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CONTENTS
LIST OF ABBREVIATIONS
LIST OF TABLES
LIST OF FIGURES
Page No
PART - I: INTRODUCTION 1-4
PART - II: OBJECTIVES OF THE STUDY 5
PART – III: REVIEW OF LITERATURE Chapter I - Historical Review 6-8
Chapter II - Vyutpatti and Nirukti of Kasa 9 Nidana 10-11 Samprapti 12-14 Poorvaroopa 15 Bheda 15 Roopa 16-17 Upashaya Anupashaya 18 Upadrava 18 Sadhyasadhyata 19 Arista Lakshana 19 Sapeksha Nidana 20 Chikitsa 21-22 Pathya-Apathya 23-25 Modern Disease Review 26-37
Chapter III - Dhoomapana 38-47
Chapter IV - Drug Review 48-53
PART - III: CLINICAL STUDY
Materials and Methods 54-60
Observations 61-86
Effect of treatment 87-126
PART – IV: DISCUSSION 127-141
PART –V: CONCLUSION 142
PART –VI: SUMMARY 143-146
BIBLIOGRAPHY 147-162
ANNEXURE
Abbreviations
LIST OF ABBREVIATIONS
1. A.H. : Ashtanga Hridaya
2. A.P.I. : A.P.I.Text Book Of Medicine
3. A.S. : Ashtanga Sangraha
4. A.K. : Amarakosha
5. B.P. : Bhava Prakasha
6. B.R. : Bhaishajya Rathnavali
7. C.S. : Charaka Samhita A
8. C.D. : Chakra Datta
9. Ckr. : Chakrapani.
10. D.P.P.M. : Davidson’s Practice and Principles of Medicine
11. Dl. : Dalhana
12. D.N. : Dhanvantari Nighantu
13. D.G. : Dravya Guna Vijnana
14. G.N. : Gada Nigraha
15. H.P.I.M. : Harrison’s Principle Of Internal Medicine
16. H.S. : Harita Samhita.
17. K.S. : Kashyapa Samhita
18. K.N. : Kaiyadeva Nighantu
19. Madhu. : Madhukosha
20. M.N. : Madhava Nidana
21. M.P.N. : Madanapala Nighantu
22. R.P.B.D. : Robbin’s Pathologic Basis Of Disease
Abbreviations
23. R.R.S. : Rasa Ratna Samucchaya
24. R.N. : Raja Nighantu
25. R.V. : Rugveda
26. S.N. : Saligrama Nighantu Bhushana
27. S.K.D. : Shabda Kalpa Druma
28. Sh.S. : Sharangadhara Samhita
29. Su.S. : Sushruta Samhita
30. T.B.P. : Text Book Of Pathology By Harsh Mohan
31. Vag. : Vagbhata
32. Vang. : Vangasena
33. Y.R. : Yogaratnakara
ABBREVIATIONS OF STHANAS AND KHANDAS
1. Chi. : Chikitsa Sthana
2. Ind. : Indriya Sthana
3. Ka. : Kalpa Sthana
4. Ma.Kha. : Madhyama Khanda
5. Ni. : Nidana Sthana
6. Po.Kha. : Poorva Khanda
7. Sha. : Shareera Sthana
8. Si. : Siddhi Sthana
9. Su. : Sutra Sthana
10. Ut. : Uttara Tantra
11. Vi. : Vimana Sthana
Abstract
ABSTRACT
Our life style in inclined towards various modifications and shortcuts to achieve
nothing but happiness. But very less care for health is devoted in the process to stand in
this competitive world. Kaphaja kasa is the disease entity which arises due to such
negligence to the primary symptomatology of coughing. Incidence shows that kaphaja
kasa has an alarming increasing due to overcrowding of cities, pollution; un controlled
smoking habits and alterations in the environment.
Many attempts have failed to conclude at the best remedy in curing kaphaja kasa.
Ayurvedic literatures giving various accounts of therapy are unexplored to the fullest. So
here an attempt is made to try the combination of Haridradi Dhoomapana and Kaphaketu
rasa which also fulfills the treatment criteria of shodhana and shaman for kaphaja kasa.
Methods- it is a single blind comparative clinical study in which 21 patients
suffering from kaphaja kasa were randomly assigned into two groups. 10 patients in the
trial group were administered Haridradi Dhoomapana in a single sitting per day for a
period of 7 days along with Kaphaketu rasa in a dose of 125mg, t.i.d. was given with
Ardraka swarasa as Anupana for a period of 1 month. 11 patients in the control group
was administered with a similar dose of Kaphaketu rasa for 1 month.
Results- it was noticed that marked improvement was seen in both the groups in
terms of symptomatology of kaphaja kasa such as cough and expectoration; physical
signs and pulmonary function tests. The comparative study showed better results from the
patients in Dhoomapana group. There were significant results of Dhoomapana group
patients over Kaphaketu group patients in symptoms like expectoration, fullness of chest,
Peenasa and headache; pulmonary function test values like FVC and the FEV1/FVC %
Overall results showed 20% patients in either groups having complete remission
of the illness. Another 20% patients had marked reduction in the disease process in either
groups. Maximum patients from both the groups had moderate improvement, they were 5
and 4 for Dhoomapana and Kaphaketu groups respectively. The remaining 1 patient from
Dhoomapana group and 3 patients from Kaphaketu group had average improvement of
the disease kaphaja kasa. None of the patients had any aggravation of symptoms or any
complication noted.
LIST OF TABLES Tb.No. List of tables Pg.
No. 1 showing the samanya nidana of kasa 12 2 showing the poorvaroopa of kasa 15
3 showing the roopa of kaphaja kasa 17
4 showing classification of Dhoomapana according to different classics 38 5 showing the different time of administration of prayogika dhoomapana 39 6 Showing the different time of administration for Vairechanika
Dhumapana 40
7 showing the different time of administration for snaihika dhoomapana 41 8 Showing the indications of Dhumapana mentioned by different authors 42 9 Showing the Contraindications of Dhumapana mentioned by Different
authors 43
10 showing the ingredients of Haridradi Dhoomapana 48 11 showing description of Haridra 48
12 Showing Description of Daruharidra
49 13 Showing Description of Manasheela 49 14 Showing ingredients of Kaphaketu Rasa 50 15 Distribution of 21 Patients in Different Age Groups 62 16 Distribution of 21 Patients According to their Sex 63 17 Distribution of 21 Patients According to Religion 64 18 Distribution of 21 Patients According to Marital status 65 19 Distribution of 21 Patients According to Educational status 66 20 Distribution of 21 Patients According to their Occupation 67 21 Distribution of 21 Patients According to Socio-economic status 68 22 Distribution of 21 Patients According to Mode of Onset of the illness 69 23 Distribution of 21 Patients According to the Course of illness 70 24 Distribution of 21 Patients According to the Severity of illness 71
25 Distribution of 21 Patients According to the Consistency of Sputum
72
26 Distribution of 21 Patients According to the Aggravating factors
73
27 Distribution of 21 Patients According to the Condition of Working place 74
28 Distribution of 21 Patients According to the Dietary Habits 75 29 Distribution of 21 Patients According to Dominant rasa in Ahara 76 30 Distribution of 21 Patients According to their Addictions 77 31 Distribution of 21 Patients According to Prakriti 78 32 Distribution of 21 Patients According to Sara 79
33 Distribution of 21 Patients According to Samhanana 80 34 Distribution of 21 Patients According to Satmya 81 35 Distribution of 21 Patients According to Satva 82 36 Distribution According to Ahara Abhyavaharana and Jarana Shakti in
patients of Kaphaja kasa 83
37 Distribution According to Vyayama Shakti in patients of Kaphaja kasa 84 38 Distribution According to Vaya of patients 85 39 Distribution According to Desha of patients 86 40 Effect on Severity in Dhoomapana Group 87 41 Effect on Kasa in Dhoomapana Group 87 42 Effect on Nishteevana in Dhoomapana Group 88 43 Effect on Ura Vankshana Sampoornata in Dhoomapana Group 88 44 Effect on Kapha Poorna Deha in Dhoomapana Group 89 45 Effect on Asya Madhuryata in Dhoomapana Group 89 46 Effect on Mandagni in Dhoomapana Group 90 47 Effect on Aruchi in Dhoomapana Group 90 48 Effect on Peenasa in Dhoomapana Group 91 49 Effect on Shiroruja in Dhoomapana Group 91 50 Effect on Phonation in Dhoomapana Group 92 51 Effect on Quantity of Sputum in Dhoomapana Group 92 52 Effect on Respiratory Rate in Dhoomapana Group 93 53 Effect on Absolute Values of Spirometric Parameters in Dhoomapana
Group 94
54 Effect on Predicted percentage of Spirometric Parameters in Dhoomapana Group
95
55 Effect on Severity in Kaphaketu Group 96 56 Effect on Kasa in Kaphaketu Group 96 57 Effect on Nishteevana in Kaphaketu Group 97 58 Effect on Ura Vankshana Sampoornata in Kaphaketu Group 97 59 Effect on Kapha Poorna Deha in Kaphaketu Group 98 60 Effect on Asya Madhuryata in Kaphaketu Group 98 61 Effect on Mandagni in Kaphaketu Group 99 62 Effect on Aruchi in Kaphaketu Group 99 63 Effect on Peenasa in Kaphaketu Group 100 64 Effect on Shiroruja in Kaphaketu Group 100 65 Effect on Phonation in Kaphaketu Group 101 66 Effect on Quantity of Sputum in Kaphaketu Group 101 67 Effect on Respiratory Rate in Kaphaketu Group 102 68 Effect on Absolute Values of Spirometric Parameters in Kaphaketu
Group 103
69 Effect on Predicted Percentage of Spirometric Parameters in Kaphaketu Group
104
70 comparison of effect on severity 105 71 comparison of effect on kasa 106 72 comparison of effect on nishteevana 107
73 comparison of effect on uravankshana sampoornata 108 74 comparison of effect on kapha poorna deha 109 75 comparison of effect on asya madhurata 110 76 comparison of effect on mandagni 111 77 comparison of effect on aruchi 112 78 comparison of effect on peenasa 113 79 comparison of effect on shiroruja 114 80 comparison of effect on Phonation 115 81 comparison of effect on Quantity of sputum 116 82 comparison of effect on respiratory rate 117 83 comparison of Effect on absolute values of FVC 118 84 comparison of Effect on absolute values of FEV1 119 85 comparison of Effect on absolute values of PEF 120 86 comparison of Effect on absolute values of FEV1/FVC 121 87 comparison of Effect on predicted percentage of FVC 122 88 comparison of Effect on predicted percentage of FEV1 123 89 comparison of Effect on predicted percentage of PEF 124 90 comparison of Effect on predicted percentage of FEV1/FVC 125 91 overall effect of the treatment in both the groups 126
Lists of figures Fig.No. List of Figure Pg.No. Method of Dhoomapana and the materials used Plate1 1 showing the samprapti of kaphaja kasa 14 2 showing the pathophysiology of chronic bronchitis 30 3 Distribution of 21 Patients According to Age 62 4 Distribution of 21 Patients According to Sex 63 5 Distribution of 21 Patients According to Religion 64 6 Distribution of 21 Patients According to Marital status 65 7 Distribution of 21 Patients According to Educational status 66 8 Distribution of 21 Patients According to their Occupation 67 9 Distribution of 21 Patients According to Socio-economic status 68 10 Distribution of 21 Patients According to Mode of Onset of the illness 69 11 Distribution of 21 Patients According to the Course of illness 70 12 Distribution of 21 Patients According to the Severity of illness 71 13 Distribution of 21 Patients According to the Consistency of Sputum 72 14 Distribution of 21 Patients According to the Aggravating factors 73 15 Distribution of 21 Patients According to the Condition of Working
place 74
16 Distribution of 21 Patients According to the Dietary Habits 75 17 Distribution of 21 Patients According to Dominant rasa in Ahara 76 18 Distribution of 21 Patients According to their Addictions 77 19 Distribution of 21 Patients According to Prakriti 78 20 Distribution of 21 Patients According to Sara 79 21 Distribution of 21 Patients According to Samhanana 80 22 Distribution of 21 Patients According to Satmya 81 23 Distribution of 21 Patients According to Satva 82 24 Distribution According to Ahara Abhyavaharana and Jarana Shakti in
patients of Kaphaja kasa 83
25 Distribution According to Vyayama Shakti in patients of Kaphaja kasa
84
26 Distribution According to Vaya of patients 85 27 Distribution According to Desha of patients 86 28 comparison of effect on severity 105 29 comparison of effect on kasa 106 30 comparison of effect on nishteevana 107 31 comparison of effect on uravankshana sampoornata 108 32 comparison of effect on kapha poorna deha 109 33 comparison of effect on asya madhurata 110 34 comparison of effect on mandagni 111 35 comparison of effect on aruchi 112 36 comparison of effect on peenasa 113 37 comparison of effect on shiroruja 114 38 comparison of effect on Phonation 115 39 comparison of effect on Quantity of sputum 116
40 comparison of effect on respiratory rate 117 41 comparison of Effect on absolute values of FVC 118 42 comparison of Effect on absolute values of FEV1 119 43 comparison of Effect on absolute values of PEF 120 44 comparison of Effect on absolute values of FEV1/FVC 121 45 comparison of Effect on predicted percentage of FVC 122 46 comparison of Effect on predicted percentage of FEV1 123 47 comparison of Effect on predicted percentage of PEF 124 48 comparison of Effect on predicted percentage of FEV1/FVC 125 49 overall effect of the treatment in both the groups 126
Acknowledgement
ACKNOWLEDGEMENT
First and foremost I pray to the almighty God, who is omnipresent, omniscient and
omnipotent. He is the possessor of the ocean of knowledge and wisdom to which I would like
to contribute a drop in the form of my dissertation. As it is said, each and every drop goes to
make an ocean, so this is my humble endeavor towards its goal of wisdom.
It gives me inexpressible pleasure to offer my sincere thanks to all those who have
rendered their whole hearted support, guidance and co-operation in completing the thesis work.
My deep sense of gratification is due for my parents who are the architects of my
career. The culture, discipline and perseverance, which I could imbibe, is solely because of
their painstaking upbringing and strong moral support.
I express my deep gratitude to my respected guide Dr. V.K.Shreedhara Holla, for his
critical suggestions and expert guidance for the completion of this thesis.
I am extremely happy to express my deepest sense of gratitude to my beloved and
respected H.O.D. Dr. U.N.Prasad, whose sympathetic scholarly suggestions and guidance at
every step have inspired me not only to accomplish this work but in all aspects.
I wish to offer my sincere thanks to Prof. K. Balakrishna Bhat, Principal, Prof. K.
Ramchandra Rae, the Dean for Post Graduate faculty, and Dr. B.V.Prasanna, Associate Dean
for Post Graduate faculty, S.D.M. college of Ayurveda for their encouragement and support.
I am extremely grateful to my co-guide Dr. G.Shreenivasa Acharya, under whose
guidance, inspiration, supervision and valuable suggestions, I have been able to complete this
research work.
I take this opportunity to thank my teachers – Dr.Mrs. Sreelatha Kamath, Dr. Jonah,
Dr.Mrs.Lavanya, Dr. Veerakumar, Dr. Prasanna Mogasale, Dr. Nagraj and Dr. B.R.Dodamani
for giving me valuable guidance and helping me in completing my clinical work.
I pay my respects to the founder of this institution Dr. D.Veerendra Heggedeji,
whose divine blessings have inspired me in rendering this work. I owe my sincere thanks
to Prof. Prabhakar, honorable former secretary for his encouragement in this regard. I
also wish to express my gratitude to the other authorities of S.D.M. education society for
providing me all the requisite facilities for carrying out this work.
Acknowledgement
My gratitude due to Dr. Y. N. Shetty, superintendent and Dr. Deepak S.M., deputy
superintendent and Mr. C.S.Hedge, manager of the S.D.M. Ayurveda hospital, Udupi for their
valuable support and encouragement.
My sincere thanks goes to my colleagues – Dr. Madhusudanan I.K., Dr. Vittal Huddar,
Dr. Anilkumar Garidi, Dr. Gajanan Prabhu, Dr. Tanmay Bagade and Dr. Nagveni for their
valuable inputs and the support they provided throughout my studies.
I take this moment to express my thanks to my juniors – Dr. Kuldeep Patil, Dr.
Ramesh, Dr. Ranjit Patil, Dr. Deepthi M.S. and Dr. Shobha Itnal for their help and co-
operation.
I feel proud in expressing my sincere gratitude to internees – Dr. Harbaksh Singh, Dr.
Priya Pillai, Dr. Sholly Francis, Dr. Nisha, Dr. Sumedha, Dr. Prashant, Dr. Neeraja Reddy, Dr.
Geetha Kamath, Dr. Jyoti Dogra, Dr. Sneeta, Dr. Dhanya shetty, Dr. Divya kini, and Dr.
Sreedevi, for timely rendered help in my clinical studies.
I am grateful to the librarian Mr. Harish Bhat, library assistant Mr. Renold and Mr.
Srinidhi and to Mr. Kinni, digital library incharge for providing valuable books and internet
services in time throughout my study.
I praise the efforts of Mr. Ganesh Kamath, proprietor of Ananth Communications for
his hard work in printing and Mr. Srinivasa, proprietor of Sampark Xerox for binding this
thesis.
I cannot move further before thanking my roommates – Dr. Amol Doshi, Dr. Sameer
Velapure, Dr. Chaitanya Shah and Dr. Gautam Naik, who not only helped me but stood by me
during hours of stress and dejection.
Last but not least, I thank to the patients who are pillars of my research work and all
those names my memory fails to recall.
DR. MITHUN M. BONDRE
Introduction
INTRODUCTION
The essential disposition of living activity in a living being is said to be breathing, one
of the basic activity of pranavaha srotas. The lungs with their greater surface area (500m2) are
directly open to the external environment, with the exchange of gases, 16 times per minute
making it one of the most vulnerable sites for disease. Thus structural, functional and
microbiological changes within the lungs can be closely related to epidemiological,
environmental, occupational, personal and social factors. The primary respiratory diseases are
responsible for a major burden of morbidity and ultimately death. As a result pranavaha
srotodusti have become unavoidable making kasa the most common disease to the extent of
60% of total disease recorded.
Kasa has been described as a disease as well as a symptom making its appearance
special. From time immemorial it has remained as a common ailment within human beings.
Kaphaja kasa is a variety of kasa where early intervention is of paramount importance in the
field of medicine. Even with today’s resources, kaphaja kasa remains a challenging
pathological condition of the respiratory system and can turn heads up if neglected or
mismanaged as it may result in poor prognostic conditions such as kshataja kasa, kshayaja kasa
and tamaka shwasa.
The literary sources of both the ancient medicine and the present day medicine become
evident that kaphaja kasa can be best compatible with the information available on chronic
bronchitis. Chronic Bronchitis is very commonly seen and prevalent in all climates irrespective
of tropics and sub-tropics of the world. It is classified under the pathological process of chronic
obstructive airway disease. Chronic bronchitis presents with the clinical symptoms which may
develop in individuals due to a long and continuous exposure to various types of irritants on
the bronchial mucosa. The most important of this is tobacco smoke. Also inhalation of dust,
smoke and fumes occurred from specific occupational sources like atmospheric pollution in the
industrial cities amounts to an invasion of the disease. Infection sometimes become a
precipitating factor in the onset of chronic bronchitis. But as a fact, it continues in aggravating
the established condition. Exposure to dampness and fog, sudden changes in temperature may
also be responsible for exacerbation of chronic bronchitis.
1
Introduction
The standard of human life is changing. The life style pattern is getting better adopted
to the fast and furious growth on the globe. Thus there is a variation in immunity and affinity
of attraction for diseases. This variation is seen changing from age to age, country to country in
the world. To accomplish the sukha, man is always engaged to find the suitable ways to attain
the happiness but unfortunately the body is invited by various diseases, which interrupt the
ways of life and human is virtuously trying how to overcome it.
Few research works carried out in this regard in different institutions are listed below:
1) A clinical study on Vyaghri Haritaki in chronic Bronchitis vis-à-vis Shlaishmika kasa
was carried out by Dr. Kakati S. at Gopabandu Ayurveda Mahavidyalaya, Puri in 1990.
This study on 20 cases claimed 45% cured cases, 40% patients showed maximum
improvement and only 15% showed poor improvement. The drug was tried for a period
of 21 days in the dosage of 10grams three times a day.
2) In 1999, at Government Ayurveda Medical College, Mysore. Dr. Ravikiran conducted a
study on management of kaphaja kasa (chronic bronchitis) with different doses of kasa
kuthara rasa. Here 8 tablets of 125grams each given in a day proved to be very
efficacious with 40% patients showing complete relief, marked and moderate relief was
seen in 26% and 23% cases respectively.
3) Dr. Prasanna Mogasale of Government Ayurveda Medical College, Mysore. Did a
work on Role of Dhoomapana Chikitsa with comparison to Pushkaramulasava in
treating Tamaka shwasa, on 20 patients, in 2000. This study concludes that Manashiladi
Dhoomapana has no serious complications in its short term course and the results are
favoring statistics in patients with mild to moderate course of the disease.
4) Preparation and Physico-chemical Analysis of Kaphaketu rasa and its clinical effect on
Kaphaja kasa was done in Rasashastra Department of DGM Ayurvedic Medical
College, Gadag in 2005, by Dr. Ravikumar Pattanshetty. The clinical study on 30
Patients stated that Kaphaketu rasa is having expectorant and mucolytic action. 50%
patients well responded to the remedy, whereas 30% and 20% had moderate and mild
improvement respectively.
Kaphaja kasa has a high prevalence and arousing fatal complications. Understanding
this enormity of problem, there is an urgent need for intense research to shed light on our
knowledge in order to effectively combat the disease. The conventional medicine with its
2
Introduction
mucolytic, expectorants, bronchodilators and now the use of inhalers cannot completely rescue
the patients suffering from chronic bronchitis. With this regards an effective Ayurvedic remedy
with more targets specific approach is the need of the hour.
It is contended that by virtue of the local effect of Dhoomapana when employed in the
patients of kaphaja kasa is likely to rectify the pathology. With this shodhana effect adding
feather to the cap is kaphaketu rasa with its shamana effect on kaphaja kasa. So this
combination of shodhana and shamana is more aiding towards a complete cure.
From the foregoing it is clear that no such research has been performed on kaphaja kasa
assessing the efficacy of target specific Shodhana along with shamana therapeutic measures
elaborated in Ayurveda.
Keeping all these facts in the background, the present clinical study is designed to
evaluate the effect of Haridradi Dhoomapana and kaphaketu rasa in patients suffering from
kaphaja kasa.
The thesis includes the following chapters:-
- conceptual study
- clinical study
- discussion
- summary and conclusion
The first chapter on conceptual study also includes sub-chapters discussing the
etymological derivation of the constituent words of kaphaja kasa as well as historical review.
The general description of the illness kaphaja kasa, that includes Nidana, poorvarupa,
rupa, samprapti, upashayanupashaya, upadrava, sadyasadyata, arista, Chikitsa and
pathyapathya, all are found in the second chapter.
The details of Haridradi Dhoomapana and composition of kaphaketu rasa are briefed
under the title drug review.
The design of the present clinical study, materials and methods, criteria of assessment,
intervention, descriptive statistical analysis of the sample taken for the study, observations,
results, and its statistical analysis elaborated in tables as well as graphs all are narrated in the
clinical study.
The critical analysis of the result is made in the chapter on discussion.
3
Introduction
In the final chapter entitled summary and conclusion, the whole dissertation is briefed
and critical analysis are drawn. Based on these critical analysis, an attempt is made to compare
both the groups of treatment and conclusion is drawn regarding the merits of the treatment.
This work is carried out with a predilection that the Haridradi Dhoomapana and
kaphaketu rasa together may bring about spontaneous and definite relief then only
administering kaphaketu rasa orally, in patients suffering from kaphaja kasa. as the previous
technique delivers the medicine at the site of morbid part. I.e. pranavaha srotas itself.
This is not the end of research work in this line; rather this step will pave ways for
many other enthusiastic physicians to find a better cure for this lingering disease affecting the
prana. With this intention in mind this work is presented.
4
Objectives
OBJECTIVES OF THE STUDY:
1) To study Kaphaja Kasa with a parallel study of Chronic Bronchitis.
2) To Explore the efficacy of Haridradi Dhoomapana in the Management of
Kaphaja Kasa.
3) To evaluate the effect of Kaphaketu Rasa in the Management of Kaphaja Kasa.
5
Historical Review
REVIEW OF LITERATURE HISTORICAL REVIEW
Vedas being the earliest known literature of human beings. The mention of the disease kasa in such ancient literature proves its existence from time immemorial. The detailed knowledge about the disease kasa is present in the samhitas which is adequate enough to diagnose and plan the treatment.
This view can be best appreciated by going through the following historical review: VEDA KALA-
Few references to kasa & its management are found mentioned in Rigveda1. Atharvaveda gives a major contribution of the disease kasa amongst the Vedas. Here
kasa has been mentioned as the weapons of rudra. Also there is description that in rainy season abhraja & vataja kasa were manifested due to vitiation of Vata. So the people were advised to take shelter in the hill & forest.
Balasakasa is said to be developed as a complication of takman i.e. jwara or fever. There are some mantras (hymns) described to be recited to get rid of this disease. With this the synonyms & management of the disease kasa have been recorded.
UPANISHAD KALA- Yoga chudamani Upanishad carries the impression that kasa, hikka, pain on siras, karna
& akshi & other diseases are created by the disturbances of movement of air. This may be lokvayu or sharer vayu.
PURANA KALA – Garuda purana contains detailed reference of abhrata kasa, vatasa kasa & sumna kasa &
its management. SAMHITA KALA- The information related to the illness kasa is minimum as revealed in the earlier lines, in
regards to Veda, Upanishad and purana kala. Contrary to this from the samhitas kala onwards detailed and complete elaboration of this particular illness is worth mentioning.
The detailed description of kasa is seen in Charaka samhitas, where in its bheda, poorvarupa, samprapti, description of individual varieties of kasa in terms of Nidana, samprapti, lakshanas, sadhyasadhyatva, Chikitsa & Upadrava have been mentioned2.
Sushruta mentioned kasa not only as a disease entity, but also as symptom. He also explained its Nidana, samprapti, beheads, Uparasa, poorvarupa, individual lakshanas, sadyasadyata & with more importance over herbal medicines. Also there is description about dhoomapana in kasa rogas3.
Description about the different types, the causative factors, the symptomatology and detailed treatment is found in Bhela samhita4.
One of the major contributions among the varieties of kasa comes from hareeta samhita. He has also stated the etiology, pathology, presenting features and management of the disease5.
