Ayurvedic Approach to Childhood Respiratory Infections

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January 2013 :Volume 01: Number 01 E- ISSN: 123-456-789
E-Journal of
Indian Association of
Ayurvedic
Pediatrics
JIAAP
An official publication of Indian Association of Ayurvedic Pediatrics
THEME
“Preventive and curative Ayurvedic therapies for ‘The Respiratory tract

diseases' in children”
FOR CURRENT ISSUE
Editorial Board
Dr. Abhimanyu Kumar ( Prof & H.O.D Balrog NIA ,Jaipur/IAAP President )
In Focus
Dr. B.M. Singh (Asso. Prof.& HOD Balrog,BHU ,Varanasi )
Dr. Shailaja Rao (Prof & H.O.D Kaumrbhritya ,SDM college of ayurveda HASSAN)
Dr.A. Kale (Prof.&HOD,Govt.Ayurveda college, Usmanabad/IAAP Treasurer )
Dr. P. Pai ( Asso. Prof. College of Ayu.Bharati Vidhyapeeth ,Pune )
Dr. A. Bhattacharya : Reader , J.B.Roy Ayurveda College, Calcutta /IAAP

member
INDEX
1.Ayurvedic Measures In Preventive And Curative Aspect Of Childhood
Recurrent Upper Respiratory Tract Infections (Pratishyaya).
Dr Vinayak G Galatage,
2.Study the effect of “Amritdhara”in shwaas vyadhi used as an aerosol in
wheeze w.s.r. to its bronchodilator effect.
Dr. Sandip J. Nikam.
3.A Clinical Study of Kasahar kwath & Sadyasnehpan in younger Children of
URTI :
Dr.Renu Bharat Rathi,
4. Study on the effect of virechana and kantakaryavaleha in the management of
childhood asthma
Dr Sharashchandra R*,
5. A Clinical study on kasa with an indigenous drug compound
Dr Sharvari s Deshpande *
6.“Effect of swarnamritaprashana in recurrent attacks of kasa”
Dr. Rushikesh Tikole
7.Effect of Shvasahara Avaleha in the Management of Tamaka Shvasa in Children
Dr. Arun Raj GR,
8. CLINICAL STUDY OF IMMUNOMODULATORY EFFECT OF AN AYURVEDIC
COMPOUND (KASHYAPOKTA LEHA) IN RECURRENT URTI IN CHILDREN.
Dr. Jyotsna J.Ahir1,
9.“Effect of Amritadi lozenges in the treatment of kaphaja kasa in children”
Dr Nabisab Kamatnur*
10. An Ayurvedic Approach Towards The Management of Allergic Rhinitis
Dr. Priyanka
1
Ayurvedic Measures In Preventive And Curative Aspect Of Childhood
Recurrent Upper Respiratory Tract Infections (Pratishyaya).
Dr Vinayak G Galatage, ** Dr .Puranikmath MC
*PG Scholar, ** Asst Professor P.G Department of Kaumarbhritya ,KLE University’s Shri BMK
Ayurveda Mahavidyalaya, Shahapur, Belagaum-03.,E-mail: drvinay.galatage03@gmail.com
Introduction-
Upper respiratory tract infections account for a substantial proportion of visits to pediatricians.
Approximately one third of such illnesses feature sore throat as the primary symptom.1
Upper respiratory tract infection (URTI) is a nonspecific term used to describe acute infections
involving the nose, para-nasal sinuses, pharynx, and larynx. There are no standardized criteria laid
down in any authentic textbooks of medicine or pathology regarding the number of episodes that
are essential to coin the term ‘Recurrent Upper Respiratory Tract Infections’ (RURTI).Somewhere
mentioned that RURTI if ≥ 6 respiratory infections per annum, ≥ 1 respiratory infections per month
involving the upper airways from September to April2.It was mentioned that the disease entity
Pratishyaya covers most of these aspects described under recurrent upper respiratory infections
(RURTI).3
Challenge-
A lot of modern diseases entities can be included under the heading of pratishyaya. The diseases
entity URTI are going almost hand in hand with the pratisyaya.These URTI have significant impact
on the health and academic performance of students . 4Accordind to who recurrent infections are
major cause of decreased school performance and school absenteeism in developing as well as
developed countries.5 Usually URTI are not considered fatal or alarming, but if it is managed
improperly it can lead to several complications which may be life threatening or crippling. 6
Objectives-
1. To study conceptually the childhood recurrent upper respiratory tract infection (pratishyaya)
occurring in children contemplating both Ayurvedic and Modern points of view.
2. To focus a light on ayurvedic measures an preventive and curative aspect of recurrent upper
respiratory tract infection vis-à-vis pratishyaya
Conceptual study-
RURTI/Pratishyaya and ayurveda-
Pratisyaya is a disease, which we comeacross in daily practice. It manifests as an independent
disease and also appears as asymptom in many other disease conditions.It of vata and kapha doshas.
The hetus (causes) which break the balance of tridosha and provoke vata and kapha simultaneously
may lead to pratisyaya. Pratisyaya appears in pranavahasrotas. Even though this disease appears
simple, it runs a chronic course leading to kasa, svasa and rajayakshma.
Why URTI Incidence Is More Common in Paediatric Age Group?
Modern –
Anatomical and physiological considerations: Small narrow airways hypertrophied lymphoid
tissues, underdeveloped / undeveloped para-nasal sinuses, mucus hyper secretion and peculiarities
of Eustachian tube.
Immunological considerations: First exposure, Young cells and immature immunological defences
Social factors: Improper foods / food habits and chances of more exposure at school/ day care
centre
Ayurvedic -
1.Dosha Dushyamalalpata-7
2.Saukumaryaalpakaytwatata 8
3.Aparipakwa Dhatu9
4. Asampurna Bala9
5.Kleshasahishnutwa. 9
6.Bhyashya,krodha,Ritu vaishyama,atibshpa.10
7.Dhooli raja sheet samparka.11
8.Avashyayanil raja atiswapna,nicha upadhanaen,pitenayen varin,atyambupaan,raman Vagbhata.12
9.Guru madhura sheet aahar,satata dividha stanya pitwa,pitwa pitwa swapto,avaghan in
sheetaljail,mandagni. 13
10. Asamatvagata Prana Dosha Dhatu maloujaswam.14
All these postulations give a clear idea about the lowered immune status of the child that makes him
more susceptible for repeated infections. Moreover they provide an idea about the Dehabala,
Agnibala and Satwabala of the pediatric age group. Another aim behind these considerations is that
the child cannot tolerate all forms of medicaments and many of the treatment procedures, so these
aspects are to be well considered in the planning and implementation of treatment protocol.
Preventve aspect –
Modern-
1. Healthy Lifestyle, Hygiene -should be maintained properly15
2. Daily Habits Daily diets should include foods such as fresh, dark colored fruits and vegetables,
which are rich in antioxidants and other important food chemicals that help boost the immune
system.16
3. Vaccines Haemophilus Influenza, Viral Influenza Vaccines 17
4. Zinc supllimentation 18
5. Vitamins c Interest in the use of vitamin C for the treatment and prevention of the common cold
was heightened following the publication in 1970 of Nobel Prize winning scientist Linus Pauling’s
book Vitamin C and the common cold 19
6. Echinacea-herbal medicine used for prevention of URTI 20
7. Probiotics and thymus supplements
Ayurvedic –
In the treatment of Pratishyaya, a long list of do’s and don’ts is mentioned by various acahrya
DO’S:
• Remain in a place devoid of wind
• Cover head with thick, warm cloths
• Foods: - Having Laghu, Snigdha properties
• Not too liquid in nature
• Amla, Lavana dominant
• Jangala Mamsa, jaggery, milk
• Canaka, Trikatu, Yava, Godhuma, Dadhi, Dadima, Haritaki
• Yushas of Balamulaka or Kulattha
• Luke warm Dashamula Paniya, Purana Madya
• Vaccines: Child has to be timely vaccinated and even should undergo ‘Suvarna-
prashansanskar’ (Ayurvedic vaccination programme
• Kridanak bhumi upayog for krida
DON’TS:
Cold water, exposure to cold
Anger, stress, sorrow,
Sexual intercourse
Excess dry foods
Suppression of urges
Excess sleep and bath
Curative aspect-
Modern-
Hot beverage Nasal wash,Nasal strips,Antihistamines,Nasal decongestants,Expectorants,Zinc
preparations,Multi-vitamins,Echinacea,Nasal spray,Inhalers,Bronchodilators,Steroids
and,Antibiotics
Ayurvedic-
Ekmulik prayog in pratishyaya-
Pippali, Sunthi , Maricha, Haridra, Shirish, Amrita, Haritaki, Krishan jeerak, Daruharidra Lasun
Vidang, bhunimba
Ayurvedic formulations-
1) Vati- Shatyadi , Khadiradi
2)Kwath-Dashmoolakwath.21 , Pathyadikwath ,Abhayadikwath, Trayodashang kwath. 22
3) Khand-haridra kahnd .23
4) Choorn- Balchaturbhadra ,stopala,talassdi powder mixed with honey
5 )Rasa- Mahalaxmi vilas rasa . 24.
6)Sneha-shadbindu tail 25, Indukanta Ghrita. 26
7) Avaleha-Chyavanprash, Mustakadi avaleha 27,Gojivahadi avaleha 27,Bharyangydi avaleha.28
8) AYUSH Ghutti -“A herbo-mineral formulation” for cough and cold
Other treatment-
Snehana
Swedana
Vamana

Pradhman Nasya 29
Dhumapana
Gandusha
Discussion-
Upper respiratory tract infections account for the maximum number of physician visits worldwide.
It affects all age groups, all races and people from all geographical areas. Children being the most
vulnerable group are reported to have an incidence and recurrence much more than others.Children
having Dosha Dushyamalalpat,.Saukumaryaalpakaytwatata ,Aparipakwa Dhatu,Asampurna
Bala,Kleshasahishnutwa etc properties and their playfull nature in jala, and frequen contact with
dhool,raja sheet etc. URTI /Pratishyaya is seen more frequently in children. RURTI is most
powerful challenge in the society it gives headache to both children and parents. Though there are
much modalities are explained in modern medicine there are some limitation. On other hand
Ayurveda is having tremendous knowledge in preventive aspect eg.kridanak bhumi, use of laghu
snigdha, aamla (vit-c) lavan properties aahar etc, avoidance of kroadh ,atambupaan etc. Ayurvedic
formulations like Indukanta Ghrita,various avaleha , are also having immune modulatory ,anti-
oxidant properties which are play very encouraging effect in pratishyaya. Anti- inflammatory, Anti-
allergic, Anti-cholinergic, Anti- oxidant, Immunomodulatory etc. activities of Bharagi, Shirisha,
Vasa, Karkatshringi, Dashmula, Triphala will also potentiate the activities of trial drugs. Other
treatment like panchkarma having some limitation in children but mrudu procedure like kaval,
gandush,pratisaran , shaman nasya etc can be practiced very successfully.
Conclusion -
Recurrent upper respiratory tract infections vis a vis Pratishyaya is a common problem for all age
groups. When young children are in trouble it become a trouble for them as well as parents.
Moreover it hampers the overall growth of the child. In the management of conditions like RURTI
the other system of medicines have their own limitations. The lacuna of available clinical practices
is that the thrust is only on the curative aspect, not on the preventive. Prevention and curative
management achieved through Ayurveda. When the drugs are administered for a particular span
along with life style management anticipating that it would enhance the status of Agni and establish
the enriched status of different body tissues, thereby produce proper Bala, Ojus and ultimately
increase the Vyadhikshamatva of the children to protect them from pratishyaya/RURTI.
References-
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2. Milos Jesenak Recurrent respiratoryinfections in Children – Definition,Diagnostic Approach, Treatment and
Prevention
3. Raja hariprasad-pratishyaya-children-gojihvadi syrup-kb-2005ipgt&r, jamnagar, gujarat,
4.Nichol kl-Cold and influenza like illness in university students –impact on health,academic & work performance and
health care use.clin.infect.dis 2005,40,1263-1270
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30/33 page 835
8. Vagbhata. Ashtanga Hridaya – atrdev Comm. Arunadatta, chaumkhabha sanskriti sanstahan, Varanasi 2005 Uttara
Sthana 02/31.
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8/122)
10.Agnivesha charaka smhita com.chakrapanidatta de siddhi nanadan mishra,chaumkhba orientilia,Varanasi,chikitsa
sthan26/108 page 690)
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page118)
12. Ashtanga Hridaya – atridev Comm. Arunadatta, chaumkhabha sanskriti sanstahan, Varanasi 2005 Uttara Sthana
19//1.)
13. Kashyapa. Kashyapa Samhita Ed. Hemraj Sharma Choukhambhya sanskriti sanstahan
Varanasi, 2009, Chikitsa Sthana 12/3 pg 130
14. Kashyapa Samhita Ed. P. V. Tiwari, Choukhambhya Vishwabharati, Varanasi, 2000, Khila Sthana 3/59.
15. Klein GL. Controlling allergies by controlling environment. A big help for your patients. Stgrad Med 1992;91:215-
8, 221-4 [review].
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With elimination diet: a five-year follow-up. Ann Allergy 1980;44:273-,Breneman JC. Basics of Food Allergy.
Springfield, IL: Charles C Thomas, 1978, 45-75
17. Desai AB. Vaccines and vaccine preventable diseases: Today and Tomorrow. In
Parthasarathy A (Editor) IAP Textbook of Pediatrics 2nd Edn. Jaypee Brothers, New
Delhi 2002. 192 – 194.
18. Marshall I. Zinc for the common cold. Cochran Database System Rev. 2002;4:1-22.
19. Johnston CS, Retrum KR, Srilakshmi JC. Antihistamine effects and complications of
Supplemental vitamin C. J Am Diet Assoc 1992;92:988-9.
20. Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D' Alessio. Treatment of the
Common cold with unrefined echinacea. A randomized, double-blind, placebocontrolled
Trial. Ann Intern Med. 2002;137:939-4
21. Hemanta Kumar, Efficacy of ayurvedic medicine in the treatment of uncomplicated chronic sinusitis ,ancsci life.
2006 jul-dec; 26(1&2): 6–11. Pmcid: pmc3335227
22. Chaudhari Varsha , Rajagopala M, MistryS,Role of Pradhamana Nasya and Trayodashanga Kwatha in the
management of Dushta Pratishyaya with special reference to chronic sinusitisdoi: 10.4103/0974-8520.77165PMID:
22131734
23. Chhaya Bhakti1, Manjusha Rajagopala2, AK Shah3, Narayan Bavalatti4
A Clinical evaluation of Haridra Khanda & Pippalyadi Taila Nasya on Pratishyaya (Allergic Rhinitis)*
24. Hemanta kumar panigrahi 1, treatment of uncomplicated sinusitis By ayurvedic medicine - a randomize, open level,
Non comparative study , journal of research in ayurveda and siddha- july-september, 2009 vol. Xxx, no. 3
25. J. Nathl and P.K. Panda'MANAGEMENT OF CHRONIC SINUSITIS WITH
CLASSICAL AYURVEDIC FORMULATION JR.A.S. Vol. XXII, No. 1-2. (2001) pp.95-!02
26. Manoj Kumar AK. Immunomodulatory action by an Ayurvedic compound in recurrent
Respiratory infections, Govt. Ayurveda College Trivandrum, 1994 – Thesis Work.
27 . Lokesh A Comparative Study on the Efficacy of Mustakadi Avaleha and Gojihwadi Avaleha in the Management of
Pratishyaya w.s.r. To Recurrent Upper Respiratory Tract Infections in Children thesis Jamnagar 2005
28. Gohel SD, Anand IP, Patel KS. A comparative study on efficacy of Bharangyadi Avaleha and Vasa Avaleha in the
management of Tamaka Shwasa with reference to childhood asthma . AYU 2011;32:82-9
29. Varshachaudhari, manjusharajagopala, Sejal Mistry1, D.B. VaghelaRole of pradhamana nasya and trayodashanaga
kwatha in the management of dushta pratishyaya with special reference to chronic sinusitisayu | Year : 2010 | Volume :
31 | Issue : 3 | Page : 325-331
2
STUDY THE EFFECT OF “AMRITDHARA”IN SHWAAS VYADHI USED AS
AN AEROSOL IN WHEEZE W.S.R. TO ITS BRONCHODILATOR EFFECT.
By : Dr. Sandip J. Nikam.B.A.M.S. M.D. (scholar)
Guide : Dr. rahul h. Gujarathi M.D.(kaumarabhritya)
bharati vidyapeeth deemed university,Pune – 43.
INTRODUCTION
Wheezing - refers to high pitch whistling sounds audible on auscultation by the stethoscope. Partial
obstruction of the bronchi and bronchioles leading to narrowing produces wheezing, sufficient air
must flow through the narrowed airway to produce the wheezing sound. This obstruction may be
within the lumen or in the walls of bronchi. Pressure from outside the bronchi may also be
responsible in some cases.
Wheezing is most often due to heightened sensitivity of respiratory tract. Infection of lower
respiratory passage may cause bronchospasm. A cold or acute respiratory disease always precedes
attacks of wheezing, most frequent between 1-8yrs of age and becomes less frequent thereafter.
Wheeze is characterized by musical, continuous sounds usually caused by the development of
turbulent flow in narrow airways. This turbulence may be due to congestion due to secretions in the
lungs causing inflammation of lower respiratory tract which results in obstruction of airway
passage. This causes wheezing and difficulty in breathing. As a result of inflammation oxygen
supply becomes less and it causes respiratory distress.
Similar description towards distress and respiratory difficulty can be studied in Ayurveda also.
yada s~aotaMisa saMQya maa$t: kfpUva-k:|

