Management of Pranavaha srotas Diseases “Ayurvedic Pulmonology”

Prof. Dr. K.Shiva Rama Prasad
M.D (KC); MA, Ph.D (Jyotish)
doctorksrprasad@gmail.com

Management of Pranavaha
srotas Diseases
“Ayurvedic Pulmonology”

8-1-2008 doctorksrprasad@gmail.com 1

Thought of 2008

• “Following western scientist blindly
is not admissible. The information
available should be used
discriminatively to enrich the
knowledge and adopted to the
Indian territory and population”.
Dr. Manmohan Singh, PM India


LET - Introduction
• Life starts with breath
• Ends with breathlessness
• The maintenance of life
throughout life is
maintained by Pranavaha
srotas with its – initiative
points i.e. Hrudaya –
Heart; Mahasrotas - Lungs
and 10 Dhamani

Pranavaha srotas
• Pranavaha Srotas is a vital input capability
structure, maintaining the Life = Pranavata
• Prana is said as – Pavana / Anila – wind/ Air
• Life sustenance relays on maintenance of
Oxygen – Ambara peeyusha and water in the
body
• mÉëÉhÉuÉWûÉÌlÉÌiÉ mÉëÉhÉxÉÇ¥ÉÉMüuÉÉiÉuÉWûÉlÉÉqÉç LiÉŠ
mÉëÉhÉÉZrÉÌuÉÍzÉ¹xrÉxÉëÉåiÉ – cÉUMü ÌuÉqÉÉlÉ 5/8 cÉ¢ümÉÉÍhÉ
• mÉëÉhÉmÉuÉlÉ: mÉëÉhÉÉÌlÉsÉ: mÉëÉhÉÉÍ´ÉiÉÉå uÉÉrÉÑËUÌiÉ
– zÉÉ.xÉÇ.mÉÔ. 5/48 -AÉRûqÉssÉ

Pranavaha Sroto Moola
• Moola refers to developmental or generative
place
• PVS have Hrudaya (Heart), Mahasrotas
(trachea) and Rasavahini dhamani (pulmonary
vessels) added by Susruta as originative places
• Technically any organ takes in and sends out is
Hrudaya – either Heart or Lungs
• qÉÔsÉÍqÉÌiÉ mÉëpÉuÉxjÉÉlÉqÉç – cÉ.ÌuÉ.5/8 – cÉ¢ümÉÉÌlÉ
• iÉ§É mÉëÉhÉuÉWûÉlÉÉÇ xÉëÉåiÉxÉÉÇ WØûSrÉÇ qÉÔsÉÇ qÉWûÉxÉëÉåiÉ¶É – cÉ.ÌuÉ.5/8
• iÉrÉÉåqÉÔïsÉÇ WØûSrÉÇ UxÉuÉÉÌWûlrÉ¶É kÉqÉlrÉ: - xÉÑ.zÉÉ.9/12

Source of life
• The Prana is specific air breathed
into the lungs during the act of
inspiration.
• The effect of indoor and outdoor
air pollution on allergic disease
has received considerable
attention
• Human is continuously under the
influence of environmental
changes subjected pollution.
• Urbanized life style and
industrialization etc. compound
the problem.


Pranavata
• Pranavata initiates impulse
from Shirasa (Buddhi
Hrudayendriya chittam –
druk = aspect) travels
through nose, tongue,
pharynx, neck till Uras
understood as – reticular
formation form the Medulla
oblongata with higher center
connected especially
“Respiratory center” xjÉÉlÉÇ mÉëÉhÉxrÉ qÉÔkÉÉåïU: MühPûÎeÉÀûÉxrÉlÉÉÍxÉMüÉ
¹ÏuÉlÉ¤ÉuÉjÉÔªÉUμÉÉxÉÉWûÉUÉÌS MüqÉï cÉ – cÉ.ÍcÉ.28/6
• Promotes expulsion of mÉëÉhÉÉå§ÉqÉÔkÉïaÉ: EU:MühPûcÉUÉå oÉÑÎ®WØûSrÉåÎlSìrÉ ÍcÉ¨É SØMçü
phlegm, gas and intake of ÌlÉ¹ÏuÉlÉ ¤ÉkÉÔªÉU ÌlÉ:μÉÉxÉÉ³É mÉëuÉåzÉM×üiÉç – A.WØû.xÉÔ.12/
air and food.

