Clinical Study to Evaluate the Efficacy of Vasadi Syrup and A Yoga...

[Full title: Clinical Study to Evaluate the Efficacy of Vasadi Syrup and A Yoga Intervention Program in the management of Tamaka Shwasa W.S.R to Childhood Asthma]

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© 2023 Nandini Gupta, et al . This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( CC BY NC ND) ( https://creativecommons.org/licenses/by/4.0/ ) ORIGINAL RESEARCH ARTICLE Clinical Study to Evaluate the Efficacy of Vasadi Syrup and A Yoga Intervention Program in the management of Tamaka Shwasa W.S.R to Childhood Asthma Nandini Gupta 1 * , Laxmi Singh 2 , Kalpana Patni 3 , Mithilesh Kumar Verma 4 1 Assistant Professor, Department of Kaumarabhritya, PremRaghu Ayurvedic Medical College and Hospital, Hathras, Uttar Pradesh, India 2 Assistant Professor P.G, Department of Kaumarabhritya, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India 3 Assistant Professor P.G, Department of Kaumarabhritya, IMS, BHU, Varanasi, Uttar Pradesh, India 4 H.O.D of P.G, Department of Kaumarabhritya, State Ayurvedic College and Hospital, Lucknow, Uttar Pradesh, India 1. INTRODUCTION Childhood bronchial asthma has multifactorial causation. Geographical location, environmental, racial, as well as factors related to behaviors and lifestyles are associated with the disease. There is no cure for asthma as per the conventional medical science. Kashyap samhita is the first and foremost classic, which gave a priority to Balachikitsa . As it is a Kapha-vata predominant disorder, its incidence should be witnessed more either during the Balyaavastha , which is the normal time of Kapha dominance [1] Difficulty in breathing or shortness of breath may be simply termed as Shawas (Asthma). It may be primary - originating from respiratory system, secondary - originating from other systems of the body, but the impact is on respiratory system. Bronchial asthma is a chronic inflammatory disease of airway. It leads to the recurrent episodes of wheezing, breathlessness, tightness of chest, and cough particularly at night or early morning [2] As per Ayurveda , Shwasa is mainly cause by Vata and Kapha doshas . Shawas Corresponding Author: Nandini Gupta, Assistant Professor, Department of Kaumarabhritya, PremRaghu Ayurvedic Medical College and Hospital, Hathras, Uttar Pradesh, India. Email: nandini 2517@gmail.com is broadly classified into five types in Mahashawas (dyspnea major), Urdhawashawas (Expiratory dyspnea), Chinna shawas (Chyne stroke respiration), Kshudra shwasa (Dyspnea minor), and Tamaka shawas (Bronchial asthma). Tamak shawas is a Vatakaphaja vyadhi , originating from Pittasthan and manifested through Pranavaha srotas . Vata get obstructed by Kapha dosha and travels into Pratiloma gati (opposite direction) and in turn causes Shwasa (Dyspnea). Its clinical features resemble with bronchial asthma [3] Once among the 8 branches of Ayurveda , Kaumarabhritya specially deals with the problems related with infants and children. It is a unique practice of Ayurveda that Ayurvedic pediatrics deals from conception to 16 years of age. It deals with antenatal perinatal and postnatal care along with the different aspect of child health and disease. In Kashyap samhita , Sutrasthana chapter 25 th “ Vedana adhyaya ” it is mentioned that child suffering from Shwasa roga exhales warm air. The word Tamaka shwasa is found in Khil sthana 10 th chapter while mentioning its management [4] Shwasa is one of the most distressing diseased and is quite common in all the socioeconomic strata all the age groups and almost all over the world. This work has been done with the intension that its way to use natural medicines should justify for implementation as a whole therapy, or to set a systemic integrated approach [5] This approach can International Research Journal of Ayurveda & Yoga Vol. 6(8), pp. 15-22, August, 2023 Available online at http://irjay.com ISSN: 2581-785 X DOI: 10.47223/IRJAY.2023.6803 ABSTRACT Ayurveda is the major systems of indigenous medicines and treatment. Bronchial Asthma occurs due to many causes, for example, environmental, racial, and behavior. Tamaka shwasa is a disease according to Ayurvedic texts that shows close resemblance with bronchial asthma on the basis of clinical manifestations. In this clinical study, we include yoga which is Pranayam , Tadasana , Parvatasana , Paschimottasana , Bhujanagasana , and Shavasana . Moreover, drug is used is Vasadi Syrup which is act as bronchodilator, anti-inflammatory, antihistamine, and immunomodulator. There is no cure for asthma as per the conventional medical science. In this study, patients selected as randomized. The present study was a review on the management of Tamaka-shwasa (bronchial asthma) through Ayurvedic approach that includes a combination of Ayurvedic drugs in Shodhana and Shamana chikitsa and lifestyle management. Thus, a study concluded that the Shodhana , Shamana , herbal, and herbominerals compound ARTICLE INFO Article history : Received on: 19-06-2023 Accepted on: 02-08-2023 Available online: 03-08-2023 Key words : Bronchial asthma, Shamana chikista, Shodhana, Tamaka shwasa