Reference of kasa is also found in kashyapa samhita in the context of urogata roga as one of its complications6.
6
Historical Review
MADHYAMA KALA- Before the mughal period (1300 a.d.) kasa was found described by many authors like
Vriddha Vagbhata7 and Vagbhata8 have given detailed description of kasa, its Nidana, bheda, prodromal symptoms, samprapti, individual lakshanas, sadhyasadhyata & Chikitsa in two different chapters. Vagbhata has devoted a separate chapter for dhoomapana wherein he mentions about the dhoomapana for maintaining health, different types, contraindications, symptoms of atiyoga, time of administration, dhoomanetra, dhooma varti, method of administration, dosage, different drugs used9, etc.
Madhavakara has described the Nidana aspect of kasa in his treatise Madhava Nidana10.
Vangasena advocated the herbal remedies as well as medicaments prepared from ghee. Also mention about dhoomapana in kasa is present11
Among nighantus – Raj nighantu & Dhanwantari nighantu have recorded the disease entity kasa.
LATER THE SAMHITAS OF MEDIEVAL PERIOD
Like sharangadhara samhita, Gadanigraha12, Bhavaprakash13, Yogarathnakara14, etc. have described about kasa & its line of treatment with therapeutic measures to control kasa, they also mention about different Yogas of dhoomapana for curing kasa.
Numerous references can be seen in Bhaishajya ratnavali15, Chakradutta, Rasa ratna Samucchaya16, etc.
All the subsequent compilation works in Ayurveda could really add nothing new, except some modified medicaments.
IN THE PRESENT ERA (ADHUNIKA KALA – 19TH & 20TH CENTURY) Almost all 20th century authors like Vaidya Yadavji Trikamji Acharya, Vaidya
Vidhyadhara Shukla, Shivacharana Dhyani, Kaviraja Ramaraksha Pathak have described the disease kasa under the heading of pranavaha strotodusti vikara
HISTORICAL REVIEW OF CHRONIC BRONCHITIS: In 1808, an English Doctor named Charles Badham became the first person to discover the disease chronic bronchitis. The definitions of chronic bronchitis for clinical as well as epidemiological purposes were released in 1959, by the Ciba Foundation. Medical research council came up with a questionnaires helping in diagnosing chronic bronchitis17. Later WHO recognized this disease, chronic bronchitis, as one of the major illness of the respiratory system, with rising incidence18. Many authors of modern science, like Harrison has given a detailed account of the disease chronic bronchitis19.
7
Conceptual Study
CONCEPTUAL STUDY: ETYMOLOGICAL DERIVATION
Unique concept of naming the disease is adopted in Ayurvedic literatures. Illness occurring at a specific location is named after the specific organ as in the disease hridroga. In contrast to this several other disorders are named after the cardinal symptom. A kasa is one among such diseases and is named after the cardinal symptom of coughing.
Etymology (utpatti) The illness characterized by the act of ‘kasana’ is known as kasa. the word kasa is
derived from the root ‘kasru’, this refers to kushabda, meaning the symptom of producing hoarse phonation. The word kasa is derived from the root ‘kas gathou’, meaning course. Pathologically speaking the morbid vata Dosha either alone or in combination with morbid kapha Dosha constricting the body partslike shira, kanta, etc. and then escapes from the mouth. This abnormal course of vayu is referred as kasa20.
The word kasa is also derived from the root ‘kas gathi shatanayoh’, the meaning gathi refers to specific course. The meaning shatanayoh, refers to constriction. Thus the abnormal course of vata Dosha in this illness is referred by the word kasa. or else the abnormal act of constrictive movements of ura, kanta, etc. structures that happen while coughing is referred as kasa21.
Definition (Nirukti) By the association of the udana vayu, prana vayu assumes an abnormal upward course
and spontaneously escapes from the mouth generating the sound similar to the one produced by the broken bronze vessel, and this illness is known as kasa22.
Synonyms of kasa (paryayas)
In Atharvaveda ‘kasaa and ‘kasika’ are considered as synonyms of kasa. Kasika – means it is a roga vishesha, which produces a peculiar sound i.e. ‘kas shabdha’23.
8
Conceptual Study
NIDANA Kasa is one of the most common diseases of the pranavaha srotas. The causative factors
of it may be classified under two main headings, Samanya nidana and Vishesha nidana.
General etiological factors are responsible for the manifestation of all varieties of kasa, on the contrary specific etiological factor are responsible for the specific varieties of kasa.
For better understanding, Nidana of kasa can be broadly classified into two groups:
Aharaja Nidana -Rooksha Ahara sevana –dry food items -Ati sheeta Ahara sevana – freezed or cold food items -Katu, ushna, amla Ahara ati sevana -Ati kashaya rasa sevana -Alpa Ahara sevana – consuming diet in less quantity -Guru snigdha madhura Ahara sevana Vijjala – the substance having klinna and picchila gunas. Utkledi – the substance capable of increasing kleda in the body.
Viharaja Nidana -Bhojyanam vimargagamana - when food is consumed hastily followed by fast and
forceful deglutition it enters in wrong passage thereby causing vimargamana of bhojana - Dhoomopaghata - the smoke which causes irritation on entering nose and mouth is
called dhoomopaghata. -Raja sevana - the dust which enters mouth and nose is called raja -Sharma – work which causes physical exertion -Vegavarodha – suppression of natural urges -Ratri jagarana – awakening during night -Atisamsarga of surya and agni – excessive consumption of sunbath and external fire -Divaswapna – sleeping during day time -Ati chestana – excessive physical exercise -Vega udeerana - The onset of kaphaja kasa depends on the causative factors, which afflicts the Doshas
as well as the sthana where it produces the khavaigunyata. Depending on this the etiology is further classified under
Khavaigunya utpadaka karana – khavaigunya means deformity in srotas. The deformity may be structural or functional.
There are two main reasons for the vitiation of pranavaha srotas 1) Diet and behaviour having similar qualities to that of Dosha aggravate them. The
aggravated Doshas come in contact with dhatus and cause their vitiation. The site of such vitiated Dhatu is called as khavaigunya.
2) Diet and behaviour having opposite qualities to those of dhatus also produce defect in srotas24.
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Conceptual Study
The etiological factors like smoke, dust, atmospheric pollution etc. fall in the second category of causes, as they have antagonistic properties to that of normal rasa Dhatu. Thus causing deformity in pranavaha srotas. Further kapha is dearranged functionally, because the main seat of kapha is uras.
Kapha prakopaka Nidana: Excessive consumption of guru, snigdha, sheeta, picchila, utkledi, madhura, amla,
Lavana food stuffs and diwaswapna etc. produces the kapha Dosha Vata prakopaka Nidana: Vegavarodha, hasya, prahasya, vegaudirana, rarti jagarana, Dhatu kshaya karaka nidan,
excessive consumption of kashaya, katu rasa are the vata prakopaka nidanas. Kaphaja kasa Vishesha Nidana – the aetiological factors like guru, abhishyandi,
madhura, snigdha Ahara sevana, ratri jagarana, diwaswapna, picchila, dadhi, himashana, madanaphala taila, ALPA kanda and madyapana are the kaphaja kasa Vishesha Nidana25.
TABLE NO. 1 SHOWING THE SAMANYA NIDANA OF KASA26,27,28,29,30,31,32,33
NIDANA SU AS BP MN YR GN HS BS Dhumopaghatha + - + + + + - - Raja Sevana + - + + + + + + Shrama + - + + + + + + Bhojanasya Vimargagam+ - + + + + - - Vegavarodha + + + + + + - - Hasya, Prahasya - - - - - - + - Anila sanirodha - - - - - - + - Vega udirana - + - - - - - - Ratri jagarana - + - - - - - - Diva Swapna - + - - - - - - Dhatukshaya karaka nida- + - - - - - + Avarana - - - - - - - + Pralambana - - - - - - - + Rukshanna nishevana + + + + + + - - Atiushna guru ahara seva- + - - - - + - Ati kashaya, vijjala Asatmya, katu, amla, lavana, sita, snigdha, Utkledi ahara Sevana
- + - - - - + -
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Conceptual Study
SAMPRAPTI The etiological factors like khavaigunya utpadaka karana, nidanarthkar roga and
kaphaprakopaka nidan induces some pathological changes in pranavaha srotas. The couse of the samprapti is unique in accordance with the etiology34. The ultimate presentation is that of kasa roga irrespective of the different course of pathogenesis.Most of the time multiple causative factors are having an active role in the manifestation of kaphaja kasa. dust, pollens, smoke and similar other factors directly harm the pranavaha srotas. The result is also known as khavaigunyata of pranavaha srotas.
The etiological factors, provocating the kapha Dosha tends to cause accumulation of kapha Dosha in the amashaya35. This is the stage of sanchaya avastha. During this particular stage due to the influence of morbid kapha , the patient may suffer from symptoms like the sensation of heaviness and laziness in ura, kanta, shira, jihwa, ghrana, in rasa Dhatu and all over the body36.
Further progression of morbidity of kapha Dosha leads to its prakopavastha. In this stage, the excited kapha in the amashaya prevents the action of pitta, which is responsible for digestion. Due to this hypo functioning of Agni, the food which is not properly digested yields immature or improperly formed rasa in amashaya, which is called as ama.
At this state if the person further consumes kaphaprakopaka nidan, then the excited kapha along with amarasa circulates all over the body. This is called as prasaravastha. In the mean time agnimandya also leads to abnormal rasa Dhatu formation, resulting in rasa Dhatu vrudhi. In this stage rasa Dhatu dusti takes place due to amarasa. So the prakupita kapha and vitiated rasa Dhatu leads to pathological interaction between morbid Dosha and dushya at the site of khavaigunya.
It has already been mentioned that in pranavaha srotas khavaigunya is present in the form of injury. Evidently sthana samshraya of the morbid Dosha happens at this specific site of khavaigunya. In this particular stage of illness the patients exhibits poorvaroopas
In the absence of proper treatment at this stage of illness leads to the progression of disease to the next stage i.e. roopa. At the site of pathological interaction between morbid Dosha and dushya, there occurs the generation of kapha Dosha in its mala form. The accumulation of this mala kapha tends to obstruct the passage of prana vayu in the pranavaha srotas. This is the exclusive samprapti of kaphaja kasa37.
The further evolution of the illness is similar to any other type of kasa roga. To be more clear. The prana vayu is obstructed by kapha so it reverses and turns upward with udana vata. This prana vayu travels upto the shiras and on the way troubles the kanta and uras and then fills in the empty spaces of Shiras, further aggravation in vayu makes it to travel all over the body thus resulting in the uninterrupted pain and contraction of the body, specially hanu, manya, netra, ura and parshwa. In these organs there is a process of contraction to expel the excessive Dosha out of the body, which results in development of bouts of kasa38.
In another version it is stated that The obstruction to the anilagati causes involuntary reflex and is designated to remove the excessive secreted kapha in pranavaha srotas. Thus contraction of respiratory muscles throws this anila upwards which comes out of mouth along with sputum producing specific sound39.
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Conceptual Study
SAMPRAPTI GHATAKAS: Dosha - Kapha, vata Dushya - rasa Agni - Jataragni mandya Ama - Jataragni mandhyajanya Udbhavastana - Amashaya Sancharastana - Rasayani Adhistana - Uras Srotas - Pranavaha, rasavaha Dustiprakara - Sanga Vyadhi marga - Abhyantara FIGURE NO 1 SHOWING THE SAMPRAPTI OF KAPHAJA KASA Khavaigunya Nidanarthakara Kapha prakopaka Utpadaka Nidana Roga nidana Kapha Vridhi Agnimandya Amarasa Khavaigunya Prakupita kapha Dusta rasadhatu Malarupi kapha vridhi Sanga Vata avarodha Vata prakopaka Vata vimarga gamana karana Kaphaja kasa
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Conceptual Study
POORVAROOPA
As a result of adopting non-recommended diet and habits in excess, the Doshas gets increased and accumulated to other tissues and get them vitiated. The way of this occurrence is technically designated as sthanasamshraya. Initial to final setup of the disease some signs and symptoms may appear which is called as poorvaroopa. The prodromal symptoms like galatalu lepa is due to picchila guna vrudhi of kapha. Anorexia is due to manda guna vrudhi of kapha, discomfort in chest is due to the sthanasamshraya of Dosha in the chest. Shuka purna galasyata – feeling of presence of thorn in throat and mouth Bhojyanam avarodha – obstruction to morsel of food in throat. Or difficulty on
swallowing the morsel of food. Swashabda vaishamya – meager change in the quality of sound.
TABLE NO 2 SHOWING THE POORVAROOPA OF KASA40,41,42,43,44,45,46
POORVAROOPA CS SU AS AH MN BP GN Shukapurna gala + - + + + + + Shukapurna asya + - - - + + + Kanta Kandu + + + + + + + Bhojyanam avarodha + + - - + + + Galatalu lepa - + - - + - - Arochaka - + + + + - - Agnisada - + - - + - - Hridaya aswasta - - + - - - - Asya vairasya - - + - - - - Swashabda vaishamya - + - - - - -
Kasa bhedas (types)
The classification of kasa according to different factors
According to nature of kasa---------------productive cough / non-productive cough47
According to sadyasadyata --------------- sadya / asadya48 According to Dosha bheda---------------vataja / piitaja / kaphaja / sannipataja / Vatapittaja / Shleshmapittaja / Raktaja(kshataja) / Kshayaja49,50,51,52
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Conceptual Study
ROOPA Kapha Dosha, vata Dosha, rasa Dhatu and pranavaha srotas are the predominant factors
involved in pathogenesis of kasa and for apparent reasons; these factors determine the course and clinical manifestation of the disease.
Bahula snigdha Sandra Ghana swetha madhura stivanayukta kasa. The pratyatma lakshan of kaphaja kasa is bahula, sweta, and snigdha stivana yukta
kasa53. It is not necessary that all the characters should be present in stivana,as it may change in different conditions of the disease.
The word bahula indicates excessive or copious, it shows dravyatmaka vruddhi of kapha. Sputum have qualities like unctuous (snigdha), vicid (sandra), solid (Ghana) and sweetish (madhura)54. Shwetatwa and acchata refers to the whitishness and transparency of kapha. Sandra refers to viscidity or density of kapha, which gives pinda rupa to the sputum. This quality along with the gurutva and sthiratva are conferred by the gel state of kapha. The word Ghana refers to thick, solid or plug sputum.
Urashula55,56: In kaphaja kasa pain persists during coughing (kasamano hi ruk vaksha) and the
intensity of pain is mild (uro alpa rujathwam). Urashula is one of the symptoms of pranavaha sroto dusti. In general vata is said to be the root cause of shula. It shows karmatah vruddhi of vata. The ruksha and sheeta gunas are responsible for shula.
Peenasa57,58: The diseases related to the pranavaha srotas since deranges the system also causes
pratishyaya. According to commentator dalhana peenasa is prana vayu prakopa janita vyadhi. In kaphaja kasa, due to the prana vaha sroto dusti patients suffer from peenasa.
Kanta kandu59
It indicates karmatah vruddhi of kapha. The kleda and sheetatva produced by kapha leads to this symptom.
Swara bheda60
It means hoarseness of voice. In kaphaja kasa udanavayu prakopa is the reason for swara bheda.
Madhurasyata61
Kapha is having madhura rasa due to kapha vruddhi patient feels sweetishness. Mukha lepa62
It is due to picchila guna vruddhi of kapha. It is also one of the signs of indigestion. Utklesha and chardi63
The vitiated kapha causes dislike for food, nausea and vomiting. This phenomenon also occurs at the cellular level where by the desire for intake of nutrient substances is lost, on the contrary the body tries to expul kapha Pradhana substances.
Aruchi64
It indicates the karmatah vruddhi of kapha. It is the lack of desire for food Mandagni65
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Conceptual Study
This is a state in which the action of jatharagni is considerably inhibited due to the dominant influence of kapha, resulting in the production of ama. This ama rasa and kapha destroys the appetite completely because of snigdha, picchila and manda gunas.
Gourava66,67
Means a sensation of heaviness. Guru, snigdha and pichila guna produce sluggishness in the movement and the functioning of the body, mind and intellect.
Shirashula68
Shirashula is one of the main symptoms in vataja kasa, but in kaphaja kasa it is developed since the vitiated kapha obstructs, the normal flow of prana vata, the main seat of which is shira.
TABLE NO 3 SHOWING THE ROOPA OF KAPHAJA KASA69,70
ROOPA CS SU AS AH MN BP HS BS GN 1. Nature of stivana -Bahula, madhura, snigd ghana
+ - - - - - - - -
- Sandra - + - - + + - - + - Bahula, ghana, snigdhaswetha
- - + + - - - - -
- Ghana Bahula - - - - - - + - - - Grathita - - - - - - - + - 2. Kasamano hi ruk vaks + - - - - - - - - 3. Uro alpa rujatwa - - + - - - - - - 4. Hridaya stimitha - - + - - - - - - 5. Vaksha kaphena sampurnamiva manyate
+ - - - - - - - -
6. Kanta kandu - - - - - - - - + 7. Swara bheda - - - - - - + - - 8. Pinasa + - + - - - - + - 9. Utklesha + - - - - - - - - 10. Chardi + - + - - - - - - 11. Aruchi + + + - + - + - + 12. Asya madhurya + - - - - - - + - 13. Shira shoola - + - - + - - + + 14. Mandagni + - - - - - - - - 15. Gourava + + + - + - - + + 16. Jadyatha - - - - - - + - - 17. Angasada - + - - - - - - - 18. Romaharsha + - + - - - - - - 19. Mukhalepa - + - - - - - - - 20. Kledatha - - + - - - - - -
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Conceptual Study
UPASHAYA - ANUPASHAYA Vata vitiation, kapha vitiation and pranavaha sroto dusti are the main factors that
establishes the kaphaja kasa. Adding to the injury is the anupashaya which refers to the factors that worsens the pathological process.
So the causative factors which leads to irritation of bronchial tree, like that of dust, smoke, pollens, cold breeze, fog, polluting gases, etc. leads to aggravation of the illness. The kapha producing products like food stuffs having guru, sheeta, snigdha, abhishyandi, qualities as well as the behaviours inducing vata and kapha prakopa like that of divaswapna, ratri jagarana, etc. prolongs the kasa.
On the contrary, the factor that counteract the pathogenesis of kasa, or else the factors having opposite qualities to kapha, like that of katu rasa, ruksha, ushna, and quality products. Vata shamaka behaviour. Living in an environment which is free of dust and pollution, are considered as upashaya71,72.
UPADRAVA It is explained that if kasa is neglected then Shwasa, kshaya, chardhi, swarasada,
pinasa, yakshma like disorders will develop73. So it should be treated as early as possible. kshaya, swarabheda and vamana are also considered as the upadravas of kasa74. if kaphaja kasa is associated with pitta Dosha, then tamakaswasa would occur75. Rajyakshma has been mentioned as the upadrava of kasa roga76.
Kasa has been described as upadrava in the following diseases: raktapitta, pratishyaya, pandu, trushna, and jwara.
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Conceptual Study
SADHYA – ASADHYATHA77
The knowledge of prognosis establishes the awareness about the curability. It also helps in deciding the line of treatment with selection of medicaments. The dose with frequency also awaits prognosis. The definite knowledge of curability however upholds the dignity of the treating physician. Such knowledge saves the patient from unnecessary drug abuse, which is considered to be a financial hazard for kin and Keith of the suffering individual.
Vataja, pittaja, and kaphaja kasa are curable. The kshataja and kshayaja are yapya. An emaciated person with kshataja kasa is considered to be incurable and the result terminates to fatal. But in strong persons it may be curable or yapya. Similarly in weak person kshayaja kasa is incurable but whose is protected it becomes yapya. In early stages both kshayaja and kshataja kasa can be cured if Chikitsa chatushpada are efficient78.
It is also mentioned that in old age jara kasa is yapya due to jaravastha janya Dhatu kshaya. Kshajaya kasa when presents with all its symptoms it is non curable.
One more opinion is that kasa with single Dosha involvement is curable, two Dosha involvement are yapya and also jara kasa is yapya.
ARISTA LAKSHANA
The signs indicating immune and death in patients suffering from kasa are as follows: 1. When kasa patient spits large quantity of kapha, having the colour of blue, yellow or
red, suggests the definite sign of death79. 2. If kasa patient is mamsakshina, balakshina and if he develops romaharsha, shotha, sandramutrata and jwara is asadhya for treatment and ends in death80.
3. In a kasarogi, where extreme dhatukshaya and balakshaya are seen, and if this patient gets temperature during noon hours and along with this, if dreadful cough is present then it is an arista lakshan81.
4. A persistent vomiting in a kasarogi is a definite sign of death82. 5. If kasarogi develops atisara, jwara, hikka, chardhi and shotha in medra and vrushana, then patient is sure to die83.
6. A person suffering from kasa, when exhibits associated diseases like jwara, vamana, trishna, atisara and shopha, then it is definite sign of death84.
7. When a kasarogi exhibits the prodormal symptoms like kosta shula, hikka and chardhi then the death is sure85.
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Conceptual Study
SAPEKSHA NIDANA86: Diagnosis is successfully made by thoroughly observing the patients to explore the clinical manifestation and analyzing the symptoms to determine the vitiation of Dosha, involvement of dhatus, affliction of srotas as well as other events of samprapti. Kasa associated with kapha stivana is the presenting symptom of kaphaja kasa, which is also seen linked with other disorders like kasa varieties has the symptom of cough, tamaka shwasa and rajyakshma also resembles some of the symptoms to kaphaja kasa. So it becomes necessary to differentiate kaphaja kasa from the above said disorders. Vataja kasa – the cardinal feature of vataja kasa is dry cough. But in some condition patient expectorates small quantity of sputum with difficulty. Along with this URA shula, parshva shula, mukha sushkata, are present. These symptoms are absent in kaphaja kasa. So it can be ruled out. Pittaja kasa – the cardinal feature of pittaja kasa is pitta kapha steevana yukta kasa. Jwara is another important lakshana. Along with these pitta vriddhi lakshanas like trishna, daha, urodhumayana are present. In kaphaja kasa these symptoms are absent. So it can be ruled out. Kshataja kasa – the cardinal feature of kshataja kasa is shonitayukta kaphasteevana. There may be a history of strenuous exercise. Urashoola is the another important symptom. The nature of pain is pricking type, tenderness in the uras, jwara, shwasa, and paravatha eva kujana are associated symptoms. As these symptoms are absent in kaphaja kasa, so it is differentiated Kshayaja kasa – the cardinal features of kshayaja kasa is durgandha, hareeta, rakta, and puyayukta kaphasteevana. The patient is ksheena and is associated with jwara, urashoola, irregular bowel habits. So the absence of these symptoms in kaphaja kasa rules out the disease. Rajayakshma87 – the nature of steevana in rajyakshma is picchila, bahula, and colour is hareeta, sweta, or peeta. The Samanya lakshanas of rajyakshma are amsaa parshwabhitapa, karapada santapa and jwara, which are not present in kaphaja kasa, so it is ruled out. Tamaka shwasa88 – the cardinal feature of tamaka shwasa, which is breathlessness is absent in kaphaja kasa. Also tamaka shwasa is a vata Pradhana kaphanubandhi vyadhi whereas kaphaja kasa is a kapha Pradhana vatanubandhi vyadhi. The diagnostic features of tamaka shwasa like aggravation of symptoms on lying down and feeling comfortable on sitting is not seen in kaphaja kasa. Also cough with expectoration is primarily and predominantly seen in kaphaja kasa, which is not found in tamaka shwasa.
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Conceptual Study
CHIKITSA Human body at times goes through troublesome episodes, like that of exposure to
pollutants, dust, smoke, etc. none following diet and behavioural restrictions leads to vitiation of the Doshas. These factors ultimately leads to disease.
Kasa is a disease in which khavaigunya occurs in the prana vaha srotas, due to prolonged stress on the respiratory system from the irritants in atmosphere. Hence treatment aimed should have the first preference for removing the cause i.e. avoiding those factors which aggravate kaphaja kasa. This is best done by identifying the causative factors with a detailed history taking, inquiring about the occupation, habits, living environment, etc. once confirmed the patient should be convinced about the source for him getting the suffering. Adequate measures for avoiding these causative factors, through protection and prevention should be dispatched.
In a fully developed kaphaja kasa shodhana89 is the prime line of treatment as Dosha is generally in large quantity, reliable to emit through the shodhana procedures. Vamana gets the first preference90, as it is the best aimed shodhana for the kapha Dosha. Before going for vamana the bala of the patient is assessed91 and if he is fit for the procedure, then by performing the Poorvakarma like snehana and Swedana, vamana is to be administered. By this the vitiated kapha Dosha gets eliminated from the uras, there by breaking the samprapti and letting the prana vayu do its normal functions.
After vamana, virechana should be given92. In kaphaja kasa this procedure is very much beneficial for bringing the normalcy in vayu gathi. In kasa the prana vayu has gone upwards by achieving udana gati, so virechana which does vatanulomana brings back the prana vayu through the adhogamana. Virechana also eliminates pitta and kapha Dosha.
Shirovirechana or nasya is administered after virechana93. As in kasa the pranavayu which moves upwards into the shiras also carries the kapha Dosha with it and nasya acts directly in the head.. So nasya helps in expelling kapha and rectifying the vayu thereby giving relief from kasa as well as local symptoms like shirashula, peenasa, etc.
Next in sequence of shodhana is Dhoomapana94. There are various varieties of dhoomrapana, but the one indicated in kaphaja kasa is the Vairechanika Dhoomapana. It helps in eliminating the kapha Dosha from the pranavaha srotas by liquefying kapha, and then inducing the bronchospasm, thereby the cough reflex expulses the sputum in large amounts. By this method the srotas gets cleared from the aggravated Doshas and samprapti bhanga occurs.
Dhoomapana is the remedy which delivers the drugs directly at the site of pathology so that this target specific therapy brings up instant relief to the patients in distress. Although classics have mentioned dhoomapana in a sequence of shodhana after vamana etc. but they have given the freedom to opt for any procedure directly as per patients tolerance. Here dhoomapana can be given before other shodhana procedures, if the patient is unsuitable for them. Dhoomapana needs less physical efforts and the procedure is short which can be repeated depending upon the requirement. Thus it achieves shodhana of kapha Dosha from the uras.
After dhoomapana kavalagraha95 is aimed to remove the Dosha from the mouth and surroundings. Kaphaja kasa has the symptoms like kanta kandu, swara bheda, Aruchi, asya
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Conceptual Study
madhurata, mukhalepa, etc. these symptoms ascertains the localization of Dosha. Kavalagraha ultimately helps in relieving these symptoms.
