vaman virechan tamakswasa_pk022gdg

“EVALUATION OF THE EFFICACY OF VAMANA KARMA AND

VIRECHANA KARMA IN TAMAKA SWASA”

A COMPARATIVE STUDY

BY

DDrr.. KKAALLLLAANNAAGGOOUUDD..BB..PPAAYYAAPPPPAAGGOOUUDDAARR

Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences,

Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

DDOOCCTTOORR OOFF MMEEDDIICCIINNEE ((AAYYUURRVVEEDDAA VVAACCHHAASSPPAATTII)) IN

PANCHAKARMA Under the guidance of

DR. G.PURUSHOTHAMACHARYULU

M.D. (Ayu) Professor and HOD

P.G.Dept. of Panchakarma

And co-guidance of

Dr. SANTOSH N. BELAVADI M.D. (Ayu)

Lecturer P.G.Dept. of Panchakarma

POST GRADUATE DEPARTMENT OF PANCHAKARMA D.G MELMALAGI AYURVEDIC MEDICAL COLLEGE AND

RESEARCH CENTER GADAG – 582103 2007

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDITATE I hereby declare that this dissertation / thesis entitled “EVALUATION OF

THE EFFICACY OF VAMANA KARMA AND VIRECHANA KARMA IN

TAMAKA SWASA” A COMPARATIVE STUDY is a bonafide and genuine research

work carried out by me under the guidance of Dr.G. Purushothamacharyulu MD (Ayu),

Professor and HOD and the co-guidance of Dr.Santosh N Belavadi MD (Ayu), Lecturer,

Post Graduate Department of Panchakarma, Shri D.G.M.Ayurvedic Medical College,

Gadag.

Date: Signature of the Candidate

Place: Gadag

(Dr.Kallanagoud.B.Payappagoudar)

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “EVALUATION OF THE

EFFICACY OF VAMANA KARMA AND VIRECHANA KARMA IN TAMAKA

SWASA” A COMPARATIVE STUDY is a bonafide research work done by Dr.

Kallanagoud.B.Payappagoudar in partial fulfillment of the requirement for the

degree of Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Signature of the Guide

Place: Gadag Dr. G. Purushothamacharyulu

MD (Ayu) Professor and HOD

P.G. Department of Panchakarma,

CERTIFICATE BY THE CO-GUIDE

This is to certify that the dissertation entitled “EVALUATION

OF THE EFFICACY OF VAMANA KARMA AND VIRECHANA KARMA IN

TAMAKA SWASA” A COMPARATIVE STUDY is a bonafide research work

done by Dr.Kallanagoud.B.Payappagoudar in partial fulfillment of the

requirement for the degree of Ayurveda Vachaspathi. M.D. (Panchakarma).

Date: Dr. Santosh N. Belavadi Place: Gadag MD (Ayu)

Lecturer P.G. Dept. of Panchakarma.

ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF

THE INSTITUTION

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

OF VAMANA KARMA AND VIRECHANA KARMA IN TAMAKA SWASA” A

COMPARATIVE STUDY is a bonafide research work done by Dr. Kallanagoud. B.

Payappagoudar under the guidance of Dr.G. Purushothamacharyulu MD (Ayu),

Professor and HOD, and co-guidance of Dr. Santosh.N.Belavadi M.D. (Ayu),

Lecturer, Post Graduate Department of Panchakarma, Shri D.G.M.A.M.C, Gadag and

contributed good values to the Ayurvedic research.

Dr. G. Purushothamacharyulu Dr. G. B. Patil

Professor and HOD Principal

Post Graduate Department of Panchakarma.

COPYRIGHT

Declaration by the Candidate

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation /

thesis in print or electronic format for academic / research purpose.


Place: Gadag

Dr. Kallanagoud.B.payappagoudar

© Rajiv Gandhi University of Health Sciences, Karnataka.

ABSTRACT

In Ayurveda, chikitsa is mainly classified into Samshodhana and Samshamana.

Samshodhana is the unique understanding of Ayurveda seems to remove the root cause of

the disease by eliminating the vitiated doshas, toxins and waste products responsible for

the disease. The vitiated doshas (malas), which are eliminated from the Urdhwamarga i.e.

by mouth is called Vamana, through Adhomarga (guda) is called Virechana,

Tamaka Swasa is a common disease now a days and this can be compaired with

Bronchial asthma in modern science. Even though the scientific world has conducted

extensive studies but couldn’t find a safe and effective therapy or medicine for this

disease, in Ayurveda we offer several treatment modalities. In the treatment of Tamaka

Swasa, Vamana and Virechana therapies are good result oriented and prevent further

complications without any side effects.

Vamana and Virechana karmas are advised in Tamaka Swasa patients having

good body strength and the disease of recently manifested. The objectives of this study

are,

1) To evaluate the effect of Vamana karma in Tamaka Swasa.

2) To evaluate the effect of Virechana karma in Tamaka Swasa.

3) To evaluate the comparative effect of Vamana and Virechana karmas in

Tamaka Swasa.

Methods:

This study includes 2 groups, 15 patients in each group. In Group-A, 15 patients

were received Vamana karma and in Group-B, 15 patients were received Virechana

karma. The treatment contains the following steps.

• Deepana-pachana by Panchakola Churna.

• Shehapana by Dashamuladi Ghritam.

• Abhyanga with Moorchita tila taila and Nadisweda.

• Vamana with Madanaphaladi yoga.

• Virechana with Vyoshadi gutika.

• Samsarjana krama.

• Follow -up for 15 Days.

Results and Conclusion:

In Group A (Vamana), 03 patients got well response (20%), 06 patients are got

Moderate response (40%), 05 patients are got Poor response(33.33%) and 01 patient

showed No response (6.66%) and in Group B (Virechana) 02 patients got Well response

(13.33%), 09 patients got Moderate response (60.00%), 04 patients got Poor

response(26.66). Thus both procedures are having good and lasting results. But, by

comparing both the groups, Virechana karma is more effective than Vamana karma. In

mild and moderate type of Tamaka Swasa, classical Vamana or Virechana karma, alone

is enough to control it. Along with Shodhana karmas, administration of pathya ahara-

viharas may give more effect.

Key words –

Samshodhana, Vamana karma; Virechana karma; Tamaka Swasa; Bronchial

asthma; Panchakola Churna; Dashamuladi Ghrita; Madanaphaladi yoga; Vyoshadi

gutika.

LIST OF ABBREVIATIONS USED

A.E.C : Absolute Eosinophil Count

A.H : Ashtanga Hridaya

A.S : Ashtanga Sangraha

AT : After treatment

Bh.S : Bhela Samhita

B.P : Bhavaprakasha

B.R : Bhaishajya Ratnavali

BT : Before Treatment

C.D : Chakradutta.

C.S : Charaka Samhita

F.E.V : Forced Expiratory Volume

H.S : Highly Significant

K.S : Kashyap Samhita

M.R : Moderate Response

M.N : Madhav Nidana

P.E.F.R : Peak Expiratory Flow Rate

P.R : Poor Response

N.R : Not Response

N.S : Not Significant

Sh.S : Sharangadhara Samhita

Su.S : Sushruta Samhita

Y.R : Yoga Ratnakara

V.S : Vangasena.

W.R : Well Response

Vag : Vagbhata.

Chi. : Chikitsasthana.

Ni. : Nidanasthana.

Su. : Sutrasthana.

ACKNOWLEDGEMENT By the god’s grace and blessing of elders, I would like to express my gratitude

towards the personalities who helped me during my course of study.

I express my deep sense of gratitude to his great holiness Jagadguru Shri

Abhinava Shivananda mahaswamiji for their divine blessings.

I am highly indebted to my brother Prakash. Payappagoudar and father in

law Shri G.S.Piddanagoudar played a key role in molding my thoughts towards higher

studies with a constant enthusiastic & affectionate push and who are the driving force

behind this work.

I express my obligation to my Guide, Dr. G. Purushothamacharyulu, Prof and

HOD, Department of Panchakarma, P.G.S & R.C, D.G.M.A.M.C, Gadag, for their expert

guidance, tremendous encouragement and thought provoking advice to complete this

thesis.

I express my obligation to my co-guide, Dr. Santosh N Belavadi, Lecturer,

Department of Panchakarma, P.G.S & R.C, D.G.M.A.M.C, Gadag, for his valuable

suggestions through out this study.

I am very much thankful to Dr. Suresha Babu Prof, Dr. P. Shivaramudu Asst.

Prof, Dr. C. V. Rajashekar Asst. Prof, Dr.Yasmin.P P.G.S & R.C, D.G.M.A.M.C.

Dept of Panchakarma, for their valuable suggestions and support through out this study.

With profound sense of gratitude I express my sincere thanks to Dr. G. B. Patil,

Principal, D. G. M. A. M. C, Gadag, for encouragement and facilities provided during my

postgraduate studies.

I wish to add my warmest thanks to my PG teaching faculty Dr.Varadacharyulu,

Dr.M.C. Patil, Dr.G.V. Mulagund, Dr.K.S.R Prasad, Dr.R.V.Shetter, Dr.Danappagoudar,

Dr.MulkiPatil, Dr.Mitti, Dr.Nidagundi, Dr.Kuber Sankh, Dr. Samudri, Dr. Shankargouda

and Dr.Veena Kori.

I thank Dr.R.K.Gachinamatha, Dr.G.S.Hirematha, Dr.S.H.Radder, Dr.B.G.Swami

Dr.P.C.Chappanamatha, Dr.U.V.Purad and other undergraduate teachers,

My modest gratitude to Dr.Yarageri (RMO), Dr Hadli and other hospital staff for

their support in the clinical work.

I am very much thankful to Sri.V.M.Mundinamani (Librarian), Nandakumar

(Statistician), Mr. Tippanagoudar (Labtechnicean) Mr.Shyavi for their kind support.

I extend my gratefulness and sincere heartfelt gratitude to my senior colleagues

Dr.Santosh Yadahalli, Dr.Hugar, Dr.Jairaj, Dr.Kendadmath, Dr.Shaila, Dr.Kalmath,

Dr.Sajjan, Dr. Manjunath Akki, Dr.Suresh Hakkandi, Dr.Vijaykumar H, Dr.Lingareddi,

Dr.Ashwinidev, Dr.G.G.Patil, Dr.Shivkumar Sarvi, Dr.Umesh K, Dr.Sharanu Angadi,

Dr.Krishna J, and My colleagues Dr.Siba Prasad, Dr.D.F.Budi, Dr.Prasannakumar,

Dr.Madhushree, Dr.Natraj, Dr.Udayaganesh, Dr.Adarsh, Dr.Shailej, Dr.Mukta,

Dr.jayashankar, Dr.Deepaka, Dr.Shabaresha, Dr.Sanatha Dr.Rajesh and other scholars of

Kayachikitsa, Rasashastra and Dravyaguna Departments, for their timely support during

the study.

I am very much thankful to Smt Sushila Piddanagoudar, Smt Nagaratna.G. Patil,

Dr. S. A. Patil and Family, Shri M. D. Angadi and Family, my uncle, V. K.

Payappagoudar, my Brother in law Sri. Gurushantha, Bhabhi Smt. Jyothi Prakash, my

Sisters- Smt. Jyothi Gurushant and Shaila for their encouragement and timely support

throughout the study.

I express my eternal love to Master Pranava. P. for dispelling all the tension

with his lovely smile.

I wish to thank all my patients, who agreed, to under go my treatment, with full-

hearted co-operation. And I wish to thank all the persons who have helped me directly

and indirectly with apologies for my inability to identify them individually.

Finally, I dedicate this work whole to my respected parents Shri. Basanagoud

Payappagoudar & Mrs. Shivaleela B and my life partner Mrs. Usha Kalmesh for

their wholehearted inspiration and support to fulfill this dream.


Place: Dr. Kallanagoud. B. Payappagoudar

TABLE OF CONTENTS

Chapters Page No.

1. Introduction 1-5

2. Objectives 6

3. Review of Literature 7-89

4. Methodology 90-106

5. Observation and Results 107-137

6. Discussion 138-154

7. Conclusion 155-156

8. Summary 157-158

9. Bibilographic References 159-174

10. Annexure- Case sheet 1-11

LIST OF TABLES

SN Title of Tables Page Number

01 Table showing the 355 Formulations of Vamana 18 02 Table showing the indications of Vamana 20 03 Table showing the contra-indications of Vamana 21 04 Table showing the doses of Vamana Acc. to Sharagadhara. 28 05 Table showing the Vamana shuddi nirnaya 34 06 Table showing the Samyak Vamana lakshanas 35 07 Table showing the Vamana Atiyoga lakshanas 35 08 Table showing the Vamana Ayoga lakshanas 36 09 Table showing the Samsarjana krama 37 10 Table showing the Vamana Vyapats tat Pratikar 39 11 Table showing the 245 formulations of Virechana 46 12 Table showing the Virechana indications 47 13 Table showing the contra-indications of Virechana 48 14 Table showing the Virechana dravyas 50 15 Table showing the Virechana dravyas according to Seasons 52 16 Table showing the Matra of Virechanoushadhi 53 17 Table showing the Doshawise Virechana dravyas 55 18 Table showing the Virechana shuddi lakshanas 58 19 Table showing the Samyag Virechana lakshanas 59 20 Table showing the Virechana Ayoga lakshanas 59 21 Table showing the Virechana Atiyoga lakshanas 60 22 Table showing the Nidana of Tamaka Swasa 67-68 23 Table showing the Purvarupa of Tamaka Swasa 73 24 Table showing the Rupa of Tamaka Swasa 74 25 Table showing the Upashaya and Anupashaya of Tamaka Swasa 75 26 Table showing the Vyavachedaka Nidana of Tamaka Swasa 77 27 Table showing the Features of Extrinsic and Intrinsic Asthma 87 28 Table showing the properties of Panchakola Churna 91 29 Table showing Ingredients and properties of Dashamuladi Ghrita 94-95 30 Table showing the properties of Tila taila 96 31 Table showing Ingredients and properties of Madanaphaladi yoga 96 32 Table showing the Ingredients and properties of Vyoshadi Gutika 97-98 33 Table showing the Demographic data of Group A 108 34 Table showing the Demographic data of Group B 108 35 Table showing the data related to disease of Group A 109 36 Table showing the data related to disease of Group B 109 37 Table showing the Treatment protocol and observation of Group A 110 38 Table showing the Treatment protocol and observation of Group B 110 39 Table showing the data of Subjective parameters of Group A 111 40 Table showing the data of Subjective parameters of Group B 111 41 Table showing the data of Objective Parameters of Group-A 112

42 Table showing the data of Objective Parameters of Group-B 112 43 Table showing the incidence of Age-group 113 44 Table showing the incidence of Sex 114 45 Table showing the incidence of Religion 114 46 Table showing the incidence of Occupation 115 47 Table showing the incidence of Economical status 116 48 Table showing the incidence of Food habits 116 49 Table showing the incidence of Family History 117 50 Table showing the incidence of Koshta 118 51 Table showing the incidence of Agni 118 52 Table showing the incidence of Nidra 119 53 Table showing the incidence of Habits 120 54 Table showing the incidence of Prakruti 121 55 Table showing the incidence of Influence of Ahara 121 56 Table showing the incidence of Course of onset 122 57 Table showing the Duration of Deepana-Pachana 123 58 Table showing the Duration of Snehapana 124 59 Table showing the Samyak snigda lakshanas 125 60 Table showing the response of Samyak Vamana lakshanas 126 61 Table showing the response of Samyak Virechana lakshanas 127 62 Table showing the Vegiki lakshanas of Vamana 129 63 Table showing the Vegiki lakshanas of Virechana 129 64 Table showing the Maniki lakshanas of Vamana 130 65 Table showing the Maniki lakshanas of Virechana 131 66 Table showing the Antiki lakshanas of Vamana 131 67 Table showing the Antiki lakshanas of Virechana 132 68 Table showing the Results of Vamana Groups 133 69 Table showing the Results of Virechana Groups 133 70 Table showing the Over all Assessment 134 71 Table showing the statistical results of Vamana group (A) 135 72 Table showing the statistical results of Virechana group (B) 136 73 Table showing the comparative effect of Group-A & Group-B 137

LIST OF PHOTOS, FLOW CHARTS AND GRAPHS

SN List of Flow charts Page Number

1. Flow chart of Vamana dravya karmukata 25 2. Flow chart of Mechanism of Vomiting 43 3. Flow chart of Virechana dravya karmukata 62 4. Flow chart of Tamaka Swasa Samprapti 71 5. Photo showing the Drugs used in clinical trial 6. Photo showing the Vamana Procedure List of Graphs 1 Graph showing the incidence of Age -group 113 2 Graph showing the incidence of Sex 114 3 Graph showing the incidence of Religion 115 4 Graph showing the incidence of Occupation 115 5 Graph showing the incidence of Economical status 116 6 Graph showing the incidence of Food habits 117 7 Graph showing the incidence of Family History 117 8 Graph showing the incidence of Koshta 118 9 Graph showing the incidence of Agni 119 10 Graph showing the incidence of Nidra 119 11 Graph showing the incidence of Habits 120 12 Graph showing the incidence of Prakruti 121 13 Graph showing the Influence of Ahara 122 14 Graph showing the Course of Onset 123 15 Graph showing the Duration of Deepana-Pachana 123 16 Graph showing the Duration of Snehapana 124 17 Graph showing the Samyak snigda lakshanas 126 18 Graph showing the Samyak Vamana lakshanas 127 19 Graph showing the Samyak Virechana lakshanas 128 20 Graph showing the Vegiki lakshanas of Vamana 129 21 Graph showing the Vegiki lakshanas of Virechana 130 22 Graph showing the Maniki lakshanas of Vamana 130 23 Graph showing the Maniki lakshanas of Virechana 131 24 Graph showing the Antiki lakshanas of Vamana 132 25 Graph showing the Antiki lakshanas of Virechana 132 26 Graph showing the Results of Vamana&Virechana Group 133 27 Graph showing the Over all Assessment 134

Introduction

The comparative efficacy of Vamana and Virechana karmas in Tamaka Swasa 1

INTRODUCTION

The Ayurvedic medicinal system has been in vogue since the Vedic period or

even earlier. It emphasizes on the maintenance, promotion of health and curing the

diseases. Thus Ayurveda was developed to safe guard Arogya (health) which is

considered to be essential for the achievement of the four primary objects of life viz.

Dharma, Artha, Kama and Moksha.

Research work is done for exploring the concealed treasure of knowledge of any

system and bringing it into streamline. The progress of any branch of science depends

upon timely modification and its integration with the recent advancements. Tamaka

swasa is one such disease which needs a lot of experiment.

In Ayurveda, chikitsa is mainly classified into Samshodhana and Samshamana.

Samshodhana is the unique understanding of Ayurveda seems to remove the root cause of

the disease by eliminating the vitiated doshas, toxins and waste products responsible for

disease.

The procedure which helps to eliminate the vitiated doshas from the body is

called Shodhana. Sodhana therapy is nothing but the Panchakarma, and it is five in

number. Vamana Karma, Virechana Karma, Anuvasana basti, Niruha basti and Nasya

Karma. Sushruta mentioned Anuvasana basti and Niruha basti as Basti Karma only and

added Raktamokshana as a fifth karma. The Shodhana karmas should always be preceded

by Purvakarma, such as Pachana, Snehana karma, Swedana karma. These Purvakarma

cause vishyandana, doshapaka, srotomukha vishodhana, kostabhigamana and thus brings

the vitiated doshas from shakhas to kosta.

Introduction


Among the Panchakarmas, Vamana and Virechana karma have got more

importance in view of its easy administration through oral route in a natural direction,

thus helping the nature to do its job. The vitiated doshas (malas), which are eliminated

from the Urdhwamarga i.e. by mouth is called Vamana, through Adhomarga (guda) is

called Virechana. Both will remove the vitiated doshas and cure the disease through its

root, just as a cutted tree soon dries up together with all its twigs, fruits and flowers. I.e.

aim of treatment of Ayurveda is not directed at the level of symptoms, but at the root

cause.

Vamana is usually the first major procedure in Panchakarma therapy and is the

best treatment for Kaphadosha, Kaphastanagata doshas and kapholbana samsargaja or

sannipataja doshas. In general and particular in apakvadoshas. Vamana occupies the

place of uno among all the elimination therapeutic techniques and requires special care

during the process. It must be conducted under the supervision of practically trained

physician; otherwise a number of complications will arise. Vamana is indicated for

elimination of Doshas not only in disease states but also in healthy persons where Kapha

is aggravated within normal limits such as in Vasanta Rutu for prevention of disease and

maintenance of health.

Virechana is specially indicated for pitta dosha, pitta dosha associated with kapha

dosha and also pitta sthanshrita kapha doshajanita conditions. Along with this Virechana

is beneficial in vataja and raktaja disorders too.

“Na Tesham Punarudbhavaha” indicates importances of Panchakarma i.e.

diseases treated with Panchakarma are having less chances of reoccurrence by prohibiting

the aggravation of doshas.

Introduction


Pranavayu and Apanavayu or to say breathing out and breathing in are the sine

que non phenomenon of life. To and fro movement of air through the Pranavaha srotas is

the vital sign of Prana, the normalcy of which suggests health. The abnormality of

respiration indicates disease, and its cessation marks death. This unique sign of life is

affected in the disease Tamaka Swasa.

Tamaka Swasa has remained to be a challenging and unremitting disease. In both

sexes it may occur at any time of the age. It is chronic respiratory disease which is

increasing day by day due to change in mode of life, dietetic changes, pollution,

environmental, seasonal changes and various stimuli like dust, cold air, smoke, pollens,

house dust mite, viral respiratory tract infections. It is highly variable disease and may

differ from person to person, so needs much attention and more care.

Tamaka Swasa if not properly treated, will kill the patients like the fire burns the

dried bush. Even though Tamaka swasa is a Yapya Vyadhi, it becomes Sadhya, if the

patient possess good strength and of recent origin.

There is a feeling among the common masses that Swasa roga will go only when

Swasa (prana) goes away i.e. death. Swasa is considered krichhra sadhya or difficult to

cure. In this condition Kapha, the predominant dosha causes obstruction in the

Pranavaha srotas, thereby disturbing the movement of Vata. Consequently Vata is

aggravated and its pratilomagati takes place, which results in Swasakashtata. The

Pranavaha srotas, Annavaha srotas and Udakavaha srotas are also involved in the

Tamaka Swasa, a condition, which in modern parlance is known as Bronchial Asthma.

Clinical presentation of the illness is never ambiguous and therefore the diagnosis is easy

and straight forward.

Introduction


Bronchial Asthma is characterized by paroxysms of dyspnoea, accompanied by

wheezing, resulting from narrowing of the bronchial airways by muscle spasm, mucosal

swelling or viscid secretion. The airflow obstruction causes mismatching of alveolar

ventilation and perfusion and increases the work of breathing. Being more marked during

expiration it also causes air to be trapped in the lungs. The narrowed bronchi can no

longer effectively clear mucus by the act of coughing and in patients with severe acute

asthma; many of the smaller bronchi become obstructed by inspissated and often very

tenacious mucus.

In Tamaka Swasa two treatment modalities have been explained, one is

Shodhana, another is Shamana. Shodhana and Shamana for the persons who are strong

and Shamana for the persons who are weak. Administration of Snehana, Swedana,

Vamana, Virechana, Shamana and Brumhana line of treatment forms the complete

treatment of Tamaka Swasa as explained in Ayurvedic classics.

In Shodhana, both the Vamana karma and Virechana karma are advised for

management of Tamaka swasa. Here an attempt is made to analyse the therapeutic

efficacy of both Shodhana therapies Vamana karma and Virechana karma in

Tamaka Swasa.

Prevalence

The comparative efficacy of Vamana and Virechana karmas in Tamaka Swasa

Prevalence :

Tamaka Swasa is a very common disease in India. The prevalence of disease is

increasing day today due to genetic susceptibility, environmental factors, drugs, infection,

smoking, change in diet and life style.

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

pertaining to the respiratory disorder. It affects the people of all age groups. Some times

it is severe and fatal also. It is the serious public health problem in the countries through

out the world. Nearly 5 to 10% of the world population at some stage during life suffers

from asthma. The disease can occur at any age and affects 5% of adults and 7-10%

children commonly.

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

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

yearly.

5

Objectives

The comparative efficacy of Vamana and Virechana karmas in Tamaka Swasa

6

Need for Study:

Modern science which manages Tamaka Swasa (Bronchial asthma) by

Bronchiodilator’s and corticosteroids with long acting beta agonist, which are

having adverse effects on long term use, such as skin rashes, throat irritation,

tremors, irregular heart beat insomnia and so on. Hence there is need to find out a

treatment which is safer, effective, non toxic and cheaper remedies. Such

remedies could be explored form the huge wealth of Ayurveda.

Objectives:

Even though many research works are conducted on the effect of some

indigenous drugs on Tamaka Swasa (Bronchial asthma), only few have been

conducted on Samshodhana karma. Vamana and Virechana have great importance

in the treatment of Tamaka Swasa (Bronchial asthma) with good body strength.

These therapies are supposed to bring the dhosha to its normal level, preventing

the further complications and long lasting results.

The objectives are,

1. To evaluate the effect of Vamana karma in Tamaka Swasa.

2. To evaluate the effect of Virechana karma in Tamaka Swasa.

3. To evaluate the comparative effect of Vamana and Virechana karmas in Tamaka

Swasa.

Historical Review


HISTORICAL REVIEW

Vedas are considered as an oldest and first available literature of the world. There

are four Vedas i.e. Rigveda, Yajurveda, Atharvaveda and Samaveda. Ayurveda is

considered to be the Upaveda of Atharvaveda.

For the sake of convenience the history of Ayurveda can be derived as follows –

01. Vedic Period

02. Pauranika Period

03. Samhita and Sangraha Period

04. Modern Period

Vamana karma:

Vedic Period:

Madanaphala used for vamana, in the treatment of visha in Atharva-veda.

Madanaphala used for vamana, in visha chikitsa in Koushika sutra also.

Jivaka (the physician of Buddha) successfully performed Vamana to

Candrapradyota (the emperor of Ujjaini) in Vinayapittaka (Buddha period) 1.

Pauranika Period:

In 279th Chapter of Agnipurana, stated as, Vamana is best treatment, for the

diseases of Kaphadosh. Madana has been stated as one of the best Vamaka dravya2. It is

of great importance in Adhoga Raktapitta also3.

In 173rd Chapter of Garudapurana, used the term Shodana, Chedana and Vamana.

Vamana karma is mentioned in kushta4.

Historical Review


In 5th Chapter of Manusmruti, bath has to be taken, after the completion of

Vamana and Virechana5.

Samhita and Saghraha Period:

In Charaka Samhita - Sutrasthana 1st, 4th, 15th, 20th chapters, Kalpasthana 1-6

chapters, Siddisthana 1st, 2nd, 6th chapters explains about Vamana and drugs used for it.

In addition to these references, use of Vamana while describing the treatment of different

diseases in Chikitsasthana can be observed

In Sushruta Samhita - Sutrasthana 41st and 43rd chapters and Chikitsasthana

31st, 33rd, 34th, 39th chapters explain Vamana karma in detail.

In Ashtanga Sangraha - Sutrasthana 27th chapter and 2nd chapter in Kalpasthana

mainly deals Vamana Karma.

In Astanga Hridaya 18th chapter of Sutrasthana, 1st and 3rd chapters of

Kalpasthana deal with Vamana karma.

In Sharangadhara Samhita description of Vamana is given in detail in

Uttarakhanda.

In Kashyapa Samhita description of Vamana is given in detail in the chapters of

Siddisthana 3rd and 7th chapter of Khilasthana.

Bhela Samhita has narrated the Kalpanas of Madana, Ikshvaku, Dhamargava and

Kutaja in Kalpasthana. In Siddisthana acharya Bhela described Vamana in 2 different

chapters.

Historical Review


Apart from these Chakradatta, Harita, Vangasena and Bhavamishra have explained

Vamana karma in detail.

Modern Period:

According to Modern science, the reference of Emesis, Emetics with their types,

physiology, mode of action, mentioned in Pharmacology by Satoskar and Pharmacology

by Tripati, Physiology by Chatergy, Harrison’s Medicine and in other books

Virechana karma:

In the text Vinayapittaka, written during Buddha Kala (1425-35 B.C.) it is

mentioned that Virechana was given to Bhagvan Buddha by inhaling some powder

spread over Utpalapatra.

After this period, Virechana was dealt elaborately in Charaka Samhita, Sushruta

Samhita, Astanga Sangraha, Astanga Hridaya, etc.

Samhita and Saghraha Period:

In Charaka Smahita Sutrasthana 2nd chapter, it is mentioned about Virechana

dravya sangraha, Virechana yogas and its procedure. In kalpasthana 7th to 12th chapters,

various Virechana kalpas have been explained, where as in Siddhisthana 1st, 2nd and 6th

chapter, Virechana samyak yoga, ayoga, atiyoga, Virechana yogyayogya, Virechana

vyapat and their respective treatment are mentioned.

In Sushruta Samhita Sutrasthana 39th chapter, different Virechana dravyas

including the various preparations of Trivrit are mentioned. In Chikitsasthana 33rd and

34th chapter, the procedure of Virechana karma, samyak ayoga, atiyoga, vyapat and their

treatment is mentioned.

Historical Review


In Ashtanga Hridaya Sutrasthana 18th chapter, Virechana vidhi is explained. In

Kalpasthana 2nd and 3rd chapter, Virechana yogas and vyapatas are mentioned.

In Ashtanga Sangraha Sutrastana 27th chapter, Sharangadhara Samhitha

Uttarakhanda. Kasyapa samhita Siddisthana 3rd chapter, Bhavaprakasha Purvakhanda

Virechanaadhikara, Yogaratnakar Virechanaadhikara and Chakradatta Virechanaadhikara

71st chapter, Virechana is well explained.

Modern Period:

In Satoskar pharmacology 33rd chapter, Cathartics are used in modern medicine

for the treatment. Different types of drugs and their action are mentioned.

Tamaka Swasa:

Prevedic and Vedic Period:

The description of Pranavayu as well as Apanavayu and its role in the act of

respiration is available in literatures of Prevedic and Vedic period. Few references from

Rigveda - Pranadvayu jayate6, Ayumapranaha7, in these citations the word Prana is used

to refer the act of respiration. In many occasions the word Hridaya is mentioned in

Rigveda. This Hridaya is considered as the Mula of Pranavaha Srotas in Ayurveda. Quite

similar to this few more references from Yajurveda like Vatam Pranena Nasike8,

Pranasya Apyathatvam9, these lines express the act of respiration and effort of expiration

in regards to Prana Vayu. Further in Atharvaveda, Pranavayu is referred by the name

Maarishwa. “Vatoprana Ucyata” is a line from Atharvaveda that express the role of

Pranavayu in respiration10.

Historical Review


Upanishat Period:

The detailed account of respiration; inspiration and expiration. The two phases of

respiration are available in the Upanishad. Inhaling and exhaling the air is mentioned as

the sign of life in Amarakosha Upanishad. The original reference in this regard goes like

this – swasocchvasatmaka prana11 and Avasocchusa Hinastu Nischitam Muktaevasaha. In

Brhadaranyakopanishad, the prana is referred by the names of Angirasa and ayusya. The

function of controlling the body mechanisms are attributed pranavayu in this book12.

Angira and Brihaspati are the two names used in Chandogyopanishath referring to

Pranavayu. Added to this Pranavayu is said to nourish the body13.

The cardio respiratory system is compared to the bird Crane; the two wings of the

bird representing the lung, the trunk indicating the heart, and the neck of the bird

symbolically expressing the wind pipe are discussed in detail in Hamsopanishath

Upanishat14.

Samhita and Sangraha Period:

Charaka Samhita:

The full account of the illness Swasa roga is elaborated in the 17th chapter of

Chikitsasthana in Charaka Samhita. The text includes the Nidana, Samprapti, Purvarupa,

Rupa, Sadhyasadhyata and Chikitsa of the Swasa roga. Santamaka and Pratamaka Swasa

are told as variant forms of Tamaka Swasa. Swasa is also cited as a symptom of many

other diseases like Pandu, Udara, Karshya etc. Few prescriptions of Dhumapana in

Tamaka Swasa are also available in this Charaka Samhita and are worth mentioning.

Historical Review


Sushruta Samhita:

In Sushruta Samhita elaboration of Nidana, Bhedha, Samprapthi, Lakshana as

well as Chikitsa is explained in detail in Uttaratantra 51 chapter.

Ashtanga Hridaya and Ashtanga Sangraha:

In these treatises the Nidana aspect of the illness is described in the Nidanasthana

4Th chapter, like wise therapeutic aspect of the Swasa roga is elaborated in the

Chikitsasthana 4th chapter. The interrelation between Kasa roga and Swasa roga in the

causation is stressed in these works.

Kalyanakaraka

The description of herbomineral combinations that may be prescribed in patients

suffering from Swasa roga is unique in this text book.

Bhela Samhita :

Swasa as a symptom mentioned in Bhela Samhita. In the form of complication of

many disorders Swasa is described in this treatise.

Haritha Samhita:

Nidana, Samprapthi, Chikitsa and Pathyapathya of Swasa roga are described at

full length in Haritha Samhita. The relevant descriptions are available in the 14th chapter

of thirdsthana of this work.

Kashyapa Samhita:

Explanation related to Swasa roga is restricted to brief description in the Khila

Sthana of Kashyapa Samhita

Historical Review


Madhava Nidana:

Swasa roga is elaborated in the 12th chapter of Madhava Nidana. The description

includes the Nidana, Samprapthi, Bedha, Lakshana as well as Sadhyasadyata of the

Swasa roga.

Medieval Period:

Chakrapanidatta:

On the basis of the information available in Brihatrayi, the illness Swasa roga is

described by Chakrapanidatta.

Chakradatta:

His treatise describes Swasa chikitsa in the 12th chapter along with Hikka roga.

Arunadatta:

In his novel work, a commentary named Sarvangasundara on Astangahridaya,

Arunadatta has stressed the importance of Vata and Kapha dosha in the pathogenesis of

Swasa roga. Further he opined that Kasa roga in due course may precipitate Swasa roga

and like wise the Swasa roga may also lead to the occurrence of Kasa roga.

Ayurvedarasayana:

Morbid Kapha dosha is incriminated to cause the illness Swasa according to

Indukara.

Bhavaprakasha and Yogaratnakara:

In these two texts the description of Swasa roga at full length is based on the

Bhrihatrayi. The Pathya- apathya of the Swasa roga is also mentioned in these works.