Vata

• Vata defined as Gati –
momentum = motor and
Gandhana – sensory
perceptional or said as
information / knowledge
transformation

uÉÉ aÉÌiÉaÉlkÉlÉrÉÉå – xÉÑ.xÉÔ.21/5

Types of Evoked Potentials
• MOTOR = Gati =Measured from arm or leg muscle
• VISUAL = Druk = Monocular visual stimulation with
a checkerboard pattern is used to elicit visual evoked
potentials, which are recorded from the midoccipital
region of the scalp.
• AUDITORY = Srotra = Monaural stimulation with
repetitive clicks is used to elicit brainstem auditory
evoked potentials, which are recorded at the vertex
of the scalp.
• SOMATOSENSORY = Gandhana = Electrical
stimulation of a peripheral nerve is used to elicit the
somatosensory evoked potentials, which are
recorded over the scalp and spine.

Motor evoked potentials (MEP) = Vata Gati
• Action potentials generated in the cortex
travel down the pyramidal pathway to the
muscles.
• Surface electrodes placed on an arm or leg
muscle are used to record the summed
motor potentials. These potentials are larger
and easier to record when the subject lightly
contracts the corresponding muscle
beforehand.
• An abnormality of the MEP implies a lesion in
the peripheral or central portion of the motor
pathway.

Fundamentals of
Neurology1sted
2006.Thieme.3HA
XAP,
Mumenthaler /
Mattle, pp 59

Vata can be
calculated in terms
impulse
transportation time
CMCT (Central
Motor Conduction
Time)


Somatosensory evoked potentials
(SSEP) = Vata Gandhana
• When a repetitive electrical stimulus is applied to
the skin, impulses are generated at the terminal
sensory branch of a peripheral nerve and conducted
centrally via the peripheral nerve, nerve root,
posterior columns/ spinothalamic tract, medial
lemniscus, and thalamocortical connections. A
lesion at any point along this pathway can alter the
evoked potentials, which are recorded first over Erb
point (for the median n.) or the lumbar spine (for the
tibial n.), and then through a scalp electrode in the
parietal region on the side opposite the stimulation.
An example of delayed conduction in the central
somatosensory pathway is shown in Fig.

• Fundamentals of
Neurology1sted
2006.Thieme.3HA
XAP,
Mumenthaler /
Mattle, pp 58


Embryological appreciation of
Pranavaha Srotas
• Puppusa develop from the blood
froth
• Heart that bears the blood, build
from blood and phlegm
• Anatomical relations are – from
heart in the left lies the “Puppusa –
Left lung” and on the right “Kloma
– Right lung”
• zÉÉåÍhÉiÉTåülÉmÉëpÉuÉ: mÉÑmmÉÑxÉ: - xÉÑ.zÉÉ.4/25
• zÉÉåÍhÉiÉMüTümÉëxÉÉSeÉÇ WØûSrÉÇ – rÉSÉ´ÉrÉÉ ÌWû kÉqÉlrÉ:
mÉëÉhÉuÉWûÉ: - xÉÑ.zÉÉ 4/31
• WØûSrÉxrÉ AkÉÉå uÉÉqÉiÉ: msÉÏWû mÉÑmTÑüxÉ¶É; SÍ¤ÉhÉiÉÉå
rÉM×üiÉç YsÉÉåqÉ cÉåÌiÉ YsÉÉåqÉÌiÉsÉMüqÉç -xÉÑ.zÉÉ
4/31QûsWûhÉ

•
Development of Lung
Lungs are the essential organs of respiration
• substance of the lung is of a light, porous,
spongy texture; it floats in water, and
crepitates when handled, owing to the
presence of air in the alveoli; it is also highly
elastic
• Right (Kloma) and left (Puppusa) lung buds
grow out behind the ducts of Cuvier
• Each lung is invested by an exceedingly
delicate serous membrane, the pleura
• The lungs provide an alveolar surface area of
approximately 40 m2 for gaseous exchange.
• Each lung has: an apex which reaches above
the sternal end of the 1st rib; a costovertebral
surface which underlies the chest wall; a base
overlying the diaphragm and a mediastinal
surface which is moulded to adjacent
mediastinal structures.

Physiological appreciation of Lung unit


Present day Understanding
• The entoderm consists at first of flattened cells, which
subsequently become columnar. It forms the epithelial
lining of the whole of the digestive tube excepting part
of the mouth (Asya) and pharynx (kanta) and the
terminal part of the rectum (Pakwashaya) (which are
lined by involutions of the ectoderm), the lining cells of
all the glands which open into the digestive tube,
including those of the liver and pancreas, the
epithelium of the auditory tube and tympanic cavity
(srotra), of the trachea, bronchi, and air cells of the
lungs (Puppusa-Kloma), of the urinary bladder
(Vasti) and part of the urethra, and that which lines the
follicles of the thyroid gland and thymus.