Once shodhana is achieved the treatment is further planned for shoshana of kapha96. Here the shamana aushadis having katu rasa, ushna, laghu and ruksha gunas and which are kaphahara97 in nature is administered for example Trikatu. Also visha Dravyas like vatsanabha and Kshara like tankana, all doing kapha shoshana can be given.
In case of association of ama, langhana is followed to digest the ama and bring back normal digestion. Deepana aushadhi are given for treating agnimandya98.
After shodhana and shamana, rasayana99 is implemented as we saw earlier that prolonged exposures to irritants leading to khavaigunya has reduced the immunity of pranavaha srotas. To raise this immunity and make the srotas tolerable to the asatmya bhavas, rasayana is aimed in which the drugs specially acting on pranavaha srotas as pippalli are given in various forms like lehas.
In a nut shell in patients of kaphaja kasa, shodhana by vamana, virechana, nasya, dhoomapana and Kavala dharana. Followed by shamana to nullify kapha Dosha. Curing associated ailments and advising Nidana parivarjana followed by rasayana to avoid reoccurrence forms the complete treatment.
PATHYA AND APATHYA100,101
The unique samprapti of kaphaja kasa tells that kapha Dosha and vata Dosha have
the opposite characters which are difficult to manage and along with this the srotodusti and Dhatu involvement adds salt on the wound. This presentation claims that only treatment is not enough but with that following of certain diet and behavioral regiment is a must for complete and fast cure of this disease.
PATHYA AHARA Suka dhanya varga: Shastica shali (Oryza sativa grown in 60 days) Yava (Hordeum vulgara) Laja (Puffed rice) Godhuma (Trictum vulgarae) Shami dhanya varga: Mudga (Phoseolus trilobus)
Kulatha (Dolichos biflorae) Masha (Phaseolus mungo)
Mamsa rasa varga: Gramya mamsa (meat of tame animals) Jangala mamsa (Meat of wild animals) Bileshaya mamsa (meat of subterranean cave animals or burrowing animals)
Gorasa varga: Kshira (milk) Gritha (Ghee)
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Conceptual Study
Takra (Butter milk) Jalavarga : Ushnajala (Hot water) Phalavarga: Bimbi (Coccinia Indica)
Bijapura (Citrus medica) Madhuvarga: Madhu (Honey) Ikshu varga: Dishes prepared out of sugar Taila varga: Tila taila (sesaman oil)
Sarshapa taila (mustard oil) Bilva taila (taila extracted from aegle marmilos)
Harita varga: Jivanthi (Lepta denia reticulata) Gostani (vitis vinefera) Maricha (Piper nigrum) Pippali (piper longum) Shunti (Zingiber officinale) Mulaka (Raphanu sativus)
Balamula (root of cida cordifol Kasamardha (Cassia occidentalis)
Yusha (soup) prepared with pippali and kshara (alkali) Yusha (soup) prepared with kulatha & mulaka Laghvanna (light diet) Vihara: Sound sleep during night, Warm weather, Pollutant free environment APATHYA Ahara: Rasa: Madhura rasa (sweet) Guna: Snigdha (unctious) guru (Heavy) Picchila (slimy) Anna: Pistanna (Dishes prepared out of flour of cereals)
Payasa (food prepared with milk) Jala varga: Dusta Jala, Sheeta Jala Mamsa varga: Matsya(Fish)
Vihara: Maithuna (sexual intercourse) Dhumasevana (Smoking) Dusta Pavana Rajo Marga Nishevana (Walking on polluted roads) Vegavarodha (suppressing on natural urges)
21
Dhoomapana
DHOOMAPANA
Smoking for the therapeutic purposes using a specially designed instrument or pipe is
known by the name Dhoomapana. Using a special instrument the herbal powders are burnt and
the smoke emitted is inhaled. After going through the Nidana Panchakas, it is very interesting
to note that dhooma itself is a cause for the disease kaphaja kasa, and Dhoomapana has been
told as an effective remedy in curing this ailment. It may seem contradictory if we don’t refer
the details of Dhoomapana.
Here are the different aspects of Dhoomapana, with regards to its types, indications,
contraindications, methodology of administration and benefits.
Types of Dhoomapana:
Dhoomapana has been classified as prayogika, vairechanika and snaihika on the basis
of the action, whereas vagbhata who has a similar classification as madhya, teekshna and
snigdha, is based on the basis of Guna of drugs used for Dhoomapana.
Sushruta samhita and Chakradutta have given a similar classification of five types of
Dhoomapana which are based on the action and prabhava of the drugs used. Astanga Sangraha
and Sharangadhara has classified Dhoomapana into six varieties, amongst that all resemble to
the description given in Sushruta with a slight difference in nomenclature. Vranadhoopana is
the additional variety told by Astangasangraha and Sharangadhara, which Sushruta has not
included in Dhoomapana as it does not fit into the definition of Dhoomapana wherein
inhalation and exhalation into the lungs is a must.
Table No 4 showing classification of Dhoomapana according to different classics.
C. S. Su. S. A. H. C. D. A. S. Sh. S.
Prayogika Prayogika Madhyam Prayogika Shaman Shaman
Vairechanika Vairechanika Teekshana Snaihika Shodhana Rechana
Snaihika Snaihika Mrudu Vairechanika Brumhana Brumhana
- Vamaneeya - Kasahara Vamaneeya Vamaneeya
- Kasagna - Vamaniya Kasagna Kasagna
- - - - Vrinadhoopa Vrinadhoopa
34
Dhoomapana
Amongst these some impart the same meaning, for example madhyama and
shamana gives the same meaning of prayogika; teekshna, shodhana and rechana to that of
vairechanika and snigdha, mrudu and brumhana to that of snaihika, hence can be taken as
synonyms.
Prayogika Dhoomapana: prayogika dhoomapana is the one which is suitable for
habitual and daily use108. It has no side effects as it is very mild in nature. It should be
practiced up to two times in a day109 and the smoke is inhaled through the nose and mouth
alternatively110.
Few drugs that are used are –
1. harenuka(piper anrantiacum)
2. priyangu(allicarpa macrophylla)
3. pruthweeka(carrum carvi)
4. naga keshara(messua ferae)
5. nakha(caparis zeylanika)
Table No 5 showing the different time of administration of prayogika dhoomapana.
SL.NO. Kala C.S. Su. S. A.H. A.S.
1 Snatwa + + - -
2 Bhuktwa + + - +
3 Sammulika + - - -
4 Kshutwa + - - -
5 Danta dhawana + + - +
6 Navananthe + + + +
7 Anjananthe + - - -
8 Nidranthe + - - -
9 Kshavathu anthe + - - -
10 Vamitha anthe + - - -
11 Shashta akarmananthe - + - +
35
Dhoomapana
12 Nisha aharanthe - - + +
13 Moorchithanthe - - - +
14 Nisha - - - +
15 Shakruth visarjithanthe - - - +
16 Swedhithanthe - - - +
Vairechanica Dhoomapana:
Vairechanika dhoomapana can be administered in both swastha as well as athura for the
elimination of the obstructed kapha from the head and respiratory system111. It should be
practiced up to 3-4 times in a day112 or till Doshas come out from mouth and nose113. The drugs
used for the vairechanika dhoomapana should be teekshna and shirovirechaka. Some of them
are as follows:
1. swetha aparajitha(convolvulus pluriculis)
2. jyothismathi(celastrus panniculatus)
3. haritala(yellow arsenic)
4. manasheela(red arsenic)
Following table details the ideal time for the administration of Vairechanika
Dhumapana.
Table No 6 Showing the different time of administration for Vairechanika Dhumapana.
Sl.No. Kala Su.S. A.H A.S
1 After Chardana + + +
2 After Diwaswapna + - -
3 After Nidra - + +
4 After Nasya - + +
5 After Anjana - + +
6 After Snana + + +
36
Dhoomapana
Snaihika Dhoomapana:
Snahika dhoomapana is practiced by ruksha person or in the diseases of vata pertaining
to head and chest114. It should be practiced once in a day, till the dryness disappears and till the
person gets mardavata115 or till the eyes have watery secretions116.
Some of the drugs mentioned for snaihika dhoomapana are as follow:
1. vasa(animal fat)
2. ghruta(ghee)
3. madhucchista(bee wax)
4. guggulu(commiphora mukul)
5. tila(sesamum indicum)
Table No 7 showing the different time of administration for snaihika dhoomapana
SL.NO. Kala Su.S. A.H. A.S.
1 Mootranthe + + +
2 Kshavathu anthe + - -
3 Hasithanthe + + -
4 Rukshitanthe + - +
5 Maithunanthe + + +
6 Kshutwanthe - + +
7 Jrumbhitanthe - + +
8 Vit visarjitanthe - + +
9 Shastra karmanthe - + +
10 Dantha dhawananthe - + +
11 Shira sekanthe - + -
12 Tarpananthe - + -
13 putapakanthe - + -
37
Dhoomapana
Vamaniya Dhoomapana:
Dhoomapana when administered to induce vomiting is called as vamaniya
Dhoomapana117.
Some of the drugs used for this purpose are as follow:
1. snayu(muscle of animal especially cow)
2. charma(skin of animal especially cow)
3. go khara(cow’s heel)
4. go shrunga(cow’s horn)
5. madana phala(raundia spinosa)
6. sushka matsya(dried fish)
Kasaghna Dhoomapana:
Dhoomapana when administered to subside the Kasa(cough) is referred as Kasaghna
Dhoomapana118. Some of the drugs used in kasaghna dhoomapana are as follows:
1. Brahati (Solanum indicum)
2. kantakari (Solanum surattense)
3. Pippali (Piper longum)
4. Marica (Piper nigrum)
5. Kasamarda (Cassia occidentalis)
After going through all the classification mentioned in different classics, it can be stated that
the classification of dhoomapana is made on the basis of :
1. karmukata of dhoomapana such as kasaghna, vamaneeya, brumhana, etc.
2. the gunas of the drugs used for dhoomapana such as mrudu, teekshna, etc.
Indications and Contraindications of Dhoomapana.
The indications as well as contraindications of Dhumapana are listed in following table
38
Dhoomapana
Table No 8 Showing the indications of Dhumapana mentioned by different authors.
No. Indications C. S. Su. S. A. H. A. S.
1 Shirogourava + + - +
2 Shirashoola + + - +
3 Peenasa + + + +
4 Ardhavabhedhaka + - + +
5 Karna shoola + + - +
6 Kasa + + + +
7 Svasa + + + +
8 Hikka + - - +
9 Galagraha + + - +
10 Dantha dourbalya + + - +
11 Mukhagraha + + + +
12 Nasasrava + - + -
13 Akshi srava + - - -
14 Poothi grhana + - - +
15 Asya dourgandhya + - + +
16 Danta shoola + - - +
17 Arochaka + + - +
18 Hanugraha + + - +
19 Manyagraha + + - +
20 Mukha panduta + + - +
21 Mukha krimi + - - +
22 Galashundika + - - -
23 Upajihwika + - - -
24 Khalithya + - + +
25 Palithya + - + +
26 Kesha patana + + - +
27 Kshavathu + + - +
39
Dhoomapana
28 Atitandra + + + +
29 Buddhimoha + - - -
30 Atinidra + + - +
31 Vaman - + - -
32 Abhishyanda - - - +
33 Pakshaghata - - - +
34 Swara bheda + + + +
35 Karna srava - - + -
36 Karna kandu - - + -
37 Akshi shoola + + - +
38 Mukhe kandu + - - -
39 Sleshma praseka + - - -
40 Asyopalepa - + - -
41 Praseka - - - +
42 Asya vairasya - - - +
43 Twak dosa - - - +
TableNo9 Showing the Contraindications of Dhumapana mentioned by Different authors,
No Contraindications C. S. Su. S. A. H. A. S.
1 Virikta + + + +
2 Krate basti karmani + + + +
3 Vishartha + + + +
4 Raktadosha + + + +
5 Shokatapta + + - -
6 Garbhini + + - -
7 Shramartha + + - -
8 Mada + + - -
40
Dhoomapana
9 Amaja Vikara + - - -
10 Pittaja Vikara + - - -
11 Prajagara + - + +
12 Madya sevitha + + + +
13 Dugdha sevitha + + + +
14 Rooksha + + - -
15 Krudda + - - -
16 Talu shosha + + - -
17 Timira + + + +
18 Shiro abhighata + + + +
19 Shankakha + - - -
20 Agni rohini + - + -
21 Prameha/ Meha + + + +
22 Madatyaya + - - +
23 Bhaya - + - -
24 Raktapitta - + + +
25 Moorcha - + - -
26 Daha - + - -
27 Pipasa - + - -
28 Pandu - + + +
29 Chardhi - + - -
30 Udgara - + - -
31 Apatharpitha - + - -
32 Udara - - + +
33 Adhmana - + + +
34 Urdhwa vata - + + +
35 Bala - + + +
36 Durbala - + - -
37 Ksheena - + - -
38 Urakshatha + + - -
41
Dhoomapana
39 Madhupeetha - + + +
40 Yavagupeeta - + - +
41 Dadhipeeta - + + +
42 Mathsya khadita - + + +
43 Vrudda - + - -
44 Sneha peeta - - + -
By going through the indications we can infer that most of the diseases are pertaining to
urdhwa jathru, the uras and the disease originated by vata and kapha dosha. By observing the
contraindications we can infer that dhoomapana is contraindicated in persons having less
physical strength, emaciated by disease, pregnancy, bala or vruddha and in pittaja vikara.
Method of preparation of dhooma varti.
The suitable drugs which are intended for the preparation of dhooma should be
grinded with water so as to become a paste. As per the classical preparation mentioned the
dhooma varti(herbal stick) should be of the length 8 angulas, & should fit to the broad end of
the dhooma netra. For this a darbha stick(shalaka) of the length of 12 angulas and the thickness
of yava or kalaya is taken, care should be taken that it does not have any nodes within its
length, & should be of uniform breadth. Soak this stick in water for 24 hours. Then take a pure
silk cloth of the same length & wrap around the stick. Apply the paste prepared out of the
medicinal choorna leaving 2-2 angulas on either side(i.e. 8ang) and it is allowed to dry in
shade. This process should be repeated till the thickness comes to be of the size of a thumb. On
drying remove the shalaka & cloth. The varti is ready to use
Dhooma netra:
The special pipe made up of any metal (gold, silver, copper and bronze) or wood used
for smoking is called by the name Dhooma netra119. The pipe has two ends, the mouth end and
the free end. Free end is for fixing the herbal stick(dhooma varti) and through the mouth end
the smoke emitted by burning the herbal stick is sucked in and then inhaled. The hollow within
the pipe is not uniform rather tapering and is narrow at the mouth end and wide at the free end.
42
Dhoomapana
The width of the opening at the mouth end is approximately 5 mm(kolasthi) and is
15mm(angustha) at the free end. This pipe is also intercepted at uniform distance with three
circular hollow chambers. While sucking the smoke during the therapy, these chambers
generate turbulence in air flow and there by reducing the speed of smoke reaching the mouth.
Thus it reduces the possibility of discomfort and risk of evoking cough reflex during the
therapy. Three different lengths of such pipe are used for different therapeutic utility. The
length of the pipe for Prayogika Dhoomapana should be 48 Angula according to sushruta, 36
angula according to charaka, and 40 angula according to vagbhata; for snaihika Dhoomapana it
should be 32 Angula long. For Vairechanika Dhoomapana the Dhumanetra of the length 24
Angula is used. And for the Kasaghna as well as Vamaniya Dhoomapana the length, of the
Dhumanetra should be 16 Angula.
For the Dhoomapana the Dhumavarti is fitted to the free end of the pipe. The other end
of the varti is lighted. When the tip of the varti becomes red the flame is blown off. Now this
pipe is ready for Dhoomapana.
In the second type of instrument there are two cups(sharavas), one is kept and is filled
with powders of medicines which is lighted up with fire then the other is covered invertedly
over the previous one. It is connected by a pipe through which the smoke is inhaled.
Method of administration of Dhooma.
To begin with the patient is thoroughly examined to confirm the indications as well as
to rule out any of the contraindications. Then the patient is made to sit in a knee high chair with
his body erect and looking forwards. He should have full concentration on the therapy and
should not have any reason for distraction of mind like Kama, Krodha, Bhaya etc. The
Dhumayantra is prepared and its functioning is assessed. Then the patient is asked to inhale the
Dhooma through the mouthpiece of the instrument. And then the patient is allowed to exhale
the Dhooma only through the mouth120. If the patient has symptoms related to the nose and
head, the Dhooma may be inhaled through the nose and is once again exhaled through the
43
Dhoomapana
mouth. When the patient inhales three puffs of Dhooma it is counted as one bout of
Dhoomapana. Patient is allowed a small pause between each bout of smoking. In these way
three bouts of Dhoomapana is carried out in a single sitting. During the procedure if the sputum
comes out the patient is asked to spit it out.
Following Dhoomapana the patient is advised to take rest for several minutes and then
allowed to do his routines.
symptoms of Samyak Dhoomapana121:
following is the list of symptoms that indicate proper effect of the Dhoomapana.
Θ Hrtkantendriya samsuddhi: Clarity of the chest, throat and head,
Θ Laghutvam sirasah; Feeling of lightness in the head,
Θ Urasca laghuta: Feeling of lightness in the chest,
Θ Kanta laghuta: Feeling of lightness in the throat,
Θ Dosanam samah: Remission of symptoms produced due to morbid Dosa
Θ Kaphasca tanutam praptah: Liquefaction of the sputum,
Θ Roga prasamanah: Remission of the illness.
symptoms of Atiyoga122,123:
Θ Sira sosa paritapa: Dryness and Burning sensation in the head,
Θ Kantha sosa paritapa: Dryness and Burning sensation in the throat,
Θ Talu sosa paritapa: Dryness and Burning sensation in the palate,
Θ Trsyate: Thirst,
Θ Muhyate: Confusion,
Θ Raktasrava: Bleeding from the nose,
Θ Sirobhrama: Giddiness,
Θ Murccha: Transient loss of consciousness,
Θ Indriya upatapa: Disturbances of the sense organs.
44
Dhoomapana
Symptoms of Ayoga or Heenayoqa of Dhoomapana124,125:
Θ Avisuddha svara: Lack of clarity of the voice,
Θ Sakapha kantha: Provocation of the Kapha Dosa in the throat,
Θ Stimita mastaka: Stiffness in the head,
Θ Roga aprasamana: No remission of the symptoms of the illness,
Upadrava of Dhoomapana126 :
Θ Badhirya - Deafness,
Θ Andhya - Blindness,
Θ Mukatva - Inability to speak,
Θ Raktapitta - Bleeding disorder,
Θ Sirobhrama - Giddiness,
To sum up, the Dhoomapana is a unique procedure where in the drug is delivered in the
Pranavaha Srotas. Thus best spontaneous response to the treatment may be obtained in patients
suffering from Pranavaha Srotas disorder like kasa, etc. By virtue of the medicines used,
Dhoomapana brings about liquefaction of the sputum there by assisting easy expectoration.
Further facilitating the clarity of the Pranavaha Srota. As the Dhoomapana clears the Pranvaha
Srotas, the free movement of Pranavayu is possible remitting the illness Kasa.
45
Conceptual Study
MODERN REVIEW
CHRONIC BRONCHITIS102,103,104,105,106,107
Chronic bronchitis is a condition characterized primarily by excessive mucous secretion from
the respiratory tract and cough. Most of the times the term chronic bronchitis is used to
denote chronic or recurrent bronchial hyper secretion resulting in chronic expectoration,
when other demonstrable causes, either local or general have been excluded.
Definition
World health organization proposed the following definition for general use. Chronic
bronchitis is non-Neoplastic disorder of structures or function of the bronchi usually resulting
from prolonged or recurrent exposure to infectious or non infectious irritation.
For clinical and epidemiological purposes, chronic bronchitis is a condition associated with
excessive mucous expectoration on most days during at least 3 consecutive months for not
less than 2 consecutive years.
Epidemiology
Chronic bronchitis is a common disease. There has been increasing evidence in recent years
of a relatively high prevalence in developing countries. Prevalence rates for chronic
bronchitis range from 3.6% at ages 45 to 64 to 4.5% at ages over 65 years. As a cause of
mortality, chronic bronchitis ranks fifth and its frequency has been increasing steadily over
the past two and half decades and the mortality rate is higher in males than females. The
prevalence was 8% in men and 3% in women.
Cigarette smoking is the most important factor associated with the occurrence of mucous
hyper secretion and air flow obstructive diseases. Patients with chronic bronchitis are more
likely to have a family history of chest disease and this hereditary tendency being stronger in
female than in male patients. Mortality rate increase with increasing urbanization. The
22
Conceptual Study
highest mortality is in the winter. The incidence of chronic bronchitis is higher in poor socio-
economic classes.
AETIOLOGY
There is abundant evidence to incriminate several etiological factors as acting singly or in
concert to produce chronic bronchitis. The majority of Aetiology have been concerned with
four factors tobacco smoking, air pollution, infection and heredity. It is to be stressed that in
any individual case a combination of these factors may be responsible. These factors are
considered below in more detail.
Smoking
Tobacco smoking is the most consistently important determinate of chronic bronchitis.
Cigarette smokers have about 10 times the risk of non smokers of dying from chronic
bronchitis and death rate increases with increasing number of cigarette smoked. Chronic
bronchitis has been predominantly related to the inhalation of tobacco smoke & It is mainly
depend on tar content of cigarette, puff volume, depth of inhalation, and the frequency of
personal characteristics, such as allergy or atopy and bronchial hyperactivity.
Passive smoking
Passive/involuntary smoking has been recognized as a definite health hazard. The prevalence
of respiratory symptoms, particularly coughing and wheezing, tend to be higher(30% more)
and the level of ventilator lung function lower in the non smoking wives of smoking
husbands, with prevalence double if husband smokes 20+ cigarettes/day at home. Children of
smokers have greater chance of developing chronic bronchitis & other lung diseases.
Air Pollution
Air pollution may be domestic, urban or occupational. Domestic exposure to pollutants is
often overlooked but may be an important factor in causing disease in certain situations. For
example, the use of natural gas in home cooking is associated with an increasing in the
incidence of childhood respiratory illness and pulmonary dysfunction.
23
Conceptual Study
Dust exposure at work has been considered an important etiological factor of respiratory
disease. Types of dust was clearly important, with the high death rates among sandstone
workers, cotton strippers, tin and copper miners. Exposure to dust of vegetable origin appears
more likely to cause chronic bronchitis than exposure to most mineral dusts.
Infection
In some patients, particularly young ones who have never smoked, a clear cut history can be
elicited of the onset of chronic cough productive of mucoid or mucopurulent sputum, often
due to an episode of lower respiratory tract infection. Most of the times viral infection is
responsible for exacerbation of chronic bronchitis. The role of bacteria in acute exacerbation
is more likely, that of a secondary invader following acute viral infection. The frequency of
lower respiratory tract infection is much higher in a person who is recurrently suffering from
cold.
Hereditary
In recent studies it was found that, relatives of chronic bronchitis subjects have a higher
prevalence of bronchitis than do the relatives of controls. Concordance rates are higher in
first degree relatives than spouses, and monozygotic than dizygotic twins.But the underlying
defect that constitutes this genetic predisposing is unknown.
Exacerbation
Patients with chronic bronchitis often relate exacerbations of their disease to climatic factors,
particularly extreme variations in humidity and temperature. The excessive air dryness during
cold weather, aggravates bronchitic symptoms and the use of humidifier usually, results in a
decrease in cough and increases expectoration.
24
Conceptual Study
PATHOGENESIS:
The earliest feature of chronic bronchitis is hyper secretion of mucous in the large airways,
associated with hypertrophy of the submucosal glands in the trachea & bronchi. Proteases
released from neutrophils, such as neutrophil elastage & cathepsin, & matrix
metalloproteinases, stimulate this mucus hyper secretion. As chronic bronchitis persists, there
is also a marked increase in goblet cells of small airways – small bronchi & bronchioles.
Leading to excessive mucus production that contributes to airway obstruction. It is thought
that both the submucosal gland hypertrophy & the increase in goblet cells are a protective
metaplastic reaction against tobacco smoke or other pollutants. (e.g. -sulphur dioxide &
nitrogen dioxide)
Although mucus hyper secretion in large airways is the cause for sputum overproduction,
it is now thought that accompanying alterations in the small airways of the lung can result in
physiologically important & early manifestations of chronic airway obstruction.
Histological studies of the small airways in young smokers disclose-
1) Goblet cell metaplasia with mucus plugging of the lumen.
2) Clustering of pigmented alveolar macrophages,
3) Inflammatory infiltration &
4) Fibrosis of the bronchiolar wall
The role of infection appears to be secondary. It is not responsible for the initiation of
chronic bronchitis but is probably significant in maintaining it & may be critical in producing
acute exacerbations.
Cigarette smoke predisposes to infection in more than one way. It interferes with ciliary
action of the respiratory epithelium, it may cause direct damage to airway epithelium, & it
inhibits the ability of bronchial & alveolar leucocytes to clear bacteria. Viral infections can
also cause exacerbations of chronic bronchitis.
25
Conceptual Study
FIGURE NO 2 SHOWING THE PATHOPHYSIOLOGY OF
CHRONIC BRONCHITIS
Atmospheric pollution Smoking Recurrent R.T.I.
Irritation in Metaplasia of
Bronchial tree epithelium
Stimulation of Loss of ciliated
Secretion epithelium
Mucous gland hyperplasia
Retention of secretion
(chronic bronchitis)
Infection
Inflammation of mucosa
Broncho spasm
Spread of infection to distal bronchi
Collapse of small bronchi
Obstruction
26
Conceptual Study
STAGES OF CHRONIC BRONCHITIS
Simple chronic bronchitis
In this division, only minor changes in the structural and functional properties of the mucosa
takes place. Due to these changes there will be excessive mucous secretion which gets
thickened and tenacious. The WHO (1961) considered simple chronic bronchitis as chronic
or recurrent increase in the volume of mucoid bronchial secretion sufficient to cause
expectoration.
ii) Mucopurulent bronchitis
Chronic or recurrent mucopurulent bronchitis is defined as chronic bronchitis in which the
sputum is persistently or intermittently mucopurulent when this is not due to Localised
broncho pulmonary disease. It is suggested that in the definition of chronic mucopurulent
bronchitis the word "persistently" should be taken to imply that the sputum has been
mucopurulent for at least a part of every day for a period of at least one year. The word
"intermittently" should imply that the sputum has been mucopurulent for at least 2 periods,
each lasting not less than one week, during a period of 3 consecutive years.
iii) Chronic obstructive bronchitis
It is defined as chronic bronchitis in which there is persistent, widespread narrowing of the
intrapulmonary airways, at least on expiration, causing increased resistance to air flow.
