Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

TAMAKA SWASA (BRONCHIAL ASTHMA) Treatment Protocol by Ayush

 

INTRODUCTION

Tamaka Swasa is one among the five types of Swasa (dyspnoea) mentioned in Ayurveda. It can be compared to bronchial asthma in modern medical science. Tamaka Swasa as a diagnostic terminology encompasses various stages of asthma including atopic (allergic) asthma to chronic obstructive pulmonary disorders. The Tamaka Swasa of recent onset is curable; however it becomes incurable after attaining the chronicity.1 So early diagnosis and therapeutic intervention is important.

Case definition:

Episodic manifestation of breathlessness triggered due to dust, cloudy atmosphere, exposure to direct wind, cold water,2 often associated with cough, wheezing is called as Tamaka Swasa.

Variants

  1. Type 1 – Kaphadhika
  2. Type 2 – Vatadhika

Differential Diagnosis:

  1. Kshudra Swasa3
  2. Chhinna4 / Mahan5 / Urdhwa Swasa6
  3. Hridroga
  4. Rajayakshma
  5. Pandu Roga
  6. Vataja Grahani
  7. Kasa
  8. Urahkshata

Line of management

Type 1 – Kaphadhika Shodhana / Kapha Nissaraka / Dhuma followed with Shamana treatment, Kutipraveshika Rasayana.7

Type 2 – Vatadhika Tarpana / Shamana and Bhrimhana, Vatatapika Rasayana.8

LEVEL 1: AT SOLO AYURVEDIC PHYSICIAN’S CLINIC/ PHC

Clinical Diagnosis: On the basis of history and clinical presentation. Subtypes to be analyzed considering the tolerance of patient, periodicity and chronicity of the complaints.

Patient Examination: Detailed examination of Pranavaha Srotasa to identify the severity of breathing difficulty.

Investigations: Hemogram, ESR

Treatment:

Type 1 Kaphadhika variant: Treatment of Vegavastha (At the time of acute exacerbations): Local Abhyanga with Lavana Taila (Taila added with powdered salt and heated ) or any Vatahara Taila like Brihatsaindhavadi Taila applied over the chest and back followed with Swedana (local steam fomentation).9

 

Table 2.1: Medicines at level 1 for Kaphadhika Tamaka Swasa

 

Drugs

Dosage Form

Dose

Time of administration

Duration

Anupana

Shunthi Siddha Jala

Paniya

Q.S.

Frequently

15 days to 30 days

Nil

Dashamool-arishta

Arishta

15-30 ml

4-5 times a day

15 days to one month

-

Chandrashura Beeja Kwatha

Kwatha

15-30 ml

4-5 times a day

15 days to one month

Nil

Swasakuthara Rasa10

Powder

125 mg

Before food/ Twice or thrice daily

15 days to one month

Honey

Talishadi Churna11

Powder

2-3 gm

As linctus frequently

15 days to one month

Honey

Sitopaladi Churna12

Powder

2-3 gm

For chewing/ frequently

15 days to one month

Honey

Shatyadi Churna13

Powder

2-3 gm

Before meals/Twice or thrice daily

15 days to one month

Honey

Dasamoola Kwatha14

Decoction

60 ml

empty stomach/ Twice daily

15 days to one month

1 tsp

Honey

Bharangyadi Kwatha15

Decoction

60 ml

empty stomach/ Twice daily

15 days to one month

1 tsp

Honey

Gojihvadi Kwatha16

Decoction

60 ml

empty stomach/ Twice daily

15 days to one month

1 tsp

Honey

Vasavaleha17

Avaleha/ linctus

3-5 gm

As linctus/ frequently

15 days to one month

-

Dashamoola Rasayana18

Avaleha/ linctus

3-5 gm

As linctus/ frequently

15 days to one month

-

Agasthya

Rasayana19

Avaleha/ linctus

3-5 gm

As linctus/ frequently

15 days to one month

-

 

 

 

 

 

 

