Tamaka swasa kc038gdg

EVALUATING THE EFFICACY OF BRIHAT KATPHALADI

YOGA IN COMPARISON WITH VYOSHADI GUTIKA NITYA

SHODHANA IN TAMAKA SWASA

By

UMESH. S. KUMBAR Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial f

Ayurved

KaUnd

Dr. Shiva RamM.D. (Ayu) (Os

DepartmPost Grad

ReseaD.G. MELMALAGI AYURV

ulfilment of the degree of

a Vachaspati M.D. In

yachikitsa er the Guidance of

a Prasad Kethamakka m) M.A. (Jyotish), [Ph.D (Jyotish)]

ent of Kayachikitsa uate Studies & rch Centre EDIC MEDICAL COLLEGE, GADAG 2004-2007

Ayurmitra

TAyComprehended

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “EVALUATING

THE EFFICACY OF BRIHAT KATPHALADI YOGA IN COMPARISON WITH

VYOSHADI GUTIKA NITYA SHODHANA IN TAMAKA SWASA” is a bonafide

and genuine research work carried out by me under the guidance of Dr. SHIVA

RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D

(Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag.

Date

Place

(Umesh. S. Kumbar)

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE

GADAG - 582 103

This is to certify that the dissertation entitled “EVALUATING THE EFFICACY OF

BRIHAT KATPHALADI YOGA IN COMPARISON WITH VYOSHADI GUTIKA NITYA

SHODHANA IN TAMAKA SWASA” is a bonafide research work done by Umesh. S.

Kumbar in partial fulfilment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

Dr. SHIVA RAMA PRASAD KETHAMAKKAM.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D (Jyotish)]

GuideREADER IN KAYACHIKITSADGMAMC, PGS&RC, Gadag

Date:

Place: Gadag

Siva Ram Prasad

Prof.Dr. K.Shiva Rama Prasad

Siva Ram Prasad

Note

Accepted set by Siva Ram Prasad

Dr.K. Shiva Ram Prasad

Approved

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103

Endorsement by the H.O.D, Principal/ head of the institution

This is to certify that the dissertation entitled “EVALUATING THE

EFFICACY OF BRIHAT KATPHALADI YOGA IN COMPARISON WITH

VYOSHADI GUTIKA NITYA SHODHANA IN TAMAKA SWASA” is a bonafide

research work done by Umesh. S. Kumbar under the guidance of Dr. SHIVA

RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm) M.A. (Jyotish), [Ph.D

(Jyotish)], Reader in Kayachikitsa, DGMAMC, PGS&RC, Gadag, in partial fulfilment

of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D.

(Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore,

Karnataka.

. DP

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place:

(Dr. V. Varada charyulu) Professor & HOD

Dept. of Kayachikitsa PGS&RC

ate: lace: Gadag

Copy right

Declaration by the candidate

I here by 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 the academic / research

purpose.

Date

Place

(Umesh. S. Kumbar)

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement

Any research is not an individual effort. It is a contributory effort of many hearts and

hands and heads. I am very much thankful to the subjects of this study.

My deep senses of gratification to my inspirations of this study are my parents,

Shivarudrappa and Veeravva and my brother Dr.Mallikarjun, who are architects of my

career.

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

respected guide Dr. K.Shiva Rama Prasad, M.D., C.O.P. (German), M.A., [Ph.D.] Jyotish,

Professor, Department of Kayachikitsa, for his guidance and timely help.

I express my gratitude to Dr. V.V.Varadacharyulu M.D. (Ayu), Goldmedalist,

Professor and H.O.D of Kayachikitsa for his advice and encouragement in every step of this

work.

I am sincerely gratefulness to Dr.G.B.Patil, Principal, for his encouragement and

providing all necessary facilities for this research work

I extend my gratitude to Dr. R.V.Shettar, Dr.P. Shivaramudu, Dr. G.

Purushottamacharyulu, Dr.M.C.Patil, Dr. G.Danappagoudar, Dr.S.H.Doddamani,

Dr.S.N.Belawadi, Dr.Nedugundi, Dr.Samudri, Dr, Kubersankh. Dr.Mulgund, Dr.J.Mitti,

Dr.Mulki Patil, Dr. Yasmin A.P. and all my U.G. Lecturers for time-to-time help offered by

them.

I express my immense gratitude to my statistician Nandakumar, librarian V.B.

Mundinamani and assistant Sureban for facilitating me in collection and production of my

thesis.

Last but not least I express my deepest thankfulness whose names are not taken here

but helped me a lot along with my kith and kins Dr. Shanta and Prasanna.

Dr. Umesh. S. Kumbar

Table of contents Evaluation of the efficacy of Brihat

Katphaladi yoga and

Vyoshadi Gutika in Tamaka Swasa

Chapter Heading Page Numbers

1 Introduction 1 to 4

2 Objectives 5 to 8

3 Literature Review 9 to 56

4 Methodology 57 to 68

5 Results 69 to 110

6 Discussion 111 to 127

7 Conclusion 128 –130

8 Summary 131

9 Bibliographic References 1-11

10 Annex – Case sheet 1-7

Figures of Evaluation of the efficacy of Brihat Katphaladi yoga and Vyoshadi Gutika in Tamaka Swasa

Page

Numbers

1 Schematic diagram of Samprapti of Tamaka Swasa 28

2 Internal medicine – ingredients of Brihat Katphaladi yoga 47

3 Nitya Shodhana Vyoshadi Gutika Ingredients 52

Tables Evaluation of the efficacy of Brihat Katphaladi yoga and Vyoshadi Gutika in Tamaka Swasa

Page

Numbers

1 Nidana of Tamaka Swasa 14-15

2 Porva Roopa of Tamaka Swasa 22

3 Roopa (Lakshana) of Tamaka Swasa 24-25

4 Vyavachedaka Nidana of Tamaka Swasa 34

5 Pathya in Tamaka Swasa 43-45

6 Apathya in Tamaka Swasa 45-46

7 Internal medicine – ingredients of Brihat Katphaladi yoga 47

8 Nitya Shodhana Vyoshadi Gutika Ingredients 52

9 Table showing the demographic data of Group –A 70

10 Table showing the demographic data of Group -B 70

11 Distribution of patients by Age- gender in Groups – A & B 71

12 Results of Patients by Age in Group - A 71

13 Results of Patients by Age in Group - B 72

14 Results of patients by Gender in Group - A 72

15 Results of patients by Gender in Group - B 73

16 Distribution of patients by Religion in Groups – A & B 74

17 Results of patients by Religion in group - A 75

18 Results of patients by Religion in group - B 75

19 Distribution of patients by Occupation in Groups – A & B 76

20 Results of patients by occupation in Group -A 77

21 Results of patients by occupation in Group -B 77

22 Distribution of patients by Economical status in Groups – A & B 78

Tables Evaluation of the efficacy of Brihat Katphaladi yoga and

Vyoshadi Gutika in Tamaka Swasa – continued

Page

Numbers

23 Results of patients by Economic status in Group –A 78

24 Results of patients by Economic status in Group -B 79

25 Distribution of patients by Food Habits in Group – A & B 80

26 Patients enlisted by presenting complaints in Group –A & B 82

27 Distribution of patients by Associated features Group –A & B 83

28 Results of patients by mode of on set group –A 84

29 Results of patients by mode of on set group -B 85

30 Distribution of patients by course of on set groups A & B 86

31 Distribution of patients by frequency of attack in Group – A & B 87

32 Distribution of patients by duration of attack in Group – A & B 87

33 Distribution of patients by mode of progress in Group – A & B 88

34 Distribution of patients by periodicity in Group – A & B 88

35 Distribution of patients by preceding factors in Group – A & B 88

36 Distribution of patients by aggravating factors in Group – A & B 89

37 Distribution of patients by comfort posture at attack in Group – A & B 89

38 Distribution of patients by Agni in Group – A & B 90

39 Distribution of patients by bowel habits in Group – A & B 90

40 Distribution of patients by Addiction in Group – A & B 91

41 Distribution of patients by Prakruti in Group – A & B 91

42 Distribution of patients by Dosha Vruddhi` 92-93

43 Distribution of patients by Dosha Kshaya 94

44 Distribution of patients by Ahara Nidana 95

45 Distribution of patients by Vihara Nidana 96

46 Distribution of patients by Anya Nidana 97

47 Distribution of patients by srotas 98

48 Distribution of patients by poorva roopa 99

Tables Evaluation of the efficacy of Brihat Katphaladi yoga and

Vyoshadi Gutika in Tamaka Swasa – continued

Page

Numbers

49 Subjective parameter assessment Group – A 100

50 Subjective parameter assessment Group – B 101

51 Table showing the Objective parameters of Group –A 102

52 Table showing the Objective parameters of Group –B 103

53 Mean of Objective parameters of Group –A & B 103

54 Statistical assessment of Group – A subjective parameters 104

55 Statistical assessment of Group – B subjective parameters 105

56 Statistical assessment of Group – A Objective parameters 106

57 Statistical assessment of Group – B Objective parameters 106

58 Comparative statistical assessment of Groups subjective parameters 107

59 Comparative statistical assessment of Groups Objective parameters 108

60 Over all assessment and Result of Group-A & B 110

Graphs of Evaluation of the efficacy of Brihat Katphaladi yoga and

Vyoshadi Gutika in Tamaka Swasa

Pages

1 Distribution of patients by Age – Gender in Groups – A & B - Pictorial

presentation

73

2 Distribution of patients by Religion in Tamaka Swasa 74

3 Distribution of patients by Occupation 76

4 Distribution of patients by Economic status 80

5 Distribution of patients by food habits in Tamaka Swasa 81

6 Graphical presentation of patients by presenting complaints in Group – A & B 82

7 Graphical presentation of patients by Associated features in Group – A & B 84

8 Graphical presentation of patients by Mode of onset in Group – A & B 85

9 Graphical presentation of patients distribution by course of onset in Group – A & B

86

10 Over all assessment and Result of clinical trail 110

Abstract “Evaluating the efficacy of Brihat Katphaladi yoga in comparison with Vyoshadi

Gutika Nitya Shodhana in Tamaka Swasa”

Key words: Tamaka Swasa, Asthma, Swasa Roga, PEFR, AEC, Nitya Shodhana, BHT,

Tamaka Swasa vis-à-vis Bronchial asthma is one of the important diseases pertaining

to the respiratory disorder is a sub type of Swasa roga affects the people of all age groups.

The objectives of the study are – evaluating the Tamakaswasa haratwam (Anti

asthmatic effect) of Brihat Katphaladi yoga and Vyoshadi gutika Nitya shodhana by

assessing the Broncho-dilatory effect through pulmonary function test - Peak Expiratory

Flow Rate. In further Anti asthmatic effect and Broncho- dilatory effect in Group A and

Group B are compared. Simple random sampling technique - comparative clinical trial is

adopted here under two groups to test the significance.

The imbalance of Vata and Kapha Dosha afflicts the Rasa Dhatu in the pathogenesis

of Tamaka Swasa, treated with “Tamaketu Virechanam” other wise understood, as Nitya

Shodhana administration. Teevra vega Swasa and Ghurgurukatwam is pratyatma niyata

lakshana of Tamaka Swasa observed 100% in all patients. Statistically all subjective and

objective parameters in both Groups individually are Highly significant except

Kantodhwamsa, which is Non Significant. But in comparison Vyoshadi Gutika Nitya

Shodhana and Brihat Katphaladi Yoga internally doesn’t show any marked significance

suggests that both drugs on their respective places are the best in action.

Thus Vyoshadi Gutika Nitya Shodhana and Brihat Katphaladi Yoga internally at

Tamaka Swasa are best recommended drugs with their requisite actions.

Chapter - 1

Introduction

reathing is one of the normal physiological functions of body starts with birth

and en

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disease

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effectiv

Purgati

with B

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present

B
ds with death. Pranavata and Apanavata are responsible for the breathing in and
ng out 1. To and fro movement of air through the Pranavaha Srotas is the vital sign of

.

Normalcy of breathing in and breathing out suggests health and abnormality indicates

s and its cessation indicates death 3. This is the unique sign of life, is affected in the

Tamaka Swasa 4. The disease Tamaka Swasa has been mentioned in the classics. Its

ities with the bronchial asthma according to the contemporary sciences are well known.

Heat and dust are the factors developed by urbanization and industrialization made the

life hazardous. Apart from so many allergic factors, which are present in the

here, are spreading incidences of Tamakaswasa throughout the globe. Controlling

actors can make a prophylaxis for the disease, but it is necessary to offer natural

e non chemo-therapeutic management modalities for the ailed.

Thus the present study was designed on the bases of “tamaketu virechanam”,

on, as a Shodhana therapy to relieve the doshas. The effect of Shodhana is compared

rihat Katphaladi yoga palliative management i.e. Pitta sthana samudbhava Dosha

tion with pacification of disease.

The presentations of the Pranavaha Srotas disorders are more emblematic. They

s with generation of a variety of abnormal musical sounds. The organ of breathing also

Introduction of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

1


2

the producer of the vital sign of life turns into a musical box. It produces all sorts of music,

which is never melodious; rather it is the cry of the organ heading towards complete failure

for want of air. Among which Tamaka Swasa is one, well known for its episodic chronic

course 5. In modern parlance this illness is best compared to Bronchial asthma.

Effect of pollution on human beings

The incidence of Swasa as a disease is an increased at the present time due to various

reasons like, environmental pollutions, altered food habits; changed life style, stress and

strain, etc are discussed in detail at the literary review.

Asthmatic patients seem to be recovered completely after an attack. However there

can be a phase in which patient experiences some degree of airway obstruction daily in

unusual circumstances 6. Acute episodes can cause death. Hence respiratory diseases are

responsible for the major burden for morbidity and mortality.

Prevalence

Tamaka Swasa vis-à-vis Bronchial asthma is one of the important diseases pertaining

to the respiratory disorder. It affects the people of all age groups 7. Some times it is severe and

fatal also. It is the serious public health problem in the countries through out the world.

Nearly 5 to 10% of the world population at some stage during life suffers from asthma 8. The

disease can occur at any age and affects 5% of adults and 7-10% children commonly 9.

Between 100 and 150 million people around the globe, suffer from asthma and this

number is rising. Worldwide, deaths from this condition have reached over 180,000 yearly 10.

Tamaka Swasa is also generally comes in proximal attacks and one has to manage the attack

immediately 11. Tamaka Swasa if not treated properly it will kill the patients like the fire burns

the dried bush even though it is a Yapya Vyadhi, it become Sadya if it is Navothitha 12.


3

Aim of study

So many research works have been curried out in relation to Shodhana and Shamana

treatments as mentioned in classics and their therapeutic effect is proved. Present research

work is intended to evaluate the comparative therapeutic effect of herbal combinations used as

different line of treatments.

About concept

The word Tamaka Swasa in terms of ‘Asthma’ is derived from the Greek word.

Meaning is panting or gasping. Commonly it can be said as difficulty in breathing wherever it

is present it cannot be said as asthma. The prefix bronchial specifies that the basic problem

will be in tracheo-bronchial tree. By these two word we can definitely say that any problem in

the tracheo-bronchial tree produces difficulty in breathing i.e., bronchial asthma.

For the prevention and cure of this major disease so many remedies are mentioned by

the Acharyas like, Snehana, Swedana, kaphotkleshakara ahara, Shodhana, shamana,

dhoomapana, Rasayana Nitya Shodhana etc., (Among there line of treatments Shamana

includes oral administration of medicine is very easy and also effective) 13.

There is no necessary to compare the two drugs as a Shodhana and Shamana groups.

Shodhana groups always holds good. But here the concept of adopting a technique “Nitya

Shodhana” to eliminate the accumulated “Dosha” even though normal, eliminating a patient

with the debilitated body and strength with the Nitya i.e. daily is specific.

The present study was designed as ‘Evaluating the comparative efficacy of Brihat

Katphaladi yoga and Vyoshadi Gutika Nityashodhana’. Here an attempt is maid of evaluating

the efficacy of shodhaka Dravya (virechana) in the form of Nitya Shodhana i.e., Vyoshadi

Gutika (with reducing the dosage) with shamanoushadhi Brihat Katphaladi yoga.


4

As the Swasa is Kapha Vata pradhana Vyadhi Brihat Katphaladi yoga 14 seems to be

very effective. It contains katphala, pushkarumoola sringi shati musta, trikatu. All these drugs

are Kapha Vata Shamana property with Ushna virya.

Another formulation Vyoshadi Gutika is a vireechaka Dravya. This line of treatment

has chosen concentrating the Charaka statement. Where ever the Kapha obstructs Vata then

Anulomana in terms of Nitya Shodhana treatment holds good 15.

None of researchers have tried the management of Tamakaswasa by Nitya Shodhana

as Vata Anulomana, as par my knowledge, even though the Tamaka Swasa is a disease with

predominant Vata. With the addition of this one more attempt has made to compare the

efficacy of Nitya shamana aushadha with Nitya Shodhana.

Chapter - 2

Objectives T amaka Swasa vis-à-vis Asthma and allergies, such as atopic diseases (i.e., bronchial

ast

me

viz

sro

eff

as

alm

à-v

sha

the

mg

tex

bro

In

hma, allergic rhinitis, atopic dermatitis and allergic contact dermatitis), are common

dical problems. Tamaka Swasa and its management through various methods are possible

. Abhyanga Swedana, Virechana, Vamana, Dhoomapana, Shamana, Kapha nissarana,

tomardavata, Vata kaphahar Kapha vilayana, kasagnee, brumhana effects will be very

ective in combating the Tamaka Swasa. Considering the above the Brihat Katphaladi yoga

a shamanaoushadi and Vyoshadi Gutika Nitya Shodhana is under taken for the trial that has

ost all of these therapeutic effects is opted for this study.

The present study intended to focus on the disease evaluation i.e., Tamaka Swasa vis-

is. Bronchial asthma and the management with Brihat Katphaladi yoga as a

manaoushadi and Vyoshadi Gutika Nitya Shodhana. Among the drugs we have selected

above drugs, which are prepared according to GMP, finally which are weighing about 500

tablet and 250 mg capsule respectively for this vati we named it as it exists in the classical

t. Hypothetically this has the best therapeutic efficacy on the Tamaka Swasa vis-à-vis

nchial asthma.

this regard the objectives proposed in the study are –

1. To assess the Tamakaswasa haratwam (Anti asthmatic effect) of Brihat Katphaladi

yoga in Tamakaswasa.

2. To assess the Tamakaswasa haratwam (Anti asthmatic effect) of Vyoshadi gutika

nitya shodhana in Tamakaswasa.

Objectives of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

5

3. To assess the Broncho-dilatory effect of Brihat Katphaladi yoga through pulmonary

function test - Peak Expiratory Flow Rate in Tamakaswasa.

4. To assess the Broncho-dilatory effect of Vyoshadi gutika nitya shodhana through

pulmonary function test - Peak Expiratory Flow Rate in Tamakaswasa.

5. To compare and Assess Anti asthmatic effect and Broncho- dilatory effect in Group A

and Group B

1) To assess the Tamakaswasa haratwam (Anti asthmatic effect) of Brihat Katphaladi

yoga in Tamakaswasa.

The Tamaka Swasa is a disease manifested from Amashaya 16 i.e. “Pitta sthana

samudbhabva” with the vitiation of the Dosha Kapha and Vata 17. The ingredients of the

Brihat Katphaladi yoga are with Kapha Vata Dosha hara action and are of Katu, Tikta Rasa

predominance, thus they are potent Deepana and Pachana 18.

All ingredients of the yoga are of Ushna veerya dravyas are also does the Kapha Vata

shamana and acts as Agni vardhaka 19. The gunas like Laghu 20, Rookasha 21, Teekshna 22 and

Snigdha 23 are also help in Kapha Vata Shamana.

By observing all these characteristics of drugs Brihat Katphaladi yoga seems to be

very much beneficial in the management of Tamaka Swasa for obtaining the requisite results

of Tamaka Swasa haratwam.

2) To assess the Tamakaswasa haratwam (Anti asthmatic effect) of Vyoshadi Gutika nitya

Shodhana in Tamakaswasa.

Basically the contents of the Vyoshadi Gutika are Katu, Tikta rasa and Ushna veerya.

These drvyas are competent to eliminate the Kapha that is accumulated and also inducting the

effect of virechana there by successful elimination of the Pitta stana Dosha. The actions


6

embedded in the compound are adhobhaga Dosha haratwam and vata anulomana and

individually the components of the drug helpful to pacify the vitiated Dosha.

Considering the characteristic features of the medicine and cumulative properties

hypothetically can draw a conclusion that the Nitya virechana concept with the Vyoshadi

Gutika is capable of exhibiting the anti asthmatic effect by eliminating the accumulated

Dosha regularly.

3) To assess the Broncho-dilatory effect of Brihat Katphaladi yoga through pulmonary

function test - Peak Expiratory Flow Rate in Tamakaswasa.

As the Brihat Katphaladi yoga is hypothetically capable of inducing the anti asthmatic

effect in terms of broncho dilatory effect it has to be measured for the justification of the

research. An attempt is made here to measure the pulmonary function test through peak

expiratory flow rate. The evidential PEFR 24 is recorded before and after the study discussed

in detail later.

4) To assess the Broncho-dilatory effect of Vyoshadi gutika nitya shodhana through

pulmonary function test - Peak Expiratory Flow Rate in Tamakaswasa.

As the Vyoshadi Gutika is hypothetically capable of inducing the anti asthmatic effect in

terms of broncho dilatory effect has to be measured for the justification of the research. An

attempt is made here to measure the pulmonary function test through peak expiratory flow

rate. The evidential PEFR is recorded before and after the study discussed in detail later.

5) To compare and Assess Anti asthmatic effect and Broncho- dilatory effect in Group A

and Group B

The study is a comparative clinical Trialwhere the effect of the Brihat Katphaladi yoga

internally to pacify the Dosha in Tamaka Swasa and Vyoshadi Gutika Nitya Shodhana


7

intended to eliminate the Dosha with out any trouble inducing to patient 25. Thus the two

different aspects of the management modalities are to be compared at the clinical efficacy

with respect to the subjective and objective parameters chosen is necessary. In this attempt

the group-A and group-B designated medicaments are observed and for the efficacy of

broncho-dilatory effect and anti asthmatic effect and drawn the comparative statement.


8

Chapter - 3

Literary review

Etymological Derivations

The criteria for naming the disease in Ayurveda are not uniform. The predominant

symptoms of breathlessness are the basis for naming the disease Swasa. The word Tamaka

Swasa is the name of illness consisting of the two words Tamaka and Swasa. The word Swasa

refers to the name of the disease, where as the word Tamaka refers to a subtype of the Swasa

roga.

Tamaka:

As per derivation ‘Tamyati anena iti Tamaka’ 26, ‘Tamaka Glanou’ the word Tamaka

represents a diseased condition that presents with darkness in front of the eyes or tiredness.

‘Tamyati anena iti Tamaka’, ‘Tama eva Tama’ according to this derivations the illness that

causes darkness or the illness itself is the darkness is called by the name Tamaka.

Swasa:

The word Swasa is derived from the Sanskrit root “Shwas”, meaning, “to respire”

Swasa (pul) = swasa + karane dhanj – swasati root derives “Swasati Anena iti Swasa”, which

means respiration 27. This derivation represents the physiological aspect of breathing. But

rapid or interrupted breath is “Swasa” disease.

As per this derivation “Swasasthu Bhasthrikadhmana Vatordwagamitha” 28 the word

Swasa refers to expiration of the air, producing sound similar to the one generated while

blowing the air with a blower by the blacksmith. This refers to the forceful labored breathing,

Literary review of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

9


10

probably with wheezing sound. The description conceals the pathological expression of

breathing and is the cardinal symptom of Swasa Roga.

Tamaka Swasa:

We understand that the manifestation of the difficulty in breathing which occurs

mainly during the nighttime or cloudy day is called Tamaka Swasa 29. Difficulty in breathing

is the cardinal Symptom of Tamaka Swasa and in extreme cases it may be associated with

darkness in front of the eyes. Also the attacks of Tamaka are considered to be worst during

the night. These natures of the illness are unrevealed in the above said etymological

derivation.

Acc to contemporary science Definition of Asthma

Asthma (n) is a respiratory condition marked by wheezing derived from Greek word

“azo” which means breathe hard 30. Medically it is said as a term used to mean “difficult

breathing”; now used to denote bronchial asthma 31. Asthma is a disease characterized by

recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from

person to person. In an individual, they may occur from hour to hour and day to day. It attacks

all age groups but often starts in childhood 32.

HISTORICAL REVIEW

Pre-vedic and Vedic Period

The available literatures of Pre-vedic and Vedic period reveal that the physiology of

respiration, the role of Prana in respiration, the concept of Apana are mentioned at a number

of occasions.