Organ (Lung)
Pathology
• Inflammatory Lung diseases
• Interstitial Lung diseases
• Infectious Lung diseases
• Environmental Lung diseases
• Obstructive Lung disease
• Respiratory Insufficiency
• Pulmonary manifestations of
systemic diseases
• Pulmonary Vascular diseases
• Neoplastic Lung diseases
• Congenital Lung diseases
• Developmental Lung diseases
• Genetic Lung diseases
• Pleural diseases
• Common bronchial and pulmonary diseases –
exposure to infectious pathogens and/or air, • Apart from the above many
including tobacco smoke, causes the disorders categories are placed in URT
shown pathology

Srotas Pathology
Vitiated Dosha moving all the way in the body develops the
disease where ever is obstructed in its channel -
Atipravrutti = Excited / hyper functional activity – Hypercapnia
Sanga = Acute/chronic obstructive disorders - Asthma
Vimargagamana = Abnormal passage / infiltration or
diverticular of srotas content – pulmonary fistula
Sira-Granthi = vascular / abnormal mass tissue – makes the
extra luminal compression – Malignant Tumor
MÑüÌmÉiÉÉlÉÉÇ ÌWû SÉåwÉÉhÉÉÇ zÉUÏUå mÉËUkÉÉuÉiÉÉqÉç
rÉ§É xÉ…¡û: ZÉuÉæaÉÑhrÉÉSèurÉÉÍkÉxiÉ§ÉÉåmÉeÉÉrÉiÉå – xÉÑ.xÉÔ.24/10
AÌiÉmÉëuÉ×Ì¨É: xÉ…¡ûÉå uÉ ÍxÉUÉhÉÉÇ aÉëÎlkÉrÉÉåÅÌmÉ uÉÉ
ÌuÉqÉÉaÉïaÉqÉlÉÇ cÉÉÌmÉ xÉëÉåiÉxÉÉÇ SÒÌ¹sÉ¤ÉhÉqÉç –cÉ.ÌuÉ.5/24

Pranavaha srotodusti Hetu
Dhatu kshaya (wasting)
Vega sandharana (natural urges suppression)
Rooksha padartha sevana (indulgence in dry food)
Vyayama (excessive physical exertion)
Kshudhita (excessive hunger)
Anya daruna (other health violations pertained to PVS)
¤ÉrÉÉiÉç xÉÇkÉÉUhÉÉSìÉæ¤rÉÉiÉç urÉÉrÉÉqÉÉiÉç ¤ÉÑÍkÉiÉxrÉ cÉ –
mÉëÉhÉuÉÉÌWûÌlÉ SÒwrÉÎliÉ xÉëÉåiÉÉÇxrÉlrÉÉæ¶É SÉÂhÉÉæ:
– cÉUMü ÌuÉqÉÉlÉ 5/10

Pranavaha srotodusti Lakshana
Atisrustam (too long respiration)
Atibaddham (restricted respiration)
Kupitam (agitated respiration)
Alpalpam (shallow / short respiration)
Abhikshanam (frequent/ increased/ repeated respiration)
Sashabdam (stertrous respiration)
Sashoola (painful respiration)
AÌiÉxÉ×¹qÉÌiÉoÉ®Ç MÑüÌmÉiÉqÉsmÉÉsmÉqÉpÉÏ¤hÉÇ uÉÉ
xÉzÉoSzÉÔsÉqÉÑcduÉxÉliÉÇ SØwOèuÉÉ mÉëÉhuÉWûÉlrÉxrÉ xÉëÉåiÉÉÇÍxÉ
mÉëSÒ¹ÉlÉÏÌiÉ ÌuÉ±ÉiÉç – cÉUMü ÌuÉqÉÉlÉ 5/8

Pranavaha sroto Abhighata Lakshana

Akroshana (loud grooming)
Vinamana (deformation of the thoracic region)
Mohana (loss of consciousness)
Bhramana (illusion / giddiness)
Vepana (tremors)
Marana (death)

iÉ§É ÌuÉ®xrÉÉ¢üÉåzÉlÉ ÌuÉlÉqÉlÉ qÉÉåWlÉ pÉëqÉlÉ uÉåmÉlÉÉÌlÉ qÉUhÉÇ
uÉÉ pÉuÉÌiÉ – xÉÑ zÉÉ 9/12û

SYMPTOMS
• Cough = A sudden explosive forcing of air through the glottis,
occurring immediately on opening the previously closed glottis, and
excited by mechanical or chemical irritation of the trachea or bronchi,
or by pressure from adjacent structures.

• Wheeze = A whistling, squeaking, musical, or puffing sound made by
air passing through the fauces, glottis, or narrowed tracheobronchial
airways in difficult breathing.