Table 2.2: Medicines at level 1 for Vatadhika Tamaka Swasa

Drugs

Dosage Form

Dose

Time of administration

Duration

Anupana

Vidaryadi

Kashaya20

Decoction

60 ml

empty stomach/twice daily

15 days to one month

1 tsp

Honey

Vayu

Gutika21

Vati

125 mg

Before meals/Twice or thrice daily

15 days to one month

Honey

Dhanwantara

Gutika22

Vati

125 mg

Before meals/Twice or thrice daily

15 days to one month

Honey

Nayopayam

Kwatha23

Decoction

60 ml

empty stomach/twice daily

15 days to one month

Honey

Kantakari

Ghrita24

Ghee

3-5 gm

After food/Twice or thrice daily

15 days to one month

Warm water

Vidaryadi

Ghrita25

Ghee

3-5 gm

After food/Twice or thrice daily

15 days to one month

Warm water

Somasava

Asava

15-30 ml

4-5 times a day

15 days to one month

Equal amount of water

Mahanarayana Taila

Taila

5 ml

4-5 times a day

15 days to one month

Balajirakadi Kwatha

 

 

Pathya-apathya (diet and life style):

All such food items alleviating Kapha and Vata, Ushna in property should be taken. And all such food items increasing Vata are contraindicated. Care should be taken to improve the strength of the patient without aggravating Kapha.

Do’s (Pathya)–

  • Food (Ahara): All dietary articles should be easily digestible and served warm. Unpolished rice, wheat, green gram, horse gramne.

 

(Kulatha), goat milk, green leafy vegetables like Patola, Shigru, brin­jal, garlic, cardamom, cinnamon, pepper, ginger, honey, crab soup, Krita and Akrita Mamsa Rasa. Luke warm water for drinking26

  • Regimen (Vihara): Fomentation, hot water bath, moderate sun bath, warm clothes etc. and staying in fresh and ventilated places. Doing light exercises and maintaining daily routine.

 

 

Don’ts (Apathya)–

  • Food (Ahara): All cold and heavy food should be avoided. Oily and fried items, bakery items, fast foods, chocolates, wafers etc. should be strictly avoided. All dairy products27 especially curd, paneer and ice creams should be strictly avoided. Intake of sesame, black gram, jaggery should be limited.28
  • Vihara: Exposure to cold, dust, smokes and direct wind should be strictly avoided.29 Hard exercises and peak sun exposure are not advisable. Avoid air coolers and air conditioners. Avoid cold water bath and application of oil on head especially on symptoms of cold. Do not suppress natural urges especially coughing, sneezing and bowel and bladder responses. Avoid day sleeping.30

Referral criteria: Refer to level 2

  1. Cases not responding to above line of management.
  2. All cases of severe persistent Asthma.
  3. Patient with co-morbidity of fever, patient may be suffering from cyano­sis, patient may have signs of hyper­capnia and in acute phase of febrile illness.

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

Clinical Diagnosis:- Same as level 1 for a fresh case reporting directly.

Investigation: same as level 1, in addition

  • Sputum for AFB and Mantoux Test (Both to rule out Pulmonary TB in suspected cases)
  • X- Ray of chest – PA view to rule out structural abnormalities to bilateral lungs, allied parts and heart.
  • Pulmonary function tests- To assess the lung capacities.
  • ECG

Treatment:

Type 1 Kaphadhika Variant: Treatment of Vegavastha (At the time of acute exacerbations): The patients with Vegavastha and Utklishta Dosha should be given Abhyanga with Lavana Taila and Swedana followed by Ullekhna (Vamana) with warm saline water. Repeated Ushma Sweda with steam made from water and Tulasi leaves may be given. After Kapha Shodhana patient may be subjected to moderate laxatives (Mridu Virechana) using Trivrita Lehya 15-20 gm without any Purvakarma.31

In addition to the Shamana management mentioned in Level 1, few of the following drugs may be added as per the requirement and status of the patient.