In Rigveda, the word Prana is coined to describe the act of respiration - like

pranadvayu jayate 33, ayumapranaha 34. Yajurveda explains the process of respiration, the act


11

of inspiration, the effort of expiration and involvement of Prana Vayu in respiration are

elaborated vatam pranena nasike 35 pranasya apyathatvam 36. Atharvaveda also contributes

the concept of respiration and the role of Pranavayu in respiration is also clearly described 37.

Atmopanishath reveals the act of inspiration and expiration is mentioned as the

Pranavata is important in the moment of shareera as prime physical sign of life. Further, the

opinion of absence of respiration suggesting the death is also described 38.

Brhadaranyakopanishath explains the Prana is referred by the names Angirasa and Ayusya.

The functions of controlling the body mechanisms are attributed to Prana Vayu 39.

Chandogyopanishath also elucidate the Prana has been named as Angeera and Brhaspati. The

role of Prana in nourishing the body is elaborated here 40. Hamsopanishath refers the organ

of respiration is compared to the bird Crane; the two wings of the bird representing the organ

of respiration, the trunk indicating the heart, and the neck of the bird symbolically expressing

the wind pipe are discussed in detail 41.

SAMHITA PERIOD

The detailed description of Swasa roga is available in Charaka 42 Chikitsa 17th

chapter. The detail explanation of etiological factors, pathogenesis, premonitory symptoms,

and clinical manifestations as well as complete radical treatment of Swasa roga is available.

The whole description of Swasa roga along with its Nidana Chikitsa is available in Susruta 43

Uttara tantra 51st chapter. In the form of complication of many disorders Swasa is described

and also as a symptom is mentioned in Bhela 44 Samhita treatise. Etiopathogenesis, line of

treatment and dietetics of Swasa Roga are described at full length in Harita Samhita 45, 14th

chapter of Third Sthaana. The brief description of Swasa Roga with its treatment is described

along with Kasa Roga, In Khila Sthana Kasyapa Samhita 46. Ashtanga Hridaya 47 and


12

Ashtanga Sangraha 48 also explain the relevant description of Swasa Roga. Complete

diagnostic description of Swasa Roga is detailed in Madhava Nidana 49.

MEDIEVAL PERIOD

Apart from the commentaries on the Brihatrayee, Chakrapanidatta in his treatise

Chakradatta 50 discusses Swasa Chikitsa in detail. Sarvangasundari on Ashtanga Hridaya by

Arunadatta has revealed the hidden factors of Swasa and has opined the predominant

involvement of Kapha Dosha in the etio-pathogenesis of Swasa Roga. Indu, in his

commentary titled Ayurvedarasayana on Ashtanga Sangraha affrms that the aggravated

Kapha is the cause of Swasa.

Bhavaprakasha 51 and Yogaratnakara 52 are individual works of this period,

describes the Swasa Roga at full length and this is in accordance with the description

available in Brihatrayee.

Same nature of Works undertaken by various Institutions 53

1) Modh. K.G., Role of Virechana and Rasayana in the prevention and cure of Tamaka

Swasa, Gujarat Ayurvedic University, Jamnagar, 1991

2) Jaram Singh, Comprehensive study of Katphala w.s.r. To Tamaka Swasa, Gujarat

Ayurvedic University, Jamnagar, 2001

3) Sangeeta, Clinical study on the effect of Pippalyavaleha and Virechana karma in the

management of Swasa, Gujarat Ayurvedic University, Jamnagar, 2002


13

Nidana – Aetiology

Chakrapani commenting 54 on the nidanas of the tamaka Swasa classified them into

two heading like -

a) Vata prakopaka Nidana

b) Kapha prakopaka Nidana.

Further screening through the nidanas reveals that Nidanas like –

• Amotpadaka Nidana 55

• Khavaigunyotpadaka nidana are observed 56

Vata prokopaka nidana: The nidanas which vitiates vata are grouped here. e.g.:

Sheetapana and ashana, Ruksha bhojana, Sheetavata sevana, Raja sevana, Vyayama and

Vegadharana, etc.

Kapha Prakopaka Nidana: The nidanas which vitiates kapha are grouped here. e.g.

Gurubhojana, Adhyashana, Shleshmala ahara, Sheetapana, etc.

Amotpadaka Nidana and Agni Mandyakara: The causitive factors by their virtue supresses

the Agni there by resulting in the Amotpadana. As all the diseases are produced by Ama,

Tamaka Swasa is not exception to this. e.g. Abhishyandi bhojana, Adyashana, Amaksheera,

Dadhi, etc.

Khavaigunyotpadaka Nidana: Some causitive factors apart from their action on the Dosha,

cause damage to the srotas resulting in susceptibility of that Srotas. In Tamaka Swasa the

pranavaha srotas particularly cause the airways damage by the causative factors resulting in

hyper-responsiveness of the airways. e.g.: Raja, Dhooma, etc.

For better understanding of this disease nidanas are classified into four varieties

discussed in the form of chart-1 as clasified below.


14

1. Aaharaja – Nidanas related to food and drinks

2. Viharaja - Nidanas related toexternal activities of the person

3. Vyadhinimittaja – Other diseases are also can cause the disease

4. Agantuja and Kalaja – Injuries or trauma are also can cause the disease .

Table- 1

Nidana of Tamaka Swasa 57-64

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

A. Ahara Sambandi

Sheetapan + + + + + + + +

Sheeta ashana - + - - + + + +

Guru bhojana + + - - + + + +

Abhishyandi bhojana + + - - + + + +

Rooksha bhojana + + - - + + + +

Vidahi ahara + + - - + + + +

Vitambi ahara + + - - + + + +

Adyashana + + - - - - - -

Sleshmala ahara + - - - - - - -

Jalaja mamsa + - - - - - - -

Anupa mamsa + - - - - - - -

Ama ksheera + - - - - - - -

Dadhi + - - - - - - -

Shaluka + - - - - - - -

Masha + - - - - - - -

Nishpava + - - - - - - -

Vishamashana + + - - - - - -

Pinyaka + - - - - - - -

Tila taila + - - - - - - -

Pista padartha + - - - - - - -

Ama rasa - + - - - - - -


15

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

B. Vihara sambandhi Sheeta vata sevana + + + + + + + +

Raja sevana + + + + + + + + Dooma sevana + + + + + + + + Vyayama + + + + + + + + Vega dharana + + - - - - + +

Sheeta sthaana - + - - + + + +

Bhara vahana - + - + + + + + Stree sevana - - - - + + - - Atapa sevana - - - - + - + + Abhishyndi upachara + - - - - - - - Seetasana - + - - - - - - Adhwagamana + - - - - - - - Dwandwa sevana + - - - - - - - Vyadhi/Avastha Sambandhi Nidana

Apatharpana + + - - + + + + Atisara + - + + + + + - Jwara + - + + + + + - Chardi + - + + + - - - Kasa - + + + + - - - Pandu + - + + + - - - Rookshana + - - - - - - - Anaha + - - - - - - - Vibandha + - - - - - - - Amaprodosha + + - - - - - - Shuddhi atiyoga + - - - - - - - Pratishyaya + - - - - - - - Kashata kshaya + - - - - - - - Dourbalya + - - - - - - - Vishoochika + - - - - - - - Udavartha + - - - - - - - Raktapitta + - - - - - - -

Agantu Karana

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

Visha + - + + + - - - Kantorasa pratighata + - - - - - - - Kala

Durdina - + - - - - - - Meghacchadit dina + - + + + + + +


16

Causes of Asthma from contemporary system

In Modern Medical Science, the features explained in respect to Bronchial Asthma are

seems to resemble with Tamaka Swasa, hence a study of the aetiology is as follows.

According to contemporary Medical system, they do not know exactly what causes even

asthma. Researchers are trying to find the events that cause Asthma 65. The causative factors

of asthma can be classified as inducers and trigger factors.

Inducers 66: After birth several factors intact to result in the clinical manifestations of asthma

factors are called inducers.

Trigger factors 67: Substances or factors, which cause narrowing of airways and therefore

induce asthma, are called trigger factors. Each person with asthma has his or her own unique

set of triggers. Most triggers cause attacks in some people with asthma and not in others.

Based on mechanism of induction of asthma trigger factors are divided in two categories.

1. Allergic - Allergic trigger factors induce attack by triggering allergic reaction in the

body.

2. Non-allergic.- Non allergic factors trigger asthma without inducing allergic reaction in

the body.

Some of the examples of allergic and non allergic trigger factors are -

Allergic trigger factors Non allergic trigger factor

Dust mite Exercise

Pollen Psychological factors (Stress)

Animals and Insects Kitchen fumes

Mold Cold

Drugs Pollution

Food and Drinks Chest infection

http://www.asthmacure.com/triggers/asthma_trigerdustmite.htm

http://www.asthmacure.com/triggers/asthma_triggerexercise.htm

http://www.asthmacure.com/triggers/asthma_triggerpollan.htm

http://www.asthmacure.com/triggers/asthma_triggerstress.htm

http://www.asthmacure.com/triggers/asthma_triggerkitchen.htm

http://www.asthmacure.com/triggers/asthma_trigermold.htm

http://www.asthmacure.com/triggers/asthma_trigercold.htm

http://www.asthmacure.com/triggers/asthma_triggerdrugs.htm

http://www.asthmacure.com/triggers/asthma_triggerpollution.htm

http://www.asthmacure.com/triggers/asthma_triggerfood.htm

http://www.asthmacure.com/triggers/asthma_othertriggerfactor.htm


17

Allergic trigger factors

1) Dust and mites 68

Most atopic asthmatics report symptoms on exposure to house dust. Usually when

making beds and when dusting exposure while in bed may cause perennial rhinitis and

nocturnal attacks of asthma. An occasional patient shows sensitivity to house dust and not to

mites.

2) Pollen 69

Plant pollen grains are major causes of seasonal rhinitis and in such patients

commonly provoke asthmatic symptoms as well. Allergy to the pollen causes a distinctive

illness in that rhinitis is usually associated also with itchy conjunctivitis and lacrimination and

the symptoms have a distinctly seasonal pattern. Pollens may travel hundreds of miles in the

air but high concentrations obviously are only likely to occur close to a source.

3) Animals (insects)70

Up to 25% of atopic asthmatics show skin sensitivity to an animals. Sensitization

usually arises as a result of regular contact normally cats, dogs, horses, etc. If the sensitization

is of clinical significance the patient is likely to have noticed rhinitis conjunctivitis and

wheeze on contact with the animals. This stimulus differs from other naturally occurring

provocations. It does not evoke long-term squealae not does it change airway reactivity.

4) Molds 71

Molds are a species of plants, which grows on damp places with high humidity. They

are green - black reticular growths commonly seen over damp places in monsoon season.

Molds are microscopic fungi. These reproduce by releasing spores into the air, which then

settles on organic matter, and grow into new molds. Air born spores when inhaled can lead to


18

asthmatic attacks. Asthma caused by molds gets aggravated during the later part of rainy

season. Optimum temperature for this growth is 20-30 degree Celsius and humidity above 70

percent.

5) Drugs

Drugs are the important occasional cause of asthmatic attack. Aspirin and other

NSAID’s are most frequent offenders followed closely by beta blockers, asprin sensitivity

occur particularly in non atopic adult asthmatics 72. Beta blockers can induce broncho

constriction even when administered in the form of eye drops, approximately 10% of the

asthmatic patients when given salicylates (eg. aspirin) or NSAIDs agents 73.

6) Food and drinks

Atopic asthmatics may occasionally notice that their symptoms are provoked by

certain foods and drinks. It occurs about 10% of such individuals. The foods most suspected

are milk, eggs, fish, cereals, nuts and chocolates etc. Food may also provoke asthma via

mechanisms that may not be related to Ig E related allergy 74.

Non-allergic trigger factor 1) Exercise

Exercise is one of the most common precipitants of acute episodes of asthma. This

stimulus differs from other naturally occurring provocations. Exercise probably provokes

bronchospasm to some extent in every asthmatic patient and in some it is only the trigger that

produces symptoms. Thus the onset of this problem frequently is the first manifestation of the

full down asthmatic syndrome 75.


19

2) Psychological factors (stress)

Psychological factors like shock bereavement or excitement, such factors are the

dominant cause of the disease. Any cause of severe anxiety or stress can exacerbates asthma

and acute emotion may provoke an acute attack but there is no evidence of asthmatics that are

primarily psychologically disturbed 76.

3) Kitchen fumes

Kitchen with poor ventilation causes more problems for an asthmatic patient. Cooking

and the kitchen have a lot to do with triggering asthma attacks. Kitchen fumes are an

important trigger factor of asthma in Indian housewives.

During healthy periods inner lining of respiratory tract becomes normal and trivial

irritation of kitchen fumes does not aggravate asthma. During asthmatic attack the inner layer

of respiratory tract is inflamed, ulcerated and becomes very delicate. Even slight irritation by

kitchen fumes hurts it and results into an asthmatic attack. Combustion products of fuels,

cooking oil, and fumes generated by frying of pepper and other spices in oil or ghee are very

irritant to nasal and bronchial mucosa. Regular exposure can prolong duration of asthma

episodes to make it a chronic disease 77.

4) Cold

Climatic variations have massive effect on an asthmatic person who is prone to dust,

humidity, high temperature, and dusty environment the cold weather is more dangerous.

Many persons with asthma or rhinitis get aggravation of their disease on exposure to cold. It

has been shown that airway cooling is an important trigger factor causing asthma. Airway

cooling enhances inflammation thereby causing narrowing of airways and an asthma attack.

Breathing cold air also causes congestion of inner layer of nose (nasal mucosa) and therefore


20

leads to nasal obstruction. Cooling of other parts of the body has also been shown to

aggravate asthma 78

5) Pollution

Atmospheric pollutions, irritants like cigarette, smoke, strong perfumes, dusts, haze of

fumes can provoke or worsen attack of asthma 79. Asthmatic patients may notice

exacerbations in relation to episodes of air pollution. Like high traffic density sunlight and

temperature inversion may promote exacerbations of asthma and smokes containing Sulphur

dioxide 80.

6) Chest Infection

Many viral and bacterial infections of the respiratory system produce transient.

Increase in airway responsiveness in asthmatic patients. Viruses in particular are an important

cause of asthma exacerbations 81. Viral infection in childhood may predispose to the

development of asthma and bronchial hyper reactivity in later life. Viral infections in adults

are frequently followed by protected cough and wheeze in distinguishable form asthma 82.

Other Triggering factors

Sore throat, Bacterial infection, sleep, sudden climatic change, Rainy days, Mosquito

repellants, Tobacco smoke, Pets, Fireworks & crackers, Worship lighting agarbatti / hawan,

Lady's Head Washing, and Farming works, etc 83.


21

Poorvarupa of Tamaka Swasa

The Lakshana which appear before the onset or manifestation of disease are

considered as Poorva Roopa 84. No specific Poorva Roopa has been explained for Tamaka

Swasa, but the Poorva Roopa explained in the context of Swasa holds good for Tamaka

Swasa even.

Pathology of Tamaka Swasa includes the vitiation of Vata and Kapha Dosha afflicting

the Rasa Dhatu in the Uras 85. This unique pathology determines the premonitory symptoms

in the premonitory stage. The symptoms like Anaha, Adhmana, Bhakthadwesa, and Vairasya

all are the result of the illness stemming out from the Pittasthana. Needless to say, these are

also suggestive of imbalance of Kapha Dosha. Further, Parswa Shoola and Shankha Nistoda

indicate the extent of Doshic circulation. Hridaya pidana and Pranavilomata are pathogenic of

localization of the Dosha in the Uras.

Following table gives the glance of the Poorva roopa of the illness, which are also

premonitory symptoms of other types of Swasa.


22

Table-2

Porva Roopa of Tamaka Swasa 86-93

POORVA RUPA CS SS AS AH BP YR GN MN

1 Anaha + + + + + + + +

2 Adhmana - - - - + + + +

3 Arati - + - - - - - -

4 Bhaktadwesha - + - - - - - -

5 Hritpeeda + + + + + + + +

6 Kantha Gurutwa + - - - - - - -

7 Kashaya vadanata + - - - - - - -

8 Parshva Shula + + + + + + + +

9 Prana Vilomata + - + + - - - -

10 Shankha Toda - - + + + + + +

11 Uro Guruta + - - - - - - -

12 Vaktra Vairasya - + - - + + + +

Contemporary medical Science has also mentioned the poorva roopa on the heading of

‘Early Warning Signs of Asthma’ 94. These signs are experienced before the start of an asthma

episode. And these signs are unique to each person, and signs may be the same, similar or

entirely different with each episode. Some early warning signs may be noticed only by the

individual, while other early warning signs are more likely to be noticed by other persons.

Those signs are as follows - Breathing changes, Sneezing, Moodiness, Headache,

Runny/stuffy nose, Coughing, Chin or throat itches, Feeling tired, Dark circles under eyes,

Trouble sleeping, Poor tolerance for exercise and Downward trend in peak flow number. It

has been clearly explained in all the related Ayurvedic classics as Hritpeeda, Parshva shula,

Adhmana, etc


23

Lakshana (Roopam) of tamaka Swasa

Vata as well as Kapha Dosha, Rasa Dhatu and Pranavaha Srotas are the predominant

factors involved in the pathogenesis of Tamaka Swasa. And for apparent reasons these factors

determine the course and clinical manifestation of the disease.

The lakshana of Tamaka Swasa has been explained with clinical course of the disease

rather than listing of signs and symptoms. The appreciable lakshana of Tamaka Swasa are

explained as –

1) Vishista or Pratyatma niyata lakshana

2) Upashayanupashaya rupi lakshana

3) Samanya lakshana

1) Vishista / Pratyatma lakshana:

The symptom specific Tamaka Swasa is considered as Vishistha / Pratyatma lakshana

of Tamaka Swasa. Those lakshana are Svasakrichrata, Kasa, and Ghurgurakam etc

2) Upashayanupashaya rupi lakshana:

Some lakshana explained under Tamaka Swasa indicates the upashaya-anupashaya

swaroopi lakshana. They are considered as aggravating and relieving factors of

Tamaka Swasa.

3) Samanya lakshana are enlisted in table -3 as below.


24

Table No- 3

Roopa (Lakshana) of Tamaka Swasa 95-102

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

Swasa (Dyspnoea) + + + + + + + +

Ghurughuraka (Wheezing) + + + + + + + +

Prana prapeedana (Discomfort) + + + + + + + +

Kasa (Cough) + + + + + + + +

Pratamyati (loss of consciousness) + + + + + + + +

Sannirudyati (Immobilized) + - - - + + + +

Pramoham Kasamanascha + + + + + + + +

Sleshma vamokshante

Labhate sukham + + + + + + + +

Kantodwamsa (Throat irritation) + - - - + + + +

Krichrena bhashitam

(Difficulty in speaking) + - - - + + + +

Na labhate nidra (Sleeplessness) + - - - + + + +

Shayanasya swasa peeditha

(Discomfort in lying down posture, + + + + + + + +

Shayanasya sameesana

Parswe shoola (sides pain) + - + + + + + +

Ushna abhinandana(Like hot thing) + - + + + + + +

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

Latat Sweda (Sweating on forehead) + + + + + + + +

Brushrmarthi (maximum distress) + - + + + + + +

Shushkasyata (Dryness of mouth) + - + + + + + +

Muhur Swasa, Muhuschaiva avadhamyati-

(Short breath with all effort to breath) + + + + + + + +

Megha, ambu, sheeta, pragwaha

shelshmalancha pravardhanti

(Increase after exposure to

kaphakara ahara) + - + + + + + +


25

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

Pratishyaya (normal discharge) + - + + + + + +

Aruchi (Anorexia) - + + + - - - -

Trishna (Excessive thirst) - + + + - - - -

Vepathu (Tremors) - - + + - - - -

Vamathu (Expectoration) - + - - - - - -

Ghoshena Mahate - + - - - - - -

Samprapti (Pathogenesis) of Tamaka Swasa

Swasa Roga Samprapti

Charaka opines that the Vitiated kapha along with vitiated vata obstructs the srotas,

the obstructed vayu tries to over come the obstruction and moves in all the direction resulting

in Swasa 103.

Susruta says the Pranavayu goes against its individually (Prakriti) combines with

Kapha causing Swasa Roga 104.

Bhavamishra 105 and Yogarathnakara’s 106 opinion regarding Samprapti coincides with

Charaka, Madhavakara’s 107 corresponds with Sushruta.

Vagbhata 108 further emphasised that the Annavaha Srotas is also involved and hence

the production of Kapha in Amashaya is affected. Thus Swasa Roga is regarded as Amasaya

Samudbhava.

Tamaka Swasa Samprapti

Vata Dosha and Kapha Dosha are invariably involved in the pathogenesis of Tamaka

Swasa 109. Imbalance of Vata Dosha is best treated by Snigdha line of treatment 110. Whereas,

vitiated Kapha Dosha is treated by Ruksha line of treatment 111. Theoretically, when both

Vata and Kapha Dosha are vitiated mutually, contradictory therapeutic procedures have to be


26

employed, thus posing a practical problem in planning the final treatment. Kapha Dosha and

Rasa Dhatu both belong to the same category in relation to their properties 112. It is a general

principle of pathogenesis, that the Dosha and the Dhatu belonging to the same category have a

natural tendency to rapidly progress in the process of pathogenesis 113.

Similar to this in Tamaka Swasa also, Kapha Dosha that afflicts the Rasa Dhatu

contributes to the rapid development of the illness. Further, during the course of the illness,

the Hridaya marma is said to be afflicted 114. This adds to the severity of illness.

Put together, the mutual contradictory treatment, involvement of Dosha and Dushya

belonging to the same category, as well as affliction of Hridaya marma explains the acute

onset, chronic course and severity of the illness.

The normal upward course of the Pranavata is obstructed by the abnormally stiff

Pranavaha srotas. Secondly, like the other Srotas, secretion is the natural process seen in the

Pranavaha Srotas. Here Kapha is the normal secretion and the vitiated Prana Vata abnormally

increases it. In further it adds to the obstruction of the passage and Pranavata leading to Prana

vilomata. Narrowing of the Pranavaha srotas together with accumulation of Sleshma obstructs

the smooth flow of Pranavata. Pranavilomata and the resultant turbulent breathing lead to

abnormal audibility of respiration or to say this produces wheezing. Charaka opines that the

obstruction to the passage of Pranavata also leads to rapid breathing 115.

Vitiated Prana Vata irritates the Nasa causing increased secretion and manifestations

like Peenasa, Kshawathu etc 116.

Further the presence of Kapha in Pranavaha srotas more particularly in the Kantha

(neck) region obstructs the Pranavata. The Pranavata passing through this Kapha, causes

bubbling and a peculiar sound, which is called as Kantha Ghurghuraka is, produced 117.


27

It is said that this Sleshma is thick, sticky and tenacious and contributes to the

obstruction in the Pranavaha srotas. Excessively secreted tenacious Sleshma is expectorated

out with much difficulty during the bouts of coughing 118.

Productive cough is another effect of obstruction of Pranavata in the Pranavaha srotas.

As the cough brings out the Sleshma, obstruction to the Pranavata is minimized, leading to

temporary relief in breathlessness to the patient 119.

Other than the usual presentation, involvement of the Pitta Dosha may be seen in

certain patients of Tamaka Swasa 120. When this is the case the over all presentation of the

Tamaka Swasa is also changed accordingly. The frequent episodes of Tamaka Swasa are

related to the exposure to cold, cloudy days, and heavy breeze and/or such other factors that

are provocative to Vata and Kapha Dosha, which is the usual presentation in Tamaka Swasa

121. If the association of Pitta Dosha is present this nature of the illness is reversed and hence

exposure to these factors may bring about remittance of symptoms in the patient. This unique

nature of the illness is attributed to Pitta Dosha involvement. These symptoms like Jwara,

Murcha are suggestive of Pitta vitiation. Such a variant form of Tamaka Swasa with the

typical symptoms of Pitta Dosha is called as Pratamaka and Santamaka Swasa 122.


of Tamaka Swasa. During the attack of Tamaka Swasa almost all the symptoms of Kapha

Dosha vitiation are mediated through the Rasa Dhatu. Among the list of symptoms:

productive cough, sputum etc are the symptoms pathognomonic of Rasa Dhatu abnormality.

Moreover, abdominal symptoms like Anaha, etc. are also the result of incriminated Rasa

Dhatu 123. As the disease runs a chronic course, the vitiated Vata Dosha dries up the

circulating Rasa Dhatu contributing to the weakness and emaciation in the patient.