ivaYvagva/jait saM$Qdstda Svaasaankraoit sa:||
ca.,ica.,17/45
Ayurveda has also blamed local inflammation/oedema to cause difficulty in breathing along with
many other disorders and are collectively called as shotha updrava.
Cid- Svaasaao|$icas%aRYNaa jvarao|itsaar eva ca:|

saPtkao|yaM sadaOba-lya Saaoqaaopd/vasaMga/h:||
ca . saU. 18/18
AIMS AND OBJECTIVES
1. To study Wheeze of respiratory origin in detail.
2. To study Shwasa vyadhi in detail.
3. To study chemistry and pharmacological action of Menthol,Thymol and
Camphor singly and as a mixture.
4. To study Aerosol through nebulization as a route of drug
Administration.
5. To study the role of ‘Amritdhara’-A mixture of Menthol,Thymol and
Camphor used as an aerosol through nebulizer in wheeze for
bronchodilatation .
DISEASE REVIEW
Definition :
Shwasa word is used to denote respiration (both phases) and
exchange of air in the body. So the Shwasa Roga may be defined simply as a disease in which the
respiration and exchange of air is disturbed.
Sushruta has mentioned the detailed definition of Shwasa roga in
Uttartantra.
On the basis of above definition it is clear that when the Prana Vayu is not performing its normal
physiological functions (vitiated) and become defiles (Viguna); obstructed by Kapha and
moves upwards i.e., unable to function properly, then the condition is known as Shwasa Roga. This
definition seems to be very scientific and describes all the aspects of dyspnoea.
Wheezing in Children
1)Bronchiolitis : An infection usually caused by the respiratory syncytial virus (RSV), which
produces swelling and mucus production in the small breathing tubes of child's lungs. The
symptoms of a common cold, with a runny nose and mild cough worsens and child may develop
fever, wheezing and difficulty breathing.
2)Asthma: (also called reactive airway disease) is a common problem in infants and children. The
most common symptoms include coughing, wheezing and trouble breathing, which is caused by
inflammation and tightness in the breathing tubes of the lungs. The coughing and wheezing may be
worse after exercise, after exposure to common triggers (cold air, smoke, and other irritants), and at
night.
3)Foreign body aspiration: If child ingests an object, such as a coin, peanut, etc and it gets stuck
in a breathing tube, then it may cause wheezing and difficulty breathing. It is most common in
children 1 to 4 years of age. Unlike asthma, the wheezing may be just on one side of his chest.
4)Gastroesophageal Reflux: Children with GER can sometimes have wheezing as the stomach
contents are aspirated into the lungs or as the esophagus gets more acid in it. The symptoms of
coughing and /or wheezing may be worse when he lies down.
5)Vocal Cord Dysfunction: In children with this condition, the vocal cords close inappropriately
and this can lead to difficulty breathing that is often confused with asthma.
6)Other conditions that can chronic wheezing include cystic fibrosis, anatomical abnormalities,
including a narrowing of the airways (bronchomalacia and tracheomalacia) or blood vessel
abnormalities, such as a web or vascular ring.
PROPERTIES AND PHARMACOLOGICAL ACTIONS
Ajmoda Pudina Karpoor

Rasa Katu,Tikta Katu Tikta,Katu, Madhura
Virya Ushna Ushna Sheeta

Vipaka Katu Katu Katu
Guna Laghu,Ruksha Laghu,Ruksha, Laghu,Ruksha

Tikshna
Karma Dipana, Vidahi, Kaphahara, Kaphavatahara, Dipana,
Kaphavatajit, Ruchikrut,
Shoolaghna Vatahara, Dipana, Krumihara
Rochana
Antiseptic, Expectorant, Decongestant, Anti Nervous pacifier,
Antimicrobial, Anti fungal, inflammatory, Decongestant, stimulant,
Pharmacologi
Mouthfreshner Anesthetic, Anti spasmodic,
cal action
Cooling agent, Antiseptic, Germicide,
Muscle relaxant Anti inflammatory
STUDY DESIGN
3 Type of Study:- Single blind, comparative, Randomized study.
2. Place of Work:- Bharati Vidyapeeth’s College of Ayurveda and Hospital, Pune.
3. Standardization:- B. V. Bhide, Research Laboratory, Pune.
4. No. of Patients :- Total 30 patients were selected and they were randomly divided in two
groups-15 in each group.
5. Form of Drug :- Satva in liquid form.
6. Duration :- For a period of 24 hours.
7 . For clinical trial special Case Performa was prepared.
INCLUSION CRITERIA
1)Patients of either sex are included.
2)Children between age group of 4-8 years .
3)Children having complaints of wheezing of respiratory origin.
4)Patients not having broncho-constriction/compression due to any external cause.
EXCLUSION CRITERIA
1)Children having tubercular infection.
2)Children with history of malignancy or any other debitiating disorder.
3)Patients with anatomical abnormalities of chest and respiratory system.
4)Patients in life threatening conditions viz, -Respiratory acidosis, Diabetic acidosis, Respiratory
Distress Syndrome, etc.
5)Children with age below 4 yrs.
6)Children with age above 8 yrs.
Criteria of Assessment
Visual No. of Wheezing Lobes Forced Peak Expiratory

Analogue Volume(L/min)
Scale
Pre Treatment
Post Treatment
0 hrs
4 hrs
8 hrs
12 hrs
16 hrs
20 hrs
24 hrs
METHODOLOGY
PREPARATION OF DRUG – The trial drug was prepared by mixing equal amounts W/W of
Thymol, Menthol and Camphor .
Administration of Drug:
Drugs No.of patients Dose and Vehicle Period
Amritdhara 15 0.5ml(+)1ml N.S. 4 hourly

Salbutamol 15 0.5ml(+)1ml N.S. 4hourly
Sulphate
Comparison of visual analogue score in group 1 and group 2 at pre treatment, immediately
post treatment, 4th hr , 8th hr, 12th hr, 16th hr, 20th hr and 24th hr.
VAS
VAS at Group
3 4 5 6 7
Group 1 0 0 6 8 1
Pre treatment
Group 2 0 0 5 9 1
Immediately post Group 1 0 0 6 8 1
treatment Group 2 0 0 6 8 1
Group 1 0 0 8 6 1
4th hr
Group 2 0 1 9 5 0
Group 1 0 6 7 2 0
8th hr
Group 2 1 4 8 2 0
Group 1 0 8 7 0 0
12th hr
Group 2 1 9 5 0 0
Group 1 1 10 4 0 0
16th hr
Group 2 5 9 1 0 0
Group 1 0 9 6 0 0
20th hr
Group 2 1 9 4 1 0
Group 1 3 8 4 0 0
24th hr
Group 2 2 11 2 0 0
u
Median grade
e
Group 1 Group 2
Pre treatment 6 6 0.775
Immediately post treatment 6 6 0.999
4th hr 5 5 0.389
8th hr 5 5 0.902
12th hr 4 4 0.436
16th hr 4 4 0.074
20th hr 3 3 0.713
24th hr 3 3 0.806
Conclusion :- By using Mann Whitney U test p-value > 0.05 therefore there is no significant
difference between group 1 and group 2 with respect to VAS score at pre treatment, immediately
. Comparison of Wheezing score in group 1 and group 2 at pre treatment, immediately post
treatment, 4th hr , 8th hr, 12th hr, 16th hr, 20th hr and 24th hr.
g
Wheezing at Group
2 3 4 5 6 7 8
Group 1 0 0 2 1 8 1 3
Pre treatment
Group 2 0 0 2 3 5 3 2
immediately post Group 1 0 0 2 1 8 1 3
treatment Group 2 0 0 2 3 5 3 2
Group 1 0 0 2 4 5 3 1
4th hr
Group 2 0 1 2 4 5 2 1
Group 1 0 0 2 9 1 3 0
8th hr
Group 2 0 1 4 6 3 1 0
Group 1 0 2 3 7 3 0 0
12th hr
Group 2 0 3 6 3 2 1 0
Group 1 0 3 10 0 2 0 0
16th hr
Group 2 0 6 6 1 2 0 0
Group 1 3 5 5 2 0 0 0
20th hr
Group 2 3 5 4 2 1 0 0
Group 1 3 7 5 0 0 0 0
24th hr
Group 2 5 5 3 2 0 0 0
u
Median grade
e
Group 1 Group 2
Pre treatment 6 6 0.806
Immediately post treatment 6 6 0.806
4th hr 6 6 0.624
8th hr 5 5 0.389
12th hr 5 4 0.389
16th hr 4 4 0.567
20th hr 3 3 0.87
24th hr 3 3 0.838
Conclusion :- By using Mann Whitney U test p-value > 0.05 therefore there is no significant
difference between group 1 and group 2 with respect to Wheezing score at pre treatment,
immediately post treatment, 4th hr , 8th hr, 12th hr, 16th hr, 20th hr and 24th hr.
. Comparison of FPEV in group 1 and group 2 at pre treatment, immediately post treatment,
4th hr , 8th hr, 12th hr, 16th hr, 20th hr and 24th hr.
FPEV u
Number of (Mean ± SD) e
patients Group 1 Group 2
Pre treatment 15 144.00 ± 26.40 138.67 ± 19.59 0.535
Immediately post
15 144.00 ± 26.40 138.67 ± 19.59 0.535
treatment
4th hr 15 148.00 ± 25.13 153.33 ± 18.39 0.513
8th hr 15 153.33 ± 26.37 159.33 ± 18.70 0.479
12th hr 15 157.33 ± 26.31 166.00 ± 21.97 0.336
16th hr 15 163.33 ± 27.69 172.00 ± 20.07 0.336
20th hr 15 169.33 ± 27.38 178.67 ± 23.26 0.323
24th hr 15 176.67 ± 29.92 186.00 ± 21.97 0.339
Conclusion :- By using 2 independent sample t-test p-value > 0.05 therefore there is no
significant difference between mean FPEV in group 1 and group 2 at pre treatment, immediately
3
A clinical Study of Kasahar kwath & Sadyasnehpan in younger Children of URTI
Author-Dr.Renu Bharat Rathi, Asso.Prof., Kaumarbhritya Dept.
Affiliation- Mahatma Gandhi Ayurved College, Salod, Wardha, MH
Introduction-
URTI means Upper Respiratory Tract Infection is the most frequent medical problems in childhood,
usually due to viral infection of the upper respiratory tract. It is associated with nasal discharge,
congestion, dry or cough with expectoration, tachypnoea, breathlessness, adventitious sounds, lack
of appetite, Irritability, sleeplessness etc . In recent years, there is prevalence of recurrent RTI-
Respiratory Infections may be due to pollution or sedentary, stressful lifestyle
Rural, remote population still have limited or no access to modern medicines, hence trial yog has
taken which is available at home. Ayurveda contributes several modalities of t/t. Among all the
modalities, polyherbal preparations arfe said to be more safe, effective & well accepted. sadya
snehpan & fresh, warm kwath with dhumpan of kwath are beneficial to provide instant relief in
suffering, without side effects. The goal of URTI t/t has shifted from symptom relief to disease
control.
Aim & Objectives -
The aim of the treatment was to explore the role of Kasahar kwath with dhumpan
(dhum coming out from kwath) for nasal congestion & to see the efficacy of sadyasnehpan of
warm Til tail in 30 children of acute or chronic URTI
Objectives: To prevent susceptibility of URTI & improve immunity, allergy removal to stop
recurrent infections
Material & Methods -
I. Inclusion Criteria
Patients of URTI of 0 to 5 years age group having clinical features of nasal discharge, congestion,
dry or cough with expectoration, tachypnoea, breathlessness, adventitious sounds, lack of appetite,
Irritability, sleeplessness etc irrespective of their sex.
Exclusion Criteria-
The same age group & >5 yrs children suffering from secondary infection like fever, Otitis media,
Pneumonia, Tonsilitis etc. were excluded from the study. Written informed consent was obtained
from each & every patient of both the groups .
Withdrawal Criteria-
If in patients of both groups the clinical features would have aggravated into secondary infection&
/or if they will be irregular in the decided course of treatment, such patients will be withdrawn from
the study
Assessment criteria- All the patients were evaluated for –
1. Subjective relief & tolerance to physical activities
2. Objective parameter- ESR, Eosinophil, leucocyte count
Study design & duration:
An open ended randomized clinical trial, carried out in OPD/IPD of MGACHRC,Salod,Wardha.
In this study, total 60 patients having acute or chronic URTI in younger children
of 0 to 5 years age were divided into 2 equal groups of acute & chronic.
. No control group has added as it was a pilot study.
Acute group- Treated with Kasahar kwath, dhumpan, warm Til tail oral intake
Chronic group: Treated with same medication in the morning & evening at kaphkala as per
age & severity. Chronicity was considered as >5 days URTI
Dose , anupan, duration & Follow-up :

Kasahar kwath was prepared fresh & warm with dhumpan & saindhav yukta Tiltail was
given twice a day morning & evening, in 0-5 yrs age group for 1 week with lukewarm
water for both groups
Dose-In 0-2 years age, 5ml warm kwath & tiltail,
In 2-5 years age, 10 ml warm kwath & tiltail with warm water anupan.
Trial yog-Kasahar kwath was made up of following ingredients
Ajwain, trikatu, haridra, Tulsi, Saindhavlavan, guda/jaggery, Betalleaf/nagvel pan, equal
parts & water to be added as decoction method but reduction proportion was kept more
owing to younger children’s Pediatric doses alongwith warm Tiltail (Sesamum oil)
Above drugs having Kaph-vatahar properties which help in treating URTI
Pathya of diet & daily regimen were suggested to both groups
Gradation for Clinical features
1. Nasal discharge- It was considered as mild, moderate, severe as per severity of complaints.
Mild - Whenever discharge occurs intermittently off & on
Moderate- Whenever discharge occurs morning & evening, night at kaphkal
Severe- Whenever discharge run continuously.
2. Cough (Dry/Wet)-
Mild - When it occurs intermittently off & on
Moderate- Whenever it irritate child at morning, evening, night at kaphkal
Severe- Many times in a day.
3. Breathlessness-
Mild - When it occurs intermittently off & on
Moderate- Whenever it irritate child at morning, evening, night at kaphkal
Severe- Many times in a day.
4. Lack of Appetite-
Mild- Diet is slightly reduced
Moderate- Diet is reduced to half or more
Severe- Diet is drastically reduced with refusal to eat
Criteria for overall assessment of Results-
Assessment of Results was made with the help of subjective & objective parameters
Complete remission- total disappearance of S/S
Major improvement- Severity comes to mild
Minor improvement- complaints shift moderate to mild
Observation & Discussion
It was observed that maximum patients were belong to 2 to 5 years age group. In acute group mild
grade patients were maximum as compare to severe grade who excluded due to high fever. Out of
those 60 % patients got complete remission due to disappearance of disease but 40 % having low
immunity with less adoption of pathya were shifted to moderate gradation. In chronic group
patients, result of medication was more as compare to acute group. As per severity external snehan-
swedan, matra basti with warm saindhav yukta tiltail was also used but no other medication was
used.
The Kasahar kwath is having tikta-katu rasa, teekshna, ruksha guna, ushna virya, katu vipak,
vatakafaghna properties. It was raw coarse powder given as per age, agni, severity up to
continuous 1 week tds to be prepared at home to remain fresh, warm. Follow up was taken for next
fortnight to check recurrence. Sadya snehapan & external snehan swedan with warm saindhav
yukta Tiltail pacifies bouts of dry cough, facilitates expectoration & provides instant relief. All
patients were assessed by subjective parameters & objective by CBC . The patients whose CBC
level was increased get reduced by Trial warm homemade kwath as all trial drugs are known
immunomodulator, anti allergic in action It was seen that other patients CBC were moving within
the normal range.
Table 1: Comparison of parameters before and after
treatment in acute group
ers Mean N Std. Deviation Std. Error Mean
Before t/t 9.39 30 0.72 0.13
Hb%
After t/t 9.52 30 0.65 0.12
Before t/t 6258.33 30 781.69 142.71
TLC
After t/t 6135.00 30 615.20 112.32
Before t/t 57.96 30 5.05 0.92
Neurophils
After t/t 56.10 30 5.71 1.04
Before t/t 32.53 30 6.48 1.18
Lymphocytes
After t/t 31.76 30 5.59 1.02
Before t/t 3.23 30 1.13 0.20
Eosinophils
After t/t 2.03 30 0.80 0.14
Before t/t 22.70 30 13.97 2.55
ESR
After t/t 18.66 30 9.80 1.79
Student’s paired t test of Acute group

u
Paired Differences t df
e
95% Confidence
Std.
Std. Interval of the
Mean Error
Deviation Difference
Mean
Lower Upper
0.038
Hb% -0.12 0.31 0.05 -0.23 -0.00 2.16 29
S,p<0.05
0.106
TLC 123.33 405.08 73.95 -27.92 274.57 1.66 29
NS,p>0.05
Neurophils 1.86 2.87 0.52 0.79 2.93 3.55 29 0.001 S,p<0.05
Lymphocyt 0.163
0.76 2.93 0.53 -0.32 1.86 1.43 29
es NS,p>0.05
Eosinophil
1.20 0.84 0.15 0.88 1.51 7.76 29 0.000 S,p<0.05
s
ESR 4.03 5.57 1.01 1.95 6.11 3.96 29 0.000 S,p<0.05
Comparison of parameters before and after treatment in Chronicl group
Parameters Mean N Std. Deviation Std. Error Mean
Before t/t 10.62 30 1.38 0.25
Hb%
After t/t 10.93 30 1.50 0.27
Before t/t 7294.66 30 1406.38 256.77
TLC
After t/t 6900.66 30 1119.82 204.45
Neurophils Before t/t 60.70 30 4.68 0.85
After t/t 58.43 30 4.17 0.76
Before t/t 35.03 30 4.19 0.76
Lymphocytes
After t/t 34.23 30 3.84 0.70
Before t/t 3.33 30 1.32 0.24
Eosinophils
After t/t 2.33 30 0.84 0.15
Before t/t 23.03 30 9.16 1.67
ESR
After t/t 18.46 30 7.53 1.37
Student’s paired t test of Chronic group