• Dyspnea = Shortness of breath, a subjective difficulty or distress in
breathing, usually associated with disease of the heart or lungs;
occurs normally during intense physical exertion or at high altitude.


SYMPTOMS
• Stridor = A high-pitched, noisy respiration, like the blowing of the
wind; a sign of respiratory obstruction, especially in the trachea or
larynx.

• Hoarseness voice , Chest pain, Haemoptysis

• Cyanosis = A dark bluish or purplish coloration of the skin and
mucous membrane due to deficient oxygenation of the blood, evident
when reduced hemoglobin in the blood exceeds 5 g per 100 ml.

• Clubbing = A condition affecting the fingers and toes in which
proliferation of distal tissues, especially the nail-beds, results in
thickening and widening of the extremities of the digits; the nails are
abnormally curved and shiny.

Krichra swasa (Dyspnoea) cardinal
symptom of Pranavaha srotodusti
Common disease with
Dyspnoea are -
euÉU
WØûSìÉåaÉ
U£üÌmÉ¨É
eÉsÉÉåSU
qÉåSÉåUÉåaÉ
zÉÉååjÉ
AÌiÉxÉÉU
mÉëqÉåWû (qÉkÉÑqÉåWû)
aÉsÉaÉlQû
aÉÑsqÉ
AÉl§ÉuÉ×Î®
zÉÔsÉ

qÉÂiÉ: mÉëÉhÉuÉÉWûÏÌlÉ Symptoms of Importance
xÉëÉåiÉÉÇxrÉÉÌuÉzrÉ MÑümrÉÌiÉ
– EU:xjÉ MüTüqÉÑ®ÕrÉ
ÌWû‚üÉμÉxÉÉlÉç MüUÉåÌiÉ xÉ;
- cÉ ÍcÉ17/17 Swarabheda
rÉ: mÉëÉhÉuÉÉÌWûÌlÉ Urah shoola
xÉëÉåiÉÇxrÉluÉåÌiÉ iÉålÉ μÉÉxÉ: Kasa
mÉëÌiÉzrÉÉrÉ¶É eÉÉrÉiÉå –
cÉ ÌlÉ 6/4 Raktasteevana
Hikka
Swasa
Pratishyaya


Examination of
PVS ailment
General Examination
Vital data
Systemic Examination
Inspection
Palpation
Percussion
Auscultation
Instrumental Examination
Imaging
PEFR
etc,


PVS Diagnostic Instruments
Pulmonary Function Testing
Pulmonary Exercise testing
Pleural / Pulmonary pathology diagnostic
procedures
Pulmonary Imaging
Pre operative evaluation & diagnostic
procedures


Haematological and biochemical
tests
• Haemoglobin, to detect the presence of anaemia or
polycythaemia
• Packed cell volume (secondary polycythaemia occurs
with chronic hypoxia)
• routine biochemistry (often disturbed in carcinoma and
infection).
• B-type natriuretic peptide may be a useful test to
distinguish cardiac from non-cardiac breathlessness. A
rapid bedside test is available but is not yet in routine
clinical use.
• D-dimer can be measured to detect intravascular
coagulation. A negative test makes pulmonary embolism
very unlikely.

Sputum
• yellowish green indicates inflammation (infection
or allergy)
• the presence of blood suggests neoplasm or
pulmonary infarct
• Microbiological studies (Gram stain and culture)
are not helpful in upper respiratory tract
infections or in acute or chronic bronchitis. They
are of value in:
• pneumonia
• the diagnosis of tuberculosis (Ziehl-Neelsen or auramine-
phenol stains)
• unusual clinical problems
• Aspergillus lung disease.

Pulmonary Function Testing
• STATIC LUNG
VOLUMES
• Gas Dilution
Techniques
• Plethysmography
• Radiographic Total
Lung Capacity
• Spirometry
• Peak Expiratory Flow
and Peak Flow Meters

Respiratory function tests and exercise tests

Micro Medical Micro Loop and
Micro Lab spirometers

Pulmonary Exercise testing
• Clinical integrative cardiorespiratory exercise testing is
the ability to assess oxygen uptake (VO2) from
measurements of ventilation and respired gas
concentrations as Fick's relationship
• Where VE is ventilation, K is a constant, VCO2 is CO2
production, and D is dead space volume flow (VD ×
respiratory rate). The linkage of CO2 and VD to ventilatory
demand is clear. These factors represent the metabolic
rate and the fraction of wasted ventilation. Ventilation is
tightly linked to CO2 rather than to O2.
• Anaerobic (Lactate) Threshold = At a certain work
intensity, usually about 50% of the individual VO2max,
lactic acid starts to accumulate in the muscles and in the
blood at a faster rate, and this metabolic level can be
detected from measurements of gas exchange.