Figure - 1

Schematic diagram of Samprapti of Tamaka Swasa

Nidana

Vata prakopa kapha prakopa

Vata vrudhi kapha prakopana


28

Pranavaha sroto pravesha

Vata prakopana

Vata avarana by urasthita prakupita Kapha

Pranavata margavarodha

Sarvato gachati

Pratiloma gati

Tamaka Swasa

Pratamaka Santamaka


29

SAMPRAPTI GHATAKA

Dosha : Charaka - Kapha, Vata.

i

t

t

: Susruta - Dom nance of Kapha

: Arunadatta – Both Kapha and Vata are involved

Dushya : Rasa

Srotas : Pranavaha, Udakavaha, Annavaha

Srotodusthi : Atipravra ti

Utpatti sthana : : Vagbhata - Amashaya.

: Charaka - Pitta s hana

Sanchara sthana : Ura kantha Siras

Vyaktha sthana : Uras

Rogamarga : Abhyantara

Adhisthana : Shareerika

Samprapti Bhedas

For the complete understanding of the disease, Samprapti can be classified as

Sankhya, Pradhanya, Vidhi, Vikalpa, Bala and Kala 124.

In the disease Tamaka Swasa also detail study of Hetu, Samprapti, lakshana and

Sadhyasadhyata can be elaborated in the framework of Samprapti bhedas as -

1) Sankhya Samprapti

The Tamaka Swasa is categorized under pancha bheda of Swasa 125. Tamaka Swasa

doesn’t have direct classification to fit in the sankhya samprapti, but have Pratamaka and

Santamaka as the avastha bhedas 126.

2) Pradhanya Samprapti

Charaka has considered Tamaka Swasa, as kaphavatatmaka Vyadhi 127 where as

Madhavakara has considered it as Kapha pradhana 128. Its Samprapti indicates the kapha


30

pradhanyata, as per the clinical course of the disease and principles of treatment both kapha

and vata seems to be pradhana 129. Vata holds prime importance in the management.

3) Vidhi Samprapti

Under vidhi samprapti, Tamaka Swasa can be classified in different categories as,

Ashukari 130, Yapya 131, and Krichra sadhya 132. According to Charaka Hikka and Swasa are

Ashukari, Ghora, and Sheeghra Pranaharaka.

Further he explained with chronicity as more than one year are considered as yapya

and of duration less than one year in the durbala rogi, as krichra sadhya. Acharya Sushruta has

considered Tamaka Swasa as krichrasadhya; and asadhya in durbala rogi.

4) Vikalpa Samprapti

Observing the Tamaka Swasa Samprapti, lakshana, Upashaya and Anupashayas

presence of vikriti in Pranavata and is aggravated by the properties such as Sheeta, Ruksha

gunas and increase in its Chala guna 133. Similarly Urosthita Avalambaka kapha gets

aggravated by Guru, Snigdha, Sheeta, Abhishyandi gunas and becomes Ghana and Picchila.

5) Bala Samprapti

Bala of Vyadhi depends on virulence of the hetus, presence of poorva rupa or rupa in

the course of development of disease or in developed form. And also it depends on the

involvement of different Srotases, Rogamarga and vital parts of the body. Hence the bala of

the Vyadhi differs for individual patients, thus the Tamaka Swasa is considered as Krichra

sadhya, Yapya and Ashukari Vyadhi by various authors 134.

6) Kala Samprapti

The name of disease itself indicates of the nature of disease with respect to time factor.

It is episodic, paroxysmal and mostly nocturnal in its nature. Sometimes it is even observed


31

that the symptoms get aggravated in the early morning, and with respect to seasons it

aggravates in the winter and autumn due to cold climate 135.

Pathogenesis of asthma from contemporary system 136

The common denominator underlying the asthmatic diathesis is a nonspecific

hyperirritability of the tracheo-bronchial tree. When airway reactivity is high, symptoms are

more severe and persistent. In both normal and asthmatic individuals, airway reactivity rises

after viral infections of the respiratory tract and exposure to oxidant air pollutants such as

ozone and nitrogen dioxide (but not sulfur dioxide). Viral infections have more profound

consequences, and airway responsiveness may remain elevated for many weeks after a

seemingly trivial upper respiratory tract infection. In contrast, airway reactivity remains high

for only a few days after exposure to ozone. Allergens can cause airway responsiveness to rise

within minutes and to remain elevated for weeks. It is widely believed that the physiologic

and clinical features of asthma derive from an interaction among the resident and infiltrating

inflammatory cells in the airway surface epithelium, inflammatory mediators, and cytokines.

The cells thought to play important parts in the inflammatory response are mast cells,

Eosinophils, lymphocytes, and epithelial cells.

Pathophysiology from contemporary system 137

Asthma is multifunctional in origin, arising from the interaction of both genetic and

environmental factors. Airway inflammation characterizing asthma occurs when genetically

susceptible individuals are exposed to environmental factors but the exact process may vary

from patient to patient. The timing intensity and mode of exposure to aero-allergens are

important environmental factors which stimulate the production of Ig E.


32

Pathology from contemporary system 138

The bronchiectatic activities may be lined by lined by granulation tissue, Squamous

epithelium or normal ciliated epithelium. There may also be inflammatory changes in the

deeper layer of the bronchial wall and hypertrophy of the bronchial arteries. Chronic

inflammatory and fibrotic changes are usually found in the surrounding lung tissue.

Upashaya of Tamaka Swasa

Any of the Dravya bhuta (Oushadhi, Ahara etc.) or Adravyabhuta (Vihara)

Upacharas leads to Sukhanubandha is defined as Upashaya 139. Sleshma Vimokshana is

considered as Upashaya in Tamaka Swasa 140, which can be achieved by mechanical process

such as coughing etc, by pharmacological measures such as administering Sleshmavilayana

dravyas.

The dravyas possessing Ushna guna i.e. properties can be administered as Upashaya in

Tamaka Swasa. 141. Non-pharmacological procedures such as change of position; changing to

the sitting position from recumbent position; relives from the severity for short period 142.

Anupashaya of Tamaka Swasa

Ahara, Vihara, and Oushadhi aggravates the condition of the Tamaka Swasa are called

as Anupashaya of Tamaka Swasa. They are Asatmya to the Vyadhi 143. Meghambu sheeta

pragvatai Sleshlmalaischa abhivardheyate is considered as Anupashaya 144.“Nacha

pinidramlabhate Shayanahasvasapeeditaha” indicates the aggravation of the disease in the

recumbent position 145.

Upadrava of Tamaka Swasa

There is an in direct reference regarding the upadravas of Tamaka Swasa mentioned in

‘Trishna chikitsa’ is Trishna appears as upadrava in Jwara, kshaya, Swasa etc 146.


33

Aristha of Tamaka Swasa

Regarding the aristha lakshana, there is no direct reference in the context of Tamaka

Swasa, where as in reference with different contexts aristha lakshana for Swasa can be

established. At the time of death whatever the disease he may suffer, ultimately he will die

with Hikka and Swasa 147.

It is mentioned that the person producing unnatural sounds with heavy breath, suffering

with Atisara, Trishna, Shushkasyata and loss of body strength is definitely going to die 148.

The person who’s Urdhva Swasa is rapid, throat occluded by Kapha; reduction in strength,

complexion and food intake is not going to survive for longer period 149. The person taking

long inspiration and gives of short expiration gets fainted; such person is stated to die within

short period 150.

Sadhyasadhyata of Tamaka Swasa

Tamaka Swasa, which is chronic of more than one year, is considered as yapya and of

duration less than one year in the durbala rogi, as krichra Sadhya 151. If Tamaka Swasa is

Navotita (newly developed) it is as sadya (curable) 152. Susruta has considered Tamaka Swasa

as krichrasadhya vyadhi and asadhya in durbala rogi 153. According to Vagbhata Tamaka

Swasa is yapya, but can be Sadhya if it is treated in early stages in the strong persons 154.

Table – 4

Vyavachedaka Nidana of Tamaka Swasa

Differential diagnosis between panchavidha Swasa 155

Lakshana Tamaka Swasa Maha Swasa Urdhva Swasa Chinna Swasa Kshudra Swasa

Swasa Ateva teevra vega Swasa

Uchaihi swasati Dheergam swasati, Urdhvam swasati, adhoswasa nirodha

Swasate vichinnam Ruksha aayasottha Swasa

Shabdha Ghur-ghuraka Matta vrashabho vatt

Consciousness Pramoha Pranastha jnana vijnana

Pramoha Moorcha

Netra Uchritaksha Vibhranta lochana and vivrataksha

Urdhvadristhi and vibhrantaksha

Viplutaksha, raktaika lochana

Shula Shayanasya parshvagraha

VedanartaMarmachedavat rugarditaha

Vak Kruchrakrichnoti bhashitaha

Viksheena vak Pralapana

Asya Vishushkasya Shushkasya Parishushkasya

Sweda Lalata sweda Sarva daihika sweda

Upashaya Sleshma vimokshana

Sadhyasadhyata Yapya Asadhya Asadhya Asadhya Sadhya


34


35

Chikitsa in Tamaka Swasa

The effective treatment of Tamaka Swasa cannot be unified, as the pathology

involves multiple varying factors. Vitiated Vata and Kapha Dosha stemming out from the

Pitta Sthana, afflicting the Rasa Dhatu in the Pranavaha Srotas produces the illness.

Therefore, the procedures aimed at the rectification of the imbalances of Vata Dosha, as

well as Kapha Dosha forms the sheet anchor of treatment of Tamaka Swasa, which is

individually quite opposite. Thus, the unique pathogenesis poses complexity in planning

the treatment. The final treatment planned should pacify the Vata as well as Kapha Dosha

effectively, simultaneously not causing any further addition to the imbalance of Vata and

Kapha Dosha. With the due consideration of this, following principles of treatment are

advocated in the Ayurvedic classics.

1. Abhyanga and Swedana –Application of the oil over the chest followed by sudation.

2. Vamana – Therapeutic emesis

3. Nitya Shodhana – Daily clanging the Dosha by Anulomana

4. Virechana Karma – Therapeutic purgation

5. Pratisyaya Chikitsa – Treatment of rhinitis

6. Kasaroga Chikitsa – Treatment of Kasaroga

7. Dhoomapana – Therapeutic inhalation of the smoke from the burning herbs

8. Kaphahara Chikitsa – Pacification of vitiated Kapha Dosha.

9. Vatahara Chikitsa – Elimination of vitiated Vata Dosha

10. Kapha Vilayana Chikitsa –Liquefaction of the sputum

11. Srotomardavakara Chikitsa – Softening of the channels of respiration

12. Kaphanissaraka Chikitsa – Expectoration of sputum


36

13. Kasaghna Chikitsa – Treatment of cough

14. Manasa Dosha Chikitsa –Correction of emotional disturbances

15. Rasayana Chikitsa – Rejuvenating the Pranavaha Srotas and body 156

For the prevention and cure of any disease so many remedies are mentioned in

Ayurvedic classics according to the Vyadhi. Vyadhibala. rogibala, doshavastha,

doshanubandhata etc. The proper management of Tamaka Swasa seems to be difficult by

observing these points.

For the proper management of this disease exclusively Charaka has explained so

many different management and treatment principles. With comparison of other authors

the principles of management are as follows.

Nidana Parivarjana

The disease Tamaka Swasa has wide range of etiologic factors, it becomes difficult

to identify the specific cause and avoid it. More ever it is a typical disease where in the

initial sensitizations by specific factor, sets a platform for the onset of acute episodes, with

exposure to even smallest or mildest stimuli. Hence it is difficult to manage the condition

only by nidana parivarjana.

One has to be very precise regarding the precipitating or triggering factors. Avoid

exposing to that particular factor, which mostly helps to prevent the onset of acute

episodes or acute attacks. Acaryas have clearly explained nidanas of the Swasa roga are to

be avoiding as a Nidana Parivarjana 157.

Management of Swasa rogi depends on:

1. Bala bala (Balawan or Durbala)

2. Doshadhikya (Kaphadhikya or Vatadhikya)


37

If the patient is kaphadhikyata and balawan rogi - Doshas are to be expelled by

vamana and virechana. After pathya ahara, vihara and later followed by Swasa nashaka

dhuma, avaleha etc are to be administered.158.

If the patient is vatadhikyata and durbala, Baala, vruddha rogi- Vata has to be

alleviated by vatanashaka dravyas, tarpana, sneha, yusha, mamsarasa etc are to be

administered 159.

If the samshodhana karma is performed in condition anutklistha kapha dosha,

durbala and those who have not undergone swedana, vata gets grossly provoked; becomes

fatal with causing marma samshoshana.

In case of balawan, kaphabahula rogi- Before performing the Vamana karma

anoopa and jalaja mamsa rasa and swedana are to be given. Contradictory to it, in durbala,

alpa kaphavastha, he has to be treated with brumhana chikitsa 160. Swasa rogi having

ruksha shareera, suffering from shushkata in uras, kantha and talu has to be treated by

ghrita 161.

Doshanubandhi Swasa Chikitsa

In case of vatanubandhi Swasa, the ghrita prepared by mamsa of shasha, shallaka

etc. or ghrita prepared by pippali, mamsa and shonita has to be administered 162. In case of

vatapittanubandha Swasa Shali Odana prepared with Suvarchala swarasa, dugdha, ghrita

and trikatu has to be administered 163. Gangadhara commenting on this suvarchala

swarasa, dugdha, ghrita can be administered separately with trikatu churna after food 164.

In case of pittanubandhata utkarika gritha are to be administered 165.

In case of kaphapittanubandha swasa shirisha pushpa swarasa or saptaparna

swarasa, mixed with pippali choorna and madhu has to be administered 166.


38

According To Doshas Swasa Chikitsa

Acharya Charaka explained a special line of treatment in managing the Swasa rogi,

with respect to doshas 167.

1. Vatakruddha kaphahar. The upakramas those aggravate Vata and mitigate Kapha.

2. Kaphakruddha anilapham. The upakramas those aggravate Kapha and mitigate

Vata.

Both the principles can be used differently according to the condition, but

treatment aiming towards single Dosha must not be performed i.e. Vata karaka, Kapha

karaka, Vata shamaka or Kapha shamaka, in indispensable condition to implement one

amongst the above four. It is superior to go for vatashamaka upakramas 168.

Snehana And Swedana

Acharyas have considered bahya snehana on uras by Tila taila with Lavana as an

initial treatment and it is followed by swedana either of Nadi, Prastara or Sankara, with the

help of snigdha dravyas. This helps for liquefaction of the grathita Kapha i.e. facilitating

easy expelling of vitiated kapha. It also helps for Vata Anulomana and leads for

smoothness of Srotas 169.

Swedana karma is contraindicated for the Swasa rogis in case of Pittaja Prakrati,

Pitta dosha pradhanayata and persons suffering from Daha, Raktapitta, Atisweda, Dhatu

Ksheenata, Bala Ksheenata, Gharbhini or the persons with Ruksha Prakrati.

If the Swedana is necessary in above said persons mrudu swedana has to be

performed for a short period i.e. pariseka by ushna snehas; sharkara yukta ushna utkarika

or upanaha 170. Swasa rogis suffering with associated Swaraksheena, Atisara, Raktapitta,

and Daha; they are to be treated with madhura, snigdha, sheetal dravyas 171.


39

Swasa rogis, suffering with Navajwara or Amadosha, they has to be treated with

ruksha sweda, Langhana or Vamana has to be performed by administering Ushnajala and

Saindhava Lavana 172. After samyak swedana, snigdha odana, matsya / shukara

mamsarasa or dadhi manda has to be administered, which helps for sleshma vardhana 173.

Kosta Shodhana with Vamana and Virechana:

After snigdhadi bhojana, when kapha gets increased sufficiently, then vamaka

yogas such as pippali choorna, saindhava lavana and madhu have to be administered. Thus

the vitiated Kapha is expelled. Also obstruction to Vata is relieved facilitating its normal

movements and srotas becomes clear. The vamaka dravyas should not be Vata virodhi 174.

Chakrapani commenting on vata avirodhi word, he says not to use ruksha and teekshna

vamaka yogas. That indicates to use mridu vamaka dravyas.

For the proper management of Swasa some more clues are given by the acaryas

as, to expel vitiated doshas by vamana, if patient is suffering from Swasa along with kasa,

swarabheda and for Tamaka Swasa Kapha Vata hara dravyas are to be used for Virechana.

Gangadhara comments as - in swarabheda yukta Swasa and Tamaka Swasa Virechana and

swatantra kasa, swarabheda vamana has to be administered 175.

If Vata gets aggravated due to atiyoga of Vamana, patient has to be treated by

vatashamaka upakramas. Patient has to be provided food along with mamsa rasa,

abhyanga with Vata nashaka dravyas. Which are neither too hot nor too cold 176.

If Swasa rogi is suffering from udavarta and adhmana vatanulomana has to be

performed with matulunga, amlavetasa, hingu, pilu and bida lavana 177.

Abnormal response of patients for simple factors like dust is said to be due to

Khavaigunyata of the Pranavaha Srotas. In the modern counterpart, this is described as


40

hypersensitivity or allergy of the respiratory system. This may be said as Khavaigunyata,

or else called as Asatmyata or even may be named as faulty Vyadhikshamatva. And the

fact is that, the patient unfavorably responds to simple factors like dust, atmospheric

change, or food. The friendly environment in which the patient has to live becomes hostile

to him and is like the enemy of the patient. The interaction in such a situation between the

patient and the environment is just like the two mirrors facing each other. The mirrors

facing each other produce infinite number of images and quite similar to this, the patient

suffers from innumerable attacks of Tamaka Swasa.

Charaka pronounced this as “Tamake Tu Virechanam” 178. The Virechana

procedure may not be of much use during the attack of Tamaka Swasa. But when

employed in between the attack, prevents the attacks of Swasa, reduces its severity, and

minimizes the duration of illness.

After Virechana, Samasarjana Karma is advised for about 3 to 5 days 179. This

procedure eliminates Doshas in Tamaka Swasa eliminated, as is told in the classics;

Doshas stemming out from Pitta Sthana is best eliminated by Virechana procedure. It is

worth mentioning here that; Vata Dosha is the predominant Dosha involved in the

Samprapti of Tamaka Swasa. Virechana normalizes the course of Vata Dosha and thus

helps in the reversal of the Vilomagati of Pranavata. Distension of the abdomen,

constipation and such other symptoms may be associated in some patients and these

symptoms are best treated by this procedure.


41

Rasayana Chikitsa in Tamaka Swasa

The one more answer for such a nature of illness is Rasayana Chikitsa. Even in

some patients, this procedure Virechana in combination with Rasayana Chikitsa brings

about complete cure.

Dhumapana

After completion of Vamana karma smaller quantity of vitiated dosha will remain in

the srotas. To expel such leena doshas, Dhumapana has been explained. For the purpose of

dhumapana; haridradi dhuma varti is generally indicated in classics 180.

Nasya

Different yogas; such as rasona, palandu, grinjanaka swarasa, madhura varga

dravyas siddha ghrita are indicated for nasya karma for hikka in the context of hikka and

Swasa Chikitsa 181, but it is not directly indicated in Swasa; Vagbhata also supports the

same; where as Arunadatta commenting on the same indicates nasya prayoga in Swasa

also. Susruta explains the utility of bhringraja siddha taila as nasya, abhyanga and

acchapana in swasa and hikka 182.

Kshara prayoga

If Kapha obstructs the path of Pranavata; ksharaavaleha has to be administered, in

order to relieve the obstruction of Pranavata. It makes the Kapha vilayana and anulomana

183.

Brumhana and Shamana Chikitsa

If Swasa rogi are treated with brumhana; the complication that take place due to

treatment are milder in nature and can be easily managed as brumhana leads to increase in

bala and Kapha. If the same has been treated with shamana Chikitsa, there is a least


42

possibility of complication due to Chikitsa as it pacifies both Kapha and Vata; on contrary

karshana will lead to decrease the bala of rogi, also aggravates the Vata and the

complications due to treatment are difficult to manage 184.

Apart from all Chikitsa modalities Charaka says even though the Swasa rogi is

shodhita or ashodhita, he has to be treated with shamana and brumhana Chikitsa 185.

Susruta says Nidigdhikadi yoga as Swasa, kasahara siddhatama yoga, containing

kantakari kalka of amalaka pramana; half the quantity hingu has to be administered for

three days along with madhu, which will positively relieve the patient from the Swasa

roga 186. Vagbhata has explained the use of pippalyadi takra in treating Swasa and hikka187.

With all the above principles of management of Tamaka Swasa, there are still many

number of Swasahara yogas explained in the context of Swasa Chikitsa by the various

authors.

Asthma management in contemporary medical science

In contemporary medical science Asthma management principles are as follows –

1) Patient education

2) Avoidance of the aggravating factors

3) Avoiding respiratory irritants

4) Psychological treatment

5) Disintegration or immune therapy

6) Prevention of infection

7) Physiotherapy and

8) Drug management


43

Pathyapathya in Tamaka Swasa

A number of predisposing factors may initiate an attack of Tamaka Swasa or may

worsen the episode, if the patients are already in the symptomatic phase. In a patient who

has reduced immune mechanism of the Pranavaha srotas, which is described, as

Khavaigunyata or Asathmyata, exacerbation or else initiation of an attack of the Swasa

Roga is likely. Hence, understanding of Pathya as well as Apathya gains importance both

in preventing as well as planning the treatment. Mainly, the factors that influence the

balance of Vata Dosha as well as Kapha Dosha are either Pathya or Apathya as per their

role in pacifying or else aggravating these Doshas respectively. Following table depicts

the list of Pathya and Apathya factors in Tamaka Swasa.

Table No 5

Pathya in Tamaka Swasa

Pathya Ahara C .S.189 S .S.190 A .H.191 Y.R.192 B.R.193

I Shaali Dhanya

Purana Shali + - - + + Tandula - - - + +

II Vrihi Dhanya

Shashtika + - + + +

III Shooka Dhanya

Yava + - + + + Godhuma + - + + +

IV Shimbi

Mudga + - + - - Kulatha - - + + +


44

V Shakha Varga


Guduchi + - - + + Patola - - - + +

Vartaka - - + + + Rasona - - - + + Bimbi - - - + +

Vastuka - - - - + Moolaka + - + - + Potaki - - - - + Shigru + - - - -

Kasamarda + - - - -

VI Mamsa Varga

Janghala - - - + + Shasha - - - + + Titira - - - + + Bhuka - - - + + Lava - - - + +

Dhanva - - - + + Shuka - - - + +

Mruga Dwija - - - + +

VII Phala Varga

Jambira - - - + + Draksha + + - + +

Mathulunga + + + - + Amalaka + + + - -

Bilwa + + + - -

VIII Madhya Varga

Sura - + - + + Varuni - - + - -

IX Madhu Varga

Madhu + + + + +

X Mootra Varga

Gomutra - - - - +

XI Dugdha Varga

Aja Kshira - - - + +


45

XII Ghrta Varga


Purana sarpi - + - + + Ajasarpi - - - + +

XIII Krtanna Varga

Yusha + - + - - Yavagu + - - - -

Peya + - + - - Satthu - - + - - Varuni - - + - -

Pathya Vihara

Virechana + - - + + Swedana + - - + +

Dhoomapana + - - + + Prachardana - - - + +

Swapanam Diva - - - + + Table No.6

Apathya in Tamaka Swasa

Apathya Aahara I Shimbi Dhanya


Nishpava + - - + - Masha + - - + - Thila + - - - -

Sarshapa - - - + +

II Shaaka Varga Kanda - - - + +

III Mamsa Varga Jalaja + - - - - Anupa + - - - + Pishita + - - - - Matsya - - - + +

IV Dadhi Varga Dadhi + - - - -

V Kshira Varga Kshira + - - + +

Mahisha Kshira + - - - -


46

VI Grita Varga Pathya Ahara C .S.189 S .S.190 A .H.191 Y.R.192 B.R.193

Mahisha Gritha - - - + +

VII Krtanna Varga Tailabhrsta Nishpava - - - - +

Pistanna + - - - - Pinyaka + - - - -

Apathya Vihara Sheeta Snana + + + - -

Raja + + + + + Dhooma + + + + +

Anila + + + + + Vyayama Karma + + - - -

Bhara - + - - + Adhwa - + - - +

Vegaghata - + - - - Apatharpana + + - - - Rakta srava - - - - -

Pragvata - - - - - Marmaghata + - + + + Sooryatapa - - - - + Daurbalya + - - - -

Aanaha + - - - - Abhighata - + - - - Strigamana - + - - -

Vegavarodha-Mootra, Udgara, Chardi, Trushna,

Kasa

- + - - -

In a nutshell, the factors that help in maintenance of normalcy of Vata Dosha and

Kapha Dosha, both during the symptomatic and asymptomatic period are considered as

Pathya. Added to this, the factors that favour the normal physiological functioning of

Pranavaha srotas, is popularly known by the name Pathya.