Clinical features
Chronic bronchitis of any etiology is manifested by symptoms, the character of which
depends on – clinical form, degree of bronchial obstruction, phase of course, the presence and
the character of complications Cough is the most common symptom of the disease. The character
of cough and sputum suggests a version of the disease course.
The earliest stage of chronic bronchitis, that is the simple chronic bronchitis is discovered
by the production of non-purulent sputum, with no evidence of airway obstruction. The sputum
is thick, mucoid and tenacious. The cough develops usually in the morning, after exercise or in
27
Conceptual Study
connection with accelerated respiration. The amount of expectorated sputum can increase in
exacerbation of bronchitis. General symptoms like hyperhydrosis, weakness, elevated
temperature, fatigue, decreased work capacity, etc. symptoms can develop during exacerbation
of the disease. At first those exacerbations may be so mild that the patient does not stay off work
and the cough subsides to its usual level in a week. Later the person may be febrile during the
attacks and may develop wheeze and dyspnoea.
Patients with purulent and muco-purulent bronchitis usually complain of yellowish
sputum. For accurate diagnosis of mucopurulent bronchitis, inspection of the sputum is essential.
The cough in mucopurulent chronic bronchitis gradually becomes more continuous and
productive. It occurs during the day as well as in the morning and may keep him awake at night,
although spontaneous cough appears to be at least partly suppressed at night in these patients. At
a relatively early stage the patients cough is usually susceptible to cold and damp weather
leading to wheeze and dyspnoea. Between the attacks the sputum is usually mucoid.
Cough is productive but difficult to expectorate in obstructive bronchitis. It is attended by
dyspnoea. Development of exertional dyspnoea in patients, who complain of cough for a
long time, usually indicates bronchial obstruction.
Respiratory system examination findings in chronic bronchitis
In the early stage of chronic bronchitis most of the patients are not having any abnormal
signs. Auscultative findings can develop at later period: harsh respiration, elongation of the
expiratory phase during normal & especially forced expiration and dry diffuse rales, the tone
of the rales depend on the caliber of the affected bronchi. Whistling sounds, that are
especially pronounced during expiration, are characteristicof involvement of small bronchi.
Basic methods of diagnosing chronic bronchitis
The important symptoms of chronic bronchitis are cough and expectoration. They do not
always attract sufficient attention early in the course of the disease and it then progresses to a
damaging stage. The most accurate diagnosis is often made on the basis of a detailed history
rather than an examination of a patient.
28
Conceptual Study
The three basic methods of investigating chronic bronchitis are
Questionnaire,
lung function test – the commonly used instruments are spirometer & peak flow meter.
Measurement of sputum expectorated.
INVESTIGATIONS
During the initial stage of chronic bronchitis or in remission, the laboratory and
instrumental findings can be normal. But these findings can become very informative at certain
stages of chronic bronchitis. They are used to determine the activity of inflammation, to verify
the clinical form of the disease, to reveal complications, to differentiate the disease from the
other diseases with similar clinical symptoms.
Blood –
Routine blood examinations are within normal limits in initial stages. Activity of
inflammation is least of all charecterised by blood counts. In the acute phase, indices are
moderately increased and leucocyte counts are moderately high. Eosinophilia is possible
suggesting allergy.
Urine –
Routine urine examinations are in normal limits.
Sputum –
Examination of sputum helps to establish the degree of inflammation. Sputum
must be examined when it is fresh. Mucoid sputum usually contains many opaque cellular flakes,
which are partially translucent and grey or brown in colour. Under the microscope these flakes
are seen to contain neutrophil and eosinophil. Pus may be diffused throughout the sputum or may
occur in flakes. Pus is uniformly opaque, range in colour from pale yellow to darker yellow or
green and has a creamy consistency. Under the microscope, pus consists almost entirely of dense
shuts of neutrophil and polymorphs with few other types of cell.
In the sputum, the presence of atypical cells, tuberculous mycobacteria and elastic
fibre is a positive indication for revision of the previous diagnostic conjecture in favour of
bronchogenic carcinoma, tuberculosis or lung abscess.
29
Conceptual Study
Chest X-RAY
Most of the cases of chronic bronchitis are having normal chest
radiograph. In some patients posterior-anterior view of chest radiograph shows over inflation
with increased bronchovascular markings, suggestive of thickening of bronchi. However
radiographic examination of the chest organs is of great help in diagnosing complications and in
differentiating the disease, in which bronchitic symptoms may attend the main process like
tuberculosis, bronchogenic cancer, etc.
TREATMENT
It is found that one clinical form of chronic bronchitis can transform into another form. Long
standing simple chronic bronchitis can, for example convert into mucopurulent bronchitis if
infection joins. If the prevalence of the obstructive phenomena over all other manifestations
of the disease is marked, the disease converts into the obstructive form. So the treatment of
chronic bronchitis includes a combination of measures that slightly differ from one another
during exacerbation and remission of the disease
STEPS IN MANAGEMENT
Smoking Cessation:
Smoking cessation is the single most important therapeutic maneuver that can alter the
course of chronic bronchitis with air flow limitation. Thus, all efforts at behavioral
modification leading to smoking cessation should be made. If the cessation of the smoking is
done in the early stages of the disease, there is good evidence of improvement in symptoms.
In more advanced cases there may be little improvement in function.
Avoidance of atmospheric pollution:
Atmospheric pollution and industry occupations are having role in the manifestation of the
chronic bronchitis. Sometimes a change from polluted occupation or change in dwelling
place shows improvement in the condition.
30
Conceptual Study
Bronchodilators:
Bronchodilators are widely used in patients who demonstrate even a small degree of
reversibility of airflow obstruction in chronic bronchitis.
Expectorants and mucolytics:
The main item of chronic bronchitis therapy is restoration of bronchial potency by improving
drainage and by removing Bronchospasm. Bronchial drainage can be improved by
expectorants and mucolytics. Expectorants can stimulate the output of respiratory tract fluid,
either directly or reflex. Direct stimulants are administered orally or by inhalation with
steam, which can increase the respiratory secretions probably by a direct action. Reflex
expectorants act by stimulating the gastric reflexes which help to increase the respiratory
secretion.
COMPLICATIONS
One clinical form of bronchitis can transform into another form of bronchitis. In obstructive
chronic bronchitis, the obstruction of small bronchi, over distends the alveoli during
expiration and impairs elasticity of the alveolar walls. All these factors favor development of
lung emphysema. Chronic bronchitis undergoes evolution during its course. Emphysema and
fibrosis, and often the asthmatic component result in uneven and asynchronous lung
ventilation. In combination with local inflammation it upsets gas exchange, causes
respiratory distress, arterial hypoxemia and pulmonary hypertension with subsequent
development of right ventricular failure. The later is the main cause of death of chronic
bronchitis patients. So complications of chronic bronchitis can be classed into two groups:
i) Complications directly connected with infections pneumonia, bronchiectasis,
Bronchospasm and asthma.
ii) Complications connected with evolution of bronchitis, lung emphysema, diffuse
fibrosis, pulmonary failure, corpulmonale and development of right ventricular failure,
31
Conceptual Study
PROGNOSIS
Most favourable prognosis is in cases with simple chronic bronchitis. In rest of the varieties
complete recovery is hardly possible. The least favourable prognosis is in obstructive chronic
bronchitis and with complications.
DIFFERENTIAL DIAGNOSIS:
Simple and recurrent mucopurulent chronic bronchitis is by definition, a diagnosis based
on exclusion of other pathologies. In non-smokers presenting with chronic cough, a specific
cause can often be identified. So the following possibilities should be considered.
Mucopurulent chronic bronchitis – in mucopurulent bronchitis patient expectorates
yellowish sputum. General symptoms like hyperhydrosis, weakness, elevated temperature,
fatigue, decreased work capacity, etc. symptoms can develop. The blood investigation findings
shows moderately increase in ESR level and leucocyte counts are moderately high. The clinical
and laboratory findings are present here, whereas absent in Simple and Recurrent Mucopurulent
Chronic Bronchitis, so it can be ruled out.
Obstructive chronic bronchitis – in obstructive bronchitis cough is low productive and
difficult to expectoration. Development of exertional dyspnoea in patients, who complains of
cough for a long time, usually indicates bronchial obstruction. Patient with air flow limitation
also present with a history of breathlessness and exercise intolerance. As the disease progresses
exercise becomes more limited. So that the patient may have difficulty in routine works. Lung
volumes are also reduced in case of chronic obstructive bronchitis. These findings are absent in
Simple and Recurrent Mucopurulent Chronic Bronchitis, so it can be ruled out.
Bronchiectasis – it is localized irreversible dilation of the bronchi. The chief complaints
are cough with copious purulent expectoration which has a postural relationship. The sputum is
frequently blood tinged, and occasionally foul smelling. Fever and other constitutional symptoms
may occur during episodes of bronchial infection. Physical findings in a patient with
32
Conceptual Study
bronchiectasis include evidence of malnutrition in chronic and long standing cases with the
evidence of digital clubbing. Examination of the chest reveals persistant course crepitations over
a localized region of the lung, usually at the lung base. Radiographic findings may show cystic
lesions, looking like a bunch of grapes. As these symptoms are absent in Simple and Recurrent
Mucopurulent Chronic Bronchitis, it can be ruled out.
Pulmonary tuberculosis – typically there is a gradual onset of symptoms over weeks or
months. Tiredness, malaise, anorexia and loss of weight together with fever and cough remain
the outstanding feature of pulmonary tuberculosis. Sputum in tuberculosis may be muciod,
purulent or bloodstained. Investigation shows high ESR and leucocytosis, sputum is positive for
AFB. The chest X-ray typically shows patchy or nodular shadows in the upper zones, loss of
volume and fibrosis with or without cavitation. All these are absent in Simple and Recurrent
Mucopurulent Chronic Bronchitis.
Bronchogenic carcinoma – the clinical manifestation of bronchogenic carcinoma are
variable from case to case depending upon its size, site of origin, and its spread to other areas. In
the initial stage partial complaints of dry cough is present but later the cough is accompanied by
a thin watery secretion. Most of the times the patient is usually middle aged male having history
of smoking. In the later stage the sputum is grey and viscid. It is usually purulent in the presence
of infection. In long standing cases clubbing of digits is present and lymph nodes may be
palpable. So with the help of clinical picture and chest radiograph, it can be differentiated from
Simple and Recurrent Mucopurulent Chronic Bronchitis.
33
Drug Review
DRUG REVIEW:
Drug as defined by WHO is any substance or product that is used or intended to
be used to modify or to explore physiological systems or pathological status for the
benefit of recipient. Ayurveda considers Drug (Dravyas) as a whole and treat the patient
as a whole and believes that each and every substance existing in this universe is
panchbhautic in nature. Acharya Charaka has observed "In the light of this knowledge,
there is in the world no substance that may not be used as medicine in this or that manner
for this or that purpose." Purposiveness and rationality are the two parameters to judge
and use any substance as medicine. So, any substance or mixture of substances intended
to be used internally or externally for the preservation & fortification of health and for
prevention, mitigation or cure of disease of either man or other animal is called Dravyas.
Obviously, both dietetic and medicinal substances are Dravyas in this context.
In this chapter, the details of haridradi dhoomavarti ingredients and kaphaketu
rasa are compiled, and discussed
HARIDRADI DHOOMAPANA127:
Table No. 10 showing the ingredients of Haridradi Dhoomapana
Shuddha Manasheela
Haridra
Ingredients
Daruharidra
Indications :- kaphaja kasa
Mode of use: - dhoomapana by dhumavarti
46
Drug Review
Haridra
Table No 11 showing description of Haridra
Botanical name Curcuma longa
Family Zinzeberacea
Synonyms Nisha, Gauri
Gana lekhaniya, shirovirechana
Rasa Tikta, katu
Guna ruksha, laghu
Virya ushna
Vipaka katu
Karma kaphavatahara, lekhana
Parts used Rhizome
Daruharidra
Table No 12 Showing Description of Daruharidra
Botanical name Berberis aristata / Cosimum fenestratum
Family Berberidaceae
Synonyms daru nisha, darvi
Gana lekhaniya
Rasa tikta, kashaya
Guna laghu, ruksha
Virya ushna
Vipaka katu
Karma kaphapittahara, chedana
Part used stem, root
47
Drug Review
Manasheela
Table No 13 Showing Description of Manasheela
Local name Realgar
Formula AS2S2(arsenic disulphide)
Synonyms nagmata, manogupta, rasagandhaka, nepalika
Rasa katu, tikta
Guna snigdha
Virya ushna
Karma vatanashak, lekhana
KAPHAKETU RASA128:
Kaphaketu rasa is a Khalvirasayana with a unique herbomineral combinations
of drugs to treat kaphaja kasa. Even though the name suggests that it is a rasa preparation, it
does not contain rasa (mercury) as an ingredient. The author of Bhaishajya ratnavali has
explained kaphaketu rasa, its ingredients, and three bhavanas of Ardraka swarasa for it, and the
vatis prepared of one ratti pramana or one gunja matra. He also explains Ardraka swarasa as
Anupana. In Rasendra sara sangraha kaphaketu rasa is explained under kapha roga Chikitsa.
Table No 14 Showing ingredients of Kaphaketu Rasa
Drug Botanical/scientific name quantity
Shuddha Tankana Borax 1 part
Shuddha Vatsanabha Aconitum ferox Wall 1 part
Shankha Bhasma Calyx of Conch shell 1 part
Pippali Piper Lon gum Linn 1 part
Ardraka (swarasa)(for bhavana) Zingiber officinale Rose Q. S.
Indications:- kapha vikara, kasa, jwara
Dosage :- 1 ratti, i.e. 125 mg thrice in a day, after meals
Anupana :- ardraka swarasa (1 teaspoon)
48
Drug Review
The following classification of the ingredient drugs is made for clear understanding the
properties of each individual component which combines to form a kaphaketu rasa.
Tankana :
Tankana is mentioned in all the Bruhatrayees. It is one among Ksharatraya and
Ksharapanchaka. Tankana is also included under Uparasa varga. After 8th century A.D. it has
been used as an antidote of Vatsanabha in Rasashastra.
Local name - Borax
Synonyms – kshararaja, ksharashresta, soubhagya
Rasa – katu
Guna – ruksha, teekshna, ushna, sara
Virya – ushna
Vipaka – amla
Doshagnata – vatakapha shamaka
Chemical composition – Na2B4O710H2O (sodium pyroborate)
Action – Diuretic, Emmengogue, Astringent, Antacid, Local sedative and Antiseptic.
Rogaghnata – Kasa, Shwasa, Jwara, kshaya, shoola
Vatsanabha :
Vatsanabha has been mentioned under sthavara vishas. it is also described under
13 varieties of Kanda Vishas.
Botanical name – Aconitum ferox
Family – Ranunculaceae
Synonyms – amrutam, ugra visha, mahoushadam, nabhi
Rasa – madhura
49
Drug Review
Guna – laghu, ruksha, teekshna, vyavayi, vikashi
Virya – ushna
Vipaka – katu
Prabhava - rasayana
Karma – yogavahi, shoola prashamaka, mootrala, balya, madakari.
Doshagnata – vatakapha shamaka
Part used – tuber roots
Chemical composition – Roots contain toxic Alkaloids, pseudoaconitine along
with bikhaconitine, chasma coniine, indaconitrine, verotroyl pseudaconitine and
diacetyl pseudoaconitine.
Action – Diaphoretic, diuretic, antidiabetic, antiphlogistic and antipyretic action
Rogaghnata – Jwara, shwasa, kasa, Agnimandya, pandu.
Shankha Bhasma:
Shankha is explained under Varishiya varga. Various medicinal uses have also
been explained. It is considered under shukla varga.
It is a molluscan species and it is also identified as sacred chank or conch shell
Formula – CaCO3 ( calcium carbonate)
Synonym – trirekha, haripriya, mahanada, samudraja
Bhasma rasa – kshariya swada, katu
Guna – sheeta, grahi
Virya – sheeta
Sparsha – sukshma
Gandha – nirgandha
Rupa – sweta
Karma – deepana, pachana, grahi, balya, vilekhana, vishagna
Doshagnata - vatashamaka
50
Drug Review
Action – it is used as Diuretic, emmenogogue, astringent, antacid, local sedative
and antiseptic.
Rogaghnata – shwasa, amlapitta, grahani, kapha vikara.
Pippalli :
It has been quoted among the Dashemaniya gana.
Botanical name – Piper longum Linn.
Family – Piperaceae
Synonyms – granthikam, ushnam
Rasa – katu
Guna – laghu, snigdha
Virya – ushna
Vipaka – katu
Karma – deepana, pachana, ruchya, vrushya, rasayana, amadoshahara, sara
Doshagnata - kaphavatahara
Parts used – dried unripe fruits as well as root are used.
Chemical composition – it contains essential oil, piperine, piplartine,
piperlongurminie, piperlonguminine, pipernonaline, pipercide, sesamin, sitosterol, starch, fatty
acids, gum, etc.
Action – infusion is stimulant, carminative and alternative tonic. Aphrodisiac,
diuretic, vormifuge and emmenogogue.
Rogaghnata – kasa, shwasa, udara, jwara, kusta, kshaya
51
Drug Review
Ardraka:
It has been described under Deepaniya and Truptighna gana
Botanical name – Zingiber officinale
Family – Zinzeberacea
Synonyms – sringavera, katubhadra, ardrika
Rasa – katu
Guna – guru, ruksha, tikshna
Virya - ushna
Vipaka – madhura
Doshagnata – vatakaphahara
Part used – rhizome
Chemical composition – volatile oil, starch, fat, protein, fibre, inorganic
material, residual moisture.
Action – agni deepana, ruchya, jihwa kanta vishodhaka, kasa shwasa hara
Rogaghnata – it is useful in agnimandya, shwasa, kasa, jalodhara, sheetapitta.
52
PLATE NO. 1
DARBHASHALAKA
DHOOMA NETRA DHOOMA VARTI
PLATE NO 2
KAPHAKETU RASA DARUHARIDRA
MANASHILAHARIDRA
Clinical Study
MATERIALS AND METHODS:
Aim of study :
This study is planned to evaluate the therapeutic effect of the haridradi
dhoomapana and Kaphaketu rasa in patients suffering from kaphaja kasa.
Source of the data:
The patients who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda Hospital,
Kuthpady, Udupi, Karnataka, during the period of February 2005 to January 2006,
having the symptoms of kaphaja kasa were screened. Among these patients 21
Patients who fulfilled the below mentioned criteria of inclusion were taken for the
study. While selecting these 21 patients care was also taken to see that there was no
any factor in these patients listed in the exclusion criteria. The selected patients
detailed profile is prepared as per the detailed proforma designed for the same
purpose, which incorporates relevant data like symptomatology, physical signs,
laboratory investigation reports as well as assessment criteria.
Inclusion criteria
21 patients taken in this clinical trial were according to the following inclusion
criteria-
Patients with pratyatma lakshanas of Kaphaja Kasa with parallel diagnosis of
Chronic Bronchitis.
Age group above 16 years and below 70 years.
History of illness should be of minimum 3 months each for 2 consecutive years.
Patients selected according to incidence irrespective of sex, occupation, caste, etc.
53
Clinical Study
Exclusion criteria
The patients suffering from kaphaja kasa showing the presence of following criteria
were excluded from the study
Patients associated with any other systemic illness.
Pregnant women.
Complications of Chronic Bronchitis like Cor-Pulmonale, Pulmonary Hypertension.
Investigations
Following are the list of investigations carried out in 21 patients of kaphaja kasa
taken for this study.
Blood – TC, DC, ESR, Hb%, other investigations if needed
Spirometric test
Design:
It is a single blind comparative clinical study with a pre-test and post-test design. In
this study 21 patients diagnosed as Kaphaja Kasa of either sex were selected. These
patients were randomly allocated into two groups.
First test group is the Dhoomapana Group and in short this group is referred as DP
Group. Kaphaketu Group is the second group and is also the control group. This
group is also referred as KK Group.
Intervention:
In the Dhoomapana group : 10 patients were taken and administered with Haridradi
Dhoomapana, once daily, early morning for 7 days, along with Kaphaketu Rasa in the
dose of 125mg with Ardraka swarasa(1 teaspoon) thrice a day for 1 month.
In the Kaphaketu group : 11 patients were taken and administered with Kaphaketu
Rasa in the dose of 125mg with Ardraka swarasa(1 teaspoon) thrice a day for 1
month.
Follow-up – The follow-ups for Dhoomapana Group will be everyday for the first 7
days and then weekly till one month of the treatment.
54
Clinical Study
The follow-ups for Kaphaketu Group will be taken weekly till one month of the
treatment.
Assessment criteria:
The state of the disease kaphaja kasa changes after the intervention. Improvement
or otherwise was determined by adopting the standard methods of scoring. Functional
efficiency of the respiratory system was assessed both before and after the intervention to
note any change by using the spirometer. The details of the assessment criteria are given
as follow.
Assessment parameters:-
Grade
1. Severity 0- No symptoms
Lung function test – Normal spirometry
1- Symptoms < 2 times in a week
Brief exacerbations for few hours in few days
Lung function test – FVC, FEV1 60-80% predicted. Mild
abnormality
2- Symptoms > 2 times in a week but < 2 times in a day, with little
discomfort in routine activities.
Exacerbations for few hours in few days
Lung function test – FVC, FEV1 40-60% predicted. Moderate
abnormality
3- Daily symptoms, persistent during night/ at rest. With discomfort in
routine activities
Exacerbations throughout/ at most times of symptoms
Lung function test – FVC, FEV1 < 40% predicted. Severe/very
severe abnormality
55
Clinical Study
2. Kasa (cough)
0- No cough
1- Intermittent cough in the morning and/or after exercise or in
connection with accelerated respiration, which does not inhibit
routine activities.
2- Continuous cough during the day as well as in the morning, which
inhibits the routine activities.
3- Continuous cough during day and night, which disturbs sleep and
prohibits the routine activities.
3. Nishteevana (Expectoration)
0- No expectoration
1- Thick mucoid expectoration which is intermittent during cough.
2- Mucoid and sticky expectoration which is accompanied during cough
3- Mucopurulent expectoration which is accompanied with each bout of
cough.
4> Uraha vankshana sampoornamiva
0- No feeling of heaviness and discomfort in the chest
1- Heaviness and pain/discomfort in chest during cough only, which is
relieved after expectoration.
2- Heaviness and discomfort in chest by which the patient is bound to
change his posture after a few minutes, it is relieved slightly after
expectoration
3- Restlessness due to heaviness and discomfort in chest, and whose
facial expression self indicating.it is not relieved after expectoration
5. Kapha poorna Deha
0- No heaviness in the body
1- Feels Heaviness in body but does not hamper routine activity
2- Feels Heaviness in body which hampers daily routine activity
56
Clinical Study
3- Feels Heaviness all over the body which hampers movements of the
body
6. Asya madhurata
0- Absent
1- Present early morning and up to 3 hours after eating shadrasa Ahara
2- Present throughout, even empty stomach
7. Mandagni
0- Normal appetite after 3-6 hours of previous food taken
1- appetite after 6-9 hours of previous food taken
2- appetite after 9-12 hours of previous food taken
3- No appetite even after 12 hours of previous food taken
8. Aruchi
0- Willing towards normal food
1- Willing towards only most likely food and not to others
2- Unwilling for food but could take meals
3- Totally unwilling for meals, does not take meals.
9. Peenasa
0- No nasal discharge
1- Intermittent nasal discharge (watery)
2- Persistent nasal discharge (watery/mucoid)
3- Persistent nasal discharge (thick & odoursome)
10. Shiroruja
0- Not present
1- Mild, Intermittent on cough
2- Moderate, Persistent
3- Severe, Persistent
57
Clinical Study
11. Phonation
0- Not affected
1- Hoarseness of voice during morning hours, Pain in throat during
speech
2- Hoarseness of voice throughout day and night, pain in throat so able
to speak only phrases
3- Unable to speak /speaks only words with difficulty.
12. Quantity of sputum
0- Less than 2.5ml/day
1- 2.5ml to 15ml/day
2- 15ml to 25ml/day
3- >25ml/day
13. Respiratory rate
0- normal rate 16-18/min
1- 24-30/min
2- >30/min
3- <10/min
Spirometric tests:
Computerized electronic kit micro spirometer is used in this study for assessing the
functional efficacy of the lung. The technical features of this spirometer includes-
• Flow meter - Bi-directional digital turbine
• Range for flow measurement - 0.03-20l/s
• Range for volume measurement - 10l
• Accuracy of measurement - 3% or 50ml
• Dynamic resistance @ 12I/s - <0.7cmH2O/l/s
58
Clinical Study
The interpretation of the predicted values for spirometric lung volumes was calculated
following the ERS 93 criteria (official statement of the European Respiratory Society, The
European Respiratory Journal Volume 6, Supplement 16, and March 1993.) following is the list of
spirometric tests, included in the present study on kaphaja kasa
Symbol UM Parameter
FVC l (btps) forced expiratory vital capacity
FEV1 l (btps) forced expiratory volume in 1 second
PEF l/sec Peak expiratory flow
FEV1/FVC% FEV1 as a percentage of FVC
Assessment of overall effect:
As per the reduction in the total scores of the assessment parameters, the overall effect is
calculated as follow-
Complete remission - total score is 0 after the treatment
Marked improvement – reduction between 75-99% of the initial score
Moderate remission - reduction between 50-74% of the initial score
Average remission - reduction between 25-49% of the initial score
Unchanged - reduction between 0-24% of the initial score
59
Observations
OBSERVATIONS
A total of 21 patients suffering from Kaphaja Kasa fulfilling the inclusion criteria were
taken for the study. All these 21 patients who were registered have completed the
stipulated schedule of the study. They were randomly categorized into two groups.
In the Dhoomapana Group, 10 patients were selected and In the Kaphaketu Group 11
patients were selected irrespective of age, sex, and caste. The Dhoomapana Group was
the test Group and the Kaphaketu Group was the trial Group.
The observation and the results as well as statistical analysis of these two groups are
elaborated in the following headings :
• Descriptive statistical analysis of the patients
• Analysis of the therapeutic effect of Haridradi Dhoomapana and Kaphaketu Rasa
in patients of Kaphaja Kasa, and the assessment of the significance of the
treatment by adapting the paired ‘t’ test.
• Comparison of the effects of treatment between the Dhoomapana group and
Kaphaketu rasa, and statistical analysis of the comparison by performing unpaired
‘t’ test.
Descriptive Statistical Analysis
Descriptive statistical analysis of 21 patients of kaphaja kasa belonging to Dhoomapana
group as well as Kaphaketu group includes the distribution of patients according to their
age, sex, marital status, place, dietary habits, Satmya, prakruti, satva, etc. the same is
elaborated in the following pages.