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16 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 helpful to those patients burdened by drug induce toxic side effect and have turned to seek help from natural herbal care 1.1. Aim and Objective of Study To study the concept of Tamaka Shwasa along with childhood asthma through Ayurvedic and modern text and evaluate and observe the effect of Vasadi Syrup with and without Yoga in the management of Tamaka shwasa 2. MATERIALS AND METHODS 2.1. Protocol of Research Approval of synopsis for human trial was obtained from the Institutional Ethical committee of S.A.C. and Hospital, Lucknow, U.P (No. IEC/ AYM/0932018). The study was registered in the Clinical Trial Registry of India (CTRI Registration no: CTRI/2019/05//019137) 2.2. Clinical Study 2.2.1. Sample source All the patients were selected from the OPD & IPD of PG Department of Kaumarabhritya State Ayurvedic College and Hospital, Lucknow U.P 2.2.2. Type of study Randomized two groups comparative clinical trial 2.2.3. Sample size Minimum 30 patients out of which 15 in each group 2.3. Method of Trial Drug The compound will be prepared in the form of syrup on the basis of classical sharkara kalpa preparation to enhance its palatability for easy administration in children 2.4. Inclusion Criteria 1. Age 6–14 years of age both sex 2. Cardinal features of childhood asthma 3. History of at least 3 attacks in last year 2.5. Exclusion Criteria 1. Age <6 and >14 years 2. Shwasa roga associated with complications 3. Secondary infections of respiratory system 4. Children with cardiac disease 5. Children having to pneumonia and tubercular infection 6. Children with any systemic disorder which interfere with the present treatment 7. Children with any congenital anomalies and genetic disorders 2.6. Discontinuation Criteria 1. Parents are not willing to continue the treatment 2. Aggravation of complaints 3. Any other acute illness 2.7. Subjective Criteria 2.7.1. Scoring criteria The detail of the score adopted for the main sign and symptom in this study which is given in MRC Dyspnoea Scale [Table 1] [6] 2.8. Objective Criteria ● The effect of medicine will also be analyzed on certain parameters before and after treatment ● Peak Expiratory flow rate (PEFR) ● BLOOD – Hb%, TLC, DLC, ESR, AEC 2.9. Funding Agency for Lab Investigation ● PEFR ● BLOOD – Hb%, TLC, DLC, ESR, AEC All these are done by self finance 2.10. Overall Effect of Therapy The total effect of therapy of this trial will be grouped as follow 1. Complete remission - 100% 2. Markedly improvement - >75<100% 3. Moderate improvement - >50–75% 4. Mild improvement - >25–50% 5. No improvement - 0–25% 2.11. Content of the Vasadi Syrup Described Below [Table 2] [7] 2.11.1. Group allocation The present study was done on two groups, in which the dissertation work is divided into following sections 2.11.2. Yoga intervention program The following yoga practices will be performed for 20 min daily in the morning for 6 days a week under expert supervision and 1 day at home under parent’s supervision for 30 days up 3 months of trial. The duration of the yoga session will be as follows: Sukshma Vyayam (warming up) - 2 min Pranayam (Respiratory exercise) - (1) Anulome Vilome (4 min) (2) Kapalbhati (4 min) Asanas (Postures) - 8 min Relaxation ( Shavasana ) - 2 min Asanas are Tadasana , Paschimottanasana , Bhujangasana , and Parvatasana shavasana. 2.11.3. Clinical plan The observation of the present study was documented under the headings of demographic observation, to understand the etiological aspects of the disease, clinical observation, to understand the prevalence of signs and symptoms in patients and therapeutic observations, and to assess the effect of therapy on symptoms of Tamaka shwasa. 2.12. Observation 2.12.1. Distribution according to age The minimum age of the subjects was 6 years, whereas maximum age was 15 years. The three age groups 6–9 years, 10–12 years, and 13–15 years were in proportion 33.3%, 38.9%, and 27.8% in Group A, 50%, 33.3%, and 16.7% in Group B, and 41.7%, 36.1%, and 22.2% overall 2.12.2. Distribution according to sex Among the study subjects, 33.3% were female, whereas rest 66.7% were males 2.12.3. Distribution according to religion Among the study subjects, 83.3% were Hindus, whereas rest 16.7% were Muslim. The Group A contained 77.8% Hindus and 22.2%