Paired Differences t df e
95% Confidence
Std.
Std. Interval of the
Mean Error
Deviation Difference
Mean
Lower Upper
0.029
Hb% -0.30 0.72 0.13 -0.57 -0.03 2.30 29
S,p<0.05
TLC 394.00 498.13 90.94 207.99 580.00 4.33 29 0.000 S,p<0.05
Neurophils 2.26 2.94 0.53 1.16 3.36 4.21 29 0.000 S,p<0.05
Lymphocyt 0.141
0.80 2.89 0.52 -0.28 1.88 1.51 29
es NS,p>0.05
Eosinophil
1.00 1.25 0.22 0.52 1.47 4.34 29 0.000 S,p<0.05
s
ESR 4.56 5.17 0.94 2.63 6.49 4.83 29 0.000 S,p<0.05
Table showing Clinical features of both groups with relief in %

c
GRADE Acute
CLINICAL
FEATURES Relief in
BT AT Relief in % BT AT
%
Pratishyay 11 6 55.5 15 11 73.3
Breathlessness 10 6 60 13 10 76.9
Mild Cough 12 7 58.33 14 12 85.7
Adv. sounds 17 11 64.7 17 15 88.2
Lack of Appetite 14 12 85.7 12 8 66.6

c
GRADE Acute
CLINICAL
FEATURES Relief in
Moderate BT AT Relief in % BT AT
%
Pratishyay 15 8 53.33 10 8 80
60
Breathlessness 10 6 13 9 69.2
Cough 8 4 50 11 8 72.7
Adv. sounds 10 6 60 14 12 85.7
Lack of Appetite 10 8 80 10 8 80
GRADE Acute
CLINICAL
FEATURES
Relief in
BT AT Relief in % BT AT
%
Pratishyay 4 2 50 5 3 60
Breathlessness 5 3 7 5 71.4
60
Severe Cough 8 5 62.5 3 2 66.6
Adv. sounds 5 3 60 2 1 50
Lack of Appetite 6 4 66.6 4 2 50
In severe grade patients who started worsening due to secondary infections & low immunity,
irregular in pathya sevan were excluded from the study. Sadya snehpan with warm tiltail,
Matrabasti, snehan-swedan, dhumpan of kwath & frequently warm intake of Kasahar kwath help
in treating URTI
Conclusion-
It is found that trial kwath with sadyasneh is very effective in acute & chronic kasa without S/E due
to ushna, teekshna, katu-tikta rasatmak act as a good kaf-vathar has ability to stop s/s of acute &
chronic URTI with shoth-shoolher, deepan, pachan effect & no any side effect .The ingredients
may be collectively effective on airflow obstruction by bronchodilator, anti-inflammatory,
antihistaminic properties.
In Chronic group subjective as well as objective results were significant as compare to
acute group
kwath yog shows immunity modulator, allergy removal, kasahar effect.
Multiapproach is necessary in severe grade pts. i.e. snehan-swedan, matrabasti,
pathyasevan, repetition of dose a/c to severity.
Thus trial yog is statistically significant, safe, effective & well accepted with easy availability.
Further double blind comparative or placebo controlled study in a higher population is
recommended
References-
Astanga Hrdaya, Uttara sthana, Chapter19th Page No.173 – 175,sloka no.1-15 and 20th chapter Page No.179-
182,sloka no.1-17 edited by Prof. KR.Srikantha Murthy, Reprint edition,2002.
Sushruta Samhita,Uttara sthana, Chapter 24th sloka no.3 & 9, edited with Ayurveda tattva sandipika (Hindi
commentary) by kaviraj ambika datta sashtri, Chaukhamba Sanskrit Samsthan,Varanasi,16th edition.
Charak Samhita- sutrasthan12, 13,14, Vidyadhar Shukla, Ravidatta Tripathi
Charak Samhita, Chikitsa sthana– 26th chapter, shloka no – 97 to 103, Page No 434&435 & shloka no – 127 to
150, Page No 439-441, eloberated by Charaka and redacted by Dridhabala , edited by Prof.Priyavrt Sharma,
Chokhambha Sanskrit Samsathan, Varanasi,7th edition,2003 .
Dravyaguna vigyan-P.V.Sharma
Bhavprakash Nighantu
References from www.incredibleayurveda.com
Essential Pediatrics- O. P. Ghai
4
STUDY ON THE EFFECT OF VIRECHANA AND KANTAKARYAVALEHA IN THE
MANAGEMENT OF CHILDHOOD ASTHMA
Dr Sharashchandra R*, Dr Reena**, Dr Rahul***, Dr Shailaja****

*P.G scholar, Department of Kaumarabhritya, SDMCA&H, Hassan, Karnataka
Email ID: dr.sharash@gmail.com
INTRODUCTION:
Tamaka Shvasa is one among the five varieties of Shvasa explained in almost all the classics of
Ayurveda1, which is analogous with bronchial asthma mentioned in modern medicine. Since
centuries Tamaka Shvasa remained to be a challenging & unremitting disease. In both sexes it may
occur at any age. Tamaka Shvasa is one of the chronic diseases of children, which causes a lot of
worries to the patients as well as parents. It affects school attendance, play works, school
performance, day to day activities and growth of the child2.
Bronchial asthma is a worldwide problem having 1.8:1 male to female ratio3. In general
population, Asthma may have its onset at any age; 26.3% of patients are symptomatic by one year
of age, 51.4% by 1-5 years & 22.3% after five years of age4. Thus asthma is a chronic respiratory
disease in children which is increasing day by day due to the mode of life, dietetic changes,
pollution environmental variations and various stimuli like dust, cold air, smoke, pollens, house
dust mite, viral respiratory tract infections etc. Childhood asthma is highly variable and may differ
from patient to patient, so needs much attention and care.
The younger asthmatic child is often very troubled by cough especially at night rather than flank
wheezing. So the diagnosis is often given as bronchitis or spastic bronchitis rather than asthma.
Chronic nocturnal cough is one of the symptoms of asthma children. The older children with
asthma, typically has episodic attacks of wheezing and breathlessness, usually worst at night or
early morning and are often accompanied by cough, but little or no sputum production. The attacks
are separated by symptoms free interval and duration of attack varies from patient to patient5.
The nature of attacks of asthma and the pattern of recurrence varies considerably from
child to child and this has an importance on treatment.
Virechana is explained as best treatment in Tamakashvasa i.e. Tamaketu Virechanam6. As
the disease in Pittasthana Samudbhava, Virechana may help a lot. Caraka explains that according to
disease, Bheshaja should be used in reduced dosage and in mild form for children. Adopting the
same principles, Mridu Virechana with Trivrutta can be administered to children, which does not
cause much discomfort to them7. Generally it is seen in practice that only Virechana may not cure
the disease and some Shamana Yoga has to be given. Bhavaprakasha has indicated
Kantakaryavaleha to manage Shvasa Raga8. Moreover the medicine is palatable & sweet in taste,
hence can be administered to children easily.
In the present clinical study patients were divided into 2 groups. Total 30 patients were
completed the clinical study with 15 patients in each group. Group A patients were admitted in
S.D.M.C.A & H, Hassan and Virechana therapy administered followed by Kantakaryavaleha for
Shamana Chikitsa. In groups B patients only Kantakaryavaleha was administered.
MATERIALS AND METHODS
Formulations:
3. Moorchita Ghrita
4. Trivritthavaleha
5. Kantakaryvaleha
6. Trikatu choorna
Research Design: Interventional, single blinded, randomized control trial.
Research setting: Outpatient department & Inpatient department of department of
Kaumarabhritya, SDMCA&H, Hassan, Karnataka, India.
Research population: The children with Tamaka Shvasa, 5 to 16 years of age attending
Kaumarabhritya OPD, SDM Ayurvedic hospital, Hassan, Karnataka, India
Sampling: Simple random sampling technique using random number tables
Sampling element: Children from 5 to 16 years affected with Tamaka Swasa of mild to moderate
degree.
INCLUSION CRITERIA:
Patients suffering from Tamakashvasa between age group of 5 to 16 years were included in
the study.
Patients were selected irrespective of sex, religion, occupation, socio economic status.
EXCLUSION CRITERIA:
Patients suffering from other types of Shvasa were excluded from the study.
Patients with Pulmonary tuberculosis, COPD, Bronchiectasis & Tropical eosinophilia or
with any other systemic disorders were excluded.
Patients with acute or severe exacerbation & status asthmatics who require immediate
intervention were excluded.
ASSESSMENT CRITERIA:
Both subjective and objective parameters were considered for the assessment of response to
the treatment on signs and symptoms of Tamaka Swasa, number of recurrent attacks, assessment of
clinical parameters, and quality of life assessment were given importance. Laboratory assessment
included haematology for Hb%, total white blood cell count, total red blood cell count, differential
count, erythrocyte sedimentation rate and absolute eosinophil count.
DRUG DOSAGE:
Doses of Kantakaryavaleha:
3 gm twice daily before food for 5 to 10 years of age
Duration of treatment will be for a period of 2 months in each group
TREATMENT SCHEDULE:
As per the inclusion criteria, the selected 30 patients were then randomly allocated into two
groups by simple random sampling method. Group A was given with Kramataha Virecana
including Deepana pacana, Snehapan with Moorchita ghrita, Virecana with Trivrithavaleha. After
Samsarjana Krama, Kantakaryavaleha, as per dose was given for 2 months. In group B,
Kantakaryavaleha as per dose was given for 2 months.
STATISTICAL ANALYSIS:
The observations made before and after treatment were considered for analysis. Statistical
analysis was carried out using paired t test.
OBSERVATIONS:
An observation of present study reveals that maximum number of Patients i.e. 66.73% were
between the age group of 11-16 years. Many of them were chronic patients. It might be due to their
early exposure to allergens.
It was observed that more numbers of patients were boys i.e. 60% and 40% were girls.
Childhood asthma ratio between boys and girls is 2:1 as per the study reports. Here the ratio
coincides with previous research data.
Maximum number of patients i.e. 90% belonged to Hindu community. This might be due to
Hindu’s residing here are more in number. Hence there is no research significance.
Out of 30 cases taken for the study, 66.66% patients were having family history of asthma;
whereas 33.37% had no family history of asthma. This study reveals that more number of children
had got asthma even in the presence of hereditary factors and others who are not having family
history may suggest that allergens, viral infections and environmental factors etc. may play an
important role in childhood asthma, instead with hereditary factors.
In majority of children upper respiratory tract infection symptoms were present before
commencing an asthmatic attack.
The incidence of cold air exposure induced asthma was reported in maximum number of
patients. (100%) and exposure to smoke, dust, exercise induced asthma reported in 93% patients.
Cough and breathlessness was reported after long running or exercise in these cases. Almost all
parents restricted their children for exercise in fear of recurrence of symptoms.
It was somewhat difficult to assess the Ahara Shakti in the children because of the
variability in appetite and digestive capacity. However, only 10% had Pravara Ahara Shakti. It was
observed that majority of patients (56.67%) were having Avara Ahara Shakti.
In majority of the patients (66.67%) mandagni was observed and Samagni was observed in
26.67% patients. Majority of patients having mandagni were suffering from moderate to severe
asthma. The Samagni was observed in mild asthmatic children. This shows the definite relation of
Agnimandya and Ama with the severity of disease.
Most of the Vihara Sambandhi Nidanas described in classics were observed in the asthmatic
children. Especially Nidanas like Vayu Sevana, Raja Sevana, Dhooma Sevana, Vyayama, Asatmya
Sevana, Sheeta Sthana and Sheeta Snana were reported as Vyanjaka Nidana for Tamaka Shvasa.
In all the children one or more of the above said Nidanas were acting as allergens and cause
for upper respiratory tract infections (Peenasa), cough (Kasa) followed by dyspnea. This can also
be justified by the observation made in the present study that the Pratishyaya (in 25 Patients’
i.e.83.33%), Kasa (in 27 patients i.e. 90%) and Jwara (in 13 patients i.e. 43.33%) were the
Nidanarthakara Rogas.
Ahara Sambamdhi Nidanas in the initiation of asthmatic symptoms were observed in
majority of the cases.
Sheeta Pana (cold water/drinks), sheeta Ashana (ice creams, fruits like Banana, Sponge
Guard, Watermelon Jackfruit, Guava fruit etc) Shleshmala Ahara (Curd, Cheese etc), Guru
Bhojana, Abhishyandhi Bhojana and oily foods and fried food materials were observed as Nidanas
for Tamakashvasa Lakshanas.
Most of the Poorvaroopa mentioned in the classics was not observed as premonitory signs
of Tamakashvasa. But the symptoms like Hridaya Peedana, Pranasya Vilomata and Parshwa
Shoola was observed during Roopavastha of Tamakashvasa.
Chief complaints of Tamakashvasa viz. Gurguruka, Shvasakrichrata, Kasa, and
Pranaprapeedana were observed in all the patients (100%). In majority of cases, Kasa in the Night
time (nocturnal cough) followed by Shvasakrichrata (nocturnal dyspnoea) was seen.
Peenasa (common cold), Kantodwansa (throat infection) and Kasa (cough) were observed in
80-90% of children both before and after establishment of Tamaka Shvasa Lakshanas.
Vamathu (vomitting) was reported in minimum number of cases and vomiting relieved the
symptoms to some extent in these children. Aruchi was noticed in most of the cases especially
during the episodic attacks. This observation indicates the role of Agnimandya and Ama in the
manifestation of Tamakashvasa.
Clinical assessments of a set of graded clinical symptoms that are frequently associated with
asthma before and after treatment in study group are described in table1
DISCUSSION:
On observing the comparison data of all groups for improvement/ relief in all the
parameters, it is clear that the improvement/relief was better in group A. i.e. in the patients who
received Virechana therapy followed by Kantakaryavaleha, there was maximum reduction in
number of attacks, duration of symptoms and better increase in PEFR was observed. Group B
patients who were administered only Kantakaryavaleha showed less improvement compared to
group A. Hence it may be concluded that Shodhana followed by Shamana is potent in controling
the Tamaka Shvasa in children (childhood asthma) to the maximum extent.
Kantakaryavaleha appears work better if given after Shodhana this may be due to Rasayana
and Vyadhipratyanik action of drug & Dosha Nirharantva of Virecana. In the group of patients who
received Kantakaryavaleha without shodhana as a Shamana Chikitsa Kantakaryavaleha appears
work better after two months of prolonged administration than in the initial days.
This study shows that in Bahudoshavastha, patients with chronic history, increased number
of attacks Kantakaryavaleha with Shodhana has shown good improvement. Patients received only
Kantakaryavaleha without Virechana has shown improvement after two months of prolonged
administration of Kantakaryavaleha. This may suggest that prolonged administration of
Kantakaryavaleha is needed if given without Shodhana therapy.
CONCLUSION:
Preventing asthma exacerbations is one of the most important goals in asthma management.
It represents a good indicator of the degree of overall disease control. The clinical trial proved
efficacy of Kantakaryvaleha by its presumed action of Shvasahara & Rasayana. The effect was
more when it was administered after virecana, as it clears the Dosha from the body & provides a
favourable condition for the action of the drug. Kantakaryavaleha when administered without
shodhana shown improvements is after two months of prolonged administration. Hence
Kantakaryavaleha is effective in the management of Childhood Asthma.
REFERENCES:
Agnivesha: Charaka Samhita with ‘Ayurveda Deepika’ commentary by Pt. Kasinatha Sastri, Edited by
st
Dr. Ganga Sahay Pandeya, Part II, 1 edition, Chaukhambha Samskrit samsthan, Varanasi, Chikitsa
Sthana Chapter 17 (1997)
Parthasarathy A. (ed). IAP textbook of Paediatrics, 4th ed. New Delhi: Jaypee brother’s medical
publishers (P) Ltd; 2009. Vol 1. p.593
Acharya YT. (ed). Caraka Samhita of Agnivesha, 5th ed. Varanasi: Chaukhambha Sanskrit Samsthana;
Reprint. 2011. p538
Acharya YT. (ed). Caraka Samhita of Agnivesha, 5th ed. Varanasi: Chaukhambha Sanskrit Samsthana;
Reprint. 2011. p645
Pandey SHP. (ed). Bhava prakasha of Bhavamishra, Vidyotini Teeka, 11th ed. Varanasi:
Chaukhambha Sanskrit bhavan. 2010. p155
Table 1: Effectiveness on Clinical Assessment under Different Treatment