60
Observations
Distribution of 21 Patients According to Age: Out of 21 patients of kaphaja kasa
studied in this work, maximum number of 6 (28.57%) patients belonged to the age group
of 21 to 30 years and 41 to 50 years, against no patient was present in the age group of 16
to 20 years. The details are given in the Table No. 1 and Graph No. 1
Table No. 15: Distribution of 21 Patients in Different Age Groups
No. of patients Age in years
Group DP Group KK
Total %
16-20 0 0 0 0
21-30 4 2 6 28.571
31-40 1 1 2 9.523
41-50 4 2 6 28.571
51-60 1 3 4 19.047
61-70 0 3 3 14.285
Figure No. 3 : Distribution of 21 Patients According to Age
0
28.5
9.5
28.5
19
14.2
0
5
10
15
20
25
30
%
16-20 21-30 31-40 41-50 51-60 61-70Age group
61
Observations
Distribution of 21 Patients According to their Sex: 12 (57.14%) of patients of Kaphaja
kasa were males as against only 9 (42.85%) of females in the present study. The details
are elaborated in the Table No. 2 and Graph No. 2.
Table No. 16: Distribution of 21 Patients According to their Sex
No.of patients Sex
Group DP Group KK
Total %
Female 5 4 9 42.857
Male 5 7 12 57.142
Figure No. 4 : Distribution of 21 Patients According to Sex
42.8
57.1
0
10
20
30
40
50
60
%
FEMALE MALE
62
Observations
Distribution of 21 Patients According to Religion: As shown in the Table No. 3 and
Graph No. 3, 15 (71.42%) of patients were Hindus, 4 (19.04%) were Muslims and only 2
(9.52%) of patients were Christians
Table No. 17: Distribution of 21 Patients According to Religion
No.of patients Religion
Group DP Group KK
Total %
Christian 1 1 2 9.523
Hindu 7 8 15 71.428
Muslim 2 2 4 19.047
Figure No. 5 : Distribution of 21 Patients According to Religion
9.5
71.4
19
01020304050607080
%
Christian Hindu MuslimReligion
63
Observations
Distribution of 21 Patients According to Marital status: Among the 21 patients of
kaphaja kasa taken for this study, a maximum of 13 (61.90%) patients were married as
against mere 7 (33.33 %) of unmarried people. There was 1 (4.761%) widow patient in
the study. The details are shown in the Table No. 4 and Graph No. 4.
Table No. 18: Distribution of 21 Patients According to Marital status
No.of patients Marital status
Group DP Group KK
Total %
Married 6 7 13 61.904
Unmarried 4 3 7 33.333
Widow 0 1 1 4.761
Figure No. 6 : Distribution of 21 Patients According to Marital status
61.9
33.3
4.70
10203040506070
%
Married Unmarried WidowMarital status
64
Observations
Distribution of 21 Patients According to Literacy: Prevalence of literates was recorded
in the present study involving 21 patients of kaphaja kasa. 33.33% of the patients were
illiterates and the remaining 66.66% of patients had education, as detailed in the Table
No. 5 and Graph No. 5.
Table No. 19: Distribution of 21 Patients According to Educational status
No. of patients Educational Status
Group DP Group KK
Total %
Illiterate 3 4 7 33.333
Primary 0 1 1 4.761
Secondary 1 0 1 4.761
Higher Secondary 2 3 5 23.809
Graduate 3 3 6 28.571
Post Graduate 1 0 1 4.761
Figure No. 7 : Distribution of 21 Patients According to Educational status
33.3
4.7 4.7
23.828.5
4.7
05
101520253035
%
ILL PR SC H SC GR P GRLITERACY
65
Observations
Distribution of 21 Patients According to their Occupation: It is observed that 7
(33.33%) of the females in this study were house wives by their occupation. Also, this
formed the largest category of patients leaving behind the patients engaged in other
occupations. There was only 1 (4.76%) patient in the agriculture category recorded.
Details are given in the Table No. 6 and Graph No. 6.
Table No. 20: Distribution of 21 Patients According to their Occupation
No.of patients Occupation
Group DP Group KK
Total
%
Agriculture 1 0 1 4.761
Business 0 2 2 9.523
Employee 1 3 4 19.047
House wife 3 4 7 33.333
labourer 2 1 3 14.285
Student 3 1 4 19.047
Figure No. 8 : Distribution of 21 Patients According to their Occupation
4.79.5
19
33.3
14.219
05
101520253035
%
AGR BUS EMP HW LAB STUOccupation
66
Observations
Distribution of 21 Patients According to Socio-economical status : The study revealed
that most of the patients belonged to middle socio-economic status i.e.13 (61.90%)
against the upper socio-economic status which comprised 3 (14.28%). The details are
given in the Table No. 7 and Graph No. 7.
Table No. 21: Distribution of 21 Patients According to Socio-economic status
No. of patients So.Eco.St
Group DP Group KK
Total %
Lower 1 4 5 23.809
Middle 7 6 13 61.904
Upper 2 1 3 14.285
Figure No. 9 : Distribution of 21 Patients According to Socio-economic status
23.8
61.9
14.2
010203040506070
%
Lower Middle UpperSocio-economic status
67
Observations
Distribution of 21 Patients According to Mode of Onset of the illness: Out of 21
patients suffering from kaphaja kasa taken for the study, a maximum of 17 (80.95%)
patients had insidious onset of the disease. None of the patient had a sudden onset of
illness. Details are given in Table no 8 and Graph no 8.
Table No. 22: Distribution of 21 Patients According to Mode of Onset of the illness
No of patients Mode of onset
Group DP Group KK
Total %
Gradual 0 4 4 19.047
Insidious 10 7 17 80.952
Sudden 0 0 0 0
Figure No. 10 : Distribution of 21 Patients According to Mode of Onset of the illness
19
80.9
00
102030405060708090
%
GRAD INSD SUDNMode of Onset
68
Observations
Distribution of 21 Patients According to the Course of Illness : it is observed that a
maximum of 13 (61.90%) patients had recurrent attacks of cough and expectoration
whereas only 1 (4.76%) patient had a continuous attack of the disease. The details are
given in Table no 9 and Graph no 9
Table No. 23: Distribution of 21 Patients According to the Course of illness
No of patinets Course of illness
Group DP Group KK
Total %
Continuous 0 1 1 4.761
Episodic 3 2 5 23.809
Progressive 0 2 2 9.523
Recurrent 7 6 13 61.904
Figure No. 11 : Distribution of 21 Patients According to the Course of illness
4.7
23.8
9.5
61.9
010203040506070
%
CONT EPIS PROG RECUCourse of illness
69
Observations
Distribution of 21 Patients According to the Severity of Illness : 13 (61.90%) patients
were in the moderate category and 3 (14.28%) patients were in mild category of severity
of illness out of 21 patients taken for the study. Table no 10 and Graph no 10 gives the
details.
Table No. 24: Distribution of 21 Patients According to the Severity of illness
No of patients Sev of illness
Group DP Group KK
Total %
Mild 0 3 3 14.285
Moderate 7 6 13 61.904
Severe 3 2 5 23.809
Figure No. 12 : Distribution of 21 Patients According to the Severity of illness
14.2
61.9
23.8
010203040506070
%
MILD MOD SEVSeverity of illness
70
Observations
Distribution of 21 Patients According to the Consistency of Sputum : Table no 11 and
Graph no 11 gives the details wherein a maximum of 9 (42.85%) patients had mucous
and sticky expectoration against a minimum of 2 (9.52%) patients had thin mucoid
expectoration.
Table No. 25: Distribution of 21 Patients According to the Consistency of Sputum
No of patients Sptm consistency
Group DP Group KK
Total %
Thin Mucoid 0 2 2 9.523
Thick Frothy 1 5 6 28.571
Mucous & sticky 6 3 9 42.857
Mucopurulent 3 1 4 19.047
Figure No. 13 : Distribution of 21 Patients According to the Consistency of Sputum
9.5
28.5
42.8
19
05
1015202530354045
%
Th Mu Th Fr Mu St Mu PuConsistency of Sputum
71
Observations
Distribution of 21 Patients According to the Aggravating Factors : in 21 patients
suffering from kaphaja kasa, all patients had an aggravation of the illness on exposure to
Dust, Smoke and change in Weather. 17 (80.95%) patients had aggravation of the illness
on exposure to cold food items, and 15 (71.428%) had aggravation on exposure to
pollens. Details are provided in Table no 12 and Graph no 12.
Table No. 26: Distribution of 21 Patients According to the Aggravating factors
No of patients Agg factors
Group DP Group KK
Total %
Dust 10 11 21 100
Pollens 7 8 15 71.428
Sheeta ahara 9 8 17 80.952
Smoke 10 11 21 100
Weather 10 11 21 100
Figure No. 14 : Distribution of 21 Patients According to the Aggravating factors
100
71.480.9
100 100
0102030405060708090
100
%
DUST POL S AHAR SMOKE WTHAggravating Factors
72
Observations
Distribution of 21 Patients According to the Condition of Work place : in the present
study on 21 patients suffering from kaphaja kasa, it revealed that 15 (71.42%) patients
were working in non-polluted environment towards only 6 (28.57%) patients working in
polluted environment. Table no 13 and Graph no 13 gives the details
Table No. 27: Distribution of 21 Patients According to the Condition of Working
place
No of patients Cond of work place
Group DP Group KK
Total %
Polluted 3 3 6 28.571
Non-polluted 7 8 15 71.428
Figure No. 15 : Distribution of 21 Patients According to the Condition of Working
place
28.5
71.4
01020304050607080
%
Poll unPollCondition of working place
73
Observations
Distribution of 21 Patients According to the type of Diet consumed :
Maximum 80.952% of patients were having mixed diet and 19.047%
patients were vegetarians. Table no 14 and Graph no 14 gives details.
Table No. 28: Distribution of 21 Patients According to the Dietary Habits
No.of patients Dietary habit
Group DP Group KK
Total %
Mixed 9 8 17 80.952
Veg 1 3 4 19.047
Figure No. 16 : Distribution of 21 Patients According to the Dietary Habits
80.9
19
0102030405060708090
%
MIXED VEGDietary Habit
74
Observations
Distribution of 21 Patients According to Dominant Rasa in Ahara : 52.38% had
comsumption of food stuffs dominant of madhura and amla rasa, 47.61% were
consuming more of katu rasa Ahara and only 1 patient was dominantly taking kashaya
rasa. Details are given in Table no 15 and Graph no 15
Table No. 29: Distribution of 21 Patients According to Dominant rasa in Ahara
No of patients Dominant rasa
Group DP Group KK
Total %
Madhura 5 6 11 52.380
Amla 4 7 11 52.380
Lavana 3 4 7 33.333
Katu 6 4 10 47.619
Tikta 3 1 4 19.047
Kashaya 0 1 1 4.761
Figure No. 17 : Distribution of 21 Patients According to Dominant rasa in Ahara
52.3 52.3
33.3
47.6
19
4.70
10
20
30
40
50
60
%
mad aml lav kat tik kasDom. rasa in ahara
75
Observations
Distribution of 21 Patients According to their Addictions: Large percentage of
patients in this study had addiction towards tea and coffee. Only 6 (28.57%) patients
reported addiction to tobacco chewing where as equal number of 9 (42.85%) patients
were addicted to alcohol and smoking. Table No. 18 and Graph No. 18 show the details
of the habits of patients.
Table No. 30: Distribution of 21 Patients According to their Addictions
No.of patients Addictions
Group DP Group KK
Total
%
Alcohol 5 4 9 42.857
Coffee 8 8 16 76.190
Smoking 4 5 9 42.857
Tea 10 11 21 100
Tobacco chewing 1 5 6 28.571
Figure No. 18 : Distribution of 21 Patients According to their Addictions
42.8
76.1
42.8
100
28.5
0102030405060708090
100
%
Alc Cof Smo Tea T chAddictions
76
Observations
Distribution of 21 Patients According to Prakriti : All the patients in the present study
belonged to the Dvandaja Prakriti. 6 (28.57%) patients were of Vatapitta prakriti and 4
(19.04%) patients were of Vatakapha prakriti. The maximum 11 (52.38%) patients were
of kaphaPitta Prakriti. Table No. 20 and Graph No. 20 give the details.
`Table No. 31 : Distribution of 21 Patients According to Prakriti
No.of patients Prakriti
Group DP Group KK
Total %
VP 2 4 6 28.571
KP 6 5 11 52.380
VK 2 2 4 19.047
Figure No. 19: Distribution of 21 Patients According to Prakriti
28.5
52.3
19
0
10
20
30
40
50
60
%
VP KP VKPrakruti
77
Observations
Distribution of 21 Patients According to Dhatu Sara : The assessment of Sara in 21
patients of kaphaja kasa showed maximum number of patients having Madhyama Sara 16
(76.19%) the remaining 3 (14.28%) and 2 (9.52%) patients belonged to Avara and
Pravara Sara respectively. Incidence of patients according to their Sara is detailed in the
Table No. 21 and Graph No. 21.
Table No. 32: Distribution of 21 Patients According to Sara
No.of patients Sara
Group DP Group KK
Total %
Pravara 1 1 2 9.523
Madhyama 8 8 16 76.190
Avara 1 2 3 14.285
Figure No. 20: Distribution of 21 Patients According to Sara
9.5
76.1
14.2
01020304050607080
%
Prav Madh AvarDhatu Sara
78
Observations
Distribution of 21 Patients According to Samhanana : Samhanana of every patient
was assessed before the treatment, and it was observed that among the 21 patients 14
(66.66%) of the patients had Madhyma Samhanana. Pravara Samhanana was recorded in
just 1 (4.76%) of the patients. Remaining 6 (28.57%) of the patients showed characters of
the Avara Samhanana. The detail of the same are given in the Table No. 22 and Graph
No. 22
Table No. 33: Distribution of 21 Patients According to Samhanana
No.of patients Samhanana
Group DP Group KK
Total %
Pravara 0 1 1 4.761
Madhyama 9 5 14 66.666
Avara 1 5 6 28.571
Figure No. 21: Distribution of 21 Patients According to Samhanana
4.7
66.6
28.5
010203040506070
%
Prav Madh Avarsamhanana
79
Observations
Distribution of 21 Patients According to Satmya : Observation of 21 patients of
kaphaja kasa revealed that only 1 (4.76%) of the patients had Pravara Satmya, 17
(80.95%) of patients showed Madhyama Satmya and the remaining 3 (14.28%) of
patients showed Avara Satmya. Table No. 23 and Graph No. 23 show the details.
Table No. 34: Distribution of 21 Patients According to Satmya
No.of patients Satmya
Group DP Group KK
Total %
Pravara 1 0 1 4.761
Madhyama 7 10 17 80.952
Avara 2 1 3 14.285
Figure No. 22: Distribution of 21 Patients According to Satmya
4.7
80.9
14.2
0102030405060708090
%
Prav Madh Avarsatmya
80
Observations
Distribution of 21 Patients According to Satva : Majority of 18 (85.71%) patients
belong to Madhyama Satva, 1 (4.76%) were of Pravara Satva and 2 (9.52%) were of
Avara Satva in this study. The details are shown in Table No. 24 and Graph No. 24.
Table No. 35: Distribution of 21 Patients According to Satva
No.of patients Satva
Group DP Group KK
Total %
Pravara 1 0 1 4.761
Madhyama 7 11 18 85.714
Avara 2 0 2 9.523
Figure No. 23: Distribution of 21 Patients According to Satva
4.7
85.7
9.5
0102030405060708090
%
Prav Madh Avarsatva
81
Observations
Distribution According to Ahara Abhyavaharana and Jarana Shakti in patients of
Kaphaja kasa: Interrogation of the 21 patients of kaphaja kasa revealed that 13 (61.90%)
of the patients had Madhyama Abhyavaharana Shakti and 5 (23.80%) patients had
Pravara Abhyavaharan Shakti. The remaining 3 (14.28%) patients had Avara
Abhyavaharan Shakti Details are given in the Table No. 25 and Graph No. 25.
Table No. 36: Distribution According to Ahara Abhyavaharana and Jarana Shakti
in patients of Kaphaja kasa
Abh Shakti No.of patients Ahara
Jar Shakti Group DP Group KK
Total %
Pravara 1 2 3 14.285
Madhyama 7 6 13 61.904
Avara 2 3 5 23.809
Figure No. 24: Distribution According to Ahara Abhyavaharana and Jarana Shakti
in patients of Kaphaja kasa
14.2
61.9
23.8
010203040506070
%
Prav Madh AvarAhara Shakti
82
Observations
Distribution According to Vyayama Shakti in patients of Kaphaja kasa : Madhyama
Vyayama Shakti is recorded in 11 (52.38%) of patients. 6 (28.57%) of the patients had
Avara Vyayama Shakti and the remaining 4 (19.04%) patients had Pravara Vyayama
Shakti. The same is given in the Table No. 27 and Graph No. 27.
Table No. 37: Distribution According to Vyayama Shakti in patients of Kaphaja
kasa
No.of patients Vyayama shakti
Group DP Group KK
Total %
Pravara 2 2 4 19.047
Madhyama 5 6 11 52.380
Avara 3 3 6 28.571
Figure No. 25: Distribution According to Vyayama Shakti in patients of Kaphaja
kasa
19
52.3
28.5
0
10
20
30
40
50
60
%
Prav Madh AvarVyayama Shakti
83
Observations
Distribution According to Vaya of patients : Amongst the 21 patients taken in this
study a maximum of 16 (76.19%) belonged to Madhyama Vaya. None of the patient was
form the Bala age category. This has been shown in Table No. 28 and Graph No. 28.
Table No. 38: Distribution According to Vaya of patients
No.of patients Vaya
Group DP Group KK
Total %
Baala 0 0 0 0
Youvana 9 7 16 76.190
Vrudha 1 4 5 23.809
Figure No. 26: Distribution According to Vaya of patients
0
76.1
23.8
01020304050607080
%
baala youv vrudvaya
84
Observations
Distribution According to Desha of patients : out of 21 patients taken for the study, a
maximum of 80.95% were born and grown up in anupa desha, whereas a maximum of
90.47% patients had suffered the disease in anupa desha. Details in Table and Graph form
is given below
Table No. 39: Distribution According to Desha of patients
No of patients Desha
Group
DP
Group
KK
Total %
Anupa 6 11 17 80.952
Jangala 0 0 0 0
Jata
Sadharana 4 0 4 19.047
Anupa 6 11 17 80.952
Jangala 0 0 0 0
Samvruddha
Sadharana 4 0 4 19.047
Anupa 9 10 19 90.476
Jangala 0 1 1 4.761
Vyadhita
Sadharana 1 0 1 4.761
Figure No. 27: Distribution According to Desha of patients
81 8190
0 04.8
19 19
4.80
102030405060708090
%
anup jang sadhDESHA
JATASAMVRVYAD
85
Effect of Treatment
EFFECT OF TREATMENT IN DHOOMAPANA GROUP Effect on Severity :
Patients treated with haridradi dhoomapana and kaphaketu rasa had marked
remission of the severity of the illness. 2.8 was the mean initial score of severity in 10
patients of kaphaja kasa which came down to 1.2 after the treatment. The improvement to
the tune of 57.14% is found to be statistically highly significant (P≤0.001) as shown in
the Table No. 33 and Graph No. 30.
Table No 40 : Effect on Severity in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 2.800
±0.133
1.200
±0.249
1.600 57.14 0.843 6.000 ≤0.001
Effect on Kasa :
Kasa, one of the cardinal symptoms of Kaphaja Kasa relieved by 58.33% as the
initial score of Kasa which was 2.4 reduced to 1.0 after the treatment with Haridradi
Dhoomapana and Kaphaketu rasa. This improvement when analyzed by the paired ‘t’ test
found to the highly significant (P≤0.001). Table No. 34 and Graph No. 31 provides the
details.
Table No 41 : Effect on Kasa in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 2.400
±0.221
1.000
±0.211
1.400 58.33 0.699 6.332 ≤0.001
86
Effect of Treatment
Effect in Nishteevana :
77.27% of improvement was observed in the symptom Nishteevana. 2.2
was the initial mean score of Nishteevana recorded in the 10 patients of Kaphaja kasa in
this group. This was brought down to 0.5 after the administration of Dhoomapana and
Kaphaketu rasa. This improvement after the treatment is found to be highly significant
(P≤0.001) as per the paired ‘t’ test. The detail of the different statistical values are shown
in the Table No. 35 and Graph No. 32.
Table No 42 : Effect on Nishteevana in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 2.200
±0.200
0.500
±0.224
1.700 77.27 0.483 11.129 ≤0.001
Effect on Ura Vankshana Sampoornata : 2.6 was the mean initial score of Ura Vankshana Sampoornata before the
treatment in patients of Dhoomapana group. This initial mean score came down to 0.8
after the treatment. The improvement to the tune of 69.23% was highly significant
(P≤0.001) as revealed by the paired ‘t’ test. Details of the same are given in the Table No.
36 and Graph No. 33
Table No 43 : Effect on Ura Vankshana Sampoornata in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 2.600
±0.163
0.800
±0.291
1.800 69.23 0.632 9.000 ≤0.001
87
Effect of Treatment
Effect on Kapha Poorna Deha :
Kapha poorna deha is another symptom of Kaphaja kasa. The initial mean
score of the patients in this Dhoomapana group was 2.5 which was reduced to 0.5 after
the treatment. The improvement to the tune of 80% is said to be statistically highly
significant. Details of the same are represented in the Table No. 37 and Graph No. 34.
Table No 44 : Effect on Kapha Poorna Deha in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 2.500
±0.307
0.500
±0.224
2.000 80.00 0.943 6.708 ≤0.001
Effect on Asya Madhuryata : Before the treatment the total score of symptoms of Asya Madhuryata was 0.5.
After the treatment with Haridradi Dhoomapana and Kaphaketu Rasa this was reduced
completely, giving 100% effect. The change that occurred with the treatment is not great
enough to exclude the possibility that the difference is due to chance (P = 0.052) as
assessed by the paired ‘t’ test. The details of the same is given in the Table No. 38 and
Graph No. 35.
Table No 45 : Effect on Asya Madhuryata in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 0.500
±0.224
0.000
±0.000
0.500 100 0.707 2.236 =0.052
88
Effect of Treatment
Effect on Mandagni :
Patients treated with haridradi dhoomapana and kaphaketu rasa had
marked remission of agni mandya. 1.4 was the mean initial score in 10 patients of
kaphaja kasa which came down to 0.3 after the treatment. The improvement to the tune of
78.57% is found to be statistically significant (P=0.003) as shown in the Table No. 39
and Graph No. 36.
Table No 46 : Effect on Mandagni in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 1.400
±0.306
0.300
±0.153
1.100 78.57 0.876 3.973 =0.003
Effect on Aruchi Aruchi was relieved by 80% as the initial score, which was 1.5 reduced to 0.3
after the treatment with Haridradi Dhoomapana and Kaphaketu rasa. This improvement
when analyzed by the paired ‘t’ test found to the highly significant (P≤0.001). Table No.
40 and Graph No. 37 provides the details.
Table No 47 : Effect on Aruchi in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 1.500
±0.342
0.300
±0.213
1.200 80.00 0.789 4.811 ≤0.001
89
Effect of Treatment
Effect on Peenasa :
85% of improvement was observed in the symptom Peenasa. 2 was the
initial mean score recorded in the 10 patients of Kaphaja kasa in this group. This was
brought down to 0.3 after the administration of Dhoomapana and Kaphaketu rasa. This
improvement after the treatment is found to be highly significant (P≤0.001) as per the
paired ‘t’ test. The detail of the different statistical values are shown in the Table No. 41
and Graph No. 38.
Table No 48 : Effect on Peenasa in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 2.000
±0.211
0.300
±0.213
1.700 85.00 0.675 7.965 ≤0.001
Effect on Shiroruja : 1.3 was the mean initial score of Shiroruja before the treatment in patients of
Dhoomapana group. This initial mean score came down to 0.4 after the treatment. The
improvement to the tune of 69.23% was significant (P=0.010) as revealed by the paired
‘t’ test. Details of the same are given in the Table No. 42 and Graph No. 39
Table No 49 : Effect on Shiroruja in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 1.300
±0.396
0.400
±0.221
0.900 69.23 0.876 3.250 =0.010
90
Effect of Treatment
Effect on Phonation : The initial mean score of the patients in this Dhoomapana group was 0.8 which
was reduced to 0.2 after the treatment. The improvement to the tune of 75% is said to be
statistically significant as per paired t test with P=0.005. Details of the same are
represented in the Table No. 43 and Graph No. 40.
Table No 50 : Effect on Phonation in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 0.800
±0.200
0.200
±0.133
0.600 75.00 0.516 3.674 =0.005
Effect on Quantity of Sputum : Before the treatment the total score of Quantity of Sputum was 1.7, After the
treatment with Haridradi Dhoomapana and Kaphaketu Rasa this was reduced to 0.4. the
effect was 76.47%. This improvement after the treatment was found to be statistically
highly significant (P≤0.001) as assessed by the paired ‘t’ test. The details of the same is
given in the Table No. 44 and Graph No. 41
Table No 51 : Effect on Quantity of Sputum in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 1.700
±0.260
0.400
±0.163
1.300 76.47 0.823 4.993 ≤0.001
91
Effect of Treatment
Effect on Respiratory Rate :
Patients treated with haridradi dhoomapana and kaphaketu rasa had
marked improvement in Respiratory Rate. 0.4 was the mean initial score in 10 patients of
kaphaja kasa which came down to 0.1 after the treatment. The improvement to the tune of
75% is not found to be statistically significant (P=0.081) as shown in the Table No. 45
and Graph No. 42.