[Find the meaning and references behind the names: Male, Vega, Dose, Attack, Final, Cases, Chapi, Middle, Mean, Ses, Kasa, Lower]

17 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 Muslim, whereas Group B contained 88.9% Hindus and 11.1% Muslim. Among the study subjects, maximum 50% were belong to the middle SES, 36.1% belong to upper, and 13.9% belong to lower SES 3. RESULTS 3.1 Effect of Treatments on ShawasaKashtata (Breathlessness) in both the Groups (Table 3) In Group A, significant improvement was found from BT to Day 15 (78.95%, P < 0.001) and onward. 100% improvements were seen from BT to Day 60 ( P = 0.001) and onward. In Group B, significant improvement was found from BT to Day 15 (91.67%, P = 0.011) and onward. 100% improvements were seen from BT to Day 30 ( P = 0.011) and onward 3.2. Intergroup Comparison of ShawasaKashtata (Breathlessness) in between the Groups No significant difference in mean ShawasaKashtata (Breathlessness) was found between the groups at BT and any follow-up during the treatment ( P > 0.05) 3.3 Effect of Treatments on Ghurghurakam (Wheezing) in both the Groups (Table 4) In Group A, significant improvement was found from BT to Day 15 (76.47%, P = 0.001) and onward. 100% improvements were seen from BT to Day 45 ( P = 0.001) and BT to Day 60 ( P = 0.001) and AT ( P = 0.001). In Group B, significant improvement was found from BT to Day 15 (100%, P = 0.007) and onward 3.4. Intergroup Comparison of Ghurghurakam (Wheezing) in between the Groups No significant difference in mean Ghurghurakam (Wheezing) was found between the groups at BT and any follow-up during the treatment ( P > 0.05) 3.5. Effect of Treatments on Kasa (Cough) in both the Groups (Table 5) In Group A, significant improvement was found from BT to Day 15 (77.27%, P = 0.002) and onward and at AT 90.91% improvement was seen ( P = 0.001). In Group B, significant improvement was found from BT to Day 15 (76.19%, P = 0.012) and onward and at AT 90.48% improvement was found and this was significant ( P = 0.008) 3.6. Intergroup Comparison of Kasa (Cough) in between the Groups No significant difference in mean Kasa (Cough) was found between the groups at BT and any follow-up during the treatment ( P > 0.05) 3.7. Effect of Treatments on Frequency of Shwasa Vega (Frequency of attack) in both the Groups (Table 6) In Group A, significant improvement was found from BT to Day 15 (66.67%, P = 0.003) and onward and at AT 100% improvement was seen ( P = 0.001). In Group B, significant improvement was found from BT to Day 15 (69.44%, P = 0.003) and onward and at AT 100% improvement was found and this was significant ( P = 0.001) 3.8. Intergroup Comparison of Shwasa Vega (Frequency of attack) in between the Groups No significant difference in mean Frequency of Shwasa Vega (Frequency of attack) was found between the groups at BT and any follow-up during the treatment ( P > 0.05) 3.9. Effect of Treatments on Na ChapiNidraLabhate (Night Symptoms) in both the Groups (Table 7) In Group A, significant improvement was found from BT to Day 15 (87.50%, P = 0.026) and onwards and at AT 100% improvement was seen ( P = 0.026). In Group B, no significant improvement was found from BT to any time of follow-up ( P > 0.05) 3.10. Intergroup Comparison of Na ChapiNidraLabhate (Night Symptoms) in between the Groups No significant difference in mean Na Chapi Nidra Labhate (Night Symptoms) was found between the groups at BT and any follow-up during the treatment ( P > 0.05) 3.11. Effect of Treatments on AsinoLabhateSaukhyam in both the Groups (Table 8) In Group A, significant improvement was found from BT to Day 15 (90.91%, P = 0.002) and onward and at AT 100% improvement was seen ( P = 0.001). In Group B, no significant improvement was found from BT to any time of follow-up ( P > 0.05) 3.12. Intergroup Comparison of AsinoLabhateSaukhyam in between the Groups No significant difference in mean Asino Labhate Saukhyam was found between the groups at BT and any follow-up during the treatment ( P > 0.05) 3.13. Effect of Treatments on Clinical Investigations in both the Groups (Table 9) In Group A, significant changes were found in Eosinophils and PEFR ( P < 0.05). In Group B, significant changes were found in TLC, eosinophils, monocytes, AEC, PEFR, PR, and RR. Rest changes were insignificant 3.14. Final Improvement Status in both the Groups (Table 10) In Group A, the proportion of complete remission and marked improved was 93.8% and 6.3%, respectively, whereas in Group B, the proportion of complete remission, moderate improved, and mild improved was 87.5%, 6.3%, and 6.3%, respectively. No significant difference was found in the proportion of improvement levels between the groups ( P = 0.596) 4. DISCUSSION The enrolled cases of Tamaka shwasa for the present clinical study were kept into two groups. The Vasadi Syrup has been administered in the dose of 1 mL/kg body weight in 3 divided doses. All the necessary measures regarding the preparation of trial drug have been taken carefully. In second group, Vasadi syrup along with a yoga intervention program. The observation was divided into following points: demographic observation, clinical observation, therapeutic observation, in demographic observation, clinical observation, and therapeutic observations. In demographic observation present, we observed 36 patients. In the observation, 66.7% male, 33.33% female, 83.33%