 

 

Table 2.3: Medicines at level 2 for Kaphadhika Tamaka Swasa

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Dashamoola Katutrayadi

Kashaya32

Decoction

60 ml

Empty stomach/ Twice daily

15 days to one month

1 tsp

honey

Swasakuthara Rasa33

Churna / Vati

125-250 mg / 1-2 Vati

After meal/twice daily

2-3 weeks

Honey/ Luke warm water

Svasakasa Chimtamani Rasa 34

Churna / Vati

125-250 mgs/ 1-2 Vati

After meal/twice daily

2-3 weeks

Honey/ luke warm water

Kanakasava35

Asava

10-20 ml

After meal/ twice daily

2-3 weeks

Equal quantity of water

Pipplayasava36

Asava

10-20 ml

After meal / twice daily

2-3 weeks

Equal quantity of water

Vyaghriharitaki Avaleha37

Avaleha

5-10 gm

Before meal twice daily

2-3 weeks

-

Shirisharishta38

Arishta

10-20 ml

After meal/ twice

2-3 weeks

Equal quantity of water

Suvarnamalini Vasanta39

Churna/ Vati

125-250 mg / 1-2 Vati

After meal/twice daily

2-3 weeks

Honey/ Luke warm water

Swasakuthara mishrana Swasakuthara Rasa40 1 part, Sutasekhara Rasa41 1 part and Karpooradi Churna42 4 part

Powder

1-2 gm

3-4 times a day during attack

During attack

Honey

Laxmivilasa Rasa43

Powder

250 mg

After food thrice a day

2-3 weeks

Honey

Mrityunjaya Rasa44

Powder

250 mg

After food thrice a day

2-3 weeks

Honey, Ardraka Swarasa, Narilkela Sitayukta

 

 

Type 2 Vatadhika variant: Snigdha Mridu Virechana with Eranda Taila 15-20 ml and milk (50-75 ml) may be given. Dhanwantarm Gutika45 in frequent doses with Jeeraka water may be given in increased distress.

Pathya-Apathya (diet and life style): Same as Level 1

Referral Criteria: Refer to Level 3

  1. Cases not responding to above therapy.
  2. Moderate to Severe cases of Tamaka Swasa with complications.
  3. Severe cases associated with tuberculosis, cardiac diseases etc.
  4. Chronic cases of Tamaka Swasa which require classical Shodhana therapy

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL

LEVEL OR DISTRICT HOSPITAL / INTEGRATED AYURVEDIC

HOSPITALS

Clinical Diagnosis: Same as level 1 for a fresh case reporting directly

Investigation:-

  • TMT to rule out Cardiac pathology and to ensure fitness for Shodhana therapy.
  • 2D Echocardiography

Treatment: In addition to the management of Level 1 and Level 2, if needed Panchakarma procedures can be performed.

Type 1 Kaphadhika variant: Purvakarma as Pachana, Deepana (Rookshana if required), Snehapana and Swedana may be done before Shodhana

  1. Pachana & Deepana
  2. Rookshana if required - Butter milk with Hingvashtaka Churna to be given frequently for 2-3 days.
  3. Snehapana & Swedana
  4. Vamana followed with Dhoomapana
  5. Virechana
  6. Rasayana

Table 2.4: Medicines at level 3 for Kaphadhika Tamaka Swasa

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Vardhamana Pippali Prayoga

Kshirapaka

Starting with 3 Pippali increasing upto 33 Pippali

Early morning empty stomach

1 course (22 days)

Nil

Agasthya Rasayana46

Avaleha

15 gm

Early morning empty stomach

One month

Warm water

Chyavana Prasha Avaleha47

Avaleha

15 gm

Early morning empty stomach

One month

Warm milk

 

Type 2 Vatadhika variant: Same line of management in Level 2 during Vegavastha. Patient can also be supported with application of 20-30 drops of Ksheerabala (101) Avrita48 over the chest and mild massage. Debilitated patients may be planned for Sarvanga Abhyanga with Dhanwantaram Taila49 and Shashtika Pinda Sweda as IPD.

Table 2.5: Medicines at level 3 for Vatadhika Tamaka Swasa

Drugs

Dosage form

Dose

Time of administration

Duration

Anupana

Malla Naga Mishrana (Malla Sindoora 1 part50, Naga Guti 1 part51, Abhraka Bhasma1 part52, Shringha Bhasma 4 part53

Powder

250 to 500 mg

3-4 times as frequent dose

One month

With honey

Prabhakra Vati54

Vati

750 mg

Twice daily

One month

Arjunarishta

 

 

 

REFERENCES

 

 

