Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa w.s.r....

[Full title: Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa w.s.r. to Bronchial Asthma]

[Find the meaning and references behind the names: Modern, Raja, Code, Doi, Class, India, Vata, Key, Sita, Date, Vega, Cure, Hospital, Million, Wide, Present, Show, Safe, Diet, Original, Data, Tablet, Age, Patel, Patient, Days, Pankaj, July, Dhananjay, Plays, Nija, Quick, Given, Due, Role, Hara, Shita, Pita, Study, Strong, Aug]

ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2017 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2017 | Vol. 2 | Issue 4 9 Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa w.s.r. to Bronchial Asthma Pankaj Chhayani, 1 Hemang Raghavani, 2 Dhananjay Patel 3 1,2 Assistant Professor, Department of Panchakarma, JS Ayurveda College, Nadiad, Gujarat, 3 Professor and H.O.D. of Kayachikitsa, Gulabkunvarba Mahavidyalaya, Jamnagar, Gujarat, India. I NTRODUCTION Asthma affects 300 million people world-wide and more than 100 million persons will be diagnosed by 2025 [1] Tamaka Shvasa is Vata-Kapha Pradhana and Pita Sthana Samudbhava Vyadhi. [2] When Vata is obstructed by Malaroopa Kapha in Pranavaha Srotas, its movement becomes Pratiloma and Atitivra Vega. [3] In Tamaka Shvasa, Nija Hetus (Intrinsic factors) like unwholesome diet and Agantus Hetus like Raja , Dhuma , Shita Vata etc. are involved [4] Due to Jatharagnimandya and Rasagnimandya, Malaroopa Kapha is produced more in Tamaka Shvasa. In these conditions drugs having properties of Vatanulomana, Vata-Kapha Hara, Ushna plays an important role in Chikitsa of Tamaka Shvasa. [5] For Address for correspondence: Dr. Pankaj Chhayani Assistant Professor , Department of Panchakarma, JS Ayurveda College, Nadiad, Gujarat, India. E-mail: chhayani.ayurved@gmail.com Submission Date : 03/08/2017 Accepted Date: 20/08/2017 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 2 i 4.9321 this purpose, Shirishadi tablet was selected Both contents of tablet have Vata-Kaphahara, Deepana, Rasayana and Shvasaghna properties. O BJECTIVES To assess the efficacy of Shirishadi tablet in management of Tamaka Shvasa and to provide safe and effective remedy to the patients of Tamaka Shvasa. M ATERIALS AND M ETHODS Selection of the patients In present study, 15 patients having classical signs and symptoms of Tamaka Shvasa were selected from O.P.D. & I.P.D. of Kayachikitsa, Government Akhandanand Ayurveda Hospital and Maniben Ayurved Hospital, Ahmedabad. Criteria for Diagnosis The patients were diagnosed on the basis of classical signs and symptoms of Tamaka Shvasa described in Ayurvedic classics. The details of each patient were noted in specific proforma Inclusion Criteria 1 Patients of Tamaka Shwasa in the age group of 16 - 60 were taken A B S T R A C T Tamaka Shvasa is described as a most difficult to cure ( Yapya ) among all diseases in Ayurveda . In present study Tamaka Shvasa is correlated with Bronchial Asthma because of its symptomatology is much similar with Tamaka Shvasa . In modern medical science, steroids and bronchodilators are mainly used for its management, but they cause certain side effects. Present study was undertaken to provide safe and effective remedy for Tamaka Shvasa through Ayurvedic medicaments . Shirishadi tablet was given as internal medicine for 30 days. Upto 60% relief was found in signs and symptoms of Tamaka Shvasa . Key words: Bronchial Asthma, Shirishadi Tablet, Tamaka Shvasa.