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18 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 Hindu, 16.75% Muslim, 50.00% lower middle class, 97.2% of patients have complete immunization status, 47.2% of patients have good hygiene status, and 2.8% of patients have disturbed sound, 47.2% of patients have mixed diet, 52.8% of patients have Vataj-kaphaj Prakriti , 41.7% of patients have Vataj pittaj prakriti , 86.1% of patients have Madhayam saar , 77.8% of patients have Madhayam satmya , 63.9% of patients have Madhayam satva , 88.9% of patients have Madhyam Ahara sahakti , 61.15% of patients have Avar Vyayam Shakti , 52.8% of patients have dust sensitivity, 16.7% of patients have cold sensitivity, and 16.7% patients have positive family history. The therapeutic observations were done on 32 patients who completed the trial. Trial drug shows highly significant results on Shwasakrucchata , Ghurghuraka , Frequency of Shwasa Vega , Kanthodhvamsa , Asino Labhte Saukhyam , and Usnaschavabhinidti , Parshvashula , Krichchhrabhashitam, and significant results on Kasa , Na Chapi Nidra Labhate saukhyam. Mean PEFR value significantly increased and mean AEC value significantly decreased in objective parameters. Hb% significantly increased, raised ESR, and eosinophils are significantly decreased. Trial drug formed shows positive and hopeful results in response of signs and symptoms of Tamaka shwasa. The result in the present trial drug research work was assessed on the basis of symptomatic improvement. In Group A, 93.8% of patients were completely relieved, 6.3% of patients were markedly improvement, 0.0% patients were moderately improved, and 0.0% patients were mildly improved. In Group B, 87.5% of patients were completely relieved, 0.0% of patients were markedly improvement, 6.3% of patients were moderately improved, and 6.3% of patients were mildly improved 5. CONCLUSION After treatment, the mean PEFR value was significantly increased. The mean AEC value was significantly decreased. Mean PEFR value significantly increased and mean AEC value significantly decreased in objective parameters. Drug shows highly significant results on Shwasakrucchata , Ghurghuraka , Kasa , Peenasa, and Kanthodhwansha and significant results on Lalata sweda and Asino labhte saukhyam (breathlessness during sitting position) in subjective parameters. Hb% significantly increased, raised ESR, and eosinophils are significantly increased. Ingredients of Vasadi syrup are Kaphavatashamak and have different therapeutic actions such as antiallergic, antitussive, antihistaminic, mast cell stabilizing activity, antiinflammatory, and immunomodulatory action 6. ACKNOWLEDGMENTS None 7. AUTHORS’ CONTRIBUTIONS All authors give equal contribution while preparing manuscript 8. FUNDING Nil 9. ETHICAL APPROVALS Approval of synopsis for human trial was obtained from the Institutional Ethical committee of S.A.C. and Hospital, Lucknow, U.P (No. IEC/ AYM/0932018). The study was registered in the Clinical Trial Registry of India (CTRI Registration no: CTRI/2019/05//019137) 9. CONFLICTS OF INTEREST Nil 11. DATA AVAIBALITY This is an original manuscript and all data are available for only review purposes from principal investigators 12. PUBLISHERS NOTE This journal remains neutral with regard to jurisdictional claims in published institutional affiliation REFERENCES 1. Shastri K. Charaka Samhita-Vidhyotini Hindi. Varanasi: Chaukhambha Bharati Academy; 1994 2. Pandyan H. Bhava Prakasha, Vidhyayotini Bhasa Tika. 5 th ed. Vanaransi: Chaukhmbha Sanskrita Shirija; 1980 3. Bagga RK. Esential Pediatrics. 8 th ed. CBS Publishers and Distributers; 2014. p. 383 4. John H. Harrision’s Principle of Internal Medicine. 13 ed. USA: MC Graw-Hill Health Professions Division; 2008. p. 1352-8 5. Patil V. Role of Ayurveda in life style diseases. Int J Yoga 2009;2:22-5 6. Karmakar S, Gupta N, Prasad R. Stress and Asthma. In: Souvenir of 11 th National Seminar on Management of Mental Health through Yoga and Naturopathy. 2015. p. 40-2 7. Morse D. Yoga for Asthma. Int J Yoga Ther 2007;17:81-8 How to cite this article: Gupta N, Singh L, Patni K, Verma MK. Clinical Study to Evaluate the Efficacy of Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa W.S.R to Childhood Asthma. IRJAY. [online] 2023;6(8);15-22 Available from : https://irjay.com DOI link- https://doi.org/10.47223/IRJAY.2023.6803