Clinical group P
symptom a
i
r
e
d
Mean ‘
%improvem
t
ent
’
t
e
s
t
S.D. S.E.M
B.T. A.T. ‘t’ P
(±) . (±)
Dyspnea Group A
3.08 0.92 93 1.99 0.39 5.41 <0.001
Group B 2.42 0.88
60 0.64 0.12 12.12 <0.001
Wheezing Group A
2.8 0.2 92 0.63 0.16 15.9 <0.001
Group B
2.53 0.53 79 0.65 0.16 11.83 <0.001
Cough Group A 2.28 0.76
66 0.87 0.17 17.32 <0.001
Group B 2.23 1.00
55 0.51 0.10 11.20 <0.001
Sputum Group A 2.04 0. 60
70.5 0.65 0.13 11.06 <0.001
Group B 2.26 0.96
57 0.61 0.12 10.79 <0.001
Impact on Group A
2.00 0.84 58 0.37 0.07 15.50 <0.001
activity
Group B 1.92 1.00
48 0.39 0.76 12.0 <0.001
3
PEFR Group A
142 201 41 29.99 6.70 8.83 <0.001
Group B 149.
193.4 29 23.19 5.18 8.56 <0.001
0
Frequency of Group A
2.4 0.9 62 0.68 0.15 9.75 <0.001
attack
Group B 2.05 0.95 53 0.96 0.21 5.8 <0.001
Duration of Group A
2.5 0.8 68 0.65 0.14 11.57 <0.001
symptoms
Group B 1.95 0.65 66 0.73 0.16 7.93 <0.001
A CLINICAL STUDY ON KASA WITH AN INDIGENOUS DRUG COMPOUND
Dr SHARVARI S DESHPANDE *
*** P.G Scholar, Dept of Kaumarabhritya, SDMCA&H, HASSAN, KARNATAKA
**** Proffessor & H.O.D, Dept of Kaumarabhritya, SDMCA&H, HASSAN, KARNATAKA
Introduction
“the war between health and diseases starts with the onset of life”. Hence every child needs to be
protected from mortality and morbidity, to grow up as a healthy citizen.
Uchhwasa and nishwasa 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 life, the
normalcy of which suggests health..the abnormality in respiration indicates disease, and its
cessation marks death. This unique sign of life is affected in the disease kasa.
Kasa (cough) is one of the commonest complaints in day to day pediatric practice and it is also a
symptom of various diseases of respiratory system.
Kasa may not be life threatening but increasingly annoying and irritating to the individuals in his
routine activity. More over when neglected they may lead to a series of complications later. Kasa
has a broad-spectrum of etiology, ranging from allergens to infections. Recurrent attacks makes the
school going child suffer and may have its adverse effects on the studies of the child.
Cough occurs in association with acute upper respiratory infection, acute pharyngitis, acute
bronchitis and chronic sinusitis, all of which rank among the top 10 reasons for visiting family
physicians.
Methodology
The present clinical study entitled “a clinical study on kasa with an indigenous drug compound”
was carried out with the following objectives.
Objectives of the study:
To evaluate the effect of the syrup of an indigenous drug compound in reducing kasa.
To evaluate the effect of syrup of an indigenous drug compound in associated symptoms of
kasa like peenasa, jwara etc.,
To make a follow up for any relapse of symptom of kasa or recurrence of kasa etc.
Ingredients of syrup:
syrup of an indigenous drug compound by the name of syrup shati compound contains the
following ingredients.
Shati kandha
Badara twak
Sugar
Sodium benzoate
Source of data:
Patients with complaints of kasa with many associated symptoms as explained in classics under
kasa rogadhyaya were taken randomly from kaumarabhritya o.p.d and i.p.d of s.d.m. ayurvedic
hospital, hassan.
Inclusion criteria:
1. Patients presenting with kasa.
2. Any of two or more symptoms described in the context of kasa were
included.
3. Kasa of less than 15 days duration was included.
4. Patients were taken irrespective of sex and between the age group of
2-10yrs
Exclusion criteria:
the following conditions were excluded from the study.
Kshataja kasa
Kshayaja kasa
Kasa as anubhandha lakshana (complication) in other systemic diseases.
Kasa with sub acute condition and of more than 30 days of chronicity of history.
Sampling:
1. The patients of either sex between the age group of 2-10yrs were randomly included in the study.
2. The patients thus included were randomly divided into four groups, each consisting of minimum
10 patients
Group a (treated group-11 patients)

This group predominantly with productive cough was given the syrup shati compound in a dose
of 5ml four times a day for 10days for the age group 5-10yrs. And half of this dose was given to
children below 5yrs.
Group b(controlled group-10 patients)
This group predominantly with productive cough was given the placebo i.e. Syrup concentrated
with sugar solution in a dose of 5ml four times a day for 10days for the age group 5-10yrs. And
half of this dose was given to children below 5yrs.
Group c (treated group-12 patients)
This group predominantly with dry and non-productive cough was given the syrup shati
compound in a dose of 5ml four times a day for 10days for the age group 5-10yrs. And half of this
dose was given to children below 5yrs.
Group d (controlled group-10 patients)
This group predominantly with dry and non-productive cough was given the placebo i.e. Syrup
concentrated sugar solution in a dose of 5ml four times a day for 10days for the age group 5-
10yrs. And half of this dose was given to children below 5yrs.
These groups were followed for any recurrence of symptoms at a regular interval of 7 days for a
period one month there after.
Assessment criteria
Assessment was made on the basis of improvement in the clinical
features.
The assessment was based on the gradation of both subjective and objective clinical features
before and after treatment.
Subjective criteria:
Number of bouts of cough: the number of bouts of cough in one hour was noted in each
patient and graded as follows;
More than 8 bouts of cough 03
3 to 7 bouts of cough 02
Less than 3 bouts of cough 01
Absence of bouts of cough 00
Duration of bouts of cough: the duration of each bout of cough in seconds was observed
and the duration of 10 such bouts were counted and mean time of cough was calculated.
Duration of cough more than 15 secs 04
Duration of cough in between 10 – 15 secs 03
Duration of cough in between 5 – 10secs 02
Duration of cough less than 5 secs 01
Absence of cough 00
Disturbance of sleep: the disturbed sleep pattern was assessed on the following gradations
Cough always disturbs sleep 03
Gets cough before sleeping or wakes the child in the morning 02
Cough occasionally disturbs sleep 01
Cough not interfering with sleep 00
Objective criteria:
Throat infection:
Severe throat infection 03
Moderate to severe throat infection 02
Mild throat infection 01
Throat infection absent 00
Added sounds: added sounds like wheeze and crepitations were observed and graded as
follows.
(a) wheeze:
Marked polyphonic wheezing all over the lung field 04
Polyphonic moderate wheezing all over the lung field 03
Marked polyphonic wheezing limited to zones 02
Mild monophonic wheeze present 01
Wheezing absent 00
(b) crepitations:
Scattered all over the lung field 03
Distributed here and there in all the zones 02
Present in one or two zones 01
Absent crepitations 00
Sputum:
The quantity, colour and consistency of sputum was observed and graded as follows.
Kapha- puthi, puya, grathita and offensive 04
Thick large quantity of solid white sputum 03
Moderately thick slightly yellowish in colour 02
Serous expectoration with traces of thick sputum 01
No productive cough 00
Fever:
The presence of fever associated with cough was graded as follows.
More than 1030 f 03
Between 1000 f to 102.80 f 02
0 0
Between 98.6 f to 99.8 f 01
No fever 00
Laboratory investigations: improvement in laboratory investigation reports was observed
before and after treatment to assess the improvement of the condition of the patient.
Results
Forty- eight patients were registered for the clinical trial. By following the inclusion and exclusion
criteria 48 patients were randomly included. These patients were then divided into four groups.
Each group consisting 12 patients. One patient from a group discontinued the treatment as the
cough aggravates after taking the syrup shati compound. In group b two patients had discontinued
the treatment as the cough aggravated after taking placebo. In group d two patients did not came for
follow up due to unknown results. Thus the complete clinical trial was completed on forty-three
patients.
Observations based on assessment criteria
Number of bouts of cough
It was found that there was a reduction of 56.20% in bouts of cough in group a which
is statistically significant as the ‘p’ value is <0.001 while group b showed a reduction
of 3.44%. C group showed a reduction of 93.16% which is statistically significant as
the ‘p’ value is <0.001 while group d showed a reduction of 25.71%.
Duration of bouts of cough
62.89% of reduction in duration of bout of cough was seen in group a, which is statistically
significant as the ‘p’ value is <0.001, where as group b showed a reduction of 15.62%. C
group showed a reduction of 92.85% which is statistically significant as the ‘p’ value is
<0.001 while group d showed a reduction of 31.42%.
Sleep disturbance
It was found that there was a reduction of 52.63% in sleep disturbance in the
children with cough in group a while group b showed no reduction in sleep
disturbance. C group showed a reduction of 91.66% in sleep disturbance and was
highly significant with the ‘p’ value <0.001 and group d showed a reduction of 33.33%
which is not significant.
Throat infection
A group showed 66.97% reduction in throat infection with ‘p’ value <0.001 which is
statistically significant, while group b showed a reduction of 9.09%. C group showed a
reduction of 78.44% which is statistically significant as the ‘p’ value is <0.001 while group
d showed a reduction of 44.44% which is not significant.
Wheezing
53.11% of reduction in wheezing was seen in group a, which is statistically insignificant as
the ‘p’ value is <0.025, where as group b showed a reduction of 6.25%. C group showed a
reduction of 87.96% which is statistically significant as the ‘p’ value is <0.01 while group d
showed a reduction of 25%.
Crepitations
A group showed 70.66% reduction in crepitations with ‘p’ value <0.05 which is statistically insignificant,
while group b showed no reduction in crepitations. C group showed a reduction of 68% in
crepitations with a ‘p’ value <0.2 which is statistically insignificant while group d showed a
reduction of 50% in crepitations.
Quantity and quality of sputum
It was found that there was a reduction of 43.38% in quantity and quality of sputum in the children with
cough in group a which ic statistically significant as the ‘p’ value is <0.001while group b showed a
reduction of 3.57%. In c group there was a reduction of 100% in quantity and quality of sputum
while group d showed a reduction of 70%.
Fever
A group and c group showed 91% and 100% reduction in fever respectively and both groups were
found statistically significant with the ‘p’ value <0.001 and <0.005 respectively
Laboratory investigation values

A) aec group a showed 5.4% reduction in mean score of aec, where as group b showed 1.53%
reduction in mean score of aec. C group showed 8.15% reduction in mean score of aec where as .
Laboratory investigation values
a) aec Group d showed 2.36% of reduction
B) esra group showed 15.3% reduction in mean score of esr and it is statistically significant as
the ‘p’ value <0.025 and b group showed 7.14% reduction in mean score with the ‘p’ value of
<0.4 which is statistically insignificant.
C group showed reduction of 28.24% in mean score of esr and it is statistically insignificant as
the ‘p’ value <0.025 where as group d showed 9.37% of reduction in esr.
Showing the percentage of gross improvement in four groups:
Sr. No. Clinical features
Gr. A Gr. B Gr. C Gr. D
1 No of bouts of cough 56.20 3.44 93.16 25.71
2 Duration of bouts of cough 62.89 15.62 92.85 31.42
3 Sleep disturbance 52.62 0 91.66 33.33
4 Throat infection 66.97 9.09 78.44 44.44
5 Wheezing 53.11 6.25 87.96 25
6 Crepitations 70.66 0 68 50
7 Quantity and quality of sputum 43.38 3.57 100 70
8 Fever 91 0 100 75
Total 57.97 5.42 87.43 39.98
Group c showed maximum improvement (87.43%) in clinical features while group a

showed 57.97% of improvement.
Discussion
Kasa being the common childhood ailment has been given more emphasis by the medical people
because it diverts parents psyche from their routine work. Its incidence varies from locality to
locality depending upon the atmosphere. The disease kasa is well described in different ayurvedic
samhitas with their severity in respective doshik predominance. Alternative medicine has focused
regarding infections e. G. Adenovirus, bordetella pertussis etc and allergens like pollens, feathers,
dust, moisture etc and patients of cough are categorized as dry and productive cough.
the present study included a total of 43 patients in four groups i.e. Group a and group c received
syrup shati compound and these belonged to productive and dry cough groups respectively where
as group b and group d received placebo these groups belonged to productive and dry cough
respectively and acted as control.
Discussion on methodology:
Irrespective of sex, children of 2-10 years of age had been taken as sample for the present study.
Syrup had been prepared with shati and badara by taking the references of madanapala-nighantuh
and kaiyadeva-nighantuh and given emphasis on the views of prof. Dr. C.h.s. sastry in his clinical
experience for the management of kasa in children.
Initially the drug was administered for 8 times per day as per the severity of the disease. Later on
for the convenience of school going children it was reduced to 4 times per day.
Conclusion
Most of the nidanas explained in ayurvedic classics were found to act as precipitating or
triggering factors in production of kasa especially vihara sambandhi nidanas like exposure
to raja, dhooma and sheeta vayu. There was significant role of ahara sambandhi nidana in
initiation of kasa in children.
Nidana parivarjana has a definite role in reducing the recurrence of cough in children.
Samprapti of individual kasa is complex as various known or unknown exogenous and
endogenous etiological factors are responsible in pathogenesis of kasa.
Prevalence of kasa is observed more in male children and from middle socio economic
group.
Dry cough disturbs the sleep in the night time.
The action of syrup shati compound is effective in relieving the symptoms of kasa in
children in general within the duration of 7 to 10 days.
6
“EFFECT OF SWARNAMRITAPRASHANA IN RECURRENT ATTACKS OF
KASA”
Rushikesh Tikole1, Prasanna N. Rao2, Shailaja U.3,Shital Desai.4
Background: Certain diseases may not be life threatening but increasingly annoying and
irritating to the individual in his routine activity. A very common condition is kasa ,it is one
among them increasingly prevalent now days, demanding greater concern over it.Objective:
Observational study is designed with an aim to evaluate effect of Swarnamrita prashana in
recurrence of kasa and its associated complaints.
Materials & methods: Study was carried out in OPD & IPD Dept.Of Kaumarabhritya ,SDM
CA& H,Hassan. Children satisfying diagnostic criteria & having age 3-8 years were included in
study daily 1 ml of Swarnamritaprashana administered early morning on empty stomach for
the period of 1month. The graded response subjective and objective clinical parameters were
assessed before treatment and after treatment.
Results: Effect of Swarnamritaprashana on treatment provided 43.83% reduction in duration

of bouts of cough /month significant at P>0.001, Effect of treatment provided 69.22%
reduction in sleep significant at P>0.001,Effect on ronchi treatment provided 37% reduction in
ronchi significant at P>0.001,Effect on treatment provided 40% reduction in duration of bout
of cough/hour significant at P>0.001, Effect on duration treatment provided 49% reduction in
duration of bout of cough significant at P>0.001,Effect on rals treatment provided 61.90%
reduction in rals significant at P>0.001,Effect on nature of sputum treatment provided 66.70%
nature of sputum statistically significant P>0.001,Effect on provided treatment 66.70%
reduction of inflammation of pharynx insignificant at P<0.05,Effect on tonsils treatment
provided 50% reduction of inflammation of tonsil significant at P> 0.001,effect on treatment
provided 65.21% reduction of dyspnea significant at P>0.001, thus efficacy of
Swarnamritaprashana is proved in recurrent attacks of kasa.
Keywords: Swarnamritaprashana,kasa,
Materials and methods

