 13 43.33

36-45 5 16.66

46-55 7 23.33

56-65 - 00.00

The patients selected for the study were between the age group 16-60 years.

Maximum number of 13 (43.33%) patients were between the age group of 26 -35

years, followed by 7 (23.33%) patients between the age group of 46-55 years,

5 (16.66%) patients each in 16 - 25 & 36-45 years respectively.

Results - 91


DATA RELATED TO SEX INCIDENCE :

Table No. 26 Showing the sex incidence

67%

33%MaleFemale

Sex No. of Patients Percentage Male 20 66.66

Female 10 33.33 The sex incidence of the disease was more in male patients i.e.20 (66.66%)

were affected.

Graph 1

DATA RELATED TO RELIGION :

Table No. 27 Showing the Religion

Religion No. of Patients Percentage Hindu 25 83.33 Muslim 4 13.3 Christian 1 3.33

It was observed that in this study maximum 25 (83.33%) patients were

belonging to Hindu religion, 4 (13.3%) patients were Muslim and 1 (3.33%) patient

was Christian religion.

DATA RELATED TO OCCUPATION :

Table No. 28 Showing Occupational Incidence

Occupation No. of Patients Percentage

Student 6 20 Labour 9 30 Executive 3 10 Sedentary 6 20 House Wife 6 20

Maximum number of 9 (30%) patients were affected in labour group, 6 (20%)

patients each in student, Sedentary and House Wife respectively, 3 (10%) patients

were executives.

Results - 92


DATA RELATED TO SOCIO – ECONOMICAL STATUS :

Table No. 29 Showing socio – economical status of patients

Economical Status No. of Patients Percentage

Poor Class 12 40.00 Middle Class 13 43.33 Higher Class 4 13.30

It was observed that 13 (43.33%) patients were belonged to Middle class, 12

(40%) patients were belonged to poor class and 4 (13.3%) patients were belonged to

higher class.

40%43.33%

13.3%

0

5

10

1520

25

30

35

40

45

No. of Patients

Poor ClassMiddle ClassHigher Class

Graph 2

DATA RELATED TO HABITAT :

Table No. 30 Showing incidence of Habitat

Habitat No. of Patients Percentage

Urban 18 60 Rural 12 40

It was found that maximum 18 (60%) patients were affected with Kaphaja

kasa were from Urban and 12 (40%) patients were from Rural.

Results - 93


SECTION II - DATA RELATED TO DISEASE :

DATA RELATED TO CHIEF COMPLAINTS :

Table No. 31 Showing the chief complaints of the patients

Chief Complaints No. of Patients Percentage

Kasa 30 100 Bahula Madhura, Ghana Snigdha Kapha

30 100

Ashya Madhuryata 19 63.33 Kapha poorna Deha 17 56.66 Urahavankshana sampoornamiva

30 100

Gourava 19 63.33 Peenasa 10 33.33 Mandagni 17 56.66 Aruchi 13 43.33 Kleda 09 30.00 Chardhi 03 10.00 Utklesha 07 23.33 Shiroruja 08 26.66 Romaharsha 05 16.66

It was observed that maximum 30 (100%) patients had Kasa, Bahula

madhura, Gaha snighdha Kapha, Urahavankshana Samvorpnamiva, 19 (63.33%)

patients had Ashya maduryata, Gourava and 17 (56.66%) patients had kapha poorna

deha and mandagni.

DATA RELEATED TO FAMILY HISTORY :

Table No. 32 Showing the incident of Chronic respiratory disorders in the family

Incident of Chronic respiratory disorders No. of Patients Percentage

In family 13 43.33 Not in family 17 56.66

Out of 30 patients 13 (43.33%) patients had family history of the Chronic

respiratory disorder and 17 (56.66%) patients, there was no family history.

Results - 94


Results - 95

53.33%

46.66%

42 44 46 48 50 52 54

Polluted

Non Polluted

No. of Patients

56.66%

43.33%

0

10

20

30

40

50

60

No. of Patients

History of recurrent URTI No history of recurrent URTI

DATA RELEATED TO CONDITION OF WORK PLACE :

Table No. 33 Showing the condition of work place

Condition of environment No. of Patients Percentage

Polluted 16 53.33 Non Polluted 14 46.66

Out of 30 patients 16 (53.33%) patients were working in polluted environment

and 14 (46.66%) patients were working in non polluted environment.

Graph 3

DATA RELEATED TO RECURRENT URTI :

Table No. 34 Showing the incident of history of recurrent URTI

Incident No. of Patients Percentage

History of recurrent URTI 17 56.66 No history of recurrent URTI 13 43.33

It was noticed that among 30 patients, 17 (56.66%) patients had a recurrent

history of respiratory tract infection where as 13 (43.33%).did not have the history.

Graph 4


DATA RELEATED TO MODE OF ON SET OF DISEASE :

Table No. 35 Showing the mode of on set of disease

Mode of on set of disease No. of Patients Percentage

Sudden 10 33.33 Gradual 18 60.00 Insidious 02 06.66

The mode of onset of disease was considered to be gradual in 18 (60.00%)

patients, sudden in 10 (33.33%) and Insidious in 2 (6.66%) patients.

DATA RELEATED TO COURSE OF THE DISEASE:

Table No. 36 Showing the course of the disease

Course No. of Patients Percentage

Progressive 24 80 Recurrent 06 20

Maximum number i.e 24 (80%) patients had progressive course and 6(20%)

patients had recurrent course of the disease.

DATA RELEATED TO PERIODICITY:

Table No. 37 Showing the periodicity of cough

Periodicity No. of Patients Percentage

Seasonal 23 76.66 Irregular 02 6.66 Perineal 05 16.66

Seasonal

Irregular

Perineal

76.66%

6.66% 16.66%

0

10

20

30

40

50

60

70

80

No. of Patients

It was observed that the periodicity of the cough was seasonal in 23 (76.66%),

Irregular in 2 (6.66%) & perineal in 5 (16.66%) patients.

Graph 5

Results - 96


DATA RELEATED TO SPUTUM:

Table No. 38 Showing various types of sputum in cough

Nature of Sputum No. of Patients Percentage

Thin Mucoid 03 10 Thick frothy 03 10 Mucous and sticky 16 53.33 Muco purulent 08 26.66

16 (53.35%) patients had mucous and sticky sputum, 8(26,.66%) patients had

mucoporulent and 3 (10%) patients each had thin mucoid and thick frothy sputum

respectively.

DATA RELATED TO AGGRIVATING FACTORS:

Table No. 39 Showing the incidence of Aggravating factors

Aggravation factors No. of Patients Percentage

Smoke 4 46.66 Dust 13 43.33 Cold weather 08 10.00 Sheetahara 04 16.66 Pollens 02 20.00 Cosmetics 01 3.33 Drugs 02 26.66

It was observed that maximum patients had attack of cough when they

exposed to smoke, Air pollution, dust etc.

46.66%43.33%

10%

16.6%20%

3.33%

26.66%

0

5

10

15

20

25

30

35

40

45

50

No. of Patients

SmokeDustCold weatherSheetaharaPollensCosmeticsDrugs

Graph 6

Results - 97


DATAS RELATED TO PERSONAL STATUS :

DATA RELATED TO SMOKING :

Table No. 40 Showing incidence of smoking

Incidence No. of Patients Percentage

Smokers 13 43.33 Non Smokers 17 56.66

43.33%

56.66%

0 20 40 60

No. of Patients Non Smokers

Smokers

Among 30 patients, 17(56.66%) patients were non smokers and 13 (43.33%)

were smokers.

Graph 7

DATA RELATED TO NATURE OF FOOD :

Table No. 41 Showing Nature of Food in patients

Nature of Food No. of Patients Percentage

Veg 23 76.66 Mixed 07 23.33

It was observed that maximum 23 (76.66%) patients were vegetarians and 7

(23.33%) patients were having mixed diet.

Results - 98


DATA RELATED TO DOMINANT RASA IN FOOD : Table No. 42 Showing Dominant rasa in food

Dominant rasa No. of Patients Percentage

Madhura 15 50.00 Amla 06 20.00 Lavana 02 6.66 Katu 06 20.00 Tikta 00 00.00 Kashaya 01 3.33

It was observed that maximum 15 (50%) patients consume Madhura rasa

dominant ahara, 6 (20%) patients Amla, 2 (6.66%) patients Lavana, 06 (20%) patients

Katu, 1 (3.33%) patients Kashaya rasa dominant ahara.

DATA RELATED TO INCIDENCE OF VYASANA :

Table No. 43 Showing the incidence of Vyasana

Vyasana No. of Patients Percentage

Tea 10 33.33 Coffee 02 6.66 Tobacco 10 33.33 Alcohol 09 30.00

It was observed that 10 (33.33%) patients had addicted to tea and 02(6.66%)

patients to coffee consumption, 10(33.33%) patients tobacco chewing and 09(30%)

patients had addicted to alcohol.

DATA RELATED TO INCIDENCE OF NIDRA :

Table No. 44 Showing the incidence of Nidra

Nidra No. of Patients Percentage

Sama 02 6.66 Vishama 17 56.66 Alpanidra 11 36.66 Anidra 00 00.00

It was observed that in Kaphaja kasa patients maximum number i.e., 17

(56.66%) had Vishama nidra, 11 (36.66%) patients had Alpanidra, 2(6.66%) patients

had Sama nidra.

Results - 99


DATA RELATED TO AGNI :

Table No. 45 Showing the type of Agni of Kaphaja kasa patients

Dominant rasa No. of Patients Percentage

Samagni 00 00.00 Mandagni 17 56.66 Vishamagni 11 36.66 Teekshnagni 02 6.66

Regarding status of Agni, Mandagni seen in 17 (56.66%) patients followed by

Vishamagni in 11(36.66%) patients, Teekshnagni in 02 (6.66%) patients.

DATA RELATED TO KOSTA :

Table No. 46 Showing type of Kostha

Kostha No. of Patients Percentage

Mrudu 17 56.66 Madhyama 10 33.33 Kroora 03 10.00

Out of 30 Kaphaja kasa patients maximum number i.e., 17 (56.66%) patients

had Mrudu Kostha, 10(33.33%) patients had Madhyma Kostha and 03 (10.00%)

patients had Mrudu kostha.

DATA RELATED TO EXPOSURE :

Table No. 47 Showing exposure to any aggravating factors during working hours

Exposure No. of Patients Percentage

Yes 16 53.33 No 14 46.66

It was observed that 16 (53.33%) patients were exposed to aggravating factors

and 14 (46.66%) were not exposed to aggravating factors during working hours.

Results - 100


Table No. 48 Showing whether symptoms produced during working hours

Symptoms produced No. of Patients Percentage

Yes 13 43.33 No 17 56.66

17 (56.66%) patients had not produced symptoms and 13 (43.33%) patients

were produced symptoms during working hours.

Table No. 49 Showing whether the symptoms reduce by change of place

Symptoms reduced No. of Patients Percentage

Yes 09 30 No 21 70

In 21(70%) patients no reduction of symptoms by change of place. In 9 (30%)

patients symptoms were reduced after change of place.

DATA RELATED TO DASHAVIDHA PAREEKSHA :

Table No. 50 Showing Prakruti of patients

Prakruti No. of Patients Percentage

Vata kapha 17 56.66 Kapha pitta 10 33.33 Vata pitta 03 10.00

Out of 30 Kaphaja kasa patients maximum number i.e., 17 (56.66%) patients

had Vata kapha, 10 (33.33%) patients had Kaphapitta and 03 (10.00%) had Vatapitta.