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19 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 Table 2: Content of the vasadi syrup described below Drug Scientfic name Vasa patra Adhatoda vasica Haridra Curcuma longa Dhanika Coriandrum sativum Guduchi Tinospora cardifolia Bharangi Clerodendrum serretum Nagar Zingiber officinale Kana Piper longum Kantakari Solanum surratense Marich Piper nigrum Table 1: (Continued) Presenting symptoms Score grade No Sleep difficulty of breathlessness whole Night 3 (7) Krichchhrabhashitam (Difficulty in Speaking) No Difficulty in Speaking 0 Difficulty in Speaking during attack 1 Difficulty continuous soon after attack 2 Difficulty continuous for more than time 3 (8) Parshvashula (Chest pain) No pain 0 Pain on exertion 1 Pain on cough 2 Persistent pain 3 (9) Usnaschavabhinidti (Desire to Hot) NO Desire to Hot food and Drink 0 Mild Desire to Hot food and Drink 1 Moderate Desire to Hot food and Drink 2 Severe Desire to Hot food and Drink 3 (10) Asino Labhate Saukhyam Relief in Supine Position 0 Temporarily, feels better in Sitting Posture 1 Relief in Sitting Position 2 Spontaneous Sitting Posture, Cannot Sleep 3 Table 1: Subjective criteria Presenting symptoms Score grade (1) Shwasakashtata (Breatlessness)-(MRCdyspnoea scale) Not troubled by breathlessness and strenuous exercise 0 Not troubled by breathlessness except on strenuous exercise 1 Walks slower than contemporaries on level ground because of breathlessness or have to stop for breath after walking at own pace 2 Stop for breath after walking about 100 meters or after a few minutes on level ground 3 (2) Frequency of Shwasa Vega (Frequency of Attack) No attack during 1 month 0 Frequency of attack once in 1 week or 2 week 1 Frequency of attack once in 2 week or 4 week 2 Frequency of attack once in four or Eight 3 (3) Ghurghurakam (Wheezing) No Wheezing 0 Weezing present during attack 1 Very often Wheezing 2 Always Wheezing found 3 (4) Kasa (Cough) No Kasa 0 Kasa vega sometimes but not troublesome 1 Troublesome kasa , but do not disturbing the sleep 2 Very Troublesome Kasa , does not even allowing to the sleep at night 3 (5) Kanthodhvamsa (irritation in Throat) No Kanthodhvamsa 0 Occasional kanthodhvamsa 1 Very often Kanthodhvamsa 2 Always Kanthodhvamsa 3 (6) Na Chapi Nidra Labhate (Night symptoms) No Night symptoms 0 Sleep Disturbed because of Slight breathlessness 1 Awakening because of breathlessness 2 (Contd...)