Table No 52 : Effect on Respiratory Rate in Dhoomapana Group
Means No. of
Patients BT
±SEM
AT
±SEM
Differe
nce in
mean
% S.D t P
10 0.400
±0.163
0.100
±0.100
0.300 75.00 0.483 1.964 =0.081
92
Effect of Treatment
Effect on Absolute Values of Spirometric Parameters : 10 Patients of Kaphaja Kasa were assessed before and after the administration of
Haridradi Dhoomapana and Kaphaketu rasa revealed that, Forced vital capacity had an
improvement of 91.34%, the initial mean score was 1.386 which was raised to 2.652. this
improvement as per paired t test stands to be statistically highly significant with P<0.001.
similarly Forced expiratory volume was also highly significant with mean score rising to
1.907 from 1.033. 102.05% was the improvement in Peak expiratory flow which is highly
significant as per the paired t-test, while the difference in FEV1/FVC showed a
statistically significant result with P = 0.006. all the four parameters have shown a
significant result in improvement of the values. The details are given in Table no. 46 and
Graph no 43
Table no 53 : Effect on Absolute Values of Spirometric Parameters in Dhoomapana Group
Mean
Parameters BT
±SEM
AT
±SEM
Difference in mean
% S.D t P
FVC 1.386
±0.099
2.652
±0.187
1.266 91.34 0.471 8.499 ≤0.001
FEV1 1.033
±0.121
1.907
±0.182
0.874 84.60 0.504 5.483 ≤0.001
PEF 2.137
±0.429
4.318
±0.563
2.181 102.05 0.898 7.679 ≤0.001
FEV1/FVC 61.144
±5.461
79.581
±3.057
18.437 30.15 14.15 3.591 =0.006
93
Effect of Treatment
Effect on Predicted percentage of Spirometric Parameters : 10 Patients of Kaphaja Kasa were assessed before and after the administration of
Haridradi Dhoomapana and Kaphaketu rasa revealed that, Forced vital capacity had an
improvement of 90.22%, the initial mean score was 39.300 which was raised to 74.760.
this improvement as per paired t test stands to be statistically highly significant with
P<0.001. similarly Forced expiratory volume was also highly significant with mean score
rising to 62.32 from 34.69. 101.52% was the improvement in Peak expiratory flow which
is highly significant as per the paired t-test, while the difference in FEV1/FVC showed a
statistical significant result with P = 0.006. all the four parameters have shown a
significant result in improvement of the values. The details are given in Table no. 47 and
Graph no 44
Table no 54 : Effect on Predicted percentage of Spirometric Parameters in Dhoomapana Group
Mean
Parameters BT
±SEM
AT
±SEM
Difference in mean
% S.D t P
FVC % 39.300
±2.792
74.760
±4.457
35.460 90.22 11.339 9.889 ≤0.001
FEV1% 34.690
±4.430
62.320
±4.644
27.630 79.64 13.845 6.311 ≤0.001
PEF% 27.590
±5.559
55.600
±6.904
28.010 101.52 10.717 8.265 ≤0.001
FEV1/FVC%
74.350
±6.357
99.99
±3.566
25.64 34.48 26.79 3.544 =0.006
94
Effect of Treatment
95
Effect of Treatment
EFFECT OF TREATMENT IN KAPHAKETU GROUP Effect on Severity :
Patients treated with kaphaketu rasa had marked remission of the severity of the
illness. 2.182 was the mean initial score of severity in 10 patients of kaphaja kasa which
came down to 1.273 after the treatment. The improvement to the tune of 41.65% is found
to be statistically significant (P=0.002) as shown in the Table No. 47 and Graph No. 44
Table No 55: Effect on Severity in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 2.182
±0.122
1.273
±0.273
0.909 41.65 0.701 4.303 =0.002
Effect on Kasa :
Kasa, one of the cardinal symptoms of Kaphaja Kasa relieved by 45.45% as the
initial score of Kasa which was 2 reduced to 1.091 after the treatment with Kaphaketu
rasa. This improvement when analyzed by the paired ‘t’ test found to the highly
significant (P≤0.001). Table No. 48 and Graph No. 45 provides the details.
Table No. 56 : Effect on Kasa in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 2.000
±0.191
1.091
±0.211
0.909 45.45 0.539 5.590 ≤0.001
95
Effect of Treatment
Effect on Nishteevana :
74.98% of improvement was observed in the symptom Nishteevana. 1.455
was the initial mean score of Nishteevana recorded in the 10 patients of Kaphaja kasa in
this group. This was brought down to 0.364 after the administration of Kaphaketu rasa.
This improvement after the treatment is found to be highly significant (P≤0.001) as per
the paired ‘t’ test. The detail of the different statistical values are shown in the Table No.
49 and Graph No. 46.
Table No. 57 : Effect on Nishteevana in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.455
±0.207
0.364
±0.203
1.091 74.98 0.302 12.00 ≤0.001
Effect on Ura Vankshana Sampoornata : 1.909 was the mean initial score of Ura Vankshana Sampoornata before the
treatment in patients of Kaphaketu group. This initial mean score came down to 0.909
after the treatment. The improvement to the tune of 52.38% was significant (P=0.004) as
revealed by the paired ‘t’ test. Details of the same are given in the Table No. 50 and
Graph No. 47
Table No. 58 : Effect on Ura Vankshana Sampoornata in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.909
±0.163
0.909
±0.315
1.000 52.38 0.894 3.708 =0.004
96
Effect of Treatment
Effect on Kapha Poorna Deha :
Kapha poorna deha is another symptom of Kaphaja kasa. The initial mean
score of the patients in this Kaphaketu group was 2.182 which was reduced to 1 after the
treatment. The improvement to the tune of 54.12% is said to be statistically significant.
Details of the same are represented in the Table No. 51 and Graph No. 48.
Table No. 59 : Effect on Kapha Poorna Deha in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 2.182
±0.377
1.000
±0.330
1.181 54.12 0.982 3.993 =0.003
Effect on Asya Madhuryata : Before the treatment the total score of symptoms of Asya Madhuryata was 0.273.
After the treatment with Kaphaketu Rasa this was reduced completely, giving 100%
effect. The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.082) as assessed by the paired ‘t’
test. The details of the same is given in the Table No. 52 and Graph No. 49
Table No. 60 : Effect on Asya Madhuryata in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 0.273
±0.141
000
±000
0.273 100 0.467 1.936 =0.082
97
Effect of Treatment
Effect on Mandagni :
Patients treated with kaphaketu rasa had marked remission of agni
mandya. 1 was the mean initial score in 10 patients of kaphaja kasa which came down to
0.09 after the treatment. The improvement to the tune of 90.9% is found to be statistically
highly significant (P≤0.001) as shown in the Table No. 53 and Graph No. 50.
Table No. 61 : Effect on Mandagni in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.000
±0.191
0.090
±0.090
0.909 90.90 0.539 5.590 ≤0.001
Effect on Aruchi Aruchi was relieved by 92.85% as the initial score, which was 1.273 reduced to
0.09 after the treatment with Kaphaketu rasa. This improvement when analyzed by the
paired ‘t’ test found to the highly significant (P≤0.001). Table No. 54 and Graph No. 51
provides the details.
Table No. 62 : Effect on Aruchi in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.273
±0.237
0.090
±0.090
1.182 92.85 0.751 5.221 ≤0.001
98
Effect of Treatment
Effect on Peenasa :
63.17% of improvement was observed in the symptom Peenasa. 1.727 was
the initial mean score recorded in the 10 patients of Kaphaja kasa in this group. This was
brought down to 0.636 after the administration of Kaphaketu rasa. This improvement
after the treatment is found to be highly significant (P≤0.001) as per the paired ‘t’ test.
The detail of the different statistical values are shown in the Table No. 55 and Graph No.
52
Table No. 63 : Effect on Peenasa in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.727
±0.195
0.636
±0.203
1.091 63.17 0.302 12.00 ≤0.001
Effect on Shiroruja : 0.273 was the mean initial score of Shiroruja before the treatment in patients of
Kaphaketu group. This initial mean score came down to 0.09 after the treatment. The
improvement to the tune of 66.66% was not significant (P=0.167) as revealed by the
paired ‘t’ test. Details of the same are given in the Table No. 56 and Graph No. 53
Table No. 64 : Effect on Shiroruja in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 0.273
±0.195
0.090
±0.090
0.182 66.66 0.405 1.491 =0.167
99
Effect of Treatment
Effect on Phonation : The initial mean score of the patients in this Kaphaketu group was 1.091 which
was reduced to 0.273 after the treatment. The improvement to the tune of 74.97% is said
to be statistically highly significant as per paired t test with P=0.001. Details of the same
are represented in the Table No. 57 and Graph No. 54
Table No. 65 : Effect on Phonation in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.091
±0.251
0.273
±0.141
0.818 74.97 0.603 4.500 =0.001
Effect on Quantity of Sputum : Before the treatment the total score of Quantity of Sputum was 1.182, After the
treatment with Kaphaketu Rasa this was reduced to 0.364. the effect was 69.20%. This
improvement after the treatment was found to be statistically highly significant (P=0.001)
as assessed by the paired ‘t’ test. The details of the same is given in the Table No. 58 and
Graph No. 55
Table No. 66 : Effect on Quantity of Sputum in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 1.182
±0.122
0.364
±0.203
0.818 69.20 0.603 4.500 =0.001
100
Effect of Treatment
Effect on Respiratory Rate :
Patients treated with kaphaketu rasa had marked improvement in
Respiratory Rate. 0.364 was the mean initial score in 10 patients of kaphaja kasa which
came down to 0 after the treatment. The improvement to the tune of 100% is found to be
statistically significant (P=0.038) as shown in the Table No. 59 and Graph No. 56
Table No. 67 : Effect on Respiratory Rate in Kaphaketu Group
Means No. of
Patients BT
±SEM
AT
±SEM
Difference
in mean
% S.D t P
11 0.364
±0.152
000
±000
0.364 100 0.505 2.390 =0.038
101
Effect of Treatment
Effect on Absolute Values of Spirometric Parameters : 11 Patients of Kaphaja Kasa were assessed before and after the administration of
Kaphaketu rasa revealed that, Forced vital capacity had an improvement of 24.72%, the
initial mean score was 2.095 which was raised to 2.613. this improvement as per paired t
test stands to be statistically highly significant with P<0.001. similarly Forced expiratory
volume was also highly significant with mean score rising to 2.175 from 1.632. 37.94%
was the improvement in Peak expiratory flow which is significant as per the paired t test,
while the difference in FEV1/FVC showed a statistically significant result with P =
0.010. all the four parameters have shown a significant result in improvement of the
values. The details are given in Table no. 60 and Graph no 57
Table No. 68 : Effect on Absolute Values of Spirometric Parameters in Kaphaketu Group
Mean Parameters BT
± SEM AT
± SEM
Difference
in mean
% S.D t P
FVC 2.095 ±0.280
2.613 ±0.310
0.518 24.72 0.366 4.698 ≤0.001
FEV1 1.632 ±0.229
2.175 ±0.286
0.544 33.33 0.408 4.420 ≤0.001
PEF 3.845 ±0.627
5.304 ±1.033
1.459 37.94 1.248 2.665 =0.024
FEV1/FVC 76.265 ±4.229
83.982 ±3.454
7.716 10.11 8.093 3.162 =0.010
102
Effect of Treatment
Effect on Predicted Percentage of Spirometric Parameters : 11 Patients of Kaphaja Kasa were assessed before and after the administration of
Kaphaketu rasa revealed that, Forced vital capacity had an improvement of 26.12%, the
initial mean score was 59.736 which was raised to 75.345. this improvement as per paired
t test stands to be statistically highly significant with P<0.001. similarly Forced
expiratory volume was also highly significant with mean score rising to 74.545 from
55.718. 39.07% was the improvement in Peak expiratory flow which was significant as
per the paired t- test, while the difference in FEV1/FVC showed a statistical significant
result with P = 0.010. all the four parameters have shown a significant result in
improvement of the values. The details are given in Table no. 61 and Graph no 58
Table No. 69 : Effect on Predicted Percentage of Spirometric Parameters in Kaphaketu Group
Mean Parameters BT
±SEM AT
±SEM
Difference
in mean
% S.D t P
FVC% 59.736 ±4.781
75.345 ±5.214
15.609 26.12 10.853 4.770 ≤0.001
FEV1% 55.718 ±4.717
74.545 ±6.155
18.827 33.78 11.860 5.265 ≤0.001
PEF% 49.164 ±7.082
68.373 ±9.447
19.209 39.07 16.26 3.140 =0.011
FEV1/FVC%
96.155 ±4.811
105.955 ±3.957
9.800 10.19 10.217 3.181 =0.010
103
Effect of Treatment
104
Effect of Treatment
COMPARISON OF THERAPEUTIC EFFECTS BETWEEN THE GROUPS.
Effect on Severity :
Favourable response was obtained in both the groups in regards to effect
of the treatment on severity of the illness. Also, comparatively a better response was
observed in the Dhoomapana group. The difference in mean symptom scores before and
after the treatment was 1.6 in the Dhoomapana group, and is higher than the one noted in
the kaphaketu group, which was 0.909. Though the statistical analysis of the same by
adapting the unpaired ‘t’ test does not rule out the chance factor for such a difference
between the groups, the efficacy is better in Dhoomapana group. Details are given in
Table No. 62 and Graph No. 59.
Table No. 70 : comparison of effect on severity
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.8 1.2 1.6 0.843 0.267
KK 11 2.182 1.273 0.909 0.691
0.701 0.211 2.050 P=0.054
Figure no 28 : comparison of effect on severity
0
0.5
1
1.5
2
2.5
3
mea
n sc
ore
DP KKseverity
BTAT
104
Effect of Treatment
Effect on Kasa :
Kasa the cardinal symptom of the disease kaphaja kasa was reduced in
both the groups after the treatment. The difference in mean scores before and after the
treatment in two groups when compared reveals that the Dhoomapana group is better in
relieving the kasa. In the kaphaketu group the difference in mean scores before and after
the treatment was 0.909, and is lesser than 1.4, the one noted in Dhoomapana group. The
difference observed between these groups could be due to chance. Statistically this
difference was insignificant (P=0.086). Table No. 63 and Graph No. 60 show the details.
Table no. 71 : comparison of effect on kasa
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.4 1.0 1.400 0.699 0.221
KK 11 2.0 1.091 0.909 0.491
0.539 0.163 1.811 P=0.086
Figure no. 29 : comparison of effect on kasa
0
0.5
1
1.5
2
2.5
mea
n sc
ore
DP KKkasa
BTAT
105
Effect of Treatment
Effect on Nishteevana :
Comparison of effects on nishteevana in two groups reveals that, better
improvement was found in patients treated with Dhoomapana. The variance of symptom
score before and after the treatment in Dhoomapana group was 1.7 and the same in
kaphaketu group was 1.091. The change observed between the groups was statistically
significant according to unpaired ‘t’ test. Same is represented in Table No. 64 and in
Graph No. 61
Table no. 72 : comparison of effect on nishteevana
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.2 0.5 1.700 0.483 0.153
KK 11 1.455 0.364 1.091 0.609
0.302 0.090 3.503 P=0.002
Figure no. 30 : comparison of effect on nishteevana
0
0.5
1
1.5
2
2.5
mea
n sc
ore
DP KKnishteevana
BTAT
106
Effect of Treatment
Effect on Ura Vankshana Sampoornata :
Comparison of effects on ura vankshana sampoornata in two groups
reveals that, better improvement was found in patients treated in Dhoomapana group. The
variance of symptom score before and after the treatment in Dhoomapana group was 1.8
and the same in kaphaketu group was 1.091. The change observed between the groups
was statistically significant according to unpaired ‘t’ test. Same is represented in Table
No. 65 and in Graph No. 62
Table no. 73 : comparison of effect on uravankshana sampoornata
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.6 0.8 1.800 0.632 0.200
KK 11 1.909 0.818 1.091 0.709
0.831 0.251 2.182 P=0.042
Figure no. 31 : comparison of effect on uravankshana sampoornata
0
0.5
1
1.5
2
2.5
3
mea
n sc
ore
DP KKura vankshana sampoornata
BTAT
107
Effect of Treatment
Effect on Kapha Poorna Deha :
Favourable response was obtained in both the groups in regards to effect of the
treatment on kaphapoorna deha. Also, comparatively a better response was observed
in the Dhoomapana group. The difference in mean symptom scores before and after
the treatment was 2 in the Dhoomapana group, and is just higher than 1.182, the one
noted in the kaphaketu group. Though the statistical analysis of the same by adapting
the unpaired ‘t’ test does not rule out the chance factor for such a difference between
the groups, the efficacy is marginally better in Dhoomapana group. Details are given
in Table No. 66 and Graph No. 63.
Table no. 74 : comparison of effect on kapha poorna deha
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.5 0.5 2.0 0.943 0.298
KK 11 2.182 1.0 1.182 0.818
0.982 0.296 1.944 P=0.067
Figure no. 32 : comparison of effect on kapha poorna deha
0
0.5
1
1.5
2
2.5
mea
n sc
ore
DP KKkapha poorna deha
BTAT
108
Effect of Treatment
Effect on Asya Madhurata :
The difference in means of asya madhurata score before and after the treatment in
the Dhoomapana group was 0.5 as against 0.273 in the kaphaketu group. This difference
proves the better efficacy of the Shodhana and shamana in relieving the asya madhurata
in comparison to the relief obtained by only shamana. Table No. 67 and Graph No. 64
gives the detail
Table no. 75 : comparison of effect on asya madhurata
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 0.5 0.0 0.5 0.707 0.224
KK 11 0.273 0.0 0.273 0.227
0.467 0.141 0.877 P=0.391
Figure no. 33 : comparison of effect on asya madhurata
00.05
0.10.15
0.20.25
0.30.35
0.40.45
0.5
mea
n sc
ore
DP KKasya madhurata
BTAT
109
Effect of Treatment
Effect on Mandagni :
In patients treated with Dhoomapana and kaphaketu rasa a difference of 1.1 was
recorded in the difference in mean scores before and after the treatment. The value of the
same in the kaphaketu group was 0.909. This difference in values states that there is
better effect in Dhoomapana group in relieving kaphaja kasa. But the unpaired ‘t’ test
could not prove the statistical significance of the variations seen between the groups.
Table No. 68 and Graph No. 65 represents the same.
Table no. 76 : comparison of effect on mandagni
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 1.4 0.3 1.1 0.876 0.277
KK 11 1.0 0.09 0.909 0.191
0.539 0.163 0.608 P=0.550
Figure no 34 : comparison of effect on mandagni
0
0.2
0.4
0.6
0.8
1
1.2
1.4
mea
n sc
ore
DP KKmandagni
BTAT
110
Effect of Treatment
Effect on Aruchi :
The difference in means of Aruchi score before and after the treatment in the
Dhoomapana group was 1.2 as against 1.182 in the kaphaketu group. This difference
proves the better efficacy of the shodhana and shamana in relieving the symptom aruchi
in comparison to the relief obtained by the shamana only. Table No. 69 and Graph No. 66
gives the detail
Table no. 77 : comparison of effect on aruchi
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 1.5 0.2 1.2 0.789 0.249
KK 11 1.273 0.09 1.182 0.018
0.751 0.226 0.054 P=0.957
Figure no. 35 : comparison of effect on aruchi
00.20.40.60.8
11.21.41.6
mea
n sc
ore
DP KKaruchi
BTAT
111
Effect of Treatment
Effect on Peenasa :
Comparison of effects on the symptom peenasa in two groups reveals that, better
improvement was found in patients treated with Dhoomapana. The variance of symptom
score before and after the treatment in Dhoomapana group was 1.7 and the same in
kaphaketu group was 1.091. The change observed between the groups was statistically
significant according to unpaired ‘t’ test. Same is represented in Table No. 70 and in
Graph No. 67
Table no. 78 : comparison of effect on peenasa
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.0 0.3 1.7 0.675 0.213
KK 11 1.727 0.636 1.091 0.609
0.302 0.090 2.715 P=0.014
Figure no 36 : comparison of effect on peenasa
00.20.40.60.8
11.21.41.61.8
2
mea
n sc
ore
DP KKpeenasa
BTAT
112
Effect of Treatment
Effect on Shiroruja :
Comparison of effects on the symptom shiroruja in two groups reveals that, better
improvement was found in patients treated under Dhoomapana group. The variance of
symptom score before and after the treatment in Dhoomapana group was 0.9 and the
same in kaphaketu group was 0.182. The change observed between the groups was
statistically significant according to unpaired ‘t’ test. Same is represented in Table No. 71
and in Graph No. 68
Table no. 79 : comparison of effect on shiroruja
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 1.3 0.4 0.9 0.876 0.277
KK 11 0.273 0.09 0.182 0.718
0.405 0.122 2.452 P=0.024
Figure no. 37 : comparison of effect on shiroruja
0
0.2
0.4
0.6
0.8
1
1.2
1.4
mea
n sc
ore
DP KKshiroruja
BTAT
113
Effect of Treatment
Effect on Phonation :
In patients treated with kaphaketu rasa, a difference of 0.818 was recorded in the
mean of difference before and after the treatment. The value of the same in the
Dhoomapana group was 0.6. This difference in values states that the unpaired ‘t’ test is
not statistical significance of the variations seen between the groups. Table No. 72 and
Graph No. 69 represents the same.
Table no. 80 : comparison of effect on Phonation
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 0.8 0.2 0.6 0.516 0.163
KK 11 1.091 0.273 0.818 0.218
0.603 0.182 0.886 P=0.387
Figure no. 38 : comparison of effect on Phonation
0
0.2
0.4
0.6
0.8
1
1.2
mea
n sc
ore
DP KKphonation
BTAT
114
Effect of Treatment
Effect on Quantity of Sputum :
Quantity of sputum was reduced in both the groups after the treatment. The
difference in mean scores before and after the treatment in kaphaketu group was 0.818,
and is lesser than the one noted in Dhoomapana group. Here in patients treated with
Dhoomapana the difference in mean symptom score before and after the treatment was
1.3. The difference observed between these groups could be due to chance. Statistically
this difference was insignificant (P=0.140). Table No. 73 and Graph No. 70 show the
details.
Table no. 81 : comparison of effect on Quantity of sputum
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 1.7 0.4 1.3 0.823 0.260
KK 11 1.182 0.364 0.818 0.482
0.603 0.182 1.540 P=0.140
Figure no 39 : comparison of effect on quantity of sputum
00.20.40.60.8
11.21.41.61.8
mea
n sc
ore
DP KKQuantity of sputum
BTAT
115
Effect of Treatment
Effect on Respiratory Rate :
The difference in means of respiratory rate score before and after the treatment in
the kaphaketu group was 0.364 as against 0.30 in the Dhoomapana group. This difference
proves the better efficacy of the shamana in correcting the respiratory rate in comparison
to the relief obtained by the shodhana with shamana. Table No. 74 and Graph No. 71
gives the detail
Table no. 82 : comparison of effect on respiratory rate
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 0.4 0.1 0.3 0.483 0.153
KK 11 0.364 0.0 0.364 0.063
0.505 0.152 0.295 P=0.772
Figure no. 40 : comparison of effect on respiratory rate
00.05
0.10.15
0.20.25
0.30.35
0.4
mea
n sc
ore
DP KKRespiratory Rate
BTAT
116
Effect of Treatment
Comparison of Effect on Absolute values of FVC :
10 patients from Dhoomapana group and 11 patients from kaphaketu group were
assessed for the evaluation of absolute values of spirometric parameters and it revealed
that the difference in mean of Forced vital capacity in Dhoomapana group was higher
than that in Kaphaketu group. this difference to the tune of 0.748 with P value less than
0.001 is statistically highly significant as per the un-paired t test.
Table no. 83 : comparison of Effect on absolute values of FVC
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 1.386 2.652 1.266 0.471 0.149
KK 11 2.095 2.613 0.518 0.748
0.366 0.110 4.085 P≤0.001
Figure no. 41 : comparison of Effect on absolute values of FVC
0
0.5
1
1.5
2
2.5
3
mea
n sc
ore
DP KKFVC
BTAT
117
Effect of Treatment
Comparison of Effect on Absolute values of FEV1:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were assessed for the evaluation of absolute values of spirometric parameters and it revealed that the difference in the mean scores between the groups of the value of Forced expiratory volume was 0.33, which is not statistically significant. As per the un-paired t-test.
Table no. 84 : comparison of Effect on absolute values of FEV1
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 1.033 1.907 0.874 0.504 0.159
KK 11 1.632 2.175 0.544 0.330
0.408 0.123 1.658 P=0.114
Figure no. 42 : comparison of Effect on absolute values of FEV1
0
0.5
1
1.5
2
2.5
mea
n sc
ore
DP KKFEV1
BTAT
118
Effect of Treatment
Comparison of Effect on Absolute values of PEF:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were assessed for the evaluation of absolute values of spirometric parameters and it revealed that the difference between the Peak expiratory flow values between the groups does not rule out the possibility of chance factor, as P is equal to 0.148.
Table no. 85 : comparison of Effect on absolute values of PEF
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 2.137 4.318 2.181 0.898 0.284
KK 11 3.845 5.304 1.459 0.722
1.248 0.376 1.507 P=0.148
Figure no. 43 : comparison of Effect on absolute values of PEF
0
1
2
3
4
5
6
mea
n sc
ore
DP KKPEF
BTAT
119
Effect of Treatment
Comparison of Effect on Absolute values of FEV1/FVC:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were assessed for the evaluation of absolute values of the difference between FEV1 and FVC. it revealed that there was a statistically significant change with higher difference values to the tune of 18.437 in Dhoomapana group compared to 7.716 in Kaphaketu group.
Table no. 86 : comparison of Effect on absolute values of FEV1/FVC
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 61.144 79.581 18.437 14.15 4.475
KK 11 76.265 83.982 7.716 10.721
8.093 2.440 2.157 P=0.044
Figure no. 44 : comparison of Effect on absolute values of FEV1/FVC
0102030405060708090
mea
n sc
ore
DP KKFEV1/FVC
BTAT
120
Effect of Treatment
Comparison of Effect on Predicted Percentage of FVC:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were
assessed for the evaluation of predicted percentage of spirometric parameters and it
revealed that the difference in mean of Forced vital capacity in Dhoomapana group was
higher than that in Kaphaketu group. this difference to the tune of 19.851 with P value
less than 0.001 is statistically highly significant as per the un-paired t test.
Table no. 87 : comparison of Effect on predicted percentage of FVC
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 39.3 74.76 35.460 11.34 3.586
KK 11 59.736 75.345 15.609 19.851
10.85 3.272 4.098 P≤0.001
Figure no. 45 : comparison of Effect on predicted percentage of FVC
01020304050607080
mea
n sc
ore
in %
DP KKFVC
BTAT
121
Effect of Treatment
Comparison of Effect on Predicted Percentage of FEV1:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were assessed for the evaluation of predicted percentage of spirometric parameters and it revealed that the difference in the mean scores between the groups of the value of Forced expiratory volume was 8.793, which is not statistically significant as per the un-paired t-test.
Table no. 88 : comparison of Effect on predicted percentage of FEV1
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 34.69 62.32 27.620 13.86 4.385
KK 11 55.718 74.545 18.827 8.793
11.86 3.576 1.566 P=0.134
Figure no. 46 : comparison of Effect on predicted percentage of FEV1
01020304050607080
mea
n sc
ore
in %
DP KKFEV1
BTAT
122
Effect of Treatment
Comparison of Effect on Predicted Percentage of PEF:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were assessed for the evaluation of predicted percentage of spirometric parameters and it revealed that the difference between the Peak expiratory flow values between the groups does not rule out the possibility of chance factor, as P is equal to 0.164.