Table No. 51 Showing the Vyayam shakti of kaphaja kasa patients

Vyayam shakti No. of Patients Percentage

Pravara 09 30.00 Mahyama 17 56.66

Avara 04 13.33 It was observed that maximum number of patients 17 (56.66) had madhyama

Vyayam shakti.

Results - 101


Table No. 52 Showing Aharashakti of Kaphaja kasa patients

Aharashakti No. of Patients Percentage

Pravara 07 23.33 Madhyama 19 63.33

Avara 04 13.33

It was observed that maximum number patients 19(63.33%) had madhyama

Ahara shakti.

Table No. 53 Showing the Satmya of the Kaphaja kasa patients

Satmya No. of Patients Percentage


Avara 06 20.00

It was observed that maximum number of patients 19(63.33%) had madhyam Satmya.

Table No. 54 Showing Satwa of Kaphaja kasa patients

Satwa No. of Patients Percentage


Avara 06 20.00

It was observed that maximum number of patients 15 (50%) had madhyam Satwa.

Table No. 55 Showing Sara of patients

Sara No. of Patients Percentage


Avara 02 6.66

It was observed that maximum number of patients 21 (63.33%) had madhyam Sara.

Results - 102


Table No. 56 Showing pramana of Kaphaja kasa patients

Pramana No. of Patients Percentage


Avara 01 3.33

It was observed that maximum 15 (50%) patients were having Madhyama Pramana.

Table No. 57 Showing the incidence by Samhanana

Samhanana No. of Patients Percentage

Pravara 05 16.66 Madhyama 20 66.66 Avara 05 16.66

It was observed that maximum number 20 (66.66%) patients were had Madhyama

Samhanana.

EFFECT OF THE DISEASE OVER ROUTINE ACTIVITIES :

Table No. 58 Showing the effect of the disease over routine activities

Affect over routine activities No. of Patients Percentage

Severely affected 03 10.00 Moderately affected 18 60.00

Mildly affected 09 30.00 Not affected 0 0

It was observed that the maximum number 18 (60%) patients had moderately

affected and for 3(10%) patients had severely affected and 09 (30%) patients had

mildly affected over routine activities.

INVOLVEMENT OF SROTASES:

Table No. 59 Showing the observed symptoms of Pranavaha Srotas symptoms

Sl No. Symptoms No. of

Patients Percentage Sl No. Symptoms No. of

Patients Percentage

1 Alpalpam 00 00.00 4 Atisristam 06 20 2 Atibaddam 08 26.66 5 Abeekshnam 00 00 3 Kupitam 14 46.66 6 Sashoolam 00 00

Results - 103


Table No. 60 Showing the observed symptoms of Rasavaha srotas symptoms Sl

No. Symptoms No. of Patients Percentage Sl

No. Symptoms No. of Patients Percentage

1 Ashrudda 0 00 9 Jwara 08 26.66 2 Aruchi 20 66.66 10 Tama 02 6.66 3 Ashyavairashyatha 18 60.00 11 Pandutva 06 20.00 4 Arasagnata 00 00 12 Sada 0 0.00 5 Hrillasa 03 10.00 13 Krishangata 01 3.33 6 Gourava 17 56.66 14 Agninasha 12 40.00 7 Tandra 06 20.00 15 Tripti 00 00 8 Angamarda 09 30.00 16 Hridroga 00 00

It was observed that mainly Pranavaha srotas is vitiated in Kaphajakasa and

Rasavaha srotas is also vitiated in this disease.

DATA RELATED TO NIDANA :

Table No. 61 Showing the observed nidanas in Kaphaja kasa Sl

No. Symptoms No. of Patients Percentage Sl

No. Symptoms No. of Patients Percentage

1 Bojyanama Vimaargagamana

03 36.66 7 Doomopghata 09 30.00

2 Guruabhishandi ahara sevana

17 56.66 8 Rajasewana 04 13.33

3 Madhura rasa sevana

15 50.00 9 Veganam avarodha

12 40.00

4 Sheetahara sevana

9 30.00 10 Diwaswpna 11 36.66

5 Asatmya ahara sevana

11 36.66 11 Vyayama 11 36.66

6 Snigdhahara sevana

17 56.66 12 Kshavathu dharana

04 13.33

It was observed that maximum 17 (56.66%) patients had nidana factors as

guru abhishandi ahara sevana Snigdha ahara sevana.

DATA RELATED TO POORVA ROOPA :

Table No. 62 Showing the observed purva roopas in Kaphaja kasa

Sl .No. Purva Rupa No. of Patients Percentage

1 Shookapoorna galashyata 12 40.00 2 Kanthe Kandu 10 33.33 3 Bojyanam avarodha 08 26.66 4 Arochaka 13 43.33 5 Galatalu lepa 15 50 6 Agni sada 17 56.66 7 Swashabda vaishamya 10 33.33

Results - 104


SECTION III - DATA RELATED TO RESULTS :

Clinical condition of all patients was assessed before and after the response to

treatment. The subjective parameters like Kasa, Nishteeavana, Urahavankshana

Sampoornmiva, were assessed before and after treatment and objective parameters

like quantity of sputum, TC, DC, ESR & AEC were checked out before and after

treatment.

ASSESSED PARAMAETERS

SUBJECTIVE PARAMETERS:

1. KASA

Table No. 63 Showing the number of patients with Kasa

S No. Degree of Kasa B. T. % A. T. % 1 Nil 0 0 24 80 2 Mild 2 6.66 6 20 3 Moderate 17 56.66 0 0 4 Severe 11 36.66 0 0 Total 30 100 30 100

It was observed that 17 (56.66%) patients had moderate attack, 11 (36.66%)

patients had severe attack and 2 (6.66%) patients had mild attack of Kasa before the

treatment. After treatment 6 (20.00%) patients were left with mild degree of kasa and

24 (80%) patients were completely relieved. The improvement is statistically showed

highly significant. (P < 0.001).

2. NISHTEEVANA (EXPECTORATION)

Table No. 64 Showing the number of patients with Nishteevana

S No. Degree of Nishteevana B. T. % A. T. % 1 Nil 0 0 24 80 2 Mild 3 10 6 20 3 Moderate 19 63.33 0 00 4 Severe 7 23.33 0 00 Total 30 100 30 100

Results - 105


Before treatment 19(13.3%) patients had moderate, 7(23.33%) patients had

severe and 3(10%) patients had mild degree of Nishteevana. After treatment 6

(20.00%) patients were left with mild degree of Nishteevana and 24 (80%) patients

were completely relieved. The improvement is statistically showed highly significant.

(P < 0.001).

3. URAHA VANKSHANA SAMPOORNMIVA

Table No. 65 Showing the number of patients with Uraha Vankshana

Sampoornmiva

S No. Degree of Uraha Vankshana Sampoornmiva B. T. % A. T. %

1 Nil 0 0 24 80 2 Mild 0 0 6 20 3 Moderate 12 40 0 0 4 Severe 18 60 0 0 Total 30 100 30 100

Before treatment 18(60%) patients had severe, 12(40%) patients had moderate

degree of Uraha Vankshana Sampoornmiva symptom. After treatment 6 (20.00%)

patients were left with mild degree of Uraha Vankshana Sampoornmiva symptom and

24 (80%) patients were completely relieved. The improvement is statistically showed

highly significant. (P < 0.001).

OBJECTIVE PARAMETERS:

1. QUANTITY OF SPUTUM (MORNING BOUT)

Table No. 66 Showing the number of patients with Quantity of Sputum

(morning bout)

S No. Quantity of Sputum B. T. % A. T. % 1 Nil 0 0 24 80 2 Mild 0 0 6 20 3 Moderate 8 26.66 0 00 4 Severe 22 73.33 0 00 Total 30 100 30 100

Results - 106


Before treatment 22 (73.33%) patients had severe, 8(26.66%) patients had

moderate quantity of Sputum. After treatment 6 (20.00%) patients were left with mild

quantity of Sputum and 24 (80%) patients were completely relieved. The

improvement is statistically showed highly significant. (P < 0.001).

2. ERYTHROCYTE SEDIMENTATION RATE (E. S. R.)

It was observed that there was reduction in the count of Erythrocytes in the

objective parameter ESR shows more significant than other parameters.

Table No. 67 Showing the ESR before and after treatment

E. S. R

Sl No. BT AT Sl No. BT AT

1 49 16 16 26 10 2 21 09 17 41 12 3 30 08 18 34 09 4 18 06 19 35 21 5 23 10 20 22 11 6 28 09 21 27 07 7 25 14 22 20 12 8 31 19 23 37 18 9 33 18 24 33 17 10 37 16 25 34 16 11 17 05 26 28 09 12 32 15 27 34 16 13 24 08 28 31 14 14 29 13 29 30 11 15 19 06 30 36 16

Before Treatment no patients and after treatment 12 (40%) patients were lied

in the range 0-10 ESR level. Before Treatment 4 (13.33%) patients and after

treatment 17 (56.66%) patients were lied in the range 11-20 ESR level. Before

Treatment 12 (40%) patients and after treatment 1 (3.33%) patients were lied in the

range 21-30 ESR level. Before Treatment 12 (40%) patients were lied in the range

31-40 and 2 (6.66%) patients were lied in the range 41 – 50 ESR level.

Results - 107


3. BLOOD INVESTIGATIONS AEC, TC, DC BEFORE AND AFTER TREATMENT

Table No. 68 Showing the AEC, TC, DC values before and after treatment

AEC TC DC P E

OPD NO. B. T. A. T. B. T. A. T. B.T. A.T B.T A.T 2563 840 630 12500 10500 74 66 08 06 2564 492 410 7500 6800 68 60 04 03 2618 570 435 10100 9200 69 53 06 04 2620 365 312 5980 5450 62 50 03 02 2621 484 442 6432 6028 65 63 05 04 2656 360 310 7846 7205 68 59 06 03 2660 480 436 5830 5403 60 54 07 04 2706 376 325 8342 7900 67 58 06 02 2940 710 690 10936 10400 72 67 09 08 3010 515 436 9584 8675 76 61 05 01 3017 510 445 4770 4347 56 51 05 02 3036 490 432 7863 7020 68 52 05 03 3165 330 328 6735 5976 56 61 04 04 3169 556 555 5988 5535 68 62 06 03 3170 488 430 5020 4786 60 55 05 02 3171 499 415 8256 7935 64 58 06 04 3178 825 705 12439 10635 68 66 09 09 3332 345 305 6786 6100 69 62 06 02 3333 435 430 9835 8842 71 66 05 03 3344 537 510 6652 6136 67 65 08 06 3345 585 458 6800 6333 62 49 06 05 3381 370 340 5089 4675 58 51 05 04 3432 770 695 10680 10080 69 69 08 07 3436 356 320 8496 7800 63 60 06 03 3448 496 430 8798 7912 67 59 07 05 3457 445 450 6783 5985 64 57 06 04 3565 330 330 8670 8500 70 66 05 02 3576 930 860 10534 10024 69 68 07 06 3592 735 555 7346 6670 59 53 06 03 3609 880 740 11330 10266 71 69 07 07

AEC = Absolute Esinophil Count BT= Before treatment

TC = Total Count AT = After treatment

DC = Differential Count

Results - 108


STATISTICAL ANALYSIS

Table No. 69 Showing statistical analysis of subjective parameters

Sl. No. Subjective parameters Mean S. D. S. E. t-value p-value Remarks

1 Kasa 2.1 0.480 0.087 24.137 < 0.001 H. S. 2 Nisteevana 2.0 0.643 0.117 17.09 < 0.001 H. S. 3 Uraha Vankshana Sampoornamiva 2.4 0.498 0.090 26.40 < 0.001 H. S.