[Find the meaning and references behind the names: Imp]

20 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 Table 3: Effect of treatments on ShawasaKashtata (Breathlessness) in both the groups Shawasa Kashtata (Breathlessness) Group A Group B Mean SD % imp z-value! P -value Mean SD % imp z-value P -value BT 1.19 1.38 - - - 1.50 1.71 - - - Day 15 0.25 0.77 78.95 −3.49 <0.001 0.13 0.34 91.67 −2.54 0.011 Day 30 0.06 0.25 94.74 −3.25 0.001 0.00 0.00 100.00 −2.55 0.011 Day 45 0.06 0.25 94.74 −3.24 0.001 0.00 0.00 100.00 −2.55 0.011 Day 60 0.00 0.00 100.00 −3.37 0.001 0.00 0.00 100.00 −2.55 0.011 Day 90 0.00 0.00 100.00 −3.37 0.001 0.00 0.00 100.00 −2.55 0.011 AT 0.00 0.00 100.00 −3.37 0.001 0.00 0.00 100.00 −2.55 0.011 Table 4: Effect of Treatments on Ghurghurakam (Wheezing) in both the Groups Ghurghurakam (Wheezing) Group A Group B Mean SD % imp z-value! P -value Mean SD % imp z-value P -value BT 1.06 1.44 - - - 1.31 1.58 - - - Day 15 0.25 0.68 76.47 −3.42 0.001 0.00 0.00 100.00 −2.70 0.007 Day 30 0.13 0.34 88.24 −2.98 0.003 0.00 0.00 100.00 −2.70 0.007 Day 45 0.00 0.00 100.00 −3.23 0.001 0.00 0.00 100.00 −2.70 0.007 Day 60 0.00 0.00 100.00 −3.23 0.001 0.06 0.25 95.24 −2.69 0.007 Day 90 0.14 0.34 86.76 −3.23 0.001 0.00 0.00 100.00 −2.70 0.007 AT 0.00 0.00 100.00 −3.23 0.001 0.00 0.00 100.00 −2.70 0.007 Table 5: Effect of Treatments on Kasa (Cough) in both the Groups Kasa (Cough) Group A Group B Mean SD % imp z-value! P -value Mean SD % imp z-value P -value BT 1.38 1.31 - - - 1.31 1.35 - - - Day 15 0.31 0.48 77.27 −3.17 0.002 0.31 0.48 76.19 −2.51 0.012 Day 30 0.31 0.79 77.27 −2.77 0.006 0.31 0.79 76.19 −2.22 0.027 Day 45 0.13 0.34 90.91 −3.21 0.001 0.13 0.34 90.48 −3.02 0.003 Day 60 0.19 0.75 86.36 −2.63 0.009 0.19 0.75 85.71 −2.35 0.019 Day 90 0.02 0.06 98.86 −3.20 0.001 0.02 0.06 98.81 −2.97 0.003 AT 0.13 0.50 90.91 −3.21 0.001 0.13 0.50 90.48 −2.67 0.008 Table 6: Effect of Treatments on Frequency of Shwasa Vega (Frequency of attack) in both the groups Frequency of Shwasa Vega (Frequency of attack) Group A Group B Mean SD % imp z-value! P -value Mean SD % imp z-value P -value BT 2.44 1.67 - - - 2.25 1.65 - - - Day 15 0.81 1.22 66.67 −2.96 0.003 0.69 1.20 69.44 −2.96 0.003 Day 30 0.25 0.58 89.74 −2.99 0.003 0.25 0.58 88.89 −2.97 0.003 Day 45 0.13 0.34 94.87 −3.11 0.002 0.13 0.34 94.44 −3.09 0.002 Day 60 0.19 0.75 92.31 −2.99 0.003 0.19 0.75 91.67 −2.90 0.004 Day 90 0.00 0.00 100.00 −3.24 0.001 0.00 0.00 100.00 −3.23 0.001 AT 0.00 0.00 100.00 −3.24 0.001 0.00 0.00 100.00 −3.23 0.001

