Ayurmitra

TAyComprehended

Ayurmitra

TAyComprehended

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.

9

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.

11

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

12

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

13

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.

17

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.

18

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

19

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

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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

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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

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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

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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

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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

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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

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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

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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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98) Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, edited by Dr. Indradev tripati, 5th edition, 1998, kasa chikitsa, sloka 1-200, page 317-335.

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100) Anonymous, Yogaratnakara, Varanasi, Chaukhamba krishnadas academy, edited by Dr. Indradev tripati, 5th edition, 1998, kasa chikitsa, sloka 41, page 321.

101) Govindadas sena’s, Bhaishajya Ratnavali, Varanasi, chaukambha Sanskrit sansthana, edited by Ambikadatta Shastry, 11th edition, 1996, chapter 15, slok 116-224, page 329.

102) A. Golwala’s, medicine for students, Mumbai, Dr. A.F.Golwala empress court, eros bldg, 7th edition, inflammation of the bronchial tree, P. 209.

103) Douglas S, Crofton and Douglas respiratory disease, Blackwill science ltd; 6th edition, 1989, chapter 19, P. 490-491

104) Davidson’s, principles and practice of medicine, London, Churchill Livingstone publication, edited by CRW Edwards, 7th edition, 1995, chapter 10, P. 332

105) Robbins’s, basic pathology, London, pub. By hercourt Asia pvt. Ltd; 6th edition, 1999, chapter 15, P. 722-723

106) API Text book of medicine, Mumbai, Associations of physicians of India, edited by G.S. Sainani, 6th edition, 1999, respiratory diseases, P. 232-233

107) Henry n, Ginsburg, ira j, Goldburg; Harrison’s principles of internal medicine, New York, Mc Graw Hill publications, volume II, 15th edition, 2000, chapter 258, P. 1451-1460

108) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 20, 738 PP, Page no. 39

109) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 36, 738 PP, Page no. 40

110) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 3, 824 PP, Page no. 554

111) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 20, 738 PP, Page no. 39

112) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 35, 738 PP, Page no. 40

113) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 1, 824 PP, Page no. 552

114) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 11, 738 PP, Page no. 38

115) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 36, 738 PP, Page no. 40

116) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 2, 824 PP, Page no. 552

117) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 3, 824 PP, Page no. 552

118) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 4, 824 PP, Page no. 552

119) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 49-50, 738 PP, Page no. 41

120) Vagbhata’s, Ashtanga Hridaya, with the commentaries of Arunadutta and Hemadri, Varanasi, Chaukambha orientalia, edited by Bhishagacharya Harishastry Paradakara Vaidya, 9th edition, 2002, sutrasthana, chapter 21 , slok 9-11, 956 PP, page no. 296

121) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 37, 738 PP, Page no. 40

122) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 54, 738 PP, Page no. 41

123) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 17, 824 PP, Page no. 554

124) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 53, 738 PP, Page no. 41

125) Sushruta’s, Sushruta Samhita, with Nibandha Sangraha commentary of Sri Dalhanacharya, Varanasi, Chaukambha orientalia, edited by edited by Vaidya Jadavji Trikamji Acharya, 7th edition, 2002, Chikitsa sthana, chapter 40, slok 17, 824 PP, Page no. 554

126) Agnivesa: Charaka Samhita redacted by Charaka and Dridabala with the Ayurveda Dipika commentary of Chakrapanidatta, Varanasi, Published by Chaukambha Sanskrit sansthana, edited by Vaidya Jadavji Trikamji Acharya, 5th edition,2001, Sutrasthana, chapter 5, Slok 38, 738 PP, Page no. 40

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.

129) French’s Index of Differential Diagnosis, F.Dudley Hart, Indian Edn. K M Varghese Company, Bombay, 12th Edn.

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