Table No. 70 Showing statistical analysis of objective parameters

Sl. No. Objective parameters Mean S. D. S. E. t-value p-value Remarks

1 E.S.R. 17.2 5.44 0.993 17.32 < 0.001 H. S. 2 T.C 693.5 396.77 72.44 9.573 < 0.001 H. S.

D. C. P 5.866 3.471 0.633 9.266 < 0.001 H. S. 3 E 2.0 1.174 0.214 9.345 < 0.001 H. S.

4 A.E.C 68.83 50.77 9.269 7.371 < 0.001 H. S. 5 Quantity of Sputum 2.533 0.571 0.104 24.35 < 0.001 H. S.

Individually the subjective parameters shows most significant than the

objective parameters. Assume that Kaphaketu rasa is not responsible for changes in

the readings of patients before and after the treatment. To test the hypothesis we use

unpaired t-test. In the subjective parameters ‘Nishteevana’ symptom shows more

significant than others. The parameter kasa (cough) and Uraha Vankshana

Sampoornamiva have the same effect in the group. The parameter kasa (cough) has

less variation than the other. [From table No. 1 by comparing t-value, co-efficient of

variation and p<0.001].

In the objective parameter the ESR shows more significant than other

parameter with stable effect within the group. The parameter ‘quantity of the sputum’

have uniform affect in the group with high mean net effect. The parameter TC, DC

approximately have the same effect on the patients. The parameter TC has more net

mean effect with more variation. The parameter AEC does not have uniform effect

on the patient within the group. [From table No. 2 by comparing t-value, co-efficient

of variation and p<0.001].

Results - 109


DISTRIBUTION OF PATIENTS BY RESULTS :

Table No. 71 Showing the overall result

Sl .No. Results No. of Patients Percentage

1 Well responded 15 50.00 2 Moderately responded 09 30.00 3 Responded 06 20.00 4 Not responded 00 00.00

Total 30 100.00

It was observed that 15 (50.00%) patients were well responded, 9(30%)

patients were moderately responded & 6 (20%) patients were responded to the

treatment.

50%

30%

20%0%

Well respondedModerately respondedRespondedNot responded

Graph 8

Results - 110


MASTER CHART 1 : SHOWING OVER ALL ASSESSMENT OF THE RESPONSE TO

“KAPHAKETU RASA” BASED ON ASSESSMENT CRITERIA.

Reduction of symptoms in % and E.S.R in hour Sl. No. OPD

No. S-1 S-2 S-3 S-4 E.S.R. Results1 2563 80% 80% 80% 80% 16 R 2 2564 100% 100% 100% 100% 9 W.R 3 2618 100% 100% 100% 100% 8 W.R 4 2620 100% 100% 100% 100% 6 W.R 5 2621 100% 100% 100% 100% 10 W.R 6 2656 100% 100% 100% 100% 9 W.R 7 2660 100% 100% 100% 100% 14 M.R 8 2706 100% 100% 100% 100% 19 M.R 9 2940 80% 80% 80% 80% 18 R 10 3010 100% 100% 100% 100% 16 M.R 11 3017 100% 100% 100% 100% 05 W.R 12 3036 100% 100% 100% 100% 15 M.R 13 3165 100% 100% 100% 100% 08 W.R 14 3169 100% 100% 100% 100% 13 W.R 15 3170 100% 100% 100% 100% 06 W.R 16 3171 100% 100% 100% 100% 10 W.R 17 3178 80% 80% 80% 80% 12 R 18 3332 100% 100% 100% 100% 09 W.R 19 3333 100% 100% 100% 100% 21 M.R 20 3344 100% 100% 100% 100% 11 W.R 21 3345 100% 100% 100% 100% 07 W.R 22 3381 100% 100% 100% 100% 12 W.R 23 3432 80% 80% 80% 80% 18 R 24 3436 100% 100% 100% 100% 17 M.R 25 3448 100% 100% 100% 100% 16 M.R 26 3457 100% 100% 100% 100% 09 W.R 27 3565 100% 100% 100% 100% 16 M.R 28 3576 80% 80% 80% 80% 14 R 29 3592 100% 100% 100% 100% 11 M.R 30 3609 80% 80% 80% 80% 16 R

S-1 = Kasa, ESR = Erythrocyte Sedimentation Rate

S-2 = Nisteevana WR = Well Responded

S-3= Uraha Vankshana Sampoorana, MR = Moderately Responded

S-4 = Quantity of Sputum, R = Responded

.

Results - 111


MASTER CHART 2 : SHOWING THE ASSESSMENT OF GRADING OF PARAMETERS

OF “CLINICAL EFFICACY OF KAPHAKETU RASA IN KAPHAJA KASA”

Kasa Nisteevana UVS Q. S. Sl. No.

OPD NO. BT AT FU BT AT FU BT AT FU BT AT FU

1 2563 3 1 1 2 1 1 3 1 1 3 1 1 2 2564 2 0 0 2 0 0 2 0 0 3 0 0 3 2618 2 0 0 2 0 0 3 0 0 3 0 0 4 2620 1 0 0 2 0 0 3 0 0 2 0 0 5 2621 2 0 0 2 0 0 2 0 0 3 0 0 6 2656 3 0 0 3 0 0 3 0 0 3 0 0 7 2660 2 0 0 1 0 0 3 0 0 3 0 0 8 2706 2 0 0 2 0 0 2 0 0 3 0 0 9 2940 3 1 1 2 1 1 3 1 1 3 1 1

10 3010 3 0 0 3 0 0 2 0 0 3 0 0 11 3017 1 0 0 2 0 0 3 0 0 2 0 0 12 3036 3 0 0 3 0 0 3 0 0 2 0 0 13 3165 2 0 0 1 0 0 2 0 0 3 0 0 14 3169 2 0 0 2 0 0 2 0 0 2 0 0 15 3170 2 0 0 2 0 0 2 0 0 3 0 0 16 3171 2 0 0 2 0 0 2 0 0 3 0 0 17 3178 3 1 1 3 1 1 3 1 1 3 1 1 18 3332 3 0 0 3 0 0 3 0 0 2 0 0 19 3333 3 0 0 2 0 0 3 0 0 3 0 0 20 3344 2 0 0 1 0 0 2 0 0 3 0 0 21 3345 2 0 0 2 0 0 2 0 0 2 0 0 22 3381 2 0 0 2 0 0 3 0 0 3 0 0 23 3432 3 1 1 2 1 1 3 1 1 2 1 1 24 3436 2 0 0 2 0 0 3 0 0 3 0 0 25 3448 2 0 0 2 0 0 2 0 0 3 0 0 26 3457 2 0 0 3 0 0 3 0 0 3 0 0 27 3565 2 0 0 3 0 0 2 0 0 2 0 0 28 3576 3 1 1 2 1 1 3 1 1 3 1 1 29 3577 2 0 0 2 0 0 3 0 0 3 0 0 30 3609 3 1 1 3 1 1 3 1 1 3 1 1

BT = Before Treatment AT = After Treatment

ESR = Erythrocyte Sedimentation Rate QS = Quantity of Suptum

UVS = Uraha Vankshana Sampoornmiva FU = Follow Up

Results - 112


Discussion is studied under the following headings.

Discussion on Drugs

Discussion on Disease

Discussion on Pharmaceutical Study.

Discussion on Analytical Study.

Discussion on Observation and Results

DRUGS:

TANKANA:

Tankana is classified into various categories depending upon the physical

appearance, generally white (sphatikabha) variety is used. The Tankana(Sphatikabha)

which is clear, transparent, crystalline with a bluish tinge is the best because as it may

have less impurities and more percentage of Na2B4O710H2O compared to other

varieties which is having more therapeutic value.

Tankana is available in ore form as well as in natural form. It is more

available in shores of dried lakes in India and Tibet in natural form. Now a days it is

artificially prepared in Laboratories also. Prior to administration it should be subjected

to Nirmalikarana and Shodhana because Tankana have external impurities and may

causes complications like Chardhi and Bhranti. Actually Grahya variety of Tankana

does not contain any impurities except water content, which may cause heaviness in

the body after comsuming. Hence Tankana was fried over stove to evaporate the

water content.

As Tankana may rich in Kshara guna and also used more in various yogas.

Hence Tankana may have synonyms like ksharashresta and kshararaja.

Discussion - 113


Tankana had the property to dissolve many metal oxides to form borates of

low melting points and used for extracting the metals as a flux. By this property,

Tankana had synonyms like Dravaka, Dravi, Dhatudravaka, and Lohavishodhaka. In

Adarsha nighantu, Tankana is considered as antidote for vishas.

Due to Rooksha, teekshna, ushna guna, Tankana does chedhana of vitiated

Kapha. By these Pharmacological properties of the Tankana, it mitigates vitiated

khapa. and subsides the kaphaja kasa. It also has an reputation as germicide and used

primarily as Bacteriostatic.

SHANKHA :

Rasarnavakar is the person who considered Shankha under Shukla varga may be of

its white colour. Shankha is the outer covering of “Molluska group” of aquatic

animal which are seen in sea. It is collected from the sea, and put in boiling water.

The animal which is present inside dies and the outer portion is Shankha. It has an

external lustrous yellowish brown horny layer and beneath it has a thick layer, chiefly

formed of Calcium carbonate.

As Shankha produces melodious sound for long time.Hence it may had synonyms

like Sunada, Dheerghanada, Pavana dhwani and Mahanada. As Dhakshinavartha

shankha is sacred and Uttama. Hence widely used for medicinal purposes than

Vamavartha shankha.

Tankana, Pippali, Vatsanabha have teekshna ,ushna guna, katu rasa and Ushna

veerya. Due to these properties they may produce gastric irritation, but this is

prevented by Shankha as it contains Calcium carbonate which is best choice of

antacid. Due to its Laghu guna and katu rasa, mitigates vitiated Kapha and helps in

curing the Kaphaja kasa.

Discussion - 114


VATSANABHA :

Charaka has considered Vatsanabha as one of the Stavara visha. But Sushruta

considered it under Kanda visha. Among Stavara vishas, Kanda visha and moola

visha are commonly used as they are claimed to be more potent.

Vatsanabha plant not allow to grow other plants nearer to it because of its

poisonous constituent i.e Aconitine. Due to this character it is called as Visha and

Garala. Aconite is a Greek word meaning arrow. The arrows were coated with this

poison and used. Hence the name Aconitine.

If Vatsanabha is administered in proper dose after purification does highly beneficial

effects to the body and even life saving too.Hence it is known as Amruta.

Rasa vagbhata mentioned that the Vatsanabha having sthoola, snigdha, guru,

naveena, pandura varna inside, phalapakanta grahya can be considered as Grahya.

This may be due to the less toxic effects compared to other varieties and have more

therapeutic effect.

Due to its pharmacological properties like Laghu, Ruksha, Teekshna, Vyavayi,

Vikasi guna, Ushna veerya and Katu vipaka does srotovishodhana .By that it removes

airway obstruction.

PIPPALI:

Charaka and Sushruta have extensively used the pippali in various

formulations. It is effective in the treatment of Pranavaha srotas. It is popularly known

as Magadhi. This is the name of place where the availability of Pippali is more.