In contrast to this, the factors either related to food or behavior that can affect the

balance of the Vata and Kapha Doshas are regarded as Apathya. Any factor that has

detrimental effect on the Pranavaha srotas is listed as Apathya. Strict observation of the


47

Pathya and Apathya prevents an episode of the illness in patients who are asymptomatic.

Likewise, Pathya and Apathya have great influence in modifying the severity of the illness

during the acute attack of breathlessness.

Drug Review

Table -7 Internal medicine – ingredients of Brihat Katphaladi yoga194

Katphala Myrica esculenta 3 Parts

Poushkara / Pushkaramoola Inula racemosa 3 Parts

Sringi (Karkatasrinigi) Pistacia intergerrima 3 Parts

Musta Cyperus rotundus 3 Parts

Shati Hydychium spicatum 3 Parts

Shunti Zingibera officinale 1 Part

Pippali Piper longum 1 Part

Maricha Piper nigrum 1 Part

All the ingredients of Brihat Katphaladi Yoga are well identified and

collected from local area; good manufacturing practice will be followed for preparation.

Even though above yoga mentioned in “churna kalpana” for easy administration it is

tabulated after 3 times fortification. The prepared drug is preserved in glass jars to protect

the shelf life of the medicine. Later at the time of distribution requisite quantity of the

medicine is packed and given to patients. The individual components of the composition

are as follows under specified headings.


48

1) Katphala - Myrica esculenta – 195-197

Prayojyanga Twak

Rasa Kashaya, tikta, katu

Guna Laghu, teekshna

Veerya Ushna

Vipaka Katu

Prabhava Sweda janaka, Shothaghna,

Doshagnata Kapha vata hara

Rogaghnata Swasa, Jwara

Chemical consttiuents Tannin, Saccharine, Salts

Prepared Medicines useful at Pranavaha Srotas

Brihat Katphaladi churna

2) Poushkara / Pushkaramoola - Inula racemosa198-200

Prayojyanga Moola,

Rasa Tikta, katu

Guna Laghu, teekshna

Veerya Ushna

Vipaka Katu

Prabhava Anulomaka, Uttejaka, Shothagna

Doshagnata Kapha vata shamaka

Rogaghnata Parshwa shoola, Swasa, Kasa, Arochaka, Shopha, Pandu

Chemical consttiuents Tridin, Glucosoide, Tannin, Calcium oxalate


Dashamoola Rasayana, Sringyadi Churna


49

3) Sringi (Karkatasrinigi) - Pistacia intergerrima 201-203

Prayojyanga Kosha

Rasa Tikta, Kashaya

Guna Laghu, Rooksha

Veerya Ushna

Vipaka Katu

Prabhava Swasaghna, Balya, Kapha nissaraka


Rogaghnata Swasa, Kasa, Hikka, Aruchi

Chemical constituents Crystalline hydrocarbon, Tannin, Essential oils


Brihat Katphaladi yoga

4) Musta - Cyperus rotundus 204-206

Prayojyanga Kanda,

Rasa Tikta, Katu, Kashaya

Guna Laghu, Rooksha

Veerya Sheeta

Vipaka Katu

Prabhava Deepana, Pachana, Grahi

Doshagnata Kapha pitta shamaka

Rogaghnata Aruchi, Amatisara

Chemical consttiuents Essential oils, Carbohydrate


Chyavanaprasha, Kantakaryava lehya


50

5) Shati - Hydychium spicatum 207-209

Prayojyanga Kanda

Rasa Katu, Tikta, Kashaya

Guna Laghu, Teekshna

Veerya Ushna

Vipaka Katu

Prabhava Mootra janaka, Deepana, Swarya


Rogaghnata Swasa, Kasa,

Chemical consttiuents Methyl parachamarin acitate


Agastya Hareetaki, Dashamoola Rasayana

6) Shunti - Zingibera officinale 210-212

Prayojyanga Kanda

Rasa Katu

Guna Laghu, Snigdha

Veerya Ushna

Vipaka Madhura

Prabhava Truptighna, Deepana, Vatanulomana


Rogaghnata Swasa, Kasa, Pratishyaya,

Chemical consttiuents Camphene, Phellandrene, Zinguberine, Cinol, Borncol


Dashamoola Katurohinyadi Kashaya, Chyavanaprasaha


51

7) Pippali - Piper longum 213-215

Prayojyanga Phala

Rasa Katu

Guna Laghu, Snigdha, Teekshna

Veerya Anushna sheeta

Vipaka Madhura

Prabhava Vrushya, Medhya, Agni vardhaka


Rogaghnata Swasa, Kasa, Jwara

Chemical consttiuents Piparine, Resin,


Sitopladi churna, Haridra Khanda

8) Maricha -Piper nigrum 216-218

Prayojyanga Phala

Rasa Katu

Guna Laghu, Teekshna

Veerya Ushna

Vipaka Katu

Prabhava Agni deepaka, Kaphaghna


Karma Swasa, Shoola, Krimi

Chemical consttiuents Piparine, Piparidine, Balmaric volatile essential oil


Vasarista, Kushmanda Rasayana


52

Table – 8, Nitya Shodhana with Vyoshadi Gutika

Nitya Shodhana Vyoshadi Gutika Ingredients 219

Snaskrit Name Botanical Name Proportion

Shunti Zingibera officinale 1 part

Pippali Piper longum 1 part

Maricha Piper nigrum 1 part

Twak Cinnamomum zeylanicum 1 part

Patra ( Tejapatra ) Cinnamomum zeylanicum 1 part

Musta Cyperus rotundus 1 part

Ela Eletteria cardomum 1 part

Vidanga ( Vayu vidanga ): Embelica ribes 1 part

Amalaki Emblica officinalis 1 part

Abhaya Terminalia chebula 1 part

Mukulaka ( Danti ) Baliospermum montanum 20 parts

Trivrut Operealanta terpethum 80 parts

Sharkara Sugar 60 parts

All the ingredients of Vyoshadi Gutika are well identified and collected

from local area; good manufacturing practice will be followed for preparation. Vyoshadi

Gutika for easy administration is capsulated after preparation. The prepared drug is

preserved in glass jars to protect the shelf life of the medicine. Later at the time of

distribution requisite quantity of the medicine is packed and given to patients. The

individual components of the composition are as follows under specified headings.

1) Shunti - Zingibera officinale

2) Pippali - Piper longum

3) Maricha - Piper nigrum

4) Musta - Cyperus rotundus

- are detailed above when discussing the ingredients of Brihat Katphaladi yoga.


53

5) Twak - Cinnamomum zeylanicum 220-222

Prayojyanga Twak

Rasa Katu

Guna Laghu, Rooksha, Teekshna

Veerya Ushna

Vipaka Katu

Prabhava Shukrala, Vrushya

Doshagnata Kapha Vata shamaka, Pitta vardhaka

Rogaghnata Mukha shosha, Trushna

Chemical consttiuents Cinnamic acid, Tannin,


Marichyadi Gutika, Talisadi churna

6) Patra ( Tejapatra ) - Cinnamomum zeylanicum 223-225

Prayojyanga Patra

Rasa Madhura

Guna Laghu, Picchila

Veerya Ushna

Vipaka -

Prabhava -


Rogaghnata Aruchi, Peenasa, Arsha

Chemical consttiuents -


Dashamoola Hareetaki, Kushmanda Rasayana


54

7) Ela - Eletteria cardomum 226-228

Prayojyanga Beeja

Rasa Katu, Madhura

Guna Laghu, Rooksha

Veerya Sheeta

Vipaka Madhura

Prabhava Mootrala, Vatanulomaka

Doshagnata Vata hara

Rogaghnata Swasa, Kasa, Arsha, Mootra kruchra

Chemical consttiuents Terpinyl acetate, Cineole, Terpincol


Kushmanda Rasayana, Dashamoola Hareetaki

8) Vidanga ( Vayu vidanga )- Embelica ribes 229-231

Prayojyanga Phala

Rasa Katu, Kashya


Veerya Ushna

Vipaka Katu

Prabhava Krimighna


Rogaghnata Shoola, Adhmana, Udara, Krimi

Chemical consttiuents Embelic acid, Cbristernbine


Vyoshadi Gutika


55

9) Amalaki - Emblica officinalis 232-234

Prayojyanga Phala

Rasa Madhura, Amla, Katu, Tikta, Kashaya

Guna Guru, Rooksha,

Veerya Sheeta

Vipaka Madhura

Prabhava Rasayana

Doshagnata Tridosha hara

Rogaghnata Raktapitta, Aruchi, Agnimandya

Chemical consttiuents Gallic acid, Eligic acid,


Chyavanaprasha, Chandramruta Rasayana, Agastya Hareetaki

10) Abhaya - Terminalia chebula 235-237

Prayojyanga Phala

Rasa Kashaya, Tikta, Katu, Madhura, Amla

Guna Laghu, Rooksha

Veerya Ushna

Vipaka Madhura

Prabhava Anulomaka, Mala shodhaka

Doshagnata Tridosha hara

Rogaghnata Swasa, Kasa,

Chemical consttiuents Tannic acid, Galic acid, Lucilage, Chebulimic acid


Agastya Rasayana, Pushkaramruta


56

11) Mukulaka ( Danti ) - Baliospermum montanum 238-340

Prayojyanga moola

Rasa Katu

Guna Guru, Teekshna

Veerya ushna

Vipaka Katu

Prabhava Adhobhaga hara

Doshagnata kapha pitta hara

Rogaghnata shotha, Udara, Krimi

Chemical consttiuents Baliospermin, Montanine


Vyoshadi Gutika

12) Trivrut - Operealanta terpethum 241-243

Prayojyanga Moola

Rasa Tikta, Katu


Veerya Ushna

Vipaka Katu

Prabhava Sukha Virechaka

Doshagnata Kapha pitta hara

Rogaghnata Shotha, Udara

Chemical consttiuents � and � Turphethine


Haridra khanda

Chapter - 4

Methodology

Tamaka Swasa is a pranavaha sroto janya vikara, where cold, dust, smoke and

excessive work are the causative factors for it. The severity of the disease is seen during

conditions like meghavarana, sheeta rutu, sheeta sthana, and excessive intake of sheeta jala

and purva dishagata vayu according to Ayurveda. In most of atopic subject allergy out of

many factors including exercise, infection and emotional upsets provokes attacks of Tamaka

Swasa.

All age groups of people are prone to get this condition, but it is commonly seen in

early age groups, as Kapha is predominant and at the late ages as the Vata dominance. As this

disease is Kapha Vata pradhana, and Pitta sthana samudbhava, the general line of

management is tamaketu virechanam. Here Nitya shodhana protocol of this study relieves

avarodha of Vata by Kapha. Vyoshadi Gutika as a Nitya shodhana medicine mainly acts on

Kapha and Vata. Brihat Katphaladi yoga with its Vata Kapha shamaka dravyas acts on

Tamaka Swasa. It is necessary to discuss the materials and methods in detail at this juncture.

Materials and Methods

Method of Collection of data

1) Patients:

Patients suffering from Tamaka Swasa will be selected from department of

Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi Ayurvedic

medical college and Hospital by preset inclusion and exclusion criteria.

Methodology of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

57


58

2) Literary:

Literary aspect of study is collected from classical Ayurvedic and modern texts, which

is discussed widely in literary review.

3) Study design:

Simple random sampling technique - comparative clinical trial is adopted here under

two groups.

4) Sample size:

Minimum of 15 patients in each group irrespective of sex is under taken in the study.

5) Exclusion Criteria –

1. Patients suffering form any systemic or congenital diseases are excluded

because, it is very difficult to assess the disease condition with other

systemic disorders and congenital diseases associated.

2. History above 10 years of period are excluded because, commonly history

above 10 years are chronic asthmatic patients which falls under the COPD

conditions, difficult for treatment and also assessment.

3. Patient below 18 years and above 60 years are excluded because, study

restricted only to adults, the drug efficacy cannot be assessed in full length.

4. Status asthmatics are excluded because this condition is chronic and needs

hospitalization with supervision.

5. Pregnant and lactating women are excluded because; drug may affect the

foetus or lactating baby, through its placental barrier alkaloids. Even

though the composition is herbal and safe still they are excluded.


59

6) Inclusion criteria –

1. Patients having stated lakshana as per Ayurvedic classics are included

because, they are the prime subjective parameters of assessment.

2. Patients between 18 to 60 years irrespective of sex are included because,

restriction of the study as the assessment of these groups are easy.

3. History below 10 years are included because, the disease said as kasta

sadhya from the Ayurvedic classics.

4. Shodhana Arha are included because, the drug chosen rapidly relieves the

Dosha accumulated in the body.

7) Criteria of Diagnosis

The signs and symptoms of Tamaka Swasa mentioned in the Ayurvedic texts and

objective investigations mentioned in contemporary texts are the criteria for the diagnosis.

8) Posology-

1) Brihat Katphaladi yoga – 3 gms /per day in divided doses

2) Vyoshadi Gutika – 500 mg daily morning at 6 AM

Anupana = Madhu

9) Study Duration:

14 days for each group

10) Follow up:

14 days for each group


60

11) Assessment of Result

Results are assessed form subjective and objective parameters of base line data of

before and after treatment as discussed in the result section. The cumulative effect of the drug

over disease and the body are considered here.

12) Subjective parameters

As explained in classical Ayurvedic texts and modern texts the subjective

parameters are noted here under are vividly discussed in the literary review -

1. Teevra vega Swasa – Swasa krichrata (Dyspnonea)

2. Kasa (cough)

3. Duhkhena Kapha nissaranam (Expectoration)

4. Ghurghuratwam (Wheezing)

5. Peenasa (Coryza)

6. Kruchrena bhasate (difficulty in speech)

7. Kantodhwamsham (Hoarseness of voice)

8. Greevashirasangraha (Headache & Stiffness)

9. Urah Peeda (Chest Pain)

10. Shayane Swasa peedita (Discomfort at supine)

13) Objective Parameters

As explained in different texts the objective parameters are noted here under

are vividly discussed in the context of examination of patient in the same

chapter.

1. Peak expiratory flow rate


61

2. Breath holding time

3. Absolute Eosinophil counts

4. Erythrocyte sedimentation rate

5. Haemoglobin percentage

14) Statistical analysis:

The parameters, Subjective and Objective parameters are tested with the paired, and

un -paired T-test and non parametric test used for the testing of hypothesis. If p<0.05, the test

is highly significant.

15) Examination of a Tamaka Swasa Patient vis-à-vis asthma

1) Demographic data

The patient identity is prime in diagnosing the disease as Ayurveda specifies the

Sadhya and Asadhya based on age and relative factors such as desha, Kala etc. thus Name,

Age, Gender, Occupation, Economical status, Birth place and Food habits are recorded in the

demographic data of the case sheet along with the consent signed.

2) Chief complaints (Subjective parameters) and Associated complaints

The symptoms enumerated in the classical textbooks and contemporary systems are

detailed for the studies are noticed here under the pre prescribed grades of declarations. The

detailed discussion is made in the literary review. The grades of observation are as follows.

Swasa kricchrata –

Teevra vega Swasa

0 – Normal - no symptoms

1 – Mild – breathless with activity, frequency 1 to 2 times/week

2 – Moderate – breathless with talking, frequency 2 to 4 times/week

3 – Severe – breathless at rest, frequency 4 to 6 times/week, limited

activity

Kasa 0 – Normal - no cough


62

1 – Mild - morning bouts or after exercise - don’t disturb work

2 – Moderate - continuous cough during day and morning disturbing

work

3 – Severe - continuous and night cough disturb activities

Dukhen kapha

nissaranu

0 – Normal - no phlegm

1 – Mild - less than 2.5 ml/day without pain

2 – Moderate - 2.5 ml to 15 ml/day with mild pain

3 – Severe - 15 to 25 ml/day with pain

Ghurghurtwam

0 – Normal - no wheezing

1 – Mild - moderate wheezing at mid to end respiration, brief, not more

than 1 to 2 times/week

2 – Moderate - loud wheeze through out expiration, not more than 2 to

4 times/week

3 – Severe - loud inspiration and expiration wheeze, more than 4 to 6

times/week

Peenasa

0 – Normal - no common cold & cough

1 – Mild - initially present or occasionally

2 – Moderate - continuous day with cough

3 – Severe - continuous day and night

Krucchana bhasate

0 – Normal - difficult to speak

1 – Mild - able to speak in sentences

2 – Moderate - able to speak in phrases

3 – Severe - able to speak in words

Kantodwamsa

0 – Normal - no hoarseness of voice

1 – Mild - 0 or 1 bout while speaking sentence

2 – Moderate - 1 or 2 bout while speaking phrase

3 – Severe - associated with words and phrase

Greeva shira

samgrah

0 – Normal – no symptoms

1 – Mild - occasionally

2 – Moderate - 1 to 2 times in a week.

3 – Severe - 2 to 4 times or often


63

Uraha peeda

0 – Normal - no chest tightness

1 – Mild - able to tolerate the tight or pain

2 – Moderate - Persists during cough + mild differs

3 – Severe - feels difficulty to tolerate pain and tightness

Shayanasy Swasa

peedita

0 – Normal – no discomfort

1 – Mild - < 1 or 2 time/month

2 – Moderate - 2 time/week

3 – Severe - > 3 or frequently

3) History of present illness

At the history of present illness, Mode of onset, Course, Frequency of attack, Duration

of attack, Mode of progress, Periodicity, Preceded by what factors, Sputum, Aggravating

factors and Comfort posture at attack are discussed as listed in the annex-1 (Case sheet).

4) Personal history

The personal history is discussed as - Food habits with reference to taste, Taste

preferred, Agni, Kosta, Nidra, Addictions, Bowel habits, Menstrual History, Family history –

Specify if any has the same disease, Treatment history and History of past illness.

5) Examination of Patients (RS) 244, 245

The Sequence of the Respiratory Examination done in two positions 1) Patient supine

or seated, examining anteriorly and Patient in sitting position, examining posteriorly along

with the standard inspection, palpation, percussion and auscultation. Apart from these under

the headings of Darshana, Sparshana Akotana, shravana are sub classified with symptoms for

convenience of study. They are as follows –


64

Patient supine or seated, examining anteriorly

Inspection:

Respiratory rate, depth

Muscle use

Respiratory distress

Chest wall anomalies

Palpation:

Tracheal position

Thoracic excursion

Abdominal, costal paradox

Percussion

Auscultation

Patient in sitting position, examining posteriorly

Inspection:

Anomalies of spine and back

Palpation:

Thoracic excursion

Percussion:

Diaphragmatic excursion

Auscultation:

Breath sounds, adventitious sounds

Transmission of sounds

Darshana (Inspection) Shape

Movement

Resp. Rhythm

Respiration

Accessory muscles

Inter coastal spaces

Visible veins

Venous pulses


65

Sparshana (Palpation) Tracheal position

Pain / Tenderness

Swelling

Vocal fremitus

Shape

Lymph nodes

Akotana (percussion) As dull, resonant etc

Shravana (Auscultation) Type of breath

Vocal resonance

Respiratory Sounds

6) Ayurvedic examination

In Ayurvedic examination Dosha Vruddhi, Kshaya lakshanas are examined along with

the Dasha vidha and Astastana pareeksha. The emphasis of the Agni is made specially. The

srotas is important to examine for the disease diagnosis, as it is one of the Samprapti ghataka.

Thus the Pranavaha, Annavaha and Udakavaha srotases are examined with their vitiated

symptoms.

7) Observation of Pancha Lakshana Nidana

The pancha lakshana Nidana i.e. Nidana, Poorva roopa, Lakshana along with the

Upashaya and nupashaya are examined according to the classical references as detailed in the

annex-1.

8) Investigations and Objective parameters

The investigations and objective parameters considered in the study are –

a) Breath holding time

b) Peak expiratory flow rate

c) Absolute eosinophilic count

d) Erythrocytes sedimentation rate

e) Haemoglobin %


66

a) Breath holding time 246

Breath in can be held for variable period of time by different individuals depending

upon the functional states of lungs development of respiratory muscles practice, age, and sex

etc. The normal BHT after deep inspiration may vary from 40 seconds to over a minute. The

BHT decreases in many diseases such as chronic bronchitis emphysema, asthma, etc. of lung

disease.

Procedure:

Breath holding time (BHT) is a simple test, in which, ask the patient to take a deep

breath and count the time in seconds.

Grading of BHT

BHT Grades are declared for the sake of final assessment is as follows.

Grade 0 30 and above

Grade 1 30 to 20

Grade 2 20 to 10

Grade 3 10 and below

b) Peak expiratory flow rate 247

The Wright’s peak flow meter, introduced in 1959 is a simple, portable device. PEFR

has a very good correlation with FEVI and for measuring the ventilatory function of lungs.

This simple objective measurement of lung function helps detecting early deterioration of

lung function. Measurement of PEFR is valuable in medical care settings to measure response

to therapy during an acute exacerbation. Out of lung function, the PEFR is more useful.

Procedure

Step 1) ask patient to hold the PEFR in position

Step 2) let the patient take a deep breath in


67

Step 3) patient keep the PEFR instrument in the mouth with out any leakage of

air from sides in to the flow meter with a sharp blast

Step 4) the movement of the needle on the dial indicates the PEER in

liters/minute, which is to be noted

Taken 3 readings at one minute intervals and recorded the average of higher readings

brought to the needle back to zero by pressing the button located near the mouth piece.

Normal Range of PEFR is 350-500liters/minute.

Grading of PEFR

PEFR Grades are declared for the sake of final assessment is as follows.


Grade 1 350 to 250

Grade 2 250 to 150


c) Absolute Eosinophilic count 248

Eosinophils are important in the defence against parasites, worms, and to any

infection. Because they are also sensitive to circulating allergens (materials that trigger

allergies), Eosinophils increase in number during allergic reactions as well. Thus the absolute

Eosinophils count is a good parameter to study the Asthma. Normal range of AEC is 40-440.

Grading of AEC

AEC Grades are declared for the sake of final assessment is as follows.


Grade 1 240 to 440

Grade 2 440 to 640



68

d) Erythrocytes sedimentation rate 249

Westergren’s method (pipette method) Erythrocytes sedimentation rate measures in

the graduated tubes facilitate to understand possible presence of organic disease. It is

universally accepted that it is a good prognostic method in clinical laboratory.

Procedure:

Steps 1) draw the sufficient blood sample from patient vein

Step 2) add anti coagulant to the blood

Steps 3) suck the blood in to the ESR tube

Step 4) note the point of sedimentation on graduated tube

e) Haemoglobin % 250

Hemoglobin is responsible for the cell's ability to transport oxygen and carbon

dioxide. The haemoglobin content of whole blood is reported in terms of grams of Hb per 100

ml of whole blood (g/dl). Normal ranges are 14-18 g/dl in males and 12-16 g/dl in females.

This is estimated with the Shali’s method in general, which will show the Hb% in grams/ dl.

9) Differential diagnosis

It is observed that the Tamaka Swasa for the differences of diagnosis as told in

Ayurveda texts viz. santamaka and pratamaka with its stipulated symptoms.

10) Result declaration

Result declaration is made upon the cumulative assessment of the parameters. Out of

Subjective parameters, Teevravega Swasa, Kasa and Urah peeda were considered. At the

objective parameters BHT, PEFR and AEC are considered. The Result is declared as Well

Responded, Moderately Responded, Poorly Responded and Not Responded categories. The

discontinued patients were not considered for the result declaration.

Chapter - 5

Results

Present study registers 35 patients, out of 58 approached patients. Out of this, 5

patients were discontinued hence their data has not been included in the assessment. The

remaining 35 patients of Tamaka Swasa viz. Asthma, fulfilling the criteria of diagnosis

and inclusive criteria were included in the study, fewer than two groups as discussed in

the Methodology, distributed patients in Group-A are 15 and Group-B are 15.

All the patients were examined before and after the trail, according to the case

sheet format given in the annex. Both the subjective and objective criteria were recorded.

The data recorded are presented under the following headings.

A. Demographic data

B. Evaluating disease Data and

C. Statistical analysis of the clinical and objective parameters

Result of the Brihat Katphaldi Yoga and Vyoshadi Gutika in Tamaka

Swasa viz. asthma are group wise dealt at every event.

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. of the 15 patients in

each group are as follows.