Historical Review


Previous works done on Tamaka Swasa:

1. Dr. Tamboli .P.K -- Studies on the samprapti of Tamaka Swasa roga and its

management with katukivati and Gojihwadighanavati. Jamnagar-1984.

2. Dr.Kabara. P.R. -- A clinical study on the systemic effects of Vamana karma with

special reference to Tamaka Swasa. Jamnagar -1985.

3. Dr.Upadhyaya. k.k. –Effect of Virechana and vardhamana pippali rasayana in

Tamaka Swasa. Ahmedabad- 1985 .

4. Dr. Khatavkar Parag – Role of Vamana chikitsa on Tamaka Swasa. Pune – 1984.

5. Modh. K.G., Role of Virechana and Rasayana in the prevention and cure of

Tamaka Swasa, Gujarat Ayurvedic University, Jamnagar, 1991.

6. Dr. Singh. O. P – A comparative study on the role of Vamana and Virechana in

the management of Tamaka Swasa. Patna- 1996.

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

Ayurvedic University, Jamnagar, 2001

Recent work done on Tamaka Swasa : Work on exclusively with Vamana karma, Virechana karma and both Vamana and

Virechana karmas together on Tamaka Swasa are as fallows:

Tamaka Swasa and its management with Vamana karma and Kunjala kriya15.

Tamaka Swasa and its management with Virechana and Shamanoushadhis16.

Tamaka Swasa and its management with Virechana and Shamanoushadhis17.

Role of Virechana and gudakatutaila in the management of Tamaka Swasa18.

Clinical study on the effect of Pippalyavaleha and Virechana in management of

Swasa19.

Evaluating the efficacy of brihat katphaladi yoga in comparison with Vyoshadi

gutika nitya Shodhana in Tamaka Swasa20.

Vamana karma Review


VAMANA KARMA

Vamana karma is usually the first major procedure in Panchakarma therapy and is

the best treatment for Kapha Dosha. In addition, Virechana is the best treatment for Pitta

Dosha, Basti for Vata Dosha.

Nirukti:

According to Vachaspatyam the word "Vamana" is derived as follows21.Vam -

Udgare yakset avamit vamana Vamane lyut (Pullinga) mardane - chardane - nihsarane

cha svargabhisyanda vamanam kumarh. Ahrtau (Visva) vamathu vam - Athucha.

The word "vama" is used to denote Udgara. According to Monnier William Vama

means ejection, spitting out, vomiting, giving out, emitting, saliva, belching, sound,

roaring, echo, flowing out, issuing out etc.,

The word "vamati" is derived from the root 'VAMA' which means the act of

vomiting. The word "Vamana" is formed from the 'vama' Dhatu by adding the ‘LYUT’

Pratyaya and belongs to Masculine gender of which four meanings are given in

Vachaspatyam. These are Mardane, Chardane, Nihsarane and Svargabhisyand, and

Vamana.

It is obvious from the foregoing that the word vama - vamana - vamathu - vami

means the act of vomiting.

Vamana karma Review


Definition:

“Tatra dosha haranam urdhva bhagam vamana sangyakam” 22.

Vamana is defined by Charaka is “A process in which waste products (Dosha) are

eliminated through upper channels i.e. mouth”. Chakrapani mentions that Urdhvabhaga

should be considered as Urdhvamukha.

“Apakwa pitta shleshmanou balat urdhwam nayet tu yath |

Vamanam tadhi vijneyam madanasya phalam yatha || 23

Vamana is defined by Sharngdhara as “A process in which Apakva Pitta and

Kapha are removed forcefully through upper channels by the act of vomiting”.

Vaidyaka Kalpa Sindhu says Vamana means Urdhvamukha Doshaharana.

Vama is Udgirana by Amara Kosha.

Paryayas:

The word Vamana having synonyms of Vama, Vami, Vamana, Vamathu, Vanti,

Vantaya, Virechana, Ullekhana, Pracchardana, Chardam, Chardanam, Udgeearana,

Urdhwamukha doshaharana, Nissarana.

It should be kept in mind that, the word ‘Chardi’ is used only pertaining to a

disease or a symptom. In general, we can understand that when the chardi is induced by

medicines with proper guidance, it is called Vamana and otherwise it is either a disease or

a symptom.

Vamana karma Review


Uses:

“Kaphe vidadhyat vamanam samyoge va kapholbane!” 24 `

“Tatrotkrishte shleshmani pitta samsrishte va tat sthanagate |

va pitte anile va shleshmottare cha vamanam achareth ||”25

“Upasthite shleshma pitte vyadhou Amashayashraye |

vamanartham prayunjeetabhishagdehamadhushayam ||”26

It is indicated for kapha, kapholbana samsargaja and sannipataja doshas.

Vamana is adviced for a disease, which originates from the site of kapha, i.e. the

upper portion of the amashaya and when, the vitiated pitta comes to the site of kapha, i.e.

amashaya, then it becomes an object of emesis owing to its contact with kapha.

Vamana dravyas:

MADANA PHALA (Randia dumatorum)

JEEMUTAKA (Luffa echinata)

ISHWAKU (Lagenarea leucantha)

DHAMARGAVA (Luffa aegyptioca)

KUTAJA (Holarrhena antidysentrica)

KRITA VEDHANA (Luffa acutangula)

Basing on these six drugs, Acharya Charaka has described 355 formulations in

‘KALPASTANA’.

Vamana karma Review


Table No. 1, Showing the 355 Formulations of Vamana27 to 32:

Type of Formulation

Phala

Jeemutaka

Ikshwaku

Dhamargava Kutaja

Krita Vedhana

Kashaya 9 19 9 20 9 22

Matra 8 8 8 - - - Ksheera 4 6 8 4 - 4 Ghrita 1 1 1 1 - 1 Phanita 1 - - - - - Churna 1 - - - 5 - Ghreya 1 - 1 - - 1 Varti 6 - - - - 6 Leha 20 - 5 10 - 8

Modaka 20 - - - - - Utkarika 20 - - - - - Shadava 10 - - - - - Sashkuli 16 - - - - - Apupa 16 - - - - -

Suramanda - 1 1 1 - 1 Swarasa - 4 - - - -

Dadhimastu - - 1 - - - Takra - - 1 - - - Palala - - 1 - - - Taila - - 1 - - -

Vardhamana - - 6 - - - Mandha - - 1 - - -

Mamsarasa - - 1 - - 7 Pallava - - - 9 - -

Sakridrasa - - - 12 - - Kalka - - - 1 - - Anna - - - 1 - - Salila - - - - 3 -

Krisara - - - - 1 - Picha - - - - - 10

Ikshurasa - - - - - 1

Total 133 39 45 60 18 60

Vamana karma Review


Vamanopaga dravyas:

The drugs, which help for vomiting, are called as Vamanopaga dravyas. They are,

Ksheera, Yastimadhu, Takra.

Vamana dravyas according to Doshas: as sahapana,

In vata predominant disorders emetics should be steeped with, Tushodaka,

Maireya, Dhanyamla, Phalamla, Amla Dadhi Sura, Sauveeraka etc.

In Pitta predominant disorders Draksha, Amalaki, Madhu, Madhuka, Parushaka,

Phanita, Gokshura etc, will be used for steeping and rinsing.

In Kapha predominant disorders steep the emetics with Madhu, Mutra Vargas and

the decoctions prepared with Kaphahara drugs33.

Reasons for the preparations of different types of formulations:

To make easily palatable to everyone.

Some kinds of formulations like medicated tailas; gritas and avalehyas can be

preserved and used at any time, as some drugs may not be available in all rutu..

Some of the formulations are effecive against certain diseases. So they can be

used on dual basis simultaneously, for elimination of doshas as well as treating

the vyadhies.

Some formulations act as tonics and nourishing agents in addition to the qualities

of the elimination of vitiated doshas.

Vamana karma Review


Table No. 2, Showing the INDICATION OF VAMANA34.

DISEASES Ch. Su. As.Hr

As.Sa.

K.S.

Bh.S

Sh.S

C.D

Peenasa + + + - - - + - Nava Jwara + + + + - + + - Kushta + - + + - - + - Swasa + + + + + - + - Kasa + + + + + + + - Rajyakshama + + + + - - - - Galagraha + - - - + - - - Shleepada + + + + - - + - Galaganda + - - + + - - - Prameha + - + + + - + - Mandagni + + - + - - + - Viruddha Jeerna + + - + + - + + Visuchika + - - + + - - - Alasaka + - - + - - - - Vishapita + + + + + + + + Adhoga Raktapitta + + + + + - - - Mukhapraseka + + + + + - - - Hrillasa, Aruchi + + + + + - + - Apivaka + - - + - - - - Apachi - - + + - - + - Granthi + - + + - - - - Apasmara + + + + - + + - Unmada + + + + - - + - Atisara + + + + + - + - Pandu + - - + - + - - Mukha Paka + + - + - - - - Stanya Dusti + + + + + - + - Arbuda - - + + - - + - Vidarika - + - - + - + - Medoroga - + + + - - + - Hridroga - + - - + + + - Visarpa - + + + - + + - Chittavibhrama - + - - - - - - Vidradhi - + - - - - - - Karnasrava - + - - - - + - Galasundhika - + - - - + + - Viddha + - - + - + - - Kaphadhikya + + + + + + + +

Vamana karma Review


Table No. 3, Showing the CONTRAINDICATION OF VAMANA35.

DISEASES Ch. Su. As.Hr

As.Sa.

K.S.

Bh.S

Sh.S

C.D

Baala + + + + + - + - Vriddha + + + + + - + + Sthula + + + + + + + + Krishna + + + + - + + + Sukumara + - - + + + - - Kshaya + - - - - - - - Durbala + + + + - + - - Ksudhita + + + + - - + - Pipasita + + + + + - - - Karmahata + - - - - + - - Baharata + - - + - - - - Upavasita + - - + - - - - Maithuna Prasakta + - - + - - - - Adhyana Prasakta + - - + - - - - Garbhini + + + + + + + - Vyayama Prasakta + - - + - - - - Chinta Prasakta + - - + - - - - Samvrita Koshtha + + - + - - - - Duchhardana + + + + + - + - Kshyatakshina + + + + + - + + Krimi Koshta - + + + + - + + Urdhavarakta Pitta + + + + + - + + Urdva vata + + + + - - - - Asthapita + + + + + - + - Anuvasita + + + + + - - - Hridroga + + + + - - - - Udavarta + + + + - - + - Mutraghata + + + + - - - - Pleeha Roga + + + + + - - - Gulma + - + + + - + + Udara + + + + + - + + Asthila + + + + - - - - Timira + + + + - - + + Sankhashula + + - + - - - - Sirahshula + - - + + - - - Karnashula + - - + + - - - Arsha - - + + - - - -

Vamana karma Review


Properties and mode of action of Vamana drugs:

Bhautika Constitution: Though all Vamana drugs are Panchabautik in their

constitution, Agni and Vayu Mahabhuta are dominant in their constitution36. Sushruta

Samhita, Astanga Sangraha and Astanga Hridaya are also of the same opinion.

Chakrapani while commenting on the constitution means that Vamana drugs are

particularly Agneya37. Because of the dominance of Agneya and Vayu mahabhuta the

Vamana dravyas having Urdwaga gati which ultimately leads to Vamana38.

GUNA: 1. Ushna 2.Tikshna

3. Sookshma 4. Vyavayi 5. Vikasi

Apart from these Gunas Saratva Guna is mentioned by Sushruta39-40.

Ushna: It is Agneya, which produces Dahana, Pacana, Swedana and Vivarana41. Ushna

drugs play important role in the process of Visyandana of the Dosha Sanghata

responsible for the disease. Cakrapani mentions that Vishyandayati means “Vilinam

Kurvanti” 42. According to Apte Vilinam means to dissolve or to liquefy. In this way due

to Ushna property, the drugs used in the Vamana karma, liquefy the Dosha Sanghata. In

modern Parlance it may be like the action of catalytic agents, which may be converting

the saturated compounds in to the unsaturated one or in the form, in which they are more

reactive.

Tikshana: Produces Daha, Paka and Srava. Tikshana is responsible for the act of

Vicchindana Chakrapani says that Vicchindanti is nothing but the breaking down of the

morbid matter into the small possible particles 43. Tikshana is also Agneya; because of

this Doshas oozes out immediately. It produces Shodhana, Pachana, Chedana and

Sravana of Doshas in their places.

Vamana karma Review


On the basis of the above, it can be said that due to Tikshana property Vamana

drugs breakdown the Dosha Sanghata already softened by Agneya property into the

smaller particles. These smaller particles may either water soluble or in such a form so

that they may be taken out from the diseased place, can be brought to the blood

circulation where they may be brought into Koshta and Amashaya in case of Vamana due

to the Anu Pravanabhava of the drugs44.

Sukshma: Due to this guna the drugs can pass through minute Srotas, Vayu, Akasha and

Agni Mahabhuta are dominant in its Bhoutika Constitution. It has been mentioned that

Vamana drugs enter Sthula and Sukshma Srotas. Sharangdhara has mentioned that

Vamana drugs having this property can enter Sukshma Srotas of the body45.

Vamana drugs after breaking the Dosha Sanghata by its Ushna and Tikshna

properties, due to their Anu Pravanabhava and Purvakarma brings the Dosha again into

the Koshta without sticking to the channel as honey runs through the walls of the earthen

vessel which has been anointed with Sneha.

Vyavayi: Vyavayi guna of the drugs act directly on the body. It is generally considered

that as soon as this type of drugs are ingested, their action starts first then it’s Pachana46-

47. Due to this property the Vamana drug get absorbed and then act quickly. Dalhana says

that due to this property Vamana drugs spread into the body without changing its form48.

In other context he also mentions that Vamana drugs are circulated due to Vyavayi

property and its Pachana occurs afterwards like that of Madya and Visha49.

Vikasi: The drugs, which are having Vikasi guna, produce Shithilyata in the Sandhi and

Oja is separated from the Dhatu50. Vikasi are those, which loosens the Dhatu Bandhana.

Vamana drugs due to this property also pervade through whole body without its

Vamana karma Review


digestion, such that of Vyavayi. Loosening of Dhatu Bandhana is nothing but Dhatu

Shaithilya51.

Saratva: Due to this guna Anulomana is possible52. At other juncture Dalhana describes

that Anulomana is nothing but vata and Mala Pravartanam53. Gayadasa another

expounder is of the same opinion that Saratva is Visravana i.e., sliding, spreading. It is

possible that due to Saratva Guna Mala which is brought towards the Koshta from shaka

may be evacuated. Thus removal of Dosha may be enhanced.

Virya: Vamana drugs have Ushna Virya due to this Dahana, Swedana, Vivarana and

particularly Pachana occurs. Drugs first enter the Hridaya by potency where from they

are circulated through Dhamani to Sthula and Sukshma Srotas of the body54. Thus Ushna

Veerya helps the Vamana drugs in their circulation all over the body and also in breaking

down the Dosha Sanghata.

Vipaka: Vipaka of Vamana drugs seems not to play much role in Vamana Karma,

because Vyavayi guna gets the drugs absorbed without their digestion.

Prabhava: The main action of Vamana is due to its Prabhava.

“Urdva – Anulomana – yatcha – tat prabhava Prabhavitam” i.e. the action of Vamana and

Virechana drugs are mainly due to their Prabhava55. Elaborating Prabhava of Vamana

drugs, Chakrapani says that due to dominance of Agni and Vayu Mahabhuta in their

Panchabhautika constitution, there is a tendency of Urdva Gati of Vamana drugs. It may

be initiated by Udana Vayu. However he says that it is the Prabhava of drugs that have

important role in Urdhvagati56.

Vamana karma Review


IIUSTRATING VAMANA DRAVYA KARMUKATHA SCHEMATICALLY

Vamana Yoga Vyavayi Vikashi enters the Through Dhamani

(Aushadha) gunas heart circulates all overThe body

Atura Nirikshana Due to Sookshma Guna

Vamanavega enters Sthula & Sookshma Srotas

Shareera & Lalata Due to Agneya Guna

Pradesha Sweda Utpathi Dosha Vilayana in Srotas.

Roma Harsha

Udanavayu due to Tikshna and Ushna Guna

Hrillasa Udara Admana Dosha Chedana and Bhedana

Agni &Vayu Dosha due to Anupravana Bhava

Mahabootha Amashaya Pravesha Dushitha Dosha Ati Sookshma

Predominant Rupa not adheres to any region.

Vamana karma Review


Vamana Karma is not merely a gastric lavage as done now a day to empty the

content of stomach, but it is a complete management of systemic diseases caused by

Kapha. Amashaya particularly Urdva Amashaya is the seat of action of Kapha. The

active principle of Vamana drug taken orally is absorbed from the stomach into

circulatory system where from it is circulated to all over the body. On reaching at the site

of lesion (Dosha Sanghata), which is at the cellular level, it breaks the nexus of Dosha

and brings back the toxic substances thus released into the stomach, where from they are

expelled out of the body by the action of vomiting.

Further, generally it is considered that the drug given orally cures the diseases

originating from the stomach in better way, as it is the main seat of Kapha. Mild

inflammation is must for purification action. It is noticed that most of the drugs employed

in Vamana have mild irritation effect and produced mild inflammation facilitates the

quick absorption of the active principles (Veerya) of the drug in the initial stage. Later on

it facilitates the excretion of the morbid matters, which generally are not supposed to be

excreted out. It is possible only because inflammation increases the permeability of the

capillaries, which in turn allow the absorption as well as excretion of the substances,

which are not allowed in normal conditions.

VAMANA VIDHI VIDHANA: It includes

Poorva Karma

Pradhana Karma

Paschat Karma

Vamana karma Review


Poorva Karma: It includes

1) Sambhara Sangraha

2) Atura Pariksha

3) Matra Nirnaya

4) Atura Siddhata –

a) Amapachana

b) Vamana Poorva Bhojana Vyavastha

c) Snehana and Swedana

d) Manasa Upachara

1) Sambhara Sangraha: It is necessary to collect all the required equipments, drugs,

diet, articles etc, well in advance. buckets, measuring glass, towels, bowl, rubber tubes,

stove, spoon, cover plate, churning sticks etc. Should be made available. Eranda Nala or

Kamala Nala is also necessary.

Some drugs to treat the complications should also be made available. Similarly

the drugs to be used for Vamana Karma and diet articles required for the previous night

and for Samsarjana Karma should also be kept in store.

2) Atura Pariksha - Selection and Examination of the patient: Patient should be

examined thoroughly. First of all it should be decided that the patient is fit for Vamana

Karma or not as indicated in Table No-2 and Table No-3. If the patient is having some

other disease or complication arised from Snehana or Swedana, then it should be treated

first. The patient should be examined by Ashtavidha and Dashavidha pariksha. It has

been mentioned in Charaka Samhita that Dosha, Beshaja, Desha, Bala, Kala, Shareera,

Ahara, Satmya, Satva and Prakriti are the important factors, which must be examined

Vamana karma Review


before performing the Vamana Karma57. If the patient is not examined fully and some

point is missed in relation of the patients then Vyapadas (Complications) may occur after

performing the Vamana Karma.

3)Matra Nirnaya: Sushruta58 mentions that considering the Koshtha of the patient,

Kvatha, Kalka, Churna, Sneha etc. of Vamana drug should be given in an appropriate

dose.

The dose of Vamana drug is depending upon the individual patient. It should be in

such a quantity that the desired effect may be achieved and may be able to eliminate

Dosha from the body but should not produce any symptom of Atiyoga or Ayoga59. While

describing the process of Vamana, it has been mentioned that the dose of Madanaphala

Pippali should be Antarnakhamushti pramana (the fist of the patient) 60. As shown in the

table the dose of Kvatha, Kalka, Avaleha and churna are described in detail in

Sharangdhara Samhita61.

Table No. 4, showing the MATRA OF VAMANA DRUGS ACCORDING TO SHARNGADHARA

KALPANA UTTAMA MATRA MADHYAMA MATRA KANIYASI MATRA

Kvatha 9 prastha 6 Prastha 3 Prastha

Kalka

Avaleha

Churna

3 pala 2 pala 1 pala

Arunadatta has mentioned 3 types of Koshta.

Mrudu koshta- having Bahu kapha – Requires less dose of Vamanoushadhi.

Madhyama koshta- having Madhyama kapha – Requires madhyama pramana.

Krura koshta- having Alpa kapha – Requires more dose of Vamanoushadhi62.

Vamana karma Review


4) Atura Siddhata:

a) Deepana-Pachana:

‘Rogaha sarve api mandeagnou,’ almost diseases are arised by mandagni and

because of mandagni, ama is produced. So for Agni-deepanarta and Ama-pachanarta,

deepana-pachana dravyas are to be administered, upto the nirama lakshanas are seen.

b) Snehana and Swedana:

Snehana: Before giving the sneha, koshta of the patient is to be assessed, then start the

sneha with ‘Hrishiyashi matra’63 and daily rising in the quantity. It should be given for 3

to 7 days or until the Samyag snigda lakshanas are seen64. The snehapana is to be given

early in the morning, i.e. just after the sunrise (kinchit abhyudite Ravou) 65, in empty

stomach after observing the jeernahara lakshanas66.

Regimens followed during snehapana67:

Use of Ushnodaka

Avoid Diwaswapa

Following Brahmacharya

Should not exposed to wind

Should not suppress the natural urges like defecation, urination, flatus, thirst etc,

Should take anabhishyandhi, liquid, hot diet mixed with slight unctuous

substance.

Swedana: After snehapana, one-day gap68 should be given during which the patient

should be subjected to Abhyanga and Swedana. Chakrapani while elaborating Snehana

and Swedana states that Abhyanga should be done along with Swedana, for two or three

Vamana karma Review


days69 i.e, on the day, on which Snehapana is completed, gap day and the day on which

Vamana is to be administered.

Abhyanga: Gunas are70,

1.Jarahara, 2.Shramahara, 3.Vatahara, 4.Dristi-prasadaka,

5.Pustikara, 6.Twak dardhyakara and 7.Kaphavata Nirodhana

‘Dosha Vilayana’ takes place through the Swedana. It dilates all the channels in the body.

During the Swedana procedure the blood volume will be raised (increased). All the

bodily secretions will be increased due to stimulation of various glands. According to

Vagbhata, by the action of Snehana and Swedana, the morbid doshas are liquified,

dissolved and are brought to koshta71.

Vagbhata mentioned that, Snehana and Swedana removes the waste products

from the body, in the similar way as the dirt of the cloth is removed with the help of soap

and hot water72.

c) Vamana Poorva Bhojanadhi Vyavastha: Dietetic regimen of the patient Before

Vamana should be considered in the following three headings.

Diet at the time of Snehapana.

Diet for the previous night of Vamana.

Diet just proceeding to Vamana karma.

The diet to be taken on the days of Snehapana must be in the less quantity and it must

have Anabhisyandi, Laghu, Drava, Nathisnigdha and Ushna property73. It has been

clearly mentioned that after Snehapana, patient should take rest for one day before

performing Vamana karma74. On that day, the patient should be given the diets, which

Vamana karma Review


have a property of Kapha Utklesana. Gramya, Anupa and Udaka Mamsa Rasa, Ksira,

Dadhi, Masha, Tila, Shaka etc. are to be taken for Kapha Utklesana.

In Sushruta Samhita75 it has been stated that the diet to be taken before the day of

Vamana should be Abhishyandi. Dalhana states that this particular diet should be

administered to serve the purpose of Kaphoutklesha76. It has been narrated in Charaka

Samhita that this type of diet must be taken on the previous night of performing of

Vamana karma. It increases the Kapha and Kleda and thus Doshas start to flow towards

the Koshtha.

Yavagu mixed with small quantity of Grita should be given in the morning of the day

on which, Vamana is to be performed. However much quantity of Grita should not be

given. Vamana should not be administered to the patients having empty stomach. If it is

not possible to take diet in the morning of the day of Vamana Karma, one or two liter of

milk can be given i.e. Akantapana77.

d) Manasopachara: Patient should be prepared mentally to undergo Vamana therapy.

He should be instructed about Snehapana, Swedana, and dietary regimen, administration

of Vamana and Vamanopaga drugs. If any disturbance of manas is there, then Vamana

may not occur properly. The Svasti – Vachana, praying for God78-79, etc may keep the

patient mentally quite. The patient mind can also kept quite with the help of taking baths,

anointing body with perfumed oil, wearing of garlands of flowers having good smell and

wearing of good clothes.

Vamana karma Review


PRADHANA KARMA:

On the auspicious day, after administration of Snehapana and Swedana

successfully and ascertaining that patients mind is in tranquility, has slept soundly, food

taken by him is digested, has taken full bath, has anointed body, worn a garland and

untorn clean clothes and worshiped God, Bramhana and Guru, the physician should

administer the decoction of Madanaphala along with Madhu, Saindhava, Phanita and

decoction of Yastimadhu for Vamana Karma80.

The whole process which is to be done from the period of oral administration of

Vamana drug upto the completion of Vamana Vega may be taken as Pradhana Karma. It

can be classified under four headings as follows.

a) Administration of Vamana Yoga b) Observation during Vamana Karma

c) Ascertaining of Vamana Vega d) Observation of Shuddi Lakshana

a) Administration of Vamana yoga: Vamana is to be performed, early in the morning,

i.e. in Kaphakala81. The patient should be asked to sit on a comfortable chair. The height

of the chair should be up to the level of knee joint82, Pulse, Respiration rate and Blood

pressure should be noted before administering Vamana yoga.

Advice the patient, to take Vamanopaga preparations upto full stomach (Akanta

pana). Generally now a days Ikshurasa or Milk is preferred.

“Vamana drug should be given in full stomach, because-when the pyloric end of

stomach remains closed and all the local activities of Vamana drugs are limited to the

stomach only. As the drugs are irritant action, so a mild inflammation of stomach mucosa

is produced.”

Vamana karma Review


Generally Vamana dravya preparation should be unpleasant taste and smell and

looks ugly (Bheebatsam vamanam dadhyat) 83.As Vamana yoga generally has unpleasant

smell and ugly appearance, advice the patient to take it as quick as possible. The Mantra

is to be chanted during the administration of Vamana yoga84.

b) Observation during the Vamana karma:

After administration of Vamana drug, observe the patient carefully.

“Apakwam vamanam dosham pachyamanam virechanam ”. 85

Means, the Vamana dravya will starts its action without undergoing the paka, i.e.

by its guna and veerya etc. so don’t wait for its pakata.

After the administration of the drug, wait for ‘one muhurta’86. The appearance of

Sweat on the forehead of the patient indicates that doshas are being melted in their Srotas

and horripulation (Romaharsa) shows, doshas have started to move towards the Koshta87.

When patient develops kukshi admana, it may be guessed that the doshas have

reached to koshta. Thereafter the appearance of Praseka (salivation) and Hrillasa (nausea)

gives the indication that the doshas are in urdhwagati and are ready for elimination by the

act of vomiting through mouth. Then, intimate the attenders, to hold the forehead of the

patient. Charaka suggests that Nabhi region of the patient, should be pressed and back of

the patient should be generally massaged below to upwards i.e. Pratiloma unmardana88.

c) Ascertaining of Vamana Vega and Mana: The counting of Vega is very essential

because the Heena, Madya and Pravara Shuddi depends upon it. The Vega which is

induced immediately after the administration of Vamana drug is due to Hrillasa and Asya

Srava. Hence, this Vega should not be taken into account. Getting of eight, six and four

Vamana Vegas indicate for Pravara, Madhyama and Heena Shuddi respectively89.

Vamana karma Review


The Vomitus should also be preserved and thereafter should be measured or

weighed. According to Pravara, Madhyama and Heena Shuddi, the weight of vomitus

should be two Prastha, one and half Prastha and one Prastha respectively. Chakrapani

mentions that in the context of Shodhana, one Prastha should be taken equal to thirteen

and half Palas90.

D) Observation Of Shuddi Lakshana: Chakrapani classifies all the signs and symptoms

of Samyak Shuddi into the four groups viz. Antiki, Maniki, Vaigiki and Laingiki91. In

Vamana Karma first Kapha, then Pitta and in the last Vata Dosha are eliminated

respectively. In Vamana, Pittanta Shuddi is considered as Antiki Shuddi. Bitter taste in

the mouth indicates the Antiki Shuddi

Table No.5, Showing the Criteria for types of Shuddi in Vamana91 Vamana AVARA SUDDHI MADHYAMA SUDDHI PRAVARA SUDDHI Vaigiki 4 Vega 6 Vega 8 Vega Maniki 1 prastha 1 ½ Prastha 2 prastha Antiki PI T T A N T A M Laingiki SYMPTOMS OF SAMYAK VAMANA

The Samyak, Heena and Atiyoga should be confirmed on the basis of the

symptoms and signs described for this purpose and it are known as Laingiki Shuddi.

According to Chakrapani out of the four types of Shuddi symptoms, the main importance

should be given to the symptoms described for Samyak Yoga of Vamana93. Sushruta has

mentioned only Laingiki Shuddi94. According to Dalhana Vaigiki and Maniki Shuddi

may be discarded as the patient having different types of Prakriti, Sara, Samhanana, Vaya

and Bala etc. May not have Pravara Shuddi only by 8 Vegas but have Pravara Shuddi by

more of less than 8 Vegas also. Thus more importance has been given to Laingiki Shuddi.

Vamana karma Review


Table No.6, Showing the SAMYAK YOGA LAKSHANA OF VAMANA KARMA95

LAKSHANA Ch. Su. As.Hr As.Sa. Bh.S Sh.S Kale Pravrutti + - + - - - Elimination of Kapha Pitta and Vata respectively

+ + + - - -

Svayam avasthana + + + - - - Hridaya shuddi + + + - - + Parsva shuddi + - - - - - Murdha shuddi + + - - - + Srotas shuddi + - - - - + Indriya shuddi + - - - - - Laghuta + + - + + + Daurbalya + - - + - - Kantha shuddhi - + - + - + Kapha samsrava - + - - - - Anati mahati vyatha + - + + - - Yatha Kala kshudha, Pipasa - - - - + - Jathagnita - - - - + + Manaprasannatha - - - - + - Ashya shuddhi - - - + + -

Table No.7, Showing the ATIYOGA LAKSHANA OF VAMANA KARMA96

LAKSHANA Ch. Su. As.Hr As.Sa. Bh.S Sh.S Phenila Vamana + - + - - - Rakta Candrikayukta + - + - + + Trishna + - + + + + Moha + + + + - - Murcha + + - + + - Vata Prakopa + - + + - - Nidrahani + - - + + - Balahani + - + + - - Hridpida - + - - - - Kanthapida - + + - + + Tamahpravesha - - + - + - Brama - - + - - - Pittatiyoga - + - - - - Daha - + + - - - Udgaradhikya - - - + + + Hikka - - - + - + Hanustambha - - - + + + Mrityu - - + - - -

Vamana karma Review


Table No.8, Showing the AYOGA LAKSHANA OF VAMANA KARMA97

LAKSHANA Ch. Su. As.Hr As.Sa. Bh.S Sh.S Apravritti + - - + - - Only Aushadha Pravrutti + - + + - - Vega Vibandha + - + + - - Hridaya avishuddhi + + + + - - Srotas avishuddhi + - - - - - Guru gatrata + - - + - - Sphota + - - + - - Kandu + + + + - + Kapha Praseka + + + + - + Jvara - + + + - - Kota + - + + - + Paschat Karma: After completion of Vamana Karma, all types of care taken, till the

patient starts taking the normal diet, may be grouped under Paschat Karma. It may be

subdivided in the four groups viz. Dhumapana, Pariharya Vishaya, Samsarjana Krama

and Santarpana Chikitsa.

a) Dhumapana: After completion of Vamana Karma, the hands feet and face of the

patient should be washed with Sukoshna Jala. There after Dhumapana should be given to

him. After administration of Dhumapana the patient should be asked to wash his feet and

hand again98 Dalhana is of the view that Paschat Karma is under taken for relieving the

remaining Kapha Dosha. According to him Dhumapana is very useful for Kapha, which

is still sticking to the Srotas. Snehika Dhumapana should be given to the patient having

Vata Prakriti. If the patient is of Kapha or Pitta Prakriti and or Utklesh of Dosha is

present, Vairechanika Dhumapana should be prescribed. Shamaniya or Prayogika

Dhumapana is indicated in the case of Sama Dosha Prakriti99.

b) Pariharya vishaya100: After taking Dhumapana, patient should be transferred to the

ward in his bed. Thereafter he should be instructed not to indulge in the following factors,

which are collectively known as Pariharya.

Vamana karma Review


1) Speaking loudl 2) Too much eating 3) Too much standing 4) Moving for long time

5) Restoring to anger and grief 6) Exposure to sun and strong wind 7) Traveling by

vehicles 8) Indulging in sexual intercourse 9) Vigil during night 10) Sleeping

during day time 11) Ingestion of Viruddha, Asatmya, Guru type of food and 12)

Vegasandharana etc. Dalhana has reclassified the above-mentioned factors into three viz.

Kayika, Vachika and Manasika.

c)Samsarjana Krama: The specific diet prescribed after Vamana Karma till the patient

start taking his normal diet may be taken as Samsarjana Krama.

Soon after the Shodhana, Charaka has mentioned that Agni is decreased after

performance of Shodhana therapy101. Jejjata said that Doshas after getting liquefied are

coming towards the Amashaya. Because of unstable condition of Dosha, Agnimandya is

produced. If after Shodhana heavy diet is given, it will decreases the Jatharagni further

and may lead to many complications of Ama. Therefore it has been advised to prescribe

Peya, Vilepi, Yusha etc. to increase the Agni gradually.

Table No.9, Showing the SAMSARJANA KRAMA102 Day Annakala Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi 1st Day

Morning Evening

-- Peya

-- Peya

-- Peya

2nd Day

Morning Evening

Peya Peya

Peya Vilepi

Vilepi Krita Yusha

3rd Day

Morning Evening

Vilepi Vilepi

Vilepi Akrita Yusha

Krita mamsarasa SamanyaBhojana

4th Day

Morning Evening

Vilepi Akrita Yusha

Krita Yusha Akrita Mamsarasa

5th Day

Morning Evening

Krita Yusha Krita Yusha

Krita Mamsarasa Samanya Bhojana

6th Day

Morning Evening

Akrita mamsarasa Krita mamsarasa

7th Day

Morning Evening

Krita Mamsarasa Samanya Bhojana

Vamana karma Review


Santarpana Chikitsa: It has been mentioned that generally Samsajanakrama should be

adopted after completion of Vamana Karma103. But if Doshas are not eliminated properly,

Tarpana is indicated. Tarpana should also be given to those who are addicted to alcohol

and have the dominance of Vata and Pitta Dosha. Chakrapani mentions that in spite of

Peya and Vilepi Svaccha and Ghana Tarpana should be given respectively104. Jejjata has

also mentioned that Yusha and Rasa are the Tarpana. Vagbhata has also advised to give

Tarpana105. Arunadatta mentions that Lajasaktu should be given at first meal time. Use of

Odana of old rice is mentioned for second meal time. For the third meal time Mamsarasa

has been recommended. Charaka has also mentioned same Tarpana yoga106.