[Find the meaning and references behind the names: Luke, Work, Level, Day, Mild, Mini, Dose, Attack, Pain, Meter, Tlc, Cardinal, Rest, Sleep, Person, Few, Warm, Dlc, Ray, Council, Severe, Rate, Esr, Kasa, Weeks, Min, Peak, Able, Early, Flow]

Pankaj Chhayani et.al. Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2017 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2017 | Vol. 2 | Issue 4 10 2 The patients having clinical features of Tamaka Shvasa as per Ayurvedic classics and modern medical science were selected. 3 Patients who are weak and especially not able to tolerate Sansodhana therapy were considered. 4 Chronicity varies from 1 to 8 years. Exclusion Criteria 1 Patients having complications like CCF, Corpulmonale, Emphysema, Pneumonia, Tuberculosis & malignancy etc were not considered in research work. Investigations 1 Routine hematological investigation such as Hb%, TLC, DLC, ESR. 2 Microscopic and routine examination of Urine and stool (if needed) 3 Peak Expiratory Flow Rate by Mini Peak Flow meter. 4 X-ray chest and sputum examinations whenever required. These investigations were conducted to exclude any other underlying pathology. Grouping and management Shirishadi tablet Dose : 4 tablet (each contain 500 mg) twice a day . Duration : 4 weeks Anupana : Ushnodaka (Luke warm water) Criteria for Assessment : The following scoring pattern had prepared for the assessment of the therapy on the basis of signs and symptoms of the disease. A. Cardinal Symptoms The Medical Research Council (M.R.C.) dyspnoea scale for grading the degree of breathlessness was adopted for Shvasakastata. Shvasakastata (Breathlessness) 0 - Not trouble by breathlessness except on strenuous exercise 1 - Troubled by shortness of breath on climbing 2- 3 storeys. 2 - Walks slower than person of same age or stops after 15 min walking. 3 - Stops after walking 100 yards or after a few minute on ground level. 4 - Breathlessness at rest. Ativege Kasate (Frequent bouts of coughing) 0 - No Kasa 1 - Kasa Vega sometimes not troublesome. 2 - Kasa Vega with pain, not disturbing the sleep. 3 - Very troublesome, Kasa does not even allow to sleep at night. Parsve Avagrihyate (Chest tightness) 0 - No such feeling of chest tightness. 1 - Mild chest tightness during attack. 2 - Moderate chest tightness during attack. 3 - Severe chest tightness during attack. Ghurghurakam (Wheezing) 0 - No wheezing. 1 - Wheezing only during attack. 2 - Very often wheezing sound. 3 - Wheezing throughout the day. B. Associated Symptoms Peenasa (Coryza) 0 - No Peenasa. 1 - Peenasa along with the attack. 2 - Very often Peenasa even without attack. 3 - Always Peenasa persisting. Anindra (Disturbed sleep due to breathlessness) 0 - Sound Sleep. 1 - Undisturbed late sleep. 2 - Sleep disturbed in late night and early morning.

[Find the meaning and references behind the names: Mouth, Cant, Ils, Shayane, Comfort, Mean, Table, Shown]