Table no. 89 : comparison of Effect on predicted percentage of PEF
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 27.59 55.6 28.010 10.71 3.389
KK 11 49.164 68.373 19.209 8.801
16.26 4.904 1.447 P=0.164
Figure no. 47 : comparison of Effect on predicted percentage of PEF
0
10
20
30
40
50
60
70
mea
n sc
ore
in %
DP KKPEF
BTAT
123
Effect of Treatment
Comparison of Effect on Predicted Percentage of FEV1/FVC:
10 patients from Dhoomapana group and 11 patients from kaphaketu group were assessed for the evaluation of predicted percentage of the difference between FEV1 and FVC and it revealed that there was a marked change with higher difference values to the tune of 25.64 in Dhoomapana group compared to 9.8 in Kaphaketu group, but it did not stand significant as P was equal to 0.084.
Table no. 90 : comparison of Effect on predicted percentage of FEV1/FVC
Unpaired ‘t’ test Group No. of
patients
BT AT BT-AT Difference
in mean S.D. S.E.M. ‘t’ P
DP 10 74.35 99.99 25.640 26.79 8.472
KK 11 96.155 105.95
5
9.800 15.840 10.21 3.080
1.824 P=0.084
Figure no. 48 : comparison of Effect on predicted percentage of FEVI/FVC
0
20
40
60
80
100
120
mea
n sc
ore
in %
DP KKFEV1/FVC
BTAT
124
Effect of Treatment
Overall effect of the treatment in both the groups : After the completion of the 1 month course of treatment in the two groups the
overall assessment of the patients were made as discussed in the assessment criteria. The
analysis revealed that 2 patients each in either groups had 100% relief from symptoms of
kaphaja kasa. In both the Dhoomapana group and kaphaketu group 2 patient each had
marked improvement from the symptoms of kaphaja kasa. Moderate improvement of the
illness was seen in 50% of the patients in Dhoomapana group on the contrary only
36.3%patients had moderate improvement in Kaphaketu group. 10% patients and 27.2%
patients had average improvement in the symptoms in Dhoomapana Group and
Kaphaketu Group respectively. There were no patients under the criteria of no change in
the symptoms of illness in both the groups. All the 21 patients taken for the study had
some or the other form of improvement in the symptoms of kaphaja kasa.
125
Effect of Treatment
Table no 91 : overall effect of the treatment in both the groups
EFFECT DP
group
% KK
group
% Total %
Complete Remission 2 20 2 18.1 4 19 Marked improvement 2 20 2 18.1 4 19 Moderateimprovement 5 50 4 36.3 9 43 Average improvement 1 10 3 27.2 4 19 No change 0 0 0 0 0 0
Figure 49 : overall effect of the treatment in both the groups
2018.1 2018.1
50
36.3
10
27.2
0 005
101520253035404550
% o
f pts
C R Mrk I Mod I Av I Nochange
EFFECT
DP grpKK grp
126
Discussion
DISCUSSION
In Ayurvedic literature, the classification of the disease Kasa has been done
mainly on the basis of the nature of sputum. In kaphaja kasa patient expectorates copious,
unctuous viscid and white colored sputum. The reason for which is the hyper secretion of
mucous in pranavaha srotas. This produces restriction to airflow. Naturally to expel the
excessive secreted mucous, kasa is produced.
Definition of kasa highlights two meanings, that is despised sound and movement.
The various reasons for vitiation of Vata has direct impact on the various nature of sound
of kasa produced. That means according to the site of obstruction to the flow of Vata the
nature of sound differs. Most of the times, in laryngeal paralysis bovine like sound is
produced. A harsh, hoarse or croupy cough suggests a laryngeal infection. In destructive
lesions of the vocal cord, such as tuberculous ulceration or new growth, the cough
becomes a toneless whisper. A high-pitched brassy cough may result with tracheal
lesions129.
The movement occurring in process of kasa starts from uras and is in the nature of
falling. The word shatana indicates falling or forward movement. During the process of
cough the patient bends forward. Also during kasa the patient feels breaking pain and
jerks in the whole body. Particularly causing strain and stiffness in hanu, manya, akshi,
netra, prushta, ura and parshwa. This points out that an abnormal sound along with
abnormal movement taking place during the production of kasa.
NIDANA-Just as in all the diseases common etiological factors have been
described, in kasa also this has been described. Along with common etiological factors,
specific etiological factors of different varieties of kasa are also described. Both the types
of etiology that is common and specific to kaphaja kasa plays an important role in
producing the disease kaphaja kasa.
The onset of kaphaja kasa depends on exogenous and endogenous factors. In the
Nidana context amarasa and avarana can be taken as abhyantara karana. It is explained
that stivana is one of the symptom of kaphavruta prana vayu. So in this context avarana
can be considered as kaphavruta prana. It is also mentioned that pratishyaya if left
127
Discussion
untreated will lead to kasa. This can also be taken as an abhyantara karana. This can be
compared to the fact of the conventional medicine that upper respiratory tract infection is
one of the reason for chronic bronchitis. The factors like dhooma, raja, etc. acts as
exogenous factors.
The causative factors can also be classified as dietic causes and behavioral causes.
Further among the causative factors some act directly as khavaigunya utpadaka karana in
pranavaha srotas, some act as kapha prakopaka karana and some as vata prakopaka
karana.
SAMPRAPTI-The importance of the knowledge of the pathogenic process is to
break the sammurchana of Dosha and dushya. Along with Dosha and dushya, rest of the
samprapti ghatakas like Agni, ama, srotas, etc. also have a role in the manifestation and
progress of the disease. For the breakdown of the samprapti, a clear knowledge about the
various ghatakas are important.
The kapha Dosha is the principal basic factor in kaphaja kasa. the excessive
secreted malarupi kapha obstructs the flow of vata in kaphaja kasa. The varieties of vata
which are involved in kasa are pranavata and udanavata. As the pranavayu is obstructed
by malarupi kapha, it follows udana gati which is having upward movement. Kasa is
mentioned as one of the symptom of prakupita prana vayu.
Rasa is the dushya in kaphaja kasa. There is a mention of kasa as one of the
symptom of rasa vrudhi. Rasa sthana of uras is said to be the sanchara sthana and
adhistana of kaphaja kasa as mentioned in the samprapti.
Agnimandyata is the reason for all diseases. Here in kaphaja kasa Jathragni
mandya develops in two ways, due to exogenous factors like guru, abhishyandi Ahara,
etc. it leads to agni mandya because of their antagonistic properties. Secondly
agnimandya also occurs due to vrudha kapha Dosha, the kapha that is secreted
excessively due to the homologous properties of the etiological factors, will produce
agnimandya due to Manda Guna.
The causes of Dosha vaishamya cannot be considered as completely discussed
without the mention of ama. In kaphaja kasa due to the hypo functioning of kayagni the
food which is not properly digested, yields immature or improperly formed rasa in the
128
Discussion
udbhavasthana, that is the amashaya and this is called as ama. This ama circulates in the
body with rasa Dhatu and vitiates the kapha Dosha.
POORVAROOPA- Poorvaroopas of kasa are produced by the vitiated Doshas
during the process of sthana samshraya. Feeling of presence of thorn in the throat, itching
in the throat, and pain on swallowing the morsel of the food indicates that the sthana
samshraya of Doshas is taking place in the throat. In the commencement of inflammatory
changes in throat, patient develops throat irritation. The prodromal symptom like coating
in palate and throat, and loss of appetite indicates kapha vrudhi is taking place in the
body. Galatalu lepa and agnisada indicates that the Doshas are located in the rasa Dhatu.
Hridaya is the mula of rasavaha srotas so person feels discomfort in the chest, when rasa
Dhatu is affected.
ROOPA- Roopa are the symptoms of the actual manifestation of the disease. The
symptoms may change from time to time according to the progress or retrogress of the
disease. Even though the main pathological change is taking place in pranavaha srotas,
the other systems like the rasavaha and annavaha srotas are also involved.
The pratyatma lakshana of kaphaja kasa is bahula, sweta and snigdha steevana
yukta kasa. The word bahula indicates excessive or copious. In chronic bronchitis patient
expectorates about one eggful(25ml) of sputum. Swetatva and acchata refers to
whitishness and transparency of kapha. It is due to the presence of colloids and the gel
state. In chronic bronchitis person expels mucoid sputum in between the exacerbations
and is white in color. Viscidity along with gurutva and sthiratva are conferred by the gel
state of kapha. Due to the presence of the constituents with higher molecular weight like
glycoproteins and fat protein complex which reflects the Physico chemical qualities of
pruthvi and aap mahabhuta.
In obstructive bronchitis person expels plugs of sputum. It shows that according
to the phase of the disease the character of the sputum changes. Also in kaphaja kasa the
character of sputum is very variable.
The increased ruksha guna of prana vata when comes in contact with sheeta guna
of udana vata produces pain in chest region. Pain during coughing presumably originates
129
Discussion
in sensory nerve endings of the tracheo-bronchial tree, which is due to hyperplasic
changes in the mucosa of trachio-bronchial tree. During the process of coughing
contraction of respiratory muscles occurs resulting in increased intra-thoracic pressures
which stimulates sensory nerve endings in the place of hyperplasia, so person suffers
from pain. The sensory nerve roots are spread all over the mucosa of trachea and throat.
Due to coughing or excessive mucous secretion, the sensory nerves gets stimulation and
the patient develops itching in the throat.
Peenasa is a disease related to pranavaha srotas. Hoarseness of voice,
madhurasyata, coating of mouth, utklesha and vomiting denotes the sthanasamshraya in
the mouth as well the bahu doshavastha of kapha Dosha trying to get expelled by itself.
Aruchi and Mandagni denotes the involvement of rasa Dhatu and jathragni. Gaurava and
shirashoola explains the vitiation of kapha and vata Dosha respectively.
UPASHAYANUPASHAYA- in kaphaja kasa some times the diagnosis becomes
difficult or may not even be possible on the presentations as although patient expectorates
copious sputum easily in kaphaja kasa. But if the serous content in sputum is less, the
viscosity of the sputum becomes more hence there is difficulty in expectorating which
may mimic the presentation of vataja kasa. In such situations upashaya by katu, ruksha
and ushna drugs administration and aggravation of symptoms by consuming snigdha,
madhura and sheeta Dravyas helps to arrive at a diagnosis.
UPADRAVA- in kaphaja kasa if Pitta Dosha anubanda is present then tamaka
shwasa will develop. Similarly in conventional medicine, it is explained that in chronic
bronchitis at the time of exacerbation spasm of bronchi develop due to inflammation. So
at this time patient develops asthma.
SADYASADYATA- kaphaja kasa is mentioned as sadya in Ayurvedic classics.
Similarly conventional science also considered simple chronic bronchitis has most
favourable prognosis. In obstructive bronchitis there will be irreversible obstruction. This
is considered as bhedavastha of kaphaja kasa and is said to be difficult to treat.
130
Discussion
ARISTA- Several lakshanas having kasa as an associate symptom are mentioned
to be the signs of ultimate death.
TREATMENT- The Principles of treatment that are adopted in kaphaja kasa are
Nidana parivarjana, the first and important line of treatment. So smoking, exposure to
dust etc. should be avoided. Kapha dosha and rasa dhatu are the pathological factors of
kaphaja kasa belonging to the same category. As per the general principal if the Dosha
and dushya belong to the same category, as these factors tend to support each other in the
pathogenesis the treatment becomes more difficult. As the disease runs a chronic course,
there is likeliness that the patient losses his bala in the course of time. Depending upon
the physical strength of patients of kaphaja kasa the treatment is classified into shodhana,
shamana and rasayana for physically strong patients where only shamana and rasayana
for physically weak patients. Liquefication of the accumulated kapha dosha and there
after its expulsion forms the basis for a better samprapti vighatana so shodhana
procedures are aimed.
Vamana is the best shodhana for the kapha Dosha. After that virechana is to be
given, it is very much beneficial in kaphaja kasa for bringing the normalcy in vayu gathi.
This is followed by shirovirechana. Kapha is accumulated in the head, elimination of this
kapha and to rectify vata Dosha in the head the nasya is given. Dhoomapana is given to
expel the kapha out of the uras which is the prime location of the illness kaphaja kasa.
Kavala and gandusha is given to remove the Dosha from the mouth.
The purpose of shamana Chikitsa is to do vishoshana of the kapha which still
exists after shodhana. Here the shamana aushadis having katu rasa, ushna, laghu and
ruksha gunas and which are kaphahara in nature, also kasaghna drugs are advised. There
after To raise the immunity of the body in general and the pranavaha srotas in particular
and to make the srotas tolerable to the asatmya bhavas, rasayana is advised.
The cardinal symptom of chronic bronchitis is cough with expectoration which
can be compared to sakapha kasa, in kaphaja kasa. The expectoration in recurrent
mucopurulent chronic bronchitis is of mucoid, oily, and white in colour which resembles
to the expectoration in kaphaja kasa. In purulent chronic bronchitis the colour of the
sputum is yellow and there will be acute symptoms of infections. These symptoms
131
Discussion
develop in kaphaja kasa only when there is pitta doshanubandha. Obstructive chronic
bronchitis develop due to various reasons like mucous, edema, inflammatory cell
infiltration, muscle hypertrophy, fibrosis etc. which may produce in kaphaja kasa at the
terminal stages. Considering all these conditions kaphaja kasa can be better co-related to
Recurrent mucopurulent chronic bronchitis.
Selection of the regimen:
In the present study, the Haridradi Dhoomapana and Kaphaketu rasa is taken to
treat the patients of kaphaja kasa and to explore the efficacy of these in bringing about
cure of the illness.
In the line of treatment for kaphaja kasa, shodhana of the Dosha in different forms
have been mentioned. But when we consider today’s bala and overall health status of the
patients they are unsuitable to shodhana procedures like vamana and virechana. Over
here a shodhana procedure which will give immediate result by inducing less physical
strain and that having less restrictions to the daily routine of diet and behavior is the need
of the hour. So Haridradi Dhoomapana is considered as best type of shodhana in this
form, as it directly reaches the site of pathology and by liquefying the Dosha it brings it
out. Also the treatment is not complete if we don’t take care of the shesha Dosha which is
left even after shodhana. To achieve this Kaphaketu rasa is the treatment of choice as it
has the ingredients which will do shoshana of the kapha Dosha. For the same purpose this
combination of shodhana and shamana is taken for the study in the present work.
To compare the efficacy of relevance of this combination further a control group
is planned in which only the shamana line of treatment in the form of Kaphaketu rasa is
administered.
Plan of the study:
132
Discussion
In the present clinical study, a total of 21 patients suffering from kaphaja kasa
were taken from the O.P.D. and I.P.D. of S.D.M. college of Ayurveda and Hospital, and
all completed the course of the treatment. The disease is mainly diagnosed on the basis of
signs and symptoms of kaphaja kasa as mentioned in the Ayurvedic texts. Aided by the
signs and symptoms and criteria for diagnosis mentioned for chronic bronchitis.
Spirometric test was carried out to confirm the diagnosis as well to record the progress or
improvement in the patients after the intervention. To assess the general health status of
the patients as well as to rule out other possible pathologies routine haematological
examination was carried out in all the patients.
These 21 patients of kaphaja kasa selected for the study were randomly
segregated in to two groups irrespective of age, sex or creed as well as severity of the
illness. the first group consisting of 10 patients is treated as test group and named as
Dhoomapana group. The patients were administered with shodhana with Haridradi
Dhoomapana in a frequency of 3 bouts(each bout carrying 3 puffs) of Dhoomapana early
morning once in a day for 7 days along with shamana by Kaphaketu rasa in the dose of
125mg three times in a day along with 1 teaspoon of Ardraka swarasa as Anupana which
was continued till 1 month of the treatment.
the second group consisting of 11 patients is treated as control group and named
as Kaphaketu group. The patients were administered only shamana with Kaphaketu rasa
in a dose of 125mg taken thrice in a day along with 1 teaspoon of Ardraka swarasa for a
period of 1 month.
General description of patients:
Descriptive statistical analysis of patients:
In this study involving 21 patients of kaphaja kasa, majority of the patients
belonged to the age group of 21 to 30 and 41 to 50 years. Though the contemporary
science states that the incidence of chronic bronchitis increases with age, this study of 21
patients of kaphaja kasa being small could not represent this general observation. 42% of
the patients were females and 58% were males. The significance of this figure is
133
Discussion
doubtful. The incidence of chronic bronchitis is said to be 10 times more in males to that
of females. one of the reasons could be the exposure to irritants is more amongst females
and they are also exposed to passive smoking which is more harmful than active
smoking. Majority of the patients were Hindus in the present series. The religion has
nothing to do with the causation of the illness, and the predominance of Hindus
accounting 71% in this study only represent the population in around Udupi, which is
dominated by Hindus. Majority of patients accounting 62% were married as against only
33% of the patients who were unmarried. This only represents the adult age group of the
patients that is taken for the study, 33% of the patients were illiterates, and 28% of the
patients were graduates. Once again education has no role in the predisposition of the
illness, and this only correspond to the educational status of population at large from
which the present sample is selected. Most of the patients, in particular females revealed
house hold as their occupation, for cooking purpose they were exposed to natural gas and
smoke which are the devastating causes of chronic bronchitis. More number of lower
middle class people, were recorded in this study, the middle socio-economic status of the
patient has nothing to do with the causation of the illness, more over this incidence only
represents the socio-economic status of the patients in and around Udupi. The mode of
onset of kaphaja kasa was considered to be insidious in 17 cases and gradual in 4 cases.
This states that the gradual onset proves the true nature of kaphaja kasa but the maximum
patients having insidious onset, states that the infection must have followed the damage
to the bronchial tree which is more likely considering the dusty atmosphere where the
patients are dwelling. No patients had sudden onset which rules out presence of any acute
infection. Maximum patients 62% had recurrent course of the illness. This states that they
disease develops at intervals having symptom free periods. This is true as almost all
patients reported of alteration in symptoms with change in weather also all patients had
history of exposure to some or other form of pollutants. Patients having moderate severity
of illness were more in this study. There were 9 patients having mucoid and sticky
expectoration and 6 patients were having thick frothy expectoration whereas 4 patients
had mucopurulent sputum. As the patients visiting for the treatment had presentations of
different stages of chronic bronchitis as per the chronicity in the illness the patients had
different consistencies of sputum. Udupi being situated near sea shore and also being an
134
Discussion
anupa desha all aggravating factors for kaphaja kasa are dominant in this area, the same
was reflected in the patients taken in present study. More number of patients 71%
reported that their working place was non-polluted. It may be that the patients had more
symptoms during traveling, during altered weather conditions and housewives when
exposed to passive smoking in contrast to working people getting exposed to house dust
and cooking smoke. 17 patients out of 21 were having mixed dietary habits. It shows that
more of guru, snigdha, food was consumed in the form of mamsa which is considered as
causative factors for kaphaja kasa. Similarly dominance of madhura and amla rasa was
found in the diet once again contributing to the etiology. There were 9 smokers out of 21
patients taken for the study. As the number of patients in this study is small, this data is
insufficient to conclude as per general observations which states that smoking is the
dominant cause for chronic bronchitis.
Ekadoshaja Prakriti as well as Sama Prakriti was not observed in any patients of
kaphaja kasa. All the patients belonged to the Dvandvaja Prakriti, and in that 53% of the
patients had KaphaPittaja Prakriti. It is said that, diseases due to morbidity of kapha is
common in kapha Prakriti people, this nature of the incidence of the illness reflects the
same data. Interrogation of the patients revealed that 85% of the patients had Madhyama
Satva as against 10 % of patients having Avara Satva. It is understood that, mental
tension and anxiety has some role to do with the severity of the illness, and the present
observation in this sample showing majority of the patients with either Madhyama or
Avara Satva bear the same understanding. Analysis of the Sara in 21 patients of kaphaja
kasa revealed that 76% of the patients had Madhyama Sara and the remaining 14% had
Avara Sara whereas only 10% had Pravara sara. In the pathogenesis of the kaphaja kasa
runs a chronic course and this chronicity has a tendency to cause depletion of the body
elements and that may be reason the patients showing Madhyama or Avara Sara in their
physique. Analogous to Sara of the patients, assessment of the Samhanana of the patients
showed the higher incidence of Madhyama Samhanana. 66% of the patients had
Madhyama Samhanana out of 21 patients of kaphaja kasa. Dominance of patients from
middle and then from poor socio-economic status reveales the lack of nutrition. This
leads to reduced samhanana. Madhyama Satmya was observed in 90% of the patients of
135
Discussion
kaphaja kasa. Satmya of the patients has direct bearing with the Sara and Samhanana,
predominance of Madhyama Satmya also explains preponderance of Madhyama Sara as
well as Madhyama Samhanana. Assessment of the Agni was also carried out in all the
patients suffering from kaphaja kasa. It was observed that majority of 62% of the patients
had Madhyama Abhyavaharana as well as Madhyama Jarana Shakti. 24% of the patients
had Avara Abhyavaharana and Jarana Shakti. Impairment of the Agni is a common
phenomenon of kaphaja kasa. Impaired functioning leads to impaired ability to consume
food as well as reduced digestive ability. The same is reflected in the present sample with
a minimum 14% of patients showing good functioning of the Agni. Physical strength is
likely to be reduced as the depletion of the body element is a regular phenomenon due to
the chronicity of the illness in patients suffering from kaphaja kasa. Corroboratory to this
phenomenon, in the present study also majority of 11 patients had madhyama whereas 6
patients had avara ability to do the physical exercise. Maximum number of patients were
from anupa desha as Udupi and surrounding from were the patients were taken lie in
anupa desha.
The therapeutic effect of the treatments in both the groups was assessed
methodically in regards to the salient features of kaphaja kasa, like severity, kasa,
expectoration, fullness of chest, heaviness all over the body, sweetness of mouth, loss of
appetite, loss of desire for food, coryza, headache, effect on speech, quantity of sputum,
effect on respiratory rate and effect on mental status. Assessment in the improvement of
lung capacity was made using spirometric evaluation of absolute values of the
spirometric parameters as well as its predicted percentage. Overall effect of the
treatments was also analyzed. The results of the treatments in both the groups are
discussed in the following pages.
Effect on severity – remission of the severity of the illness was recorded in both the
groups. Improvement observed in the Dhoomapana group was statistically highly
significant (P≤0.001). and also in the Kaphaketu group the effect of the treatment on
severity was statistically significant (P=0.002). a better improvement was recorded in the
Dhoomapana group in comparison to the patients in Kaphaketu group. However the un-
136
Discussion
paired t-test could not confirm the statistical significance(P=0.054) of better improvement
in Dhoomapana group.
Effect on kasa – the symptom kasa was reduced following treatment in both the groups.
The difference in means following the treatment was 1.4 in Dhoomapana group against
0.9 in the Kaphaketu group. The statistically highly significant results in both the groups
reveal that, there is a marked reduction in the cardinal symptom of kaphaja kasa by both
the modifications of therapies. (P=0.086) confined that the results between the groups
were not statistically significant although the Dhoomapana group patients had a better
improvement over the Kaphaketu rasa patients.
Effect on Nishteevana – an assessment of the sputum consistency in the two groups
showed a better improvement in the Dhoomapana group. The difference in mean score
was 1.7 in Dhoomapana group as against 1.1 in the Kaphaketu group. This difference was
found to be statistically significant(P=0.002) as per the un-paired t-test. Proving that
Haridradi Dhoomapana in combination with Kaphaketu rasa has the ability to correct the
thick consistency of the sputum which is one of the Cardinal Symptom of kaphaja kasa.
Dhoomapana liquefies the thick kapha Dosha in the uras and helps in breaking the
pathogenesis, to relieve from kaphaja kasa.
Effect on ura vankshana sampoornata - an assessment of the heaviness and discomfort
in the chest in the two groups showed a better improvement in the Dhoomapana group.
The difference in mean score was 1.8 in Dhoomapana group as against 1 in the
Kaphaketu group. This difference was found to be statistically significant(P=0.042) as
per the un-paired t-test. Proving that Haridradi Dhoomapana in combination with
Kaphaketu rasa has the ability to relieve the heaviness from the chest by liquefying and
expectorating the increased kapha Dosha from the chest.
Effect on kapha poorna deha – marked remission in heaviness all over the body was
observed in patients treated under both the groups. The difference in mean in the
Dhoomapana group was 2 and the same in Kaphaketu group was 1.2. However this better
response in patients treated with Dhoomapana may be due to random sampling
variability. The un-paired t-test shows insignificant change between the
Groups(P=0.067). More to say, kapha Dosha which is increased in the body in the
pathology of kaphaja kasa has guru, manda gunas. This increased kapha travels and
137
Discussion
accumulates all over the body causing heaviness. Remission in this symptom is by the
reduction in this kapha Dosha, which is achieved by the combination of Haridradi
dhoomapana and Kaphaketu rasa.
Effect on Asya Madhuryata – the symptom which is usually seen in kaphaja kasa, in the
21 patients taken for the study very few presented with the symptom of continuous sweet
taste in mouth. This symptom was reduced completely in both the groups. But the effect
could not rule the possibility of difference due to chance within the groups as per paired
t-test as well as between the groups as per the un-paired t-test (P=0.391). asya
madhuryata is due to localization of kapha Dosha in the mouth which was relieved by
both the modalities of treatment.
Effect on Mandagni – following the treatment in both the groups there was an increase
in appetite. The difference in means following the treatment was 1.1 in Dhoomapana
group against 0.9 in the Kaphaketu group. The improvement in Dhoomapana group was
slightly better than that in Kaphaketu group. This difference was statistically insignificant
as per the un-paired t-test (P=0.55). it was assured that both the group contains
medicaments which are having deepana qualities and hence there was an increase in
appetite.
Effect on Aruchi - the symptom Aruchi was reduced following treatment in both the
groups. The difference in means following the treatment was 1.2 in Dhoomapana group
against 1.1 in the Kaphaketu group. The statistically highly significant results in both the
groups reveal that, there is a marked reduction in loss of taste by both the modifications
of therapies. (P=0.957) confined that the results between the groups were not statistically
significant although the Dhoomapana group patients had a better improvement over the
Kaphaketu rasa patients.
Effect on Peenasa - an assessment of the peenasa in the two groups showed a better
improvement in the Dhoomapana group. The difference in mean score was 1.7 in
Dhoomapana group as against 1.1 in the Kaphaketu group. This difference was found to
be statistically significant(P=0.014) as per the un-paired t-test. This proves that the
Haridradi dhoomapana and Kaphaketu rasa has better effect in relieving the symptom
peenasa.