Pleural/Pulmonary pathology
diagnostic procedures
• Thoracentesis
• Pleural Fluid Analysis
• Pleural Biopsy
• Open Pleural Biopsy
• Thoracoscopy


Pulmonary Imaging
Five important internal tissue
• Standard plain X-Ray PA & types may be easily
Lateral/ Apical Lordotic Films identified on CT or MRI
• Chest Fluoroscopy scans:
1. Gas (cavitation)
• COMPUTED TOMOGRAPHY 2. Low-density material
• NUCLEAR IMAGING OF THE (lipid)
3. High-density material
THORAX (hemorrhage)
• PULMONARY ANGIOGRAPHY 4. Intermediate-density
material (soft tissue)
• MAGNETIC RESONANCE
5. Calcification
IMAGING
• INTERVENTIONAL
PROCEDURES - percutaneous
biopsy

Pre operative evaluation & diagnostic
procedures
• Atelectasis = Collapse of an expanded lung
• Shunting with Hypoxemia
• Factors Predisposing to Postoperative
Pneumonia
• Impaired Transport of Mucus
• Aspiration
• Pre-existing Lung Infection
• Impaired Coughing
• Respiratory Failure
• Pulmonary Embolism


• Inflammation – infection, Rhinitis (coryza), Allergy,
laryngitis, Tracheitis, bronchitis, bronchiectasis,
bronchial asthma extrinsic/ intrinsic, emphysema, lung
collapse, pneumonia, lung abscess, TB, Anthracosis,
silicosis, asbestosis, fibrosis,
• Environmental
• Tumors – epithelial, connective tissue; benign/
malignant, Acinus (primary lobule) / secondary lobule,
macropahse
• Respiration – insufficiency, Atelectasis (Collapse of
an expanded lung), gas exchange supply /demand
• Pulmonary vascular
• Pulmonary plural

Types of diseases in PVS

PROTECTIVE AGENTS IN THE
EPITHELIAL LUNG FLUID
• Defensins
• Secretory lactoperoxidase A2
• Lactoperoxidase
• IgA
• Lysozyme
• Lactoferrin
• Surfactant proteins (collectins)
• Antiproteinases:
• α1-antiproteinase, secretory
leucocyte protease inhibitor (SLPI),
elafin
• Antioxidants: glutathione

• Alveolar macrophages.
Scanning electron micrograph
showing alveolar macrophages
(arrow) patrolling the alveolar
spaces of the lung

Methodical approach to diagnose

• MåüÍcÉcNûUÏUÉmÉaÉiÉÉÈ vÉoSÉÈ xrÉÑxiÉ§É ´ÉÉå§ÉåhÉ mÉUÏ¤ÉåiÉç
cÉ.ÌuÉ. 4/7
Auscultation of the PVS is most important

• uÉhÉï xÉÇxjÉÉlÉ mÉëqÉÉhÉÉcNûÉrÉÉÈ vÉUÏUmÉëM×üÌiÉÌuÉMüÉUÉæ, cÉ¤ÉëÑUçuÉæwÉÌrÉMüÉÍhÉ rÉÉÌlÉ
cÉÉlrÉÉlrÉÑ£üÉÌlÉ iÉÉÌlÉ cÉ¤ÉÑwÉÉ mÉUÏ¤ÉåiÉ | cÉ. ÌuÉ. 4/7
The colour changes viz. Cyanosis, because O2 deprivation or
Anemia is noticed as generalized symptom. The edema –
shotha is observed and conformed by sparsha.

• xmÉzÉïÇ cÉ mÉÉÍhÉlÉÉ mÉëM×üÌiÉ ÌuÉM×üÌiÉrÉÑ£üqÉç|| cÉ. ÌuÉ. 4/7

Examination of PVS

Areas of
examination
• Major Points
– Shape of the chest
– Tracheal position
– Apical position
– Respiratory movement
• Additional Points
– Spine
– Shape & contour of chest
– Pulsations
– Veins
– Respiratory sounds like
• cough, wheeze, stridor, grunt

• lÉÉQûÏ = zsÉåwqÉåMüÉxÉå ÎxjÉUÉ qÉlSÉ μÉÉxÉå iÉÏuÉëaÉÌiÉpÉïuÉåiÉç –
UÉuÉhÉlÉÉÌQû
• qÉÔ§ÉÇ = oÉ®qÉÔ§ÉÇ / AsmÉqÉÔ§ÉqÉç MåüÍcÉiÉç EwhÉqÉÔ§ÉqÉç
• qÉsÉqÉç = oÉ®uÉcÉïxÉç
• ÎeÉÀûÉ = zsÉåwqÉÉuÉ×iÉ qÉÑZÉ / sÉåmÉ / ÌlÉUÉSìï ÎeÉÀûÉ /ÌuÉzÉÑwMüÉxrÉ