Pankaj Chhayani et.al. Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2017 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2017 | Vol. 2 | Issue 4 11 3 - No sleep. Shayane Shvasa Pidita (Breathlessness during lying posture) 0 - No Shvasa Pidita during Sleep. 1 - Occasional Shvasa Pidita during Sleep. 2 - Very often Shvasa Pidita during Sleep. 3 - Always Shvasa Pidita during Sleep. Asinolabhate Saukhyam (Comfort in sitting posture) 0 - can sleep easily. 1 - 1 pillow required. 2 - 2 pillow required. 3 - 3 pillow required. 4 - cant sleep, spontaneous sitting upright. Lalate Sweda (Sweating over forehead) 0 - No Sweating over forehead. 1 - Mild perspiration. 2 - Moderate perspiration. 3 - Excessive perspiration. Vishushkasyata (Dryness of mouth) 0 - No Vishushkasyata. 1 - Occasional Vishushkasyata. 2 - Very often Vishushkasyata 3 - Always Vishushkasyata. Assessment on the basis of complaints Controlled - 100% relief in complaints Marked Relief - ≥ 75% relief in complaints Moderate Relief - ≥ 50 - 74 % relief in complaints Mild Relief - ≥ 25 - 49 % relief in complaints No Relief - < 25% relief in complaints S TATISTICAL ANALYSIS The paired ‘t’ test had used for analyzing the data generated during the study. The value of P<0.05 or 0.01 is considered as statistically significant, the value of P<0.001 is considered statistically highly significant, the value of P>0.05 is considered statistically insignificant. R ESULT Improvement in cardinal symptoms were Shwasakastata 60%, Ativege Kasate 58.06%, Parsve Avagrihyate 60.97% and Ghurghurakam 50% which were highly significant. The total effect on signs and symptoms is as shown below in Table 1, effect on Hematological values and P.E.F.R. in Table 2. The Table 3 depicts the overall effect of therapy. Table 1: Total effect of therapy on signs and symptoms of Tamaka Shwasa . n Mean Score % Relief X S.D. ± S.E. ± t p BT AT 15 18. 08 8.2 54.61 9.88 1.99 0.51 19.1 5 <0.0 01 Table 2: Effect on the Haematocrit Values of 15 Patients of Tamaka Shvasa. Paramet er Mean Score % Relief S.D. ±±±± S.E. ±±±± t p B.T. A.T. Hb% 11.9 3 12.0 2 3.35 ↑ 0.47 0.12 3.2 9 <0.0 1 TLC 8146 .6 7753 .3 4.82 ↓ 499. 23 128. 9 3.0 5 <0.0 1 Neutrop hils 4.93 2.33 52.70 ↓ 2.16 0.55 4.6 5 <0.0 01 Eosinoph ils 74.5 3 70.1 3 5.90 ↓ 3.64 0.94 4.6 8 <0.0 01 E.S.R. 25.6 17.4 32.03 ↓ 4.98 1.28 6.3 6 <0.0 01

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Pankaj Chhayani et.al. Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2017 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2017 | Vol. 2 | Issue 4 12 P.E.F.R. 174 241. 33 27.90 28.1 4 7.26 9.2 6 <0.0 01 Table 3: Overall Effect on 15 Patient of Tamaka Shvasa Assessment Group A No. of Pts % Marked responses (>75%) 0 0 Moderate response (50-75%) 13 86.66 Mild improvement (25-50%) 2 13.33 No response (<25%) 0 0 Overall effects show that complete remission was not found while 86.66% of cases found moderate relief and 13.33% cases found mild relief in this group DISCUSSION Statistically highly significant effect was observed on Shwasakastata , Ativege Kasate, Parsve Avagrihyate, Ghurghurakam, Anindra , Shayane Shwasa Pidita, Asino Labhate Saukhyam, Lalate Sweda and Vishushkasyata while significant effect was noted on Peenasa. The increase in the Peak Expiratory Flow Rate values after treatment suggest the improvement in airway obstruction in alveoli of lungs and increase in ventilatory functions Probable mode of action In Tamaka Shwasa Vata-Kapha are main Dosha while it originates in Pittasthana, [6] so Pitta also involves indirectly Shirisha is Tridoshaghna while Pippali is Vata-Kapha Hara, Pitaavirodhi [7] and Rasayana Dravya of Pranavaha Srotasa . Pippali is pivotal for the purification process in the body, because it cleans the Srotas that transports nutrients and help in the removal of wastes from the body. The main factor in the disease is Malaroopa Kapha along with Vata and the properties of Deepana and Pachana of drug help to decrease production of Malaroopa Kapha from Rasa Dhatu and consequently obstruction of Vata will clear. Extract from Shirisha include polyphenols, flavonoids, terpenes, amines etc. all of which are observed to have potential anti-allergic activity [8] while Piperine, major compound of Pippali has strong anti oxidant, immunomodulatory and anti inflammatory activity [9] CONCLUSION Shirisha is best Vishaghna (anti poisonous) Dravya. [10] It contains anti allergic and anti asthmatic activity. Pippali is good Rasayana Dravya of Pranavaha Srotas (respiratory system). In Tamaka Shwasa immunity is decreased and Pippali is good immunomodulatory drug. Overall both Pippali and Shirish showed good anti asthmatic activity and found beneficial in cases of allergic bronchial asthma Shirishadi tablet can be taken for long time and have no any side effects if it is taken in proper dose. REFERENCES 1 Nicholas A. Boon, Davidson’s Principles and practice of Medicine,Chapter 19, 20 th edition, Churchill Livingstone Elsevier Publication, 2006;p.670. 2 Agnivesha, Charaka, Dridbala, Charaka Samhita, Chikitsa Sthana, Hikka Shwasa Chikitsa Adhyaya 17/9, edited by Dr. Gangasahaya Pandeya, Chaukhambha Sanskrit Sansthan, Varanasi, 2009;p.434. 3 Agnivesha, Charaka, Dridbala, Charaka Samhita, Chikitsa Sthana, Hikka Shwasa Chikitsa Adhyaya 17/55- 56, edited by Dr.Gangasahaya Pandeya, Chaukhambha Sanskrit Sansthan, Varanasi, 2009;p.440. 4 Agnivesha, Charaka, Dridbala, Charaka Samhita, Chikitsa Sthana, Hikka Shwasa Chikitsa Adhyaya 17/11- 16, edited by Dr.Gangasahaya Pandeya, Chaukhambha Sanskrit Sansthan, Varanasi, 2009;p.435 5 Agnivesha, Charaka, Dridbala, Charaka Samhita, Chikitsa Sthana, Hikka Shwasa Chikitsa Adhyaya 17/147, edited by Dr. Gangasahaya Pandeya, Chaukhambha Sanskrit Sansthan, Varanasi, 2009;p.452 6 Agnivesha, Charaka, Dridbala, Charaka Samhita, Chikitsa Sthana, Hikka Shwasa Chikitsa Adhyaya 17/8, edited by Dr.Gangasahaya Pandeya, Chaukhambha Sanskrit Sansthan, Varanasi, 2009;p.434.