21 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 Table 7: Effect of Treatments on Na ChapiNidraLabhate (Night Symptoms) in both the Groups Na Chapi Nidra Labhate (Night Symptoms) Group A Group B Mean SD % imp z-value! P -value Mean SD % imp z-value P -value BT 1.00 1.41 - - - 0.80 1.42 - - - Day 15 0.13 0.34 87.50 −2.23 0.026 0.27 0.59 66.67 −1.63 0.102 Day 30 0.06 0.25 93.75 −2.26 0.024 0.13 0.52 83.33 −1.83 0.068 Day 45 0.00 0.00 100.00 −2.23 0.026 0.07 0.26 91.67 −1.84 0.066 Day 60 0.00 0.00 100.00 −2.23 0.026 0.07 0.26 91.67 −1.84 0.066 Day 90 0.00 0.00 100.00 −2.23 0.026 0.07 0.26 91.67 −1.84 0.066 AT 0.00 0.00 100.00 −2.23 0.026 0.07 0.26 91.67 −1.84 0.066 Table 8: Effect of Treatments on AsinoLabhate Saukhyam in both the Groups Asino Labhate Saukhyam Group A Group B Mean SD % imp z-value! P -value Mean SD % imp z-value P -value BT 0.69 1.14 - - - 0.53 1.13 - - - Day 15 0.06 0.25 90.91 −3.16 0.002 0.07 0.26 87.50 −1.47 0.141 Day 30 0.00 0.00 100.00 −3.21 0.001 0.00 0.00 100.00 −1.63 0.102 Day 45 0.00 0.00 100.00 −3.21 0.001 0.00 0.00 100.00 −1.63 0.102 Day 60 0.00 0.00 100.00 −3.21 0.001 0.00 0.00 100.00 −1.63 0.102 Day 90 0.00 0.00 100.00 −3.21 0.001 0.00 0.00 100.00 −1.63 0.102 AT 0.00 0.00 100.00 −3.21 0.001 0.00 0.00 100.00 −1.63 0.102 Table 9: Effect of Treatments on Clinical Investigations in both the groups Parameter Time Group A Group B Mean SD t-value P -value Mean SD t-value P -value Hb BT 12.5 1.4 −2.10 0.053 12.8 1.2 −0.21 0.834 AT 13.2 1.2 12.8 1.1 TLC BT 7753.1 3010.0 −1.32 0.207 9776.9 2643.7 2.94 0.010 AT 8531.3 2393.0 8306.3 3001.0 P BT 56.6 9.2 0.46 0.653 49.1 14.0 −0.95 0.358 AT 55.4 8.8 51.5 9.6 L BT 35.0 12.5 0.60 0.560 41.9 13.3 0.41 0.689 AT 32.8 11.0 40.9 9.9 E BT 6.5 3.0 2.37 0.032 6.1 3.0 3.52 0.003 AT 5.3 2.1 4.7 1.9 M BT 1.4 0.6 1.69 0.111 1.5 0.8 3.00 0.009 AT 1.1 0.8 0.8 0.9 B BT 0.0 0.0 NA NA 0.0 0.0 NA NA AT 0.0 0.0 0.0 0.0 AEC BT 495.1 231.7 0.93 0.367 944.2 1438.0 3.63 0.002 AT 456.8 229.6 732.6 1420.1 ESR BT 17.6 4.2 0.54 0.598 17.1 3.2 1.10 0.289 AT 16.9 3.6 16.2 2.7 PEFR BT 185.6 56.5 −2.33 0.034 219.4 80.3 −3.56 0.003 AT 193.4 59.1 234.6 87.0 PR BT 88.5 14.3 1.94 0.071 95.1 7.9 2.15 0.048 AT 86.6 13.4 93.4 6.3 RR BT 18.3 4.0 0.13 0.896 17.7 3.0 3.16 0.006 AT 18.3 4.5 16.4 2.9 PEFR: Peak Expiratory flow rate

[Find the meaning and references behind the names: Chi]

22 Gupta, et al .: Vasadi Syrup and A yoga Intervention Program in the management of Tamaka Shwasa 2023; 6(8):15-22 Table 10: Final improvement status in both the groups Improvement level Group A Group B Chi-sq P -value No. % No. % Complete remission 15 93.8 14 87.5 3.03 0.386 Markedly improvement 1 6.3 0 0.0 Moderate improvement 0 0.0 1 6.3 Mild improvement 0 0.0 1 6.3 Total 16 100.0 16 100.0 Graph 1: Effects in both groups

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