It is mentioned that, Pippali should not be used in excessive quantities, maight

be due to its Teekshna, Ushna guna which causes increase in the Pitta. However it

Discussion - 115


may be used as Rasayana, but it is clarified that the restriction is limited in diet and

not for medicinal usage.

Due to Pharmacological properties like Laghu, Snigdha guna, Katu rasa,

Anushna veerya, it acts as Vatakaphahara by that it subsides Kasa, Swasa, Jwara,

Krimi, Meha etc.

The crude extract of Piper longum as well as Piplartine suppressed the ciliary

movements of the esophagus of frog. These findings suggest that therapeutics efficacy

in reliving cough reflex and it has immuno modulatory property also.

SELECTION OF KAPHAKETU RASA :

Kaphaketu rasa is a herbomineral preparation mentioned in Rasagrantha’s

and indicated in Kasa & Swasa.

Acharya Charaka has mentioned that the drugs which are having Katu,

Ruksha and Ushna properties are beneficial in Kaphaja Kasa and the

ingredients of Kaphaketu rasa are also having all the prescribed properties.

In Kaphaja Kasa the excessively secreted mucous given limitation to the

flow of Vata. So the drugs which are having Kaphadravaka,

Kaphanissaraka and Kaphavatahara properties are beneficial. In the

ingredients of Kaphaketu rasa, Tankana is Kaphadravaka, Shankha is

Kaphavatahara, Vatsanabha, and Pippali having Kaphachedhaka property.

The 20th century authors have mentioned about Kshara prayoga in

Kaphajakasa because of its Kshaana (liquefying) property and most of

them having mentioned about Kantakari, Apamarga, Yavakshara and

Chitramula kshara but their preparation is a complex procedure where as

Discussion - 116


Tankana is an easily available Kshara and is one of the ingredient of

Kaphaketu rasa.

Kaphaketu rasa have four ingredients which are easily available and the

method of preparation is very easy.

With all these reasons the drug Kaphaketu rasa has been selected for the study.

PROBABLE MODE OF ACTION OF KAPHAKETU RASA:

The materials in the nature including the human body as well as drugs are

composed of Panchamahabutas. In drug composition these Mahabhutas are known by

inference on the basis of their properties like Rasa, Guna, Virya, Vipaka, Prabhava

etc., which are inherent in the drug on which the Pharmacodynamics depends.

Due to indulgence in the etiological factors, the shleshma secreted in excessive

quantity produces obstruction to Anila gati, resulting in the production of Kaphaja

Kasa.

After analyzing the each ingredients of Kaphaketurasa it was found that

majority of them were having Katu rasa, Ushnaverya, Laghu guna, Katu vipaka,

Kaphavata Shamaka. By these properties it subsides malarupi kapha and clears the

airway obstruction. By this it subsides the Kaphja kasa.

Pippali has the property of Ushna Guna, Katurasa, Anushnaveerya, Katu

vipaka, Kaphavata Shamaka. It is Deepaka, pachaka, kasa, Shwasahara, Jwarahara

Rasayana. Pippali contains active principle Piperine, it acts as bio availability

enhancer. It acts as anti inflammatory and immunomodulator. Extract of Pippali is

rich in vit A & E, it reduces tissue injury and free oxygen radical scavengers. By

these properties it reduces Kapha, inflammation of respiratory tract and clears the air

passage.

Discussion - 117


Vatsanabha has the property of Ushna Guna. Yogavahi, Katu tikta

Kashayarasa, Katu vipaka, Ushnaveerya, Kaphavata Shamaka. It does Deepana,

Pachana. Shoolahara, Jwarahara, Kasa, Shwasahara, Rasayana .

Vatsanabha contain active principles like aconitin, pseudoaconitine, these acts

as diaphoretic, anit inflammatory, analgesic. By these properties it reduces kapha,

inflammation and fever.

Tankana posess the properties like Teekshna, Laguruksha guna, Katu rasa,

Katu vipaka, Ushnaveerya, Kaphavatashamaka. It acts as Deepana, Lekhana, kasa

Swasahara. Chemically it is Borax. It acts as Germicide, Astringent and

Bacteriostatic in action. By these properties it reduces the Kapha, Checks the growth

of microorganisms thus it reduces the infection.

Shankha has the properties like Katu rasa, Laghu guna, by these properties it

subsides vitiated Kapha.

By virtue of the properties of ingredients, Kaphaketu rasa breaks the samprapti

and reduces Kapha dosha, relieves airway obstruction. In this way it helps in

subsiding the Kaphaja kasa.

DISEASE:

In Ayurvedic literature the classification of the Kasa appears to have been

done mainly on the basis of the nature of sputum. In Kaphahaja Kasa there is hyper

secretion of mucous (shleshma vriddhi) in Pranavaha srotas. This produces restriction

to anila gati (airflow), naturally to expel the excessive secreted mucous, Kasa is

produced.

Discussion - 118


Common etiological factors, Samprapti have been described for Kasa by other

authors, but Charaka is the only person who has described specific etiological factors

like Guru, Snigdha, Madhura Ahararasa sevana and Vishista samprapti for Kapahja

Kasa.

In Kaphaja Kasa at the site of dosha dushya sammurchana, hypertrophied

cells secret malarupi Kapha and the retention of malarupi Kapha in Pranavaha srotas

leads to sanga. The Kapha which is secreted excessively, due to the homologous

properties will produce Agni mandya due to mandaguna.

The obstruction to the anila gati causes involuntary reflex and is designed to

remove the excessive secreted Kapha in Pranavaha srotas. It consists of contraction

of respiratory muscles against a closed glottis, with resultant rise in thoracic pressure,

followed by opening of the glottis and forced expiration with very high flow rates and

production of Ksita Shada which is associated with Kapha.

No specific Purvarupas have been explained for Kaphaja Kasa. so the general

Purvaroopa of Kasa are considered here.

Bahula, Snigdha Sandra, Ghana, Sweta, Madhura Stivanayukta Kasa are the

main laxanas of Kaphaja Kasa. So the pratyatmaka laxanas of Kapahaja Kasa is

Bahula, Shweta and snigdha Steevana

In Kaphaja Kasa snigdha, Madhura, Shita dravays are considered as

Anupashaya dravyas and Katu, Ruksha, Ushna dravyas are considered as Uphashaya

dravyas.

Discussion - 119


Only Astanga hridaya and Yogaratanakar had mentioned about complications

of Kaphaja Kasa. Acharya Charaka clearly mentioned that if any Variety of Kasa is

not treated properly, then it will convert into Kshayaja Kasa.

Chikitsa is one which is capable to carry out Samprapti vighatana. So in

Kaphaja Kasa Acharya Charaka has mentioned Vamana as the first line of treatment.

After that, the drugs having Katu, Ruksha and Ushna properties should be

administered.

ANALYTICAL STUDY:

Though Ayurveda is having its unique analytical approach towards drugs in

present era, there is a necessity of understanding a drug based on modern

methodology of analysis also. So there is a need to evaluate the drugs with various

parameters.

All the physical properties of Kaphaketu rasa found, will fall in the

specification of Ayurvedic Pharmacopoeia of India. So the Kaphaketu rasa prepared

was genuine because of the normal physical properties.

The time required for 5 tablets to disintegrate is not more than 15 minutes.

The sample Kaphaketu rasa shows 19 minutes to disintegrate by this it is evident that

the Kaphaketu rasa has slow absorption in the gut.

The PH (1% solution) of the Kaphaketu rasa is 9.90. This shows the alkalinity

of the sample. It may be due to Tankana kshara which is alkaline in nature. Loss and

drying at 1100 C is 6.78%. This shows the moisture content present in the Kaphaketu

Discussion - 120


rasa. Test for presence of alkaloid was carried out. It was found that alkaloids are

present in it.

Total ash value for the sample is 32.91%. This shows the amount of Inorganic

material present in it. The acid insoluble ash value for the sample is 1.31%. The low

acid insoluble ash values facilitate the easy absorption of drug.

Kaphaketu rasa is slightly soluble in water, 1 M Hydrochloric acid and

Alcohol and sparingly soluble in chloroform. This shows slow absorption of

Kapaketu rasa in the gut.

It is desirable that all vatis should be uniform in weight. The

difference of weight in vatis can lead to variation in doses. If there is any weight

variations that should fall within the prescribed limits. Weight variation is + 10% for

vatis weighting 120 mg or less. For our sample weight variation is 8.10% which falls

within normal range.

If the finished vati is too hard it may not disintegrate in required period of time

and if the vati is too soft may not with stand during packing and transporting.

Hardness of 4 kg is considered suitable for handling the vatis. The hardness of

Kaphaketu rasa falls within the range i.e., 3.5 + 0.5,which shows quick disintegration

of the vati and suitable for handling.

The acceptable limits of weight loss in friability test should not be more than

0.8%. The friability of Kaphaketu rasa sample is 0.64%. This shows the ability of

vatis to withstand abrasion in packing, handling and transporting.

Discussion - 121


When the sample is subjected to test assay for Boron and Calcium, the value

obtained indicates that sample contains 3.52%, 5.34% organic Boron and Calcium

respectively.

PHARMACEUTICAL STUDY :

The raw drugs were subjected to purification and processed one by one and

preparation of Kapahketu rasa was carried out as mentioned in Vishopavishadhi,

Vijnaniya chaturvinshastrang of Rasatarangini.

Shodhana process is aimed to remove harmful impurities present in the drugs

and it also helps in removing the impurities caused by the association of other

materials and also converts mineral drugs into suitable forms for further treatment

with Marana process. By Marana process the drugs are reduced into fine particles.

So that these could be observed easily into the system and mix with Raktadi dhatus

and produce their desired effects without producing toxic effects.

Tankana Shodhana was done by frying the fine powder in an iron pan. During

frying initially it liquefied and produced crackling sounds. After continuous frying it

became bloomed and turn into white opaque substance. The weight of Tankana

before Shodhana was 300 gms. After Shodhana 170 gms, loss of weight was 170 gms

might be due to evaporation of water molecules.

Shankha Shodhana was done by Swedana in dolayantra with Jambhira nimbu

Swarasa, which may helps in quick absorption. The pottali was immersed in

dolayantra in such a manner that it should not touch the patra otherwise their may be

chance of burning of cloth and Shankha pieces coming out. After that it was washed

with hot water, by that external impurities like sand, mud etc can be removed.

Discussion - 122


Kumari was selected as a bhavana dravya for Shankha marana as it is a good

binding agent and is also have Kaphapittashamaka property, helps in subsiding

Kaphaja Kasa which is a resultant of vitiated Kapha. So the Kumari was selected for

Marana.

After subjecting for first Gajaputa to Shankha pieces, Colour change of

Shankha from white to gray and weight loss of 8 gms was observed and the Shankha

pieces became brittle so that they can be powdered easily. Shankha pieces were

powdered, Mardana was done with Kumari Swarassa and Chakrikas were prepared

and subjected for second Gajaputa, weight loss of 14 gms.was observed. The

obtianed Bhasma was subjected for Bhasma pareeksha, but did not passed. So it was

once again subjected for third Gajaputa. Only then Shankha bhasma passed the

Rekhapoornatva, Shlakshanatwa, Varitara etc tests and there was 18 gms weight loss.

There was weight loss after every Gajaputa, might be due to reduction in the particle

size and it may also due to procedures like mardhana etc.