Prashana is one of the important practice mentioned under Jatakarma in Ayurvedic classics. Among
all authors Kashyapa gave the most clear ideas on Prashana, its vidhi, indication contraindications,
ingredients, formulations, importance/advantages.
There are several references of the Svarnaprashana in Ayurvedic literatures mentioning its
actions like Balya, Brumhana, Rasayana, Medhya, Kantiprada, Tridoshahar and Vyadhidhvamsaka.
Kashyapa explains it as Medhya and Agnibala Vardhak, Aayushya, Mangala, Punya, Vrishya,
Varnya, Grahapaham. It has been further mentioned that if it is taken daily for a month, schild
becomes extremely intelligent and doesn’t suffer with recurrent diseases (“Vyadhibi Na Cha
Drushyate”) and if taken for 6 months continuously, child is able to retain whatever he hears.
As in all the references of Swarnaprashana its mentioned that it increases the Bala which is
taken as Vyadhikshmatva (Immunity) in present study and researched.
The present clinical study entitled
“Effects of Svarnamrita Prashana in recurrent attacks of Kasa” with following objectives:
1. To evaluate the effect Svarnamrita Prashana in recurrent Kasa.
2. To evaluate the effect of Svarnamrita Prashana in Kasa associated complaints.
SOURCE OF DATA:
Patients of Kasa irrespective of sex, caste, religion from outpatient department and in patient
department of Kaumarabhritya were selected. Patients from Svarnamritaprashana camp which was
conducted every month on the day of Pushya Nakshtra in S.D.M College of Ayurveda and Hospital
Hassan were also selected.
DIAGNOSTIC CRITERIA:
Cough with recurrent attacks – productive or dry
Symptoms explained in classics and modern text
Shookapoornagalaasyata,Aruchi,Sashabdha,Vaishamya,Agnisada,Gala lepa,Thalu lepa.,Kanthe
kandu,Bhojyanaam avarodha
INCLUSION CRITERIA
1) Children of age group of 3 to 8 years
2) Cough with frequent attacks at least monthly once.
3) Simple cough associated with tonsillitis, pharyngitis will also be included.
EXCLUSION CRITERIA
1) Cough with other systems involved.
2) Pulmonary tuberculosis, COPD, Bronchiectasis & Tropical eosinophilia or with any other
systemic disorders.
3) Acute or severe exacerbation & status asthmatics who require immediate intervention.
4) Cough with no recurrence or having cough for the first time.
Ingredients of Svarnamrita Prashana:
1. Guduchi Kashaya – 200 ml
2. Brahmi Churna – 2gms
3. Vacha Churna -- 2gms
4. Jatamamsi -- 2gms
5. Ashvagandha -- 2gms
6. Shankhapushpi -- 2gms
7. Yashti -- 2gms
8. Pippali -- 2gms
9. Murchita Ghrita -- 50ml
10. Madhu -- 50ml
11. Swarnabhasma-- 1.2gms
Method of Preparation:
Above ingredients (1-9) mixed & made to Madhayam Paka by Snehpak Vidhi with reference to
Sharangdhar Samhita. 50 ml of prepared Ghrita + 50 ml of Madhu + 1.2 gram of Swarna
Bhasma. Thus prepared Svarnamrita Prasha was stored in the 30 ml bottles with dropper for the
use.
Dose of Svarnamrita Prashana: 1ml daily, early morning on empty stomach
Duration of Study: 1month
Assessment Criteria
Assessment was made on the basis of improvement in the clinical features.
The assessment was based on the gradation of both Subjective and Objective clinical
features before and after treatment.
Sleep disturbance before and after treatment:

Sleep disturbance Grade
Always 2
Before & after treatment 1
Not disturbed 0
Kasa vega:
The number of bouts of cough in one hour was counted in each patient & graded as follows
More than 8 bouts of cough 03

3-7 bouts of cough 02
Less than 3 bouts of cough 01
Absence of bouts of cough 00
OBJECTIVE ASSESSMENT CRITERIA
Added sounds
Ronchi :-
Ronchi Scoring
Scattered all the lung field 03
Disturbed here & there in all zones 02
Present in one or two zones 01
Absent 00
Wheeze:-
Wheeze scoring
Marked Polyphonic wheezing all over the lung field 04
Polyphonic moderate wheezing all over the lung field 03
Marked Polyphonic wheezing limited to zones 02
Mild monophonic wheeze present 01
Wheezing absent 00
Sputum:-
Sputum Grading
Kapha- puthi, puya, grathita and offensive 04
Thick large quantity of solid white sputum 03
Moderately thick slightly yellowish in colour 02
Serous expectoration with traces of thick sputum 01
No productive cough 00
Overall Assessment criteria :-
Sl. No Signs & symptoms Before treatment After treatment
1. Kasa frequency
2. Expectoration
3. Pharynx
4. Tonsils
5. Dyspnoe
6. Sleep disturbance
7. Rales/ Ronchi
Discussion on Result:
Effect on Frequency of Kasa (Cough Bouts): Swarnamrita prashana after 30 days of treatment
provided 49.00% reduction bouts of cough, which was statistically significant at P > 0.001.
Effect on Sleep disturbance: Swarnamrita prashana after 10 days of treatment provided 69.22 %
reduction in sleep disturbance which was statistically significant at P > 0.001.
Effect on Ronchi: Swarnamrita prashana after 30 days of treatment provided 37.00% reduction in
Ronchi which was statistically significant at P > 0.001.
Effect on Duration of bout of cough/ hour: Swarnamrita prashana after 30 days of treatment
provided 40.00% reduction in Duration of bout of cough/ hour which was statistically significant at
P > 0.001
Effect of Swarnamritaprashana on bouts of cough/ month: Swarnamrita prashana after 30 days
of treatment provided 43.83% reduction in Duration of bout of cough/ month which was
statistically significant at P>0.001
Effect of Swarnamritaprashana on Rales: Swarnamrita prashana after 30 days of treatment
provided 61.90% reduction in Rales which was statistically significant at P>0.001
Effect of Swarnamritaprashana on Nature of sputum: Swarnamrita prashana after 30 days of
treatment provided 48.38 % betterment in Nature of sputum which was statistically significant at P
> 0.001.
Effect of Swarnamritaprashana on Pharynx: Swarnamrita prashana after 30 days of treatment
provided 66.70% reduction of inflammation of pharynx but was statistically insignificant as P
<0.05.
Effect of Swarnamritaprashana on Tonsils: Swarnamrita prashana after 30 days of treatment
provided 50.00% reduction of inflammation of Tonsils which was statistically significant at < 0.001
Effect of Swarnamritaprashana on Dyspnea: Swarnamrita prashana after 30 days of treatment

provided 65.21% reduction in Dyspnea which was statistically significant at P > 0.001
CONCLUSION
Suvarna prashana is effective in recurrent attacks of Kasa
Further a large scale study is needed in the subject to confirm the significant results of the present
research work.
Along with subjective criteria it’s also essential to check the levels of immunoglobulin’s .The study
can also be tried with varied dosages of Swarnabhasma and also needs a follow up for long period.
7
Effect of Shvasahara Avaleha in the Management of Tamaka Shvasa in Children
Dr. Arun Raj GR, Dr. Prasanna N. Rao, Dr. Shailaja U, Dr. Rahul Chougule
INTRODUCTION
Tamaka Shvasa is one among the five varieties of Shvasa explained in almost all the classics of
Ayurveda, which is analogous with bronchial asthma mentioned in modern medicine. Since
centuries Tamaka Shvasa remained to be a challenging and unremitting disease. In both sexes it
may occur at any age. Tamaka Shvasa is one of the chronic diseases of children, which causes a lot
of worries to the patients as well as parents. It affects school attendance, play works, school
performance, day to day activities and growth of the child (Rahul et al. 2008).
Bronchial asthma in children is a worldwide problem having an incidence rate of 10-15% in boys
and 7-10% in girls (Parthasarathy et al. 2010). In general population, about 80% of children begin
to have symptoms before the age of 4-5 years and 10% starts wheezing for the first time in the later
childhood. Thus asthma is a chronic respiratory disease in children which is increasing day by day
due to the mode of life, dietetic changes, pollution environmental variations and various stimuli like
dust, cold air, smoke, pollens, house dust mite, viral respiratory tract infections etc. Childhood
asthma is highly variable and may differ from patient to patient, so needs much attention and care.
The younger asthmatic child is often very troubled by cough especially at night rather than flank
wheezing. So the diagnosis is often given as bronchitis or spastic bronchitis rather than asthma.
Chronic nocturnal cough is one of the symptoms of asthma children. The older children with
asthma, typically has episodic attacks of wheezing and breathlessness, usually worst at night or
early morning and are often accompanied by cough, but little or no sputum production. The attacks
are separated by symptoms free interval and duration attach varies from patient to patient.
The nature of attacks of asthma and the pattern of recurrence varies considerably from child to
child and this has an importance on treatment (Bhanuprakash et al 2005)
This study was intended to evaluate the “Effect of Shvasahara Avaleha in the Management of
Tamaka Shvasa in Children”. Shvasahara Mahakashaya (Dashemani), which is indicated for
Shvasa Roga includes ten drugs like Shati (Hedychium spicatium), Pushkaramula (Inula
racemosa), Amlavetasa (Garcinia pedunculata), Ela (Elettaria cardamomum), Hingu (Ferula
narthex), Agaru (Aqualaria agalocha), Surasa (Ocimum sanctum), Tamalaki (Phyllanthus urinaria),
Jivanti (Ledtadenia reticulate) and Chanda (Angelica glauca) (Dash et al. 2006). Out of these drugs
Chanda is not available so remaining 9 drugs will be prepared in the form of Avaleha as it is
palatable and easy for administration in pediatric age group.
MATERIAL AND METHODS

Aims and Objectives:
The study was planned to evaluate the effect of Shvasahara Avaleha in the management of Tamaka
Shvasa in children.
Plan of the study:
Children for the present study were selected from the OPD and IPD of Balaroga Department of
SDM College of Ayurveda & Hospital, Hassan. Complete history and clinical presentations of all
patients are recorded in a specially designed proforma by Post Graduate Department of Balaroga of
SDM College of Ayurveda and Hospital, Hassan, Karnataka which includes the ancient as well as
modern methods of examination and assessment of cases. Children between 2 years to 10 years
were selected for the study. Total 53 cases was screened out of which 13 numbers of cases was
discontinued. Thus the study was completed in 40 cases.
METHOD OF COLLECTION OF DATA
Patients who fulfilled the diagnostic and inclusion criteria were selected for the study.
DIAGNOSTIC CRITERIA ADOPTED
The diagnosis was mainly based on lakshanas of Tamaka Shvasa described in Ayurvedic classics.
Diagnosis was be confirmed by the ICD 10 (International Classification of Disease) criteria for the
diagnosis of bronchial asthma. This criterion includes Episodes or chronic wheezing, dyspnea,
cough, feeling tightness in the chest, prolonged expiration & diffuse wheezing on physical exertion,
limitation of airflow on pulmonary function testing or positive Broncho provocation challenge test.
INCLUSION CRITERIA
1) Patients suffering from Tamakashvasa between age group of 3 to 12 years were included
in the study.
2) Patients were selected irrespective of sex, religion, occupation, socio economic status.
EXCLUSION CRITERIA
1) Patients suffering from other types of Shvasa were excluded from the study.
2) Patients with Pulmonary tuberculosis, COPD, Bronchiectasis & Tropical eosinophilia or
with any other systemic disorders were excluded.
3) Patients with acute or severe exacerbation & status asthmatics who require immediate
intervention were excluded.
SINGLE GROUP STUDY
THIS IS A SINGLE GROUP STUDY ON PATIENTS OF TAMAKA SHVASA WITH
SHVSAHARA AVALEHA FOR THE PERIOD OF 1 MONTH.
Doses of Shvasahara Avaleha:
Follow up Study:
THE PATIENTS WERE FOLLOWED AT THE INTERVAL OF 15 DAYS FOR ONE
MONTH. I.E. PATIENTS WERE ASSESSED INITIALLY AND AT THE END OF 15 DAYS
AND AT THE END OF 1 MONTH.
criteria for assessment of the effect of treatment
FOR THE PURPOSE OF ASSESSMENT OF TREATMENT PRE TEST & POST TEST
WERE MADE ON –
Assessment criteria B.T. A.T.
Breathlessness
Audible wheezes
Cough
Sputum
Common cold
Day time asthma
Night time asthma
Discomfort
Assessment criteria B.T. A.T.
Tightness of chest
Chest pain
Loss of sleep
Impact on activity
Palpitation
Respiratory rate
Frequency of attack
Duration of symptoms
PEFR
LABORATORY INVESTIGATIONS
Blood routine exam: TLC, DLC, Hb, ESR.
Urine routine exam for Albumin, sugar and microscopic exam.
X ray chest.
Peak expiratory flow rate.
The severity of disease was assessed with the help of criteria for assessment of severity,
which is given in following table;
GRADATION INDEX –
GRADE 0 1 2 3
Dyspnoea Non ≤ 2 Attacks

e per 60 days
Wheezing Non Only at the

e time of attack
Discomfort Not at On running /

all short exercise
Cough Not at
all Occasional cough
DYSPNOEA
Impact on Non WITH LOT OF
activity e ACTIVITY
Sleep Fin Sleep well,

e slight wheeze
or cough
GRADE 0 1 2 3
Frequency of No < 1 Episode /

attack. attack month
Duration of No Brief for

symptom. symptom. hours
PEFR values Norma >80% Of

l predicted
R.R. 18- 24-

23/min 30/min
Palpitation Not at On running /

all short exercise
Chest pain Not at On running /

all short exercise
Chest tightness Not at mil

all d
Cold Non Itching

e sensation
Sputum Normal More

saliva secretion
DRUG
Shvasahara Avaleha contains the following ingredients:
Sl. No: INGREDIENTS BOTANICAL NAME
1. Shati Hedychium spicatium
2. Pushkaramula Inula racemosa
3. Amlavetasa Garcinia pedunculata
4. Ela Elettaria cardamomum
5. Hingu Ferula narthex
6. Agaru Aqualaria agalocha
7. Surasa Ocimum sanctum
8. Tamalaki Phyllanthus urinaria
9. Jivanti Ledtadenia reticulate
10. Chanda Angelica glauca
OBSERVATIONS
The clinical trial was carried out on 40 patients of Tamaka Shvasa (bronchial asthma). These
patients were treated in a single group and were treated Shvasahara Avaleha. The Nidanatmaka
aspect of these 40 patients of Tamaka Shvasa is being given hereunder;
RESULT
Effect of the therapy
The effects of this therapy on the signs and symptoms of the patients are being presented here under
the separate headings.
Effect of Shvasahara Avaleha on Breathlessness of 40 Tamaka Shvasa patients
Mean t
%relief
B.T. A.T. S.D. (±) S.E. (±) ‘t’ P
2.05 1
51.2 0.71 0.11 9.3 <0.001
Effect of Shvasahara Avaleha on Wheezing of 40 Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.08 0.85 59.04 0.78 0.12 10.1 <0.001
Effect of Shvasahara Avaleha on Cough of 40 Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.1 0.88
58.33 0.69 0.11 11.10 <0.001
Effect of Shvasahara Avaleha on Sputum of 40 Tamaka Shvasa patients

Mean t
%improvement
B.T. A.T. S.D. S.E.M. ‘t’ P
1.75 0.86
52.9 0.72 0.12 8.02 <0.001
Effect of Shvasahara Avaleha on Common cold of 40 Tamaka Shvasa patients

Mean
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
0.73 0.33 54 0.73 0.12 8.02 >0.001
Effect of Shvasahara Avaleha on Day time onset of Asthma of 40 Tamaka Shvasa patients
Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
1.3 0.75 67 0.60 0.09 9.1 <0.001
Effect of Shvasahara Avaleha on Night time onset of asthma of 40 Tamaka Shvasa patients
Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.13 0.68 68 0.71 0.11 12.84 <0.001
Effect of Shvasahara Avaleha on Discomfort of 40 Tamaka Shvasa patients

Mean
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.13 0.68 68 0.71 0.11 12.84 <0.001
Effect of Shvasahara Avaleha on Tightness of Chest of 40 Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
1.85 0.68 63.6 0.68 0.11 11.01 P>0.001
Effect of Shvasahara Avaleha on Chest Pain of 40 Tamaka Shvasa patients

Mean
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
1.95 0.6 69 0.77 0.12 11.1 <0.001
Effect of Shvasahara Avaleha on Loss of Sleep of 40 Tamaka Shvasa patients

Mean
%improvement
B.T. A.T. S.D. S.E.M. ‘t’ P
1.93 0.55 71.4 0.74 0.11 11.7 <0.001
Effect of Shvasahara Avaleha on Impact on Activity of Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
1.78 0.58 67 0.88 0.14 8.60 <0.001
Effect of Shvasahara Avaleha on Palpitation of Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
1.8 0.4 76.7 0.63 0.1 14 <0.001
Effect of Shvasahara Avaleha on Respiratory Rate of Tamaka Shvasa patients

Mean %improvement
S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.08 0.9
55 0.58 0.57 12.5 <0.001
Effect of Shvasahara Avaleha on Frequency of Attack of Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.08 0.9
55 0.58 0.57 12.5 <0.001
Effect of Shvasahara Avaleha on Duration of Symptoms of Tamaka Shvasa patients