Results of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa 69


Table - 9

Table showing the demographic data of Group -A

S.No OPD Age Gender Religion Occupation Economical status

Food habits

Result

1 3803 38 Female Hindu Sedentary HM Veg MR 2 3876 53 Female Hindu Active High Mix PR 3 4861 42 Male Hindu Active HM Mix PR 4 1299 35 Male Hindu Labor Poor Veg WR 5 1329 47 Female Hindu Sedentary Mid Veg MR 6 1347 27 Male Hindu Labor Poor Mix PR 7 1353 49 Male Hindu Active Mid Veg MR 8 1399 31 Male Hindu Active Mid Mix PR 9 1401 56 Female Hindu Active Mid Veg WR 10 1421 40 Female Muslim Labor Poor Mix PR 11 1423 57 Male Hindu Sedentary Mid Veg PR 12 1426 59 Male Hindu Active Mid Veg PR 13 1427 28 Male Hindu Active Poor Veg MR 14 1430 42 Female Muslim Active Mid Mix NR 15 1431 56 Male Hindu Sedentary Mid Veg PR

Table - 10

Table showing the demographic data of Group -B

S.No OPD Age Gender Religion Occupation Economical status

Food habits

Result

1 4146 45 Male Hindu Active Mid Mix MR 2 4163 36 Male Hindu Active Mid Veg MR 3 1300 42 Female Hindu Sedentary HM Veg NR 4 1328 56 Male Hindu Labor Poor Veg NR 5 1330 41 Male Hindu Active HM Mix WR 6 1348 40 Male Muslim Labor Poor Mix PR 7 1349 53 Female Hindu Sedentary Mid Veg PR 8 1354 45 Female Hindu Active Mid Veg PR 9 1400 47 Male Hindu Active Poor Veg WR 10 1422 51 Male Hindu Sedentary Mid Veg PR 11 1424 45 Female Hindu Labor Poor Mix PR 12 1425 56 Female Hindu Labor Poor Veg MR 13 1428 25 Male Hindu Active Poor Mix NR 14 1929 32 Male Hindu Labor Mid Veg MR 15 1932 29 Male Muslim Active Mid Mix WR

HM = Higher Middle, Mid = Middle class, High = Higher class,

Veg = Vegetarian, Mix = Mixed diet, WR = well Responded, MR = Moderately

Responded, PR = Poorly Responded, NR = Not Responded


A1) distribution of patients by Age

An interval of 10 has considered from the ages 20 to 60 as discussed in the

methods. In the study it is revealed that allergy is continued from the ages of 20 onwards

and as age advances the samples are settled. A wide distribution of the disease is

observed in the 40-50 as 10 patients and 50-60- as 9 patients in the study.

Table- 11 Distribution of patients by Age- gender in Groups – A & B

Group –A Group -B Total patients Age

Mal

e

%

Fem

ale

%

Mal

e

%

Fem

ale

%

Num

ber

%

20-30 2 13.3 0 0 2 13.3 0 0 4 13.4

30-40 2 13.3 2 13.3 3 20 0 0 7 23.3

40-50 2 13.4 2 13.3 3 20 3 20 10 33.3

50-60 3 20 2 13.4 2 13.3 2 13.4 9 30

Total 9 60 6 40 10 66.6 5 33.4 30 100

Table- 12

Results of Patients by Age in Group - A

Age

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oorl

y R

espo

nded

% N

ot

Res

pond

ed

%

20-30 2 13.3 0 0 1 6.6 1 6.7 0 0

30-40 4 26.6 1 6.7 1 6.6 2 13.4 0 0

40-50 4 26.6 0 0 2 13.4 1 6.7 1 6.6

50-60 5 33.3 1 6.7 0 0 4 26.6 0 0

Total 15 100 2 13.4 4 26.6 8 53.4 1 6.6


Table- 13

Results of patients by Age in Group - B

Age

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oorl

y R

espo

nded

% N

ot

Res

pond

ed

%

20-30 2 13.4 1 6.6 0 0 0 0 1 6.6

30-40 3 20 0 0 2 13.4 1 6.6 0 0

40-50 6 40 2 13.4 1 6.6 2 13.4 1 6.7

50-60 4 26.6 0 0 1 6.6 2 13.4 1 6.7

Total 15 100 3 20 4 26.6 5 33.4 3 20

A2) distribution of patients by Gender

Table- 14

Results of patients by Gender in Group - A

Age

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oorl

y R

espo

nded

% N

ot

Res

pond

ed

%

Male 9 60 1 6.7 2 13.3 6 40 0 0

Female 6 40 1 6.7 2 13.3 2 13.4 1 6.6

Total 15 100 2 13.4 4 26.6 8 53.4 1 6.6

The results in the group-A as depicted in the table are encouraging. Here we

observe an over all well responded 2 patients with moderately responded 4 patients out of

15 patients in the group. A maximum 8 patients are exhibited with poor response as par

the gender differentiation.

Table- 15

Results of patients by Gender in Group - B

Age

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oorl

y R

espo

nded

% N

ot

Res

pond

ed

%

Male 10 66.6 3 20 3 20 2 13.4 2 13.4

Female 5 33.4 0 0 1 6.6 3 20 1 6.6

Total 15 100 3 20 4 26.6 5 33.4 3 20

The results in the group-B as depicted in the table are encouraging. Here we

observe an over all well responded 3 patients with moderately responded 4 patients out of

15 patients in the group. A maximum 5 patients are exhibited with poor response and 3

patients in the not responded as par the gender differentiation.

Graph – 1

DISTRIBUTION OF PATIENTS BY AGE – GENDER IN GROUPS – A & B - PICTORIAL PRESENTATION

Re

Age- Gender Distribution of Tamaka Swasa Patients

0

2 2 22

3 3

2

0 0

3

2

3

2 22

0

1

2

3

4

Gr-A Male 2 2 2 3Female 0 2 2 2Gr-B Male 2 3 3 2Gr-B female 0 0 3 2

20-30 30-40 40-50 50-60

sults of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa 73

A3) distribution of patients by Religion

Table – 16 Distribution of patients by Religion in Groups – A & B

Group –A Group -B Total patients Religion

Male % Female % Male % Female % Number %

Hindu 9 60 4 26.6 8 53.3 5 33.4 26 86.7

Muslim 0 0 2 13.4 2 13.3 0 0 4 13.3

Christian 0 0 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0 0 0

Total 9 6 10 5 30 100

The distribution of demographic data under the hedging in both Groups are as

depicted in the table are encouraging. Here we observe an over all Hindu patients with

Muslim 4 patients out of 30 patients.

Graph – 2

Distribution of patients by Religion in Tamaka Swasa

Results of Br

Christian Muslim Others

ihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa 74

Distribution of patients by Religion in Tamaka Swasa

0%

Hindu86.67%

13.33% 0%


Table- 17

Results of patients by Religion in group - A

Religion

T

otal

no

of

pati

ents

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oorl

y R

espo

nded

% N

ot

Res

pond

ed

%

Hindu 13 86.6 2 13.4 4 26.6 7 46.7 0 0

Muslim 2 13.4 0 0 0 0 1 6.7 1 6.6

Christian 0 0 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0 0 0

Total 15 100 2 4 8 1

The results in the Group –A of Religion category as depicted in the table are

encouraging. Here we observe an over all well responded 2 patients with moderately

responded 4 patients out of 15 patients in the group. A maximum 8 patients are exhibited

as per the religion differentiation.

Table- 18

Results of patients by Religion in group - B

Religion

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

Res

pond

ed

% N

ot

Res

pond

ed

%

Hindu 13 86.6 2 13.4 4 26.6 4 26.7 3 20

Muslim 2 13.4 1 6.6 0 0 1 6.7 0 0

Christian 0 0 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0 0 0

Total 15 100 3 4 5 3

The results in the Group –B of Religion category as depicted in the table are



with poor response and 3 patients in the not responded as per the religion differentiation.

A4) Distribution of patients by Occupation

Table –19

Distribution of patients by Occupation in Groups – A & B

Group –A Group -B Total patients Occupation

Number % Number % Number %

Sedentary 4 26.6 3 20.0 7 23.4

Active 8 53.4 7 46.6 15 50

Labour 3 20.0 5 33.4 8 26.6

Total 15 100 15 100 30 100

Graph - 3 DISTRIBUTION OF PATIENTS BY OCCUPATION

Results of B

PATIENTS BY OCCUPATION

Active50.00%

Sedentary23.33%Labour

26.67%

rihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa 76


Table - 20

Results of patients by occupation in Group -A O

ccup

atio

n

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

R

espo

nded

%

Not

Res

pond

ed

%

Sedentary 4 26.6 0 0 2 13.4 2 13.3 0 0

Active 8 53.4 1 6.6 2 13.3 4 26.6 1 6.6

Labour 3 20 1 6.6 0 0 2 13.3 0 0

Total 15 100 2 13.3 4 26.6 8 53.4 1 6.6

The results in the Group –A of occupation category as depicted in the table are



as per the occupation differentiation as tabulated below.

Table- 21

Results of patients by occupation in Group -B

Occ

upat

ion

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

R

espo

nded

% N

ot

Res

pond

ed

%

Sedentary 3 20 0 0 0 0 2 13.4 1 6.6

Active 7 46.6 3 20 2 13.3 1 6.6 1 6.6

Labour 5 33.4 0 0 2 13.3 2 13.4 1 6.6

Total 15 100 3 20 4 26.6 5 33.4 3 20

The results in the Group –B of occupation category as depicted in the table are




with poor response and 3 patients in the not responded as per the occupation

differentiation as tabulated above.

A5) Distribution of patients by Economical status

Table –22 Distribution of patients by Economical status in Groups – A & B

Group –A Group -B Total patients Economical status


Poor 4 26.6 6 40.0 10 33.3

Middle 8 53.4 7 46.6 15 50

Higher Middle 2 13.4 2 13.4 4 13.4

Higher 1 6.6 0 0 1 3.3

Total 15 100 15 100 30 100

Table- 23

Results of patients by Economic status in Group -A

Eco

nom

ic s

tatu

s

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

R

espo

nded

% N

ot

Res

pond

ed

%

Poor 4 26.6 1 6.7 1 6.6 2 13.4 0 0

Middle 8 53.4 1 6.7 2 13.4 4 26.6 1 6.6

Higher

Middle 2 13.4 0 0 1 6.6 1 6.7 0 0

Higher 1 6.6 0 0 0 0 1 6.7 0 0

Total 15 100 2 13.4 4 26.6 8 53.4 1 6.6


The results in the Group –A of Economical status category as depicted in the table

are encouraging. Here we observe an over all well responded 2 patients with moderately


as per the Economical status differentiation.

Table – 24

Results of patients by Economic status in Group -B

Eco

nom

ic

sta

tus

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

R

espo

nded

% N

ot

Res

pond

ed

%

Poor 6 40 1 6.7 1 6.7 2 13.4 2 13.4

Middle 7 46.6 1 6.7 3 20 3 20 0 0

Higher

Middle 2 13.4 1 6.6 0 0 0 0 1 6.6

Higher 0 0 0 0 0 0 0 0 0 0

Total 15 100 3 20 4 26.6 5 33.4 3 20

The results in the Group –B of Economical status category as depicted in the table

are encouraging. Here we observe an over all well responded 3 patients with moderately


with poor response and 3 patients in the not responded as per the Economical status

differentiation.

The graphical representation of the economical status is depicted as under.

Graph- 4

DISTRIBUTION OF PATIENTS BY ECONOMIC STATUS

A6) Distrib

Food habi

Vegetarian

Mixed diet

Total

The

groups for

under.

Results of Br

4

8

2

1

6

7

2

00

1

2

3

4

5

6

7

8

9

Poor Middle Higher Middle HigherResult by economical statusPatients

Group_AGroup_B

ution of patients by Food Habits

Table - 25

Distribution of patients by Food Habits in Group – A & B

Group –A Group -B Total patients ts


9 60 9 60 18 60

6 40 6 40 12 40

15 100 15 100 30 100

results in the Group –A & B of food habits show 3: 2 distributions in both

the vegetarian to mixed diet consumers. The graphic representation is as


Graph – 5

Distribution of patients by food habits in Tamaka Swasa

B) Data

B1) Dis

A

paramet

Bronchi

most co

Kruchra

patients

(Expect

Peeda (

bhasate

Results o

0 2 4 6 8 10

Vegetarian

Mixed diet

Distribution of patients by diet in Tamaka Swasa

Group-BGroup-A

related to the disease.

tribution of patients by presenting complaints

s explained in the literary review, the symptoms that are taken as subjective

ers are evaluated at this study under the heading of Tamaka Swasa vis-à-vis

al Asthma with the presenting complaints are put forth here. The first and fore

mplaint in Tamaka Swasa in both groups are Teevra vega Swasa – Swasa

ta (Dyspnonea) Ghurghuratwam (Wheezing) with all patients involved. 14

of each group are included with the Duhkhena Kapha nissaranam

oration) and Kasa (cough). Later to that the symptoms Peenasa (Coryza), Urah

Chest Pain), Shayane Swasa peedita (Discomfort at supine) and Kruchrena

(difficulty in speech) are also seen enlisted in the table below.

f Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa 81

Table-26

Patients enlisted by presenting complaints in Group –A & B Presenting complaints Group – A Group –B

Patients Percentage Patients Percentage

Teevra vega Swasa (Dyspnonea)

15 100 15 100

Kasa (cough) 14 93.3 14 93.3

Duhkhena Kapha nissaranam (Expectoration)

14 93.3 14 93.3

Ghurghuratwam (Wheezing)

15 100 15 100

Peenasa (Coryza) 13 86.6 12 80

Kruchrena bhashate (difficulty in speech)

10 66.6 8 53.3

Kantodhwamsham (Hoarseness of voice)

5 33.3 4 26.6

Greevashirasangraha (Headache & Stiffness)

8 53.3 9 60

Urah Peeda (Chest Pain) 11 73.3 10 66.6

Shayane Swasa peedita (Discomfort at supine)

12 80 11 73.3

Graph – 6 Graphical presentation of patients by presenting complaints in Group – A & B

Results of Br

Distribution by Presenting Complaints

15

14

13

15

13

10

5

8

11

12

8

9

10

11

1413

15

15

4

12

0 2 4 6 8 10 12 14 16

Dyspnonea

Cough

Expectoration

W heezing

Coryza

Difficulty in speech

Hoarseness of voice

Headache & Stiffness

Chest Pain

Discomfort at supine



B2) Distribution of patients by Associated features

Table – 27

Distribution of patients by Associated features

Group – A Group –B


Anidra (disturbed sleep) 8 53.3 6 40

Pratamyati or

Bhrushamarta (distressed) 3 20 2 13.3

Aruchi (Anorexia) 4 26.6 4 26.6

Vishukasyata (Dryness of mouth)

6 40 5 33.3

Lalata sweda (sweat over forehead)

4 26.6 3 20

Trushna (Thirst) 4 26.6 5 33.3

Angamarda (Malaise) 7 46.6 9 60

Kampa (Tremors) 1 6.6 0 0

Jwara (fever) 2 13.3 2 13.3

Pramoha (fainting) 0 0 0 0

Vamathu (nausea) 2 13.3 1 6.6

Muhur Swasa (frequent respiration)

8 53.3 6 40

Muhuchaiva dhamyati (puts all effort to breath)

4 26.6 3 20

Muhur Swasa along with Anidra and Angamarda are the major associated

symptoms observed in both groups. Pamoha and Kampa are the symptoms seldom

witnessed. Other wise all symptoms are some or the other time expressed by the patients.

All the observations pertained to the both groups are enlisted in the above table. The

pictorial expression is as follows below.

Graph – 7

Graphical presentation of patients by Associated features in Group – A & B

B3) Dis

A

groups.

response

Mode of

on set

Gradual

Sudden

Total

Results o

tribution of patients by mode of on set

s the mode of onset is observed more gradual onset patients are listed in both

In this study sudden onset patients express only response but not a maximum

to the management, enlisted below.

Table - 28 Results of patients by mode of on set group -A

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

R

espo

nded

% N

ot

Res

pond

ed

%

11 73.4 2 13.4 4 26.6 4 26.7 1 6.6

4 26.6 0 0 0 0 4 26.7 0 0

30 100 2 13.4 4 26.6 8 53.4 1 6.6

Distribution by Associated Complaints

8

34

6

4 4

7

12

0

2

8

45

0

2

01

6

32

45

6

9

3

0123456789

10

Anidra

Pratam

yati o

r Bhru

sham

artaAru

chi

Vishuka

syata

Lalata

swed

a

Trush

na

Angamard

a

Kampa

Jwara

Pramoh

a

Vamath

u

Muhur Swasa

Muhuchaiv

a dham

yati


Table- 29

Results of patients by mode of on set group -B

Mode

of

on set

Tot

al n

o of

pa

tien

ts

% W

ell

Res

pond

ed

%

Mod

erat

ely

Res

pond

ed

% P

oor

R

espo

nded

% N

ot

Res

pond

ed

%

Gradual 12 80 3 20 4 26.6 3 20 2 13.3

Sudden 3 20 0 0 0 0 2 13.4 1 6.6

Total 15 100 3 20 4 26.6 5 33.4 3 20

Graph – 8

Graphical presentation of patients by Mode of onset in Group – A & B

Resu

lts of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa 85

Distribution by Associated Complaints

11

43

12

0

2

4

6

8

10

12

14

Gradual Sudden

B4) Distribution of patients by course

Table- 30

Distribution of patients by course of on set groups A & B



Episodic 8 53.4 10 66.6

Continuous 4 26.6 3 20

Initially episodic 3 20 2 13.4

Total 15 100 15 100

Graph – 9

Graphical presentation of patients distribution by course of onset in Group – A & B

Results o

I

initially

Graph.

Patients distribution by course of onset in Group – A & B

8

433

2

10

0

2

4

6

8

10

12

Episodic Continuous Initially episodic

Group-AGroup-B


t is observed that people of episodic are more than that of either continuous or

episodic patients in both groups of the study as enlisted and expressed in the


B5) Distribution of patients by frequency of attack

Table - 31

Distribution of patients by frequency of attack in Group – A & B



Few hours 1 6.6 1 6.6

Few weeks 4 26.6 5 33.3

Few days 10 66.6 9 60

Total 15 100 15 100

B6) Distribution of patients by duration of attack

Table – 32

Distribution of patients by duration of attack in Group – A & B



Continuous 2 13.3 2 13.3

Intermittent 7 46.6 6 40

Subsides with medication 6 40 7 46.6

Total 15 100 15 100

The listed tables are expressive of the contents. In this B5 and B6 tables 31 and 32

it is expressed that the frequency and duration of the attacks at the time of observations

made. 60 % of patients noticed that the attack is of few hours and subsides with

medication and appears intermittently in 40% of each category. Thus the statements

drawn at the observations are supportive to the pathogenesis of the disease Tamaka

Swasa.


B7) Distribution of patients by mode of progress

Table – 33 Distribution of patients by mode of progress in Group – A & B



Typical 6 40 5 33.3

Rapid 3 20 3 20

Long term progress 6 40 7 46.6

Total 15 100 15 100

B8) Distribution of patients by periodicity

Table – 34 Distribution of patients by periodicity in Group – A & B



Seasonal 4 26.6 3 20

Irregular 9 60 9 60

Permanent 2 13.3 3 20

Total 15 100 15 100

B9) Distribution of patients by preceding factors

Table – 35

Distribution of patients by preceding factors in Group – A & B Group – A Group –B


Sneezing 5 33.3 4 26.6

Nasal irritation 2 13.3 3 20

Cough with Nasal irritation 8 53.3 8 53.3

Total 15 100 15 100


The listed tables are expressive of the contents. In this B7 to B9 tables 33 to 35 it

is expressed that the typical progress in all groups, irregular periodicity and cough and

sneezing as precipitating factors of the Tamaka Swasa. Thus the statements drawn at the

observations are supportive to the pathogenesis of the disease Tamaka Swasa.

B10) Distribution of patients by aggravating factors

Table – 36 Distribution of patients by aggravating factors in Group – A & B



Dust 4 26.6 3 20

Smoke 2 13.3 2 13.3

Both of above 9 60 10 66.6

Total 15 100 15 100

B11) Distribution of patients by comfort posture at attack

Table – 37 Distribution of patients by comfort posture at attack in Group – A & B



Sitting 8 53.3 6 40

Lying 1 6.6 2 13.3

Sitting & Forward bending 6 40 7 46.6

Total 15 100 15 100

The listed tables are expressive of the contents. In this B10 and B11 tables 36 and

37 it is expressed that the dust and smoke are the aggravating factors and where in the

sitting posture offers the comfort to the patients of Tamaka Swasa. Thus the statements



Swasa.

B12) Distribution of patients by Agni

Table – 38

Distribution of patients by Agni in Group – A & B Group – A Group –B


Samagni 4 26.6 2 13.3

Vishamagni 4 26.6 4 26.6

Mandagni 7 46.6 9 60

Total 15 100 15 100

B13) Distribution of patients by bowel habits

Table – 39 Distribution of patients by bowel habits in Group – A & B



Constipation 5 33.3 6 40

Loose 0 0 0 0

Normal 10 66.6 9 60

Total 15 100 15 100

The listed tables are expressive of the contents. In this B12 and B13 tables 38 and

39 it is expressed that the Mandagni patients are predominantly susceptible for Tamaka

Swasa along with normal bowel habits. Thus the statements drawn at the observations are

supportive to the pathogenesis of the disease Tamaka Swasa.


B14) Distribution of patients by Addiction

Table – 40 Distribution of patients by Addiction in Group – A & B



Tobacco 3 20 2 13.3

Alcohol 0 0 1 6.6

Alcohol + Tobacco 3 20 4 26.6

Drugs 0 0 0 0

Total 6 40 7 46.6

The listed table above expressive of the contents. In this B14 of table 40, it is

expressed that the additions are the aggravating factors in which alcohol and tobacco-

consuming patients of male category are recorded. Thus the statements drawn at the


B15) Distribution of patients by Prakruti

Table – 41

Distribution of patients by Prakruti in Group – A & B Group – A Group –B


Vata 1 6.6 1 6.6

Pitta 0 0 0 0

Kapha 1 6.6 0 0

Vata Pitta 2 13.3 3 20

Vata Kapha 8 53.3 9 60

Pitta Kapha 3 20 2 13.3

Tridosha 0 0 0 0

Total 15 100 15 100



expressed that the prakruti impact over the Tamaka Swasa. In which Vata Kapha patients

of category are recorded maximum. Thus the statements drawn at the observations are

supportive to the pathogenesis of the disease Tamaka Swasa.

B16) Distribution of patients by Dosha Vruddhi

Table –42 Distribution of patients by Dosha Vruddhi

Dosha Vruddhi Group – A Group –B


Karshya 3 20 3 20

Karshnya 4 26.6 5 33.3

Ushna kamitwa 10 66.6 11 73.3

Kampa 2 13.3 1 6.6

Anaha 3 20 2 13.3

Shakrudgraha 1 6.6 2 13.3

Balabhrmsha 2 13.3 0 0

Nidrabhramsha 10 66.6 9 53.3

Pralapa 0 0 0 0

Vat

a

Bhrama 0 0 0 0

Peeta mootrata 0 0 0 0

Peetanetra 0 0 0 0

Peetavit 0 0 0 0

Peetatwak 0 0 0 0

Adhikshudha 3 20 1 6.6

Pit

ta

Adhidaha 0 0 0 0


Dosha Vruddhi Group – A Group –B


Agni sadana 5 33.3 6 40

Praseka 3 20 3 20

Alasya 6 40 7 46.6

Swetangata 5 33.3 2 13.3

Sheetangata 10 66.6 11 73.3

Gowrava 7 46.6 5 33.3

Slathangata 0 0 0 0

Swasa 15 100 15 100

Kasa 14 93.3 14 93.3

Kap

ha

Atinidra 0 0 0 0


expressed that the Dosha vruddhi impact over the Tamaka Swasa. In which Vata lakshana

patients of category are recorded maximum with Ushna kamitwa and Nidra bhramsha. Pitta

predominant symptoms noted are Adhika kshudha. Kapha related symptom Swasa is the

pratyatma niyata lakshana seen in all patients along with Kasa, Sheetangata and Alasya. Thus

the statements drawn at the observations are supportive to the pathogenesis of the disease

Tamaka Swasa.


B17) Distribution of patients by Dosha Kshaya

Table 43

Distribution of patients by Dosha Kshaya

Presenting complaints Group – A Group –B


Angasada 2 13.3 3 20

Alpabhashite ahitam 0 0 0 0

Chesta heenata 0 0 0 0

Vyamoha 0 0 0 0

Vat

a

Sleshma vruddhi 0 0 0 0

Mandagni 7 46.6 9 60

Shareera sheetatwam 10 66.6 11 73.3

Pit

ta

Prabha hani 0 0 0 0

Bhrama 0 0 0 0

Urah shoonyata 0 0 0 0

Shira soonyata 0 0 0 0

Hridrava 0 0 0 0

Kap

ha

Sandhi saithilya 0 0 0 0


expressed that the Dosha kshaya impact over the Tamaka Swasa. In which Vata lakshana

patients of category are recorded with Angasada. Pitta predominant symptoms noted are

shareera sheetatwam and mandagni. Kapha related symptoms are not seen in any patients.