Vastanabha shodhana was done by keeping it under sunlight in Gomutra. After

soaking in Gomutra Vatsanabha became soft and colour of Gomutra changed to dark

brown. It may be due to release of some toxic substances. It is believed that the

toxicity of Vastanabha decreased by treating it with Gomutra and after exposure to

sunlight brought about a partial change of toxins aconitine and pseudoaconitine into

the less poisonous substance called Benzel aconine and Vertoroyl aconite. During

pounding of Vatsanabha ugragandha was produced may be due to Vyavayi, Vikasi,

Teekshna gunas of it. Before Shodhana it was 250 gms, after shodhana it was 150

gms. This loss is due to removal of layer and also during powdering.

Discussion - 123


After mixing the ingredients homogeneously, marhana with Ardraka swarasa

was done till it attains sticky nature so that vatis can be prepared. The ingredients

taken before were 600 gms in weight. After weight was increased to 630 gms. It was

because of Ardraka swarasa which contains fibrous and starch materials.

CLINICAL STUDY:

The sample for the study included all the patients with confirmed diagnosis of

Kaphajakasa who attended the OPD of DGMAMC, Gadag. Even though there were

different types of Kasa, the study was mainly confined to the cases of Kaphajakasa.

38 Patients were selected for the study out of which 8 patients did not reported for the

follow up. The study group thus included only 30 patients received ½ ratti B. D.

Kaphaketurasa for 21 days.

Age: The research study comprised of more number of patients between the age

group 26 – 35 yrs. There is no age specification mentioned in the disease

Kaphajakasa. The incidence of Kasa may occur in any age

Sex: In the present clinical trial there were 20 male patients and 10 female patients.

The significance of this figure is doubtful. Because it is recorded that males are 10

times more prone to be affected than females. In this study male and female ratio is

less. The ratio varied in this because of small sample size so definite figure of ratio

could not be arrived at.

Religion: Although more patients were from Hindu religion, there is no relation of

religion in the causation of disease Kaphaja Kasa.

Marital Status: The maximum number of patients were married, this is because of

the group of the patients who approached for the treatment.

Discussion - 124


Occupation: It was observed that more number of patients belongs to labour group

followed by, housewife, secondary and students. This is because more chance of

exposure to allergens like dust, smoke, house dust mite, pollens etc. Many patients

admitted that symptoms are going to disappear by change of place. It clearly shows

their exposure to allergens in their occupation.

Socio – Economical Status: Most of the patients belong to middle and poor socio

economic status.

Chief complaints: Kasa, Bahula Madhura Ghanasnighda Kapha, Urahavankshana

Sompurnamiva (100%) were present in all the patients. Ashya madhuryata, Gourava

(63.33%) were the next dominating symptoms followed by Kapha poorna deha,

Mandagni (56.66%), Aruchi (43.33%).

Family History: The orthodox science believes that relatives of Bronchitis

patients have higher prevalence of chronic respiratory disorder. In the present clinical

trail also it was observed that more number (43.33%) of patients had the family

history of chronic respiratory disorders.

Work place: Atmospheric pollution or dust exposure at work place has been

considered as an important etiological factor of respiratory disease. In the present

study also it was observed that more (53.33%) number of patients were working in

polluted area.

History of recurrent URTI: The frequency of Chronic bronchitis is much higher

in a person who is recurrently suffering from cold. Acharya Sushruta explained that if

prathishyaya is untreated it leads to Kasa. In this study 56.66% of cases had history

of recurrent URTI.

Discussion - 125


Chronicity: Maximum number of patients 14 (46.66%) belonged to the group of up

to 2yrs chronicity. This shows the relative resistance to modern drugs.

Mode of onset: The mode of onset was gradual in 18 (60%) cases and Sudden

in 10 (33.33%) cases. Patients with sudden onset, having history of rapid and severe

form of infection. There is no sharp division between these two groups, but nearly all

the patients felt that their symptoms had either developed gradually over months or

years or else had appeared suddenly after a acute respiratory infection.

Course of the disease: Course of the disease was progressive in 24 patients and

recurrent in 6 patients. In progressive cases intensity of disease was mild and later it

become worse and most of the days they were having symptoms. In the patients

having a recurrent course, the disease develops at intervals, means they were having

symptoms for less period in the course of the disease.

Periodicity of cough: Maximum numbers of 23 (76.66%) cases were having

seasonal periodicity. This shows dependency of disease over season.

Sputum: Most of the patients 16 (53.33%) showed the mucous and sticky type

of sputum followed by 8 (26.66%) cases with mucopurulent sputum. Charakacharya

mentioned that Kapha should be Bahula, Snigdha, Ghana in nature in Kaphaja Kasa.

This can be taken as mucous and sticky.

Aggravating factors: Smoke, dust, pollens etc are considered to be aggravating

factors for the disease. In the present study also more number of patients had

aggravating factors like smoke 14(46.66%), 13 (43.33%) dust, etc. This holds good

as concerned to the modern literature.

Discussion - 126


Smoking: The numbers of smokers were 13(43.33%). Most of them were

smoking 10-15 cigarettes or 25-30 beedies /day and more than half of the smokers felt

that smoking aggravates their symptoms.

Nidra: Maximum patients had disturbed sleep. It is because of cough which

disturbs their sleep pattern.

Agni & Kosta: Most of the patients had mandagni. Because as excessive Kapha

leads to mandagni. In Kaphaja Kasa, Kapha is the main dosha and in this study

17(56.66%)patients were mrudu (Kapha pradhana) kosta.

Exposure: 16 (53.33%) patients were exposure to aggravating factors during

working hours. In those 9(30%) patients showed reduction in symptoms by change

of place. This clearly shows their exposure to allergens during working.

Prakriti: The sharaeerika prakriti of the patients were analyzed based on the

major physical and behavioral features. In this study it was found that Vatakapha,

Kapha pittaja prakriti persons were more and were more prone to get Kaphaja kasa as

Kapha is dominant in them.

Nidana: In this study 13(43.33%) patients were smokers and 16(53.33%)

patients were working in polluted area. So the dhuma and raja constitutes major role

in production of Kaphajakasa. More than 50% of patients had a history of recurrent

upper respiratory tract infection. Hence it can be considered as nidanarthakarana roga

and Sheeta, Singdha ahara aggravate the condition still more.

Discussion - 127


Puravaroopa: Most of the patients were found Kanta Kandu, Arochaka,

Agnisada, Shooka Poorna Galshayata, Galatalulepa as Purvaroopa. Rests of the

Poorvaroopas were not found.

Roopa: All most all patients were presented with complaint of Kasa,

Nisteevana, Vrahavankshana sampoorna miva (100%). About 19(63.33%) patients

complained of Ashymaduryata, Gourava and 17(56.66%) patients were complained of

Mandagni, Kaphapoorna deha followed by Aruchi in 13(43.33%0 and peensa in

10(33.33%) patients.

RESULTS:

♦ In all the cases appetite was increased from 3rd day onwards and in most of

the cases it has been observed that almost all patients were relieved of

symptoms of Kaphaja kasa within the 15 days after the commencement of

treatment.

♦ Clinical improvement was noticed in almost all patients of Kaphja kasa

with the administration of Kaphaketu rasa. There was significant

reduction in the subjective parameters like Kasa, Nisteevana and symptom

Urahavankshana sampoornamiva at p value < 0.001. Erythrocyte

sedimentation rate was also reduced significantly at p value <0.001.

Though there was a decrease in Total leukocyte count, Absolute eosinophil

count, they were not statistically significant.

Discussion - 128


LIMITATIONS:

Sample size was very small.

The period of study and follow up was limited.

Analysis of only final product was done.

RECOMMENDATION FOR FUTURE STUDY:

Kaphaketu rasa and other yogas mentioned for Kaphaja kasa can be studied

comparatively.

Comparative study of different modes of preparation of Kaphaketu rasa can

be studied.

Analytical estimation can be done at various stages of the preparation of

Kaphaketu rasa.

Present study pattern can be continued in the form of prospective clinical

study with increased sample size.

Conclusion - 129


CONCLUSION

The following conclusions can be drawn from the study:

Kaphaketu rasa is highly effective in reducing the signs and symptoms of

Kaphaja Kasa.

Ingredient of Kaphaketu rasa are in unique combination for samprapthi

vighatana of kaphaja kasa.

Kaphaketu rasa is having expectorant and Mucolytic action.

Kaphaketu rasa is effective in reducing E.S.R levels, which are statistically

highly significant at P < 0.001.

Kaphaketu rasa assays shown 3.52% w/w boron, 5.34% w/w Calcium.

Kaphaja kasa is one of the Pranavaha srotodusthi vyadhi in which

Nishteevana (hyper secretion of mucous) is the predominant feature.

The disease kaphaja Kasa can be correlated with simple and recurrent Chronic

bronchitis.

It can be recommended that Kaphaketu rasa can be employed in Naveean

kaphaja kasa which showed highly encouraging results.

Conclusion - 130


aphaja kasa has been considered to be the cutting edge of the doshic type of

Kasa, which if neglected or mismanaged, may result in poor prognostic conditions of

Kshataja and Kshayaja kasa, which are very difficult to be repaired and patient needs

immediate relief due to its chronicity. Hence in Kaphaja kasa quick relief is essential.

Keeping this in mind to establish the effect of a herbomineral preparation Kaphaketu rasa

on Kaphaja kasa and to observe and identify the preliminary stage of Kaphaja kasa, the

present study entitled “Preparation, Physcio- chemical analysis of Kaphaketu rasa and its

clinical efficacy on Kaphaja kasa”, was selected for the study.

K

Need of the study, hypothesis, objectives and plan of the study is discussed in

introduction.

OBJECTIVES

• Preparation of Kaphaketu rasa.

• Physico-chemical analysis of Kaphaketu rasa.

• To evaluate the clinical efficacy of Kaphaketu rasa in the selected cases of


The review of literature relating to the research topic was done from both

Ayurveda and Modern texts.The historical review, utpatti, nirukti, paribhasha, bheda,

nidana, sadhysadhyata, chikitsa and pathyapathya of the disease Kaphaja kasa and

Chronic bronchitis has been reviewed. An effort has been made to gather references

related to Kaphaja kasa, Kaphaketu rasa and review of the ingredients in the preparation.

Summary - 131


Pharmaceutical study includes Identification and collection of raw drugs, Tankana

Shodhana , Shankha Shodhana, Shankha Marana, Vatsanabha Shodhana, Pippali

choornikarana, Vatsanabha churnikarana, preparation of Ardraka swarasa and

Preparation of Kaphaketu rasa.

The analytical study was conducted for Kaphaketu rasa. In that the Phycsico-

chemical analysis like Organoleptic characters, Size variation,. Weight variation, Total

ash value, Acid insoluble ash, Loss on drying at 110oC, PH study, Test for alkaloids,

Solubility test, Disintegration time, Friability, Assay for Borona and calcium etc., were

done for Kaphaketu rasa.

The clinical study includes selection of patients, Research design, Source of data,

Sampling method, Administration of drug, Study duration, Examination of patients,

Parameters of assessment and Statistical analysis.

Individually the subjective parameters showed most significant than the objective

parameters. In the subjective parameter ‘Nishteevana’ symptom showed more significant

than others and Kasa, Uraha vankshanasampoornamiva symptoms showed significant

results. In the objective parameter the ESR showed more significant than other

parameter with stable effect within the group. The parameter ‘quantity of the sputum’

have uniform affect in the group with high mean net effect. The parameter TC has more

net mean effect with more variation. The parameter AEC does not have uniform effect

on the patient within the group. The statistical analysis revealed that Kaphaketu rasa

showed highly significant in relieving the symptoms and reducing the ESR count.

