The
current research work entitled as “Clinical
Evaluation of Haridradi Avleha and Virechana Karma in the Management of Tamaka Shwasa w.s.r. to Bronchial
Asthma†was carried out with
following aims and objectives.
AIMS & OBJECTIVES-
·
To assess the effect of Haridradi Avleha and Virechana Karma in the management of Tamaka Shwasa.
·
To study the comparative effect of Haridradi Avleha and Virechana Karma.
·
To study pathophysiology and clinical
evaluation of Tamaka Shwasa.
In this study
following observations and results are found:
Observations& Results: 17 patients in
age group 18-30 years & 08 patients in age group 31-40 years were found; it
shows overall 83.33% patients belonged to 2nd to 3rd
decade of life. Incidence
of disease was found mildly higher in males (53.33%) than in females (46.67%). Majority of the patients (86.67%),
belonged to
Hindu religion; 70% patients were married. Maximum
36.67% patients were doing services and 33.33% patients were housewives. About
40% patients belonged to Lower middle class and 33.33% patients belonged to
Middle class. Max. 60% Patients were of Vata-Kaphaja
Prakriti which is highly associated with the development of Tamaka Shwasa, 96.67% patients were of Madhyama Sara and 90% were having Madhyama Samhanan, 96.67% patients with Madhyama Satmya, 90% patients with Madhyama Satva, 66.67% patients showed Madhyama Ahara Shakti. 56.67% patients
showed Avara Vyayama shakti, 46.67%
patients of showed Madhyama nature of
Koshtha and maximum
43.33% patients had Mandagni. In
this type of Kostha & Agni there is predominance of Kapha Dosha, which may play important
role in developing the pathogenesis of Tamaka
Shwasa.
Maximum 60% patients had duration of illness < 5 yrs, 56.67% patients had positive
drug history of Allopathic medicine and 43.33% patients have positive family
history of the disease. Maximum 100% patients had breathlessness, 60% patients had dry cough,
33.33% patients had expectoration, 53.33% patients had wheezing, 33.33%
had chest tightness, 53.33% had rhinitis, 50% had sneezing, 33.33% had anorexia,
50% had disturbed sleep and 43.33% had paroxysms of dyspnoea due to seasonal
changes before the treatment.
Out of
15 Patients, which were treated in Shodhana
Purvak Shamana, majority of cases had passed Madhyama Vega i.e. 11 to 20 times (60%). Thus they achieved Madhyama Shuddhi (60%).
Results
in the patients of Group A: In
Group A, patients treated with ‘Haridradi Avleha’ 20gm twice a
day with lukewarm water, before meal for 28 days showed
highly significant results regarding Subjective
parameters – Shwasakricchata,
Kasa,
Nidralpata,
Ghurghurakam, ACQ score with % relief of 72.55%, 75.86%, 46.43%, 68.42%
, 61.66%
respectively. In case of other Subjective
parameters i.e. Pramoha there was
significant result (P<0.05) with % relief of 89.47% and Bhashankricchata there
was non significant results (P>0.05) with % relief of 87.50%.
In
Objective parameters , PEFR had
shown significant result (p value
<0.05) with an
improvement of 29.61%, FEV1% had shown highly significant result improvement
of 24.97% , while Hb% had shown non
significant results (P >0.05) with an improvement of only 3.08%. TLC had
shown non significant result (P>0.05) with an improvement of 7.56%.
Eosinophil count had shown non significant result (P>0.05) with an
improvement of 9.65%. TEC had shown non significant result (P>0.05) with an
improvement of 7.26%. Lymphocyte count had shown significant result (P<0.05)
with an improvement of 15.86%. In other laboratory parameters, there were no
significant findings.
Results
in the patients of Group B:
In Group B, patients
were performed Virechana Karma before the administration of trial drug “Haridradi Avleha†20 gm twice a day orally with lukewarm water,
before meal for 28 days. This group showed highly significant results regarding Subjective parameters – Shwasakricchata,
Kasa,
Pramoha, Nidralpata,
Ghurghurakam, ACQ score with % relief of 76.00%, 77.27%, 96.77%, 86.11%,
78.57%
, 65.99%
respectively. In case of other Subjective
parameters i.e Bhashankricchata there
was non significant results (P>0.05) with % relief of 69.23%.
In
Objective parameters, PEFR had
shown significant result (p value
<0.05) with an
improvement of 35.10%, FEV1% had shown highly significant result
improvement of 29.18% , while in case of Hb% non significant results (P >0.05) was seen
with an improvement of only 1.79%. TLC had shown non significant result
(P>0.05) with an improvement of 0.58%. Eosinophil count had shown non
significant result (P>0.05) with an improvement of 18.56%. TEC had shown non
significant result (P>0.05) with an improvement of 16.32%. Lymphocyte count
had shown non significant result (P>0.05) with an improvement of 3.56%. Serum
creatinine had shown significant result (P<0.05) with an improvement of 9.68%.
In other laboratory parameters, there were no significant findings.
Discussion-
The formulation selected in this trial
was chosen from Yogratnakar Shwasachikitsa (2) & contents of Haridradi Avleha are Haridra, Maricha, Draksha, Pippali , Shati, Rasna, Sarshapa Taila, Guda in
the proportion of 1:1:1:1:1:1:1:14.
In this combination, it is observed that the
majority of ingredients of Haridradi Avleha
are having Vata-Kaphashamaka
property like Haridra, Maricha, Pippali,
Rasna etc. The
drugs have a potential of alleviating Kapha
by Katu Rasa and Ushna Veerya, Laghu Tikshna and Ruksha Guna, and Vata
Dosha by virtue of Ushna Veerya, Snigdha Guna of Guda, Mustard oil. Thus Kapha Shamaka properties of drug help
in breaking the Srotorodha and
digestion of Ama, which leads to
proper functioning of the body.