138
Discussion
Effect on shiroruja - an assessment of the haedache in the two groups showed a better
improvement in the Dhoomapana group. The difference in mean score was 0.9 in
Dhoomapana group as against 0.2 in the Kaphaketu group. This difference was found to
be statistically significant(P=0.024) as per the un-paired t-test. Proving that Haridradi
Dhoomapana in combination with Kaphaketu rasa has the ability to relieve the headache
in patients suffering from kaphaja kasa. as it removes the Dosha situated in the head.
Effect on Phonation - remission of the hoarseness of voice was recorded in both the
groups. Improvement observed in the Dhoomapana group was statistically significant
(P=0.005). and in the Kaphaketu group the effect of the treatment was statistically highly
significant (P=0.001). a better improvement was recorded in the Kaphaketu group in
comparison to the patients in Dhoomapana group. However the un-paired t-test could not
confirm the statistical significance(P=0.054) of better improvement in Kaphaketu group.
Effect on Quantity of Sputum – following treatment the amount of sputum reduced in
patients treated in both the groups. The difference in means following the treatment was
1.3 in Dhoomapana group against 0.8 in the Kaphaketu group. The improvement in
Dhoomapana group was better than that in Kaphaketu group. However this better
response may be due to random sampling variability.This difference was statistically
insignificant as per the un-paired t-test (P=0.14). it was assured that both the group were
capable of reducing the quantity of sputum which is increased as a result of increased
kapha Dosha in kaphaja kasa.
Effect on respiratory rate – difference in mean score of rate of respiration showed
improvement in both the groups. Further, comparison of the difference mean revealed a
better response in the Kaphaketu group. However the variation in results of two groups
was statistically insignificant (P=0.772) expressing the possibility of random sampling
variability. Thus this symptom is usually present in later stages of the illness kaphaja
kasa, very few patients presented with slightly increased respiratory rate. Hence correct
efficacy to claim Kaphaketu rasa group better than dhoomapana group cannot be made.
Spirometric evaluation – FVC, FEV1, PEF and FEV1/FVC were assessed before and
after the treatment. The result showed that there was an increase in the lung volumes
following the treatment in both the groups. The difference in means of the absolute
139
Discussion
values of FVC was 1.26 in the Dhoomapana Group, in contrast to this the difference in
mean was 0.51 in the Kaphaketu group. The un-paired t-test revealed that the difference
is statistically highly significant (P≤0.001). Also the predicted percentage of FVC assured
a similar improvement with statistically significant levels of difference between the two
groups.
The difference in means of the absolute values of FEV1 was 0.8 in the Dhoomapana
group, in contrast to this the difference in mean was 0.5 in the Kaphaketu group. The un-
paired t-test revealed that the difference is statistically insignificant (P=0.114). Also the
predicted percentage of FEV1 showing a better improvement in Dhoomapana group
could not be affirmed by the statistical analysis(P=0.134).
The difference in means of the absolute values of PEF was 2.1 in the Dhoomapana
Group, in contrast to this the difference in mean was 1.4 in the Kaphaketu group. The un-
paired t-test revealed that the difference could be due to chance factor and is not
statistically significant (P=0.148). Also the predicted percentage of PEF claimed a similar
improvement but the difference between the two groups was statistically insignificant
(P=0.164) expressing the possibility of random sampling variability.
The difference in means of the absolute values of the difference between FEV1 and FVC
was 18.4 in the Dhoomapana group, in contrast to this the difference in mean was 7.7 in
the Kaphaketu group. The un-paired t-test revealed that the difference is statistically
significant (P=0.04). the predicted percentage of the difference between FEV1 and FVC
showed that the better response in the Dhoomapana group to that of the Kaphaketu group
was not statistically significant as per the un-paired t-test(P=0.08).
These improvements in the absolute and predicted values suggest the increase of lung
volume, which was reduced due to the accumulation of kapha Dosha. Further better
increase in the lung volumes in the patients treated with dhoomapana confirms that
response to this treatment is better than only oral administration of Kaphaketu rasa.
After the completion of the 1 month course of treatment in the two groups the
overall assessment of the patients were made as discussed in the assessment criteria. The
analysis revealed that 2 patients each in either groups had 100% relief from symptoms of
kaphaja kasa. In both the Dhoomapana group and kaphaketu group 2 patient each had
140
Discussion
marked improvement from the symptoms of kaphaja kasa. Moderate improvement of the
illness was seen in 50% of the patients in Dhoomapana group on the contrary only
36.3%patients had moderate improvement in Kaphaketu group. 10% patients and 27.2%
patients had average improvement in the symptoms in Dhoomapana Group and
Kaphaketu Group respectively. There were no patients under the criteria of no change in
the symptoms of illness in both the groups. All the 21 patients taken for the study had
some or the other form of improvement in the symptoms of kaphaja kasa.
None of the patients in both the groups developed any untoward symptoms or any
side effects during the course of the treatment and therefore these medicines in
therapeutic dosage are very safe.
In the present study both the Dhoomapana group and Kaphaketu group patients
have shown improvement following medication. This implies that these medications have
therapeutic effects like kapha vilayana, kapha nissaraka, kasagna, kaphahara, and
pranaanulomana, along with deepana and pachana qualities.
The ingredients of Haridradi dhoomapana are haridra, daruharidra and
manasheela. All these ingredients are ushna, katu, tikta, which helps in alleviating the
kapha Dosha. Haridra and manasheela are having lekhana qualities due to which the
kapha Dosha is removed from its site of pathogenesis, also daruharidra has got chedana
qualities which helps in penetrating in deep srotas and removing out the Doshas. Haridra
and daruharidra are laghu, ruksha and kaphahara in nature, so it treats the increased kapha
Dosha, also manasheela has vatahara properties. In this way both the aggravated Doshas
in the samprapti of kaphaja kasa are taken care of, ultimately relieving the symptoms.
The ingredients of Kaphaketu rasa are tankana, vatsanabha, shankha, pippali and
bhavana of Ardraka swarasa. All these ingredients are having kaphahara and vatahara
qualities. Katu, ruksha, teekshna, and ushna are the common qualities in all the
ingredients which helps in doing kapha shamana. The vyavayi, vikashi and yogavahi
qualities in vatsanabha, also the sukshma qualities in shankha bhasma helps in
penetration into the deeper organs to remove the pathogens, these qualities also helps in
faster action of the formulation. The deepana and pachana effect in shankha and pippali
helps to control the digestive fire. the balya and rasayana qualities in vatsanabha, shankha
141
Discussion
and pippali assures the long term benefit and also less chances of re-occurance of the
illness kaphaja kasa.
Dhoomapana has the tendency to directly act on the pranavaha srotas, thereby
liquefying tenacious thick sputum adherent to the pranavaha srotas. As revealed in the
study, the combined effect of Dhoomapana and Kaphaketu rasa is best in comparison to
oral administration of Kaphaketu rasa alone in curing kaphaja kasa. the course of
medication was 1 month which is less compared to the chronicity of kaphaja kasa. to get
better benefit in cure and also to get the rasayana effect of the medicaments, a longer
course is advisable.
142
Conclusion
CONCLUSION:
1. On the basis of etiology, symptomatology and prognosis the Kaphaja kasa is best
compatible to recurrent chronic bronchitis.
2. The efficacy of Haridradi Dhoomapana at any stage of kaphaja kasa is proved
beyond doubt and it has its best results in moderate and severe conditions. The paired t
test affirms the statistical significance
3. Dhoomapana gives best results within a short duration of 7 days with its definite
and immediate action in liquefying and expelling the morbid kapha.
4. There is no possibility of any serious complications during the short term course
of proper administration of Dhoomapana with manasheela as one of its ingredients.
5. The effect of oral medication with Kaphaketu rasa in a dose of 125 mg tid as a
shamana medication is better seen in mild to moderate conditions of kaphaja kasa.
6. The combination of shodhana by Haridradi Dhoomapana and shamana by
Kaphaketu rasa helps in checking the pathology, the effect of the combination is
expectorant, mucolytic and soothing to the respiratory tract.
7. The symptom of Nishteevana and Ura vankshana sampoornata were better
controlled in the Dhoomapana Group than in the Kaphaketu Group as stated statistically
significant by the un-paired t-test. This confirms the superior expectorant activity of
Haridradi Dhoomapana which relieves the accumulation of kapha Dosha in the chest.
8. This regimen is economical, effective and equally safe.
143
Conclusion
144
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127) Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, edited by Dr. Indradev tripati, 5th edition, 1998, kasa chikitsa, sloka 82.
128) Govindadas sena’s, Bhaishajya Ratnavali, Varanasi, chaukambha Sanskrit sansthana, edited by Ambikadatta Shastry, 7th edition, 1983, Jwarachikitsa, slok 859-860.
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Discussion
Summary
The essential disposition of living activity in a living being is said to be breathing, one
of the basic activity of pranavaha srotas. The lungs with their greater surface area (500m2) are
directly open to the external environment, with the exchange of gases, 16 times per minute
making it one of the most vulnerable sites for disease. Thus structural, functional and
microbiological changes within the lungs can be closely related to epidemiological,
environmental, occupational, personal and social factors. The primary respiratory diseases are
responsible for a major burden of morbidity and ultimately death. As a result pranavaha
srotodusti have become unavoidable making kasa the most common disease to the extent of
60% of total disease recorded.
The movement occurring in process of kasa starts from uras and is in the nature of
falling. The word shatana indicates falling or forward movement. During the process of
cough the patient bends forward. Also during kasa the patient feels breaking pain and
jerks in the whole body. Particularly causing strain and stiffness in hanu, manya, akshi,
netra, prushta, ura and parshwa. This points out that an abnormal sound along with
abnormal movement taking place during the production of kasa.
The onset of kaphaja kasa depends on exogenous and endogenous factors.
In the Nidana context amarasa and avarana can be taken as abhyantara karana. The
causative factors can also be classified as dietic causes and behavioral causes. Further
among the causative factors some act directly as khavaigunya utpadaka karana in
pranavaha srotas, some act as kapha prakopaka karana and some as vata prakopaka
karana.
The kapha Dosha is the principal basic factor in kaphaja kasa. The excessive
secreted malarupi kapha obstructs the flow of vata in kaphaja kasa. The varieties of vata
which are involved in kasa are pranavata and udanavata. As the pranavayu is obstructed
by malarupi kapha, it follows udana gati which is having upward movement. Kasa is
mentioned as one of the symptom of prakupita prana vayu. Rasa is the dushya in kaphaja
kasa.
127
Discussion
Poorvaroopas of kasa are Feeling of presence of thorn in the throat, itching in the throat,
and pain on swallowing the morsel of the food. The pratyatma lakshana of kaphaja kasa
is bahula, sweta and snigdha steevana yukta kasa. The word bahula indicates excessive or
copious. Upashaya by katu, ruksha and ushna drugs administration and aggravation of
symptoms by consuming snigdha, madhura and sheeta dravyas helps in differentiating the
kaphaja kasa from other varieties.
The Principles of treatment that are adopted in kaphaja kasa are Nidana
parivarjana, the first and important line of treatment. So smoking, exposure to dust etc.
should be avoided. Depending upon the physical strength of patients of kaphaja kasa, the
treatment is classified into; shodhana, shamana and rasayana for physically strong
patients. whereas only shamana and rasayana for physically weak patients. Dhoomapana
is given to expel the kapha out of the uras which is the prime location of the illness
kaphaja kasa. Kavala and gandusha is given to remove the Dosha from the mouth.
In the present study, the Haridradi Dhoomapana and Kaphaketu rasa is taken to
treat the patients of kaphaja kasa and to explore the efficacy of these in bringing about
cure of the illness.
Plan of the study:
In the present clinical study, a total of 21 patients suffering from kaphaja kasa
were taken from the O.P.D. and I.P.D. of S.D.M. college of Ayurveda and Hospital, and
all completed the course of the treatment. These 21 patients of kaphaja kasa selected for
the study were randomly segregated in to two groups irrespective of age, sex or creed as
well as severity of the illness. The first group consisting of 10 patients is treated as test
group and named as Dhoomapana group. The patients were administered with shodhana
given with Haridradi Dhoomapana in a frequency of 3 bouts(each bout carrying 3 puffs)
of Dhoomapana early morning once in a day for 7 days along with shamana by
Kaphaketu rasa in the dose of 125mg three times in a day along with 1 teaspoon of
Ardraka swarasa as Anupana which was continued till 1 month of the treatment. The
second group consisting of 11 patients is treated as control group and named as
128
Discussion
Kaphaketu group. The patients were administered only shamana with Kaphaketu rasa in a
dose of 125mg taken thrice in a day along with 1 teaspoon of Ardraka swarasa for a
period of 1 month.
Observation and results
In this majority of the patients belonged to the age group of 21 to 30 and 41 to 50
years. 42% of the patients were females. Majority of the patients were Hindus. 62% were
married. 33% of the patients were illiterates. All the patients belonged to the Dvandvaja
Prakriti, and in that 53% of the patients had KaphaPittaja Prakriti. 85% of the patients
had Madhyama Satva. 76% of the patients had Madhyama Sara. Madhyama Satmya was
observed in 90% of the patient.s 24% of the patients had Avara Abhyavaharana and
Jarana Shakti.
The therapeutic effect of the treatments in both the groups was assessed
methodically in regards to the salient features of kaphaja kasa, like severity, kasa,
expectoration, fullness of chest, heaviness all over the body, sweetness of mouth, loss of
appetite, loss of desire for food, coryza, headache, effect on speech, quantity of sputum,
and effect on respiratory rate. Assessment in the improvement of lung capacity was made
using spirometric evaluation of absolute values of the spirometric parameters as well as
its predicted percentage. Overall effect of the treatments was also analyzed. The results of
the treatments in both the groups are discussed in the following pages.
Remission of the severity of the illness was recorded in both the groups. A better
improvement was recorded in the Dhoomapana group in comparison to the patients in
Kaphaketu group. The symptom kasa was reduced following treatment in both the groups
and confined that the results between the groups were not statistically significant
although the Dhoomapana group patients had a better improvement over the Kaphaketu
rasa patients. An assessment of the sputum consistency in the two groups showed a better
improvement in the Dhoomapana group, This difference was found to be statistically
significant(P=0.002) as per the un-paired t-test. Following treatment, the amount of
sputum reduced in patients treated in both the groups, The improvement in Dhoomapana
group was better than that in Kaphaketu group, This difference was statistically
insignificant as per the un-paired t-test (P=0.14).
129
Discussion
Spirometric evaluation – FVC, FEV1, PEF and FEV1/FVC were assessed before and
after the treatment. The result showed that there was an increase in the lung volumes
following the treatment in both the groups. The un-paired t-test revealed that the
difference is statistically highly significant (P≤0.001). The predicted percentage of the
difference between FEV1 and FVC showed that the better response in the Dhoomapana
group to that of the Kaphaketu group was not statistically significant as per the un-paired
t-test(P=0.08).
These improvements in the absolute and predicted values suggest the increase of lung
volume, which was reduced due to the accumulation of kapha Dosha. Further better
increase in the lung volumes in the patients treated with Dhoomapana confirms that
response to this treatment is better than only oral administration of Kaphaketu rasa.
After the completion of the 1 month course of treatment in the two groups the
overall assessment of the patients were made as discussed in the assessment criteria. The
analysis revealed that 2 patients each in either groups had 100% relief from symptoms of
kaphaja kasa. In both the Dhoomapana group and kaphaketu group 2 patient each had
marked improvement from the symptoms of kaphaja kasa. Moderate improvement of the
illness was seen in 50% of the patients in Dhoomapana group on the contrary only
36.3%patients had moderate improvement in Kaphaketu group. 10% patients and 27.2%
patients had average improvement in the symptoms in Dhoomapana Group and
Kaphaketu Group respectively. All the 21 patients taken for the study had some or the
other form of improvement in the symptoms of kaphaja kasa.
None of the patients in both the groups developed any untoward symptoms or any
side effects during the course of the treatment and therefore these medicines in
therapeutic dosage are very safe.
In the present study both the Dhoomapana group and Kaphaketu group patients
have shown improvement following medication. This implies that these medications have
therapeutic effects like kapha vilayana, kapha nissaraka, kasagna, kaphahara, and
pranaanulomana, along with deepana and pachana qualities.
130
Discussion
Dhoomapana has the tendency to directly act on the pranavaha srotas, thereby
liquefying tenacious thick sputum adherent to the pranavaha srotas. As revealed in the
study, the combined effect of Dhoomapana and Kaphaketu rasa is best in comparison to
oral administration of Kaphaketu rasa alone in curing kaphaja kasa. The course of
medication was 1 month which is less compared to the chronicity of kaphaja kasa. to get
better benefit in cure and also to get the rasayana effect of the medicaments, a longer
course is necessary.
131
Case Proforma
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA
SRI DHARMASTHALA MANJUNATHESHWARA AYURVEDA COLLEGE & HOSPITAL, KUTHPADY, UDUPI
CASE PROFORMA FOR CLINICAL STUDY TO EVALUATE THE EFFECT OF HARIDRADI
DHUMAPANA AND KAPHAKETU RASA IN PATIENTS OF KAPHAJA KASA
Guide : Dr. V. K. Sridhara Holla M.D.(Ayu) Mithun M. Bondre P.G. scholar Co-Guide : Dr. G. Srinivasa Acharya M.D.(Ayu)
1. Name of the Patient: GROUP -A 2. Age: Sl. No: 3. Sex: Male/Female O.P.D/I.P.D No: 4. Religion: H /M /C /J /S /Others Bed No: 5. Marital status: M /UM /W /D D.O.A : 6. Educational status: I /P /S /HS /G /PG D.O.D : 7. Occupation: Business /House Wife /Employee /Farmer /Student /others 8. Economical status: L /M /U 9. Address:
A) PRADHANA VEDANA (main complaints):
SL.NO. Complaints P /A Duration 1. Kasa 2. Kapha Nishteevana 3. Uraha vanksha sampoornamiva 4. Kapha poorna deha 5. Asya madhurata 6. Mandagni 7. Aruchi 8. Gourava 9. Peenasa 10. Utklesha 11. Lomaharsha 12. Kleda 13. Shiroruja
B) ANUBANDHA VEDANA (associated complaints): -------------------- duration ---------
Case Proforma
C) VEDANA VRITTANTA (h/o present illness):
Mode of onset : Sudden /Gradual /Insidious Course : Recurrent /Episodic /Continuous /Progressive Severity : Mild /Moderate /Severe Cough : Dry /Productive -The time of maximum incidence - day /night /on rest /on activity /seasonal- -Character : Paroxysmal /short -Frequency : Continuous /intermittent Sputum : Consistency
Thin mucoid (Ghana kapha) Thick frothy (Ghana kapha) Mucous & sticky (Snigdha Ghana) Muco purulent (Bahula snigdha Ghana)
-Colour- -Odour- -Volume- Aggravating factors : Dust /Food /Smoke /Animals /Pollens /Cosmetics /Drugs /Weather / Sheeta ahara /Others
D) POORVA VYADHI VRITTANTA (past history) :
E) CHIKITSA VRITTANTA (treatment history) :
F) KOUTUMBIKA VRITTANTA (family history) :
Father Mother Brothers/sisters Son/daughter Others
G) OCCUPATIONAL HISTORY :
Work involving any mental stress Exposure to any aggravating factors during working hours Whether symptoms produced during working hours Whether symptoms relieved by change of place
Case Proforma
H) PRASUTI VRITTANTA : if the patient is female
Prasava vrittanta Deliveries - normal /abortions /operations Rutusrava vrittanta Age of - menarche /menopause Artava pravritti Days - sama /alpa /adhika
I) VAYAKTIKA VRITTANTA (personal history) : 1) Ahara :
- type :- vegetarian /mixed - quantity :- alpa /madhyam /ati - dominant rasa :- madhura /amla /lavana /katu /tikta /kashaya - dietic habits :- samashana /vishamashana /adhyashana /anashana
Agni :- sama /teekshna /vishama /manda Koshta :- mridu /madhyama /teekshna 2) Vyasana :
Habits Duration Occasional/ Regular
Stopped/ Reduced
Quantity
Tea Coffee Smoking
Alcohol Tobacco chewing others
3) Nidra : Vishama /Alpa /Anidra /Sama 4) Bowel : Formed /Unformed /Hard /Smooth /Regular /Constipated /Incontinence in ------- days 5) Micturation : Regular /Retention /Incontinence in ------- days
J) ROGI PAREEKSHA :
ASHTASTHANA PAREEKSHA : Nadi Shabdha Mala Sparsha
Mootra Drika Jivha Akruti
Case Proforma
SAMANYA PAREEKSHA :
Temperature dF Blood pressure mm of Hg
Heart rate /min
DASHAVIDHA PAREEKSHA :
1. Shareera prakruti : V /P /K /VP /KP /VK /VPK 2. Sara : Pravara /Madhyama /Avara 3. Samhanana : Pravara /Madhyama /Avara 4. Satmya : Pravara /Madhyama /Avara 5. Satwa : Pravara /Madhyama /Avara 6. Pramana : Height Weight 7. Ahara shakti - Abhyavaharana shakti Pravara /Madhyama /Avara
Jarana shakti Pravara /Madhyama /Avara 8. Vyayama shakti : Pravara /Madhyama /Avara 9. Vaya : Bala /Youvana /Vrudda 10. Desha : Jata - Jangala /Anupa /Sadharana Samvruddha - Jangala /Anupa /Sadharana Vyadhita - Jangala /Anupa /Sadharana
K) GENERAL EXAMINATION :-
• Built - Slender /Lanky /Muscular /Stocky /Obese • Nourishment - Good /Fair /Poor • Nails - Pink /Pallor /Bluish • Conjunctiva - Pink /Pallor /Bluish • Cyanosis - Extremities – Upper /Lower Buccal mucosa /Lips /Conjunctiva • Deformities – • JVP - Raised /only during Expiration /Pulsation • Edema - Foot /Ankle /Leg /Sacrum /Hands /Face Pitting /non-pitting • Nasal discharge - Watery /Mucoid /Purulent /Blood stained /Mucosal alasation /Polyp / Hypertrophy of turbinates /Atrophy /Ulceration /active alae nasi • Sinuses - Frontal /Maxillary • Teeth - Caries • Gums - Spongy /Bleeding /Unhealthy • Pharynx - inflamed /Adenoids • Tonsils - Enlarged /inflamed /Follicles • Skin -
Case Proforma
L) SYSTEMIC EXAMINATION :
RESPIRATORY SYSTEM EXAMINATION –
I) DARSHANA - Nasa : polyps /Inflammation Mukha : Kantha: Lymph nodes : Tonsilar - Normal /Enlarged Peritonsilar - Normal /Enlarged Cervical - Normal /Enlarged Accessory muscles – Normal /Overactive Engorged veins - Present /Absent Uraha: Shape - Normal /Abnormal Respiratory rate ------- Character -------- Rhythm---------- Chest movements - Abdominal -------- Thoracic --------- Thoraco abdominal --------
II) SPARSHANA Trachea : Central /Shifted to Supraclavicular L.N. - Normal /Enlarged Axillary L. N. - Normal /Enlarged Chest Expansion - Measurement - Expiration -------- Inspiration --------- Vocal fremitus - Normal /Increased /Decreased Tenderness - Present /Absent III ) AKOTANA : Normal note /Dull note /Strong dull note /Hyper resonant note IV ) SHRAVANA Air entry - Good /Diminished /Absent Breath Sounds - Intensity - Normal /Reduced /Increased Type of Breathing - Vesicular /Bronchial /Bronchovesicular If Bronchial type - Tubular /Cavernous /Amphoric Vocal resonance - Normal /Increased /Decreased /Absent Added Sounds - Rales P/A ------- Fine /course Rhonchi P/A ------- Inspiration /expiration Pleural Rub P/A ------ Stridor - Laryngeal – P /A , Tracheal P /A
OTHER SYSTEMS:
Case Proforma
M ) EXAMINATION OF SROTASA – 1) Pranavaha srotas :-
1. Atisristam 4. Alpalpam
2. Atibaddam 5. Abheeksham
3. Kupitam 6. Sashoolam
2) Rasavaha srotas :-
SL.NO SYMPTOMS P/A SL.NO SYMPTOMS P/A 1. Asradda 9. Jwara 2. Aruchi 10. Tama 3. Asyavairasyam 11. Pandutwa 4. Arasajnata 12. Sada 5. Hrillasa 13. Krishangata 6. Gourava 14. Agninasha 7. Tandra 15. Trupti 8. Angamarda 16. Hridroga
OTHERS :-
N) VIKRITITAHA PAREEKSHA :- NIDANA –
SL.NO AHARA P/A SL.NO VIHARA P/A
1. Bojyamana vimargamana 1. Dhoompaghata
2. Guru Abhishyandi 2. Raja sevana
3. Madhura rasa sevana 3. Veganam avarodha
4. Sheetahara sevana 4. Diwa swapna
5. Asatmyaahara sevana 5. Avyayama
6. Snigdha ahara sevana 6. Kshavathu dharana
Case Proforma
POORVA ROOPA
Shookapoorna Galasyata Gala talu lepa
Kante Kandu Agni sada
Bhojyanam avarodha Swara bheda
Arochaka
ROOPA
Kasa with Ghana Kapha Gourava
Bahula Madhura Snigdha kapha Peenasa
Kapha Poorna deha Shiroruja
Aruchi Utklesha
SAMPRAPTI
Dosha Dushya
Adhistana Srotas
Srotodusti Rogamarga
UPASHAYA & ANUPASHAYA
Upashaya
Anupashaya
UPADRAVA
Jwara Hrillasa Kshaya
Arochaka Swara Bheda
ARISHTA LAKSHANA :- SADHYASADHYATA :-
Case Proforma
Lab Investigations :- Hb% ESR RBS TC DC –N E B M L Others
CHIKITSA:- 1) Haridradi Dhoomapana - once daily, early morning, 3 bouts, thrice at single sitting - for 7 days with 2) Kaphaketu Rasa - 1 ratti (125mg), thrice daily - for 30 days Anupana - Ardraka swarasa (5ml)
ASSESMENT CRITERIA
Symptoms BT D1 D2 D3 D4 D5 D6 D7 D14 D21 D30
Severity
Kasa
Nishteevana
Uraha vankshana sampoornamiva
Kapha poorna Deha
Asya madhurata
Mandagni
Aruchi
Peenasa
Case Proforma
Shiroruja
Speech
Quantity of Sputum
Respiratory Rate
Mental Status
Best FVC
FVC
FEV1
PEF
PEFT
PIF
FEV1/FVC%
FEF25-75%
MEF75%
MEF50%
MEF25%
MET100%
Diagnosis OA RA
RESULT – Complete Remission /Moderate Remission /Average Remission /Unchanged DISCUSSION - Signature of the Guide Signature of the co-Guide Signature of Scholar