Ayurvedic Diagnostic tools

• zÉoS = ÌuÉzÉÏhÉïuÉÉMçü / xÉzÉoS EcduÉÉxÉ
• xmÉzÉï = SåWû zÉÏiÉ xmÉzÉï / mÉëlÉ¹¥ÉÉlÉqÉç
• SØMçü = iÉqÉÉåpÉÉuÉÇ / ÌuÉpÉëÉliÉsÉÉåcÉlÉqÉç / FkuÉïSØÌ¹ /
• AÉM×üÌiÉ = SÏlÉ / AÉxÉÏlÉÉå sÉpÉiÉå xÉÑZÉÇ

• Methods of • Internal Environment
Management – Ushna vs Sheeta
– Eliminative – Snigdha vs Rooksha
– Suppressive • Lung Disease is
– Palliative Suggested as
– Reductive Sheeta-Rooksha
• Should under go Vyadhi requires
either Volatile or Ushna-Snigdha
Stable medicament chikitsa
management

Management principles

MüÉxÉ MüxÉÌiÉ MühPûÉSÕ²ïÇ aÉcNûiÉÏÌiÉ CÌiÉ MüÉxÉ
- uÉÉiÉeÉ
Dhoomopaghata - ÌmÉ¨ÉeÉ
Anna Vimarga gamana - MüTüeÉ
Ama Rasa - ¤ÉiÉeÉ
Rookshanna sevana - ¤ÉrÉeÉ
Kshaya
Vegadharana
NˇÁÃ “zoÏ -
áÓ™ÁzúVÁoÁ¸ÃoÀos{ƒ Vyayama
√ÆÁÆÁ™øqÁãåuå zƒmÁXY @
uƒ™ÁTîTnƒÁXY u“ ßÁzåÀÆ
ƒzTÁzú∫ÁzáÁo‚ qƒsÁzÀos{ƒ @@1@@

NˇÁÃ Ã©ú¿Áuõo -
ú¿ÁmÁz —ÆÏtÁåÁåÏTo: ú¿tÏ…b: Ã ußãåNˇÁÊÀÆÀƒåoÏ¡ÆVÁz : @
uå∫zuo ƒMﬁÁnÃ“ÃÁ ÃtÁz Áz ™åyu uß: NˇÁÃ Fuo ú¿ut…b: @@2@@

M×üiÉblÉÉå eÉÉrÉiÉå qÉirÉï: MüTüuÉÉlÉç μÉÉxÉMüÉxÉuÉÉlÉç – uÉæ±ÍcÉÇiÉÉqÉÍhÉ
AjÉ: mÉëÌiÉWûiÉÉå uÉÉrÉÑÃkuÉïçÇxÉëÉåiÉ:xÉqÉÉÍ´ÉiÉ:
ESÉlÉpÉÉuÉqÉÉmÉ³É: (FkuÉïaÉÌiÉxuÉpÉÉuÉqÉÉmÉ³É) MühPåû xÉiMüxiÉjÉÉåUÍxÉ
AÉÌuÉzrÉ ÍzÉUxÉ: ZÉÉÌlÉ xÉuÉÉïÍhÉ mÉëÌiÉmÉÔUrÉlÉç
AÉpÉÉgeÉ³ÉÍ¤ÉmÉlÉç SåWÇû WûlÉÑqÉlrÉå iÉjÉÉÅÍ¤ÉhÉÏ
lÉå§É mÉ×¸qÉÑU:mÉÉμÉåï ÌlÉpÉÑïerÉ xiÉqpÉrÉÇxiÉiÉ:
zÉÑwMüÉå uÉÉ xÉ MüTåü uÉÉÅÌmÉ MüxÉlÉÉiMüÉxÉ EcrÉiÉå – cÉ. ÍcÉ 18/6-8

MüÉxÉ

Acute Bronchitis
ICD 10 = J20 & J21
• Include: Exclude:
• bronchitis: · NOS, in those • bronchitis: · NOS, in those 15
under l5 years of age years of age and above ( J40)
· acute and subacute (with): · allergic NOS ( J45.0)
· bronchospasm · chronic:
· fibrinous · NOS ( J42)
· membranous · mucopurulent ( J41.1)
· purulent · obstructive ( J44.-)
· septic · simple ( J41.0)
· tracheitis • tracheobronchitis: · NOS ( J40)
• tracheobronchitis, acute · chronic ( J42)
· chronic obstructive ( J44.-)