Vamana vyapat tat Pratikara:

The patients to whom Snehana and Swedana have been performed properly, if

Vamana drug is given in correct dose and with concentration of the patient’s mind, the

Samyak Yoga of Vamana will be produced107. However, chances of occurrence of

complications due to fault of physician, drug, nurse and patients are responsible108.

According to Charaka Vyapath’s may be caused due to Ayoga and Atiyoga. Ayoga of

Vamana is responsible for Admana, Parisrava, Hridgraha, Gatragraha, Klama, Stambha,

Upadravas and Atiyoga of Vamana is responsible for Parikartika, Jeevadana and

Vibramsha109.

Ayoga Chikitsa – Deepana, Pachana, Hridya, Balya, Shamana Aoushadis,

Snehana, Swedana, Vamana, Niruha Basti with Gomutra, Anuvasana Basti etc are

beneficial110.

Atiyoga Chikitsa – If excessive Vamana occurs give Mrudhu Virechana, Sheetala

Jala Parisheka111. If the tongue is protruded apply the paste of Tila and Draksha over the

tongue and then gradually push into the mouth. If the tongue is dragged into the buccal

cavity then Kavalagraha with Dadimarasa Yusha, milk, Mamsarasa is administered112.

Vamana karma Review


Table No.10, Showing the Vamana vyapat tat Pratikara

Vyapats Charaka Sushruta Treatment Adhmana + + Abhyanga, Swedana, Phalavarti Prayoga, Niruha

and Anuvasana Basti Parikartika + + Langhana, Pachana, Rooksha Ushna Laghu Ahara

Sevana, Gritha Manda Anuvasana, Picchaabasti / Sheeta Jala Parisheka Gritha Madhu, Madhura, Sheetala lepa, Madhura Ksheera Bhojana

Parisrava + + Vamana or Tikshna Virechana, choorna Asava Arista Prayoga

Gatragraha + + Sneha, Sweda, Vatahara karma Hridgraha + + In Pitta Janya Murcha use Madhura Dravya and

Kapha Janya Murcha use Katu Dravya for Vamana then for Sheshadosha give Pachana Dravya. If vata is aggravated use Snigdha Amla Lavana Dravya and if Pitta and Kapha are aggravated then use Rooksha, Tikta and Katu Dravya mainly Madhura Dravya Prayoga is beneficial.

Jeevadana + + Pittaharakarma, Raktha Pana, Sheetala piccha Basti, Grutha manda Anuvasana Basti

Vibramsha + - Santhwana, Priyashabda Vachana Stambha + - Langhana, Pachana, Tikshnavasti, Tikshna

Virechana Klama + - Langhana, Pachana, Snigdha Dravya, Tikshna

Shodhana Upadrava + - Snehana, Sweda, Vatahara Kriya Vamanasya Adhogati

- + Snehana, Tikshna Vamana

Virechansya Urdva Gati

- + Vamana, Virechana

Savashesha Aushadha

- + Give Ushna Jala for Vamana

Jeerna Aushadha

- + Tikshna Aushadha Prayoga

Alpa Dosha harana

- + Sneha, Sweda, Virechana

Vata Shoola - + Sneha, Sweda Yashti Madhu Taila Anuvasana Ayoga - + Vamana with Madana Phala and Lavana Mishrita

Laja, Anuvasana and Asthapana Basti, Atiyoga - + Abhyanga, Sheeta Jala Snana, Avaleha Prayoga,

Ksheera Bhojana Pravahika - + Snehana, Samshodhana Vibandha - + Vamana, Avasthanusara Chikitsa

Vamana karma Review


EMESIS

‘Emesis’ the term is derived by ‘emein’ (Greek) means, to vomit113.

It may be gastric, systemic, and nervous or reflex origin or due to irritation of

Vomiting center.

‘Vomit’, is derived by the Latin word-‘vomere’ means, to vomit. i.e.

1) Material that is ejected from the stomach through mouth.

2) To eject stomach contents through the mouth.

The act is usually reflex involving coordinated activity of both Voluntary and

Involuntary muscles.

‘Vomitory’ a Latin word, derived by ‘Vomitorious’114

means, to vomit and Causing vomiting, an agent inducing emesis and a vessel to receive

vomitus.

‘Vomiturition’ it’s also a Latin word, derived by term ‘Vomitorious’ i.e.a

repeated involuntary and ineffective effort to vomit.

Synonyms: Emesis, Vomiting, and Retchin115.

Retch and Retching = to make an involuntary attempt to vomit.

Definition:

“Vomiting is a reflex which serves to relieve the upper GI tract by forcible

expulsion of gastric contents through the mouth.” This may occur either because the

contents are irritating or organs themselves or the nerves that supply them are more

irritable than normal. Excessive distension & compression or irritation of the intestine,

appendix, bile ducts and other abdominal viscera can also initiate this movement. This is

a reflex movement116.

Vamana karma Review


Vomiting is a highly integrated and complex reflex, involving both autonomic &

somatic neural pathways. Synchronous contraction of the diaphragm, intercostals muscles

and abdominal muscles raises intra-abdominal pressure and combined with relaxation of

the lower oesophageal sphincter, results in forcible ejection of gastric contents117.

The drugs that produce vomiting [Emetics] can be classified according to their

site of action as118

1) Centrally acting, - by stimulation of the CTZ e.g. Apomorphine, morphine

and hydergine.

2) Peripherally acting, - e.g. mustard, antimony, potassium tortarate (tartar

emetic) and hypertonic sodium chloride.

3) Both peripherally and centrally acting e.g. Ipecacuanha.

Cause: The commonest cause of vomiting is gastric irritation and its purpose is to drive

out the irritant from the stomach.

Physiology119: The act of vomiting is accompanied by a complex series of movements,

which are controlled by the vomiting center present in the dorsal portion of the lateral

reticular formation in the medulla oblongata. The vomiting center is the final common

pathway for the act of vomiting. It receives afferent impulses from;

Chemo receptor trigger zone (CTZ)

Vestibular apparatus.

Higher centers in the brain.

Peripheral structures including the GI tract & nucleus tractus soliterius (NTS)

A major sensory relay station in the afferent vomiting pathway is Chemoreceptor

trigger zone (CTZ). Histologically, CTZ resembles the carotid body & is not a part of the

Vamana karma Review


brain. It must be pointed out, however, that the CTZ being a purely sensory relay station,

is incapable of initiating vomiting in the absence of vomiting center, while direct

electrical or chemical stimulation of the latter can evoke vomiting irrespective of the

CTZ. Vomiting due to irritation, over distension or over excitation of the upper GI tract

(especially the duodenum) does not involve the CTZ, but is directly mediated by the

vomiting center. Similarly it is likely that vomiting of central origin due to emotions,

nauseous odors and other similar factors does not involve the CTZ, but is due to impulses

directly reaching the vomiting center. On the other hand vestibular origin is mediated by

the pathway; vestibular nuclei, cerebellum, CTZ and vomiting center.

Mechanism of Vomiting:

Vomiting is a reflex process. Straight forward vomiting is governed by a

“Vomiting center”, which is situated in the dorsal part of the lateral reticular formation of

the medulla lying ventral to solitary tract and its nucleus120.

Vomiting occurs due to stimulation of the emetic (vomiting) center, situated in the

medulla oblongata. Afferent impulses from the GIT and other viscera, vestibular

apparatus, higher centers and CTZ situated near the vomiting center are relayed to the

vomiting center. The latter coordinates the movements, that results in the vomiting.

Nausea is mediated by higher centers and is associated with reduced gastric tone and

peristalsis along with increased tone of duodenum. Conditions that inhibit gastric

emptying promote vomiting.

There are 2 pathways, by which the vomiting center is affected,

Nervous path

Vascularpath

Vamana karma Review


The nervous path lies in the various afferent pathways coming from the various

organs, especially digestive tract. The most sensitive part is in the first part of duodenum.

The afferent impulses may also arise in the throat (tickling sensory nerves 5 & 9),

stomach (irritation), intestine or other organs outside the gastro-intestinal tract like heart,

kidney, uterus or semicircular canals. The efferent impulses, both excitatory and

inhibitory, are carried in the Phrenic chiefly and Vegus and Sympathetic.

The CTZ has dominant dopaminergic (DA) as well as other H1, 5HT3, Ach and

opoid receptors. It is sensitive to many blood borne drugs and hormones, and is Un

protected by Blood-Brain-Barrier. The vestibular impulses are transmitted through a

cholinergic pathway. Histamine also probably serves a fecilitatory role in the neurogenic

mechanisms of vomiting.

MECHANISM OF VOMITING121:

HIGHER CENTRES Emotion/Bad smell NTS VOMITING CTZ VESTIBULAR VESTIBULAR CENTRE NUCLEI APP.ININT.EAR Visceral afferents Drugs/chemicals Gastritis, AMI Radiation Biliary colic Endogenous Toxins Motion sickness Ureteric colic etc.

NTS - Nucleus tractus soliterius.

CTZ – Chemoreceptor trigger zone.

AMI - Acute myocardial infarction.

Virechana karma Review


VIRECHANA KARMA

Vyutpatti:

The word virechana has got three components (Vachaspatyam)

Vi- Upasarga prefix, Ricpor – Ric Dhatu (Root)

Lyut – Pratyaya - (i.e Maladeha Nihsarane)

According to shabdakalpadruma -Rechana is derived from root word

“Rici-dhatu & lyut- pratyaya ” (Means Malabhedana) 122

Virechana word is formed by the root “Rici” dhatu, “Vi-upasarga with “Nich” &

“lyut” pratyayas giving meaning visheshana Rechayateeti”

According Kavi-Kalpadramu, “Rici” dhatu is explained in terms of samparchana

(Combination) & viyojana (Seperation).- ‘’samparka viyogayo’’

The Root ‘Ric’ is also very important to understand the systemic action of

Virechana.

Nirukti:

“Tatradoshaharanam Adhobhagam Virechanam Sanjnyakam |” 123

The act of expelling vitiated doshas (malas) through adhobhaga is known as

Virechana. Here Chakrapani commented adhobhaga means “Guda” .

“Vireko Mukhapeetam Gudamargenanta: sthetastha |

Doshasya Nirasaaranam Pittasya Paramaushadham ||” 124

Virechana is the process in which the orally administered drugs along with the

vitiated doshas are eliminated through adhomarga and it is best treatment for pittadosha.

“Virechanam Pittaharanam Shreshtam |” 125



“Pitta Tu Virekam Shleshma Samsrushte Vaa Tatsthanagate Vaa Shleshmaneeti |” 126

Virechana is a specially indicated for Pitta dosha, Pitta dosha associated with

Kapha dosha and Kapha dosha which is situated in Pittasthana.

Paryayas:

Reka, Rechana, Virechana, Praskandana127.

Anulomana, Prakledana128.

According to Sanskrit-English Dictionary, Purgative, Cathartic, Evacuant

and Aperient are the different meanings of Virechana129.

Virechana dravya gunas:

Virechana dravyas will have all the properties of Vamana dravyas i.e. Ushna,

Teekshna, Sukshma, Vyavayi, Vikashi, except Urdhobagahara in case of Vamana and

Adhobagahar in Virechana. But unlike Vamana, the Virechana dravyas consist

predominance of Prithvi and Jala mahabuthas130, which show specific property of

removing the doshas through adhobhaga. i.e. Guda marga. Apart from these gunas,

Sushruta has mentioned the Saratva guna131.

Virechana dravyas: The drugs, which causes for rechana are called as Virechana

dravyas. They are, Trivrit, Triphala, Danti, Kampillaka, Nalini, Saptala, Aragwada etc132

Virechanopaga dravyas: The drugs, which helps for Virechana are called as

Virechanopaga dravyas. They are, Draksha, Kashmarya, Parushaka, Abhaya,Amalaki

etc133.

Based on the below six drugs, acharya Charaka has described 245 Virechana

formulations in ‘KALPASTHANA. They are as follows,



Table No. 11, Showing the 245 Formulations of Virechana 134 Sl. No

Type of formulation

Shyama Trivrit

Chaturangula

Tilwaka

Sudha Saptala / Shankini

Danti / Dravanti

Total

1 With Amladi 9 1- - - - - 10 2 Saindhavadi 12 - - - - - 12 3 With gomutra 18 - - - - - 18 4 Yashtimadhu 2 - - - - - 02 5 Jeerakadi 14 - - - - - 14 6 Dugdadi-

Dadhyadi 7 -

5 - - 3 15

7 Leha 8 1 3 1 3 6 22 8 With sita 4 - - - - - 04 9 Panakadi 5 - - 1 - - 06 10 Acc.to rutu 6 - - - - - 06 11 Modaka 5 - - - - 2 07 12 Ghrita+Dugda 3 2 4 3 8 5 25 13 Ksheera 1 - - - - - 01 14 Tarpana 2 - - - - - 02 15 Madya 2 - - - 5 1 08 16 Kanjika 2 - - - - - 02 17 Shadavadi 10 - - - - - 10 18 Draksharasa - 1 - - - - 01 19 Sura,sidhu,

souviraka, suramanda,Dadhimanda Etc.

- 4 2 8 - 3 17

20 Trivrit, bilva kashaya

- 1+1=2 - - - - 02

21 Asava Arishta - 1 1 - - 5 07 22 Kampillaka - - 1 - 1 1 03 23 Ghreya

(Nasya) - - - 1 - - 01

24 Yusha / yavagu

- - - 3 - 3 06

25 Matsyamamsa - - - 2 - - 02 26 Kashaya - - - - 16 1 17 27 Taila - - - - 6 - 06 28 Priyala - - - - - 5 05 29 Sneha - - - - - 3 03 30 Ikshurasa - - - - - 1 01 31 Mamsarasa - - - 1 - 6 07 32 Churna - - - - - 2 02 33 Utkarika - - - - - 1 01

Total 110 12 16 20 39 48 245



Table No. 12, Showing the Virechana indication.135

Sl.No Diseases Ch Su A.S A.H SD/YR/ BP

1 Kushta + + - + + 2 Jwara(jeerna jwara) + + - - - 3 Meha + + - + + 4 Urdhwaraktapitta + + + + - 5 Bhagandhara + + + - + 6 Udara + + + + + 7 Arsha + + + + + 8 Bhagna + - - - - 9 Pleeha + + + + + 10 Gulma + + + + + 11 Arbhuda + + - - - 12 Galaganda + - - - - 13 Granthi + + - - + 14 Visuchika + + + - + 15 Alasaka + + - - - 16 Mutraghata + + + + + 17 Krimikoshta + + + + + 18 Visarpa + + - - - 19 Panduroga + + - - + 20 Shirashoola + + + - + 21 Parshwashula + - - - - 22 Udavarta + - + - - 23 Netradaha + + - - + 24 Asyadaha + - - - - 25 Hridroga + + - - + 26 Vyanga + - + + - 27 Neelika + - - - - 28 Netra,Nasika,Mukh

a srava + - - - -

29 Haleemaka + - + + - 30 Swasa + - - - - 31 Kasa + - - - - 32 Kamala + - - + - 33 Apachi + - - - - 34 Apasmara + + - - - 35 Unmada + - - - - 36 Vatarakta + + + + + 37 Yoni dosha + + + + + 38 Reto(shukra) dosha + - + - - 39 Timira + + + + - 40 Arochaka + + - - +



41 Avipaka + - - - - 42 Chardi + + + + + 43 Shwayathu + + - - - 44 Visphotaka + + + + + 45 Vidhradi - + + + + 46 Anaha - + - - - 47 Vriddhi - + - - - 48 Abhishyanda - + + + - 49 Akshipaka - + + - - 50 Kshara-Agni dagda - + + - - 51 Dushtavrina - + + + - 52 Pakwashayashula - + + + - 53 Vibandha

(shakridgraha) - + + - -

54 Pittaja vikaras + + + - - 55 Pitta sthanagata

vyadhis - + - - -

56 Anila vyadhis - - - - + 57 Garavisha - + - + + 58 Shastrakshata - + - - - 59 Karnaroga - + - - - 60 Nasaroga - + - - + 61 Mukharoga - + - - + 62 Gudaroga - + - - + 63 Medhraroga - + - - + 64 Daha - + - - - 65 Koshtagata vata - - - + -

Table No. 13, Showing the Contra-indications of Virechana136

Sl. No Diseases Ch Su A.S A.H YR/BP

/ SD C.D V.S

1 Sukumara + - - - - - - 2 Kshtataguda + - + - - - - 3 Muktanala + - - - - - - 4 Adhoga Raktapitta + + + + - + + 5 Langhita + - + - - - - 6 Durbala indriya + - - - - - - 7 Alpagni

(mandagni) + - + + - - -

8 Niruhita (Asthapita)

+ - - - - + -

9 Kamadi vyagra + - - - - - - 10 Ajeerna + + - - - + +



11 Navajwari + + + + + + + 12 Madatyaya + + + - + - + 13 Adhmana + - + - - - - 14 Antashalya pidita

(shalyardita) - - + + + + -

15 Abhihata (Aghata) + - - - - - - 16 Atisnigda

(Atisnehita) + - + + + + -

17 Atiruksha + - + - + - - 18 Atidaruna koshta + + - - - - - 19 Kshataksheena

(ksheena) + + - + + + -

20 Bala + + - - + + + 21 Vriddha + - - - + + + 22 Durbala + - - - - - - 23 Shranta + + - - + + + 24 Pipasita

(Trisharta) + - - - - - -

25 Kshudhita + - - - - - - 26 Karmahata + - - - - - - 27 Bharahata + - - - - - - 28 Adhwahata + - - - - - - 29 Maithuna prasakta + - - - - - - 30 Chinta prasakta + - - - - - - 31 Vyayama prasakta + - - - - - - 32 Adhyayana

prasakta + - - - - - -

33 Kshatha + - - - - - - 34 Garbhini + + - - + + + 35 Bhayopatapta

(Bheeta) - + - - + - +

36 Nava pratishyaya - + - - - - + 37 Nava prasuta - + - - + + + 38 Na Snehadi - + - - - - + 39 Ratri jagarita - - + - - - - 40 Rajayakshma

(Shosha) - - + - - - -

41 Krurakoshta - - + + - + - 42 Atisara - - + + - + - 43 Shula - + - - + - - 44 Urakshata - - - - - - + 45 Shoka tapta - - - - - - +



Classification of Virechana dravyas:

The detailed reference in Ayurvedic classics regarding the drugs of Virechana can

be found in the chapter’s dealing with Panchakarma in addition to it that numerous

scattered references are available in the literature regarding the actions of Virechana

drugs.

Virechana dravyas may be classified in the following groups.

Table No. 14, Showing the Virechana Dravyas

I) Virechana Dravyas According to their origin & parts used

a) Animal origin b) Plants origin c) Miscellaneous

2) According to the mode of action a) Anulomana b) Samsrana c) Bhedana d) Rechana

3) According to the intensity of action a) Mrudu b) Madhyama c) Tikshna

4) Virechana drugs according to the seasons

V

I R

E C

H A

N A

D R

A V

Y A

S

5) Virechana drugs according to kalpanas 1) According to origin and parts used:

a) Animal : Mutra, Ksheera, Takra137.

b) Plant : Trivrit, Triphala, Danti etc138.

c) Miscellaneous : Madya, Dhanyamla, Guda, Ikshurasa, Ushnasjala, lavana139.

d) Mulini :Trivrit, Danti, Dravanti, Saptala, Jyotishmati etc 16 dravyas140.

e) Phalini : Jeemutaka, Dhamargava, Ikshwaku, Aragwada Haritaki,

Kampillaka etc 18 dravas141.

f) Ksheera : Swarna ksheeri, Arka and Snuhi142.

g) Twak : Putika, Krishnagandha and Tilwaka143.

h) Patra : Putika, Karavellaka etc144.



2) According to Mode of action145:

a) Mrudu virechana – Aragwada

b) Teekshna virechana –Snuhi

c) Sukha virechana – Trivrit

3) According to mode of Acton:

a) Anulomana b) Sramsana

c) Bhedana d) Rechana

a) Anulomana: means sending or putting in right way

The drug, which will digest the pakwa and apakwa (digested and undigested)

malas expels from the Adhomarga is called as Anulomana. e.g. Haritaki146.

Sushruta considers, Sara as the synonym for Anulomana. According to Dalhana,

Anulomana causes expulsion of vata and kapha147.

b) Sramsana: means to slip or fall down.

The drug which expels the malas adhered to the lumen of the intestines into the

rectum without digesting (paka) them is called as Sramsana. e.g. Aragwada148.

In the contest of Jwara chikitsa, it has been mentioned that, sramsana eliminates

the pitta and kapha situated in pakwashaya149.

c) Bhedana: means break or split or devide or separate.

The drug, which disintegrates the ‘Abaddha (unformed)’, or ‘Baddha (formed)’,

or ‘Pindita (dreid fecal matter)’ form of malas, by facilitating penentration into it and

then evacuating through the lower gut, is called as ‘Bhedana’. e.g. Katuki150.



Bhedana is a process, in which shareera mala nissarana is brought about. Charaka

explained the ‘Bhedaneeya dashemani’ in sutrasthana.i.e.Shyama, Arka, Urubuka151.

d) Rechana: means elimination or purgation.

The drud which eliminates ‘Pakwa (digested)’ and ‘Apakwa (undigested)’ mala or

doshas through lower route by making them watery is called as Rechana. e.g. Trivrit 152.

4) According to the seasons 153:

Table No. 15, Showing the Virechana Dravyas According to the seasons

Varsha Sharada Hemanta Shishira and Vasanta

Grishma All seasons

Preparations Trivrita Kutaja Bija Pippali Shunthi

Trivrita Duralabha Musta Chandana Bala Chandana

Trivrita Chitraka Patha Jivaka Sarala Vacha, Hemakshiri

Trivrita Pippali Nagara Saindhav Shyama

Trivrita Trivrita Danti Hapusha Saptala Katuki Svarnakshiri

Anupana Draksha Swarasa & Honey

Yashti in Draksha decoction

Warm water Honey Sugar Bhavana with cow’s urine

Adhamalla in Sharangadhara commentary mentioned that the drugs for Virechana

in shishira, vasanta and hemanta rutu are same. Adhamalla in his commentary154 opined

that saindhava, vriddhadaru, shyama trivrut is to be used for Virechana in hemanta rutu.

Charaka mentions trivrit, chitraka, patha etc, are to be used for Virechana in hemanta

rutu.



5) According to kalpanas:

For the purpose of convince to take the drugs and for maintainance of the active

principles of drugs for longer period the different kalpanas i. e. choorna, vatikriya, asava,

arista, avaleha, sneha, kashaya etc.

1. According to sushruta the different kalpanas are mentioned are155

1) Ghrita yoga 2) Taila yoga 3) Kshira yoga

4) Medhya yoga 5) Mutra yoga 6) Mamsarasa yoga

7) Bakshanayoga 8) Avalehya yoga

6) According to Dosha156:

Vataja vikaras – Snigdha, ushna veerya with lavana.

Pittaja vikaras – Kashaya, madhura rasa pradhana.

Kaphaja vikaras – Katu rasa pradhana.

7) According to Kostha and Matra:

Table No. 16, Showing the Matra of Virechanoushadhi157.

Kalpana Uttama matra for

Krura kostha

Madhyama matra for

Madhyama kostha

Heena matra for

Mridu kostha

Kashaya 8 Tola(2 pala) 4 Tola(1 pala) 2 Tola(1/2 pala)

Kalka, Churna,

Modaka, Avaleha

4 Tola(1 pala) 2 Tola(2 karsha) 1Tola(1 karsha)

VIRECHANA KARMA: It includes A) Poorva karma

B) Pradhana karma

C) Paschat karma



A) Poorva karma: It includes 1) Sambhara sangraha

2) Atura pariksha

3) Matra nirnaya

4) Atura siddhata

1) Sambhara sangraha: The medicines and instruments useful for Snehana, Swedana,

Virechana and the treatment of Virechana vyapat must be collected prior to the

administration of Virechana therapy.

Specific Drugs for Virechana158:

Pittottare Trivrut churnam Draksha kwathadibhihi Pibet !

Triphalakwath Gomutraihi Pibetdravyopam Kapharditah !!

Trivrutsaindhavashuntinam Churnam Amlaihi Pibennarah !

Vatadito Virekaya Jangalanam Rasenava !!

Pitta pradhana -Trivrut churna + Draksha kwatha.

Kapha pradhana -Triphala kwatha, gomutra and trikatu.

Vata radhana -Trivrit + saindhava+ shunthi + kanji or mamsa rasa.

Children between the(Age of 4-12 years) - Draksharasa + Aragvadha phala majja

2) Atura Pariksha: The details are same as explained in Vamana karma

3) Matra Nirnaya:

The dose of Virechana drugs should be in such a quantity that the desired effect

may be achieved and may be able to avoid atiyoga. This should be decided according to

Dosha, Aturabala, Bheshaja, Kala, Desha, Agni, Koshta, Shareera, Ahara, Satmya, Satva,

Prakruti, Vaya,Samaavastha and Vikara .



If the given dose is more than Vyadhibala, may cause another vyadhi. If it is more

than Agnibala it may cause Ajeerna, Vishtambha and if it is more than Aturabala then it

may cause Atipravrtti or Apravrtti. So, the dose should be in Sama Pramana.

Nature of Kostha And Virechana159:

Mrudwi matra mrudou koshte madhyakoshte cha madhyama !

Krure teekshnamata dravyaimrudumadhyama teekshnakaihi !

Acharya sharangadhara opines that for persons of mrudu kostha- Virechana drugs

must be mild and their dose should be minimum for madhyama, medium dose and for

krura kostha persons. The Virechana drug should be teekshna and its dose is minimum.

Table No. 17, Showing the Doshawise virechana dravyas

Sl No. Dosha Virechana Dravyas 1. Vataja Vikara Snigdha, ushna virya with lavana 2. Pittaja Vikara Kashaya, madhura rasa pradhana 3. Kaphaja Vikara Katu rasa pradhana

4) Atura Siddhata: it includes 1) Deepana-Pachana

2) Snehana

3) Abhyanga and Swedana (Vishrama kala)

4) Virechana poorva bhojana vyavastha

1) Deepana-Pachana: Same as explained in Vamana karma.

2) Snehapana: Same as explained in Vamana karma.

3) Abhyanga and Swedana (Vishrama kala): About this Abhyanga and Swedana

details are same as explained in the Vamana Karma.

“Snehaat Praskandanam Jantuhu Triratroparata…… 160

In case of Virechana, 3 days vishrama kala is mentioned after Snehapana. During these

days Abyanga and Swedana is advised.



4) Virechana poorva bhojana vyavastha:

During the vishrama kala, below type of food is to be followed.

… ……. Pibet |

sneham cha dravamushnam cha trayam bhuktwa rasoudanam||”

Snigdha, Drava, Ushna bojana, Mamsarasa, Odana, Amlarasa are recommended.

Virichyate mandakaphastu samyak…… i.e. the diet should be such that, it does not

increase ‘Kapha’ otherwise Vamana might occur. ‘Manda Kapha’ term is used for the

state of Kapha, which is desired for the proper Virechana161.

B) Pradhana Karma: This starts right from the intake of medicine to the

commencement of Vegas. This includes -

Administeration of Virechana yoga.

Atura paricharya and Nirikshana.

Shuddhi nirnaya.

Observation of samyak, heena and atiyoga lakshanas.

Virechana yoga sevana:

Before the administration of Virechana yoga the physician must examine the

patients physical and mental health once again. Patient must have digested, the food

taken on previous day and must got sound sleep on the previous night.

Shleshma kaale Gate Jnyatwa Koshta Samyak Virechayeet | 162

According to Vagbhata, the patient has to take Virechana karma just after

shlesmakala. It can be understood as the time is so adjusted that the Virechana should be

started during Pittakala. The Pittakala falls between 10.00 am to 2.00 pm. Hence, the time

and dose of the Virechana dravya should be decided depending upon the koshta and



agnibalabala of the patient. Ushna or sheeta jala can be used as anupana in accordance

with Virechana yoga.

Aatura Paricharya:

If Virechana does not occur timely then hot water should be given to drink and

laghu swedana should be done on the abdomen with heat produced by frictions of both

palms i.e., pani taptai cha jatharagni swedyet163. The physician must observe the signs ad

symptoms of jeerna aushadha, ajeerna aushadha, hritdosha, vyapats etc.

Aushadhi jeerna lakshana:

Anulomo Anilaha Swasthyamkshudhatrushnaurjamanakhiya!

Laghutwaindriyodgarashuddhihi Jeernoshadhakrutihi !! 164

The following signs and symptoms of Virechana are to be observed

Vatanulomana, Swasthya, Kshudha, Trusha, Indriya laghuta and Udgara shuddhi.

Aushadhi ajeerna lakshana:

KlamodahangasadanamBhramomurchha Shirorujaha !

Arati Balahanishcha Sa avasheshoudhakruti !! 165

Aushadhi Ajeerna Lakshana are Klama, Daha, Angasada, Bhrama, Murccha,

Shiroruja, Arati and Balahani.

If Aushadhi Jeerna symptoms are present and Virechana is not induced then

Virechaka dravyas are given on next day. If still Virechana is not induced then after 10

days again the whole procedure should be initiated166. If the medicine itself obstructs the

doshas and there is no induction of Vamana or Virechana along with body ache then

fomentation should be executed over abdomen. If Paittika symptoms like polydyspia

occur then they should be treated by Madhura, Sheeta Aushadhi.



Hritdosha lakshana:

The Virechana is considered as Kaphanta and Hritdosha if there is consecutive

defaecation of Vata, Pitta and Kapha along with Gatradaurbalya and Laghuta. After

getting these symptoms if Virechana does not terminate then Vamana should be given167.

Shuddhi Lakshana168 :

Four types of Shuddhi viz. Laingiki, Antiki, Vaigiki and Maniki should be

observed according to Chakrapani, but the importance should be given to Laingiki

Shuddhi. All the shuddhi are described below in a tabular form:-

Table No. 18, Showing the Antiki, Vaigiki and Maniki Shuddhi Of Virechana karma

Shuddhi Pravara Madhyama Avara

Vaigiki 30 vegas 20 vegas 10 vegas

Maniki 4 prastha 3 prastha 2 prastha

Antiki Kaphanta Kaphanta Kaphanta

Laingiki Shuddhi, Lakshana are given in table. Thereafter the Ayoga and Atiyoga

Symptoms mentioned in the texts have been presented in the tabular form. In the last

various types of complications which may occur during Virechana are depicted.

According to Sharangadhara in Uttam Virechana there are 30 vega and it is Kaphanta, in

madhyama Virechana there are 20 vega, it is Kaphanta and in Hina virechana there are 10

vega and it is Kaphanta.

The number of Vegas should be counted after leaving the first 2-3 Vegas, as it

contains only fecal matter. Then it should be counted till the Kapha comes out169.



Table No. 19, Showing the Samyaka Yoga Lakshana of Virechana karma169.

Lakshana Cha. Su. Vag.

Sroto Vishuddhi + - -

Indriya Prasada + + -

Laghuta + + -

Agnivriddhi + - -

Anamayatva + + -

Kramat Vitta Pitta Kaphagamana + + -

Vatanulomana - + -

Absence of Ayoga Lakshana - - +

Table No. 20, Showing the Ayoga Lakshana of Virechana Karma170.

Lakshana Cha. Su. Vag.

Kapha Prakopaka + + +

Pitta prakopaka + + +

Vata prakopaka + - -

Agnimandya + + -

Gaurava + + -

Pratishyaya + - +

Tandra + - -

Chardi + - -

Aruchi + + +

Vata Pratilomana + - Vatagraha

Daha - + +

Hridaya Ashuddhi - + +

Kukshi Ashuddhi - + +

Kandu - + +

Vitta Sanga + + +

Mutrasanga - + -

Pidika - - +



Table No. 21, Showing the Atiyoga Lakshana of Virechana Karma171.

Lakshana Ca. Su. Vag.

Kapha kshaya vikara + + -

Pitta kshaya vikara + - -

Vata kshaya vikara + - -

Supti + - -

Angamarda + - -

Klama + - -

Vepathu + - -

Nidra + - -

Bal abhava + - -

Tamahpravesha + - -

Unmada + - -

Hikka + - -

Murchha - + -

Gudabramsha - - -

Kapha Pitta rahit shveta Udaka nihsarana - - +

Pitta rahit Lohita Udaka nihsarana - - +

Mamsa Dhavana vat Udak srava - - +

Medokhandavat srava - - +

Trishna - - +

Bhrama - - +

Raktakshayaja vikara + - -



PASCHAT KARMA:

a) Samsarjana krama: The details are same as explained in the context of Vamana

karma.

b) Virechana vyapats and pratikara: Same as explained in context of Vamana karma.

VIRECHANA AUSHADHA KARMUKATA:

The Vamana and Virechana dravyas posses similar properties like ushna,

teekshna, sukhma, vyavayi and vikashi gunas. Drugs will reach the hridaya by its veerya

thereby it enters into dhamanis, sthula and sukshma srotas of the body. The Vikashi guna

is responsible for quick absorption, due to ushna guna vishyanadana will be produced.

Teekshna guna does chhedana of samhata doshas and brings back them to koshta. Form

there due to prithwi and jala mahabhoota gunas and adhobhagahara prabhava the doshas

get eliminated through gudamarga. Both Virechana and Vaman oushadhas are having the

similer propereties exept Urdwabhagahara in Vamana, adhobhagahara in case of

Virechana dravyas and it is only because of Prabhava the Virechana drugs produces

Virechana karma172.

Sushruta added sara guna along with the ushnadi gunas and this sara guna act as

anulomana173.

Acharya charaka says, the drugs act not only due to its prabhava but also due to

its dravya prabhava guna prabhava and both dravyagunat prabhava. And the factors

mentioned here may change based on the different conditions. The effect produced is

Virechana karma. The factor responsible for manifestation of effect is Prabhava173.