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Pankaj Chhayani et.al. Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa. ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2017 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2017 | Vol. 2 | Issue 4 13 7 Susruta, Sushruta Samhita, Sutra Sthana, 46/223. Edited by Dr.Bhaskar Govind Ghanekar, Meharchand Lachhamandas Publications, New Delhi, 2004;p.286. 8 Venkatesh P, Mukhereje PK, Kumar NS, Bandopadhyay A, Fukui H, Mizuguchi H, Islam N; Anti allergic activity of standardized extract of Albizia Lebbeck with reference to catechin as a phytomarker; Immunopharmocal Immunotoxicol 2010, Jun; 32(2)272-6. 9 Beena Joy, CP Sandhya and KR Remitha; Comparison and bio-evaluation of piper Longum fruit extracts; J.Chem.Pharm.Res.,2010, 2 (4): 612-622. 10 Agnivesha, Charaka, Dridbala, Charaka Samhita, Sutrasthana, Yajjapurusheeya Adhyaya 25/40, edited by Dr.Gangasahaya Pandeya, Chaukhmbha Sanskrit Sansthan, Varanasi, 2009;p.319. ******************************* How to cite this article: Pankaj Chhayani, Hemang Raghavani, Dhananjay Patel. Clinical Study of Shirishadi tablet in the management of Tamaka Shvasa w.s.r. to Bronchial Asthma. J Ayurveda Integr Med Sci 2017;4:9-13. http://dx.doi.org/10.21760/jaims.v 2 i 4.9321 Source of Support: Nil, Conflict of Interest: None declared.

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Kayachikitsa, Bronchial asthma, Associated symptoms, Tamaka-Shvasa, Statistical analysis, Inclusion criteria, Exclusion criteria, Immunomodulatory activity, Anti-allergic activity, Intrinsic Factor, Total effect of therapy, Peak Expiratory Flow Rate, Cardinal symptom, Vata-Kapha Hara, Rasayana Dravya, Anti-asthmatic activity, Vata Kapha Pradhana, Ayurvedic medicament, Safe and effective remedy, Medical Research Council, Pranavaha Srota.