Summary - 132


Discussion was done on the various aspects of drug Kaphaketu rasa, disease

Kaphaja kasa, Pharmaceutical study, Analytical study, on demographic data like sex

incidence, age incidence, occupation incidence, smoking incidence, chronicity of disease,

past history of recurrent URTI. The rationality behind the Shodhana, Marana and

probable mode of action of Kaphaketu rasa were also discussed.

On the basis of results finally this study concluded that Kaphaketu rasa by virtue

of its ingredients properties, does the Samprapti vighatana and subsides the Kaphaja

kasa.

Summary - 133


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81. Agnivesha, Charaka samhita, Sutrasthana,. Edited by Rajeshwaradatta Shastry, 2nd edn. Varanasi : Choukambha Sanskrit Sansthana ; 1983. Sutrasthana, Chapter 4. Shloka 6. p. 60.





86. Ibid Shloka 45. p.68.



89. Ibid Shloka 10. p. 61.

Bibilography - 139


90. Sushruta, Sushruta samhita,. Edited by Kaviraj Ambikadatta Shastry, 11th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Sutrasthana, Chapter 39, Shloka 22, p.143.


92. Shrimad Vriddha Vagbhata, Astanga Sangraha, Edited by Ravidatta Tripathi, 2nd edn. Varanasi : Choukambha Sanskrit Series ; 1992 Sutrasthana, Chapter 16, Shloka 40. p. 324.

93. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981. Chapter 4, p.275.

94. Bhavamishra, Bhavaprakasha Nighantu. Edited by G.S. Pande., 7th edn. Varanasi : Choukambha Bharati Academy ; 1982 Haritakyadi varga. Sholka 55-58. p. 15.

95. P. V. Sharma, Kaidev Nighantu, 2nd edn. Varanasi : Choukambha Orientalia ; Aoushadhi varga, Shloka 1165-1169. p.215.

96. Bapalal G. Vaidhya, Nighantu Adarsha 1st edn. Varanasi : Choukambha Bharati Academy ; 1985, pippalyadi varga. p.353

97. Pandit Narahari’s Rajanighantu, Edited by Indradeva Tripathi, 2nd edn. Varanasi: Krishnadasa Academy; 1998. Pippalyadi varga, Shloka-11-12. p.135-136.

98. Dhanavantari Nigantu, P. V. Sharma 1st edn. Varanasi: Choukambha Bharati Academy; 1982, Shatapushpadi Varga, Shloka 73. p. 83.

99. Nrupa Madanapala, Madanapala nighantu, edited by Pandith Ramaprasad Vaidhya Upadhyaya, Mumbai : Khemaraja Sri Krishnadas Prakashan ; Shloka 12. p.66.

100. Dr. K. M. Nadakarni’s, Indian Materia Medica Vol-I. Edited by A. K. Nadakarni, 3rd edn. Bombay : Popular Prakashana ; 1982. p.960.

101. J. L. N. Shastri Dravyaguna Vinjnana, Vol II, 1st edn. Varanasi : Choukambha Orientalia ; 2002. Pippali, p.453.

102. Ibid. p.454.

103. Sushruta, Sushruta samhita,. Edited by Kaviraj Ambikadatta Shastry, 11th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Sutrasthana, Chapter 46, p.187.

104. Agnivesha, Charaka samhita,. Edited by Kashinath Shastry, 4th edn. Varanasi : Choukambha Bharathi Academy; 1994. Chikistasthana Chapter 12. Shloka 42, p.363-364.

105. Pandit Narahari’s Rajanighantu, Edited by Indradeva Tripathi, 2nd edn. Varanasi: Krishnadasa Academy; 1998. Pippalyadi varga, Shloka 1. p.135.

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106. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981. Chapter 4, p.276.

107. P. V. Sharma, Kaidev Nighantu, 2nd edn. Varanasi : Choukambha Orientalia ; Aoushadhi varga, Shloka 1166. p.216.

108. Bhavamishra, Bhavaprakasha Nighantu. Edited by G.S. Pande., 7th edn. Varanasi : Choukambha Bharati Academy ; 1982 Haritakyadi varga. Sholka 55-56. p. 16.

109. Dr. K. M. Nadakarni’s, Indian Materia Medica Vol - I. Edited by A. K. Nadakarni, 3rd edn. Bombay: Popular Prakashana ; 1982. p.965.

110. Dhanavantari Nigantu, P. V. Sharma 1st edn. Varanasi: Choukambha Bharati Academy; 1982, Shatapushpadi Varga, Shloka 74. p. 83.


112. Bapalal G. Vaidhya, Nighantu Adarsha, 1st edn. Varanasi : Choukambha Bharati Academy ; 1985, pippalyadi varga. p.354

113. Bhavamishra, Bhavaprakasha Nighantu. Edited by G.S. Pande., 7th edn. Varanasi : Choukambha Bharati Academy ; 1982 Haritakyadi varga. Sholka 58. p. 57.

114. Nrupa Madanapala, Madanapala nighantu, edited by Pandith Ramaprasad Vaidhya Upadhyaya, Mumbai: Khemaraja Sri Krishnadas Prakashan; Shloka 13-15. p.66.

115. P. V. Sharma, Kaidev Nighantu, 2nd edn. Varanasi: Choukambha Orientalia; Aoushadhi varga, Shloka 1167-1169. p.215.

116. Net source Pubmed 12046863. Khajauria A, Thusu N, Zutshia, at M anitoba Institue of cell biology, Winnipeg Canada.

117. Agnivesha, Charaka samhita, Edited by Kashinath Shastry, 12th edn. Varanasi: Choukambha Bharathi Academy; 1996. Chikistasthana, Chapter 23. Shloka 11-12, p.265.

118. Sushruta, Sushruta samhita, Edited by Kaviraj Ambikadatta Shastry, 11th edn. Varanasi: Choukambha Sanskrit Sansthan ; 1997. Kalpasthana Chapter 2, Shloka 5. p. 17.

119. Shrimad Vriddha Vagbhata, Astanga Sangraha, Sutrasthana, Chapter 25, Shloka 5. Edited by Yudunandana Upadhyaya, , 10th edn. Varanasi: Choukambha Sanskrit Pratisansthana; 1996. p. 447.

120. J. L. N. Shastri Dravyaguna Vinjnana, Vol II, 1st edn. Varanasi : Choukambha Orientalia ; 2002. Vatsanabha, p.1.

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121. Dhanavantari Nigantu, P. V. Sharma 1st edn. Varanasi: Choukambha Bharati Academy; 1982, Mishrakadi Varga, Shloka 111. p. 280.


123. Bhavamishra, Bhavaprakasha Nighantu. Edited by G.S. Pande., 7th edn. Varanasi : Choukambha Bharati Academy ; 1982 Dhatwadi varga. Sholka 1. p. 629.

124. Bapalal G. Vaidhya, Nighantu Adarsha, poorvardha, 1st edn. Varanasi : Choukambha Bharati Academy ; 1985, pippalyadi varga. p.354

125. Dattaram Choube, Bhrihat Rasaraja Sundara, 2rd edn. Varanasi : Choukamba Orientalia ; 2000. Vasthanabha. p.213

126. V.G. Neginal, Draveya guna vignana, 1st edn. Bangalore: Publication division, Directorate of ISM and M. Govt. of Karnataka ; 1998 Vasthanabha. p.265-268.

127. K.R. Kirithikar and B.D. Basu, Indian Medicianl Plants, 2nd edn. Dehardun: Bishen Singh, Mahendra pala singh; 1980. p.47-48

128. J. L. N. Shastri Dravyaguna Vinjnana, Vol II, 1st edn. Varanasi : Choukambha Orientalia ; 2002. Vatsanabha, p.11-12.

129. Yogaratnakara. Edited by Shri Laxmipati Shastry. 5th edn. Varanasi: Choukamba Sanskrit Sansthana; 1993. Poorvardha , Shloka 2. p. 165.


131. Acharya Shri Madhava, Ayurveda Prakasha. Edited by Gulraja Sharma Mishra, 3rd edn. Varanasi : Choukamba Bharati Academy ; 1986. Chapter 6, Shloka 17. p. 487.


133. Bhavamishra, Bhavaprakasha Nighantu. Edited by G.S. Pande., 7th edn. Varanasi : Choukambha Bharati Academy ; 1982 Dhatwadi varga. Chapter 7,Sholka 19. p. 630.


135. Ibid.Shloka -18. p. 651.

Bibilography - 142


136. Ibid. p.Shloka -19-25.p. 652

137. Vaidya Yadavaji Trikamji Acharya, Rasamritam. Edited by Damodar Joshi, 1st edn. Varanasi : Choukamba Sanskrit Sansthana ; 1998. Rasayo vignaneeyam. p. 282-283.

138. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981. p.110

139. Yogaratnakara. Edited by Shri Laxmipati Shastry. 5th edn. Varanasi: Choukamba Sanskrit Sansthana; 1993. p. 241.

140. Bhudeb Mookarje, Rasajalanidhi Vol-II, 2nd edn. Varanasi : Shri Gokul Mudranalaya ; 1984.Vatshanabha. p.339.


142. Sushruta, Sushruta samhita,. Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. Kalpasthana Chapter 2, Shloka 12. p. 20.

143. Bapalal G. Vaidhya, Nighantu Adarsha, poorvardha, 1st edn. Varanasi : Choukambha Vidhya Bhavan ; 1981, Vatshanabha varga. p. 4

144. Vaghatacharya, Rasaratna Samuchaya, 9th edn. Editied by Ambikadatta Shastri, Varanasi; Choukambha Amar Bharathi Prakashana; 1998 Chapter -29 Shloka – 145.


146. Krishnan. V.T. Text book of Forenisic medicine and Toxicology, 2nd edn. Delhi: B.Chirchall’s Livingstone Private Limited ; 2002, 12th Chapter. p. 940-942.

147. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981.3rd Chapter p.106.

148. Dhanavantari Nigantu, P. V. Sharma 1st edn. Varanasi: Choukambha Bharati Academy; 1982, Mishrakadi Saptam Varga, Shloka 111. p. 280.

149. Dr. K. M. Nadakarni’s, Indian Materia Medica Vol-I. Edited by A. K. Nadakarni, 3rd edn. Bombay : Popular Prakashana ; 1982. p.23.

150. Sadananda Sharma, Rasatarangini. Edited by Kashinath Shastri, 11th edition. Varanasi : Motilal Banarasi Das; 1979, 24th Taranga, Shloka-64 -66. p. 660.

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151. Pandit Narahari’s Rajanighantu, Edited by Indradeva Tripathi, 2nd edn. Varanasi: Krishnadasa Academy; 1998. Pippalyadi varga, Shloka 27-28. p.139.

152. Restomjee, Indian Meteria Medica, 2nd edn. Delhi: Nearest Publishing House; 1985, p. 600.

153. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981. p.331-334

154. C.K. Kokate, Pharmacognosy, 12th edn. Pune : Nirali Prakashana; 1999, Volatile oils and Trepenoids. P. 285-286.

155. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981.Chapter 5. p.356.

156. C.K. Kokate, Pharmacognosy, 12th edn. Pune : Nirali Prakashana; 1999, Drugs containing glycosides . P. 154.

157. Prof. P.V. Sharma, Dravyaguna vignana, Vol- II. 1st edn. Varanasi : Choukambha Bharati Academy ; 1981.Chapter 5. p.356.

