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
- Type 1 – Kaphadhika
- Type 2 – Vatadhika
Differential Diagnosis:
- Kshudra Swasa3
- Chhinna4 / Mahan5 / Urdhwa Swasa6
- Hridroga
- Rajayakshma
- Pandu Roga
- Vataja Grahani
- Kasa
- 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
- Cases not responding to above line of management.
- All cases of severe persistent Asthma.
- 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
- Cases not responding to above therapy.
- Moderate to Severe cases of Tamaka Swasa with complications.
- Severe cases associated with tuberculosis, cardiac diseases etc.
- 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
- Pachana & Deepana
- Rookshana if required – Butter milk with Hingvashtaka Churna to be given frequently for 2-3 days.
- Snehapana & Swedana
- Vamana followed with Dhoomapana
- Virechana
- 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 |
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