ICD-9CM CODES = 466.0 Acute bronchites


Chronic Bronchitis


Bronchiectasis


Kasa Chikitsa sutra
qÉÑWÒûqÉÑïWÒûÌuÉïwÉcNûÌSïÌWïûkqÉÉiÉ×Oèû μÉÉxÉMüÍxÉwÉÑ – A.WØû. xÉÔ. 13/-
MåüuÉsÉÉÌlÉsÉÇ MüÉxÉÇ xlÉåWæûUÉSÉæmÉÉcÉUåiÉç – A WØû ÍcÉ 3/1
mÉæÌ¨ÉMåü xÉMüTåü MüÉxÉå uÉqÉlÉÇ xÉÌmÉïwÉÉ ÌWûiÉÇ – cÉ. ÍcÉ. 18/83
mÉëcNûkÉïlÉÇ MürÉÍzÉUÉåÌuÉUåMüÉxiÉjÉæuÉ kÉÔqÉÉ: MüuÉsÉaÉëWû¶É
EwhÉ¶É sÉåWûÉ: MüOÒûMüÉ ÌlÉWûliÉÑ: MüTÇü ÌuÉzÉåwÉåhÉ MüTüzÉÉåwÉhÉÇ cÉ – xÉÑ.E.52/28
MüÉxÉqÉÉirÉÌrÉMÇü qÉiuÉÉ ¤ÉiÉeÉÇ iuÉUrÉÉ eÉrÉåiÉç
qÉkÉÑUæeÉÏïuÉlÉÏrÉæ¶É oÉsÉqÉÉÇxÉÌuÉuÉkÉïlÉæ: - cÉ ÍcÉ 18/138
SÏmÉlÉÇ oÉ×ÇWûhÉqÉåuÉÉSÉæ MÑürÉÉïSalÉå¶É SÏmÉlÉqÉç
urÉirÉÉxÉÉiÉç ¤ÉrÉMüÉÍxÉprÉÉå oÉsrÉÇ xÉuÉïÇ ÌWûiÉÇ pÉuÉåiÉç – cÉ. ÍcÉ 18/187
AaêrÉ – ÌuÉSÎaSMüÉ - MülOûMüËU (Solanum xanthocarpum)
MüxÉWûU uÉaÉï :- SìÉ¤ÉpÉrÉÉqÉsÉMü ÌmÉmmÉsÉÏSÒUÉsÉpÉÉ zÉ×…¡ûÏMühOûMüËUMüÉ
uÉ×¶ÉÏUmÉÑlÉlÉïuÉÉiÉÉqÉsÉYrÉÉ CÌiÉ SzÉåqÉÉÌlÉ MüxÉ WûUÉÍhÉ pÉuÉÎliÉ – cÉ. xÉÔ.4/16


A total 1238 compounds for
treating Kasa in Ayurveda
342 Rasa aushadhi
• Talisadi churna – srungyadi churna
• Abhraka bhasma – Shrungi bhasma
• Trijatakadi vati – Lavangadi vati
• Dashamoolarista – Vasarista
• Amrutaprasha ghruta – Vasa ghruta
• Vasakantakari Avaleha – Agastya Rasayanam
• Mahalaxmivilasa Ras - Agni kumara ras
• Hemagarbha pottali – Hemabhra sindhura -
Swarnamalivi vasantam

Kasa Yoga
• Kadaliphala yoga = kadali +
Maricha (Basava Rajiya)
• Swarna Bhupati Ras =
Sarva Kasaharam (Vaidya
chintamani)

• Ahara = Vidahi, Vistambhi, Abhishyandi, Vidruddha,
Vishamashana, Amapardosha, Anaha,
• Guna = Guru, Rooksha, sheeta
• Bahya = rajas, Dhooma, Atapa, anila,
• Other = Vyayama, Bharadhwa, Vegarodha, Apatarpana,
Gramyadharma, Dourbalya, Marmabhighata, Shodana
viparyaya,
• Nidanarthakara roga = Atisara, Jwara, Chardi, Peenasa,
Urahkshata, Raktapitta, Udavarta, Vishuchi, Alasaka,
Pandu, Visha
u“MNˇÁ≈ƒÁÃ “zoÏ -
uƒtÁu“TÏªuƒ…bu©ßøqÁuß…ÆuãtßÁzå{: @
∆yoúÁåÁ∆åÀsÁå∫ÁzáÓ™ÁoúÁuå¬{: @@1@@
√ÆÁÆÁ™Nˇ™îßÁ∫ÁÜƒƒzTÁVÁoÁúoúîm{: @ Hikka- Swasa
u“MNˇÁ ≈ƒÁÃ≈Y NˇÁÃ≈Y åwmÁÊ Ã™ÏúÁÆoz @@2@@