Thus the statements drawn at the observations are supportive to the pathogenesis of the

disease Tamaka Swasa.


B18) Distribution of patients by Ahara Nidana

Table 44 Distribution of patients by Ahara Nidana

Group – A Group –B Ahara Nidana Patients Percentage Patients Percentage

Visamashana 3 20 2 13.3 Adhyashana 5 33.3 4 26.6 Anasana 1 6.6 0 0 Sheetashana 0 0 0 0 Visha 0 0 0 0 Sheetapana 13 86.6 14 93.3

Vat

a

Rukshanna 12 80 13 86.6

Tilataila 0 0 0 0

Pit

ta

Vidahi 0 0 0 0

Pistanna 3 20 2 13.3

Nispava 0 0 0 0

Saluka 0 0 0 0

Guru dravyas 9 60 11 73.3

Jalajamamsa 2 13.3 2 13.3

Anupa mamsa 4 26.6 4 26.6

Abhishyandi 12 80 10 66.6

Masa 4 26.6 2 13.3

Dadhi 11 73.3 10 66.6

Vistambhi 2 13.3 2 13.3

Kap

ha

Amaksira 0 0 0 0


expressed that the Ahara Nidana impact over the Tamaka Swasa. In which Vata Ahara

Nidana consuming patients of category sheeta pana and Rookshanna are recorded with

Adhyasana. Pitta Ahara are not seen. Kapha related Nidana are Abhishyandi ahara and

Dadhi. Thus the statements drawn at the observations are supportive to the pathogenesis

of the disease Tamaka Swasa.


B19) Distribution of patients by Vihara Nidana

Table –45 Distribution of patients by Vihara Nidana

Vihara Nidana Group – A Group –B


Rajas (V) 15 100 15 100

Vata (V) 15 100 15 100

Sheeta Sthana (V) 0 0 0 0

Sheeta ambu (V) 6 40 7 46.6

Ativyayama (V) 3 20 5 33.3

Abhighata (V) 0 0 0 0

Dhuma (V) 7 46.6 5 33.3

Apatarpana (V) 1 6.6 2 13.3

Bharakarshita (V) 1 6.6 0 0

Adhwahata (V) 5 33.3 4 26.6

Kanthapratighata (V) 0 0 0 0

Karmahata (V) 0 0 0 0

Veganirodha (V) 2 13.3 4 26.6

Shuddhi Atiyoga (V) 0 0 0 0

Gramya dharma (V) 0 0 0 0

Urahpratighata (V) 0 0 0 0

Marmabhighata(V) 0 0 0 0

Usna (P) 0 0 0 0

Abhishyandi Upacara (K) 0 0 0 0

Divasvapna (K) 5 33.3 3 20


expressed that the Vihara Nidana impact over the Tamaka Swasa. In which Vata Vihara

Nidana consuming patients of category Rajas and Vata are recorded with Sheetambu


sevana and Karmahata. Pitta Vihara are not seen. Kapha related Vihara Nidana is

Divaswapna. Thus the statements drawn at the observations are supportive to the

pathogenesis of the disease Tamaka Swasa.

B20) Distribution of patients by Anya Nidana

Table –46

Distribution of patients by Anya Nidana

Anya Nidana Group – A Group –B


Ksataksaya 0 0 0 0

Udavarta 0 0 0 0

Kshaya 0 0 0 0

Atisara 0 0 0 0

Vibandha 5 33.3 6 40

Anaha 3 20 2 13.3

Visucika 0 0 0 0

Panduroga 2 13.3 0 0

Vat

a

Dourbalya 2 13.3 0 0

Rakta pitta 0 0 0 0

pitta

Jwara 2 13.3 2 13.3

Kasa 14 93.3 14 93.3

Pratisyaya 9 60 10 66.6

Amapradosha 0 0 0 0

Amatisara 0 0 0 0

Kap

ha

Chardi 3 20 2 20



expressed that the Vihara Nidana impact over the Tamaka Swasa. In which Vata Anya

Nidana consuming patients of category Vibandha and Anaha are recorded with Pandu

Roga and Dourbalya. Pitta Anya Nidana only Jwara is recorded. Kapha related Anya

Nidana are Kasa and Pratishyaya along with Chardi for 3 patients. Thus the statements


Swasa.

B21) Distribution of patients by srotas

Table –47

Distribution of patients by Srotas

Srotas Group – A Group –B


Atisrustam 11 73.3 10 66.6

Kupitam 8 53.3 9 53.3

Alpalpa 11 73.3 10 66.6

Ati badhdama 5 33.3 5 33.3

Abheekhnam 8 53.3 7 46.6 Pran

avah

a

Sashoolam 7 46.6 5 33.3

Aruchi 7 46.6 5 33.3

Chardi 3 20 2 13.3

Ajeerna 5 33.3 6 40

Ann

avah

a

Anannabhilasha 2 13.3 3 20

Jihwashosha 4 26.6 2 13.3

Ostashosha 3 20 3 20

Talushosha 2 13.3 2 13.3

Udk

avah

a

Pipasa 9 60 7 46.6



expressed that the Srotas examination in Tamaka Swasa. In which Pranavaha srotas

symptoms are predominant in patients as Atisrusta, Alpalpa Abheeshan and Sashoola. On

the other hand symptoms of Annavaha stoats also expressed as Aruchi and Ajeerna. Out

of Udakavaha srotas pipasa is predominant. Thus the statements drawn at the


B22) Distribution of patients by Poorva Roopa

Table -48

Distribution of patients by Poorva Roopa

poorva roopa Group – A Group –B

SN Patients Percentage Patients Percentage

1 Hrutpeeda 4 26.6 3 20

2 Kshudra Swasa 5 33.3 4 26.6

3 Shankha bheda 6 40 6 40

4 Shoola 1 6.6 2 13.3

5 Pranavilomata 8 53.3 10 66.6

6 Vaktra vairasya 0 0 0 0

7 Parshwashoola 7 46.6 6 40

8 Vibandha 5 33.3 6 40

9 Anaha 3 20 2 13.3

10 Arati 7 46.6 6 40

11 Bhakta dwesha 7 46.6 8 53.3

12 Admana 0 0 0 0



expressed that the Poorva Roopa examination in Tamaka Swasa. In which Prana

vilomana, Parshwa shoola, Arati and Bhakta dwesha are predominant. Occasionally

Kshudra Swasa and Shankha Bheda are also observed along with other symptoms

enlisted in the tabular statements drawn at the observations are supportive to the

pathogenesis of the disease Tamaka Swasa.

C1) Subjective parameter assessment Group – A

Table – 49

Subjective parameter assessment Group – A

Patients Before % Patients

After % Patients Relived %

Teevra vega Swasa

(Dyspnonea) 15 100 11 73.3 4 26.6

Kasa (cough) 14 93.3 10 66.6 4 26.6

Duhkhena Kapha

nissaranam (Expectoration) 14 93.3 11 73.3 3 20

Ghurghuratwam

(Wheezing) 15 100 11 73.3 4 26.6

Peenasa (Coryza) 12 80 8 53.3 4 26.6

Kruchrena bhasate

(difficulty in speech) 10 66.6 5 33.3 5 33.3

Kantodhwamsham

(Hoarseness of voice) 5 33.3 3 20 2 13.3

Greevashirasangraha

(Headache & Stiffness) 8 53.3 6 40 2 13.3

Urah Peeda (Chest Pain) 11 73.3 7 46.6 4 26.6

Shayane Swasa peedita

(Discomfort at supine) 12 80 8 53.3 4 26.6


C2) subjective parameter assessment Group – B

Table – 50

Subjective parameter assessment Group – B

Patients Before % Patients

After % Patients Relived %

Teevra vega Swasa

(Dyspnonea) 15 100 11 73.3 4 26.6

Kasa (cough) 14 93.3 10 66.6 4 26.6

Duhkhena Kapha

nissaranam (Expectoration) 14 93.3 12 80 2 13.3

Ghurghuratwam

(Wheezing) 15 100 10 66.6 5 33.3

Peenasa (Coryza) 12 80 9 60 3 20

Kruchrena bhasate

(difficulty in speech) 8 53.3 5 33.3 3 20

Kantodhwamsham

(Hoarseness of voice) 4 26.6 2 13.3 2 13.3

Greevashirasangraha

(Headache & Stiffness) 9 60 5 33.3 4 26.6

Urah Peeda (Chest Pain) 10 66.6 5 33.3 5 33.3


(Discomfort at supine) 11 73.3 6 40 5 33.3


C3) Objective parameters of Group -A

Table – 51

Objective parameters of Group -A

PEFR BHT AEC ESR Hb% S.No OPD

B A B A B A B A B A

Result

1 3803 150 270 13 25 500 400 10 8 10.8 11.4 MR

2 3876 120 250 11 22 450 350 8 10 10 10.6 PR

3 4861 70 160 8 15 650 550 16 14 11.5 11.2 PR

4 1299 210 370 22 36 450 300 12 12 12.6 13 WR

5 1329 130 260 12 23 500 400 8 6 9.4 10.2 MR

6 1347 150 240 13 20 500 450 14 12 13 13.2 PR

7 1353 160 290 15 25 450 300 12 10 11.5 12.2 MR

8 1399 130 300 12 26 550 450 14 12 11.8 11.4 PR

9 1401 180 380 18 32 550 400 10 8 9.5 9.2 WR

10 1421 110 200 11 18 550 450 10 6 10.4 10.6 PR

11 1423 90 140 8 14 650 600 14 14 9 9 PR

12 1426 140 240 14 22 500 450 16 14 9.6 10 PR

13 1427 190 350 15 28 550 450 12 14 12.8 13 MR

14 1430 120 230 12 20 600 500 8 6 10.6 11.2 NR

15 1431 100 170 10 16 600 550 12 10 9 9.4 PR


C4) Objective parameters of Group –B

Table - 52 Objective parameters of Group –B

PEFR BHT AEC ESR Hb% S.No OPD

B A B A B A B A B A

Result

1 4146 180 290 15 24 550 450 14 12 11.6 12 MR

2 4163 160 310 12 25 550 450 12 10 12.4 12 MR

3 1300 110 190 10 16 600 600 10 10 10 10.6 NR

4 1328 180 240 14 20 450 400 14 10 9.5 9.8 NR

5 1330 220 380 25 35 450 350 12 8 11.5 11.8 WR

6 1348 70 150 7 13 650 650 12 14 11.5 11.5 PR

7 1349 130 200 11 17 600 550 8 6 10.4 10.8 PR

8 1354 170 260 14 18 550 550 8 8 10 10.5 PR

9 1400 280 400 25 38 450 400 10 8 11.2 11.5 WR

10 1422 190 280 15 23 550 450 10 12 10.4 11.2 PR

11 1424 90 170 8 15 650 600 10 9 9.5 9 PR

12 1425 200 310 18 28 500 400 8 9 10.2 11 MR

13 1428 160 240 12 20 550 500 12 10 13.2 13.4 NR

14 1929 150 270 12 23 500 400 12 12 12.5 12.8 MR

15 1932 240 360 21 32 450 350 12 10 12 12.4 WR

TABLE –53 MEANS OF OBJECTIVE PARAMETERS

PEFR BHT AEC ESR Hb% B A B A B A B A B A

Group-A 136.6 256.6 12.9 22.8 536.6 440 11.73 10.4 10.76 11.04Group-B 168.6 270 14.6 23.13 536.6 473.3 10.93 9.86 11.06 11.35


C5) Statistical assessment of Group – A subjective parameters

Table –54

Statistical assessment of Group – A subjective parameters

Mean SD SE t Value P value Remarks

Teevra vega Swasa

(Dyspnonea) 1.066 0.258 0.066 16.15 <0.001 HS

Kasa (cough) 0.866 0.516 0.133 6.511 <0.001 HS

Duhkhena Kapha

nissaranam (Expectoration) 0.666 0.487 0.125 5.328 <0.001 HS

Ghurghuratwam

(Wheezing) 0.8 0.414 0.106 7.54 <0.001 HS

Peenasa (Coryza) 0.533 0.516 0.133 4.0 <0.01 HS

Kruchrena bhasate

(difficulty in speech) 0.466 0.516 0.133 3.503 <0.01 HS

Kantodhwamsham

(Hoarseness of voice) 0.133 0.351 0.090 1.477 >0.05 NS

Greevashirasangraha

(Headache & Stiffness) 0.4 0.507 0.1309 3.076 <0.02 HS

Urah Peeda (Chest Pain) 0.4 0.507 0.1309 3.076 <0.01 HS


(Discomfort at supine) 0.6 0.507 0.1309 4.58 <0.001 HS


C6) Statistical assessment of Group – B subjective parameters

Table –55

Statistical assessment of Group – B subjective parameters


Teevra vega Swasa

(Dyspnonea) 0.933 0.258 0.066 14.13 <0.001 HS

Kasa (cough) 0.666 0.487 0.125 5.328 <0.001 HS

Duhkhena Kapha

nissaranam (Expectoration) 0.666 0.487 0.125 5.328 <0.001 HS

Ghurghuratwam

(Wheezing) 0.733 0.457 0.118 6.211 <0.001 HS

Peenasa (Coryza) 0.533 0.516 0.133 4.007 <0.01 HS

Kruchrena bhasate

(difficulty in speech) 0.266 0.457 0.118 2.25 <0.05 HS

Kantodhwamsham

(Hoarseness of voice) 0.133 0.351 0.090 1.477 >0.05 NS

Greevashirasangraha

(Headache & Stiffness) 0.33 0.487 0.125 2.64 <0.05 HS

Urah Peeda (Chest Pain) 0.466 0.516 0.133 3.495 <0.01 HS


(Discomfort at supine) 0.466 0.516 0.133 3.495 <0.01 HS


C7) statistical assessment of Group – A : Objective parameters

Table –56

Statistical assessment of Group – A Objective parameters


PEFR 120.0 40.53 10.46 11.47 <0.001 HS

BHT 9.866 3.044 0.785 12.568 <0.001 HS

AEC 96.66 35.186 9.085 10.639 <0.001 HS

ESR 1.866 0.915 0.236 7.906 <0.001 HS

Hb% 0.393 0.212 0.054 7.27 <0.001 HS

C8) Statistical assessment of Group – B : Objective parameters

Table –57

Statistical assessment of Group – B Objective parameters


PEFR 100 23.9 6.172 16.202 <0.001 HS

BHT 8.33 2.49 0.644 12.93 <0.001 HS

AEC 63.33 39.94 10.31 6.142 <0.001 HS

ESR 1.733 1.222 0.315 5.501 <0.001 HS

Hb% 0.48 0.407 0.105 4.571 <0.001 HS


C9) Comparative statistical assessment of Groups subjective parameters

Table –58

Comparative statistical assessment of Groups subjective parameters

GR

OU

P

Mean SD SE PSE

t Val

ue

P v

alue

Rem

arks

A 0.933 0.7037 0.181 Teevra vega Swasa

(Dyspnonea) B 0.933 0.7037 0.181 0.255 - - -

A 0.8666 0.639 0.165 Kasa (cough)

B 0.8 0.676 0.174 0.239 0.276 >0.05 NS

A 0.733 0.457 0.118 Duhkhena Kapha

nissaranam

(Expectoration) B

0.866 0.516 0.133 0.178 0.747 >0.05 NS

A 0.733 0.457 0.118 Ghurghuratwam

(Wheezing) B 0.733 0.593 0.153 0.193 - - -

A 0.666 0.617 0.159 Peenasa (Coryza)

B 0.666 0.617 0.159 0.225 - - -

A 0.4 0.507 0.130 Kruchrena bhasate

(difficulty in speech) B 0.333 0.487 0.125 0.181 0.386 >0.05 NS

A 0.2 0.414 0.106 Kantodhwamsham

(Hoarseness of voice) B 0.133 0.351 0.0908 0.139 0.482 >0.05 NS

A 0.6 0.507 0.1309 Greevashirasangraha

(Headache & Stiffness) B 0.4 0.632 0.163 0.209 0.956 >0.05 NS

A 0.466 0.516 0.133 Urah Peeda (Chest Pain)

B 0.333 0.487 0.125 0.182 0.730 >0.05 NS

A 0.533 0.516 0.133 Shayane Swasa peedita

(Discomfort at supine) B 0.4 0.507 0.1309 0.1866 0.738 >0.05 NS


C10) Comparative statistical assessment of Groups Objective parameters

Table - 59

Comparative statistical assessment of Groups Objective parameters

GR

OU

P

Mean SD SE PSE

t Val

ue

P v

alue

Rem

arks

A 256.66 73.15 18.88 PEFR

B 272.0 71.73 18.52 26.44 0.58 >0.05 NS

A 22.8 6.155 1.589 BHT

B 23.13 7.424 1.917 2.489 0.132 >0.05 NS

A 440.0 87.013 22.46 AEC

B 473.33 96.11 24.81 33.47 0.995 >0.05 NS

A 10.4 3.042 0.785

ESR B 9.86 2.030 0.524

0.944 0.572 >0.05 NS

A 11.04 1.373 0.354 Hb%

B 11.42 1.158 0.299 0.463 0.820 >0.05 NS

Statistical report– Brihat Katphaladi yoga and Vyoshadi Gitika in Tamaka Swasa

To compare the mean effect of two groups using un-paired t-test by assuming that

the mean effect of the two groups is same in all the parameters does the statistical

analysis. From the analysis all the parameters show non-significant (as p>0.05 (table)

among objective parameters the mean effect of AEC is more with more variation after the

treatment in-group –B.

Among the subjective parameters the parameter ‘Kasa’ is having more mean

effect in the group –A where as the parameter Ghurghurata shows more variation after


the treatment in group-a the mean effect of Tivravega Swasa, Ghurghurata and Penesa is

more in both the groups (by comparing mean and standard deviation from table).

To compare the mean effect of drug with in the group the statistical analysis done

by using paired t-test by assuming that the drug is not responsible for the change in the

observations before and after the treatment.

Over all the group- A shows more highly significant than group-B among

subjective parameters Tivravega Swasa, Kasa, Greeva Shira Sangraha, Krucherena

bhashita and Shayana Swasa peedita shows more highly significant in group – A than

group – B.

The parameter Dhukhena Kapha nissaranam and Peenasa are having equal highly

significance in both the groups. The parameter Kantodwamsa shows not significant in

both the groups (by comparing p value and t value from tables). Among objective

parameters in the group – A absolute Eosinophils count Erythrocyte sedimentation rate

and Hemoglobin percentage are more highly significant in group-A than group-B.

The parameter peak expiratory flow rate and breath holding time shows more

highly significant in-group – B (by comparing p value and t value from the tables)

D1) Over all assessment and Result of the Brihat Katphaladi yoga and Vyoshadi

Gutika Nitya Virechana in Tamaka Swasa

Table -60

Over all assessment and Result

Category Group – A

Brihat Katphaladi yoga

Group –B

Vyoshadi Gutika

Nitya Virechana

Patients % Patients %

Well responded 2 13.4 3 20

Moderate Responded 4 26.6 4 26.6

Poor Responded 8 53.4 5 33.4

Not Responded 1 6.6 3 20

Total 15 100 15 100

Graph - 10

Over all assessment and Result of clinical trail

Results of Brihat Katphaladi yoga / Vyoshadi Gutika N

RESULT _ Group A

Poor Responded

53%

Well responded

13.33%

Moderate Responded

26.67%

Not Responded

7%

Well Not

itya Shodhana in Tamaka Swasa 110

Result of Group -B

Poor Responded

33%

responded20.00%

Moderate Responded

26.67%

Responded20%

Chapter - 6

Discussion Mortality due to Tamaka Swasa vis-à-vis asthma is not comparable in size to the

day-to-day effects of the disease. Although largely avoidable, asthma tends to occur in

epidemics and affects young people. The human and economic burdens associated with

this condition are severe. The costs of asthma to society could be reduced to a large

extent through concerted international and national action 251.

Between 100 and 150 million people around the globe, suffer from asthma and

this number is rising. Worldwide, deaths from this condition have reached over 180,000

annually. Asthma is not just a public health problem for developed countries. In

developing countries like India, however, the incidence of the disease varies greatly 252.

• India has an estimated 15-20 million asthmatics.

• In India, rough estimates indicate a prevalence of between 10% and 15% in 5-11

year old children.

WHO recognizes asthma as a disease of major public health importance and plays

a unique role in the co-ordination of international efforts against the disease. International

action is needed to:

• Increase public awareness of the disease to make sure patients and health

professionals recognize the disease and are aware of the severity of associated

problems;

• Organize and co-ordinate global epidemiological surveillance to monitor global

and regional trends in asthma;

Discussion of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

111

• Develop and implement an optimal strategy for its management and prevention

(many studies have shown that this will result in the control of asthma in most

patients); and

• Stimulate research into the causes of asthma to develop new control strategies and

treatment techniques 253.

Out of the above policies of WHO, the ancient Ayurveda, a medical system of

India places lots of management modalities to neutralize the effect of Tamaka Swasa, a

demon in the present air polluted society. The present trial entitled “evaluating the

efficacy of Brihat Katphaladi yoga in comparison with Vyoshadi Gutika Nitya Shodhana

in Tamaka Swasa” is an optimal strategy to develop and implement a perfect treatment to

the Tamaka Swasa as a research Stimulation into the causes of asthma. The word

derivation is from Tama root with Kwip Pratyaya, which means to darkness, to choke or

to be suffocated seen in the Tamaka Swasa predominantly.

At this context here the causes and pathogenesis discussion is necessary. Thus the

discussion on disease Tamaka Swasa is divided and discussed under following headings,

as expressed below.

1. Discussion on Nidana (etiological factors)

2. Discussion on Roopa (symptoms) and Samprapti (Patho-physiology)

3. Discussion on Chikitsa (treatment)

4. Effect of Brihat Katphaladi yoga in Tamaka Swasa (Group-A)

5. Effect of Vyoshadi Gutika in Tamaka Swasa (Group-B)

6. Discussion on comparative Results


112

1) Discussion on Nidana

Nidana parivarjana i.e. prevention of etiological factors as a part of supportive

therapeutic measures of the treatment is idol any time. Especially as Tamaka Swasa

patients are very much exposed to the different verities of the subjects at different times

and places in the atmosphere particularly air and dust, it is very much necessary to

evaluate.

Specific Nidana for Tamaka Swasa is not mentioned in classics as it is a sub type

of Swasa roga same Nidana are applicable to Tamaka Swasa also. We cannot find a clear

view regarding the patho-physiological changes occurring due to specific type of Tamaka

Swasa Nidana. Chakrapani commenting on the Nidana verses as he explains about Vata

prakopaka gana and Kapha prakopaka gana, which are responsible for the development

of Tamaka Swasa.

For the better under standing causative factors are classified as Ahara sambhandi

(rukshanna pisthanna), Vihara sambhandi (sheetambhu stivyayana), Anya vyadhi avastha

sambhandi ( pratishaya chardi ), Agantuja (marmabhigata kanta urobhighata) and Kalaja

Nidana (durdina mega chadita dina etc) discussed in the literary review. Summarizing the

etiological factors, it is noticed that they are responsible either for Dosha drusti

amotpadana or kha vaigunyotpadaka. Ayurveda expressed Nidana i.e. etiology are

vividly discussed here under specified headings.

a) Vata Nidana

Out of Vata Nidana Ahara, Sheeta Ashana and Visha Ashana are not

recorded in either of groups. Out of the enlisted Nidana, in the Group – A,

Sheeta pana is 86.6% and in Group –B it is 93.3%. Second bests of


113

recording is Rooksha Anna which is 80% in Group-A and 86.6% in

Group-B. Adhyashana is 33.3% and 26.6% in Group A & B respectively.

The other recorded are – Vishamashana 20% and 13.3%, Anashanana

6.6% and 0% in Group –A & B respectively.

Vata Vihara Nidanas are many as shown in table. Out of these many, Vata

(wind) and Rajas (Spores & Dust) are 100% observed in both groups.

Karmahata is 46.6% in Group –A and 33.3% in Group-B respectively

observed. Sheetambu utilization is observed as one of the cause in Group-

A 40% and 46.6% in Group-B.

The other Nidana observed as Vata alleviators, Vibandha (33.3% and

40%), Pandu, Anaha and Dourbalya in fewer percentages are observed.

The above data is strongly suggestive of the involvement of Vata in

causation of Tamaka Swasa.

b) Pitta Nidana

As the Pitta Ahara Nidana is not relevant to cause any pathogenesis of the

Tamaka Swasa and also they are not found in the patients under taken, the

involvement of these Nidana are ruled out.