IIUSTRATING VIRECHANA DRAVYA KARMUKATHA SCHEMATICALLY

Virechana Yoga Vyavayi Vikashi enters the Through Dhamani

(Aushadha) gunas heart circulates all overThe body

Due to Sookshma Guna

Virechanavega enters Sthula and Sookshma

Srotas

Due to Agneya Guna

Dosha Vilayana in Srotas

Adhobhagahara due to Tikshna and Ushna Guna

Prabhava Dosha Chedana and Bhedana

Prithwi and Ap due to Anupravana Bhava

Mahabootha Dosha Dushitha Dosha Ati Sookshma

Predominant Amashaya Parvesha Rupa not adheres to any region



MODERN CONCEPT OF LAXATIVES175:

Laxatives are act through multiple mechanisms affecting the epithelial transfer,

directly or indirectly, leading to decreased sodium absorption and increase in chloride

secretion by intestinal epithelial cells.

These drugs are sometimes classified according to intensity of action as mild,

moderate or drastic. Laxative effect suggests the elimination of soft-formed stool without

gripping and without much loss of water. In large doses many laxatives promote

catharsis, which means purgation and passage of more fluid stools. Laxatives can be

classified according to their mechanism of action as follows:

I. Stimulant or Irritant Laxatives:

Antroquinone group – This acts by stimulation of large bowel and also probably

by inhibiting NaCl water absorption in the colon. eg. Cascara sagrada and senna.

Pharmacological actions: As these drugs act mainly on large bowel evacuation occurs 6

to 8 hours after their ingestion. Stools are usually semisolid in consistency and incidence

of griping is low.

Irritant oils – eg. Castor oil.

It is fixed oil obtained by expression of the seeds of Ricinus communis Linn.

Chemically, it is triglyceride of ricinoleic acid, an unsaturated hydroxy fatty acid. Castor

oil itself is nonirritant. When ingested, it is hydrolysed in the intestine by pancreatic

lipase to glycerol and ricinoleic acid. Ricinoleic acid acts as an irritant and produces

purgation.

Pharmacological actions: As ricinoleic acid acts on small intestine, it produces

copius liquid stools, with associated fluid loss. Colonic emptying may be so complete

that patient may not pass the stool for several days. The action is quicker than that of the

anthroquinone and is evident within two to tnree hours. It causes griping.

Miscallaneous – eg. Phenolphthalein bisacodyl, sodium picosufate.

Pharmacological actions : Mechanism of action is not known but the drug acts

as stimulant mainly on the large bowel after 6 to 8 hours and produces soft, semisolid

stools associated with a little griping. An interesting aspect of phenopthaline is that about



15% of the dose is absorbed, some of which is re-excreted in the bile. This enterohepatic

circulation of the drug causes prolongation of its laxative effects.

II. Osmotic laxatives

Certain salts when given orally are not much absorbed and are retained in the

gastrointestinal tract. Such preparations exert an osmotic effect and therefore hold

considerable amount of water, thus increasing the intestinal bulk. This acts as a

mechanical stimulus causing an increase in the intestinal motor activity and

evacuation.

Pharmacological actions : these compounds act in the small as well as large

intestines and therefore produces a watery evacuation within 3 to 6 hours. Because of

their quick onset of action they are given early in the morning before breakfast. They do

not cause irritation and there is very little griping. Patients should be instructed to take

plenty of water along with these drugs since administration of hypertonic solution may

produce dehydration due to water extraction from the circulation.

III. Bulk laxatives – eg. Methyl cellulose, Agar agar, Ptantago seeds, Bran.

These are various natural or semisynthetic polysaccharides and cellulose

derivatives, which when orally are not absorbed and increase the indigestible residue.

These agents absorb water and swell up, thus providing the stimulus of mechanical

distention for evacuation.

Pharmacological actions: These agents act purely because of their physical

property. Their action is mild and is usually seen 12 to 36 hours after ingestion. They

produce evacuation of solid or semisolid stools without any irritation or griping. Some

agents also have lubricating properties. Usually, these drugs are administered at bed time.

IV. Emollient laxatives: eg: Liquid paraffin and Dioctyl sodium sulfosuccinate.

Liquid paraffin mineral oil most widely used emollient laxative. It consists of a

mixture of hydrocarbons obtained from petroleum given orally. It is not significantly

absorbed and exerts a softening and lubricating effect on faeces.

Pharmacological actions: It is mild in action and itself does not initiate peristalsis.

Because of its lubricant action, the straining during defaecation can be avoided. It is

usually given at bed time, but can be taken at any time of the day.

Disease Review


TAMAKA SWASA

Nirukti of Tamaka Swasa:

The word Tamaka Swasa (TS) is composed of two words. They are Tamaka and

Swasa.

The word ‘Tamaka’ is derived from the dhatu (root) “Tamaka glanu” with

“Kwip” pratyaya. It means; to choke, darkness, be suffocated176. It is also

defined as “Tamyati iti Tamaka”-“tama eva Tamaka” in Shabdakalpadruma,

which means dark curtains i.e. ‘tama’ occurs, in Tamaka Swasa177.

The word ‘Swasa’ is derived from the dhatu “Swas” with “gahs” pratyaya. It

means to breathe178.

The word Tamaka Swasa means difficulty in breathing; which occurs mainly

during night hours.

Tamaka Swasa vis-à-vis Bronchial Asthma is a condition of the lungs in which

there is widespread narrowing of airways, varying over short periods of time

either spontaneously or a result of treatment, due in varying degrees to

contraction (spasm) of smooth muscle, oedema of the mucosa, and mucus in the

lumen of the bronchi and bronchioles; these changes are caused by the local

release of spasmogens and vasoactive substances (e.g., histamine, or certain

leukotrienes or prostaglandins) in the course of an allergic process179.

Paribhasha of Tamaka Swasa

The attack of Swasa with tamapravesha which occurs specially during durdina

is called as Tamaka Swasa. i.e. “Visheshyaddurdine tammyethi Swasa ha sa

tamako mataha” 180

Disease Review


Vijayarakshita the commentator of Madhavanidana explained as “Swasastu

bastrikadmana samavatordwa gamitha”. i.e. sound similar to the sound of

bellow of blacksmith181.

Dalhana and Chakrapani182 commented Tamah praveshana which refers the

darkness or black curtains in front of the eyes.

The features or the clinical picture of Tamaka swasa; looks identical with the

features of Bronchial Asthma (BA) and resembles for a greater extent.

Nidana Panchaka of Tamaka Swasa:

An attempt has been made to review the Nidana panchaka of Tamaka Swasa,

those are Nidana, Samprapti, Purvarupa, Rupa, Upashaya and Chikitsa from various

classical texts and contemporary explanation regarding the (Asthma) aetiology,

pathophysiology of the Bronchial Asthma (Tamaka Swasa) also be reviewed from

various texts, journals and websites for better understanding of the disease aspect as well

as treatment aspect of the Tamaka Swasa.

Nidana:

In Ayurvedic classics nidana parivarjana is considered as first line of treatment.

So the knowledge of nidana is essential. Nidana of the Tamaka Swasa includes specific

dietetic and behavioral factors as well as certain diseases. More to say, some of the

etiological factors directly involve in the pathogenesis of the Tamaka Swasa that may be

named as Utpadaka Hetu which include dietetic as well as certain behavioral factors. In

contrast to this there are several other factors that precipitate an attack of the illness in

patients suffering from Tamaka Swasa like exposure to dust and smoke and these are

better understood as Vyabhicari Hetu.

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Table No. 22, Showing the Nidana of Tamaka Swasa183.

Factors C. S S.S A.H A.S M.N

Vata-Prakopa Ahara Rukshanna + + - - + Visamashana + + - - + Adhyashana - + - - - Anasana - + - - + Dvandvatiyoga + - - - - Sheetashana - + - - + Visha + + - - + Sheetapana - + - - +

Kapha-Prakopa Ahara Nispava + - - - - Masa + - - - - Pistanna + - - - - Saluka + - - - - Guru dravyas + + - - + Jalajamamsa + - - - - Anupa mamsa + - - - - Dadhi + - - - - Amaksira + - - - - Utkleda + + - - + Vistambhi + + - - +

Vata-Prakopa Vihara Rajas + + + + + Dhuma + + + + + Sheeta Sthana + + - - + Sheeta ambu + + + + + Ativyayama + + - - + Gramya dharma + - - - + Apatarpana + - + - + Shuddhi Atiyoga (Vamana and Virechana) + + - - + Kantha/Urah pratighata + - - - + Bharakarshita + + - - + Adhwahata + + - - + Karmahata + + - - + Veganirodha - - - + - Abhighata - + + + - Marmabhighata + - - - +

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Kapha-Prakopa Vihara Abhishyandi Upacara + - - - + Divasvapna - - - - -

Vyadhi /Avastha Sambandhi Nidana

Anaha + - - - -

Dourbalya + - - - -

Atisara + - - - +

Kshaya - + - - -

Ksataksaya + - - - -

Udavarta + - - - -

Visucika + - - - -

Panduroga + + + + -

Visa Sevana + + + + -

Vibandha + - - - -

Kasa - - + + -

Amapradosa + + - - -

Chardi + - + + -

Pratisyaya + - - - -

Amatisara - - + + -

The etiological factors listed above can independently cause the imbalance of

Vata and Kapha Dosha, the predominant Sannikrista Hetu of Tamaka Swasa. Along with

this, the list also includes some factors that may vitiate the Pitta Dosha as well as derange

the Pitta Sthana. Most of the etiological factors particularly the one related to the food

mediate the vitiation of the Dosha through the Amashaya. Some other factors like

exposure to the dust directly provocate the Vata Dosha in the Pranavaha srotas.

Disease Review


Samprapti:

Samprapti vighatana itself is the chikitsa. Sushruta has described that due to the

indulgence in the etiological factors, Pranavayu goes against its individually (Prakriti)

combines with Kapha produces Swasa184. While commentating on Prakriti of Pranavayu,

Dalhana has explained that Pranavayu is in the Viguna form and its Atmalakshanas and

functions are altered. Vagbhata is of the view that obstruction to Gati of Vayu is

produced by Kaphadosha. This obstructed vayu further produces dushti of Pranavaha,

Udakavaha and Annavaha srotas leading to Swasa185. Arunadutta has annotated as a

“Pavanam Pratiloma – Viparyayam”, i.e. movement of Vayu in opposite direction occurs

in this disease. Further he has mentioned “Kapha Udiryam Urdhvam Preryam”, i.e.

Kapha has impelled in upward direction by Vayu.

Charaka has mentioned the Samprapti of Tamaka Swasa separately, according to

him, due to obstruction in the Srotas; Gati of Vayu is altered in the Pratiloma form. The

Vayu in the Pratiloma form produces vitiation of Kapha, which in turn produces Tamaka

Swasa186. Chakrapani has emphatically stated that the root cause responsible to produce

obstruction to Gati of Vayu is Kapha.

The normal upward course of the Pranavayu is obstructed by the abnormally

narrowed Pranavaha srotas. Secondly, like the other Srotas, mucous secretion is the

natural process seen in the Pranavaha srotas. Here Sleshma is the normal secretion to

protect it from friction and is abnormally increased by the vitiated Pranavayu. This

further, adds to the obstruction to the passage of Pranavayu leading to Prana vilomata.

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

smooth flow of Pranavayu. Pranavilomata and the resultant turbulent breathing leads to

Disease Review


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

the obstruction to the passage of Pranavayu also leads to rapid breathing. Further the

presence of Sleshma in Pranavaha srotas more particularly in the Kanta region obstructs

the Pranavayu. Due to obstruction of pranavayu in srotas causes wheezing which is called

as Kanta Ghurghuraka is produced.

Productive cough is another effect of obstruction of Pranavayu in the Pranavaha

srotas. As the cough brings out the Sleshma, obstruction to the Pranavayu is minimized,

leading to temporary relief in breathlessness to the patient.

The frequent episodes of Tamaka Swasa are related to the exposure to Sheeta,

Snigdha and such other factors that provocates the Vata and Kaphadosha and this is the

usual presentation. If the association of Pittadosha is present this nature of the illness is

reversed and hence exposure to these factors may bring about remittance of symptoms in

the patient. This unique nature of the illness is attributed to Pittadosha involvement.

These symptoms like Jwara, Murcha are suggestive of Pitta vitiation. Such a variant form

of Tamaka Swasa with the typical symptoms of Pittadosha is called as Pratamaka and

Santamaka Swasa.

Vitiated Pranavayu also irritates the Nasa causing increased secretion and

manifestation like Peenasa, Kshawathu etc. The imbalance of Vata and Kaphadosha is

involved in the pathogenesis of Tamaka Swasa. During the attack of Tamaka Swasa

almost all the symptoms of Kaphadosha vitiation are present. Moreover, abdominal

symptoms like Adhmana, Anaha are also the result of incriminated Rasadhatu. As the

disease runs a chronic course, the vitiated Vatadosha dries up the circulating Rasadhatu

contributing to the weakness and emaciation in the patient.

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Schematic representation of Samprapti NIDANA SEVANA SANCHAYA

AGNIMANDYA DOSHA DUSHTI (vata & kapha dushti)

in pittasthana

i.e adho amashaya Obstruction to gati of vayu by

AMARASOTPATTI kapha PRAKOPA

MALA ROOPA KAPHA

PRASARA PRATILOMA GATI OF VATA

PARIBRHAMANA

PRANAVAHA SROTOGAMANA

STHANA KAPHA makes AVARANA to PRANAVAYU SANSHRAYA

PRANA try to overcome the AVARANA

VYAKTAVASTHA SWASA. (Swasavarodha, Swasativriddhi,Gghurghurkam etc.)

Disease Review


Factors involved in the generation of Samprapti of Tamaka Swasa are elaborated

in the following lines.

Samprapti Ghataka –

1. Dosha involved :Kapha and Vata.

2. Dushya : Rasa.

3. Agni : Jataragni,Rasadhatwagni.

4. Ama :Jataragnijanya and dhatwagnijanya.

5. Srotas involved : Pranavaha srotas

Udakavaha srotas, Annavaha srotas

6. Srotodushti prakara : Sanga , Vimarga gamana.

7. Udbhava Sthana : Amashaya.

8. Sancharasthana : Urah , Kantha , Shiras(Pranavaha srotas).

9. Adhishtana :Urah, Pranavaha srotas.

10. Vyakta sthana :Urah(Lungs).

11. Rogamarga :Abhyantara.

12. Vyadhi swabhava :Chirakari

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Purvarupa:

The morbid Vata and Kaphadosha stem out from the Pittasthana and circulate all

over the body; then localizes in the Uras and Shiras in the Pranavaha Srotas, and then

cause Tamaka Swasa. This is the Samprapti of Tamaka Swasa in short. Accordingly

the some premonitory symptoms are related to the amashaya as the Dosha are

stemming from Pittasthana. Constitutional symptoms like Arati also manifest as the

Dosha circulate all over the body. Localization of the Dosha in the Uras as well as

Shiras, leads to Prana Vilomata and Sirasula respectively. In this way depending upon

the course of morbid Dosha, the patient of Tamaka Swasa suffers from few of the

Purvarupa, and is listed in the following table.

Table No. 23, Showing the Purvarupa of Tamaka Swasa 187.

Symptoms CS SS AH MN

Anaha + + + + Adhmana - - - + Arati - + - - Bhakthadwesa - + - - Vadanasya vairasya - + - - Parshwa shoola + + + + Peedanam hrudayasya + + + + Pranasya vilomatha + - + + Shankanistida - - + +

Rupa:

By influenced etiological factors the Vayu in Vilomagati obstructed by Kapha in

Pranavaha srotas producing Tamaka Swasa. And for apparent reasons, these factors

determine the course and clinical manifestation of the disease. More details of the

symptoms are given in the table.

Disease Review


Table No. 24, Showing the Rupa of Tamaka Swasa188:

The ultimate clinical presentation may vary from attack to attack or from patient

to patient. This variation is due to the relative predominance of morbid Vatadosha or

Kaphadosha. The determination of the predominance of Dosha is mandatory while

planning the treatment. Severe breathlessness and dry irritant cough probably indicates

predominance of Vata Dosha in the pathogenesis of Tamaka Swasa. Contrary to this

severe paroxysmal cough with copious tenacious sputum is suggestive of predominance

of Kapha Dosha.

Sl. No.

Symptoms C.S S.S A.S A.H

1 Pinasa + + + + 2 Tevravega Swasa + + + + 3 Amuchyamane Tu Bhrisham + + + + 4 Vimokshante Sukham + + + + 5 Anidra. + - - - 6 Sayanah Swasa Piditaha + + + + 7 Aseeno Labhate Soukhyam + + + + 8 Pratamyati Ati Vegat + - + + 9 Kasa + + + + 10 Pramoham Kasamanascha + - + + 11 Kanta Ghurghuraka + - - - 12 Kantodhwamsa + - - - 13 Utshoonaksa + - + + 14 Vishuskasya + - + + 15 Lalata Sweda + + + + 16 Meghaihi Abhivardhate + - + + 17 Sheeta Ambu + - + + 18 Pragvata + - + +

19 Sleshmala + - + + 20 Usnabhinandate + - + + 21 Aruchi - + + + 22 Trishna - + + + 23 Vepathu - - + + 24 Vamathu - + - -

Disease Review


Upashaya and Anupashaya:

Upashaya indicates that which creates happiness to patient and which is

homologous for the patient189. Following table gives the details of Upashaya and

Anupashaya in Tamaka Swasa.

Table No. 25, Showing the Upasaya and Anupasaya in Tamaka Swasa190.

Upadrava of Tamaka Swasa:

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

mentioned in ‘Trishna chikitsa’ is Trishna appears as upadrava in Jwara, kshaya, Swasa

etc191.

Aristha of Tamaka Swasa:

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

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

can be established. At the time of death whatever the disease he may suffer, ultimately he

will die with Hikka and Swasa192.

Upashaya Anupashaya

Ushna Ahara Vihara Sheeta Ahara Vihara, Sheeta Ambu.

Aseeno Labhate Soukhyam Shayanath Swasa Piditaha

Vimokshante Sukham Presence of Kapha in the Pranavaha srotas worsens the difficulty in breathing.

Dry sunny weather relieves the symptoms

Meghaihi Abhivardhate

Quiet atmosphere is favorable Pragvata

Clear atmosphere, devoid of smoke and dust helps in reducing the symptoms.

Exposure to dust or smoke worsens the attack of Tamaka Swasa

A factor that reduces the Kapha vitiation brings out relief.

Sleshmala - Kapha aggravating factors add to the disease.

Disease Review


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

suffering with Atisara, Trishna, Shushkasyata and loss of body strength is definitely

going to die193. The person who’s Urdhva Swasa is rapid, throat occluded by Kapha;

reduction in strength, complexion and food intake is not going to survive for longer

period194. The person taking long inspiration and gives of short expiration gets fainted;

such person is stated to die within short period195.

Sadhyasadhyata of Tamaka Swasa:

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

and of duration less than one year in the durbala rogi, as krichra Sadhya196-a. If Tamaka

Swasa is Navotita (newly developed) it is sadya (curable) 196-b. Sushruta has considered

Tamaka Swasa as krichrasadhya vyadhi and asadhya in durbala rogi197. According to

Vagbhata Tamaka Swasa is yapya, but can be Sadhya if it is treated in early stages in the

strong persons198.

Disease Review


Table No. 26, Showing the Vyavachedaka Nidana of Tamaka Swasa199.

Lakshana

Tamaka Swasa

Maha Swasa Urdhva Swasa

Chinna Swasa Kshudra Swasa

Swasa

Ateva teevra vega Swasa

Uchaihi swasati

Dheergam swasati, Urdhvam swasati, adhoswasa nirodha

Swasate vichinnam

Ruksha aayasottha Swasa

Shabdha

Ghur-ghuraka Matta vrashabho vatt

Consciousness

Pramoha

Pranastha jnana vijnana

Pramoha Moorcha

Netra

Uchritaksha Vibhranta lochana and vivrataksha

Urdhvadristhi and vibhrantaksha

Viplutaksha, raktaika lochana

Shula

Shayanasya parshvagraha

Vedanarta

Marmachedavat rugarditaha

Vak

Kruchrakrichnoti bhashitaha

Viksheena vak

Pralapana

Asya

Vishushkasya Shushkasya Parishushkasya

Sweda

Lalata sweda

Sarva daihika sweda

Upashaya

Sleshma vimokshana

Sadhyasadhyata

Yapya Asadhya Asadhya Asadhya Sadhya

Disease Review


Chikitsa:

The effective treatment of Tamaka Swasa can not be united, as its pathology

involves multiple varying factors as vitiated Vata and Kaphadosha stemming out from the

Pittasthana, afflicting the Rasadhatu in Pranavaha srotas produces the illness. Therefore

the treatment aimed at the rectification of the imbalances of Vatadosha as well as

Kaphadosha, forms the sheet anchor of treatment of Tamaka Swasa which is individually

quite opposite. Thus, the unique pathogenesis posses complexity in planning the

treatment. The final treatment planned should pacify the Vata dosha as well as

Kaphadosha effectively. Simultaneously not causing any further addition to the

imbalance of Vata and Kaphadosha, with the due consideration of this, following

principles of treatment for Tamaka Swasa are advocated in the Ayurvedic classics.

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

2. Vamana – Therapeutic emesis

3. Virechana Karma – Therapeutic purgation.

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

5. Vata and Kaphahara Chikitsa – Pacification of vitiated Kapha Dosha.

6. Brumhana and Shamana Chikitsa200.

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

Ayurvedic classics according to the Vyadhi. Vyadhibala. Rogibala, Doshavastha,

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

observing these points. For the proper management of this disease exclusively Charaka

has explained so many different management and treatment principles. With comparison

of other authors the principles of management are as follows.

Disease Review


Management of Swasa rogi depends on:

1. Bala and Abala (Balawan or Durbala)

2. Doshadhikya (Kaphadhikya or Vatadhikya)

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

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

dhuma, avaleha etc are to be administered201.

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

alleviated by Vatanashaka dravyas, Tarpana, Sneha, Yusha, Mamsarasa etc are to be

administered202.

If the Smshodhana karma is performed in condition anutklistha Kapha dosha,

durbala and those who have not undergone Swedana, Vata gets grossly provoked;

becomes fatal with causing marma samshoshana. In case of balawan, Kaphabahula rogi,

before performing the Vamana karma anoopa and jalaja mamsa rasa and swedana are to

be given. Contradictory to it, in durbala, alpa Kaphavastha, he has to be treated with

Brumhana chikitsa 203. Swasa rogi having ruksha shareera, suffering from shushkata in

uras, kantha and talu has to be treated by ghrita204.

Doshanubandhi Swasa Chikitsa:

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

etc. or ghrita prepared by pippali, mamsa and shonita has to be administered205. In case of

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

and trikatu has to be administered206. Gangadhara commenting on this suvarchala

swarasa, dugdha, ghrita can be administered separately with trikatu churna after food207.

In case of Pittanubandhata Utkarika gritha are to be administered208. In case of

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Kaphapittanubandha Swasa shirisha pushpa swarasa or saptaparna swarasa, mixed with

pippali choorna and madhu has to be administered209.

According To Doshas Swasa Chikitsa:

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

rogi, with respect to doshas210.

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

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

Vata.

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

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

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

Amongst the above four. It is superior to go for Vatashamaka upakramas211.

Abhyanga and Swedana

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

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

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

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

for smoothness of Srotas212.

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

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

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

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

Disease Review


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

or upanaha213. Swasa rogis suffering with associated Swaraksheena, Atisara, Raktapitta,

and Daha, they are to be treated with madhura, snigdha, sheetal dravyas214.

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

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

Saindhava Lavana215. After Samyak Swedana, snigdha odana, matsya shukara mamsarasa

or dadhi manda has to be administered, which helps for Sleshma vardhana216.

Vamana and Virechana:

After snigdhadi bhojana, when Kapha gets increased sufficiently, then Vamaka

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

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

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

virodhi217. Chakrapani commenting on vata avirodhi word, he says not to use ruksha and

teekshna vamaka yogas. That indicates to use mridu vamaka dravyas. For the proper

management of Swasa some more clues are given by the acaryas as, to expel vitiated

doshas by vamana, if patient is suffering from Swasa along with kasa, swarabheda and

for Tamaka Swasa Kaphavatahara dravyas are to be used for Virechana. Gangadhara

comments as, in swarabheda yukta Swasa and Tamaka Swasa Virechana and swatantra

kasa, swarabheda vamana has to be administered218.

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

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

abhyanga with Vata nashaka dravya sidda tailas.. Which are neither too hot nor too

cold219. If Swasa rogi is suffering from udavarta and adhmana Vatanulomana has to be

performed with matulunga, amlavetasa, hingu, pilu and bida lavana220.

Disease Review


Charaka pronounced this as “Tamake Tu Virechanam” 221. The Virechana

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

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

minimizes the duration of illness. After Virechana, Samasarjana Karma is advised for

about 3 to 7 days222. Doshas stemming out from Pitta Sthana is best eliminated by

Virechana procedure. It is worth mentioning here that; Vata Dosha is the predominant

Dosha involved in the Samprapti of Tamaka Swasa. Virechana normalizes the course of

Vatadosha and thus helps in the reversal of the Vilomagati of Pranavata. Distension of

the abdomen, constipation and such other symptoms may be associated in some patients

and these symptoms are best treated by this procedure.

Dhumapana:

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

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

purpose of dhumapana; haridradi dhuma varti is generally indicated in classics223.

Kshara prayoga:

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

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

Anulomana224.

Brumhana and Shamana Chikitsa:

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

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

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

Disease Review


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

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

complications due to treatment are difficult to manage225.

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

shodhita or ashodhita, he has to be treated with Shamana and Brumhana Chikitsa226.

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

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

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

roga227. Vagbhata has explained the use of pippalyadi takra in treating Swasa and

hikka228. With all the above principles of management of Tamaka Swasa, there are still

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

various authors.

Pathyapathya229:

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

may worsen the episode, if the patients are already in the symptomatic phase.

Understanding of Pathya as well as Apathya gains importance both in preventing as well

as planning the treatment. Mainly the factors that influence the balance of Vata Dosha as

well as Kapha Dosha are either Pathya or Apathya as their role in pacifying or else

aggravating these Doshas respectively.

Following Pathya should be followed by a person:

Shukadhanya : Shashtika Shali, Raktashali, Godhuma, Yava

Shamidhanya : Shasha, Tittira, Lava, Shuka, Dhanva, Mruga

Shaka Varga : Shigru,Atarushaka,Mulaka, Pathya, Jambir, Bimbi, Amlavetasa.

Phalavarga : Draksha, Amalaka, Matulunga, Karchura,

Madya Varga : Sura, Madira

Jala Varga : Ushnodaka

Gorasa varga : Purana Sarpi, Ajaghrita, Aja paya

Ikshu Varga : Sharkara

Madhu Varga : Madhu

Disease Review


BRONCHIAL ASTHMA Definition:

Asthma is a disease of airways that is characterized by increased responsiveness

of the tracheobronchial tree to a multiplicity of stimuli. It is manifested physiologically

by a widespread narrowing of the air passages, which may be relieved spontaneously or

as result of therapy230.

Prevalence:

Asthma is very common; it is estimated that 4 to 5% of the population of the USA

is affected. Similar figures have been reported from other countries. Bronchial Asthma

occurs at all ages but predominantly in early Life. About one-half of cases develop before

Age10 .In childhood, there is a 2:1 male / Female preponderance but the sex ratio

equalizes by age 30. The prevalence of asthma is increasing by age worldwide. The

reasons for this increase clear, but may include:

Increased exposure to air-bone allergens, particularly house-dust mites.

Exposure to occupational allergens.

Increased urbanization, and hence exposure to adjustments such as dietary-

components and pollutants.

Reduced exposure to bacterial and viral infection in early infancy.

Etiology:

From an etiologic standpoint, asthma is a heterogeneous disease. It is useful for

epidemicologic and clinical purpose to classify asthma by the principle stimuli that are

associated with acute episodes.

The etiological factors of Bronchial Asthma can be divided into two groups.

A) Predisposing factors.

B) Precipitating factors.

A) Predisposing factors:

The most important factors predisposing to asthma is “Atopy”. This codition

characterized by excessive production of IgE in response to allergens.

The term ‘Atopic’ – is applied to people with a history of allergic illness that

often develop in the first few years of life. The prevalence of asthma increase with

increasing serum IgE concentrations, and the majority of Asthma patients express IgE

Disease Review


directed to inhale allergens. Atopic diseases such as asthma tend to run in families, with

heritability accounting for up to 50% of the clinical expression.

Gender:

Childhood Asthma is more common in boys than in girls until the age of about 10

years, when the difference disappears. There is some evidence that this difference is due

to differences in allergen sensitivity between boys and girls.

Bronchial Hyper responsiveness:

In all types of Asthma an underlying problem seems to lie in an abnormal reactivity

of the airways, that is they narrow excessively in response to stimuli which would not

affect normal subjects.

This temporary increase in reactivity occurs because such infection dendue the

tracheal and bronchial mucosa exposing sensory receptors in the mucosa. However,

neurological reflexes are only a part of the responsiveness of airways.

B) Precipitating factors:

Precipitating factors which are important in bronchial asthma are:

Infections,inhaled allergens,dusts,environmental pollution foods occupation,

psychological, hormonal, gastro – esophageal reflux are the commonest factors claimed

as precipitating acute attacks of Bronchial Asthma.

Pathogenesis

The exposure of etiological factors on respiratory tract produces airway

sensitization. This airway sensitization predisposes the airways to narrow in response to a

variety of stimuli. This episodic airway narrowing and resilient reduced airflow constitute

an asthma attack.

Pathological features are apparent in the airways even mild asthmatic but are

more marked in moderate and severe asthmatics pathology of the Asthmatic airway. The

airway obstruction is caused by contraction of Bronchial smooth muscle, plugging of

airways by mucus and shed epithelial cells, and airway wall oedema. With sub epithelial

collagen deposition by myofibroblasts, hyperplasia of mucus glands and hypertrophy of

bronchial muscle the bronchial mucosa is infiltrated by activated T – cells eosinophils

and mast cells.

Disease Review


Areas of epithelial damage / shedding

Sub-epithelial fibrosis

Mucus plugging of small airways in sever Asthma

Mucus gland hyperplasia

Bronchial smooth muscle Hypertrophy

Characteristic Inflammatory cell Infiltrate, espacially of eosinophils and T

lymphocytes, with evidence of mast cell are de-granulation.

Classification Of Asthma:

In modern Medicine also various classification of Bronchial Asthma are

described which can be explained as follows:

Etiological Classification:

According to etiological asthma has been divided into two basic type:

Extrinsic[Allergic, Atopic ] Asthma.

Intrinsic[Idiosyncratic, Non Atopic] Asthma.

Extrinsic Asthma:

This has identifiable external triggering factors, such as specific allergens. It is

common in young people and is associated with positive immediate skin – prick tests and

a personal or family history of asthma, hay fever and eczema.

Intrinsic Asthma:

This is more common in older patients. There are no obvious triggering stimuli

other than respiratory infection and often, there is less reversibility, with more long –

standing airflow obstruction of some degree.

Disease Review


Table No.27, Showing the Characteristic Features of Extrinsic and intrinsic Asthma.

Extrinsic Intrinsic

Starts in childhood. Often starts in adulthood.

Eczema and Rhinitis often present Often persistent symptoms.

Positive skin tests to common allergens Negative skin tests

Precipitating factors evident from history No obvious precipitating factor

except infection

Episodic Aspirin – sensitive

Positive family History Subjects usually Intrinsic

IgE frequently raised Normal or Low IgE

Prognosis favorable Prognosis poor

Mixed Asthma:

Many patients may not come into either of the groups, but shows features of both

groups. Sometime asthmatics to start with, have seasonal Asthma and later pass on to this

stage of perennial Asthma. Initially triggered by non-atopic factors such as exercise,

infection, psychic disturbance etc.

Clinical Manifestations:

The classic symptoms of Asthma are intermittent reversible attacks of dyspnoea,

wheezing and a sense of chart tightness, cough and increase in sputum volume and

viscosity. Sometimes the patient describes a sensation of chocking in the neck, or

tightness in the chest, rather than wheezing. Sometimes the cough is given more

emphasis than wheezing, particularly then it occurs at night.

Age of onset: Asthma may occur for the first time at any age. Males predominate in

childhood and females in later life. In childhood, extrinsic factors and associated atopy

are much likely to be encountered than later in life.

Disease Review


Patterns of Variability in Asthma

Acute Asthma:

Distressing wheezing of more or less acute onset is the hallmark of asthma. The

majority of patients have such attack at some time and often to them as ‘spasms’.

The patient sits or stands, bracing shoulders with the hands on the knees or on

the arms of a chair. The expression is one of preoccupation with the business of

breathing. Both are wheezy, examination reveals over-inflation of the chest, use of

accessory muscles of respiration and marked recession of the lower part of the chest

during inspiration. There is tachycardia and usually pulsus paradoxus; cyanosis may be

present. Ausculation usually reveals universal inspiratory and expiratory Rhonchi.

Sometimes in very severe acute Asthma, wheezing is unimpressive or absent. Most attack

subsides spontaneously in minutes but some are prolonged for hours despite treatment.

Unconsciousness is occasionally encountered in an acute attack. Sometimes

actual asphyxia may be accompanied by impairment of venous return due to over-

inflation.

Chronic Asthma:

Some patients have persistent symptoms, which may be mild or severe. There is

virtually always a characteristic diurnal variability.

Diurnal Variation

Diurnal variation in symptoms is one of the most important diagnostic features of

Asthma; it is seen in chronic Asthma as well as during exacerbations. The main elements

are:

Morning tightness:

The patients notice tightness and wheezing usually within seconds of waking and

this may take minutes or hours to subside, coughing exacerbates symptoms.

Nocturnal attacks:

Attacks at night are also characteristic of Asthma. The patients generally wake

between 2 and 3 a.m. with tightness, cough and wheezing dyspnoea. He or she may get

up and sit by on open window. Nocturnal attacks may be prolonged or repeated. Such

episodes are commonly misdiagnosed as ‘paroxysmal Nocturnal’ dyspnoea due to left

ventricular failure.

Disease Review


Seasonal variation:

Marked seasonal variation is characteristic of extrinsic Asthma. Aggravation in

the winter month is common and probably due to two factors - frequent upper respiratory

tract infection and house dust mite sensitivity.

Physical signs:

During Attack

(1) On Inspection:

The chest seems to be maintained in a position of inspiration, but little expansion

with short inspiration.