158. Agnivesha, Charaka samhita,. Edited by Kashinath Shastry, 16th edn. Varanasi : Choukambha Orientalia ; 1989. Chikistasthana Chapter 1. Shloka 96-106, p.44-45.

159. Sushruta, Sushruta samhita,. Edited by Kaviraj Ambikadatta Shastry, 16th edn. Varanasi : Choukambha Sanskrit Sansthan ; 2002. Kalpasthana Chapter 43, Shloka 217-221. p. 186

160. Pandit Narahari’s Rajanighantu, Edited by Indradeva Tripathi, 2nd edn. Varanasi: Krishnadasa Academy; 1998. Shloka 8. p.505.

161. Dr. K. M. Nadakarni’s, Indian Materia Medica Vol-II. Edited by A. K. Nadakarni, 3rd edn. Bombay : Popular Prakashana ; 1976. p.232-233.

162. P. V. Sharma Dhanavantari Nigantu, edited by Guru Prasad Sharma 1st edn. Varanasi: Choukambha Bharati Academy; 1982, Suvarnadi Varga,. p. 217.

163. Gopalalan C.et.al Proximate principle common foods, Nutritivve values of Indian Foods, 1st edn. Hydrabad: Naitional Institute of Nutrition; 1999 p. 112.

164. K.C. Churukar and Gange Sahay Pandey, Bhavaprakash Nighantu, 9th edn. Varanasi : Choukambha Bharati Academy; 1993. p. 317-320.

165. Agnivesha, Charaka samhita, , Edited by Rajeshwaradatta Shastry, 4th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1994 Vimanasthana, Chapter 5 Shloka 7. p. 7-10

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166. Sushruta, Sushruta samhita, Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. Sharirasthana, Chapter 9, Shloka 12. p. 71.

167. Pandit Ramagovinda Trivedi, Rigveda Samhita, Delhi Choukambha Sanskrit Prastistan ; 1992. Chapter 8 Astam Astaka 161 Shookta p. 1447.

168. Agnivesha, Charaka samhita,. Edited by Kashinath Shastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Chikistasthana Chapter 18. Shloka 1-190, p.554-578.

169. Sushruta, Sushruta samhita, Edited by Kaviraj Ambikadatta Shastry, 13th edn. Varanasi : Choukambha Sanskrit Sansthan ; 2000. Sharirasthana, Shloka 1-52. p. 382-392.

170. Haritha, Haritha Samhita, Edited by Ramavalamba Shastri, Varanasi: Prachy Prakashana; 1985 p. 279.

171. Vriddha Jeevaka, Kashyap Samhita, Chikitsasthana, Edited by Hemaraj Sharma, 3rd edn. Varanasi : Choukambha Sanskrit ; Rajayakshma Chikitsadhyaya,. p.108-111.

172. Vagbhata, Astanga Hridaya, Edited by Vaidya Yadunandana Upadhyaya, 11th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1993. Sutrasthana, Chapter 3 p. 304.

173. Arunadatta, Astanga Hridaya, Sarvanga sundhari commentary, Edited by Pt. Harisadashiva Shatry Paradakara Bhisagacharya, 6th edn. Varanasi : Choukambha Orientalia ;1997. Chapter 3 Shloka 1-180. p. 585-602.

174. Madhavakara, Madhava Nidana,. Edited by Sudarshana Shastry, 25th edn. Varanasi: Choukambha Sanskrit Sansthan ; 1996. Poorvardha Chapter 11 p. 271-280

175. Vaidhya Shodala, Gandnigraha, edited by Gangasahaye Pandeya, Chikitsa Kanada 2nd part 1st edn. Varanasi: Choukambha Sanskrit Series; 1969 Chapter 10 Sholka 1-99. p. 332-356.

176. Pandit Narahari’s Rajanighantu, Edited by Indradeva Tripathi, 2nd edn. Varanasi: Krishnadasa Academy; 1998.Rogadhi varga Shloka 3. p.618

177. Sharangadhara, Sharangadhara Samhita, Edited by Radha Krishna Parashara, 3rd edn. Varanasi : Choukambha Orientalia ; 2003.Roga Ganana Prakarana p.135.

178. Bhavamishra, Bhavaprakasha,. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan; Kasarogadhikara Chapter 12, Shloka 1 p.147-155.

179. Yogaratnakara. Edited by Indradev Tripati. 5th edn. Varanasi: Choukamba Krishnadas Academy ; 1998 Kasa Chikitsa Shloka 1-200 p. 317-335.

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180. Vaghatacharya, Rasaratna Samuchaya, 9th edn. Editied by Ambikadatta Shastri, Varanasi; Choukambha Amar Bharathi Prakashana; 1995 Kasa. p. 230-234.

181. Shri. Govindadas, Bhaishajya Ratnavali. Edited by Ambikadatta Shastry, 7th edn. Varanasi : Choukamba Sanskrit Sansthana ; 1983, Chapter 5 Jwara Chikitsa, Shloka-1-224. p. 315-329.

182. Deva.R.K., Shabda Kalpadruma, part II, Varanasi : Choukamba Sanskrit Series office. P.25.

183. Sushruta, Sushruta samhita, Edited by Kaviraj Ambikadatta Shastry, 8th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. Sutrasthana,Chapter 21 Shloka 5. p. 87.

184. Sushruta, Sushruta samhita, Edited by Kaviraj Ambikadatta Shastry, 6th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1987. Uttarkhanda, Chapter 52, Shloka 5. p. 382.

185. Chakrapanidatta, Charaka samhita, Ayurveda Deepika commentary, Chikitsasthana, Chapter 18. Shloka 8. Edited by Vaidya Yadavaji Trikamji Acharya Varanasi : Choukambha Surabharati prakashana ; 1992. p. 455.

186. Gangadhar Commentry Charaka Samihta Chaturta khanda, Shree Narendranath Sengupta, Varanasi : Choukambha Orientalia: 1991, Chapter 18, Shloka 8. p.30-34.

187. C. Dwarakanath, Introduction to Kayachikitsa, 2nd edn. Varanasi : Choukambha Orientalia: 1996. p.218

188. Agnivesha, Charaka samhita,. Edited by Kashinath Shastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Chikistasthana Chapter 18. Shloka 8, p.454.


190. Sushruta, Sushruta samhita, Dalhana commentary, Chikitsasthana, Edited by Kaviraj Ambikadatta Shastry, 4th edn. Varanasi : Choukambha orientalia ; 1980. Chapter 52, Shloka11. p. 765.

191. Madhavakara, Madhava Nidana,. Edited by Sudarshana Shastry, 25th edn. Varanasi: Choukambha Sanskrit Sansthan ; 1996. Poorvardha Chapter 11 p. 303.

192. Shastri R.G, Vedome Ayurveda, Madana Mohanalal Delhi: Ayurvedic anusandhana trust; P.100.

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194. Ibid, Shloka 4 p. 454


196. Vagbhata, Astanga Hridaya,. Edited by Kaviraj Atridev Gupta, 10th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1992. Nidanasthana, Chapter 3, Shloka 18. p. 229.

197. Haritha, Haritha Samhita, Edited by Ramavalamba Shastri, Varanasi: Prachy Prakashana; 1985 p. 280



200. Bhavamishra, Bhavaprakasha,. Edited by Bhishagrashro Bhramhashankara Mishreshastry, 5th edn. Varanasi: Choukambha Sanskrit Sansthan; Chikitsasthana Kasarogadhikara Chapter 12, Shloka 1 p.146.

201. Madhavakara, Madhava Nidana,. Edited by Sudarshana Shastry, 25th edn. Varanasi: Choukambha Sanskrit Sansthan ; 1996. Poorvardha Chapter 11, Shloka 1. p. 303.

202. Yogaratnakara. Edited by Indradev Tripati. 5th edn. Varanasi: Choukamba Krishnadas Academy ; 1998 Kasa Prakarana Shloka 1.p. 317.

203. Vaidhya Shodala, Gandnigraha, edited by Gangasahaye Pandeya, Chikitsa Kanada 2nd part 1st edn. Varanasi: Choukambha Sanskrit Series; 1969 Chapter 10 Sholka 2. p. 332.



206. Shrimad Vriddha Vagbhata, Astanga Sangraha, Edited by Ravidatta Tripathi, 10th edn. Varanasi : Choukambha Sanskrit Pratisansthana ; 1996. Nidanasthana, Chapter 3 ,Shloka 21. p164.

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210. Vaidhya Shodala, Gandnigraha, edited by Gangasahaye Pandeya, Chikitsa Kanada 2nd part 1st edn. Varanasi: Choukambha Sanskrit Series; 1969 Chapter 10 Sholka 5 p. 334.

211. Agnivesha, Charaka samhita,. Edited by Kashinath Shastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Chikistasthana Chapter 18. Shloka 18-19, p.456.


213. Shrimad Vriddha Vagbhata, Astanga Sangraha, Edited by Ravidatta Tripathi, 10th edn. Varanasi : Choukambha Sanskrit Pratisansthana ; 1996. Nidanasthana, Chapter 3 ,Shloka 32-33. p165.




217. Vaidhya Shodala, Gandnigraha, edited by Gangasahaye Pandeya, Chikitsa Kanada 2nd part 1st edn. Varanasi: Choukambha Sanskrit Series; 1969 Chapter 10 Sholka 8 p. 335.

218. Agnivesha, Charaka samhita,. Edited by Kashinath Shastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Chikistasthana Chapter 18. Shloka 6-8, p.455.

219. Ibdi, Shloka 133 p. 470

220. Ibdi, Shloka 4 p. 454

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221. Shrimad Vriddha Vagbhata, Astanga Sangraha, Edited by Ravidatta Tripathi, 10th edn. Varanasi : Choukambha Sanskrit Pratisansthana ; 1996. Nidanasthana, Chapter 3 ,Shloka 45 p167.

222. Yogaratnakara. Edited by Indradev Tripati. 5th edn. Varanasi: Choukamba Krishnadas Academy ; 1998 Chapter 17 .p. 319.



225. Shrimad Vriddha Vagbhata, Astanga Sangraha, Edited by Ravidatta Tripathi, 10th edn. Varanasi : Choukambha Sanskrit Pratisansthana ; 1996. Nidanasthana, Chapter 3 ,Shloka 44p166

226. Yogaratnakara. Edited by Indradev Tripati. 5th edn. Varanasi: Choukamba Krishnadas Academy ; 1998 Chapter 17 .p. 318

227. Agnivesha, Charaka samhita,Chakrapani Edited by Kashinath Shastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Chikistasthana Chapter 18. Shloka 4, p.454.


229. Agnivesha, Charaka samhita,Chakrapani Edited by Kashinath Shastry, 5th edn. Varanasi : Choukambha Sanskrit Sansthan ; 1997. Chikistasthana Chapter 18. Shloka 10-12, 14-16,20-23,24-30. p.455-457.

230. Ibid. Chapter 8. Shloka 19. p.228.

231. Ibid. Chapter 18. Shloka 133. p.470.

232. Yogaratnakara. Edited by Indradev Tripati. 5th edn. Varanasi: Choukamba Krishnadas Academy ; 1998. Kasa chikitsa shloka – 41. .p. 321.

233. Ibid. Shloka- 198-200. p.334.

234. Shri. Govindadas, Bhaishajya Ratnavali. Edited by Ambikadatta Shastry, 11th edn. Varanasi : Choukamba Sanskrit Sansthana ; 1996, Chapter 15. Shloka-116 - 224. p. 329.