Most drugs of Haridradi
Avleha are having Tikta Rasa. It
completed the Pachana of Ama Dosha. This property controls the
initial Ama formation,
if formed in any way it can be neutralized which is vital in preventing the
disease. Katu Rasa pacifies Kapha and Vata due to its Ushna,
Tikshna, Vishada Guna. Vishada Guna helps in absorption of Kleda. Katu Rasa also helps in Deepana,
Pachana, and Srotoshodhaka
action.
Most of the ingredients of Haridradi Avleha (Haridra, Rasna, Shati,
Maricha & Pippali) have Ushna Veerya property, which will treat the Doshic pathology. From the action, it can be assumed that the drug is Veerya
Pradhana indeed. That is
why most of the contents of Haridradi
Avleha are Kaph-Vatashamaka in
nature.
In Haridradi Avleha, Draksha, Guda are
having Madhura Rasa, which helps in
pacifying Vata Dosha. Madhura Rasa
balances the Ushna, Tikshna & Ruksha Guna of other drugs by its Shita, Snigdha, Picchila,
Guru Gunas. It also has Brimhana
properties, that is required in the management of Tamaka Shwasa.
Some ingredients of
study drugs have Rasayana Prabhava (Pippali). The Rasayana drug is supposed to increase both qualitatively and
quantitatively, all Dhatus of the
body
In Group B Virechana Karma procedure has been done.
Virechana Karma procedure is best for
Pittaja Vyadhi. Although Tamaka Shwasa is not Pittaja Vyadhi but it is Pittasthana Samudbhav Vyadhi and Acharya Charaka has indicated Virechana Karma in Tamaka Shwasa as ‘Tamke tu
Virechanam’ in Charaka Samhita
Chikitsasthana 17/121. So the Shodhana
Karma is necessary to remove the obstruction of Kapha in the passage of Vata.
The drug used for the Virechana Karma is Abhyadi
Modak. As Acharya Charaka has
said that the Virechana should be done with
‘Vatashleshmahara dravya’ So Abhyadi
Modak has been used because most of the drugs of Abhyadi Modak are Ushna
Veerya, hence possess
Vatakaphashamaka property.
Most of the drugs of Abhyadi Modak are Katu, Tikta Rasa dominant like Trivrutta,
Danti, Mustak, Pippalimoola, Pippali etc. which possess the Deepana Pachana property, hence these drugs are used for Aampachana.
Most of the drugs are Laghu, Rukshna, Tikshna Guna dominant, hence
possess Kaphaghna property which helps
in Srotoshodhana.
Virechana helps in Vatanulomana thus help in correcting the Pratilomgati of Vayu. Virechana causes Deeptagni,
Indriyaprasadan, Dosha Samyata also.
Virechana Karma decreases water
and electrolyte absorption deplete extracellular fluid to lesser extent thereby
decreasing blood pressure. Virechana
Krama removes undigested food material and prevents stimulation of
inflammatory mediators.
v CONCLUSION
The Tamaka Shwasa is Vyadhi of Pranvaha Srotas,
Vata-Kaphaja in nature. It is a Pittasthanasamudbhava Vyadhi and Yapya in nature. It is correlated with
modern entity Bronchial Asthma due to its similarity in signs and symptoms and causative
factors.
v It can be concluded that hypo-functioning of Agni otherwise termed as Mandagni is largely responsible for the formation
of Ama which is chief pathogenic factor of the disease.
v Tamaka Shwasa is the disease
having Vata and Kapha predominance. But, in fact it
is Tridoshaja in origin from Adhoamashaya (Pittasthanasamudbhava).
v Hridradi
Avleha (Group A)- has
provided better
relief
in most
of
the symptoms
of the disease like Shwasakricchata, Kasa,
Nidralpata, Ghurghurakam at highly
significant level. Pramoha at
significant level. It shows highly significant result in ACQ score.
v Group A has showed highly significant result
in objective parameters FEV1% and significant result in PEFR.
v Virechana Karma with Vata-Shleshmahara
Dravyas is mentioned in classical texts. Virechana Karma balances all the three Doshas in equilibrium. It removes the unwanted waste material and
toxins from the body. It purifies the body and makes it healthier. Samsarjana Karma after Virechana is very necessary because body
is not able to digest Guru Ahara, hence
Laghu Ahara is advised for 3-7 days
according to Shuddhi. After Shodhana Karma the Shamana Aushadi works more effectively.
v Virechana Karma and Haridradi Avleha (Group B):- Group
B has provided better relief in most
of the symptoms of the disease like Shwasakricchata, Kasa, Pramoha
Nidralpata, Ghurghurakam at highly significant
level. It shows highly significant result in ACQ score.
v Group B has showed highly significant result
in objective parameters FEV1% and in PEFR.
v The
study has revealed that there was no adverse effect on renal and liver function
tests, with which it can be concluded that the drug Haridradi Avleha and procedure Virechana
Karma are safe for use in the patients of Tamaka Shwasa (Bronchial Asthma).
v On comparing the effect of two therapies
it can be concluded that Group
B (Virechana Karma & Haridradi Avleha)
provided better relief than Group A (Haridradi
Avleha) in most of the sign and symptoms
of the disease at significant level.
v Thus
it can be concluded that Haridradi Avleha
and Virechana Karma can be used
as effective and safe therapeutic agents in the management of Tamaka Shwasa (Bronchial Asthma).