No Pitta vihara also observed as like the Ahara Nidana.

Jwara a condition related to Pitta is observed out of Anya Nidana, suggests

the infection in the upper respiratory tract with 13.3% in both Groups.

c) Kapha Nidana

Out of the Kapha Ahara Nidana Abhishyandi Ahara is 80% and 66.6% in

Group –A & B respectively suggests the blockage of Kapha in the


114

channels. Guru dravya 60% and 73.3% in Groups A & B suggest that the

involvement of Kapha productive factors in the Tamaka Swasa. The third

one is Dadhi, which is a factor of Kapha vitiation and Ama genesis is

observed as 73.3% and 66.6% in Group-A & B respectively. The other

relevant Nidana are – Anupa Mamsa (26.6% in each Group), Jalaja

Mamsa (13.3% in each Group), Pistanna (A - 20 & B -13.3%), Vistambhi

(13.3 in both Groups), and Masha (26.6% and 13.3%). Ama Ksheera,

Nishpava and Shalooka are not in use by any patients observed.

Divaswapna is one Kapha Vihara Nidana observed in the pathogenesis of

Tamaka Swasa in both groups viz. Group-A is 33.3% and Group –B is

20%.

Kasa is observed 93.3% in both Groups along with Pratishyaya as 60% in

Group A and 66.6% in Group-B. Chardi is one more compliant observed

as a symptom of elimination of Kapha from Amashaya in 20% both

groups.

2) Discussion on Roopa (symptoms) and Samprapti (Patho-physiology)

As per the Tamaka Swasa Samprapti is concerned the vitiated Kapha Dosha along

with Vata Dosha obstructs the srotas to secrete Kapha from Pranavaha srotas. Here the

Kapha is the normal secretion and is abnormally increased by the vitiated Pranavata.

Further this action adds to the obstruction of the passage where Pranavata gets the Prana

vilomata. Narrowing of the Pranavaha srotas along with accumulation of Kapha in it

obstructs the smooth flow of Pranavata. Prana vilomata is resultant with turbulent


115

breathing which leads to abnormal audibility of respiration even to out side or to say

produces wheezing.

In Tamaka Swasa the course of the illness starts from Hridya said to be afflicted

adds the severity of illness. Kapha Dosha (Dosha) and Rasa dhatu (dushya) belonging to

the same category and affliction of Hridaya indicates the acute onset chronic course and

severity of illness.

a) Poorva Roopa

Prana vilomata: it is observed as 53.3% and 66.6% in both groups respectively

suggest that the symptom is related to Prana, Pranavaha srotas and the obstructive

phenomenon of it.

Bhakta dwesha: 46.6% and 53.3% in Group A & B respectively, suggests that the

disease is Amashaya samutha, producing Ahara dwesha.

Arati and Parshwa shoola: these are observed as 46.6% and 40% respectively

inGroup –A and B supports strongly above point.

Shankha Bheda: It is a pain condition occurred because of Prana Urdhwa gati and

there by observed as 40% in both Groups.

Vibandha: It is observed as 33.3% and 40% respectively in Group-A and B is

because of the Prana Vata Urdhwa gati in Tamaka Swasa.

b) Lakshana in Tamaka Swasa:

Teevra vega Swasa and Ghurgurukatwam is pratyatma niyata lakshana of Tamaka

Swasa observed 100% in all patients.

Kasa and Duhkhen kapah anissarana observed almost all i.e. 93.3% in both

Groups.


116

Peenasa is a relevant disease associated and also a symptom, observed in 86.6%

and 80% in Group-A and B respectively.

Shayane Swasa peeditam, which is causing inconvenience in Tamaka Swasa, is

seen in 80% and 73.3% of the Group-A and B respectively suggests the blockage

of Kapha while sleeping.

Urah peeda i.e. chest pain is observed as 73.3% and 66.6% in Group A & B as the

chest is the seat of the disease.

c) Samprapti Ghataka

Agni: as Agni is observed it is found that 46.6% in Group A and 60% of patients

in Group-B are subjected for the Agnimandya or Mandagni. It is told in Ayurveda

the mandagni is the root cause of development of disease and Ama.

Prakruti: Many patients are of Vata Kapha prakruti observed in the study viz.

Group-A 53.4% and Group-B 60%. The disease manifest to the people with Vata

Kapha people as the disease is of Kapha Vata Dosha predominant.

Prana vaha Srotas: 73.3% of patients are reported in Group-A, with prime

symptom of pranavaha sroto dusti are Atisrustam and Alpalpam, where as in

Group-B they are 66.6%. The adhistana of the vyadhi is uras i.e. chest in terms of

pranavaha srotas, thus the symptoms pertained to that of pranavaha srotas is

relevant.

Annavaha Srotas: Symptoms observed in this are Aruchi (A = 46.6%, B = 33.3%)

and Ajeerna (A = 33.3%, B = 40%). All the disease manifestation as it is

discussed from GIT and that too from stomach. The importance of Annavaha


117

srotas and Amashaya is relevant with symptoms of Aruchi exhibited to state the

disease is Amashaya samudbhava.

Udakavaha Srotas: In this category Pipasa in Group-A is 60% and Group-B is

46.6%. The other symptoms are Jihwa sosha (A = 26.6%, B = 13.3%) and

Ostashosha (20% in both Groups). The air ventilation is naturally through nasal

cavity but when it is not possible gives rise to oral breathing, which causes the

jihwa sosha, which is a Udakavaha srotas symptom.

Onset of disease: The onset is observed as gradual in many patients viz. Group-A

73.3% and Group-B 80%. It suggests that the disease in chirakari and takes the

long time to manifest its symptoms.

Course of onset: Patients are observed with the episodic onset maximum as 53.4%

in Group –A and 66.6% in Group-B.

Frequency of attack: it is observed that few day onset in Group-A 66.6% patients

and 60% in Group-B patients.

Mode of progress: The disease development is typical as observed in Group-A

with 40% and Group-B 33.4% patients.

Periodicity: An irregular periodicity is observed in the study with 60% in both

groups.

Preceding factors: These are sneezing, nasal irritation and cough out of cough is

in 53.4% of patients in both Groups.

Mode of progress: it is observed that the disease is of long-term progress with the

40% and 46.6% in Group-A & B patients respectively.


118

Aggravating factors: Dust and Smoke are observed as the aggravating factors in

60% of Group-A and 66.6% of Group-B patients.

Comfort posture: The comfort posture recorded for the patients is sitting with

forward bending. It is 40% and 46.6% in Groups A & B respectively.

3) Discussion on Chikitsa (treatment)

The treatments suggested in the clinical trial are internally with Brihat Katphaladi

Yoga pacifying the Dosha viz. Kapha and Vata in the group-A patients and Vyoshadi

Gutika Nitya Shodhana in Group-B patients.

The former management is a routine method of treating patients of Tamaka

Swasa, as they are not strong enough to with stand the massive elimination methods, such

as Vamana etc. The selected drug management has specific action on the Dosha

distribution and also to induce a Dosha dooshya vighatana. Out of the composition many

alkaloids found in different individual herbs and also the pharmacological properties

suggests that the Brihat katpahaladi yoga is a unique medicament as a palliative

management.

The later is a unique technique, in the unfit persons of strong shodhana i.e.

elimination of the Dosha. Here many times it is stated that the Anulomana or a mild

rechana makes the Kosta suddhi. In these patients who suffer from a chronic disease of

upper respiratory tract with continuous exposure to the causative factors needs an

elimination therapy, which could relieve the pains and accumulated phlegm of patients.

Thus the Vyoshadi Gutika is implied in the management of Tamaka Swasa as a Nitya

shodhaka. In further as the Kapha obstructs the passage of Vata in Tamaka Swasa a

clanging method is adopted in terms of Nitya shodhana.


119

5) Effect of Brihat Katphaladi yoga (Group-A) in Tamaka Swasa

All the ingredients of the Brihat Katphaladi yoga are of Kapha Vata hara

action and these are of Katu, Tikta and Kashaya rasa in general. There fore all

these acts as Kapha hara. Thus the Brihat Katphaladi yoga is good choice in

Tamaka Swasa.

Agni deepana is a prime treatment as “Kayasya antaragni Chikitsa” is

Kayachikitsa. In this concern Katu and Tikta rasa along with Ushna veerya

does the Deepti of Agni. In further it takes care of non-formation of Ama,

which helps the prevention of disease progression. Thus the Brihat Katphaladi

yoga is good choice in Tamaka Swasa.

All the dravya in Brihat Katphaladi yoga are of Ushna veerya except Musta,

by which acts as Pitta kara and Kapha Vata shamaka. Laghu, Teekshna,

Snigdha and Rooksha guna does act as Kapha Vata shamaka.

Vata and Kapha are of Sheeta guna nature. The veerya of the selected Brihat

Katphaladi yoga are of Ushna. Thus the Ushna veerya evaporates the Kapha

and pacifies the Vata even though it increases the Pitta.

Laghu guna is said as Kapha hara and Snigdha guna is Vata hara. Teekshna

guna is Kapha Vata hara. This combination of Brihat Katphaladi yoga by it

Guna helps in keeping the Dosha in equilibrated state.

Shunti specifically by its pharmacological action it is Kanta vishodhana i.e.

relieves the obstruction at the neck which is plugged by the vitiated Kapha.

Karkata Srungi is Kapha Nissaraka, which means evaporation, or drying of

Kapha is undertaken.


120

Maricha, which is Ushna veerya but helps in elimination of Kapha by its

Rechaka action.

Age: More prevalence i.e. 33.4% is observed in the category of 50-60 age

group. As observations are noticed it is clearly evidential that the higher age

group people are prone to get this disease because of the decreased lung

capacity in terms of Vata Dosha predominance. Results are encouraging in 30-

40 and 50-60 age groups with Well response. Only one patient in the age

group of 40-50 not responded with treatment.

Gender: The male female ratio of the study is 3:2. It is because of Male

dominant society observing and moving or exposing to the etiology much

more than that of Females who are staying at home. Out of which no much

gender specifications were observed as par the results are concerned.

Religion: Most of the cases are of Hindu community with 86.6%. The rest are

of Muslim community with 13.4%. It may not discriminate the community.

As results are observed all 2 patients of well responded are from Hindu

community. The one patient who is Not responded to the treatment is from

Muslim community. This may be because of the dietetics (Jalaja and Anupa

Mamsa) followed at this community.

Occupation: At the study 53.3% of patients show Active Occupation suggests

that people who are exposure to the external atmosphere with pollution are

getting the disease Tamaka Swasa.


121

Economical Status: Middle class people are always recorded much in any

study because of incapability of getting corporate treatment. Here in this study

it is 53.4%.

Dietetic Habits: Vegetarian to Mixed diet practitioners ratio is 3:2. This ratio

may not be significant in the study but else where discussed as Mixed diet

practice impacts the result and creates Ama in the body and aggravates the

Kapha.

The Results of the Brihat Katphaladi yoga are in Tamaka Swasa as followed

in Group-A are declared as Well responded, Moderately Responded, Poorly

Responded and Not Responded.

Well-responded patients are only 2 i.e. with 13.4% and Moderately responded

patients are 4 i.e. 26.6%. It is clear evidence that the disease is not possible to

be treated in perfect when the patients are subjected from the etiological

factors such as Dust and fumes in day-to-day life.

Poor Responded patients are 8 i.e. 53.3% and 1 patient i.e. 6.6% of Not

responded. This result is observed irrespective of the gender.

An effort is made to uproot the ailment in this trial ultimately observed with

the less percentage of maximum relief patients suggests that the Brihat

Katphaladi yoga is a good choice of palliative medicament in Tamaka Swasa.

Statistically all subjective and objective parameters show High significance

except Kantodhwamsa, which is Non Significant.


122

6) Effect of Vyoshadi Gutika in Tamaka Swasa

Mrudu virechakas are not causing any difficulties to patients, where the Dosha

is in tarunavasta 254. Administration of these medicaments repeatedly holds

good.

In a weak patient holds with excessive accumulation of Dosha, mrudu

virechaka medicaments are advised for repeated administration 255.

Whenever Kapha obstructs Vata it is essential that the continuous elimination

through Anulomana dravyas as Nitya Shodhana to eliminate Vata 256.

Vagbhata offers Pratimarsha Nasya 257 to practice many times when any

elimination is needed, like the same here to remove the Dosha many times

kosta Dosha is eliminated through Anulomaka Nitya rechana Shodhana.

As the kosta of these Tamaka Swasa patients are not possible to assess or

irrespective of Kosta practice (Aparijnata Kosta) 258 of management through

the Anulomaka Nitya rechana Shodhana with Vyoshadi Gutika makes one’s

Dosha elimination and Kosta suddhi for better practice if palliative medicines.

Many patients because of lack of time not practicing the proper Virechana

elimination methods. The Anulomaka Nitya rechana Shodhana. With

Vyoshadi Gutika doesn’t disturb the daily routines of individual and possible

to administer any time anywhere.

Vyoshadi Gutika is used as Nitya shodhana material at this trial. The Nitya

shaodhana means

Vyoshadi Gutika cumulatively consists of Laghu, Rooksha and Teekshna

Guna, by which Drvya invades in to srotas and eliminates the accumulated


123

Kapha. Laghu guna makes the sroto vishodhana thus the Kapha moving in the

srotas are eliminated by the rechaka property.

Katu, Tikta, Kashaya and Madhura rasa in Vyoshadi Gutika makes Deepana

and Pachana along with kindling of the fire at Jathara and Dhatu. It impacts

the Dosha Kapha to get vilayana i.e. melt and eliminate easily.

Ushna Veerya predominant Vyoshadi Gutika pacifies the Kapha and Vata by

rapid elimination through its sroto shodhaka property.

Vyoshadi Gutika by virtue of combination it is Kapha Vata shamaka and

Tridosha shamaka. It is used here to evacuate the Dosha in small quantity

daily with out giving any problem to the patient.

The qualities of Vyoshadi Gutika are said as Mrudu virechaka, Rechaka,

Anulomaka and Sukha virechaka other wise said as Adhobhagahara. At the

time of mentioning properties, Charaka affirmed that the medicament of

Tamaka Swasa should be Kapha Vata hara and Anulomaka.

Age: More prevalence i.e. 40% is observed in the category of 40-50 age

group. As observations are noticed it is clearly evidential that the active age

group people are prone to get this disease because of the increased lung

infiltration with dist and smoke in terms of Vata Dosha predominance. Results

are encouraging in 40-50 and 20-30 age groups with Well response. One

patient in each age group viz. 20-30, 40-50 and 50-60 not responded with the

treatment.

Gender: The male female ratio of the study is 2:1. It is because of Male

dominant society observing and moving or exposing to the etiology much


124

more than that of Females who are staying at home. Out of which no much

gender specifications were observed as par the results are concerned. All 20%

of well-responded patients are Males, means to understand the phenomenon of

elimination actively administrated in Males.

Religion: Most of the cases are of Hindu community with 86.6%. The rest are

of Muslim community with 13.4%. It may not discriminate the community.

As results are observed 2 patients of Hindu and 1 patient from Muslim

community are well responded. The patients who are Not responded to the

treatment are Hindu community. This may be because of the dominance of

Hindus at this locality.

Occupation: At the study 46.6% of patients show Active Occupation suggests

that people who are exposure to the external atmosphere with pollution are

getting the disease Tamaka Swasa.

Economical Status: Middle class people are always recorded much in any

study because of incapability of getting corporate treatment. Here in this study

it is 46.6%.

Dietetic Habits: Vegetarian to Mixed diet practitioners ratio is 3:2. This ratio

may not be significant in the study but else where discussed as mixed diet

practice impacts the result and creates Ama in the body and aggravates the

Kapha.

The results of the Vyoshadi Gutika as Nitya Shodhaka in Tamaka Swasa as

followed in Group-B are declared as Well responded, Moderately Responded,

Poorly Responded and Not Responded.


125

Well-responded patients are only 3 i.e. with 20% and Moderately responded

patients are 4 i.e. 26.6%. It is clear evidence that the disease is not possible to

be treated in perfect when the patients are subjected from the etiological

factors such as Dust and fumes in day-to-day life.

Poor Responded patients are 5 i.e. 33.3% and 3 patient i.e. 20% of Not

responded. This result is observed irrespective of the gender.

An effort is made to uproot the ailment in this trial ultimately observed with

the less percentage of maximum relief patients suggests that the Vyoshadi

Gutika as Nitya Shodhaka in Tamaka Swasa is a good choice of elimination

medicament in Tamaka Swasa.

Statistically all subjective and objective parameters show High significance

except Kantodhwamsa, which is Non Significant.

7) Discussion on Results

The Result of the study from Group-A and B with Brihat Kayphaladi Yoga

and Vyoshadi Gutika are discussed at above paragraphs, which are highly

significant at individual aspect. Even though the medicaments are of very

effective individually they are not valued at the efficacy of Result with Well-

Response at the patients.

To compare the mean effect of two groups using un-paired t-test by assuming

that the mean effect of the two groups is same in all the parameters does the

statistical analysis.

Over all the group-A shows more highly significant than group-B among

subjective parameters Tivravega Swasa, Kasa, Greeva Shira Sangraha,


126

Krucherena bhashita and Shayana Swasa peedita shows more highly

significant in group – A than group – B.

The parameter Dhukhena Kapha nissaranam and Peenasa are having equal

highly significance in both the groups. The parameter Kantodwamsa shows

not significant in both the groups (by comparing p value and t value from

tables).

The parameter peak expiratory flow rate and breath holding time shows more

highly significant in-group – B (by comparing p value and t value from the

tables)

To get a less result of the well responded, many causes could be attributed.

Viz. the patients are of well-established disease, the medicament chosen is

Kapha suppresser, Kapha is not totally eliminated with the medicine, dose

may be insufficient, duration of the study is less etc.

As observed in the study the both groups are effective at the time trial and

give symptomatic relief to the all patients i.e. all subjective parameters taken

for the study show remarkable differences at the time of management.

With the above observations it is clear that the medicaments used in the study

for the Tamaka Swasa viz. Brihat Katphaladi Yoga in Group-A and Vyoshadi

Gutika in Group-B are effective at their functional area to relieve Kapha from

the pranavaha sroatas to pacify and to eliminate in terms of Nitya Shodhana

by Vyoshadi Gutika.


127

Chapter - 7

Conclusions The predominant symptoms of breathlessness are the basis for naming the disease

Swasa. The word Tamaka Swasa is the name of illness consisting of the two words Tamaka

and Swasa. The word Swasa refers to the name of the disease, where as the word Tamaka

refers to a subtype of the Swasa roga.

Specific Nidana for Tamaka Swasa is not mentioned in classics as it is a sub type of

Swasa roga same Nidana are applicable to Tamaka Swasa also.

Lakshana (Roopam) of tamaka Swasa corresponds Vata as well as Kapha Dosha.


of Tamaka Swasa. During the attack of Tamaka Swasa almost all the symptoms of Kapha

Dosha vitiation are mediated through the Rasa Dhatu.

If Tamaka Swasa is Navotita it is as sadya. Susruta has considered Tamaka Swasa as

krichrasadhya vyadhi and asadhya in durbala rogi.

Therefore, the Brihat Katphaladi Yoga in Group-A and Vyoshadi Gutika in Group-B

aimed at the rectification of the imbalances of Vata Dosha, as well as Kapha Dosha forms the

sheet anchor of treatment of Tamaka Swasa, which is individually quite opposite.

The final treatment planned should pacify the Vata as well as Kapha Dosha

effectively, simultaneously not causing any further addition to the imbalance of Vata and

Kapha Dosha. If the patient is Kapha adhikyata and balawan rogi - Doshas are to be expelled

by vamana and Virechana. Here at this trial Vyoshadi Gutika eliminates the Dosha in

sequence i.e. through Nitya Shodhana.

Conclusions on Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

128

Tamaka Swasa is treated with “Tamaketu Virechanam” other wise understood, as

Nitya Shodhana administration.

One out of such is Brihat Katphaladi Yoga said by Sharangadhara is safe and effective

palliative medicament.

Even though much number of predisposing factors may initiate an attack of Tamaka

Swasa or may worsen the episode, the Brihat Katphaladi Yoga with its combination effect

cures the Tamaka Swasa patients.



Vibandha is observed as 33.3% and 40% respectively in Group-A and B is because of

the Prana Vata Urdhwa gati in Tamaka Swasa.

An effort is made to uproot the ailment in this trial ultimately observed with the less

percentage of maximum relief patients suggests that the Brihat Katphaladi yoga is a good

choice of palliative medicament in Tamaka Swasa. Well-responded patients in Group-A i.e.

Bruhat Katphaladi Yoga internally, are only 2 i.e. with 13.4% and Moderately responded

patients are 4 i.e. 26.6%. Poor Responded patients are 8 i.e. 53.3% and 1 patient i.e. 6.6% of

Not responded.

Statistically all subjective and objective parameters in Group-A i.e. Bruhat Katphaladi

Yoga internally, show High significance except Kantodhwamsa, which is Non Significant.

Vyoshadi Gutika by virtue of combination it is Kapha Vata shamaka and Tridosha

shamaka. At the time of mentioning properties, Charaka affirmed that the medicament of

Tamaka Swasa should be Kapha Vata hara and Anulomaka.


129

An effort is made to uproot the ailment in this trial ultimately observed with the less

percentage of maximum relief patients suggests that the Vyoshadi Gutika as Nitya Shodhaka

in Tamaka Swasa is a good choice of elimination medicament in Tamaka Swasa. Well-

responded patients in Group-B i.e. Vyoshadi Gutika Nitya Shodhana, are only 3 i.e. with 20%

and Moderately responded patients are 4 i.e. 26.6%.

It is clear evidence that the disease is not possible to be treated in perfect when the

patients are subjected from the etiological factors such as Dust and fumes in day-to-day life.

Poor Responded patients are 5 i.e. 33.3% and 3 patient i.e. 20% of Not responded. This result

is observed irrespective of the gender.

Statistically all subjective and objective parameters in Group-B i.e. Vyoshadi Gutika

Nitya Shodhana, show High significance except Kantodhwamsa, which is Non Significant.

With the above observations it is clear that the medicaments used in the study for the

Tamaka Swasa viz. Brihat Katphaladi Yoga in Group-A and Vyoshadi Gutika in Group-B are

effective at their functional area to relieve Kapha from the pranavaha sroatas to pacify and to

eliminate in terms of Nitya Shodhana by Vyoshadi Gutika.

Recommendations for further study

1) It would be worth to test by large sample study.

2) Spirometry studies may be applied to extend the study.

3) Long standing administrations of medicaments required for long standing disease.

4) As texts avow the usage of Muhurmuhu administration irrespective of fixed quantity

may be tried with these medicines viz. Brihat Katphaladi Yoga.


130

Chapter - 8

Summary The word Tamaka Swasa is the name of illness consisting of the two words

Tamaka and Swasa.

Specific Nidana for Tamaka Swasa is not mentioned in classics, as it is a sub type

of Swasa roga, same Nidana are applicable to Tamaka Swasa also.

The imbalance of Vata and Kapha Dosha afflicts the Rasa Dhatu in the

pathogenesis of Tamaka Swasa.

Tamaka Swasa is treated with “Tamaketu Virechanam” other wise understood, as

Nitya Shodhana administration.

Even though much number of predisposing factors may initiate an attack of

Tamaka Swasa or may worsen the episode, the Brihat Katphaladi Yoga with its

combination effect cures the Tamaka Swasa patients.



Statistically all subjective and objective parameters in both Groups individually

are Highly significant except Kantodhwamsa, which is Non Significant.

But in comparison Vyoshadi Gutika Nitya Shodhana and Brihat Katphaladi Yoga

internally doesn’t show any marked significance suggests that both drugs on their

respective places are the best in action.

Thus Vyoshadi Gutika Nitya Shodhana and Brihat Katphaladi Yoga internally at

Tamaka Swasa are best recommended drugs with their requisite actions.

Summary of Brihat Katphaladi yoga / Vyoshadi Gutika Nitya Shodhana in Tamaka Swasa

131

Bibliographic References

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2) Ibid, 5/7 , pp 324 Chakrapani 3) K.R. Srikantha Murthy edited, Astanga Hrudaya Sutra 12/4-5, 3rd ed, 1996,

Krishnadas academy, Varanasi, pp 167 4) Ibid, Chikitsa, 17/5, pp 533 5) Ibid, 17/62, pp 535 6) Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th ed.