235. Toratora’s Principles of Anotomy and Physiology. 7 th edn.

236. ASPIF. Golwall, medicine for students. 7th edn. Mumbai : Published by Dr. A. F. Golwalla empress court, Eros building Church gate ; Inflammation of the Bronchial tree. P .209.

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237. Douglas

238. Davidson’s Principles and Practice of medicine, Nutrition, Metabolism and Environmental diseases. 10th Chapter. Edited by CRW Edwards. 7th edn. London : Churchil Livngstone Publications ; 1995. p. 332.

239. Kumar Cotran Robbins, Basic Pathology, 6th edn. London: Published by Hercourt Asia Pvt. LTD ; 1999.

240. ASPIF. Golwall, medicine for students. 7th edn. Mumbai : Published by Dr. A. F. Golwalla empress court, Eros building Church gate ; Inflammation of the Bronchial tree. P .210.

241. Henry N, Ginsburg, Ira J. Goldburg, Harrison’s Principles of International Medicine, volume II. 14th edn. New York. : Mc Graw Hill Companies 1998. p. 1455-1456.

242. API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai: Association of Physicians of India ; 1999. Respiratory Diseases. p.232-233.

243. Makolkin, Internal Diseases, Moscow : Mir publishers,2 pervy Rizhsky pereulok 1-110, GSP ; P.42-46, 49.

244. MRC, Definition and classifications of Chronic bronchitis for clinical and epidemiological purposes , Lancet I, 1965. p.776.

245. API text book of medicine, Edited by G. S. Sainani, 6th edn. Mumbai: Association of Physicians of India ; 1999. Respiratory Diseases. p.232.

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SPECIAL CLINICAL TRIAL PERFORMA FOR KAPHAJA KASA

POST GRADUATE AND RESEARCH CENTER (RASASHASTRA)

SHRI D. G. M. AYURVEDIC MEDICAL COLLEGE, GADAG.

Guide : Dr.B.Dilip Kumar M.D (Rasashastra) R. B. Pattanashetti P.G.Scholar Co-guide: Dr.G.N.Danappagoudar. M.D.(Rasashastra) Sl.No. 1.Name of the patient: O.P.D. No. 2.Father’s Name/ Husband’s Name: D.O.I. D.O.C 3.Age: yrs Male Female 4. Sex:

Hindu Muslim Christian Others 5. Religion: Married Unmarried 8.Marital status:

6.Educational status: Labour Student Executive Sedentary 7.Occupation

Poor Middle Higher 7.Economical status : 8.Marital status: Married Unmarried 9.Address: Tel-

Well responded Moderately responded Not responded Discontinued 10. Result:

Consent: I -------- -------- Son / Daughter / Wife of----------- Exercise my free will in the said

study, I have been informed to my satisfaction by attending the purpose of the clinical

evaluation and nature of drug treatment. I am also aware of my right to quit at any time during

the schedule.

Patient’s Signature

A) PRADHANA VEDANA

Sl.No. Complaints P/A Duration 7th 14th 21st F7 F15 1 Kasa 2 Nishteevana

a.Ghana kapha b.Snigdha ghana kapha c.Bahula snigdha Ghana kapha

4 Uraha vanksha sampoornamiva 5 Kapha poorna deha 6 Asya madhurata 7 Mandagni 8 Aruchi 9 Gourava 10 Peenasa 11 Utklesha 12 Lomaharsha 13 Kleda 14 Shiroruja

B) ANUBANDHA VEDANA (SAVADHI) : C) VEDANA VRITTANTA: SPECIFIC ENQUIRES IN FOLLOWING HEADINGS: Condition of work place: Polluted

Non polluted Mode of onset: Sudden Gradual Insidious Course: Episodic Continuous Initially episodic

Duration: Cough:

Dry Productive Day On rest On activity Night

Thin mucoid (Ghana kapha) Thick frothy (Ghana kapha) Mucous & sticky (Snigdha Ghana) Muco purulent ( Bahula snigdha Ghana)

In case of productive cough Nature of sputum :

Aggravating Dust Food Smoke Animals Pollens

Cosmetics Drugs Weather Sheeta ahara Others factors: D) POORVA VYADHI VRITTANTA. History of recurrent URTI Yes No E) CHIKITSA VRITTANTA: F) KOUTUMBIKA VRITTANTA:

Incidence of chronic respiratory disorder In family Not in family

G) OCCUPATIONAL HISTORY

Yes No o Work involving any mental strain.

Yes No o Exposure to any aggravating factors during working hours.

Yes No o Whether symptoms produced during working hours.

o Whether symptoms relieved by change of place. Yes No H) PRASUTI VRITTANTA: If the patient is female

Abortions Operation

Age of menarche Age of menopause

Rutusrava vrittanta Artava pravritti Day Sama Alpa Adhika

H) VAYAKTIKA VRITTANTA: 1) Ahara: Vegetarian Mixed diet Dominant Rasa in food 2) Vyasana: Smokers

Non smokers Coffee Tobacco Alcohol Tea

Vishama Alpa Anidra Sama 3) Nidra:

Mandagni Vishamagni Teekshnagni Samagni 4) Jataragni bala:

Mridu Madhyama Teekshna 5) koshta I) ROGI PAREEKSHA: ASHTASTHANA PAREEKSHA:

Nadi Shabdha Mala Sparsha Mootra Drika Jivha Akruti

SAMANYA PAREEKSHA:

Pulse rate bpm Blood Pressure mm of Hg Respiration rate /min Height Cms Temparature oF Weight Kg Heart rate /min

DASHAVIDHA PAREEKSHA: 1)Shareera prakriti: V P K VP KP VK VPK

2)Manasa prakriti: V P K VP KP VK VPK

Pravara Madhyama Avara 3) Sara:

4) Samhanana: Pravara Madhyama Avara

5) Satmya: Pravara Madhyama Avara

Pravara Madhyama Avara 6) Satwa: 7)Vyayama shakti: Pravara Madhyama Avara 8) Vaya: Bala Youvana Vrudda 9) Desha: Jangala Anupa Sadharana

10) Akriti:

J. SYSTEMIC EXAMINATION: RESPIRATORY SYSTEM EXAMINATION. I) DARSHANA Nasa: Polyps Inflammation Mukha:(mouth). Kantha:(neck):

Normal Enlarged Lymph nodes: Tonsilar:

Normal Enlarged Peritonsilar.

Normal Enlarged Cervical. Accessory Muscles: Normal Overactive Engorged viens: Present Absent Uraha: (Chest)

Normal Abnormal Shape: Respiration rate Character Rhythm

Chest movements: Abdominal Thoracic Thoraco abdominal

II) SPARSHANA:(PALPATION): Trachea: Central Shifted to Supraclavicular LN: Normal Enlarged Axillary LN: Normal Abnormal

Measurment Expiration Inspiration Chest expansion: Vocal fremitus: Normal Increased Decreased Tenderness: Present Absent III) AKOTANA:(PERCUSSION):

Normal note Dull note Strong dull note Hyper resonant note

IV) SHRAVANA:(ASCULATION): Breath sounds: Intensity: Normal Reduced Increased Type of breathing: Vesicular Bronchial Broncho vesicular If branchial type:

Tubular Cavernous Amphoric

Vocal resonance: Normal Increased Decreased Absent

Rales P/A If present Fine Course Added sounds: Rhonchi P/A If present Inspiration Expiration Pleural rub Present Absent Stridor: Laryngeal P A Tracheal P A 2) CARDIOVASCULAR SYSTEM: 3) GASTRO INTESTINAL SYSTEM:

4) OTHER SYSTEMS: 5) EXAMINATION OF SROTAS:- 1) Symptomatology of disordered Pranavaha srotas:

1 Atisristam 4 Alpalpam 2 Atibaddam 5 Abheeksham 3 Kupitam 6 Sashoolam

2) Symptomatology of disordered Rasavaha srotas:

Sl.No Symptoms P/A Sl.No. Symptoms P/A 1 Asradda 9 Jwara 2 Aruchi 10 Tama 3 Asyavairasyam 11 Pandutwa 4 Arasajnata 12 Sada 5 Hrillasa 13 Krishangata 6 Gourava 14 Agninasha 7 Tandra 15 Trupti 8 Angamarda 16 Hridroga

VIKRITITAHA PAREEKSHA:

NIDANA:

Sl.No. Ahara P/A Sl.No. Vihara P/A 1 Bojyamana Vimargagamana 1 Dhoompaghata 2 Guru Abhishyandi

Ahara sevana 2 Raja sevana

3 Madura rasa sevana 3 Veganam avarodha

4 Sheetahara sevana 4 Diwa swapna

5 Asatmyahara sevana 5 Avyayama

6 Snigdha ahara sevana 6 Kshavathu dharana

POORVA ROOPAM:

Shookapooma Galasyata Arochaka Kante Kandu Galatalu lepa Bhojyanam avarodha Agnisada Swara

ROOPA:

Kasa with ghana kapha Gourava. Bahula madhura snigdha kapha. Peenasa. Kapha poorna deha Shiroruja Aruchi. Utklesha.

SAMPRAPTI:

Dosha Dushya Adhistana Srotas Srotodusti Rogamarga

UPASHAYA & ANUPASHAYA:

Upashaya Anupashaya

UPADRAVA:

Jwara Hrillasa Kshaya Arochaka Swarabheda

ARISTA LAKSHANAS: SADHYASADHYATA: LAB INVESTIGATIONS:

Before After DC Before After Hb % gm % gm % N % % ESR mm/h mm/h E % % RBS mg/dl mg/dl B % % TC % % M % % AEC Cells/Cumm Cells/Cumm L % % Sputum for AFB

URINE ROUTINE:

Before After Albumin Microscopic Sugar

X-ray reading: Chest PA view: Before : After : CHIKITSA: YOGA : KAPHA KETU RASA

a) Posology - 1/2 ratti (62.5mg) bid

b) Anupama - Madhu

DURATION OF TREATMENT : 21 days . FOLLOW UP -15 days

PATHYA: APATHYA: ASSESSMENT OF RESULTS: SUBJECTIVE PARAMETERS:

Sl.No. Complaints 0st day 7th day 15 days 21st F15 1 Kasa 2 Nishteevana 3 Urahavankshana

sampoorna miva

4 Quality of sputum OBJECTIVE PARAMETERS:

Sl.No Investigation 0th day 21st day 1 ESR 2 TC 3 DC 4 AEC

Aggrivation of Symptoms after exposure to Present Absent Nidana

Investigator’s note: Signature of Co - Guide Signature of Guide

For the purpose of assessment the signs and symptoms were graded as follow

i) Kasa (cough) Grade

o No Complaints - 0 o Intermittent cough - 1 o Constant cough - 2 o Worsened cough - 3

ii. Nishteevana (Expectoration)

o No Expectoration - 0 o Thick expectoration - 1 o Mucoid & sticky expectoration - 2 o Mucopurulent - 3

iii. Uraha vankshana sampoornamiva

o No feeling of Heaviness - 0 o Heaviness relieved completely


o Heaviness relieved slightly With expectoration - 2

o Heaviness not relieved with Expectoration - 3

• Comparing the objective parameter values of Quantity of sputum, TC, DC, ESR and AEC before and after treatment.

• Quantity of sputum was graded as below:

o No sputum - 0 o Less than 2.0ml - 1 o 2.0 – 4.9 ml - 2 o 5.0 to more ml - 3

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Kaphaketuras kaphajakasa rs003-gdg