Mean t
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
2.08 0.9
55 0.58 0.57 12.5 <0.001
Effect of Shvasahara Avaleha on PEFR of 40 Tamaka Shvasa Patients

Mean
%improvement S.E.M.
B.T. A.T. S.D. (±) ‘t’ P
(±)
149.0 193.4 29% 23.19 5.18 8.56 <0.001
Discussion
Tamaka Shvasa is one among the chronic pulmonary disease, which resembles with bronchial
asthma in modern science. Etiopathology, clinical features and prognosis almost resemble with
asthma. An observation of present study reveals that maximum number of Patients i.e. 55% was
between the age group of 9-12 years.It was observed that more numbers of patients were boys i.e.
62.5% and 37.5% were girls. Maximum number of patients i.e. 87.5% belonged to Hindu
community. This might be due to Hindu s residing here are more in number.Out of 40 cases taken
for the study, 65% patients were having family history of asthma; where as 35% had no family
history of asthma. This study reveals that more number of children had got asthma in the presence
of hereditary factors.
In majority of children upper respiratory tract infections, symptoms were present before
commencing an asthmatic attack. This report corroborates with the following study,
Viral infection accounts for some 80-85% of asthma exacerbations in children aged 9-11
years (Johson et. al. 1995)
Viral infection is commonest provoking factors for asthma in young children.
Respiratory Syncytial Virus (RSV) can induce immunological changes in the host (Wellirer
et. al. 1979 – 1981
Rhinovirus infection and allergy to common inhalants was more in older children (Duff et.
al. 1993).
It was observed that majority of patients (62%) were having Avara Ahara Shakti. In majority of the
patients (65%) mandagni was observed and Samagni was observed in 12.5%. Ahara Sambandhi
Nidana showed Sheeta, Guru, Shleshmala pana (60%), Ruksha Vidahi Bhojana (27.5%),
Adhyasana and Vishamashana (72.5%), Ksheera and Dadhi pana (37.5%), Madhur, Amla, Pishta
Padartha (65%), Jalaja and Anoop mamsa in 45% of Tamaka Shvasa patients in the study. Most of
the Vihara Sambandhi Nidanas described in classics were observed in the asthmatic children.
Especially Nidanas like Sheeta vayu Sevana (100%), Raja Sevana (90%), Dhooma Sevana (85%),
Vyayama (67.5%), Asatmya Sevana, Sheeta Sthana and Sheeta Snana were reported as Vyanjaka
Nidana for Tamakashvasa.
Discussion on
results
Effect of the Treatment

On observing for improvement in all the parameters, it is clear that the improvement was
promissable. i.e. the patients who received therapy with Shvasahara Avaleha, there was maximum
reduction in number of attacks, duration of symptoms and better increase in PEFR. Hence, it may
be concluded that Shvasahara Avaleha is potent in controlling the Tamaka Shvasa in children to the
maximum extent.
Shvasahara Avaleha appears work better; this may be due to Rasayana and Vyadhipratyanik action
of drug. In this study the patients received Shvasahara Avaleha as a Shamana Chikitsa,.
Shvasahara Avaleha worked better after one month of prolonged administration than the initial
days.
This study shows that in Bahudoshavastha, patients with chronic history, increased number of
attacks, Shvasahara Avaleha shown good improvement but complete cure of the disease is not
attained. So, prolonged administration of Shvasahara Avaleha is needed for complete samprapti
vighatana of Tamaka shvasa.
Mode of Action
In all the patients, appetite was increased after administration of Shvasahara Avaleha. This might
be due to the ingredients of Shvasahara Avaleha i.e. Hingu, Bhumyamalaki, Tulasi, and Amlavetasa
which are having Ushna, Tikshna guna. Ushna Veerya and deepana, pachana, kasashwasahara and
shleshmahara properties (Sastry 2008). Hence, Shvasahara Avaleha administration might have
increase Jatharagni and does amapachana, thus helping in reducing the severity and attacks of
Tamaka Shvasa.
Shvasahara Avaleha was palatable, as no patients refused to take orally. Shvasahara Avaleha is
having Deepana Pachana, Kaphavatashamaka, Shvasa-kasahara, Peenasahara and
Parshwapeedahara properties. Thus Shvasahara Avaleha might have reduced the vitiated Vata and
Kapha helped in reducing the symptoms of Tamaka Shvasa.
SUMMARY AND CONCLUSION
Tamaka Shvasa (Bronchial Asthma) is a global health problem, which is increasing since last three
decades, both in developed and developing countries. Samprapti of Tamakashvasa is complex
because of various known and unknown etiological factors operating in the pathological process.
Even though Kapha and Vata both are vitiated; Kapha in the initial stage and Vata in the later stage
have an important role in the manifestation of Tamaka Shvasa. Acharya Charaka has indicated
Shvasahara Mahakashaya (Dashemani) in the Sutrasthana to manage Shvasa Roga.So, that
Mahakashaya has prepared in Avaleha form for easy administration.. Moreover the medicine is
palatable & sweet in taste, hence can be administered to children easily.Therefore this clinical study
was planned to evaluate the Effect of Shvasahara Avaleha administered in the management of
Tamaka Shvasa in children.
Most of the Nidanas explained in Ayurvedic classics were acting as precipitating or triggering
factors especially Ahara-Vihara Sambhandi Nidanas like Vishamasana, Gurusheeta bhojana,
exposure to raja, Dhooma, Sheetavayu and Nidanarthakara Rogas like Pratishyaya & Kasa.
Upper respiratory tract infections especially rhinitis was usually found premonitory for
development of Tamaka Shvasa in children. Pratisyaya is explained in Poorvaroopa of
Tamakashvasa. So in known patients of Tamakashvasa progress of disease can be arrested with
administration of drugs.
Samprapti of Tamaka Shvasa is complex, as various known/unknown, exogenous or endogenous

etiological factors are responsible for pathological process.Effect of Shamana Chikitsa with
Shvasahara Avaleha in the long-term management in arresting Tamaka Shvasa was found to give
better results. In allergic symptoms like sneezing and common cold significant improvement
P<0.001 is seen in patients underwent Shamana Chikitsa with Shvasahara Avaleha. This may be
suggestive of Shamana therapy is necessary to reduce symptoms associated with allergy.
Shamana Chikitsa therapy with Shvasahara Avaleha has given more additional therapeutic
effects and showed maximum improvement in all the parameters of assessment criteria.
REFERENCES
RAHUL, P. et al. (2008) Role of Virechana and Kantakaryavaleha in the Management of Tamaka Shvasa
in Children. Unpublished thesis (MD), Rajiv Gandhi University of Health Sciences.
PARTHASARATHY, A. et al. (2010) IAP Textbook of Pediatrics. 4th ed. Mumbai: Jaypee Brothers
Medical Publishers (P) Ltd.
BHANU, P. et al. (2005) A Clinical study on Tamaka Shwasa with Thambula Avaleha in Balas.
Unpublished thesis (MD), Rajiv Gandhi University of Health Sciences.
DASH, VB. et al. (2006) Vatakalakaleeya. Charaka Samhita. 1st ed. Varanasi: Chaukhamba Sanskrit
Series Office, pp. 97.
SASTRY, JLN. (2008) Illustrated Dravyaguna Vijnana. 3rd ed. Varanasi: Chaukhambha Orientalia.
8
CLINICAL STUDY OF IMMUNOMODULATORY EFFECT OF AN AYURVEDIC
COMPOUND (KASHYAPOKTA LEHA) IN RECURRENT URTI IN CHILDREN.
Dr. Jyotsna J.Ahir1, Dr. Ajit R. Shirsat.2
Dept. of Kaumarbhritya, Yashwant Ayurvedic College Post Graduate Training & Research
Centre Kodoli, Panhala, Kolhapur, State - Maharashtra.
E mail – drjyotsnaahir@gmail.com1, ajit.planz@gmail.com2
Introdction :-
Childhood is a state susceptible for infectious disease due to poor immunity as the immune system
plays a vital role in maintaining the body’s overall health and resistance to disease. Immune system
is immature in children thus, they are unable to protect their body from invaders .It suggests there is
deficiency in the local or systemic host defenses. The cases of recurrent URTI were routinely seen
in day-today practice.
Kashyapokta Leha has been said to be very effective in promoting Vyadhi kshamatva by Acharya
Kashyapa in Ayurveda.
With this idea, we had started giving Kashyapokta Leha, in the Kaumarbhritya OPD of Y.A.C.P.G.T
& R. C. Kodoli, 9 months ago. We made a study on children who had recurrent URTI coming to our
day-today OPD.
When a child gets born, the doctors regularly advise their parents, for the protection of their child’s
health by recommending different types of vaccines, at different periods of age. Modern Science
has recommended several vaccines for several diseases which is the recent vaccine concept. Vaccine
is invented in near past, but the basic idea of vaccine is described in Indian medical science i.e.
Ayurveda in the context of Vyadhikshmatva, which is unknown to the people. If body has sufficient
immunity, not a single infection or epidemic can affect it. Therefore, Ayurveda gifted us
Kashyapokta Leha to improve immunity of Child.
Kashyapokta Lehawas described by Acharya Kashyapa in kashyapa SamhitaSutrasthana,

‘Lehanadhyaya’ According to him-
समंड़ा ऽफ़ला ॄा े बले िचऽकःतथा ।
मधुसपरित ूाँय◌ं् मेधायुबल
वृ$ये ॥
का. सं. सु. लेहना(याय
Drug review :-
The drug used for Kashyapokta Lehawas prepared in 3 steps.
1) Preparation of Samangadi churna.
2) Preparation of Bramhi Ghruta.
3) Preparation of Shuddha Madhu.
Drug
Preparation of steps drug
Composition of drugs
Rasa /Virya/Vipak
Action of drug
Kashypokta Leha
1.Samangadi churna.
Manjishtha
Kashaya,Tikta,madhur/Katu/Ushna
Dipan,Pachan,Rasayan
krumighna,Kushthghna,
Jwaraghna
Hirda
Panchrasa
(except Lawan)/Madhur/Ushna
Tridoshghna,Medhya, krumighna,Kushthghna,Jwaraghna
Bhehada
KashayMadhur/
Madhur/Ushna
Tridoshghna, Dipan, Dhatuvardhk, Kasghn,
Jwaraghna
Awala
Pancharasa (expect Lawan)/Madhur/Shit.
Dipan,Rasayan,Kushthghna,Jwaraghna
Brahmi
Tikta/Kashaya/Madhur/shita
Balya,Swarakarini,Kasaghna,Jwarahari,
Rasayana
Bala, Atibala
Madhur/Madhur/Shita
Bruhan,Ojovardhak,
Jwaraghna,
Chitraka
Katu/Katu/ Ushna
Dipan,Pachan,krumighna,
Kushthghna,Jwaraghna
2.Bramhi Ghruta
Bramhi Swarasa
Tikta/Kashaya/
Madhur/shita
Balya,Swarakarini,
Kasaghna,Jwarahari,
Rasayana
Vacha
Tikta Katu/katu/Ushna
Balya,Kaphaghna
Kushtha
Tikta/Katu/katu/Ushna
shwasaghna, Kasaghna,
Jwaraghna.
Shankhapushpi
Tikta Katu/Madhur/shita
Balya,Swarakarini,
Tridoshaghna Grahadoshanashak
Goghrita
Madhur/madhur/shita
Balya
3.Shuddha Madhu
Madhur-Kashaya /madhur/shita
As a Anupan dravya ,lekhan of kapha dosha

Aim & Objective:-
1) To evaluate the efficacy of Kashyapokta Lehain preventing recurrent episodes Upper
Respiratory Tract Infection in children.
2) To evaluate untoward effect of Kashyapokta Leha by taking history from parents & with the
help of child assessment.
2) Clinical study:-
A) material and Methods:-
Material:-
Inclusion Criteria :- Children with recurrent episodes of Upper Respiratory tract infection.
(Defined as more than 4 episodes of URTI during the period of 3 months prior to enrollment in the
study)
Exclusion Criteria :-
1) Children with immune –compromised disorder like HIV, T.B.& with known
Infective pathology.
2) Children having serious form of disease.
3) Children receiving corticosteroids.
4) Children with H/O receiving Suvarnaprashana.
Methods:-
A clinical study of 60 children of (1 month to 10 yrs) age having recurrent episodes of URTI
were randomly divided in to 2 subgroups of A & B. Children of subgroups received Kashyapokta
Leha for 3 months and children of subgroups B fro did not receive Kashyapokta Leha.
During this period, the children who had respected infection were treated with an appropriate
treatment.
This study was done at the OPD of Kaumarbhritya Dept. of Y.A.C. Hospital, Kodoli. The total
no. of episodes of recurrent infections; overall well being and adverse effects were assessed at every
month.
2) Clinical study :-
Out of 68 patients, 60 children were actually included in study & remaining 8 children were
showed adverse effect like nausea, stomatitis, flatulence & some children were refused to take that
medicine so they were excluded from the study. The procedure was done as follows-
Groups Subgroup A no. of pt. Subgroup B no. of pt.

Recurrent URTI 30 30
Sub gr. A B
No of Patient 30 30
Drug Kashyapokta Leha Not received Kashyapokta
Leha
Rout of AdministrationOral
Dose For 1 to 6 months 5 Drops. ------
For 6 months to 1yr.8 drops.
For 1yr to3yr.10 drops.
For 3yr to 5yr.15 drops.
For 5yr to 8yr.20 drops.
For 8yr to 10yr. 25 drops taken in
spoon then given to a child.
Duration 2 times a day before food for continue -------
3 months.
Advice Normal diet, proper hygienic Normal diet, proper
condition & exercise. hygienic condition
&Exercise
Criteria of Assessment :-
The criteria of Assessment were totally based on individual history & clinical assessment of the
child as per following signs and symptoms.
For Recurrent URTI :-

a) Dry cough
b) Fever
c) Sore throat
d) Running nose
e) No Wheeze or any added sound.
Assessment of Results :-
Following criteria was applied for assessment of total effect of therapy in both sub groups.
Improved –Children having no or only one episodes of respected disease in 3
consecutive months.
Unchanged- Children who were not fulfilling above criteria.
Results :-
The obtained data of 60 children were tabulated as follows.
FOR GROUP – Recurrent URTI The results was
Group 2– Recurrent Total patients Of Recurrent Improved Unchanged
URTI URTI
Sub–group A 30 12 18
Sub–group B 30 5 25
Episodes of Recurrent URTI were reduced in 40 % children of subgroup A & in 16.66% children
of sub Group B within 3 months.
Statistical analysis :-
By considering above obtained data we made a contingency table, then applied CHI square test to
draw an inference.
Contingency table for Group – Recurrent URTI
Group – Recurrent URTI
Improved Unchanged Row Total
Sub–group A
12 18 30
Sub–group B
5 25 30
Column Total
17 43
Grand Total =60
Then with the help of calculation & CHI square table, the obtained CHI square values for Group -
Recurrent URTI were,
Calculated CHI square value
Table CHI square value
Inference
3.84
Significant Result.
That results was assessed at 1 degree of freedom for 5% level.
Discussion :-
According to Rutu there might be variations in episodes of above disease & also in the effect of
Rasayana Chikitsa (Kashypokta Leha). Hence it requires long period study to show its best results.
So by taking these two points into consideration we made a conclusion.
Conclusion:-
Kashypokta Leha showed significant results in case of recurrent URTI ,but here by considering
point of RUTU effect there is a need of prolonged study at least for one year, which includes all
‘Shada-rhutues’ and also the study must be conducted in more number of children in sub each
group.
Referances:-
Kashyap Samhita – Nepalrajguru Pandit Heamraj Sharma – Chaukhamba Sanskrit Sansthan Varanasi.
Kaumarbhrityam By Dr. V. L. N. Sastry – Chaukhamba orientalia, Vaeanasi – 2009.
Essential Pediatrics – O. P. Ghai. – CBS Publication – 7th edition – 2010.
The short textbook of pediatrics - Suraj Gupte – Jaypee – 9th edition – 2001.
Dravyaguna Vignyan – P. V. Sharma – Chaukhamba Bharti Academy – 2007.

Rasabhaishajya Kalpana Vignyan– Santish Kumar Khandel – Publication Scheme Jaipur – 7th edition – 2006.
Methods In Biostatistics – B. K. Mahajan – Jaypee Brothers Medical publishers Pvt. Ltd.