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chapter, Harcourt (India) Pvt. Ltd., India, pp 455 9) G.S.Sainani ed, API Textbook of Medicine, 6th ed, 1999, sec 6-ch 7, The Association

of physicians of India, Mumbai, pp 226 10) http://www.who.int/respiratory/asthma/burden/en/print.html 11) Antony Seaton, et.al, Crofton and Dougla’s Respiratory diseases, chapter 26, edited

by Neil O. Brein, published by Oxford University press, New Delhi, 4th edition, 1989, pp 665

12) Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, 17/9, Chakrapani Ayurveda deepika, Chaukhambha Ayurvijnana Grandhamala - 34, reprint 1992, Chaukhambha Surabharathi Prakashan, Varanasi, pp 533

13) Ibid, 17th chapter, pp 533-539 14) Srikanta Murthy edited, Sharangadhara Samhita Madhyama Khanda, 6/ 40-41, 4th

edition 2001, Jaikrishnadas Ayurved Series - 58, published by Chaukhambha Orientalia, Varanasi, pp 89


16) K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana 4/13, 3rd ed, 1996, Krishnadas academy, Varanasi, pp 37-38


18) K.R. Srikantha Murthy edited, Astanga Sangraha Sutra 1/34, 2rd ed, 1998, Chaukhambha Orientalia, Varanasi, pp 30

19) P.V.Sharma, Dravyaguna Vijnana, Vol-1, part 2, 14th ed, 1990, Chaukhambha Bhrati academy, Varanasi, pp 229

20) Ibid, pp 138 21) Ibid, pp 141 22) Ibid, pp 142

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65) http://www.asthmacure.com/triggers/asthma_triggerfirst.htm 66) Aspi F Golwal, Golwal Medicine for students, 17th ed, 1999, A F Golwal Publishers

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3

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88) K.R. Srikantha Murthy edited, Astanga Sangraha Nidana 4/6, 2rd ed, 1998, Chaukhambha Orientalia, Varanasi, pp 168

89) K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana 4/4, 3rd ed, 1996, Krishnadas academy, Varanasi, pp 38

90) Bramha Shankar Mishra edited, Vidyotini commentary on Bhavaprakasha, Madhayma Khanda Swasarogadhikara, 14/3, 2nd edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp 161

91) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 4th ed, 1998, Choukumbha Sanskrit samsthan, Varanasi, pp 428

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4

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96) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/8-10 Dalhana comentary, Dalhana Nibandha Sangraha, Chaukhambha Ayurvijnana Grandhamala - 42, 1st ed, reprint 1994, published by Chaukhambha Surabharathi Prakashan, Varanasi, pp 762


98) K.R. Srikantha Murthy edited, Astanga Sangraha NIdana 4/8-13, 2rd ed, 1998, Chaukhambha Orientalia, Varanasi, pp 169

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100) Bramha Shankar Mishra edited, Vidyotini commentary on Bhavaprakasha, Madhayma Khanda Swasarogadhikara, 14/14-21, 2nd edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp 163

101) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara/5-8, 4th ed, 1998, Choukumbha Sanskrit samsthan, Varanasi, pp 430

102) Ganga Sahay Pande ed, Gadanigraha, 11/29-38, 1st ed.vol-2, 1969, Choukumbha Samskrut Samstan, Varanasi, pp 363-4


104) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/4 Dalhana comentary, Dalhana Nibandha Sangraha, Chaukhambha Ayurvijnana Grandhamala - 42, 1st ed, reprint 1994, published by Chaukhambha Surabharathi Prakashan, Varanasi, pp 761

105) Bramha Shankar Mishra edited, Vidyotini commentary on Bhavaprakasha, Madhayma Khanda Swasarogadhikara, 14/4, 2nd edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp -161

106) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 4th ed, 1998, Choukumbha Sanskrit samsthan, Varanasi, pp 427

107) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/4, 15th ed, 1985, Choukumbha Samskrut samstan, Varanasi, pp 283



110) K.R. Srikantha Murthy edited, Astanga Hrudaya Sutra 13/1, 3rd ed, 1996, Krishnadas academy, Varanasi, pp 182

111) Ibid, 13/10, pp 183 112) Ibid, 11/8, pp 156


5

http://www.diseases/

113) Yadavji Trikamji Acharya edited, Charaka Samhita Sutra, 10/14 , Chakrapani Ayurveda deepika, Chaukhambha Ayurvijnana Grandhamala - 34, reprint 1992, Chaukhambha Surabharathi Prakashan, Varanasi, pp 66

114) Ibid, Chikitsa 17/8-9, pp 533 115) Ibid, 17/17, pp 533 116) Ibid, 17/55, pp 535 117) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/8 Dalhana comentary,



119) Ibid, 17/58, pp 535 120) Ibid, 17/63-4, pp 535 121) Ibid, 17/62, pp 535 122) Ibid, 17/63 Chakrapani, pp 536 123) K.R. Srikantha Murthy edited, Astanga Hrudaya Sutra 11/6, 3rd ed, 1996, Krishnadas

academy, Varanasi, pp 156 124) Yadavji Trikamji Acharya edited, Charaka Samhita Nidana, 1/11, Chakrapani


125) Ibid, Chikitsa, 17/63-64 Chakrapani, pp 536 126) Ibid, Sutra 19/4, pp 110 127) Ibid, Chikitsa, 17/8, pp 533 128) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/12, 15th ed, 1985, Choukumbha



130) Ibid, 17/68, pp 536 131) Ibid, 17/62, pp 535 132) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/13 Dalhana comentary,


133) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 12/17, 15th ed, 1985, Choukumbha Samskrut samstan, Varanasi, pp 290-2



136) Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 ch. 14th ed. India: Mcgraw Hill, New York, 1998.p 1420

137) CRW Edwords, Davidson’s Principles of Practice of Medicine, 19th edition, 1979, Churchill Livingstone, London, pp 513


6

138) Ibid, 514 139) Yadunandan Upadhyay, Madhava Nidana, Vol-1, Madhukosha 1/8, 15th ed, 1985,

Choukumbha Samskrut samstan, Varanasi, pp 44 140) Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, 17/58, Chakrapani


141) Ibid, 17/60, pp 535 142) Ibid, pp 535 143) Yadunandan Upadhyay, Madhava Nidana, Vol-1, 1/9, 15th ed, 1985, Choukumbha



145) Ibid, 17/59, pp 535 146) Ibid, 22/17, pp 567 147) Ibid, 17/7, pp 533 148) Ibid, Indriya, 7/24, pp 366 149) Ibid, 7/25, pp 366 150) Ibid, 8/15, pp 367 151) Ibid, Chikitsa 17/62, pp 535 152) Bid, 17/58, pp 535 153) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/13 Dalhana comentary,


154) K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana 4/18, 3rd ed, 1996, Krishnadas academy, Varanasi, pp 40

155) Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, 17/49-67, Chakrapani Ayurveda deepika, Chaukhambha Ayurvijnana Grandhamala - 34, reprint 1992, Chaukhambha Surabharathi Prakashan, Varanasi, pp 534-6

156) Ibid, 17th chapter, 533-9 157) Ibid, 17/138, pp 539 158) Ibid, 17/89, pp 537 159) Ibid, 17/90, pp 537 160) Ibid, 17/91-92, 537 161) Ibid, 17/139, pp 539 162) Ibid, 17/112, pp 538 163) Ibid, 17/113, pp 538 164) Rajeswar Dutt Shastri, Charaka Samhitachikitsa 17/113, 1st ed, reprint 1998,

Chaukhambha bharathi academy, Varanasi, pp 524 165) Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, 17/111, Chakrapani


166) Ibid, 17/114, pp 538 167) Ibid, 17/148, pp 539 168) Ibid, 17/48 Chakrapani, pp 539 169) Ibid, 17/71, 536


7

170) Ibid, 17/82, pp 536 171) Ibid, 17/81, pp 536 172) Ibid, 17/85, pp 536 173) Ibid, 17/74-75, pp 536 174) Ibid, 17/74-76, pp 536 175) Ibid, 17/121, pp 538 176) Ibid, 17/86, pp 537 177) Ibid, 17/87, pp 537 178) Ibid, siddhi \, 1/11, pp 678 179) Ibid, 17/121, pp 538 180) Ibid, 17/77-80, pp 536 181) Ibid, 17/131, pp 538 182) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/30 Dalhana comentary,



184) Ibid, 17/149, pp 539 185) Ibid, 17/151, pp 539 186) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, 51/55 Dalhana comentary,


187) K.R. Srikantha Murthy edited, Astanga Hrudaya Chikitsa 4/29, 3rd ed, 1996, Krishnadas academy, Varanasi, pp 534

188) Satya Narayan Shastri, Charka Samhita Chikitsa 17/47, 1st ed. 2001,Choukumbha Bharati Academy, Varanasi, pp 529

189) Ambika Datta Shastri, Susruta Samhita Uttara 51/46-47, 15th edition, 2002, 190) Choukumbha Sanskrit Samsthana, Varnasi, p 381 191) K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, 4/25, 2nd ed, 1996, Krishnadas

Academy, Varanasi, pp 249 192) Brahma Shankara Shastri, Yogaratnakara, Swasadhikara, 1-8 sl, 5th ed, 1993,

Choukumbha Sanskrit samsthan, Varanasi, pp 435-36 193) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, 16/132-6, 6th ed, 1981,

Choukumbha Samskrut Pratistan, Varanasi, pp 339 194) Srikanta Murthy edited, Sharangadhara Samhita Madhyama Khanda, 6/ 40-41, 4th

edition 2001, Jaikrishnadas Ayurved Series - 58, published by Chaukhambha Orientalia, Varanasi, pp 89

195) P.V.Sharma, Dravyaguna Vijnana, Vol-2, 14th ed, 1990, Chaukhambha Bhrati academy, Varanasi, pp 575-77

196) Bramha Shankar Mishra edited, Bhavaprakasha (Vidyotini commentary), vol-1, 2nd edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp - 100

197) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, popular prakashan, Bombay, 1996, pp 828


8



200) Ibid, pp 95 201) P.V.Sharma, Dravyaguna Vijnana, Vol-2, 14th ed, 1990, Chaukhambha Bhrati

academy, Varanasi, pp –184-6 202) Bramha Shankar Mishra edited, Bhavaprakasha (Vidyotini commentary), vol-1, 2nd

edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp - 98


204) P.V.Sharma, Dravyaguna Vijnana, Vol-2, 14th ed, 1990, Chaukhambha Bhrati academy, Varanasi, pp –370-72









213) P.V.Sharma, Dravyaguna Vijnana, Vol-2, 14th ed, 1990, Chaukhambha Bhrati academy, Varanasi, pp –275-9






9

218) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, 1996, popular prakashan, Bombay, pp 969

219) Yadavji Trikamji Acharya edited, Charaka Samhita Kalpa, 7/46-49, Chakrapani Ayurveda deepika, Chaukhambha Ayurvijnana Grandhamala - 34, reprint 1992, Chaukhambha Surabharathi Prakashan, Varanasi, pp 664









228) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, 1996,popular prakashan, Bombay, pp 475


230) Bramha Shankar Mishra edited, Bhavaprakasha (Vidyotini commentary), vol-1, 2nd edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp -52

231) K.M Nadakarni, Indian Materia Medica, Vol I, 3rd edition, 1996,popular prakashan, Bombay, pp 478



234) Ibid, pp 11 235) P.V.Sharma, Dravyaguna Vijnana, Vol-2, 14th ed, 1990, Chaukhambha Bhrati

academy, Varanasi, pp 753-58 236) Bramha Shankar Mishra edited, Bhavaprakasha (Vidyotini commentary), vol-1, 2nd

edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp – 1-8



10



240) Yadavji Trikamji Acharya edited, Charaka Samhita Kalpa, 7/46-49 Chakrapani Ayurveda deepika, Chaukhambha Ayurvijnana Grandhamala - 34, reprint 1992, Chaukhambha Surabharathi Prakashan, Varanasi, pp


242) Bramha Shankar Mishra edited, Bhavaprakasha (Vidyotini commentary), vol-1, 2nd edition, Kashi Sanskrit series –130, Chaukhambha Sanskrit Sansthan, Varanasi, pp – 397


244) GEORGE L. ACKERMAN, M.D. et.al., Department of Medicine, University of Arkansas College of Medicine, Little Rock, Arkansas, Clinical Methods, ch 35, An Overview of the Pulmonary System by Eric Honig @ http://www.ncbi.nlm.nih.gov/books/bookres.fcgi/cm/ch035pdf.pdf, pp 194

245) Michel Swash, Hutchinson’s Clinical Methods, 21st ed, 2002, Saunders, Totonto, pp 60-78

246) Suresh R.D, The Evaluation of Padmapatradi Yoga in Tamaka Swasa (Broncheal Asthma), DGMAMC, Gadag, RGUHS, 2001, pp 66

247) Ibid, pp 67 248) Ramnik Sood, Medical Lab Technology, 4th ed, 1994, Jaypee Brothers, New Delhi,

pp 224 249) Ibid, pp 184-85 250) Ibid, pp 171 251) http://www.who.int/respiratory/asthma/burden/en/print.html 252) http://www.who.int/respiratory/asthma/scope/en/print.html 253) http://www.who.int/respiratory/asthma/activities/en/print.html 254) Yadavji Trikamji Acharya edited, Charaka Samhita Kalpa, 12/69, Chakrapani


255) Ibid, 12/68, pp 674 256) Ibid, Chikitsa, 17/122, pp 538 257) K.R. Srikantha Murthy edited, Astanga Hrudaya Sutra 20/26-29, 3rd ed, 1996,

Krishnadas academy, Varanasi, pp 260-1 258) Yadavji Trikamji Acharya edited, Charaka Samhita Kalpa, 12/67, Chakrapani



11

http://www.ncbi.nlm.nih.gov/books/bookres.fcgi/cm/ch035pdf.pdf

http://www.who.int/respiratory/asthma/burden/en/print.html

http://www.who.int/respiratory/asthma/scope/en/print.html

http://www.who.int/respiratory/asthma/activities/en/print.html

SPECIAL CASE SHEET FOR THE EVALUATION OF BRIHAT KATPHALADI YOGA IN COMPARISON WITH VYOSHADI GUTIKA NITYA SHODHANA IN TAMAKA SWASA” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA)

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

Guide: Dr. K. Shiva Rama Prasad

Scholar: Umesh Kumbar

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM Date Month Year Time

Hours Minutes PM

9) Selection Included Excluded

10) Schedule dates Initiation completion

11) Result Well

Responded

Moderately

Responded

Not

responded

Discontinued

INFORMED CONSENT I Son/Daughter/Wife of

am exercising my free will, to participate in above study as a subject. I have been informed to

my satisfaction, by the attending physician the purpose of the clinical evaluation and nature of

the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any

time during the course of the treatment. EzÀÄ £Á£ÀÄ ²æÃ/²æÃªÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ

PÉÆqÀÄªÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀÄªÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ

0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.

gÉÆV0iÀÄ gÀÄdÄ / Patient's Signature

“Evaluating the efficacy of Brihat Katphaladi yoga in comparison with Vyoshadi Gutika nitya shodhana in Tamakaswasa” 1


12) CHIEF COMPLAINTS WITH DURATION (Subjective Parameters) Complaints Duration

1 Teevra vega Swasa (Dyspnonea) 2 Kasa (cough) 3 Duhkhena Kapha nissaranam (Expectoration) 4 Ghurghuratwam (Wheezing) 5 Peenasa (Coryza) 6 Kruchrena bhasate (difficulty in speech) 7 Kantodhwamsham (Hoarseness of voice) 8 Greevashirasangraha (Headache & Stiffness) 9 Urah Peeda (Chest Pain) 10 Shayane Swasa peedita (Discomfort at supine) 13) ASSOCIATED COMPLAINTS Associated Complaints Duration

1 Anidra (disturbed sleep) 2 Pratamyati or Bhrushamarta (distressed) 3 Aruchi (Anorexia) 4 Vishukasyata (Dryness of mouth) 5 Lalata sweda (sweat over forehead) 6 Trushna (Thirst) 7 Angamarda (Malaise) 8 Kampa (Tremors) 9 Jwara (fever) 10 Pramoha (fainting) 11 Vamathu (nausea) 12 Muhur Swasa (frequent respiration) 13 Muhuchaiva dhamyati (puts all effort to breath)

14) HISTORY OF PRESENT ILLNESS Mode of onset - sudden / Gradual Course episodic/ continuous/ initially episodic Frequency of attack few hours / few days / few weeks Duration of attack continuous / intermittent / subsides with medication Mode of progress Typical / Rapid / Longtime non progressive Periodicity seasonal / irregular / perennial Preceded by sneezing / nasal irritation/ cough/ Talking Aggravating factors dust/ food/ smoke/ pets / pollens/ Stress Comfort posture at attack sitting/ lying/ standing/ forward bending

15) Occupational History if any


16) PERSONAL HISTORY

Food habits Vegetarian Mixed diet

Taste preferred Sweet Sour Salty Pungent Bitter Astringent

Agni Sama Vishama Manda Teekshna

Kosta Mrudu Madhyama Krura

Nidra Day Night Sound Disturbed

Addictions Tobacco Alcohol Drugs

Bowel habits Normal Loose Constipated

Menstrual History Regular Irregular Amenorrhea Menopause

Family history – Specify if any has the same disease

Other system medications Bronchodialtors Treatment history Cortico steroids Other medicines RS Since how long

History of past illness

17) EXAMINATION (a) Vitals

Temperature ºF Pulse / min Respiration rate / min

Height Cms Weight Kg Blood pressure mmHg

(b) General

Oedema Present Absent Icterus Present Absent

Pallor Present Absent Cyanosis Present Absent

Clubbing Present Absent Palpable lymph nodes

Present Absent

(c) Respiratory system

Shape Normal / Kyphosis / Scoliosis/ Flattening/ over inflation Movement Normal / Reduced Resp. Rhythm Normal / Abnormal Respiration Thoracic/ Abdominal / Thoraco abdominal Accessory muscles Not involved / Involved / Inter coastal spaces Visible veins Absent / present

Dar

shan

a

Venous pulses Normal / Raised Tracheal position Centrally placed / Deviated Pain / Tenderness Swelling Vocal fremitus Shape Symmetrical / Asymmetrical Sp

arsh

ana

Lymph nodes Not palpable / palpable at Akotana Normal / Resonant / Hyper Resonant / Dull

Type of breath Broncho-vesicular/ Vesicular / Bronchial Vocal resonance Normal / Increased/ Decreased/ Absent

Shra

vana

Resp. Sound Rales/ Ronchi/ Crepitating/ Plural Rub /


(d) Dosha Examination (Ayurvedic)

Desham (Deha) Bhumi Jangala Anupa Sadharana Vata B A Pitta B A Kapha B A

Karshya Peeta mootrata Agni sadana

Karshnya Peetanetra Praseka

Ushna kamitwa Peetavi t Alasya

Kampa Peetatwak Swetangata

Anaha Adhikshudha Sheetangata

Shakrudgraha Adhidaha Gowrava

Balabhrmsha Slathangata

Nidrabhramsha Swasa

Pralapa Kasa

(a) Dosha Vruddhi

Bhrama At in idra

Vata B A Pitta B A Kapha B A

Angasada Mandagni Bhrama Alpabhashite

ahitam Shareera sheetatwam Urah

shoonyata

Chesta heenata Prabha hani Shira soonyata

Vyamoha Hridrava

(b) Dosha Kshaya

Sleshma vruddhi Sandhi saidhi lya

Nadi V P K VP VK PK VPK

Prakruti V P K VP VK PK VPK

Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya

Nadi Dosha Pravrutti Gati Varna Purnata Gandha

Spandana Kathinya

Mutra

Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa

Mala

Shabda Sparsha Sheeta Ushna

Ast

asth

ana

Drik Akruti


(e) Srotas Before After Before After Pranavaha Atisrustam Ati badhdama Kupitam Abheekhnam Alpalpa Sashoolam Annavaha Aruchi Ajeerna Chardi Anannabhilasha Udakavaha Jihwashosha Talushosha Ostashosha Pipasa

18) Tamaka Swasa Nidana Visamashana (V) Tilataila (P) Pistanna (K) Masa (K)

Adhyashana (V) Vidahi (P) Nispava (K) Dadhi (K)

Anasana (V) Saluka (K) Vistambhi (K)

Sheetashana (V) Guru dravyas (K) Amaksira (K)

Visha (V) Jalajamamsa (K)

Sheetapana (V) Anupa mamsa (K)

Aha

ra

Rukshanna (V) Abhishyandi (K)

Rajas (V) Abhighata (V) Kanthapratighata (V) Urahpratighata (V) Vata (V) Dhuma (V) Karmahata (V) Marmabhighata(V) Sheeta Sthana (V) Apatarpana (V) Veganirodha (V) Usna (P) Sheeta ambu (V) Bharakarshita

(V) Shuddhi Atiyoga (V) Abhishyandi

Upacara (K) Vi

hara

Ativyayama (V) Adhwahata (V) Gramya dharma (V) Divasvapna (K) Ksataksaya Atisara Visucika

Udavarta Vibandha Panduroga

Vata

Kshaya Anaha Dourbalya

Pitta Rakta pitta Jwara

Kasa Amapradosa Chardi

Any

a / V

yadh

i Ava

sta

sam

band

ha

Kapha

Pratisyaya Amatisara

19) Tamaka Swasa Poorvaroopa

BT AT BT AT

Hrutpeeda Parshwashoola

Kshudra Swasa Vibandha

Shankha bheda Anaha

Shoola Arati

Pranavilomata Bhakta dwesha

Vaktra vairasya Admana


20) Tamaka Swasa Vikalpa Samprapti

Santamaka Pratamaka

Udavarta Jwara

Rajaobhighata Moorcha

Ajeerna

Vata nirodha

21) Upashaya and Anupashaya

Asheene labhate sowkhyam Sleshma vimokshante sukham Upashaya

Usnamchaivabhinandate Shayanasya sameerane parshwe ghrnnati

Anupashaya Shayanasya Swasa peedita Meghambu sheeta pragwata

22) INVESTIGATIONS (Objective parameters) Investigations for screening

Sputum examination (if necessary) Chest-X-Ray (if necessary) Erythrocyte Sedimentation Rate Absolute Eosinophil count Total Count WBC

Lymphocytes Neutrophils Eosinophils Basophils

Differential count

Monocytes 23) Assessment A) Disease Assessment 1) Subjective parameters Before After Follow-up Comment

1 Teevra vega Swasa (Dyspnonea)

2 Kasa (cough)

3 Duhkhena Kapha nissaranam (Expectoration)

4 Ghurghuratwam (Wheezing)

5 Peenasa (Coryza)

6 Kruchrena bhasate (difficulty in speech)

7 Kantodhwamsham (Hoarseness of voice)

8 Greevashirasangraha (Headache & Stiffness)

9 Urah Peeda (Chest Pain)

10 Shayane Swasa peedita (Discomfort at supine)


2) Objective parameters Before After Follow-up

1 Breath holding time /sec /sec /sec

2 Peak expiratory flow rate L/m L/m L/m

3 Erythrocytes sedimentation rate mm/1st Hour mm/1st Hour mm/1st Hour

4 Haemoglobin % Gm% Gm% Gm%

5 Total Count WBC

6 Absolute eosinophilic count /cumm /cumm /cumm

7 Eosinophilic Differential count

B) Assessment of Nitya Shodhan: (Samyak Virechana Lakshana) (for Group-B only) Sno Symptom Before Day 7 Day 14 Day 21 Final

Pranavaha Udakavaha

1 Sroto Prasadanam (VAS 100 each, 300 max) Annavaha

Srotra Sparsha Chkshau Rasana Ghrana

2 Mano Indriya Prasadanam (VAS100 each, 600 max)

Manas 3 Laghava (Body Lightness) (VAS100 max) 4 Agni Vruddhi (VAS100 max) 5 Anamayatwa (As depicted in subjective

parameters VAS 100 each, 1000 max)

6 Ayoga lakshana abhava (VAS100 max) Total

(ArÉÉåaÉ sÉ¤ÉhÉ = ¾ÒûiÉ MÑüÍ¤É AvÉÑÌ®, MüTü ÌmÉ¨É EiYsÉåvÉ, AÂÍcÉ, MüÇQÒû, ÌuÉSÉWû, ÌmÉÌQûMü, mÉÏlÉxÉ, uÉÉiÉÌuÉÄQûaÉëWû)

24) Treatment schedule of “Brihat Katphaladi yoga / Vyoshadi gutika Tamakaswasa” Schedule Investigator’s observation

Day 1

Day 7

Day 14

Day 21 1st Follow up

Day 28 (Final Follow up)

Investigators Note:

Signature of Guide

(Dr. K. Shiva Rama Prasad)

Signature of Scholar

(Umesh Kumbar)

Documents

Tamaka swasa kc038gdg