Accessory muscle such as sterno – mastoid salanius and pectoralis are in

continuous action to add breathing.

Jugular vein distended.

The lips, cheeks, nails and later the skin as a whole become cyanosed.

(2) On palpation :

Expansion of chest diminished.

Vocal fremitus diminished.

(3) On percussion :

Note is hyper resonant especially so when after many attack, emphysema also

supervenes.

(4) On Auscultation:

The Inspiratory effort is shortened and may hardly be audible.

Expiration Prolonged.

High pitched musical Rhonchi with prolonged expiration replace the normal

Vascular murmurs.

In severe asthma airflow may be insufficient to produce Rhonchi and a ‘silent

chest’ in such patients is an ominous.

Drug Review


DRUG REVIEW

Stiffness of the srotas as well as accumulation of the Kapha in the Pranavaha srotas,

there by obstructing the free passage of the Pranavayu is the prime pathology of Tamaka

Swasa. Hence alleviation of Vata and Kaphadosha forms the sheet anchor by the

treatment. Pacification of Vatadosha brings about srotomardava in the Pranavaha srotas.

Expectoration of Kapha dosha removes the obstruction in the air passagess. The ultimate

result is the clarity of the passage of Pranavayu. Thus aborting the pathology of the

Tamaka Swasa. So Vamana karma and Virechana karma is effective procedures.

Before undergoing for the procedure’s the Purvakarma is must.

1) Drugs used for Purvakarma:

Panchakola churna : For Deepana-Pachana231

Dashamuladi Ghrita : For Snehapana232

Moorchita Tila taila : For Abhyanga233

2) Drugs used for Pradhanakarma:

Madanaphaladi yoga : For Vamana234

Vyoshadi Gutika : For Virechana235

Drug Review


Panchakola Churna:

Selected for Deepana Pachana because ingredients are having mainly Kapha

Vatahara property.

Table No.28, Showing the properties of ‘Panchakola Churna’.

Dravya Rasa Guna Veerya Vipaka Doshagnatha Karma

Pippali236

And Pippali Mula (Piper

longum)

Katu Laghu Snigdha Tikshna Pippali Mula is Rooksha

Anushna Sheeta Pippali Mula is Ushna

Madhura

Pippali Mula is

Katu

Kapha Vata hara

Medhya Deepana Mutrala

Kasahara

Chavya237 (Piperretro fractum)

Katu Laghu Rooksha

Ushna Katu Kapha Vata hara

Triptigna Deepana Pachana Krimigna

Chitrak238

(Plumbao Zeylanica)

Katu Laghu Rooksha Tikshna

Ushna Katu Kapha Vata hara

Deepana Pachana

Grahi Krimigna

Nagara239 (Zingiber officinale)

Katu Laghu Snigdha

Ushna Madhura Kapha Vata hara

Deepana Pachana Vrushya

Anulomana

Dashamuladi Ghrita:

The drugs used for Ghrita preparation is almost of, katu-tikta rasa, katu-vipaka,

ushna-veerya, laghu, ruksha-guna and Kapha Vata shamaka in nature.

Ingredients are,

For Kashaya – Dashamoola(Bilwa, kashmarya, agnimantha, shyonaka, patala,

shalaparni, prishnaparni, brihati, kantakari, gokshura), and Dhadimand should be taken.

2 Drona water, kept on fire for heating. When Chaturtamsha is reduced i.e. it

becomes ½ Drona, remove from the fire and filter it.

Drug Review


Next add 2 prastha Moorchita Ghrita and the below mentioned kalka dravyas.

Kalka dravyas: Pippali, Souvarchala lavana, Yavakshara,Vayastha, Hingu, Chorapusphi

and Kayastha- All are in equal quantity.

Preperation:

Mix all in a vessel and kept on a fire of medium flame and prepared as per

Ghritapaka vidhi. When Ghrita sidda lakshanas are seen, taken out from the fire and

filtered it.

Moorchita Tila Taila: Properties are,

Latin name of Tila : Sesamum indicum

Family : Pedaliaceae

Rasa : Madhua, kashaya, Tikta

Guna :Sookshma, vyavayi, vikashi, vishada, guru, sara, teekshna.

Veerya : Ushna

Vipaka : Madhura

Doshaghnata : Tridosha

Karma : Deepana, Pachana, , Vrinahara, Mamsadhatu pushtikara,

Keshya, Netrya, Brimhana and Karshyakara.

Drug Review


Madanaphaladi yoga: Ingredients are,

Madanaphala pippali : 4 parts

Vacha choorna : 2 parts.

Saindhava : 1 part

Honey : as per requirement and

Yasthimadhu for Phanta : as per requirement

Vyoshadi Gutika: Ingredients of Vyoshadi Gutika is as below –

01. Pippali

02. Maricha

03. Shunti

04. Twak

05. Musta

06. Patra

07. Ela

08. Vidanga

09. Haritaki

10. Amalaki

All together taken in equal parts – 1 part

11. Danti – 2 parts

12. Trivrit – 8 parts

13. Sharkara – 6 parts

14. Madhu – Avashyanusa

Method of preparation:

All the drugs were identified and collected form the local areas. Collected drugs

were prepared for the preparation by removing the physical and chemical impurities. All

the ingredients were made into powder form and mixed well with Madhu thereafter

stored in the form of Avaleha or Gutika.

Table No.29, Showing the Ingredients and properties of “Dashamuladi Ghrita”. Sl.No

Sanskrit name

Lat.name & Family

Rasa Guna Veerya Vipaka Chem-Compotition.

Useful part

Doshagnata

Karma

1 Bilwa 240 Aegle marmelos (Rutaceae)

Kashaya, Tikta

Laghu, Rukshna

Ushna Katu Marmelosin, Aegelin, Na, K,Fe,Ca, marmin,

Fruit, Root, Bark, Leaves

K-V Deepana, Pachana, Mridurechaka, Shotagna, Krimigna

2 Kashmarya241 (Gambhari)

Gmelina arborea (Verbenaceae)

Tikta, Kashaya, Madhura

Guru Ushna Katu Viscid oil, Benzoicacid, Resin

Root, Bark, Fruit, Leaves

VPK Anulomana, Medhya, Balya, Vrishya, Shotagna

3 Agnimantha2

42 (Shriparna) Premna mucronata (Verbenaceae)

Tikta, Katu Kashaya, Madhura

Laghu, Ruksha

Ushna Katu Fixed oil Root-bark, leaves

K-V Anulomana, Shotahara, Vedanasthapana

4 Shyonaka243

(Tuntuka) Oroxylum indicum (Bignoniaceae)

Madhura, Tikta, Kashaya

Laghu, Ruksha

Ushna Katu Oroxylon, Acric principle, Pectin

Root, Bark, Fruit Leaves

K-V Deepana, Pachana, Shothahara, Grahi, Krimigna

5 Patala 244 Stereospermum suareolens (Bignoniaceae)

Tikta, Kashaya

Laghu, Ruksha

Ushna Katu Albuminous Sacchrine, Wax

Flower Root Bark

VPK Hridya,Shothahara, Vajikara,Trishnashamaka, Vedanasthpaka

6 Shalaparni245 Desmodium gangeticum (Papilionata)

Madhura, Tikta

Guru Snigdha

Ushna Madhura Resin, Oil, An alkaloid

Whole plant

VPK Anulomana, Vrishya, Shotahara, Mutrala, Krimigna

7 Prishnaparni2

46

Uraria picta (Papilionatae)

Madhura, Tikta

Laghu, Snigdha

Ushna Madhura Resin Root VPK Deepana,Anulomana,Vrishya,Shothahara,Mutrala,Sandhaniya,

8 Kantakari 247 Solanum surattense (Solanaceae)

Tikta, Katu

Laghu, Ruksha, Tikshna

Ushna Katu Diosgenin,Pot.Nitrate/carbonate/sulphat

Panchanga

K-V Kantya, Mutrala, Shothahara,Kasagna, Krimigna,Vajikara

94

9 Brihati 248 Solanum indicum (Solanaceae)

Katu, Tikta

Laghu Ruksha, Tikshna

Ushna Katu Solanin, Solanidine,

Fruit Root

K-V Mutrala, Shothahara, Vajikara, Kandugna, Kushtagna

10 Gokshura 249 Tribulus terrestris (Zygophyllaceae)

Madhura Guru, Snigdha

Sheeta Madhura Alkaloid, Resin, Fixed oil

Entire plant

V-P Anulomana, Mutrala, Vrishya, Shothahara, Ashmarinashana

11 Pippali & Pippali mula

Piper longum (Piperaceae)

Katu Laghu, Snigdha,Tikshna

Anusna shita

Madhura Piperine, Resin, Starch, Gum, Volatile oil

Root Fruits

K-V Pachana, Medhya, Triptigna, Kasahara, Rakta shodhaka

12 Souvarchala lavana250

-- Katu Laghu SuksmaVishada

Ushna Katu - - VPK Pachana, Rochna Bhedana, Hridya, Vatanulomana

13 Yavaskhara2

51 Potasii carbonas Katu Laghu,

Snigdha, Suksma

Ushna Katu Alkaloid, Root

K-V Deepana, Shothahara,Vatanulomana.

14 Amalaki 252 Emblica officinalis (Euphorbiaceae)

Pancharasa

Guru, Ruksha Sheeta

Sheeta Madhura Vit-c, Gallic & tannic acid, Ca, Al Cellulose

Fruit Leaves Root Flower

VPK Keshya, Medhya, Chakshushya, Pramehagna, Rasayana

15 Hingu253 Ferula narthex (Umbelliferae)

Katu Laghu, Snigdha,Tikshna

Ushna Katu Asaresinotaannol, ferulic acid, Disulphide.

Niryasa K-V Pachana, , Medhya, Triptigna, Kasahara, Rakta shodaka.

16 Chorapuspi (Choraka) 254

Angelica glauca (Umbelliferae)

Katu, Tikta

Laghu, Tikshna

Ushna Katu Oil. Root K-V Pachana, , Medhya, Triptigna, Kasahara, Rakta shodaka.

17 Kayastha 255(Haritaki)

Terminalia chebula (Combretaceae)

Pancharasa

Laghu, Ruksha

Ushna Madhura Tannic, Gallic, Chebulinic acid

Fruit VPK Anulomana,Hridhya,Shothahara,Rasayana

95

Table No.30, Showing the Properties of ‘Tila taila’.

Sl

No. Sanskrit

Name Latin name &

Family Rasa Guna Veerya Vipaka Doshaghanata Karma

01. Tila256 Sesamum indicum (Pedaliaceae)

Katu, Tikta, Madhura, Kashaya

Snigdha, Guru, Grahi

Ushna Katu Pitta and vata

Agnideepana, Pachana, Srotoshodhana, Vatanulomana, Mutrajanana, Balya, Keshya, Vrinaropaka

Table No.31, Showing the Ingredients and Properties of ‘Madanaphaladi yoga’.

Sanskrit

Name

Latin name

& Family

Rasa Guna Veerya Vipaka Chemical

Composition

Parts

used

Dosha

gnata

Karma

Madana

phala 257

Randia

dumetorum

(Rubiaceae)

Kashaya

Madhura

Tikta,

Katu

Laghu,

Ruksha

Ushna Katu Saponin,

Randia oil,

Phala K-V,

K-P

Shamaka

Vamaka,

ShothaharaVatanulo

maka Lekhana,

Swedajanana

Vacha 258 Acorus calamus (Araceae)

Katu, Tikta

Laghu, Tikshna

Ushna Katu Acorin, Acoretin Calamin Tannin

Dried Rhizome

K-V Medhya, Deepana, Sanjnyasthapana, Swedajanana

Yashtimad

hu 259

Glycyrrhiza

glabra

(Papilionatae)

Madhura Guru,

Snigda

Sheeta Madhura Glycyrrhizin,A

sparagin,sugar,

Starch,Mucilag

e,

Root V-P Chedana,Mridurecha

na, Vatanulomana,

Mutrala,Shukravardh

aka

96

Table No.32, Showing the Ingredients and Properties of ‘Vyashadi Gutika’.

S.N. Sanskrit

Name Latin name & Family

Rasa Guna Veerya Vipaka Doshaghanata Karma

01. Shunthi Zingiber officinale (Zingiberacease)

Katu Laghu, Snigdha

Ushna Madhura Vata and Kpaha

Agnideepana, Pachana, Bhedana, Vatanulomana

02. Maricha Piper nigrum (Piperaceae)

Katu Ruksha, Teekshna

Ushna Katu Kapha and Vata

Deepaka, Pachaka, Krimighna, Uttejaka, Vatanulomaka

03. Pippali Piper longum (Piperaceae)

Katu Snigdha, Lahgu

Anushna Madhura Vata and Kapha

Deepaka, Pachaka, Vatanulomana, Vrishya, Krimighna

04. Twak260 Cinnamomum zeylanicum (Lauraceae)

Tikta, Madhura

Laghu, Ruksha, Teekshna

Ushna Katu Vata and Pitta

Deepana, Pachana, Vatanulomana, Uttejaka, Krimighna.

05. Musta261 Cyprus rotendus (Cyperaceae)

Katu, Tikta, Kashaya

Laghu, Ruksha

Sheeta Katu Kapah and Pitta

Deepana, Pachana, Swedajanaka, Krimighna.

06. Patra262 Cinnamomu tamala (Lauraceae)

Madhura, Tikta

Alpa Teekshna, Picchila, Laghu

Ushna Katu Kapha and Vata

Deepana, Pachana, Vatanulomana, Uttejaka, Mutrala.

07. Ela263 Elettaric Cardamomum (Zingiberaceae)

Katu, Madhura

Laghu, Ruksha

Sheeta Madhura Vata Deepana,Pachan Rochaka,Mutral,Uttejaka, Krimighna, Raktashodhaka

08. Vidanga264 Emblica ribes (Myrsinaceae)

Katu, Kashaya

Teekshna, Ruksha

Ushna Katu Kapha and vata

Deepana, Pachana, Vatanulomana, Raktashodhaka, Krimighna.

09. Haritaki265 Terminalia chebula (Combretaceae)

Lavana avrjhit pancharasa

Ruksha, Laghu

Ushna Madhura Tridosha Deepana, Rasayana, Medhya, Anulomaka.

97

10. Amalaki266 Emblica officinalis (Euphorbiaceae)

Pancharasa Lavana varjit

Mrudu, Ruksha, Sheeta

Sheeta Madhura Tridosha Deepana, Pachana, Rasayana, Yakrit Uttejaka,

11. Danti267 Baliospermum montanum (Euphorbiaceae)

Katu Teekshna, Guru

Ushna Katu Kapha and Pitta

Rechaka, Shothaghna, Raktashodhaka

12. Trivirt268 Operculina terpenthelum

Madhura, Tikta, Katu

Ruksha, Laghu, Teekshna

Ushna Katu Tridosha Rechaka, Bhedana, Sukhavirechaka

13. Sharkaa269 _

Madhura Sheetala Madhura Madhura Vata and Pitta

Dahashamaka, Rakta viakraghna, Ruchya, Jwaraghna

14. Madhu270 _

Madhura, Kashaya

Laghu, Ruksha, Sukshma, Vishada, Sheeta

_

_

kapha Deepaka, Lekhana, Srotoshadhaka, Varnya, Yogavahi, Rakta shodhaka

98

Methodology


METHODOLOGY

Research approach:

In this work the main aim was to evaluate the comparative efficacy of Vamana

and Virechana karmas in Tamaka Swasa.

After the completion of the full treatment, the results were assessed by comparing

the before treatment, After Shodhana and after follow up data.

Research Design:

Comparative clinical trial was conducted. The patients were assigned in to 2

groups.

Group-A : 15 patients were received classical Vamana karma.

Group-B : 15 patients were received classical Virechana karma.

The treatment modalities used in this clinical study are Vamana and Virechana

karmas, which includes, Deepana-pachana with Panchakola churna, Snehapana with

Dashamuladi ghritam, Abhyanga-sweda with moorchita tila taila and Nadi sweda.

Vamana with Madanaphaladi yoga, Virechana with Vyoshadi gutika and followed by

Samsarjana krama and follow up for 15 Days. During the follow-up period, patients were

received placebo capsules.

Source of Data: Patients suffering from Tamaka Swasa were selected from P.G. S. &

R.C, Dept. of Panchakarma O.P.D. and I.P.D of D.G.M. Ayurvedic Medical College and

hospital, Gadag, by preset inclusion and exclusion criteria.

Methodology


Sample size & Grouping:

A Minimum of 30 patients was taken for study, divided in two groups.

Group-A : 15 patients were received classical Vamana karma.

Group-B : 15 patients were received classical Virechana karma.

Diagnostic criteria: The diagnosis of the disease Tamaka Swasa is made according to

signs and symptoms mentioned in Ayurvedic and Modern texts.

Inclusion criteria:

Patients satisfying the following criteria were taken for study. They are –

Patients having Tamaka Swasa lakshanas as per classics.

Patients between 20 years to 60 years irrespective of sex.

History of Tamaka Swasa of less than 10 years duration.

Tamaka Swasa patients having good strength and who are fit for Vamana

and Virechana karma.

Exclusion criteria:

If any of the following conditions were noted, such patients were excluded from the

study. They are –

Patients suffering from other systemic diseases.

Patients under intensive bronchodilatory treatment.

Status asthmatics condition.

Pregnant and lactating women.

Plan of study: Shodhana therapy is divided into Purvakarma, Pradhanakarma and

Paschatkarma.

Methodology


Purvkarma: For both the groups, Purvakarma is same. i.e.

Deepana-pachana: with Panchakola churna 3-6 gm, 3 times a day ½ hr before food,

with hot water, till nirama laskhanas appears.

Snehapana: For Snehapana, Dashamuladi ghrita was selected. After attaining appropriate niramata,

the Snehapana was started with Hruseeyasi matra i.e. 30 ml and Arohana Snehapana till Samyak

Snigdha lakshanas are seen. Totally for Seven days.

Vishrama kala (Abhyanga and Sweda): The patients were administered with abhyanga

and Nadisweda. For abhyanga moorchita tila taila was used. Vishrama kala for Vamana

is 1 day and for Virechana is 3 days.

Pradhana karma:

A) Vamana karma: For Group-A patients. After attending Samyak Snigdha lakshanas

one day rest was given. Next day Vamana yoga after assessing the status of patient’s

koshta, bala, etc. The medicine used was Madanaphaladi yoga.

B) Virechana karma: For Group-B patients. After attending Samyak Snigdha lakshanas,

three days rest was given. Next Day Virechana yoga after assessing the status of patient’s

koshta, bala, etc. The medicine used was Vyoshadi gutika. Sukoshnajala was used for

Anupana.

Paschat karma:

Samsarjana karma: In both the groups, Samsarjana krama was performed depending

upon the Shuddhi.

Follow up: Follow up for 15 day. During this period, placebo capsules were given and

patients were advised to follow the diet, which the patient had followed prior to our

study.

Methodology


Investigations and Selection of Patients:

Subjective parameters:

Apart from the above parameters, the following parameters were also taken for

assessing the patient. They are

Tevra vega Swasa (Dyspnonea)

Kasa (cough)

Duhkhena Kapha nissaranam (Expectoration)

Ghurghuratwam (Wheezing)

Urah Peeda (Chest Pain)

Shayane Swasa peedita (Discomfort at supine)

Frequency of Attack

Duration of Attack

Objective parameters:

The following investigations were done prior to the study.

Peak expiratory flow rate

Absolute Eosinophil counts

Investiogations:

Haemoglobin%

ESR

Total count WBC

Eosinophillic differential count

Methodology


Method of assessment of Grading:

The assessment of results, by observing the severity of symptomatology, as well

as the laboratory investigations. The severity of the symptoms, Peak expiratory flow rate,

Absolute Eosinophil counts were assessed before Shodhana, after Shodhana and after

follow-up of 15days.

Grading of parameters:

The results were evaluated by observing subjective and objective parameters by

grading method. The grading was done in the following manner.

Subjective parameters:

Teevra vega Swasa:

0 – Normal - no symptoms

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

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

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

activity.

Kasa:

0 – Normal - no cough

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

2 – Moderate - continuous cough during day and morning disturbing work

3 – Severe - continuous and night cough disturb activities

Dukhen Kapha nissarana:

0 – Normal - no phlegm

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

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

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

Methodology


Ghurghurtwam:

0 – Normal - no wheezing

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

than 1 to 2 times/week

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

4 times/week

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

Times/week

Uraha peeda:

0 – Normal - no chest tightness

1 – Mild - able to tolerate the tight or pain

2 – Moderate - Persists during cough + mild differs

3 – Severe - feels difficulty to tolerate pain and tightness

Shayanasy Swasa peedita:

0 – Normal – no discomfort

1 – Mild - < 1 or 2 time/month

2 – Moderate - 2 time/week

3 – Severe - > 3 or frequently

Frequency of Attack

0- No symptoms

1- One episode/month

2- >one episode/ month

3- >Four episode/ month

Duration of Attack

0- No symptoms

1- Brief for one hour

2- Prolonged for 2-3 days

3- Almost continuous

Methodology


Peak expiratory flow rate:

The Wright’s peak flow meter, introduced in 1959 is a simple, portable device.

PEFR has a very good correlation with FEVI and for measuring the ventilatory function

of lungs. This simple objective measurement of lung function helps detecting early

deterioration of lung function. Measurement of PEFR is valuable in medical care settings

to measure response to therapy during an acute exacerbation. Out of lung function, the

PEFR is more useful.

Procedure:

Step 1) ask patient to hold the PEFR in position

Step 2) let the patient take a deep breath in

Step 3) patient keep the PEFR instrument in the mouth without any leakage of air

from sides in to the flow meter with a sharp blast

Step4) the movement of the needle on the dial indicates the PEER in liters/minute,

which is to be noted.

Taken 3 readings at one minute intervals and recorded the average of higher

readings brought to the needle back to zero by pressing the button located near the mouth

piece. Normal Range of PEFR is 350-500liters/minute.

Grading of PEFR:

PEFR Grades are declared for the sake of final assessment is as follows.

Grade 0- 350 and above

Grade 1-350 to 250

Grade 2-250 to 150

Grade 3-150 and below

Methodology


Absolute Eosinophilic count:

Eosinophils are important in the defense against parasites, worms, and to any

Infection. Because they are also sensitive to circulating allergens (materials that trigger

allergies), Eosinophils increase in number during allergic reactions as well. Thus the

absolute Eosinophils count is a good parameter to study the Asthma. Normal range of

AEC is 40-440.

Grading of AEC:

AEC Grades are declared for the sake of final assessment is as follows.

Grade 0- 240 and below

Grade 1- 240 to 440

Grade 2- 440 to 640

Grade 3- 640 and above

Assessment of overall effect of the Treatment:

Total effect of the therapy was announced on the basis of the following responses:

1. Well Response = > 75 % relief in signs and symptoms

2. Moderate Response = > 50% relief in signs and symptoms

3. Poor Response = > 25% relief in signs and symptoms

4. No Response = < 25% relief in signs and symptoms

Results


In the present clinical study subjective and objective changes were considered for

the assessment of Ayurvedic management of Tamaka Swasa by classical Vamana and

Virechana karmas. 30 patients were selected and divided 15 patients in each Group. For

Group-A patients, Vamana karma was administered and for Group-B patients Virechana

karma was administered. All the patients were assessed by subjective and objective

parameters, before treatment, after Shodhana and after follow up data. Changes were

recorded according to proforma of the case sheet.

The data were collected from both the Groups and presented as follows,

1. Demographic data of both the Groups.

2. Data related to etiological factors, duration, etc. of both the Groups.

3. Data related to incidence of disease and response to treatment in both the Groups.

4. Data related to subjective and objective parameters before and after treatment, of both

the Groups.

5. Statistical analysis and assessment for response of both the Groups.

6. Over all assessment of the results.

Table No.33, Showing the Demographic data of Group A. Sex Religion Occupation Diet Economic Status Family

History Sl. No.

OPD No.

Age (yrs)

M F H Mu S A L V Mi P MC UM HC Pr Ab 01. 2461 26 + - + - - + - + - - + - - - + 02. 2653 35 + - + - - - + + - + - - - - + 03. 2702 35 + - + - - - + - + + - - - - + 04. 2580 44 + - + - - + - + - - - + - - + 05. 2855 21 + - - + + - - - + + - - - - + 06. 3596 25 + - + - - + - - + - - + - - + 07. 3607 26 + - + - - + - - + - - + - - + 08. 2637 40 - + + - + - - + - + - - - - + 09. 4387 48 + - + - - + - - + - - - + + - 10. 2207 35 + - + - - - + - + - + - - - + 11. 5065 56 + - + - - + - + - + - - - - + 12. 5080 32 + - + - - - + + - - - + - - + 13. 6004 23 + - - + + - - - + + - - - - + 14. 5090 21 - + + - - - + + - + - - - + - 15. 6017 38 + - + - - + - + - - - + - - +

Table No.34, Showing the Demographic data of Group B.

Sex Religion Occupation Diet Economic Status Family History

Sl. No.

OPD No.

Age (yrs)

M F H Mu S A L V Mi P MC UM HC Pr Ab 01. 5058 27 + - + - - + - + - - + - - - + 02. 0307 33 + - - + + - - - + - + - - + 03. 4306 36 - + + - + - - + - - + - - + - 04. 3208 58 + - + - - - + + - + - - - - + 05. 2857 24 - + + - - + - + - - - - + + - 06. 3209 28 + - - + - - + - + + - - - - + 07. 2820 20 + - + - - + - - + - + - - - + 08. 2581 31 - + + - - + - + - - + - - + - 09. 2338 28 + - + - - + - + - - + - - - + 10. 3803 25 + - + - - + - - + - - + - - + 11. 4241 43 + - - + - - + - + - - + - + - 12. 6032 35 + - + - - + - + - - + - - - + 13. 5056 46 + - + - - + - + - - - - + - + 14. 5054 42 + - + - + - - + - - + - - - + 15. 0285 33 + - - + - - + - + + - - - - +

M – Male; F- Female; H- Hindu; Mu- Muslim; S – Sedentary; A – Active; L – Labour ; V- Vegetarian, Mi- Mixed ;

P- Poor; MC – Middle class; UM – Upper middle class; HC – High class; Pr- Present, Ab- Absent;

108

Table No.35, Showing the data related to disease of Group A. Kostha Agni Nidra Habits Prakriti Abhyavarana Shakti Jarana Shakti Sl.

No. OPD No. Mr Ma Kr V M S So D Sm Al To No VP PK VK P M A P M A

01. 2461 - + - - + - - + - - + - - + - - - + - - + 02. 2653 - + - - - + - + + - - - - - + - + - - + - 03. 2702 - + - - + - + - + - - - - - + - + - - + - 04. 2580 + - - - - + - + - - - + - - + - + - - + - 05. 2855 - + - - - + - + + - - - - + - - + - - + - 06. 3596 - - + + - - + - - - + - - + - - - + - - + 07. 3607 + - - - + - - + + - - - - + - - + - - + - 08. 2637 - - + + - - + - + - - - + - - - + - - + - 09. 4387 - + - - + - - + - - + - - - + - + - - + - 10. 2207 - + - - - + + - + - - - - + - - + - - + - 11. 5065 + - - - - + + - + - - - - - + - + - - + - 12. 5080 - - + - + - - + - + - - + - - + - - - - + 13. 6004 - + - - + - - + - - + - - - + - + - - + - 14. 5090 - + - - - + - + - + - - - + - - + - - + - 15. 6017 + - - - - + + - + - - - - - + - + - - + -

Table No.36, Showing the data related to disease of Group B.

Kostha Agni Nidra Habits Prakriti Abhyavarana Shakti Jarana Shakti Sl. No.

OPD No. Mr Ma Kr V M S So D Sm Al To No VP PK VK P M A P M A

01. 5058 - + - - + - + - + - - - - - + - + - - + - 02. 0307 - - + + - - - + + - - - + - - - - + - - + 03. 4306 - + - - + - - + + - - - - - + - + - - + - 04. 3208 - + - - + - - + - + - - - - + - + - - + - 05. 2857 - - - - - + + - - + - - - + - - - + - - + 06. 3209 + + - - - + - + + - - - - - + - + - - + - 07. 2820 - + - - - + + - + - - - - + - - + - - + - 08. 2581 - - + + - - - + + - - - + - - - - + - - + 09. 2338 - + - - - + + - - + - - - + - - + - - + - 10. 3803 + - - - + - - + - - + - - - + - + - - + - 11. 4241 - + - - + - - + + - - - - - + - + - - + - 12. 6032 - + - - - + - + - + - - - - + - + - - + - 13. 5056 - + - - + - + - + - - - - + - - - + - - + 14. 5054 - - + + - - - + + - - - + - - - - + - - + 15. 0285 - + - - - + - + + - - - - - + - - + - - +

Mr – Mridu, Ma – Madhyama, Kr – Krura; V – Vishama, M-Mandagni, S – Sama; So- Sound, D- Disturbed; Sm – Smoking,

Al – Alcohol, T – Tobacco; No – No habits; VP – Vata - Pitta, PK- Pitta - Kapha, VK- Vata – Kapha; P- Pravara, M- Madhyama, A- Avara.

109

Table No.37, Showing the Treatment protocol and observation of Group A. Deepana pachana

Snehapana Vamana details Sl. No.

OPD

No. 2 D

3 D

3 Day 4 Day 5 Day 6 Day

Dose T.A F. V L. V 6

7 8 Pi K KP

KPV

SA

SS

IS

L D Upto 6ltrs

6-8ltrs Above 8ltrs

01. 2461 - + 90 ml 120 ml - - 12gm 6.00Am 6.13Am 6.42Am - - + + - + + + + + + - - + - 02. 2653 + - 90 ml 120 ml - - 10 gm 6.05Am 6.24Am 6.50Am - + - + - + + + + - + + - - + 03. 2702 - + 90 ml 120 ml 150 ml 180

ml 12 gm 6.00Am 6.20Am 6.55Am - - + + - + + + + + + + - - +

04. 2580 - + 90 ml - - - 10 gm 6.15Am 6.25Am 6.55Am + - - - + + + + - + + - + - - 05. 2855 - + 90 ml 120 ml - - 10 gm 5.50Am 6.15Am 6.45Am - - + + - + + + + + + - - - + 06. 3596 _ + 90 ml - - - 12 gm 6.00Am 6.20Am 7.00Am - + - + - + + + + - + + - - + 07. 3607 - + 90 ml 120 ml - - 12 gm 6.05Am 6.25Am 6.55Am - - + + - + + + + + + - - - + 08. 2637 + - 90 ml - - - 10 gm 6.00Am 6.25Am 6.55Am + - - - + + + + + + + + + - - 09. 4387 - + 90 ml 120 ml 150 ml - 12 gm 6.00Am 6.15Am 6.50Am - - + + - + + + + + + - - + - 10. 2207 - + 90 ml - - - 8 gm 5.50Am 6.10Am 6.40Am + - - + - + + + - + + + - + - 11. 5065 + - 90 ml - - - 12 gm 6.00Am 6.15Am 6.55Am - + - + - + + + + - + - - - + 12. 5080 - + 90 ml 120 ml 150 ml - 10 gm 5.55Am 6.10Am 6.35Am - - + + - + + + + + + + - - + 13. 6004 - + 90 ml 120 ml 150 ml - 10 gm 6.00Am 6.20Am 6.55Am - - + + - + + + - + - + - + - 14. 5090 + - 90 ml - - - 8 gm 5.50Am 6.05Am 6.45Am + - - - + + + + - - + - + - - 15. 6017 - + 90 ml 120ml 150 ml - 10 gm 6.00Am 6.15Am 6.55Am - - + + - + + + + + + + - - +

Table No.38, Showing the Treatment protocol and observation of Group B. Deepana pachana

Snehapana Virechana details Sl. No.

OPD

No. 2D

3 D 3Day 4Day 5 Day 6 Day 7 Day Dose T.A F. V L. V A B C K NK

SS

IS

L AD

An

V PKV

Upto 1000ml

1000-1500ml

1500-2000ml

Above 2000ml

01. 5058 + - 90 ml - - - - 40 gm 7.30Am 10.10 Am 3.20 Pm - + - + - + + + + + + + + - - - 02. 0307 - + 90 ml 120ml - - - 35 gm 7.45Am 10.30 Am 2.50 Pm - - + + - + + + + + + + + - - - 03. 4306 + - 90 ml - - - - 35 gm 7.15Am 10.15 Am 3.00 Pm + - - + - - - + + + + + - - - + 04. 3208 + - 90 ml - - - - 35 gm 8.00Am 10.45 Am 3.15 Pm - + - + - + + - + + + + - + - - 05. 2857 - + 90 ml 120ml - - - 40 gm 7.30Am 10.00 Am 2.30 pm - - + + - + + + + + + + - - + - 06. 3209 - + 90 ml 120ml 150ml 180ml 210ml 45 gm 7.00Am 10.10 Am 3.30 Pm + - - + - - + + + + - + - - + - 07. 2820 - + 90 ml 120ml 150ml - - 40 gm 7.45Am 9.45 Am 3.00 Pm + - - + - + - + + + + + - + - - 08. 2581 + - 90 ml - - - - 35 gm 7.15Am 10.00 Am 2.45 Pm - + - + - - + + + - + + - + - - 09. 2338 - + 90 ml 120ml 150ml - - 40 gm 7.30Am 10.30 Am 2.30 Pm - + - + - + - + + + + + - + - - 10. 3803 - + 90 ml 120ml - - - 35 gm 7.45Am 10.00 Am 3.00 Pm - - + + - + + + + - + + - - + - 11. 4241 + - 90 ml 120ml 150ml - - 35 gm 7.30Am 10.15 Am 2.55 Pm - + - + - - + + + - + + - + - - 12. 6032 - + 90 ml - - - - 35 gm 8.00Am 10.30 Am 3.30 Pm - - + - + - + + + + + + + - - - 13. 5056 + - 90 ml - - - - 35 gm 7.45Am 10.15 Am 2.55 Pm - + - + - + + + + - + + - - + - 14. 5054 + - 90 ml 120ml - 35 gm 7.00Am 09.45 Am 2.30 Pm + - - - + - + + + - - + - + - - 15. 0285 - + 90 ml 120ml 150ml 40 gm 7.30Am 9.55 Am 2.55 Pm + - - + - + + + + + + + - - - +

2D – 2Days, 3D – 3Days; T.A – Time of Administration; F.V – First Vega, L.V – Last Vega; Pi-Pittanta; K-Kaphanta; KP-Kale pravrutti; KPV-Kramat Kapha,pitta,vata pravrutti; SA-Swayam Avasthana; SS-Sroto Shuddi; IS-Indriya Shuddi; L-Laghuta; D- Dourbalya; A-12-15vegas; B-9-11vegas; C-6-8vegas; NK- Na Kaphanta; AD- Agni deepti; An- Anamayatwa; V- Vatanulomana; PKV-Kramat Pitta,Kapha,Vata nirgamana.