9
“EFFECT OF AMRITADI LOZENGES IN THE TREATMENT OF KAPHAJA KASA IN
CHILDREN”
Dr Nabisab Kamatnur* Dr Veena** Dr Shailaja Rao***
*P.G scholar, Department of Kaumarabhritya, SDMC&H, Hassan
drmunnak@gmail.com
** P.G scholar, Department of Kaumarabhritya, SDMCA&H, Hassan, Karnataka
***Professor & H.O.D, Department of Kaumarabhritya, SDMC&H, Hassan
INTRODUCTION
Cough is the fifth most common symptom for which patients seek care and prevalence rate of
which is 25% in children worldwide1. Cough usually occurs in association with acute upper
respiratory tract infection, acute pharyngitis and acute bronchitis as well as in chronic sinusitis, all
rank among the top 10 reasons for visiting pediatrician2. More over in neglected cases series of
complications were encountered.
In Ayurvedic classical texts, many of the drugs and formulations have been described for the cure of
Kasa3. The research done on these drugs confirms their expectorant, pharyngeal demulcent,
mucolytic, mast cell stabilizing capacity etc. Considering the above points the present work is
undertaken by choosing the effective seven drugs in the form of Amritadi Lozenges which are
having properties to cure the cough by tackling the all possible pathologies of cough after their trial
administration and observing its efficacy in treating cough.
In the present clinical study 30 patients were treated by dividing them into trial and control group
each containing 15 patients. The drugs were administered in the Lozenge form for its easy
palatability in both the groups.
MATERIALS AND METHODS
Formulation
Ingridents of the Amritadi lozenge
Sl. no Name of the Botanical name Part used
drug
Amrita Tinospora cardifolia Stem
Vaasa Adathoda vasika Leaves
Vacha Acorus calamus Root
Yashtimadhu Glycirrhiza glabra Root
Shati Hedychium spicatum Root
Shirisha Albezzia lebbeck Twak
Arka Calotropis procera Leaves
Preparation of Drug:
After thorough cleaning and drying of raw drug in a shade, each drug was finely powdered
separately.Equal quantity of all the seven finely powdered drugs were mixed together after
weighing and double quantity of Guda was taken and Guda Paka was prepared and to it
finely powdered (mixed) drugs were added and mixed well.Lozenges were prepared, each
weighing about 2gms
For the purpose of controlled study Lozenges prepared out of wheat powder in Guda Paka,
each weighing about 2gms were used.
Research Design: Interventional, single blinded, randomized control trial.
Research setting:Outpatient department& Inpatient department of department of Kaumarabhritya,

SDMCA&H, Hassan, Karnataka, India.
Research population: The children with Kaphaja Kasa, 3 to8 years of age attending
Kaumarabhritya OPD, SDM Ayurvedic hospital, Hassan, Karnataka, India
Sampling: Simple random sampling technique using random number tables
Sampling Element: Children from 3 to 8 years affected with Kaphaja Kasa.
METHOD OF COLLECTION OF DATA:

Patients who fulfilled the diagnosis and inclusion criteria were selected for the study.
Selected children were thoroughly examined; both objective and subjective manifestations were
recorded in a specially designed clinical Performa.
Diagnostic Criteria: The diagnosis was made as per clinical signs and symptoms of Kaphaja Kasa
mentioned in Ayurvedic classics.
Inclusion Criteria: Children belonging to the age group of 3-8 years of both the sexes.
Exclusion Criteria:

Kshataja Kasa4
Kshayaja Kasa
Kasa as an Anubandha Lakshana in other systemic disease, ex. pneumonia
Kasa with sub acute condition of more than thirty days of chronic history.
ASSESSMENT CRITERIA:
Assessment was analyzed on the basis of improvement in the clinical
features.
The assessment was based on the gradation of both Subjective and Objective clinical
features before and after treatment.
Dosage and Groups of the Treatment: 33 patients of Kaphaja Kasa were randomly divided into
following 2 groups. Group A comprised of 16 patients and Group B comprised of 17 patients. Out
of 33 patients 1 patient from group A and 2 patients from group B were dropped out and the study
was completed on 30 patients.
Group-A: Children in the trial group were given 4 Amritadi lozenges per day once in 4 hour to
chew for a period of 10 days.
Group-B: Children in this group were given 4 placebo lozenges prepared out of wheat flour per day
once in 4 hour to chew for a period of 10 days.
Duration of Study:
The treatment period was for 10 days and progress during treatment was recorded
periodically once in 5 days. The children of both the groups were assessed before and after the
treatment as per the following graded clinical parameters of Kasa and relevant investigations.
Follow up Study: After the treatment period, the child was called for follow up at a frequency of
one month.
STATISTICAL ANALYSIS:
The observations made before and after treatment were considered for analysis. Statistical
analysis was carried out using paired t test.
OBSERVATION
The present clinical study entitled “Effect of Amritadi Lozenges in the treatment of Kaphaja Kasa in
children” was carried out on 33 patients of Kaphaja Kasa who were randomly divided into two
groups. First group i.e, Group A contains 16 patients who have given with Amritadi lozenges, which
is the research drug. While the second group, i.e, Group B was administered with lozenge prepared
out of wheat flour. All the patients were selected as per inclusion and exclusion criteria and were
assessed periodically for the improvement of clinical conditions. However there was 1 dropout from
first group and 2 dropouts from the second group due to some uncertain reasons thus the entire
clinical study was completed in taking 30 patients as sample of study. The observations made over
33 patients and recorded as follows.
Age: In the present study 18 (54.54%) patients belonged to the age group of 3-5yrs and 15
(45.45%) patients belonged to the age group of 6-8 years (Table-1).
Sex: In the present study among 33 patients 22 (66.66%) were male and 11 (33.33%) were females.
Group-A consisted of 12(75%) male and 4(25%) females while Group-B had 10(58.8%) males and
7(41.17%) females (Table 2).
Religion: In the present study among 33 patients of both the groups, 30 (82.35%) patients were
from Hindu and 3 (9.09%) patients from Muslim religion (Table 3).
Socio-economic status: In the present study in Group-A 10 (62.5%) patients belonged to Middle
class, 5 (31.25%) to Lower class and 1 to Upper class, while in Group-B (1313%) patients belonged
to Middle class, 2 (11.76%) each to upper and lower class. The incidence of Kasa was more
observed in middle class i.e. 23 (69.69%) patients (Table-4).
Family: In the present study out of 33 patients, 21(36.36%) patients were from single
family; where as 12 (63.63%) patients were from joint family. The high incidence of
Kasa in children from single family was noted (Table-5).
Habitat: In the present study out of 33 patients 19(57.57%) patients were from rural
area; 3 (9.09%) patients were from semi urban and 11(33.33%) patients from urban
area (Table-6).
Diet Habit: Maximum 23(69.69%) patients from mixed diet and only 10(30.30%) patients from
vegetarian diet family were seen out of 33 patients in the present study (Table-7).
Desha: Among 30 patients maximum 22 (66.66%) patients belonged to Anupa desha, remaining 11
(33.33%) patients belonged to Sadharana Desha (Table-8).
Educational status of the parents: More than Secondary education of parents was
observed in both the groups. 12(75%) fathers, 10 (62.5%) mothers in Group-A and 9
(52.94%) fathers, 4 (23.52%) mothers from Group-B were seen educated beyond
secondary level (Table-9).
Nidana: In the present study among 33 patients 2(6.06%) patients had Guru ahara as Nidana.
Snigdhahara was found as Nidana in 11(33.33%) patients, 5(15.15%) patients each had Nidana of
Abhishyandi and Madhura Ahara; Swapna vicheshta was Nidana in only 1(3.03%) patient where as
Nidana was Not significant in 8 (24.24%) patients (Table-10).
Poorva Roopa: In present study Gala talu lepa was found evidently as the Purva roopa of Kasa,
Kante kandu in 9 (27.27%) patients; Shooka poorna galaasyata in 6 (18.18%) patients and
Swashabdha Vaishamya was seen in 7(21.21%) patients (Table-11).
Pradhana Vedana: Lakshanas like Kapha nishtivana was present in 33 (100%) patients; each
Kantopalepa and Kaphotklesha in 18(54.54%); Shiroruja in 6(18.18%) patients and Asyamadhurata
in 4 (12.12%) patients (Table-12).
Anubandha Lakshana: Peenasa was present as an associated symptom in maximum 11 (33.33%)
patients; Aruchi in 9 (27.27%) patients, Vamana in 7 (21.21%) patients and Mandagni in
31(18.18%) patients (Table-13).
Kapha nishtivana: was Ghana in 31 (93.93%) patients; Bahula in 26 (78.78%) patients, madhura
in 14 (36.36%) patients and Snigdha in 1(3.03%) patient (Table-14).
Mode of onset: In the present study out of 33 patients, 19 (57.57%) patients had gradual onset.
Onset was continuous in 9 (27.27%). patients Episodic and initially episodic followed by
continuous onset was observed in 2 (6.06%) & 3 (9.09%) patients respectively (Table-15).
Time of occurrence: In the present study out of 33 patients, 16 (48.48%) patients belonged to
irregular time of occurrence of bouts of cough. 9 (27.27%) patients were noted in early morning
occurrence followed by each 4 (24.24%) patients coming into the category of evening onset where
as afternoon increase of cough was absent in both the group.(Table-16).
Periodicity of cough: It was observed in this study that 22 (66.66%) cases reported
irregular period of cough and 11 (33.33%) cases reported seasonal onset (Table-17).
Aggravating Factors: In this study it was observed that in 12 (36.36%) patients cold environment
& cold items aggravated the Kasa while in 14 (42.42%) patients Kasa aggravated on taking curds &
fruits; oily food increased Kasa in 6(48.48%) patients and it was not significant in 1 (3.03%) patient
(Table-18).
Relieving Factors: In the present study it was observed that in 13(39.39%) patients hot foodstuffs
relieved Kasa while in 12 (36.36%) patients Kasa relieved on Kaphashteevana; hot environment
decreased Kasa in 4(12.12%) patients and it was not significant in 4 (12.12%) patient (Table-19).
Immunization: 100% immunization was observed in the patients of both the groups
Prakruti: In the present study out of 33 patients, 5 (15.15%) patients belonged to vata-pitta prakruti
13 (39.39%) patients belonged to. kapha- pitta prakruti and 15 (45.45%) patients belonged to.
kapha- vata prakruti (Table-20).
Absolute Eosinophil Count (AEC): In the present study among 33 patients 17 (51.51%) patients
showed normal values of AEC; in 13 (39.39%) patients it was mildly elevated and was highly
elevated in only 3 (9.09%) patients (Table-21).
EFFECT OF THE THERAPIES

30 patients of Kaphaja Kasa were treated by randomly dividing them into two groups. Trial
Group patients were given 4 Amritadi lozenges per day to chew for 10 days and Control group
patients were given 4 lozenges prepared out of wheat flour per day to chew for 10 days. The effects
of both the therapies are being explained here under the separate heading of each group.
Comparison Of Effect Of Both The Therapies

Comparison of the effects of both the groups showed that Amritadi lozenges provided
significantly better relief in comparison to Placebo lozenges in number of bouts of cough (54.4%),
duration of cough bout (38.15%), crepitatations (60.08%), rhonchi (59%) and bad quality of sputum
(54.2 %) of Kaphaja Kasa patients. In this group overall effect was also far better in comparison to
Placebo lozenges.On the other hand Placebo lozenges not provided significantly better relief in
comparison to Amritadi lozenges in the signs and symptoms of Kaphaja Kasa (Table 23).
DISSCUSION
Kasa is a disease which is named after the cardinal symptom of coughing. In Kaphaja Kasa
the predominant Dosha is Kapha and the main feature is cough with expectoration. Even though it
is included under the diseases of Pranavaha Srotas, involvement of Rasavaha, Udakavaha and
Annavaha srotas is obvious; as the Lakshanas of Kaphaja Kasa includes Peenasa, Gaurava,
Kaphanishtivana, Shirashula, Vamana, Aruchi, and Agnimandya. The Prana and Uadana Vayu are
responsible for normal function of Pranavaha Srotas, which can be altered due to causative factors,
in turn lead to the manifestation of Kasa. Having Kapha predominant body and indulging in
Kaphakara Ahara Vihara dominantly increased the incidence of Kaphaja Kasa was observed in
children. Excessive exposure to dust, pollens, cold environment, taking Abhishyandi Sheeta Ahara
etc is considered as aggravating factors. These factors result in the vitiation of Kapha which creates
an obstruction for the movement of Vata resulting in productive cough.
By looking in to the individual herbal constituents of the drug compound taken for present
study ( Amritadi lozenges ), it appears that drugs are having both Kasaghna and Kaphaghna
properties along with Deepana, Pachana, Vatahara properties which is needed to bring back
normalcy in respiratory tract. Moreover in the present study administration of drug in the form of
lozenge is palatable along with local and systemic effects. In general cough can better tackled by
mucolytic, antitussive, expectorant, soothing and drugs with strong aromatic smell, which acts on
different corners of the pathology, a similar attempt was done in the present study by using drugs
like Amrita, Vasa, Vacha, Yashtimadhu, Shati, Shirisha and Arka. However enough care also given
to maintain the immunology of respiratory tract by adding Amrita as one of the ingredient.
CONCULSION
On the basis of present clinical study “Effect of Amritadi Lozenges in the treatment of Kaphaja
Kasa in children” the following conclusions were made.Seasonal variation, residing in Anupa
Desha and Snigdhahara were observed as predisposing factors for Kaphaja Kasa.Drugs present in
Amritadi lozenges are having antihistaminic, mucolytic, anti inflammatory, expectorant and
antitussive properties which helped in reducing the Kaphaja Kasa.Amritadi lozenges is effective
medicine in reducing Absolute eosinophil count, hence it has proved its antihistamine effects of the
same. Results of the placebo group shows that in comparison with Amritadi lozenges it is less
effective in reducing Kaphaja Kasa.Drug was palatable and no adverse effects like vomiting etc.
observed during the study.
Amritadi lozenge has shown its significant results for providing symptomatic relief in Kaphaja
Kasa by reducing mucus production, bouts of cough and bronchial constriction.Hence it is
concluded that Amritadi lozenge is safe and effective in curing signs and symptoms of Kaphaja
Kasa. However further study with large sample and modified assessment criteria is required.
FURTHER SCOPE OF THE STUDY :In this study Amritadi lozenge is found very effective in
curing Kaphaja Kasa its effect over the other types of Kasa can be tried in further study.In further
study the drug can be compared with another proved drug.
Table-1
Age-wise distribution of patients in present study
Age Group-A % Group-B % Total %
3-5Years 9 56.25 9 52.94 18 54.54
6-8 Year 7 43.75 8 47.05 15 45.45
Table- 2
Sex -wise distribution of patients in present study
Sex Group-A % Group-B % Total %
Male 12 75 10 58.8 22 66.66
Femal 4 25 7 41.17 11 33.33
e
Table-3
Religion-wise distribution of patients in present study
Group-A % Group-B % Total %
Hindu 16 100 14 82.35 30 90.90
Muslim 0 - 3 17.64 3 9.09
Christia 0 - 0 - 0 -
n
Table-4
Socio-Economic status-wise distribution of patients in present study
Socio- Group % Group- % Total %
economic -A B
status
(per annum)
Lower Class
5 31.25 2 11.76 7 21.21
(<Rs.10,000 /)
Middle class)
10 62.5 13 76.4 23 69.69
(>Rs.10,000-50,000)
Upper class
1 6.25 2 11.76 3 17.64
(>Rs.50,000)
Table-5
Type of the family-wise distribution of patients in present study
Joint 3 18.75 9 52.94 12 36.36

Singl 13 81.25 8 47.05 21 63.63
e
Table-6
Habitat -wise distribution of patients in present study
H Group-A % Group-B % Total %
a
bi
ta
t
Rural 10 62.5 9 52.94 19 57.57
Semi 2 12.5 1 5.88 3 9.09
Urban
Urban 4 25 7 41.17 11 33.33
Table-7
Dietary Habit-wise distribution of patients in present study
Vegetarian 6 37.5 4 23.52 10 30.30
Mixed 10 62.5 13 76.47 23 69.69
Table-8
Desha -wise distribution of patients in present study
Des Group-A % Group-B % Total %
ha
Anupa 12 75 10 58.8 22 66.66
Sadharana 4 25 7 41.17 11 33.33
desha
Jangala 0 - 0 - 0 -
desha
Table- 9
Educational status-wise distribution of patients in present study
G
r
o
Group-A u
p
-
Litera B
cy F F
a M a M
t ot t ot
% % % %
h he h he
e r e r
r r
Illiterate
0 - 0 - 1 5.88 0 -
Primary
1 6.25 4 25 1 5.88 7 41.17
Education
Up to
18.7
Secondary 3 18.75 3 6 35.29 6 35.29
5
Education
More than
Secondary 12 75 10 62.5 9 52.94 4 23.52
education
Table-10
Nidana recorded in patients of present study
Nidana Group-A % Group-B % Total %
Guru ahara 1 6.25 1 5.88 2 6.06
Abhishyandhi ahara 3 18.75 2 11.76 5 15.15
Madhura ahara 3 18.75 2 11.76 5 15.15
Snigdha ahara 4 25 7 41.17 11 33.33
Swapna vicheshta 1 6.25 0 - 1 3.03
No specific Nidana 4 25 4 23.52 8 24.24
Table-11
Purva roopa recorded in patients of present study
Poorva Roopa
Shooka poorna galaasyata 425 2 11.76 6 18.18