1 Charaka, Charaka Samhita, Chikitsa Sthana 17/62, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 516

2 Charaka, Charaka Samhita, Chikitsa Sthana 17/62, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 516

3 Charaka, Charaka Samhita, Chikitsa Sthana 17/65-67, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 518

4 Charaka, Charaka Samhita, Chikitsa Sthana 17/52-54, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 516

5 Charaka, Charaka Samhita, Chikitsa Sthana 17/46-48, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 515

6 Charaka, Charaka Samhita, Chikitsa Sthana 17/49-51, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 515

7 Charaka, Charaka Samhita, Chikitsa Sthana 17/89, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 521

8 Charaka, Charaka Samhita, Chikitsa Sthana 17/90, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 521

9 Charaka, Charaka Samhita, Chikitsa Sthana 17/71, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 518

10 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20:49), 2000, p. 373

 

 

11 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (7:13), 2000, p. 321

12 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (7:34), 2000, p. 348

13 Charaka, Charaka Samhita, Chikitsa Sthana 17/123-124, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 526

14 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (4:10), 2000, p.176

15 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (4:25), 2000, p. 192

16 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (4:7), 2000, p. 41

17 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (3:26), 2000, p. 153

18 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (3:14), 2000, p. 135

19 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (3:1), 2000, p. 111

20 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (4:31), 2000, p. 199

21 Vajrajivana, Sahastrayogam Gutika Prakarna, 3rd edition, Delhi: Chaukhamba Sanskrit Prathisthan; 2001, p. 255

22 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (12:14), 2000, p. 518

23 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (4:14), 2000, p. 180

24 Charaka, Charaka Samhita, Chikitsa Sthana 18/125-128, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 547

25 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (6:41), 2000, p. 297

26 Sri Govindacharya, Bhaishajya Ratnavali, Hikka-Swasa Chikitsa Adhyaya 16/137- 139, p. 509

27 Charaka, Charaka Samhita, Chikitsa Sthana 17/14-16, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 510

28 Rajkumar, Food allergy in bronchial asthma: Diagonostic modalities; Indian Journal of Allergy, Asthma and Immunology; July- Dec 2013, Vol. 27, Issue 2

29 Raj Kumar, Nirupam Sharan, Manoj Kumar, Indu Bisht, S. N. Gaur, Pattern of skin sensitivity to various aeroallergens in patients of bronchial asthma and/or allergic rhinitis in India; Indian Journal of Allergy, Asthma and Immunology Jul-Dec 2012, Volume 26, Issue 2

30 Sushruta, Sushruta Samhita, Uttara Tantra 50/3-5, In: Ambikadutta Shastri, Reprint,

 

 

Varanasi: Chaukhamba Sanskrit Sansthan; 2008, p. 365

31 Charaka, Charaka Samhita, Chikitsa Sthana 17/89, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukhamba Sanskrit Sansthan; 2009. p. 521

32 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (4:9), 2000, p.107

33 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20:49), 2000, p. 730

34 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part II (16:58), 2000, p. 241

35 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (1:9), 2000, p. 53

36 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (1:22), 2000, p. 75

37 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (3:6), 2000, p. 30

38 Sri Govindacharya, Bhaishajya Ratnavali, Swasa Rogadhikra 72/72, Chaukhamba Prakshan Varanasi, 2008

39 Siddha Bhaishajya Manimala of Mahakavi Sri Krishnaram Bhatta edited with Vaishnawra hindi commentary by Sri R. Kaladhara Bhatta and notes by Sri Laxmiram Swami. Krishnadas Academy, Varanasi. Second edition. 1999. Jvaraadhikar 60-62

40 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20:49), 2000, p. 730

41 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20:52), 2000, p. 735

42 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (7:6), 2000, p. 313

43 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (20:39), 2000.

44 Pandit Duttaram Chaubhay, Bruhat Rasa Raj Sundar p. 244, Varanasi: Chaukhambha Orientalia, 2000.

45 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (12:14), 2000, p. 518

46 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (3:1), 2000, p. 111

47 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (3:11), 2000, p. 127

48 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (8:11), 2000, p. 378

49 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (8:22), 2000, p. 394

 

50 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (15:3), 2000, p. 567

51 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (18:7), 2000, p. 609

52 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (18:1), 2000, p. 591

53 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part I (18:19), 2000, p. 642

54 Sri Govinda Dasa, Bhaishajya Ratnavali 33/40-41, In: Ambikadutta Shastri, Chaukhamba Prakashan Varanasi, 2009