110

Table No.39, Showing the data of Subjective parameters of Group A. Tevra vega

Swasa Kasa Dukhena

Kapha Nissaranam

Ghurghuratwam Urah Peeda Shayanasya Swasa Peedita

Frequency of Attack

Duration of Attack

Sl. No.

OPD NO.

BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF 01. 2461 2 1 1 2 1 1 1 0 0 2 1 1 1 0 0 1 1 1 1 0 0 2 2 1 02. 2653 2 1 1 1 1 1 1 0 1 2 1 1 1 0 0 2 1 1 1 1 1 2 1 1 03. 2702 2 1 1 2 1 1 2 1 1 2 1 1 1 1 1 2 1 0 1 0 0 2 1 1 04. 2580 3 2 1 2 1 0 2 1 1 2 1 1 1 1 1 1 1 1 2 1 1 2 1 1 05. 2855 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 1 06. 3596 1 0 0 2 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 07. 3607 2 1 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 1 0 2 0 1 08. 2637 2 1 1 1 1 1 2 1 1 2 1 1 1 0 0 2 1 1 2 1 1 1 1 1 09. 4387 2 1 1 2 2 2 2 1 1 2 2 1 1 1 1 1 1 1 2 1 1 1 1 1 10. 2207 2 1 1 1 0 1 1 1 1 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0 11. 5065 2 1 1 2 1 1 2 1 1 2 1 1 1 1 1 1 0 1 1 1 1 1 1 1 12. 5080 1 0 0 1 0 0 2 0 0 2 1 0 1 0 0 1 0 0 1 0 0 2 1 1 13. 6004 2 1 0 2 1 1 2 1 0 2 1 1 1 0 0 2 1 0 1 0 0 2 1 1 14. 5090 2 1 2 2 2 2 2 1 2 2 1 1 1 1 1 1 0 1 2 1 1 2 1 1 15. 6017 2 1 1 2 1 1 2 1 1 2 1 1 0 0 0 1 1 1 1 1 1 2 1 1

BT – Before treatment; AV – After Vamana; AF-After follow-up.

Table No.40, Showing the data of Subjective parameters of Group B. Tevra vega

Swasa Kasa Dukhena

Kapha Nissaranam

Ghurghuratwam Urah Peeda Shayanasya Swasa Peedita

Frequency of Attack

Duration of Attack

Sl. No.

OPD NO.

BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF BT AV AF 01. 5058 2 1 1 2 1 1 2 1 1 2 1 1 2 1 1 1 0 0 2 1 1 2 1 1 02. 0307 2 1 1 2 1 1 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 03. 4306 2 0 0 1 0 0 2 1 0 2 1 1 1 1 0 1 0 0 2 1 0 2 1 0 04. 3208 1 1 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 1 05. 2857 2 1 1 2 1 1 2 1 1 2 1 2 1 1 1 1 1 1 2 1 1 1 1 1 06. 3209 2 1 0 2 1 1 2 1 1 2 1 1 1 0 0 1 0 0 2 0 1 2 1 1 07. 2820 2 1 1 2 1 1 2 1 0 2 0 1 1 1 1 2 1 1 2 1 1 2 1 1 08. 2581 2 1 0 2 0 1 3 2 1 2 1 1 2 1 1 2 1 1 2 1 1 3 2 1 09. 2338 2 1 0 2 1 0 1 0 0 2 1 1 1 0 0 1 0 0 2 1 0 1 0 0 10. 3803 2 1 1 2 2 2 2 1 1 2 1 1 2 1 1 1 1 1 2 1 1 2 1 2 11. 4241 2 1 1 2 1 1 2 1 0 2 1 1 2 0 1 2 1 0 2 1 1 2 0 1 12. 6032 2 1 1 2 1 0 2 1 0 2 1 1 1 0 0 1 1 0 1 0 0 2 1 1 13. 5056 1 0 0 1 1 1 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 2 1 1 14. 5054 2 1 1 2 1 1 2 1 1 2 1 1 1 0 1 1 1 1 2 0 1 1 0 1 15. 0285 3 2 1 2 1 1 1 1 1 1 0 0 1 1 1 2 0 1 2 0 1 2 0 1

111BT – Before treatment; AV – After Virechana; AF-After follow-up.

Table No.41, Showing the data of Objective Parameters of Group-A. Table No.42, Showing the data of Objective Parameters of Group-B.

PEFR AEC Sl. No. OPD NO. BT AV AF BT AV AF

01. 2461 150 200 270 500 400 400 02. 2653 120 180 250 450 400 350

03. 2702 070 120 160 650 500 400

04. 2580 210 280 370 450 400 300 05. 2855 180 200 260 500 500 400

06. 3596 150 190 240 500 400 450 07. 3607 160 210 290 450 300 300 08. 2637 160 200 300 550 450 400

09. 4387 180 200 280 550 450 450 10. 2207 200 260 320 550 450 400

11. 5065 090 170 240 650 550 600 12. 5080 140 190 240 500 500 400

13. 6004 190 260 350 550 550 450

14. 5090 120 180 230 600 500 500 15. 6017 100 130 170 600 550 550

PEFR AEC Sl. No. OPD NO. BT AV AF BT AV AF

01. 5058 180 220 290 550 500 400 02. 0307 160 230 310 550 500 450

03. 4306 170 220 250 600 650 500

04. 3208 180 200 260 450 450 400 05. 2857 220 300 350 450 400 350

06. 3209 70 120 150 650 650 600 07. 2820 180 240 310 500 450 400 08. 2581 140 220 280 550 500 450

09. 2338 280 350 400 450 450 400 10. 3803 190 220 280 550 500 450

11. 4241 130 210 330 650 500 400 12. 6032 200 260 310 500 500 400

13. 5056 160 210 270 550 500 500

14. 5054 150 200 270 500 500 400 15. 0285 240 300 360 450 400 350

BT – Before treatment; AV – After Vamana;AF-After follow-up. BT – Before treatment; AV – After Virechana;AF-After follow-up.

PEFR- Peak Expiratory Flow Rate; AEC- Absolute Eosinophil Count.

112

Observations and Results.


Table No.43, Showing the Age-group incidence. Age-group Group-A % Group-B % Total % 20- 30 6 40 6 40 12 40 31- 40 6 40 5 33.33 11 36.66 41- 50 2 13.63 3 20 5 16.66 51- 60 1 06.66 1 06.66 2 06.66

The age group 20-30 contains, 12 patients (40%) i.e. 6 patients (40%) in

group-A and 6 patients (40%) in group-B.

The age group 31-40 contains, 11 patients (36.66%) i.e. 6 patients (40%) in

group-A and 5 patients (33.33%) in group-B.

The age group 41-50 contains, 5 patients (16.66%) i.e. 2 patients (13.63%) in

group-A and 3 patients (20%) in group-B.

The age group 51-60 contains, 2 patients (06.66%) i.e. 1 patient (6.66%) in

group-A and 1 patient (06.66%) in group-B.

Out of 30 patients, maximum number of patients i.e. 12 (40%) were between the Age-

Group of 20-30yrs.

Graph No. 1.

0

2

4

6

8

10

12

Group-A Group-B Total

Age group incidence

20-30

31-40

41-50

51-60



Table No.44, Showing the incidence of Sex.

Group-A % Group-B % Total % Male 13 86.66 12 80.00 25 83.33 Female 2 13.33 3 20.00 5 16.66

In Group-A, 13 patients (86.66%) are male, 2 (13.33%) are female.

In Group-B, 12 patients (80%) are male, 3 patients (20) are female.

Totally, 25 were male and 5 were female patients.

Graph No.2.

13

2

12

3

25

5

0

5

10

15

20

25


Incidence of Sex

Male

Female

Table No.45, Showing the incidence of Religion.

Group-A % Group-B % Total % Hindu 13 86.66 10 66.66 23 76.66 Muslim 2 13.33 5 33.33 7 23.33

In Group-A, 13 patients (86.66%) are belongs to Hindu community, 2 patients

(13.33%) are belongs to Muslim community.

In Group-B, 10patients (66.66%) are belongs to Hindu community, 5 patients

(33.33%) are belongs to Muslim community.

Totally out of 30patients, 23 were Hindus and 7 were Muslims.



Graph No.3.

13

2

10

5

23

7

0

5

10

15

20

25


Incidence of Religion

Hindus

Muslims

Table No.46, Showing the incidence of Occupation.

Group-A % Group-B % Total % Sedentary 3 20 3 20 6 20 Active 7 46.66 8 53.33 15 50 Labour 5 33.33 4 26.66 9 30

In Group-A, 3 patients (20%) were sedentary, 7 patients (46.66%) were active

and 5 patients (33.33%) were belongs to labour.

In Group-B, 3 patients (20%) were sedentary, 8 patients (53.33%) were active

and 4 patients (26.66%) were labours.

Totally, 6 were sedentary, 15 were Active and 9 were belongs to Labour.

Graph No. 4.

3

75

3

8

46

15

9

0

5

10

15


Incidence of Occupation

Sedentary

Active

Labour



Table No.47, Showing the incidence of Economical status.

Group-A % Group-B % Total % High-class 1 6.66 3 20 4 13.33 Upper middle 5 33.33 2 13.33 7 23.33 Middle 2 13.33 7 46.66 9 30 Poor 7 46.66 3 20 10 33.33

In Group-A, 1 patient (6.66%) was belongs to high-class, 5 patients (33.33%)

were belongs to upper-middle class, 2 patients (13.33%) were belongs to middle class

and 7 patients (46.66%) were poor class.

In Group-B, 3 patients (20%) were belongs to high-class, 2 patients (13.33%)

were belongs to upper-middle class, 7 patients (46.66%) were belongs to middle class

and 3 patients (20%) were belongs to poor class.

So totally, 4 were High-class, 7 were Upper middle, 9 were belongs to Middle

and 10 were Poor patients.

Graph No. 5.

0

2

4

6

8

10


Incidence of Economical status

High- class

Upper-middle

Middle

Poor

Table No.48, Showing the incidence of Food habits.

Group-A % Group-B % Total % Veg 8 53.33 9 60 17 56.66 Mixed 7 46.66 6 40 13 43.33

In Group-A, 8 patients (53.33%) were of Vegetarian and 7 patients (46.66%)

were of Mixed diet.



In Group-B, 9 patients (60%) were of Vegetarian and 6 patients (40%) were of

Mixed diet.

Totally, 17 patients were Vegetarians and 13 were of Mixed type.

Graph No.6.

0

5

10

15

20


Incidence of Food habits

Veg

Mixed

Table No.49, Showing the incidence of Family History.

Group-A % Group-B % Total % Present 2 13.33 4 26.66 6 20 Absent 13 86.66 11 73.33 24 80

In Group-A, 2 patients (13.33%) were having the family history and 13

patients (86.66%) was not having the family history.

In Group-B, 4 patients (26.66%) were having the family history and 11

patients (73.33%) was not having the family history.

Out of 30 patients, 6 are having Family-history.

Graph No.7.

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10152025


Family History

Present

Absent



Table No.50, Showing the incidence of Koshta.

Group-A % Group-B % Total % Mrudu 4 26.66 2 13.33 6 20 Madhyama 8 53.33 10 66.66 18 60 Kroora 3 20 3 20 6 20

In Group-A, 4 patients (26.66%) were of Mrudukoshta, 8 patients (53.33%)

were of madhyamakoshta and 3 patients (20%) were belongs to Kroorakoshta.

In Group-B, 2 patients (13.33%) were of Mrudukoshta, 10 patients (66.66%)

were of Madhyamakoshta and 3 patients (20%) were belongs to Kroorakoshta.

Totally, 6 patients were Mrudukostha, maximum are belongs to madhyama

kostha i.e. 18 and 6 were belongs to Kroora kostha.

Graph No.8 .

0

5

10

15

20


Incidence of Koshta

Mrudu

Madhyama

Kroora

Table No.51, Showing the incidence of Agni.

Group-A % Group-B % Total % Sama 7 46.66 6 40 13 43.33 Vishama 2 13.33 3 20 5 16.66 Mandagni 6 40 6 40 12 40

In Group-A, 7 patients (46.66%) were of Samagni, 2 patients (13.33%) were

of Vishamagni and rest 6 patients (40%) were having Mandagni.

In Group-B, 6 patients (40%) were of Samagni, 3 patients (20%) were of

Vishamagni and 6 patients (40%) were having Mandagni.

Out of 30 patients, maximum number i.e.13 (43.33%) were of Samagni and 12

were having Mandagni.



Graph No.9.

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101214


Incidence of Agni

Samagni

Vishamagni

Mandagni

Table No.52, Showing the incidence of Nidra.

Group-A % Group-B % Total % Sound 6 40 5 33.33 11 36.66 Disturbed 9 60 10 66.66 19 63.33

In Group-A, 6 patients (40%) were having sound sleep and 9 patients (60%)

were having disturbed sleep.

In Group-B, 5 patients (33.33%) were having sound sleep and 10 patients

(66.66%) were having disturbed sleep.

Out of 30, maximum were having, disturbed sleep. i.e. 19 patients and 11

patients were having sound sleep,

Graph No. 10.

0

5

10

15

20


Incidence of Nidra

Sound

Disturbed



Table No.53, Showing the incidence of Habits.

Group-A % Group-B % Total % Smoking 8 53.33 10 66.66 18 60 Drinking 2 13.33 4 26.66 6 20 Tobacco 4 26.66 1 06.66 5 16.66 No habit 1 06.66 0 00 1 03.33

In Group-A, 8 patients (53.33%) were having the history of smoking, 2

patients (13.33%) were having the history of drinking, 4 patients (26.66%) were

having the history of tobacco chewing and 1 patient (6.66%) was of no habits.

In Group-B, 10 patients (66.66%) were having the history of smoking, 4

patients (26.66%) were having the history of drinking, 1 patient (6.66%) was having

the history of tobacco chewing,

Out of 30, maximum were having the history of smoking, i.e. 18 patients, 6

patients were having the history of drinking, 5 patients were having the history of

tobacco chewing and 1 patient was having the history of no habits.

Graph No.11

0

5

10

15

20


Incidence of Habits

Smoking

Alcoholic

Tubacco

No habits



Table No.54, Showing the incidence of Prakruti.

Group-A % Group-B % Total % V – P 2 13.33 3 20 5 16.66 P – K 6 40 4 26.66 10 33.33 V - K 7 46.66 8 53.33 15 50

In Group-A, 2 patients (13.33%) were having Vata-Pittaja Prakruti, 6 patients

(40%) were having Pitta-Kaphaja Prakruti and 7 patients (46.66%) were having Vata-

Kaphaja Prakruti.

In Group-B, 3 patients (20%) were having Vata-Pittaja Prakruti, 4 patients

(26.66%) were having Pitta-Kaphaja Prakruti and 8 patients (53.33%) were having

Vata-Kaphaja Prakruti.

Out of 30, 5 were having Vata-Pittaja Prakruti, 10 were having Pitta-Kaphaja

Prakruti and 15 were having Vata-Kaphaja Prakruti.

Graph No.12.

0

5

10

15


Incidence of Prakruti

V-P

P-K

V-k

Table No.55, Showing the Influence of Ahara

Influence of Ahara Group-A % Group-B % Total % Present 12 80 12 80 24 80 Absent 3 20 3 20 6 20 In Group-A, 12 (80%) patients Influence of Ahara were Present in

precipitating an attack and in 3 (20%) patients Ahara played no role in precipitating in

the symptoms.



In Group-B, 12 (80%) patients Influence of Ahara were Present in

precipitating an attack and in 3 (20%) patients Ahara played no role in precipitating in

the symptoms.

Out of 30, 24 patients Influence of Ahara were Present in precipitating an

attack and 6 patients Ahara played no role in precipitating in the symptoms.

Graph No. 13.

0

5

10

15

20

25


Influence of Ahara

Present

Absent

Table No.56, Showing the Course of onset.

Group-A % Group-B % Total % Episodic 10 66.66 11 73.33 21 70 Continuous 3 20 2 13.33 5 16.66Initially episodic 2 13.33 2 13.33 4 13.33 In Group-A, 10 (66.66%) patients were episodic, 3 (20%) patients were

continuous and 2 (13.33%) patients were initially episodic in the distribution of

patients.

In Group-B, 11 (73.33%) patients were episodic, 2 (13.33%) patients were

continuous and 2 (13.33%) patients were initially episodic in the distribution of

patients.

Out of 30, 21 patients were episodic, 5 patients were continuous and 4 patients

were initially episodic in the distribution of patients



Graph No.14.

0

5

10

15

20

25


Course of onset

Episodic

Continuous

Initiallyepisodic

Table No.57, Showing the Duration of Deepana-Pachana. Group-A % Group-B % Total % 2 Days 4 26.66 7 46.66 11 36.66 3 Days 11 73.33 8 53.33 19 63.33

4 (26.66%) patients were took Deepana-pachana for 2 days, 11(73.33) patients

were took Deepana-pachana for 3 days, in the Group A.

7 (46.66%) patients were took Deepana-pachana for 2 days, 8(53.33) patients

were took Deepana-pachana for 3 days, in the Group B.

Thus, 11 patients were took Deepana-pachana for 2 days and 19 patients were

took Deepana-pachana for 3 days.

Graph No. 15.

0

5

10

15

20


Duration of Deepana-Pachana

2 Days

3 Days



Table No.58, Showing the Duration of Snehapana. Group-A % Group-B % Total % 3 Days 6 40 6 40 12 40 4 Days 4 26.66 4 26.66 8 26.66 5 Days 4 26.66 4 26.66 8 26.66 6 Days 1 6.66 0 0 1 3.33 7 Days 0 0 1 66.66 1 3.33

6 (40%) patients were took Snehapana for 3 days, 4(26.66) patients were took

Snehapana for 4 days, 4 (26.66%) patients were took Snehapana for 5 days, 1 (6.66%)

patient was took Snehapana for 6 days, in the Group A.

6 (40%) patients were took Snehapana for 3 days, 4(26.66) patients were took

Snehapana for 4 days, 4 (26.66%) patients were took Snehapana for 5 days, 1 (6.66%)

patient was took Snehapana for 7 days, in the Group B.

Thus, 12 patients were took Snehapana for 3 days, 8 patients were took

Snehapana for 4 days, 8 patients were took Snehapana for 5 days, 1 patient was took

Snehapana for 6 days, 1 patient was took Snehapana for 7 days.

Graph No. 16.

0

24

68

1012


Duration of Snehapana

3 Days4 Days5 Days6 Days7 Days



Table No.59, Showing the Samyak snigda lakshanas.

Group-A % Group-B % Total % Vatanulomana 13 86.66 14 93.33 27 90 Agni deepti 15 100 15 100 30 100 Purisha snigdata 13 86.66 12 80 25 83.33 Asamhata varchas

11 73.33 10 66.66 21 70

Twak snigdata 12 80 11 73.33 23 76.66 Anga laghava 11 73.33 10 66.66 21 70 Gatra mardavata 10 66.66 12 80 22 73.33. Snehodwega 09 60 11 73.33 20 66.66 Klama 8 53.33 10 66.66 18 60 Shaithilyata 7 46.66 8 53.33 15 50

Vatanulomana was seen in 13 (86.66%) patients of Group-A and 14 (93.33%)

patients, in Group-B.

Agni deepti was seen, in all 15 (100%) patients, of Group-A and Group-B.

In Group-A, Purisha snigdata was found in 13 (86.66%) patients and 12

(7380%) patients in Group-B.

Asamhata varchas was found in 11 (73.33%) patients of Group-A and 10

(66.66%) patients, in Group-B.

Twak snigdata was found in 12 (80%) patients of Group-A and 11 (73.33%)


Anga laghava was found in 11 (73.33%) patients, of Group-A and 10

(66.66%) patients, in Group-B.

Gatra mardavata was found in 10(66.66%) patients, of In Group-A and 12

(80%) patients, in Group-B.

Snehodwega was found in 9 (60%) patients of Group-A and 11 (73.33%)


Klama was found in 8 (53.33%) patients, of Group-A and 10 (66.66%)




Shaithilyata was found in 7 (46.66%) patients, of Group-A and 8 (53.33%)


Graph No.17.

05

1015202530


Samyak snigda lakshanas

Vatanulomana Agnideepti Purisha snigdataAsamhata varchas Twak snigdata Anga laghavaGatra mardavata Snehodwega KlamaShaithilyata

Table No.60, Showing the incidence and response of Samyak Vamana lakshanas.

Lakshanas Patients % W.R M.R P.R N.R Kale pravrutti 15 100 3 6 5 1 Kramat KPV pravrutti 15 100 3 6 5 1 Swayam avasthana 15 100 3 6 5 1 Sroto shuddi 11 73.33 3 3 5 0 Indriya shuddi 11 73.33 3 5 3 0 Laghuta 14 93.33 3 5 5 1 Dourbalya 8 53.33 1 4 3 0

The symptom Kale pravrutti was found in 15 (100%) patients, 3 got good

response, 6 got moderate response, 5 got poor response and 1 got no response.

In 15 (100%) patients have Kramat KPV pravrutti, in that 3 got good response,

6 got moderate response, 5 got poor response and 1 got no response .

The symptom Swayam avasthana was found in 15 (100%) patients, 3 got good

response, 6 got moderate response, 5 got poor response and 1 got no response .



The symptom Sroto shuddi was found in 11 (73.33%) patients, 3 got good

response, 3 got moderate response, 5 got poor response.

The symptom Indriya shuddi was found in 11 (73.33%) patients, 3 got good


The symptom laghuta was found in 14 (93.33%) patients, 3 got good response,

5 got moderate response, 5 got poor response and 1 got no response .

The symptom Dourbyalya was found in 8 (53.33%) patients, 1 got good


Graph No.18.

0

5

10

15

Patients W.R M.R P.R N.R

Samyak Vamana lakshanas

Kale pravrutti Kramat KPV pravruttiSwayam avasthana SrotashuddiIndriyashuddi Laghuta

Table No.61, Showing the incidence and response Samyak Virechana lakshanas.

Lakshanas Patients % W.R M.R P.R Sroto shuddi 9 60 1 5 3 Indriya prasannata 12 80 1 7 4 Shareera laghuta 14 93.33 2 8 4 Agni deepti 15 100 2 9 4 Anamayatwa 10 66.66 2 6 2 Vatanulomana 13 86.66 2 8 3 Vit P K V pravrutti 15 100 2 9 4



The symptom Sroto shuddi was found in 9 (60%) patients, among these 1

patients was got good response, 5 were moderate response and 3 were poor response.

The symptom Indriya prasannata was found in 12 (80%) patients, among these

1 patient was got good response, 7 were moderate response and 4 were poor response.

The symptom Shareera laghuta was found in 14 (93.33%) patients, among

these 2 patients were got good response, 8 were moderate response and 4 were poor

response.

The symptom Agnideepti was found in all 15 (100%) patients, among these 2

patients were got good response, 9 were moderate response and 4 were poor response.

The symptom Anamayatwa was found in 10 (66.66%) patients, among these 2

patients were got good response, 6 were moderate response and 2 were poor response.

The symptom Vatanulomana was found in 13 (86.66%) patients, among these

2 patients were got good response, 8 were moderate response and 3 were poor

response.

The symptom kramat vit, pitta, kapha, vata pravrutti was found in all 15

(100%) patients, among these 2 patients were got good response, 9 were moderate

response and 4 were poor response.

Graph No.19.

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10121416

Patients W.R M.R P.R

Samyaka Virechana lakshanas

Srotoshuddi Indiya prasannata Shareera laghutaAgnideepti Anamayatwa VatanulomanaVit PKV pravrutti



Table No.62, Showing the Vegiki lakshanas of Vamana

Vegas Patients % W.R M.R P.R N.R 6 4 26.66 0 2 1 1 7 3 20 0 1 2 0 8 8 53.33 3 3 2 0

In Group-A, 4 patients (26.66%) had 6 Vegas among these, 2 patients got

moderate response and 1 patient was poor response and 1 patient was no response .

3 patients (20%) had 7 Vegas among these, 1 patient got moderate response

and 2 patients were poor response.

8 patients (53.33%) had 8 Vegas among these, 3 patients got well response, 3

patients were moderate response and 2 patients were poor response.

Graph No. 20.

0

2

4

6

8


Incidence and Response of Vamana Vegas

6 Vegas

7 Vegas

8 Vegas

Table No.63, Showing the Vegiki lakshanas in Virechana karma.

Vegas Patients % W.R M.R P.R N.R

12-15 5 33 1 3 1 0

9-11 6 40 1 5 0 0

6-8 4 26.66 0 1 3 0

In Group-B, 4 patients (26.66%) had 6 to 8 Vegas among these, 1 patient was

moderate response and 3 patients were poor response .

6 patients (40%) had 9 to 11 Vegas among these, 1 patient got well response,

and 5 patients were moderate response.

5 patients (33.33%) had 12 to 15 Vegas among these, 1 patient got well

response, 3 patients were maderete response and 1 patient was poor response.



Graph No. 21.

0

1

2

3

4

5

6


Incidence and Response of Virechana Vegas

12-15 Vegas

11-9 Vegas

8-6 Vegas

Table No.64, Showing the Maniki lakshanas of Vamana karma.

Patients % W.R M.R P.R N.R Upto 6ltrs 3 20 0 2 0 1 6-8 ltrs 4 26.66 0 3 1 0 Above 8 ltrs 8 53.33 3 2 3 0

In Group-A, 3 patients (20%) had maniki upto 6 ltrs, among these, 2 patients

got moderate response and 1 patient was no response,

4 patients (26.66%) had maniki upto 6-8 ltrs, among these, 3 patients got

moderate response and 1 patient was poor response,

8 patients (53.33%) had maniki above 8 ltrs, among these, 3 patients got well

response, 2 patients were moderate response and 3 patients were poor response.

Graph No. 22.

0

2

4

6

8


Incidence and Response of the Manaki of Vamana

Upto 6 ltrs

6-8 ltrs

Above 8 ltrs



Table No.65, Showing the Maniki lakshanas in Virechana karma.

Patients % W.R M.R P.R N.R Upto1000ml 3 20 0 2 1 0 1000-1500ml 6 40 1 4 1 0 1500-2000ml 4 26.66 0 2 2 0 Above 2000ml 2 13.33 1 1 0 0

In Group-B, 3 (20%) patients had maniki upto 1000ml, among these, 2

patients got moderate response and 1 patient was poor response,

6 (40%) patients had maniki 1000-1500 ml, among these, 1 patient got well

response, 4 patients were got moderate response, 1 patient was got poor response,

4 (26.66%) patients had maniki above 1500-2000 ml, among these, 2 patients

were got moderate response, 2 patients were got poor response.

2 (13.33%) patients had maniki above 2000ml, among these, 1 patient got

well response,1 patient was got moderate response.

Graph No. 23.

0123456


Incidence and Response of the Manaki of Virechana

Upto 1000ml 1000-1500ml 1500-2000ml Above 2000ml

Table No.66, Showing the Antiki lakshanas of Vamana karm.

Patients % W.R M.R P.R N.R Pittanta 12 80 3 5 4 0 Kaphanta 3 20 0 1 1 1



In Group-A,12 (80%) patients had Pittanta Vamana, in that 3 patients were got

wellresponse, 5 patients were moderate response, 4 patients were poor response,

3 (20%) patients had Kaphanta Vamana, in that 1 patient was got moderate

response, 1 patient was got poor response and 1 patient was got no response.

Graph No. 24.

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1012


Incidence and Response of the Antiki of Vamana

Pittanta

Kaphanta

Table No.67, Showing the Antiki lakshanas in Virechana karma.

Patients % W.R M.R P.R N.R Kaphanta 13 86.66 2 8 3 0

Na kaphanta

2 13.33 0 1 1 0

In Group-B, 13(86.66%) patients had Kaphanta Virechana, in that 2 patients

were got well response, 8 patients were moderate response and 3 patients were poor

response , only 2 patients (13.33%) had Na kaphanta Virechana in that 1 patient was

moderate response and 1 patient was poor response.

Graph No. 25.

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101214

Patients W.R M.R N.R

Incidence and Response of the Antiki of Virechana

Kaphanta

Na Kaphanta



Table No.68, Showing the Results of Vamana karma Group.

In Group-A, Among 15 (100%) patients, 3 (20%) patients got well response, 6

(40%) patients were moderate response, 5 (33.33%) patients were poor response, 1

(6.66%) patient was no response.

Table No.69, Results of Virechana karma Group.

Well Response 2 13.33 Moderate Response 9 60 Poor Response 4 26.66 Not response 0 0.00

In Group-B, Among 15 (100%) patients, 2 (13.33%) patients got well

response, 9 (60%) patients were moderate response, 4 (26.66%) patients were poor

response and no patient was found in not response.

Graph No. 26.

0

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10

Vamana Virechana

Results of Vamana & Virechana

W.RM.RP.RN.R

Well Response 3 20 Moderate Response 6 40 Poor Response 5 33.33 Not response 1 6.66



OVER ALL ASSESSMENT

Table No.70, Showing the Over all Assessment.

Sl.No. Assessment No. of patients %

01 Well response 5 16.66

02 Moderate response 15 50.00

03 Poor response 9 30

04 No response 1 3.33

Out of 30 patients 5 (16.66%) patients got well response, 15 (50%) patients

were moderate response, 9 (30%) patients were poor response and one patient was no

response.

Graph No. 27.

Over all Results

M.R 50%

W.R 17%

N.R 3%

P.R30%

W R

M R

P R

N R



Statistical results:

Table No.71, Showing the Statistical results of Group-A (Vamana):

Statistical conclusion:

The statistical analysis is done by using paired t- test, by assuming that the

drug is not responsible for the changes into the reading of before and after the

treatment. Among the subjective parameters, all parameters shows highly significant

(as p<0.001). But except Shayanasya Swasa Peedita,Urah peeda and Kasa parameters

all other parameters shows more highly significant. And among objective parameters

both PEFR and AEC shows highly significant (by comparing t- values).

S.N. Subjective Parameter Mean S.D S.E t-value p-value Remarks1 Teevra vega Swasa 1.133 0.516 0.133 8.518 <0.001 H.S 2 Kasa 0.8 0.676 0.174 4.59 <0.01 H.S 3 Dhukhena Kapha

nissaranam 0.933 0.593 0.153 6.098 <0.001 H.S

4 Ghurghuratwam 1.066 0.258 0.066 16.15 <0.001 H.S 5 Uraha peeda 0.4 0.507 0.1309 3.055 <0.01 H.S 6 Shayanasya Swasa

Peedita 0.66 0.723 0.186 3.58 <0.01 H.S

7 Frequency of Attack 0.8 0.414 0.106 7.547 <0.001 H.S 8 Duratoin of Attack 0.733 0.457 6.211 <0.001 H.S Objective parameter 9 Peak Expiratory

florate 119.33 28.65 7.39 16.147 <0.001 H.S

10 Absolute Eosinophilic count.

113.33 51.639 13.33 8.502 <0.001 H.S



Table No.72, Showing the Statistical results of Virechana (Group-B):

S.N. Subjective Parameter Mean S.D S.E t-value p-value Remarks1 Teevra vega Swasa 1.333 0.487 0.125 10.664 <0.001 H.S 2 Kasa 1.00 0.534 0.138 7.24 <0.001 H.S 3 Dhukhena Kapha

nissaranam 1.266 0.593 0.153 8.274 <0.001 -

4 Ghurghuratwam 0.933 0.258 0.066 14.013 <0.001 H.S 5 Uraha peeda 0.533 0.516 0.133 4.00 <0.01 H.S 6 Shayanasya Swasa

Peedita 0.8 0.5606 0.144 5.55 <0.001 H.S

7 Frequency of Attack 1.00 0.534 0.138 7.246 <0.001 H.S 8 Duratoin of Attack 0.8 0.676 0.174 4.597 <0.01 H.S Objective parameter 9 Peak Expiratory

florate 118.00 31.44 8.118 14.535 <0.001 H.S

10 Absolute Eosinophilic count.

100 50.00 12.909 7.746 <0.001 H.S

Statistical conclusion:

Among the subjective parameters, all parameters shows highly significant, but

except the parameter Urah peede and duration of attack all other parameter shows

more significant. And among the objective parameters both the parameters PEFR and

AEC shows more significant (by comparing t- values).



Table No.73, Showing the comparative effect of Group-A & Group-B

S. N.

Subjective Parameter

Gr. Mean S.D S.E PSE t-value

p-value

Remarks

A

0.733 0.593 0.153 1 Teevra vega Swasa B 0.6 0.507 0.1309

0.201 0.661 >0.05 N.S

A 0.8 0.676 0.174 2 Kasa B 0.8 0.5606 0.144

0.225 - -

A 0.666 0.617 0.159 3 Dhukhena Kapha nissaranam

B 0.533 0.516 0.133 0.207 0.642 >0.05 NS

A 0.666 0.4879 0.125 4 Ghurguratwm B 0.866 0.516 0.1333

0.182 2.49 <0.02 HS

A 0.333 0.487 0.125 5 Uraha peeda B 0.6 0.507 0.1309

0.1809 1.475 >0.05 NS

A 0.533 0.516 0.133 6 Shayanasya Swasa Peedita B 0.466 0.516 0.133

0.188 0.353 >0.05 NS

A 0.4666 0.516 0.133 7 Frequency of Attack B 0.733 0.457 0.118

0.177 1.505 >0.05 N.S

A 0.866 0.351 0.0908 8 Frequency of Attack B 0.933 0.457 0.118

0.1488 0.4502 >0.05 NS

Objective parameter A 264.66 57.8 14.924 9 Peak

Expiratory florate

B 294.66 57.42 14.828 21.037 1.426 >0.05 N.S

A 423.33 82.08 21.194 10 Absolute Eosinophilic count.

B 430 64.917 16.761 27.021 0.246 >0.05 N.S

Comparative conclusion:

To compare the mean effect of the after the treatment effect in both groups,

the statistical analysis is done by using ‘un-paired t’- test, by assuming that; the mean

treatment effect in both groups after the treatment is same. From the analysis, among

the Subjective parameters except the parameter Ghurgurathwam all other parameters

shows not significant (as p>0.05).Among the Subjective parameters, Kasa, the mean

treatment effect is same in both the groups.(by comparing mean).