Kante Kandoo 2
12.5 7 41.17 9 27.27
Gala Taalu lepa 6
37.5 5 29.41 11 33.33
Swashabdha vaishamya 425 3 17.64 7 21.21
Not significant 0 - 0 - - -
Table -12
Showing Pradhana vedana recorded in patients of present study
Laksh Group-A % Group- % Tota %
ana B l
Kantopalepa 10 62.5 8 47.05 18 54.54
Shiroruja 3 18.5 3 17.6 6 18.18
Kaphotklesha 9 56.25 9 56.2 18 54.54
Asyamadhurat
2 12.5 2 11.76 4 12.12
a
Kapha
16 100 17 100 33 100
nishtivana
Table- 13
Anubandha Lakshana recorded in patients of present study
Anuba Group-A % Group-B % Total %
ndha
laksha
na
Mandagni 14 25 17 100 31 93.93
Peenasa 16 100 17 100 33 100
Aruchi 13 12.5 17 100 30 90.90
Vamana
4 25 3 17.64 7 21.21
Lomaharsha 0 - 0 - 0 -
Table-14
Qualities of kapha nishtivana recorded in patients of present study
Kaph Group-A % Group- % Total %
a B
nishti
vana
Ghana 16 100 15 88.23 31 93.93
Bahula 13 81.25 13 76.47 26 78.78
Madhura 7 37.5 8 47.05 14 36.36
Snigdha 0 - 1 5.88 1 3.03
Table-15
Mode of onset recorded in patients of present study
Mode Group-A % Group- % Tota %
of B l
onset
Sudden 0 - 0 - 0 -
Gradual 9 56.25 10 58.82 19 57.57
Episodic 1 6.25 1 5.88 2 6.06
Continuous 5 31.25 4 23.52 9 27.27
Initially
episodic
1 6.25 2 11.76 3 9.09
followed by
continuous
Table-16
Time of occurrence of bouts of cough recorded in patients of present study
Time Group-A % Group-B % Total %

Early morning 4 25 5 29.41 9 27.27
Afternoon 0 - 0 - 0 -
Evening 4 25 4 23.52 8 24.24
Irregular time 8 50 8 47.05 16 48.48
Table-17
Periodicity of cough recorded in patients of present study
Periodi Group-A % Group-B % Total %
city
Seasonal 6 37.5 5 29.41 11 33.33
Perennial 0 - 0 - 0 -
Irregular 10 62.5 12 52.94 22 66.66
Table-18
Aggravating factors of cough recorded in patients of present study
Time Group-A % Group- % Total %

B
Cold
7 43.75 5 29.41 12 36.36
environment
Oily food
3 18.75 3 17.64 6 48.48
stuffs
Curds &
6 37.5 8 47.05 14 42.42
fruits
Not
0 - 1 5.88 1 3.03
significant
Table-19
Relieving factors of cough recorded in patients of present study
Time Group-A % Group-B % Total %
Hot water 6 37.5 7 41.17 13 39.39
Hot environment 2 12.5 2 11.76 4 12.12
Kaphashteevana 6 37.5 6 35.29 12 36.36
Not significant 2 12.5 2 11.76 4 12.12
Table-20
Immunization status recorded in Patients of Kaphaja Kasa
Immunized 16 100 17 100 33 100
Un-immunized 0 - 0 - 0 -
Table-21
Prakruti recorded in Patients of present study
Deha Group-A % Group-B % Total %
Prakriti
Vata-Pitta 1 6.25 4 23.52 5 15.15
Kapha-Pitta 8 50 5 29.41 13 39.39
Kapha-Vata 7 43.75 8 47.05 15 45.45
Table- 22
AEC values recorded in patients of present study
AEC Group-A % Group-B % Total %
40-400 8 50 9 56.25 17 51.51
400-500 7 43.75 6 35.29 13 39.39
500-600 1 6.25 2 11.76 3 9.09
>600 0 - 0 - 0 -
Table-23
Improvement seen in both the groups of Kaphaja Kasa
% of improvement in
Group A Group B
No. of bouts of cough 64.10 9.7
Duration of bout of cough 55.55 17.4
Crepitation 70.58 10.5
Rhonchi 70 11.11
Quantity & quality of sputum 66.7
AEC count 12.5 2.79
REFERENCES:
1.Nelson, Text Book of Pediatrics, Reed Elsevier India Private Ltd, New Delhi, 17th Edition, 2004, pp. 835 –
1195, 1401 – 1474
2.Ghai.O.P.Essential pediatrics,INTERPRINT PUBLUICATION,New Dehli.IV Edition,1996.pp.273,274
3 Gangadhar, Charaka Samhita, Part IV, Chaukamba Orientalia, Varanasi, 1st Edition, 1999, pp. 3034, 3068
4 Madhavakara, Madhavanidana, Madhukosha Sanskrit Commentary with Vidyotini Hindi Commentary Part II,
Prof. Yadunandana Upadhayaya. 25th Edition, 1995, Part I, pp. 270, 281.
10
An Ayurvedic Approach Towards The Management
Of Allergic Rhinitis
Dr. Priyanka ( p.g.scholar dept. of kaumarbhritya KLE b.m. Kankanwadi Ayurveda
Mahavidyalaya Belgaum )
Guided by: Dr. Aziz Arbar ,HOD, Dept. of Kaumarbhritya,Dr. Veena s. Tonni
lecturer, Dept. of Kaumarbhritya
Introduction
Allergic rhinitis is used to describe an inflammation of the lining of the nose caused by an allergy.
The symptoms include a 'runny' nose and sneezing, nose, roof of the mouth, and the ears, may be
itchy .
Allergic rhinitis is a very common disorder that affects people of all ages, peaking in the
teenage years. Its prevalence is about 10-40% among all age-groups in United States and other
western countries. Prevalence is reported to range from 10-13% in Delhi state of North India. Also,
symptoms of rhinitis are reported in 75% of children and 80% of asthmatic adults in India, while it
still continues to be considered a trivial disease. Though, it is not a life-threatening disease, it can
significantly impair patient’s quality of life and productivity. In children also, physical, social,
psychological well-being and academic performance is adversely affected by the illness. .
In our classics, direct correlation of allergic rhinitis is not available yet we can relate rhinitis
successfully with Pratishyaya. . However, symptoms of Vataja pratishyaya like Tanu Nasa Srava,
Shirashoola, Kshavathu etc. more related with symptoms of allergic rhinitis. Detailed explanation is
available with our classics related with the management of the disease. This article overviews
regarding the management principles of allergic rhinitis in the view of ayurveda.
Objective
To know in brief about the effective management of allergic rhinitis w.s.r. to vattik pratishyaya
according to Ayurveda.
Materials & Methods
The data regarding the given paper is collected from various sources including books, journals,
research papers along with the web sources. Text books have been followed for the basic format.
Classical texts viz. Charak Samhita, Sushruta Samhita, Ashtang Hridyam, Yogratnakara,
Bhavprakash & Bangasen.
Allergic Rhinitis
7. Also referred to as Hay Fever.
8. It is a type of immune response in the form of inflammation of nasal passages caused by
allergic reactions to airborne substances.
9. The disease may manifest at any age, though onset in childhood is more common.
Clinical Manifestations
Rhinitis
Nasal irritation
Paroxysmal sneezing
Watery copious rhinorrhea
Nasal obstruction
Watery eyes
Headache & Fatigue
Treatment Principals
The three basic approaches for the treatment of allergic rhinitis are,
(1) Avoidance of allergens.
(2) Pharmacotherapy including drugs like Anti-histamines, Leukotriene Receptor Antagonists,
Decongestants, Topical steroids, Mast cell stabilizers.
(3) Immunotherapy.
But some of these drugs have considerable adverse effects as listed below,
Anti-Histamines may sometime cause cardiac arrhythmias.
Decongestants may lead to increase in Heart rate, Blood Pressure, Headache, Insomnia.
Long term use may lead to more severe swelling of nasal mucosa.
Topical corticosteroids have mild side effects like headache, nose bleeds & unpleasant taste
sensation.
Immunotherapy may sometime lead to small risks of anaphylaxis.
Pratishyaya
Definition
“prati kshanam shyayathi ithi pratishyayah”
i.e. Kaphadi doshas are continuously eliminated out through the nose so only called as pratishyaya.
Nidana (Aetiology)
The common aetiological factors of nasa roga are briefed as follows :-
Tridosha vitiating factors.
ex, in the intake of cold things, exposure to rain, snowfall, swimming in water, taking in-
compatible food etc.
Mano dosha vitiating factors.
ex, Excessive anger, fear etc
Abhighataj karana (injuries)
ex, shiro abhighata – nasa abhighata etc
Irritative factors or allergic factors.
ex, exposure to dust, smoke, exposure to cold wind or sunstroke etc.
Because of other chronic diseases (specific infections)
ex, TB, Leprosy, syphilis etc
Debilitative factors :-
ex, ill health, weak personality, loss of immunity, low socio-economic status, living in
unhygienic surroundings etc.
Some of the nidanas which need major emphasis considering allergic rhinitis are :-
Dhuma & raja
Sheetambu
Vegavrodha especially shakrit & vashpa vegarodha
Mano-bhavas like krodha
Lakshanas of Vataj Pratishyaya

Coming specifically to vataj pratishyaya, clinical features collectively according to various
acharayas which can be easily correlated with allergic rhinitis are :-
Nasal obstruction
Watery, cold, fresh nasal discharge
Dryness in throat and palate
Pain and discomfort in nose
Increased sneezing
Pricking pain at teeth, temporal region and head
Distaste in mouth
Hoarseness of throat
Pathogenesis among various Features
Nasal obstruction (Nasavarodha) is a cardinal manifestation of Vatika Pratishyaya. Due to it,

child is forced to take mouth breathing leading to Oshta, Gal, Talu and Mukha shosha.
Mouth breathing enhances the secondary infections.
Upper airway obstruction usually produces snoring and marked sleep disturbances (Nisha
jagarana) which in turn increases Vata producing Nasatoda, Nasavedana, Shankha pradeshe
vedana and shirahshula.
The voice disorders (Swara bheda and Swaropaghata) are exclusively inflammatory type.
As the Nasal discharge is mucoid in nature (TanuNasa srava) Kshavathu in Vatika

Pratishyaya may thought to be allergic. Sensory fibers in the Nasal area will be irritated
either by allergogens histamine or by hyperaemia. This stimulation travels in the maxillary
nerve leading to sneezing (Kshavathu).
Management of Pratishyaya
Samanya Chikitsa
According to our sciense, five diseases namely diseases of eye, diseases related with digestive track,
diseases of nose, fever and wound are primarily cured by ‘Langana’ ( Fasting) for five days.
Again, Some of the general principals to be followed in the management of rhinitis are :-
Nidana parivarjana- Avoidance of allergents like, house dust mite, animal dung,
occupational pollutants etc.
Tropical application of drugs- Application of Nasya especially in oil media like Taila.
Immuno therapy- To normalize and modulate the immune mechanism thereby reducing
susceptibility to allergens, rasayanas are being indicated. The Rasayana drugs specially
prepared with Ojovardhaka, Balya, Dushee vishahara Amapachana (immunomodulant, anti-
oxidant) Dravyas will be ideal in this condition.
Vishesh Chikitsa
While planning for treatment, it is very important to know whether the disease is in AMA stage
(nava pratishyaya) or in PAKWA stage (Jeerna pratishyaya).
Nava or Ama Pratishyaya
Following principals can be followed for pachana of Ama doshas :-
Swedana: Hot fomentation.
4) Intake of warm food which are sour in taste.
5) Ginger should be taken with milk or with sugarcane
6) Administration of Deepan pachana drugs.
7) Usage of hot water for drinking & bathing.
8) Dhumapana- Ayurvedic smoking.
9) Kavalagraha- Gargling of salted water.
10) Haritaki Sevana.
Pakwa or Jeerna Pratishyaya
All types of Pratishyaya except of recent origin should be treated by the following treatment
principles :-
General Body Treatment Topical Treatment
Snehpana Shiro-virechana
Vamana Kawalgrah
Virechana Dhoompana
Asthapan
Shaman aushadha
Some of the yogas helpful in the management of Allergic Rhinitis are :-
Maricha Churna (powder of black pepper) mixed with Jaggery and Curd,
3) Kataphaladi Churna
4) Vyoshadi Churna
5) Sarpi Guda
6) Chitraka Haritaki Avleha
7) Shadanga Yusha
8) Rasna Ghrita
9) Dashmula Ghrita
10) Panchlavana Siddha Ghrita
11) Panchamula siddha Ghrita
12) Nasya(Nasal drops) by Anu Taila
Shadabindu Taila
Gudadi Nasya
Dhuma(Medicated Fumigation) by Vidangadi Dhuma
Ghrtasaktu Dhuma
Chaturjata+ Ghruta+ Taila+ Sattu Dhumpana
Upshaya
5) Oral intake of Ghrita, (warm) containing sour ingredients.
6) Various kinds of Swedana & Vamana.
7) Nasya with the squeezed juices at appropriate time.
8) Dhumapana & Gandusha should be done.
9) Snigdha, Ushna, Lavana & Amla Padartha Sevana.
Anupshaya
Excessive intake of Guru, Madhura, Sheeta substance.
Excessive intake of Sheeta Jala.
Dhul, Raja Sevana.
Atidrava Sevana after meal .
Vishamashana
Conclusion
Pratishyaya is considered as one of the most important diseases among the nasa rogas. Charaka
explained that if disease is not treated properly or neglected, causes so many complications of Nose,
ear, throat, head & other parts of body. Some examples include Dushta Pratishyaya, Puti nasa,
Nasa paka, arbuda, Netra roga, Khalitya, Arjuna, Shwasa, Kasa, Jwara, Andhatwa, Badhirya and
many other to be named. So a proper management is mandatory. Ayurveda has its approach not only
towards cure of disease but also focuses towards improvement in quality of life. Also rasayana
therapy is also being proved to have a good immunomodulatory effect thereby showing good results
in management of allergic disorders.
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Effect of Shvasahara Avaleha in the Management of Tamaka Shvasa in children

Article · July 2013

Shailaja Uppinakudru Prasanna Narasimha Rao

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“Preventive and curative Ayurvedic therapies for ‘The Respiratory tract

Dr.A. Kale (Prof.&HOD,Govt.Ayurveda college, Usmanabad/IAAP Treasurer )

Dr. P. Pai ( Asso. Prof. College of Ayu.Bharati Vidhyapeeth ,Pune )

Dr. A. Bhattacharya : Reader , J.B.Roy Ayurveda College, Calcutta /IAAP

Dr Vinayak G Galatage, ** Dr .Puranikmath MC

yada s~aotaMisa saMQya maa$t: kfpUva-k:|

Cid- Svaasaao|$icas%aRYNaa jvarao|itsaar eva ca:|

Ajmoda Pudina Karpoor

Virya Ushna Ushna Sheeta

Guna Laghu,Ruksha Laghu,Ruksha, Laghu,Ruksha

Shoolaghna Vatahara, Dipana, Krumihara

Visual No. of Wheezing Lobes Forced Peak Expiratory

Amritdhara 15 0.5ml(+)1ml N.S. 4 hourly

Dose , anupan, duration & Follow-up :

Student’s paired t test of Acute group

Student’s paired t test of Chronic group

Table showing Clinical features of both groups with relief in %

Pratishyay 11 6 55.5 15 11 73.3

Mild Cough 12 7 58.33 14 12 85.7

Adv. sounds 17 11 64.7 17 15 88.2

Lack of Appetite 14 12 85.7 12 8 66.6

Adv. sounds 10 6 60 14 12 85.7

Lack of Appetite 6 4 66.6 4 2 50

Dr Sharashchandra R*, Dr Reena**, Dr Rahul***, Dr Shailaja****

Table 1: Effectiveness on Clinical Assessment under Different Treatment

Group a (treated group-11 patients)

Laboratory investigation values

a) aec Group d showed 2.36% of reduction

Group c showed maximum improvement (87.43%) in clinical features while group a

Results: Effect of Swarnamritaprashana on treatment provided 43.83% reduction in duration

Materials and methods

Assessment was made on the basis of improvement in the clinical features.

features before and after treatment.

Sleep disturbance before and after treatment:

More than 8 bouts of cough 03

Sl. No Signs & symptoms Before treatment After treatment

Effect of Swarnamritaprashana on Dyspnea: Swarnamrita prashana after 30 days of treatment

MATERIAL AND METHODS

Assessment criteria B.T. A.T.

Day time asthma

Night time asthma

Dyspnoea Non ≤ 2 Attacks

Wheezing Non Only at the

Discomfort Not at On running /

Sleep Fin Sleep well,

Frequency of No < 1 Episode /

Duration of No Brief for

PEFR values Norma >80% Of

R.R. 18- 24-

Palpitation Not at On running /

Chest pain Not at On running /

Chest tightness Not at mil

Cold Non Itching

Sputum Normal More

Effect of Shvasahara Avaleha on Wheezing of 40 Tamaka Shvasa patients

Dr Sharashchandra R, Dr Reena, Dr Rahul, Dr Shailaja****