Over all the Group-B shows more highly significant in both subjective and

objective parameters.

Discussion


DISCUSSION Discussion improves the knowledge and discussion with science becomes base

establishment of the concept. Thus discussion is the most essential phase of any research

work. Keeping this in view, the facts which have emerged from the study can be studied

in five ways. They are –

Discussion on Tamaka Swasa.

Discussion on clinical study.

Discussion on Shodhana karma in the management of Tamaka Swasa.

Discussion on probable mode of actions of the Drugs used.

Discussion on probable mode of actions of the Vamana and Virechana karma.

Discussion on Tamaka Swasa:

Tamaka Swasa is a chronic disease of Pranavaha Srotas and it is characterized by

Tevra vega Swasa, ghurghurakatwa, kasa, shayanasya Swasa peedita, uraha peeda,

peenasa, etc with patient feels as if entering dark ness during the paroxysm which is due

to association of Vata with Kapha obstructing the passage of Pranavata leads to a

excitement of Vata to produce up ward movement or abnormal expiratory dyspnoea

which vary in severity and frequency from person to person is in an individual they may

occur from hour to hour and day to day. The entity of disease is well known to Ayurvedic

world since the time immemorial. The well established detail description of aetio-

pathogenesis and treatment is found in Ayurvedic literature.

The contemporary medical science also has a vast description of bronchial asthma

parallel to Tamaka Swasa earlier concept about bronchial asthma that is broncho spastic

Discussion


disease have changed in recent years where as it is proved that it is an inflammatory

disease.

The national asthma education program panel states that asthma is a complex

syndrome of reversible airway obstruction, airway inflammation and bronchial hyper

irritability that occurs following exposure to stimuli such as allergens viral respiratory

infections, vigorous exercise, cold air, cigarette smoke, and air pollutants.

The recent survey of the WHO reveals that 155 million people world wide are

suffering with asthma and has increased significantly i.e., 50% every decade. India has an

estimated 15-20 million asthmatics. The concept of Tamaka Swasa and concept of

bronchial asthma seems to quite similar to the description given by contemporary medical

world. The aetio-pathogenesis, aetiological factors symptoms, prognosis has been

explained vividly and these are all equivalent to the description of asthma given in

contemporary medical science.

The principles of treatment that are adopted in Tamaka Swasa include Shodhana,

Shamana, Brumhana and Rasayana chikitsa. Observing the treatment modality explained

by Acharyas for Tamaka Swasa we can interpret them as measures during the vegavstha

and during Avegavstha. By considering the atyayika avastha of disease one can plan the

treatment. Liquefaction of the Sleshma, expectoration of the sputum and Srotomardava

chikitsa forms the key treatment during the attack of the illness. This is achieved by

Abhyanga and Nadisweda to the chest and back, Kapha utkleshana Ahara, and then

Vamana which then followed by Dhumapana and Shamana treatment.

Samshodhana measures comprehend their own vital role in the management of

Tamaka Swasa amplifying the role of Doshapratyanika Chikitsa. Vamana is the popular

Discussion


therapies adopted when Kapha laxanas are dominant, keeping in mind the roga and the

rogibala. Vamana karma is very helpful to bring down the picchilatwa and to relieve

Kapha which is occluding the Pranavaha srotas. In between the attacks the treatment is

planned to prevent the further attacks, to eliminate the Kha-vaigunyata, and to improve

the immunity of the Pranavaha srotas. This is achieved by Virechana karma, Brmhana

chikitsa and Rasayana chikitsa.

Keeping the above fact in view it was decided to go through detaile available in

Ayurvedic literature. Both Vamama and Virechana karmas are told for the management

of Tamaka Swasa. So to assess the efficacy of both Shodhana procedure, the Vamana and

Virechana kramas are selected for the clinical study in two Groups. In Group A, Vamana

karma and Group B, Virechana karmas are adopted. Here an attempt is made to compare

the efficacy of Vamana and Virechana karma in the management of Tamaka Swasa.

So such an effort is likely to give some useful information for the better management of

Tamaka Swasa,

Discussion on clinical study:

The patients of Tamaka Swasa reported to OPD & IPD Post graduate Dept. of

Panchakarma, of Shri D.G.M. Ayurvedic Medical College, were selected by pre-set

inclusion and exclusion criteria. Special medical camps were also conducted in the

college for selecting the patient. Totally 36 patients were registered, among them 3

patients were not fit for Shodhana therapies, 2 patients were discontinued during

Snehaana and Swedana, one patient not came for follow-up and finally the data of 30

patients, who had satisfied the diagnostic criteria, underwent the treatment and reported

for the follow-up are discussed here.

Discussion


These observational findings and Results are discussed as below.

In relation to Age:

Age taken from 20 years to 60years and 10 years interval period was given in

each group for study purpose. Maximum number of patients were observed in 31-40 age

group.

In relation to Sex:

In the present study out of 30 patients, 25 patients (83.33%) were male and 5

patients (16.66%) are found female.

In relation to Religion:

In the present study majority of the patients were Hindus (76.66%), but it doesn’t

mean that Hindus are more prone to this disease. This may be due to the method of

sampling. The patients were selected incidentally.

In relation to Occupation:

It was observed that out of 30 patients 15 patients (50%) were leading active life

style. 9 patients (30%) were labour and rest 6 patients (20%) are sedentary. Active

occupation suggests that people who are exposure to the external atmosphere with

pollution are getting the disease Tamaka Swasa.

In relation to Socio-economical status: A socio economic condition plays an important role. Some times it could be one

of the reasons. Here Tamaka Swasa is a condition corresponded to the high frequency of

affect and prevalence, is based upon the food habits and living style referred to the socio

economic conditions. Drugs may not be sufficient to fulfill the needs of diseased and

need better food and life style also for the benefit of patients. Out of 30 patients, 10

Discussion


patients (33.33%) were belongs to the poor class. 9 patients (30%) were belongs to the

middle class. 7 patients (23.33%) were belongs to the upper middle class. 4 patients

(13.33%) were belongs to the high class.

In relation to Food Habits:

Out of 30 patients 17 patients (56.66%) were vegetarians 13 (43.33%) were

consuming mixed diet. The percentage of the distributaries does not show any diet

differentiation to get this disease, because verity of vegetables are allergens and some

foods like fish, milk, eggs, yeasts, wheat, etc., are also responsible for the disease, this

may be the reason, dietary regimens were more impact over the disease.

In relation to Family history:

In the present study 6 patients had family history and rest of the 24 the patients

had no family history of Tamaka Swasa.

In relation to Sharirika Prakruti:

Even though Tamaka Swasa is a Vata-Kaphaja vyadhi, but the main dosha is

Vata. In the present study 15 patients (50%) were with Vata - Kapha prakriti, 10 patients

(33.33) were with Pitta - Kapha Prakriti and 5 patients (16.66) were with Vata-Pitta

Prakriti. From this we can understand the involvement of Vata as a main dosha in the

manifestation of Tamaka Swasa.

In relation to Koshta:

In this study, Maximum numbers of patients i.e. 18 (60%) were having

Madhyama kostha, 6 patients (20) were having Mrudu kostha and rest 6 patients (20%)

belongs to Kroora kostha.

Discussion


In relation to Sleep:

In this study, 19 patients (63.33) were having Disturbed sleep and 11 patients

(36.66) were having Sound sleep.

In relation to Habits:

In this study, 18 patients (60) were having the history of smoking, 6 patients (20)

were having the history of alcoholic, 5 patients (16.66) were having the history of

tobacco chewing and 1 patient (3.33) was not having any history.

In relation to Ahara:

Most of the patients i.e. 24 (80) had influence of ahar over the disease which

shows the importance of Pathy and Apathy related to Tamaka Swasa mentioned in the

classical texts.

In relation to Lakshana:

Teevra vega swasa was present in all cases. Other symptoms like Kasa, Dukhena

Kapha nissarana, Ghurguratwama, Urah peeda and Shayanasya swasa peedita were also

seen in most of the cases. This shows that the disease is characterized by the presence of

these signs and symptoms.

Discussion


Discussion on Treatment Results:

Deepana-pachana:

In this study, 11 patients (36.66%) were received the deepana-pachana for 2 days,

19 patients (63.33) were received for 3 days. The medicine used was, Panchakola churna.

Snehapana:

After the niramata by deepana pachana, Snehapana was started with Hruseeyasi

matra i.e. 30ml and Arohana Snehapana till Samyaka snigdha lakshanas are seen. In the

present clinical study 12 patients (40%) were received the snehapana for 3 days, 8

patients (26.66%) were received the snehapana for 4 days, 8 patients (26.66%) were

received the snehapana for 5 days, 1 patient (3.33%) was received the snehapana for 6

days and 1 patient (3.33%) was received the snehapana for 7 days. The medicine used

was Dashamuladi Grita.

Samyak snigda lakshanas:

Within the 7 days period of Snehapana, all 30 patients had Agnideepti,

Vatanulomana was seen in 27 patients, Purisha snigdata was seen in 25 patients, Twak

snigdata was seen in 23 patients, Gatra mardavata was seen in 22 patients, Asamhata

varchas and Anga laghava, was seen in 21patients, Snehodvega was seen in 20 patients,

Klama was seen in 18 patients and Shaithilyata was seen in 15 patients.

Vishrama kala (Abhyanga and Sweda):

The patients were administered with abhynaga and Nadi sweda. For abhynaga

moorchita tila taila was used. Vishrama kala for Vamana was 1 day and for Virechana it

was 3 days.

Discussion


One day of gap period: Considering the classics bahya abhyanga and swedana are

performed in one day gap period and especially for the purpose of Vamana to attain

Kaphothaklesha avastha.

Three days of gap period: Considering the classics bahya abhyanga and swedana were

performed in 3 days gap period and especially for the purpose of Virechana to attain

manda Kapha state this period is highly necessary.

Vamana karma:

Vamana dravya was administered at Kapha kala i.e. in early morning. Before the

administration, observations like pulse, BP, respiratory rate and temperature were noted.

All these were also noted during and after the completion of Vamana karma, because

increase in BP, pulse and respiration were seen during Vamana procedure. So, one has to

observe whether it is in normal limits or not. Parameters like vegiki, manaki, antaki and

laingiki were also noted by observing the procedure and interrogating with patient. In the

present study 4 patients had 6 Vegas, 3 patients had 7 vegas and 8 patients had 8 vegas.

In classics it is mentioned that in uttama shodhana 8 vegas, in madhyama shodhana 6

vegas and in avara 4 vegas must be odserved. In Tamaka Swasa, special care must be

taken during the administeration of Vamana, otherwise complications may arise. So in

this study 4 patients got avara shuddi, 3 patients got madhyma shuddi and 8 patients got

uttama shuddi.

Samyak Vamana lakshanas:

In this study the symptoms like Kale pravutti, kramat KPV pravrutti and swayam

avasthana was observed in all 15 patients (100%), Laghuta was observed in 14 patients

Discussion


(93.33%), Srotoshuddi and Indriyashuddi was seen in 11 patients (73.33%) and the

symptom dourbalya was seen in only 8 patients (53.33%).

Virechana karma: Virechana dravya was administered just after Kapha kala. Before the

administration, observations like pulse, B.P., respiratory rate and temperature were

recorded. All these were also noted during and after the Virechana karma, because there

may be variations in these readings during Virechana. So, one has to observe whether

these are in normal limits or not. Parameters like vegiki, manaki, antiki and laingiki were

also recorded by interrogation with the patients. In the present study 5 patients passed

Vegas between 12-15, 6 patients passed in between the 9-11 vegas and 4 patients passed

between 6-8 vegas. In classics it is mentioned that in uttama shodhana 30 vegas, in

madhyama shodhana 20 vegas and in avara 10 vegas should be noted. The drug choosen

for this study was, Vyoshadi gutika which is sukhavirechaka, not produces any

complications and produces less number of Vegas. So in this study majority of the

patients got madhyama shodhana. In the present day and in the present health condition

madhyama shodhana can be considered as uttama shodhana.

Samyak Virechana lakshanas:

In this study the symptoms kramat Pitta-Kapha-Vata pravrutti and Agnideepti was

observed in all the 15 patients (100%), Shareera laghuta was observed in 14 patients

(93.33%), Vatanulomana was observed in 13 patients (86.66%), Indriya prasannata was

observed in 12 patients (80%), Anamayatwa was seen in 10 patients (66.66) and

Srotoshuddi was seen in 9 patients (60%).

Discussion


Discussion on Shodhana karma in the management of Tamaka Swasa:

The management of Tamaka Swasa depends on the Dosha predominance and

physical stage of the patient. Therefore the treatment modalities classified according to

patient like Kaphadhika, Vatadhika, Balawana, and Durbala. Vata and Kapha involve in

the pathogenesis of Tamaka Swasa. So the treatment modalities depend upon state of

vitiation of Dosha in the disease process. The therapy which alleviates both the Dosha

should be adopted.

Our science has given more importance to the Shodana therapy. It is stated that

Vamana should be done in Kapha predominant disease. Where as the Virechana is also

indicated by charaka as the disease originate from Amashaya (pittastana samudbhava).

which could be helpful by eliminating vitiated doshas thus correcting Srotodushti.

Both procedures help to expel-out the accumulated morbid matters, from all over

the body.

Vamana and Virechana mainly correct the impaired Doshas and vitiated Agni.

The probable action of ‘Dashamuladi Ghrita:

The probable effect of Snehakarma with ‘Dashamuladi Ghrita’ in Tamka Swasa by

means of its pharmacological properties includes; the drugs used for Ghrita preparation

are almost of, katu-tikta rasa, katu-vipaka, ushna-veerya, laghu, ruksha-guna and Kapha-

Vata shamaka.

The katu-tikta rasa, katu-vipaka, ushna-veerya properties of ghrita acts as

Deepana and Pachana that corrects the Agni, by digesting the ama and prevention

of further formation of ama in the presence of diet control.

Discussion


By ruksha guna the excessive Snigdaguna of Kaphadosha will be reduced, helping

to relieve the margavarodha.

Ruksha guna in conjunction with Laghu guna, counteract with snigda and guru

guna of Kaphadosha, neutralizes the excess of Kaphadosha thus preventing its

further accumulation.

By katu, tikta, kashaya rasa teekshnoshna guna together with Akash mahabhuta

predominance and Kapha-Vata shamaka, Srotoshodhana property (by digesting

the ama) proportion of Kapha dosha will be reduced, restores Rasadhatu and

results in anulomagati of Vayu. Thus it helps in bringing the normalcy of

Vatadosha.

Sukhoshnajala was adviced as Anupana, which is Kaphahara, Deepaka,

Amapachaka and Vatanulomaka, thus helpful in proper digestion of administered

Sneha.

The drug selected for this study was ‘Madhanaphaladi yoga’, because of its

‘Anapayitwat’ character and easy availability, easy to administer and it is also good in

taste to consume, for the patients.

Pharmacodynamics of Madanaphala.

Rasa : Kashaya, tikta, katu, madhura.

Guna : Laghu, ruksha, teekshna, ushna, sukshma, vyavayi, vikasi.

Veerya : Ushna

Vipaka : Katu

Prabhava : Urdvabhagahar (Vamana).

Discussion


The Madanaphaladi yoga, after its ingestion within short time reaches the heart

and spreads all over the body due to its vyavayi guna and anutwa bhava (Anutwam cha

anumarga samcharitwam) of sukshma guna. The drug after attaining its optimal

concentration at the desired sites separates then liquefies the stagnated doshas and

dushyas in microcirculation, due to its ushna guna. Then these liquefied doshas and

dushyas. The migration of vitiated doshas from shakha to kostha is because of Anu

pranavabhava (pranavatwam iti kosthagamano mukhatwam) quality of Vamaka dravya.

The doshas after their migration into the kostha will move in upward direction due to the

prabhava (Vamana) of Madanaphaladi yoga. The panchabhoutika combination

(agni+vayu) of Vamana dravya will also help in accelerating the upward movement of

doshas. Then these doshas are eliminated through emesis by the action of Udanavata.

Thus the patients suffering with Tamaka Swasa will attain homeostasis of dosha, dhatu

and malas and will remain free from the further pathological consequences of Kapha and

Vata dusthi and avarana, in the presence of nidanaparivarjana (avoiding the defaults of

diet and life style).

Vyoshadi Gutika: For the purpose of Virechana Vyoshadi gutika is used because,

It is effective Virechana yoga.

Its ingredients are easily available.

Method of preparation is very simple.

It is palatable as it is in leha form.

It is upakalpa of trivirt, can be considered as sukha virechaka, thus safe to use.

Discussion


Dose: - The dose of the Vyoshadi Gutika mentioned in classics is 1 pala i.e. 48 gms, can

be considered as maximum dose. In the present study according to the koshta and bala of

the patient 35, 40, and 45 gms were used as Avara, Madhyama and Pravara matra

respectively.

Anupana: - All the patients were given sheetajala as anupana as mentioned in the

classics. The action of the drugs started within 1-3 hours after its administration.

Probable mode of action of Vyoshadi Gutika:

Pharmacodynamics in Ayurveda is mainly based on the fundamental doctrines of

Panchamahabhoota and Tridosha, which govern the physicochemical and biological

phenomena respectively. On assessing the properties of Vyoshadi Gutika, the drugs are

having following properties –

Agnideepaka – Agnimandya is the main cause for the disease Tamaka

Swasa.

Tridoshahara –Tamaka Swasa is Vata- Kapha pradhana, tridoshaja vyadhi.

Srotoshodhaka–Vimargagamana and Sanga type of srotodushti is found in

Tamaka Swasa, the drug enter in sookshma srotas and relieves the

srotavarodha.

Rechaka – Expels both pakwa and apakwa malas present in the

pathogenesis of Tamaka Swasa.

Vatanulomana – Vata is a pradhana dosha in the samprapti of Tamaka

Swasa.

Yakrit uttejaka – By seeing explanation in Ayurveda and contemporary

science, the important part played by the yakrit can be revealed.

Discussion


The above said factors may be responsible for the effect of Vyoshadi Gutika in

Tamaka Swasa used as Virechana yoga.

Discussion on probable mode of action of the Vamana and Virechana karma:

Vamana karma:

The efficacy of Vamana karma was observed in clinical study Vamana karma is

best in Tamaka Swasa because it is Kapha pradhana vyadhi. The probable mode of action

can be proposed as below. This Vamana karma follows the poorva karma like Snehana

and Swedhana. This poorva karma was liquefying the doshas and helps in bringing the

doshas to kostha.

As the Vamana dravya contain ushna, tikashna, sukshma, vyavayi and vikasi

gunas and because of their potency they reach the heart through the minute channels. Due

to Snehana and Swedana the vitiated dosha become liquefied and enter into minute

channels. There the Vamaka dravya further liquefies the doshas due to ushna guna and

break down into pieces because of tikshna, vikasi gunas, from there the liquefied doshas

reach the kosta without sticking to the channels as honey runs through the walls of the

earthen ware which has been anointed with oil. From there the vitiated doshas will be

expelled through mouth, because of the drugs having the dominancy of Agni and Vayu

Mahabhutas, involvement of Udhanavata and also the upward movement of drugs.

Effect on dosha: Tamaka Swasa is Kapha pradhana vyadhi. Here the vitiated Kapha will

obstruct the Pranavayu, so by Vamana karma this vitiated Kapha is eliminated and

obstruction is cleared by this there will be relief in Tamaka Swasa is observed.

Effect on srotas: Pranavaha srotas is a prime srotas involved in Tamaka Swasa. In

Pravahana srotas sanga occure due to vitiated Kapha, which will causes Vimarga gamana

Discussion


of Vata. By Vamana karma the vitiated Kapha is expelled, by this clears the Pranavaha

srotas and thereby free passage for the Vatadosa.

Effect on udbhavastana: The udbhavastana of Tamaka Swasa is amashaya, the seat of

mainly the Kapha (Urdva amashaya). In classics, the udbhavastana should be treated first

to correct the disease. Here the Vamana checks the Kaphadosha and helps in management

of Tamaka Swasa.

Virechana karma:

The efficiency of Virchana was observed in clinical study and even today

charaka’s “Tamake thu Virechanam”, statement is very effective in the management of

Tamaka Swasa. The probable mode of action can be proposed as below. This Virechana

follows the poorva karma like Snehana and Swedana. These poorva karma liquefying the

doshas and bring back to kosta.

This therapy useful in Kapha samsrusta and Pitta stanagata Kapha. Also it is useful

in Vata disorders. Snehana, Swedana, and Mrudu virechana is the treatment of Vata

disorder.

a) The qualities of Virechana drugs are ushna, tekshna, sukshma, vyavayi and vata

anulomaka

b) Effect of virechana- srotosuddhi vatanulomaka, agni deepti, expel the mala from the

body

c) Vata pradhana disorders Vyoshadi Gutika can be used as Virechana dravya

Discussion


“Tameketu virechanam” can be justified like this.

Effect on Srotas involvement: Pranavaha, Udaka and Annavaha, srotas are involved in

the disease. The importance of moolastana is that, if moolastana is affected, then it affects

the entire srotas. Pathology starts when srotas get deformed structurally or functionally.

In Tamaka Swasa Sanga and Vimargagaman type of sroto dusti occurs. In Pranavaha

srotas sanga occurs due to Kapha, which causes Vimargagamana of Vata. By Virechana

removal of sanga takes place, and Virechana causes Vataanulomana, there by relief in

Tamaka Swasa was observed.

Effect on udbhavastana: The udbhava stana is Amashaya (pittastana) is the seat of Pitta

mainly and Kapha. Even through Kapha is main dosha in this disease, but stanikadosha

and udbhavastana should be treated first. Virechana plays important role as it is a pitta

sthana samudhbava vyadhi, There by Virechana helps in the mangement of Tamaka

Swasa.

Effect on Nidana: Most of the aetiological factors cause Agnimandya which leads to the

formation of Ama. By increasing the agni, the vitiated dosha becomes normal, thus

Virechana helps in treatment of Tamaka Swasa.

Above said factors may be the reason why Vamana and Virechana karma are

effective in Tamaka Swasa.

Discussion


The present research out come is suggestive of the fact that Virechana is better

than Vamana karma. The out come of the research can be interpreted and substantiated

by the following ways:

The Vamana karma is a better therapeutic procedure to evacuate Kapha and it is

observed that Vamana did not expel the other two doshas being Pitta and Vata in

abundance. As the disease Tamaka Swasa is associated with Vata and Kapha

predominantly. Vamana karma though beneficial but not as much as Virechana karma.

Virechana karma expels Pittapradana Kaphavata dosha. When the extent of

expulsion of Vatapitta in Vamana and Kaphavata in Virechana is compared definitely,

Virechana expelling Kaphavata over takes Vamana. So as the disease is Kapha Vata

pradana tridhoshaja vyadhi. Virechana suits more to make the Samprapti vighatan.

Apart from therapeutic usage it is important to concentrate in the present era to

consider the acceptance from the patient. When both Vamana and Virechana compared, a

patient can be convinced for Virechana easily.

Conclusion

CONCLUSION

The word Tamaka Swasa is the name of disease consisting of the two words

Tamaka and Swasa. The word Swasa refers to the name of the disease, where as

the word Tamaka refers to a subtype of the Swasa roga.

By studying literature Tamaka Swasa can be compared with bronchial asthma.

Specific Nidana for Tamaka Swasa is not mentioned in classics as it is a sub type

of Swasa roga same Nidana are applicable to Tamaka Swasa also.

If Tamaka Swasa is Navotita it is as sadya. Sushruta has considered Tamaka

Swasa as krichrasadhya vyadhi and asadhya in durbala rogi.

Akanthapana is an essential measure, which has its definite impact over the

duration of Vamana and amount of the medicine to be ingested.

Vaigiki Suddhi has very little role in assessing the proportion of purification and

predicting any type of result from it.

A close persual of the observation and inference that can be drawn leads to the following

conclusions –

Vamana and Virechana karmas are good and effective treatments in Tamaka

Swasa.

If Tamaka Swasa is Navotita and rogi is Balavana, classical Vamana or Virechana

karmas, alone is enough to control it.


Conclusion

Compare to Vamana, Virechana is more effective and it shows complete

remission in newly diagnosed cases. According to Charaka, “Tamaketu

Virechana”. Virechana karma is the main line of treatment followed in case of

Tamaka Swasa as it is a Pittasthanasamudbhava vyadhi.

Along with Vamana and Virechana karmas, following of pathya ahara viharas

may give more effect.

Even though severe cases were also included in this study, they also shown

moderate response. So in severe cases of Tamaka Swasa, the usage of repeated

administration of Vamana and Virechana, along with some Shamanoushadhis,

pathya ahara-viharas may give better result.

Suggestions for the Future Study:

1. It would be worth to test by large sample study.

2. Study on, Vamana followed by Virechana karma.

3. Study on repeated Vamana and Virechana karmas, along with Shamanoushadhis in

Tamaka Swasa.

4. To study its therapeutic efficacy with help of Spirometry.


Summary

SUMMARY

The procedure which helps to eliminate the vitiated doshas from the body is

called Shodhana. Shodhana therapy is nothing but the Panchakarma, and it is five in

number. Vamana Karma, Virechana Karma, Anuvasana basti, Niruha basti and Nasya

Karma. Among the Panchakarmas, Vamana and Virechana are the two important and

highly effective therapies, the vitiated doshas (malas), which are eliminated from the

Urdhwamarga i.e. by mouth is called Vamana, through Adhomarga (guda) is called

Virechana. Both will remove the vitiated doshas and cure the disease through its root,

Vamana is a specific treatment for Kapha and Kapha samsargaja doshas. Virechana is

a specific treatment for Pitta and Pitta samsargaja doshas, also the treatment for

Kapha and Vata doshas. In the processes of Vamana and Virechana, the person will

not have that much of trouble and exhaustion as in normal Vomiting and Purgation, as

he has been subjected to Snehana and Swedana.

“Na Tesham Punarudbhavaha” indicates importances of Panchakarma i.e.

diseases treated with Panchakarma are having less chances of reoccurrence by

prohibiting the aggravation of doshas.

In Tamaka Swasa two line of treatment have been explained, one is Shodhana,

another is Shamana. Shodhana and Shamana for the persons who are strong and

Shamana for the persons who are weak. Administration of Snehana, Swedana,

Kaphothkleshaka Ahara, Vamana, Virechana and Rasayana line of treatment forms

the complete treatment of Tamaka Swasa as explained in Ayurvedic classics.

In Shodhana, the both Vamana karma and Virechana karma are advised for

management of Tamaka Swasa. So research is selected to see the therapeutic efficacy

of Vamana and Virechana karma in Tamaka Swasa.


Summary

So, the objective of this study was, ‘Evaluation of the efficacy of Vamana and

Virechana karmas in Tamaka Swasa ’ A Comparative Study.

The present work covered the following areas-

01. Introductory part regarding the present work and the objectives.

02. Historical aspect of Vamana karma, Virechana karma and Tamaka Swasa.

03. Vamana and Virechana karmas in detail along with modern concepts and

physiological aspects, mode of action.

04. Nidana panchakas of Tamaka Swasa in detail along with Modern description

regarding the Bronchial asthma.

05. Description regarding the materials and methods used in the present study.

06. Observations of the present study, results, discussion, conclusion, summary

and finally bibliography and references.

The study was conducted in 2 groups, 15 patients in each group.

In Group-A, 15 patients received classical Vamana karma and

In Group-B, 15 patients received classical Virechana karma.

The effect of the therapy in each Group was assessed statistically by using

paired t-test and the comparative effect between the two Groups was assessed

statistically by using un-paired t-test.

How Vamana and Virecana karmas acts in Tamaka Swasa:

(1) Both procedures mainly corrects, the impaired dosha and vitiated Agni.

(2) Both procedures help to expel-out the accumulated morbid matters, from

all over the body.

It was found that, both processes shown good effects, with Highly Significant

(p<0.001). But compare to Vamana, Virechana is having better effect. So after

Vamana and Virechana if the person follows strict diet, disease can be controlled in a

better manner.


Bibilography

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28. Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 2nd chapter, sloka-14-15, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 657.

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34. a) Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 2nd chapter, sloka-10, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 687-688. b) Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya,

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35 a) Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, chapter 2, sloka-8, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 687. b) Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya,

editor. Chapter 33, sloka-14-15, Varanasi: Chaukhambha Orientalia; 1980, p-517. c) Vriddha Vagbhata, Ashtangasamgraha, Sutrasthana, Dr.Ravidutt Tripathi, editor,Chapter 27,sloka-7,Varanasi:ChaukhambaSanskrit Pratishthan; 2003.p-483. d) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-3-6. Varanasi: Chaukhambha Orientalia; 1978, p-205. e) Sharangadhara, Sharngadhara samhita, Uttarakhanda, Pandit Parasurama Sasatri editor,Chapter 3, sloka-8,Varanasi: Chaukhambha Orientalia; 1983, p-305. f) Bhavamishra, Bhavaprakasha Poorvakhanda, edited by Bishakrathna Sri Brhmashanker Misra, chapter 5, sloka 7-9,Varanasi: Chaukhambha Sanskrit Sadana; 1988. p-862. g) Chakrapanidatta, Chakradatta. Chapter- 69. Sloka 24. Varanasi; Choukhamba Sanskrit series office.5th edi, 1983, p-433.

36 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Kalpasthana, chapter 1, sloka-5, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 651.

37 Ibid. 38 Vagbhata, Ashtangahridaya, Sutrasthana, ‘Sarvangasundara’ Commentary, P.V.

Sharma, editor. Chapter 18, sloka-11. Varanasi: Chaukhambha Orientalia; 1978, p-206.

39 Ibid ref. No-36. 40 Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary,

Vaidya Jadavaji Trikamji Acharya, editor, Chapter 33, sloka-33, Varanasi: Chaukhambha Orientalia; 1980, p-519.

41 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 46, sloka-22. Varanasi: Chaukhambha Orientalia; 1980, p-242.

42 Ibid ref. No-36. 43 Ibid ref. No-36. 44 Ibid ref. No-36. 45 Sharangadhara, Sharngadhara samhita, purvakhanda, Pandit Parasurama Sasatri,

editor. Chapter 4, sloka-18, Varanasi: Chaukhambha Orientalia; 1983, p-264.


Bibilography

46 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor, Chapter 46, sloka-31, Varanasi: Chaukhambha Orientalia; 1980, p-217.

47 Sharangadhara, Sharngadhara samhita, purvakhanda, Pandit Parasurama Sasatri, editor. Chapter 4, sloka-19. Varanasi: Chaukhambha Orientalia; 1983, p-264.

48 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 45, sloka-12, Varanasi: Chaukhambha Orientalia; 1980, p-218.

49 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 46, sloka-22. Varanasi: Chaukhambha Orientalia; 1980, p-216.

50 Ibid ref. No-36. 51 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary,

Vaidya Jadavaji Trikamji Acharya, editor, chapter 46, sloka-523. Varanasi: Chaukhambha Orientalia; 1980, p-252.

52 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-33. Varanasi: Chaukhambha Orientalia; 1980, p- 146.

53 Sushruta, Sushrutasamhita,Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. 46th chapter, 514-523rd sloka, Varanasi: Chaukhambha Orientalia; 1980, p-252.

54 Ibid ref. No-36. 55 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 26th

chapter, sloka-69, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, P- 148.


chapter, sloka-5, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 83.

58 Sushruta, Sushrutasamhita, Sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. 39th chapter, sloka-10. Varanasi: Chaukhambha Orientalia; 1980, p-182.

59 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 15th chapter, sloka-10, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 85.

60 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Kalpasthana, 1st chapter, sloka-14, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 654.

61 Sharangadhara, Sharngadhara samhita, Utterkhand, Pandit Parasurama Sasatri, editor. Chapter 3, 16-17th sloka. Varanasi: Chaukhambha Orientalia; 1983, p-200.

62 Vagbhata,Ashtangahridaya,Sutrasthana,‘Sarvangasundara’Commentary,P.V.Sharma editor,Chapter 18, sloka-15,Varanasi:Chaukhambha Orientalia;1978, p-207.

63 Vagbhata, Ashtangahridaya, Sutrasthana, ‘Sarvangasundara’ Commentary, P.V. Sharma, editor. Chapter 16, sloka-17-18. Varanasi: Chaukhambha Orientalia; 1978, p-246.


Bibilography

64 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1st chapter, sloka-6, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 677.

65 Sharangadhara, Sharngadhara samhita, Uttarakhanda, Pandit Parasurama Sasatri, editor. Chapter 1, sloka-1. Varanasi: Chaukhambha Orientalia; 1983, p-286.

66 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 16, sloka-19. Varanasi: Chaukhambha Orientalia; 1978, p-195.

67 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 13th chapter, sloka-62-63, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 85.


69 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Kalpasthana, 1st chapter, sloka-14, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 656.


71 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. 32th chapter, sloka-21. Varanasi: Chaukhambha Orientalia; 1980, p-514.

72 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-58-59. Varanasi: Chaukhambha Orientalia; 1978, p-268.

73 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 16, sloka-19. Varanasi: Chaukhambha Orientalia; 1978, p-248 .


75 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. 33rd chapter, sloka-5. Varanasi: Chaukhambha Orientalia; 1980, p-521.

76 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. 33rd chapter, sloka-6. Varanasi: Chaukhambha Orientalia; 1980, p-522.

77 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-13-14. Varanasi: Chaukhambha Orientalia; 1978, p-253.

78 Ibid ref. No-69. 79 Vriddha Vagbhata, Ashtangasamgraha, Sutrasthana, Dr.Ravidutt Tripathi, editor.

Chapter 27, sloka 11. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003, P-486. 80 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 15th


81 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-7. Varanasi: Chaukhambha Orientalia; 1980, p-516.

82 Ibid. 83 Ibid. 84 Vriddha Vagbhata, Ashtangasamgraha, Sutrasthana, Dr.Ravidutt Tripathi, editor.

Chapter 27, sloka 15. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003, p-487.


Bibilography

85 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Kalpasthana, 12th chapter, sloka-62, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 673.



88 Ibid 89 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1st


90 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1st chapter, sloka-14, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 679.

91 Ibid ref. No-89. 92 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1st

chapter, sloka-13-15, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 679-680.

93 Ibid ref. No-90. 94 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya,

editor. Chapter 33, sloka-5. Varanasi: Chaukhambha Orientalia; 1980, p-515. 95 a) Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1st

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96 a) Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1stchapter, sloka-17, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 680. b) Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-8. Varanasi: Chaukhambha Orientalia; 1980, p-516. c) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-25-26. Varanasi: Chaukhambha Orientalia; 1978, p-208. d) VriddhaVagbhata,Ashtangasamgraha,Sutrasthana,Dr.RaviduttTripathi,editor. Chapter 27,sloka 20.Varanasi:Chaukhamba Sanskrit Pratishthan;2003,p-489.


Bibilography

e) Bhela, Bhela Samhita, Siddhisthana, 1st chapter, 26th sloka, English Translation by Krishnamurthy K.H.,1st ed,Chaukhambha Vishwabharati,Varanasi;2000,p-521. f) Sharangadhara,Sharngadharasamhita, Uttarakhanda, Pandit Parasurama Sasatri, editor. Chapter 3, sloka-23-24. Varanasi: Chaukhambha Orientalia; 1983, p-308.

97 a) Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 1st chapter, sloka-16, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 680.

b) Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-8. Varanasi: Chaukhambha Orientalia; 1980, p-516. c) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter18, sloka 23-24. Varanasi: Chaukhambha Orientalia; 1978, p-207. d) VriddhaVagbhata,Ashtangasamgraha,Sutrasthana, Dr.Ravidutt Tripathi, editor. Chapter 27, sloka 18. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003, p-489. e) Bhela, Bhela Samhita, Siddhisthana, 1st chapter, 26th sloka, with English Translation by Krishnamurthy K.H., 1st ed. Chaukhambha Vishwabharati, Varanasi; 2000, p-521. f) Sharangadhara, Sharngadhara samhita,Uttarakhanda, Pandit Parasurama Sasatri, editor.Chapter 3,sloka-22.Varanasi:Chaukhambha Orientalia;1983, p-308.

98 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 15th chapter, sloka-14, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 95. 99 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji TrikamjiAcharya, editor. Chapter 33, sloka-10. Varanasi: Chaukhambha Orientalia; 1980, P-517. 100 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 15th hapter, sloka-15, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 95. 101 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 6th chapter, sloka-24, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 705. 102 Agnivesa, Charakasamhita, Chakrapani commentary, Sutrasthana, 15thchapter, sloka-16, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 95. 103 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-11. Varanasi: Chaukhambha Orientalia; 1980, P-517. 104 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 6th chapter, sloka-25, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 705. 105 Vagbhata, Ashtangahridaya, Sutrasthana, Sarvangasundara teeka, Chapter 18, sloka 46-47,P.V. Sharma, editor.Varanasi: Chaukhambha Orientalia; 1978, p-211. 106 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 23rd

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107 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 6th chapter, sloka-10, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 701.


Bibilography

108 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 6th chapter, sloka-29-30, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 705. 109 Ibid 110 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 6th chapter, sloka-42-43, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 715. 111 Ibid, sloka 47. 112 Ibid, sloka 54. 113 Taber, Cyclopedic Medical Dictionary, New-Delhi; Jaypee brothers. 16th edition, 1990, p-579. 114 Ibid. 115 Ibid. 116 Chatterjee C.C, Human Physiology, Vol-1, 9th chapter, Calcutta; medical Allied Agency, Reprint-1998, p-488. 117 Davidson, Principles and Practice of Medicine, Christopher Haslett editor, London; Churchill Livingstone, 18th edition, 1999, p-614. 118 Satoskar R.S, Pharmacology and Pharmacotherapeutics, S.D. Bhandarkar and S.S. Ainapure editors, Mumbai; Popular prakashan, 16th edition, 1999, p-560. 119 Ibid, p-559. 120 Ibid. ref No.116.

121 Ibid. ref No.125. 122 Ibid. ref No.21. 123 Ibid. ref No.22. 124 Y. T. Acharya, Astanga Sangraha Sutrasthana Chapter 1. 11st ed. Varanasi: Chaukhamba Orientalia; 1996.p.18. 125 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana,

25th chapter, sloka-40, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, P- 131.

126 Y. T. Acharya, Astanga Sangraha Sutrasthana Chapter 27 Shloka 5. 11st ed. Varanasi: Chaukhamba Orientalia; 1996.p.482.


128 Sharangadhara, Sharngadhara samhita, Uttarakhanda, ‘Gudarthadeepika’ commentary, Pandit Parasurama Sasatri, editor. Chapter 3, sloka-11. Varanasi: Chaukhambha Orientalia; 1983, p-306. 129 Monier Wlliams, Sanskrit-English Dictionary, vol-3, Varanasi;chaukhambha Sanskrit sansthana, 1st edition, 1960, p-412. 130 Ibid, ref No.39 131 Sushruta, Sushrutasamhita, Chikitsasthana, Vaidya Jadavaji Trikamji Acharya, editor. 33rd chapter, 33rd sloka, Varanasi: Chaukhambha Orientalia; 1980, p-519. 132 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 2nd chapter, 10th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 24.


Bibilography

133 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 4th chapter 13th, 24 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 33. 134 a) Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 7th chapter,

77-80th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 665.

b) Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 8th chapter, 17-18 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 666.

c) Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 9th chapter, 17-18 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 667.

d) Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 10th chapter, 21-22nd sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 668-669.

e) Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 11th chapter, 18-19 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 670. f) Agnivesa, Charakasamhita, Chakrapani commentary, Kalpasthana, 12th chapter, 36-40 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 671-672.

135 a) Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 2nd chapter,13th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 688. b) Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-32. Varanasi: Chaukhambha Orientalia; 1980, p-519. c) Vriddha Vagbhata, Ashtangasamgraha, Sutrasthana,Dr.Ravidutt Tripathi, editor,Chapter 27, sloka-9, Varanasi:Chaukhamba Sanskrit Pratishthan;2003.p-484. d) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-8-10. Varanasi: Chaukhambha Orientalia; 1978, p-206. e) Sharangadhara, Sharngadhara samhita, Uttarakhanda, Pandit Parasurama Sasatri, editor. 4th Chapter, 8-10 sloka. Varanasi: Chaukhambha Orientalia; 1983, p-313. f) Yogaratnakara, Poorvardha, Bhishgratna bramhashankar sastri editor, Virechana prakarana, sloka 8-11, Varanasi: Chaukhambha Sanskrit Sansthan; 6th edition, p-177. g) Bhavamishra, Bhavaprakasha Poorvakhanda, chapter 5, sloka 40-44, edited by Bishakrathna Sri Brahmashanker Misra, Varanasi: Chaukhambha Sanskrit Sadana; 1988. p-865.

136 a) Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Siddhisthana, 2nd chapter, 2nd sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 688.


Bibilography

b) Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-29-30. Varanasi: Chaukhambha Orientalia; 1980, p-519. c) VriddhaVagbhata,Ashtanga samgraha,Sutrasthana, Dr.Ravidutt Tripathi, editor. Chapter 27, sloka-10, Varanasi: Chaukhamba Sanskrit Pratishthan; 2003. p-485 d) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-10-11. Varanasi: Chaukhambha Orientalia; 1978, p-206. e) Yogaratnakara, Poorvardha, Bhishgratna bramhashankar sastri editor,

Virechana prakarana, sloka 6-8, Varanasi: Chaukhambha Sanskrit Sansthan; 6th edition, p-177.

f) Bhavamishra, Bhavaprakasha Poorvakhanda, chapter 5, sloka 39-40, edited by Bishakrathna Sri Brahmashanker Misra,.Varanasi: Chaukhambha Sanskrit Sadana; 1988. p-865. g) Sharangadhara, Sharngadhara samhita,Uttarakhanda,Pandit Parasurama Sasatri, editor. 4th Chapter, 6-8 sloka. Varanasi: Chaukhambha Orientalia; 1983, p-313. h) Chakrapanidatta, Chakradatta, 70th chapter, 29-30 sloka, editor P.V.Sharma, Varanasi; Chaukhambha Vishwabharati, 2005, p-617. i) Vangasena, Vangasenasamhitha, edited by Kaviraj Sri Shalligramji Vaishya, Virechanadhikara chapter, sloka 55-56, Mumbai; Kamaraj Sri Krishnadasa Prakashsena p-981.

137 a) Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 1st chapter, 95th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 21.

b) Agnivesa, Charakasamhita, Chakrapani commentary, Sutrasthana, 1st chapter, 112th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 22. c) VriddhaVagbhata,Ashtangasamgraha, Sutrasthana, Dr.Ravidutt Tripathi, editor. Chapter 14, sloka 4. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003, p-283.

138 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 2nd chapter, 10th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 24. 139 Vriddha Vagbhata, Ashtangasamgraha, Sutrasthana, Dr.Ravidutt Tripathi, editor. 14th Chapter, 4th sloka. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003, p-283. 140 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 1st chapter, 77-79 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 20. 141 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 1st chapter, 81-85 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 21. 142 Agnivesa, Charakasamhita, Chakrapani commentary, Sutrasthana, 1st chapter, 114-115 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 22. 143 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 1st chapter, 116-119 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 22. 144 Ibid. ref No.139.


Bibilography

145 Agnivesa, Charakasamhita, Chakrapani commentary, Sutrasthana, 25th chapter, 40th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 131. 146 Sharangadhara,Sharngadharasamhita,Prathamakhanda, Pandit Parasurama Sasatri, editor. 4thChapter, 3-4th slokaVaranasi:Chaukhambha Orientalia; 1983, p-35. 147 Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary,

Vaidya Jadavaji Trikamji Acharya, editor. Chapter 34, sloka-3. Varanasi: Chaukhambha Orientalia; 1980, p-521.

148 Sharangadhara,Sharngadharasamhita,Prathamakhanda,Pandit Parasurama Sasatri, editor. 4th Chapter, 4-5th sloka. Varanasi: Chaukhambha Orientalia; 1983, p-35.

149 Agnivesa, Charakasamhita, Chakrapani commentary, Chikitsasthana, 3rd chapter, 171-172 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 413.

150 Sharangadhara,Sharngadharasamhita,Prathamakhanda, Pandit Parasurama Sasatri, editor. 4th Chapter, 5-6th sloka. Varanasi: Chaukhambha Orientalia; 1983, p-35.

151 Agnivesa, Charakasamhita, Chakrapani commentary, Sutrasthana, 4th chapter, 9/4th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 32. 152 Sharangadhara,Sharngadharasamhita,Prathamakhanda, Pandit Parasurama Sasatri, editor. 4th Chapter, 6-7th sloka. Varanasi: Chaukhambha Orientalia; 1983, p-36. 153 Sharangadhara,Sharngadharasamhita,Uttarakhanda, Pandit Parasurama Sasatri, editor. 4th Chapter, 21-27th sloka.Varanasi: Chaukhambha Orientalia;1983, p-205. 154 Ibid. 155 Sushruta, Sushrutasamhita, sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 44, sloka-90-91. Varanasi: Chaukhambha Orientalia; 1980, p-195. 156 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. 18th Chapter, 35th sloka. Varanasi: Chaukhambha Orientalia; 1978, p-210. 157 Sharangadhara,Sharngadharasamhita,Uttarakhanda,Pandit Parasurama Sasatri, editor. 4th Chapter, 16-18th sloka.Varanasi:Chaukhambha Orientalia; 1983, p-314. 158 Ibid, sloka 19-20, p-315. 159 Ibid, sloka 13, p-313. 160 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 13th chapter, 80th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 86. 161 Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 1st chapter, 9- 10th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 678 162 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. 18th Chapter, 33rd sloka. Varanasi: Chaukhambha Orientalia; 1978, p-209. 163 Y. T. Acharya, Astanga Sangraha Sutrasthana Chapter 27 Shloka 40. 11st ed. Varanasi: Chaukhamba Orientalia; 1996, p-494. 164 Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 6thchapter, 26th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 705


Bibilography

165 Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 6thchapter, 27th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 705 166 Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. 18th Chapter, 36- 38rd sloka. Varanasi: Chaukhambha Orientalia; 1978, p-209. 167 Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 6thchapter, 21st sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 705 168 Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 1st chapter, 13-15th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 679-680. 169 a) Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 1st chapter,18-19 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 680. b) Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-23. Varanasi: Chaukhambha Orientalia; 1980, p-518. c) VriddhaVagbhata,Ashtangasamgraha,Sutrasthana,Dr.RaviduttTripathi, editor. Chapter 27, sloka-36. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003, p-495. d) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-39. Varanasi: Chaukhambha Orientalia; 1978, p-210. 170 a) Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 1st chapter

19-20 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 680. b) Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-24, Varanasi: Chaukhambha Orientalia; 1980, p-518. c) Vriddha Vagbhata, Ashtangasamgraha,Sutrasthana,Dr.Ravidutt Tripathi, editor. Chapter 27, sloka-37, Varanasi: Chaukhamba Sanskrit Pratishthan; 2003.p-495 d) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka-40-41. Varanasi: Chaukhambha Orientalia; 1978, p-210.

171 a) Agnivesa, Charakasamhita, Chakrapani commentary, Siddhisthana, 1st chapter, 18-19 sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 680.

b) Sushruta, Sushrutasamhita, Chikitsasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 33, sloka-24. Varanasi: Chaukhambha Orientalia; 1980, p-518. c) Vriddha Vagbhata, Ashtangasamgraha,Sutrasthana,Dr.Ravidutt Tripathi, editor. Chapter 27, sloka-35. Varanasi: Chaukhamba Sanskrit Pratishthan; 2003.p-495. d) Vagbhata, Ashtangahridaya, Sutrasthana, P.V. Sharma, editor. Chapter 18, sloka 38-39, Varanasi: Chaukhambha Orientalia; 1978, p-210.

172 Agnivesa, Charakasamhita, ‘Ayurveda deepika’ commentary, Sutrasthana, 26th chapter, 67th sloka, Vaidya Jadavaji Trikamji Acharya, editor. Varanasi: Chaukhambha Sanskrit Sansthan; 2004, p- 148.


Bibilography

173 Sushruta, Sushrutasamhita, sutrasthana, ‘Nibandhasangraha’ Commentary, Vaidya Jadavaji Trikamji Acharya, editor. Chapter 46, sloka 259. Varanasi: Chaukhambha Orientalia; 1980, p-232. 174 Ibid. Ref No.172, sloka 13, p-138. 175 Satuskar R.S., Bhandarkar S.D. Ainapuri S.S. Pharmacology and Pharmaco- therapeutics Chapter 38. 16th edition, Mumbai; Popular Prakashana Publications; 1999, p-580. 176 V. S. Apte, The student Sanskrit to English dictionary, 1st

edition, 1965, Shantilal Jain,New Delhi. 177 Raja Radhakanta Dev, Shabdakalpadruma,part-2, 2nd

edition, 1967, Choukumbha Sanskrit seeris office, Varanasi. 178 Ibid, ref No.176. 179 Stedman’s medical dictionary V 4, 22nd edition, 1974, Williams Wilkins co, Baltimore. 180 Ambika Datta Shastri, Susruta Samhita Uttara Chapter 51, sloka 8, 15th edition, 2002, Choukumbha Sanskrit Samsthana, Varnasi, p- 374. 181 Yadunandan Upadhyay, Madhava Nidana, Vol-1, 26th editon,1996, Choukumbha Samskrut samstan, Varanasi. 182 a)Yadavji Trikamji Acharya, Dulhana, NibandhaSangraha,Susruta SamhitaUttara, Chapter39,sloka-88,8thedition,2005,ChoukumbhaOrientalia,Varanasi,p- 678. b) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, Chapter17,sloka 61, 1st edition, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 535. 183 a) Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa,17/55-62, ChakrapaniAyurvedadeepika,ChaukhambhaSurabharathiPrakashanVaranasip-535 b)Yadavji Trikamji Acharya edited,Susruta Samhita Uttara,Chapter51,sloka8-10, Dalhanacomentary,1stedition,ChaukhambhaSurabharathiPrakashan,Varanasi,p762 c) K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana Chapter4,sloka6-10, 3rd edition, 1996, Krishnadas academy, Varanasi, p- 38. d) K.R. Srikantha Murthy edited, Astanga Sangraha NIdana Chapter 4,sloka 8-13, 2 rd edition, 1998,Chaukhambha Orientalia, Varanasi, p- 169. e) Yadunandan Upadhyay, Madhava Nidana, Vol-1, Chapter12,sloka 27-34, 15 th edition, 1985, Choukumbha Samskrut samstan, Varanasi, p- 296-7. 184 Yadavji Trikamji Acharya edited,SusrutaSamhitaUttara,Chapter51,sloka7Dalhana comentary,1stedition, ChaukhambhaSurabharathi Prakashan,Varanasi,2002,p-761. 185 K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana, Chapter 4, sloka1-2, 3 rd

edition, 1996, Krishnadas academy, Varanasi, p- 37. 186 Yadavji Trikamji Acharya edited,CharakaSamhita Chikitsa, Chapter 17, sloka-17, ChakrapaniAyurvedadeepika,ChaukhambhaSurabharathiPrakashan,Varanasi,p533 187 a)Ibid. b)Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Chapter 51,sloka-6 Dalhana comentary,1st editoin,Chaukhambha Surabharathi Prakashan,Varanasi, p- 761. c)K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana, Chapter 4, sloka-4, 3rd

edition, Krishnadas academy, Varanasi, p- 38.


Bibilography

d)Yadunandan Upadhyay, Madhava Nidana, Vol-1, Chapter 12,sloka-5, 15th

edition, 1985, Choukumbha Samskrut samstan, Varanasi, p- 285. 188 a)Yadavji Trikamji Acharya edited,Charaka Samhita Chikitsa,Chapter 17, sloka 55-62,Chakrapani Ayurveda deepika, Chaukhambha Surabharathi Prakashan, Varanasi,p- 535. b) Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Chapter 51,sloka8- 10 Dalhana comentary,1st edition, Chaukhambha Surabharathi Prakashan, Varanasi, p- 762. c) K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana Chapter 4,sloka 6-10, 3 rd edition, Krishnadas academy, Varanasi, p- 38. d) K.R. Srikantha Murthy edited, Astanga Sangraha Nidana Chapter 4,sloka 8-13, 2 rd ed, Chaukhambha Orientalia, Varanasi, p-169. 189 Yadunandan Upadhyay, Madhava Nidana, Vol-1, Madhukosha Chapter 1,sloka 8, 15 th edition, Choukumbha Samskrut samstan, Varanasi, p- 44. 190 Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, Chapter 17,sloka 147,Chakrapani Ayurveda deepika, Chaukhambha Surabharathi Prakashan, Varanasi, p- 538. 191 Ibid, Chapter 22,sloka 17, p-568 192 Ibid, Chapter 17,sloka 7, p-533. 193 Yadavji Trikamji Acharya edited,CharakaSamhita Indriyasthana, Chapter 7,sloka 24,Chakrapani Ayurveda deepika, Chaukhambha Surabharathi Prakashan, Varanasi, p- 367. 194 Ibid, Chapter 7,sloka 25, p-367. 195 Ibid, Chapter 8,sloka 15, p-368. 196 a) Ibid, Ref 190, Chapter 17,sloka 62, p-535. b) Ibid, Chapter 17,sloka 58, p-535. 197 Yadavji Trikamji Acharya edited, Susruta Samhita Uttara, Chapter 51,sloka 13 Dalhana comentary,1st edition, Chaukhambha Surabharathi Prakashan, Varanasi, p- 762. 198 K.R. Srikantha Murthy edited, Astanga Hrudaya Nidana Chapter 4,sloka 18, 3rd

edition, Krishnadas academy, Varanasi, p- 40. 199 Yadavji Trikamji Acharya edited,Charaka Samhita Chikitsa,Chapter17,sloka 49- 67, Chakrapani Ayurvedadeepika,Chaukhambha Surabharathi Prakashan,Varanasi, p- 534-6. 200 Ibid, Chapter 17, sloka 92-93,150, p-537. 201 Ibid, Chapter 17, sloka 89, p-537. 202 Ibid, Chapter 17, sloka 90, p-537. 203 Ibid, Chapter 17, sloka 91-92, p-537. 204 Ibid, Chapter 17, sloka 139, p-539. 205 Ibid, Chapter 17, sloka 112, p-538. 206 Ibid, Chapter 17, sloka 113, p-538. 207 Ibid. 208 Ibid, Chapter 17, sloka 111, p-538. 209 Ibid, Chapter 17, sloka 114, p-538. 210 Ibid, Chapter 17, sloka 148, p-541. 211 Ibid, Chapter 17, sloka 48, p-533.


Bibilography

212 Ibid, Chapter 17, sloka 71, p-535. 213 Ibid, Chapter 17, sloka 82, p-535. 214 Ibid, Chapter 17, sloka 81, p-535. 215 Ibid, Chapter 17, sloka 85, p-536. 216 Ibid, Chapter 17, sloka 74-75, p-535. 217 Ibid, Chapter 17, sloka 74-76, p-535. 218 Ibid, Chapter 17, sloka 121, p-538. 219 Ibid, Chapter 17, sloka 86, p-536. 220 Ibid, Chapter 17, sloka 87, p-536. 221 Ibid, Chapter 17, sloka 121, p-538. 222 Ibid, siddhisthana, Chapter 1, sloka 11, p- 678. 223 Ibid, Chapter 17, sloka 77-80, p-535. 224 Ibid, Chapter 17, sloka 121, p-538. 225 Ibid, Chapter 17, sloka 49, p-541. 226 Ibid, Chapter 17, sloka 151, p-542. 227 Yadavji Trikamji Acharya edited, Susruta Samhita Uttara,Chapter 51,sloka 55 Dalhana comentary,1stedition,Chaukhambha Surabharathi Prakashan,Varanasi, p- 772. 228 K.R. Srikantha Murthy edited, Astanga Hrudaya Chikitsa Chapter 4, sloka 29, 3rd edition Krishnadas academy, Varanasi, p- 534. 229 a) Satya Narayan Shastri, Charka Samhita Chikitsa Chapter 17, sloka 147, 1st

edition, Choukumbha Bharati Academy, Varanasi, p- 529. b) Ambika Datta Shastri, Susruta Samhita Uttara Chapter 51,sloka 46-47, 15th

edition, Choukumbha Sanskrit Samsthana, Varnasi, p- 381. c) K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, Chapter 4,sloka 25, 2th edition, Krishnadas Academy, Varanasi, p- 249. d) Ambikadatta Shastri, Govindadas, Bhaishajya Ratnavali, Chapter 16, sloka 132-6, 6th edition, Choukumbha Samskrut Pratistan, Varanasi, p- 339. 230 Petersdorf R.G editor, Harison principles of internal medicine, Vol-2, 252 Chapter 14th

edition,1998, India: Mcgraw Hi ll, New York, p- 1422. 231 Sharangadhara, Sharangadhara Samhita, Madyama Khanda, Chapter 6, sloka 13- 14, Edited by Dr. Smt. Shailaja Srivatsava, 3rd edition, Varanasi: Choukambha Orientalia; p.275. 232 Yadavji Trikamji Acharya edited, Charaka Samhita Chikitsa, Chapter 17, sloka 141, Chakrapani Ayurveda deepika, Chaukhambha Surabharathi Prakashan, Varanasi, p- 538. 233 Bhaishajya ratnavali,Chapter 5,Shloka1286-1287,Edited by Ambikadatta Shastry, 15th edition Varanasi: Choukambha Sanskritha Sansthana;2002 p.130-131. 234 Haridas Sridhar Kasture, Ayurvediya Panchakarma Vijnana. 6th edition, Ilahabad, Baidyanath Ayurveda Bhavan limited.1999, p-244. 235 Agnivesha, Charaka Samhita Kalpasthana Chapter 7, Shloka 46-49. 22nd edition. Varanasi: Chaukhamba Orientalia; 1996,p-623. 236 Prof. P.V. Sharma,Dravyaguna vignana,Vol- II. 16th edition, Varanasi: Choukambha Bharati Academy; 1995. p-275-278. 237 Ibid, p-335-336. 238 Ibid, p-359-361.


Bibilography

239 Ibid, p-331-335. 240 Nadkarni K.M, Indian Materia medica, Bombay; Popular Prakashan, Vol –1, 1996, p-45-46. 241 Ibid, p-584-585. 242 Sharma P.V. Dravyaguna Vijnana, Vol. II, Varanasi; Chaukhambha Bharati Academy. 1999, p- 221-223. 243 Ibid, ref 240, p-876-877. 244 Ibid, p-1168-1169. 245 Ibid, ref 242, p- 820-821. 246 Ibid, p- 822-823. 247 Ibid, ref 240, p-280-282. 248 Ibid, p-1149-1150. 249 Ibid, p-1229-1230. 250 Sushruta, Sushrutasamhita, part-1, Sutrasthana, 46th chapter, 314th sloka, Kariraj Ambikadutta Shastri editor, Varanasi; Chaukhambha Sanskrit sansthana, 12th edition, 2001, p- 209. 251 Ibid, ref 242, p-506. 252 Ibid, ref 240, p-480-481. 253 Ibid, ref 242, p-350-351. 254 Ibid, ref 242, p-34-36. 255 Ibid, ref 242, p-753-755. 256 Ibid, ref 240, p-1126-1127. 257 Ibid, ref 242, p- 376-377. 258 Ibid, ref 240, p-35-37. 259 Ibid, ref 242, p- 263-265. 260 Bhavamishra, Bhavaprakasha Poorvakhanda. 5th edition, Varanasi : Chaukhamba Orientalia; 1969. p-232. 261 Ibid, p- 243. 262 Ibid, p- 228. 263 Ibid, p- 222. 264 Ibid, p- 52. 265 Ibid, p- 5. 266 Ibid, p- 10. 267 Ibid, p- 400. 268 Ibid, p- 398. 269 Ibid, p- 797. 270 Ibid, p- 788.


SPECIAL CASE SHEET FOR TAMAKA SWASA Post Graduate Studies and Research Centre (Panchakarma) Shri. D.G.M.Ayurvedic Medical College, Gadag.

Guide : Dr. G. Purushottamacharyulu M. D (Ayu) P.G.Scholar:Dr. Kallanagouda Co-Guide : Dr. Santhosh. N. Belavadi M. D.(Ayu)

1. Name of the patient : Sl. No.

2. Father’s/Husband’s Name : OPD No.

3. Age : ………... yrs IPD No.

4. Sex : Male/Female Bed No.

5. Religion :

Hindu Muslim Christian Others 6. Occupation :

Sedentary Active Labor Others 7. Economical Status :

Poor Middle Upper middle Higher 8. Diet :

Veg Mixed 9. Address : …………………………. Phone No. …………………………. Pin code: ………………………….

10. Date of Schedule of Initiation:

11. Date of Schedule of Completion:

12. Result : Completely Relieved

Good Response

Moderate Response

Poor Response

No Response

13. Consent : I here by agree that, I have been fully educated with the disease and treatment. Here by satisfied whole heartedly, and accept the medical trial over me.

Investigator’s Signature. Patient’s Signature

1

14. A) PRADANA VEDANA WITH KALAVADHI:

SL.No Pradana Vedana Kalavadhi 1 Teevra Vega Swasa 2 Ghur-Ghur shabda 3 Kasa 4 Muhur swasa 5 Kastena-shleshma

Nisharanam

6 Peenasa 7 Kruchrena bhasate 8 Kantodhwamsham 9 Greeva shira

sangraha

10 Uraha peeda 11 Shayane swasa

peedita

B) ANUBANDHI VEDANA WITH KALAVADHI:

SL.No Anubandhi Vedana Kalavadhi 1 Anidra 2 Aruchi 3 Vishukasyata 4 Lalata sweda 5 Trushna 6 Angamarda 7 Kampa 8 Jwara 9 Pramoha 10 Vamathu 11 Pratamyati or

Bhrushamarta

15.ADYATANA VEDANA VRITTANTA:

A) Vyadhi akramna stana:

Approximate date of first attack :

Nature of attack :

Duration of attack : Lying Sitting Standing Posture during attack

The time at which the attack occurs :

Early morning Nocturnal Day

2

Number of attack :

Preceded by :

Sneezing Nasal irritation

Wheeze Eye irritation

Nasal discharge

B) Kujana duration : Mode of onset :

Sudden Natural Continues

Gradual Episodic

Periodicity : Seasonal

Perenial Irregular

C) Kasa Relation with the attack :

Nacturnal Day Dry Productive

D) Nistevan : Quantity

Posturnal Variation

Viscosity Smell Colour

16. POORVA VYADHI VRITTANTA :

Sl No

SYMPTOMS YES NO

1 Peenasa 2 Rajayakshma 3 Sheeta pitta/Udarda 4 Hridroga (IHD) 5 Vicharchika 6 Twak roga

7) Other aliments : 8) Any change of place/Living in costal area :

3

17.CHIKITSA VRITTANTA: a)Ayurvedic medicine :

Yes No If yes details :

b)Modern medicine :

Yes No If yes details : Present Absent 18.KULA VRITTANTA :

If present:

19.OCCUPATIONAL HISTORY : If any 20.VAYAKTIKA VRITTANTA a.Ahara :

Veg Mixed Sevana :

Alpa Sama Ati pramana Dietic habit :

Samashana Adhyasana Vishamashana Agni :

Manda Teekshna Vishama Sama Koshta :

Mrudu Madhya Kroora b.Nidra :

Nature of sleep Day sleep

Night sleep

Total hours

Sound Disturbed c.Vyasana :

Smoking Tobacco chewing

Alcohol None

d.Aarthavapravritti : Alpa Ati Vishama Rajonivrutti

4

20. SAMANYA PAREEKSHA

A. Asta sthāna Pareeksha : B. Vital examination

1 Nadi /Min

2 Mala

pravritti

Frequency 3

Mootra

pravritti Day Night

4 Jihwa

5 Shabda

6 Sparsha

7 Druk

8 Akruti

1 Dehoshmatha /F

2 Swasagati /min

3 Raktachaa ______mm of Hg

4 Height mtr5 Weight Kgs.

C. Systemic examination:

CVS

RS

P/A

CNS

5

D. Dasha vidha Pareekshā :

1 Prakruti V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) Tridoshaja ( )

2 Sāra Pravara. ( ) Madhyama. ( ) Avara ( )

3 Samhanana Pravara ( ) Madhyama. ( ) Avara ( )

4 Pramana Pravara ( ) Madhyama. ( ) Avara ( )

5 Sātmya Ekarasa. ( ) Sarva rasa ( ) Vyamishra ( )

Rooksha satmya ( ) Snigda satmya ( )

6 Satva Pravara ( ) Madhyama ( ) Avara ( )

7 Ahara Shakti a)Abhyavaharana shakti P ( ) M ( ) A ( )

b)Jarana shakti P ( ) M ( ) A ( )

8 Vyayam Shakti Pravara ( ) Madhyama ( ) Avara ( )

9 Vaya Yuva ( ) Vrudda ( )

E. Sroto Pareeksha : Observed Lakshanas.

1. Pranavaha srotas

2. Annavaha srotas

3. Udakavaha srotas

21. NIDANA PANCHAKA:

A.Nidana :

1. Aharaja

2. Viharaja

3. Mānasa

4. Others

6

B. Purva rupas:

SL. No.

Present Absent

1 Hrutpeeda 2 Kshudra swasa 3 Shankha bheda 4 Shoola 5 Pranavilomata 6 Vaktra vairasya 7 Parshwashoola 8 vibandha 9 Anaha 10 Bhakta dwesha 11 Admana

C. Rupas:

SL.No Chief complaints Present Absent 1 Teerva vega swasa 2 Kasa 3 Dukhena kapha

nissaranam

4 Gurguratwam 5 Peenasa 6 Kruchrena bhasate 7 Kantodhwasham 8 Greevashirasangraha 9 Uraha peeda 10 Shayane swsasa peedita

D. Samprapti ghataka’s:

1 Dosha 6 Srotodusti prakar

2 Dusya 7 Adhistana

3 Ama 8 Sanchar sthana

4 Agni 9 Roga marga

5 Srotas 10 Vyadhi swabhava

7

E. Upashaya and anupashaya:- Upashaya :- a) Asheene labhete sowkhyam

b) Sleshma vimokshante sukham

Anupashaya :- a) Shayanasya swasa peedita b) Meghambu sheeta pragwata

c) Shayanasya sameerane

parshweghrnnati

F.Upadrava :

G. Sadhyasadhyata : Sukha sadhya ( ) Kastha sadhya ( ) Yapya ( ) 22. TREATMENT PROTOCOL:

I. Deepana pachana with Panchakol Churna 3 to 6gms 2 times with ushnodaka

before food until Nirama Lakshana are seen.

From To

II. Sneha Pana –Dashamulyadi Grita.

Day

I

Day

II

Day

III

Day

IV

Day

V

Day

VI

Day

VII

Sneha Matra

Sneha pana kala

Agni pradurbhava kala

Time taken for

Sneha jeerna

8

III. Vishrama Kala: Abhyanga with murchita tila taila and Nadisweda. (Group.A) Vamana group :

Day Date

(Group.B) Virechana group : `

Day Date

IV. Pradhana Karma:

Vamana Virechana

Date

Time

Yoga

Matra

Anupana

V. Tatkaleena Nireekshana: Time of first Vega Time of last Vega Total No. Of Vegas

23. VITAL DATA: Observation Before

shodhana

During

shodhana

After

shodhana

Pulse

B.P

Resp. rate

Temperature

9

24. SHODHANA KARMA PARIMANA:

Laingiki Vaigiki Manaki Antiki

Srotoshuddi

Indriya prasannata

Shareera laghuta

Agnideepti

Anamayatwa

Vatanulomana

25. SAMSARJANA KRAMA:

Day Morning Evening I II III IV V VI VII

26. ASSESMENT OF RESULTS:

A) SUBJECTIVE PARAMETERS: SL.

No. Chief complaints Before

Shodhana After shodhana

After follow up

1 Tevra vega swasa 2 Kasa 3 Dhukhena kapha nissaranam 4 Ghurghuratwam 5 Uraha peeda 6 Shayane swasa peedita 7

Frequency of Attack

8 Duratoin of Attack

10

B) OBJECTIVE PARAMETERS:

Investigation Before shodhana

After shodhana

After follow up

Peak Expiratory florate

C/m C/m C/m

Absolute Eosinophilic count.

/Cumm

/Cumm

/Cumm

C) INVESTIGATIONS:

ESR Mm/1stHour

Mm/1stHour

Mm/1stHour

Haemoglobin% Gm% Gm% Gm% Total count WBC

Eosinophillic differential count

27. INVESTIGATOR’S NOTE:

Signature of the Scholar Signature of the Co-Guide

(Dr. Kallanagouda) (Dr. Santhosh. N. Belavadi)

Signature of the Guide

(Dr. G. Purushothamacharyulu)

11

vaman virechan tamakswasa_pk022gdg

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