≈ƒÁÃ Ã©ú¿Áuõo -
ÆtÁ Ã¿ÁzoÁÊuÃ ÃÊªÜÆ ™Áªo: Nˇ¢ˇúÓƒîNˇ: @
uƒ…ƒSƒ¿uo ÃÊªt‚áÀotÁ ≈ƒÁÃÁå‚ Nˇ∫Ázuo Ã: @@17@@
Nidana

Vata
• Prana vaha,
Udana vaha,
Kapha Ruddhopagamana Annavaha
= obliterated by it self Srotoroodha

Swasa

Tamaka swasa
• Normalcy of Pranavata suggests health in the
body, abnormality indicates disease
• Pranavata and Prana vikruti leads to the Swasa,
which is an emergency condition, leads to death
even.
• WHO 1998 estimates asthma as 155 millions
which increases 50% every decade worldwide.
• India has an estimated 15-20 million asthmatics.
• Tamaka - is derived from “Tamyati iti Tamaka”-
means; to choke, darkness, be suffocated.
• Dalhana and Chakrapani commented Tamah
praveshana which refers to the darkness or black
curtains in front of the eyes.


Tamaka Swasa Nidana
• Either Bahya or Abhyantara Nidana
(etiological factors) cause Bronchial
asthma which is heterogeneous
disease.
• Aggravating factors like
meghambu(rainy season) sheeta
sthana(cold place) and preceding
factors like peenasa (common cold)
kasa(cough) are clearly explained in
the pathology of Tamaka Swasa.


o™Nˇ≈ƒÁÃ -
ú¿uo¬Áz™Ê ÆtÁ ƒÁÆÏ: Ã¿ÁzoÁÊuÃ ú¿uoú˘oz @ • Asthma is defined as intermittent,
reversible airway obstruction in
T¿yƒÁÊ u∆∫≈Y ÃÊTw—Æ≈¬z…™ÁmÊÃ™ÏtyÆîÊ Y @@27@@
association with increased
Nˇ∫Ázuo úyåÃÊ ozå ªt‚áÁz VÏVîÏ∫NÊˇ osÁ @ nonspecific bronchial reactivity.
EoyƒÊ oyƒ¿ƒzTÊ Y ≈ƒÁÃÊ ú¿Ámú¿úygNˇ™‚ @@28@@ These physiologic changes are
ú¿oÁ©Æuo Ã ƒzTzå ow…Æoz ÃuãåªÜÆoz @ now known to exist in the context
ú¿™Áz“Ê NˇÁÃ™Áå≈Y Ã TXZuo ™ÏÛ™ÏîÛ: @@29@@ of airway inflammation. The
addition of inflammation to the
≈¬{…™lÆ™ÏXÆ™Áåz oÏ ßw∆Ê ßƒuo tÏ:uQo: @
definition has shifted the
oÀÆ{ƒ Y uƒ™ÁzqÁãoz ™Ï˜oîÊ ¬ßoz ÃÏQ™‚ @@30@@ understanding of asthma from a
osÁDÀÆÁzt‚ÜƒÊÃoz Nˇle: NwˇXZ~ÁXZMåÁzuo ßÁu oÏ™‚ @ disease of airway nerves and
å YÁuú ¬ßoz uå¸ÁÊ ∆ÆÁå: ≈ƒÁÃúyugo: @@31@@ smooth muscle to one that
úÁ≈ƒzî oÀÆÁƒTw—mÁuo ∆ÆÁåÀÆ Ã™y∫m: @ identifies inflammation as the
driving force for the symptoms
EÁÃyåÁz ¬ßoz ÃÁ{PÆ™Ï…mÊ Y{ƒÁußåãtuo @@32@@
associated with the disease. This
GuXZ~oÁqÁz ¬¬Ábzå uÀƒ˘oÁ ßw∆™Áuoî™Áå‚ @ realization has led to a dramatic
uƒ∆Ï…NˇÁÀÆÁz ™Ï“Ï: ≈ƒÁÃÁz ™ÏÛ≈YƒÁƒá©Æoz @@33@@ shift in the treatment of the
™zVÁ©§Ï∆yoú¿ÁSƒÁo{: ≈¬z…™¬{≈Yuƒƒáîoz @ disease in the past 10 years.
Ã ÆÁõÆÀo™Nˇ: ≈ƒÁÃ: ÃÁÜÆÁz ƒÁ ÀÆÁãåƒÁzunso: @@34@@ Tamaka Swasa

Nidana Sevana (Diet, Regimen & Climate)

Vatadushti Kaphadushti

Agnimandhya

Ama

Kapha vridhi Rasadushti

Pranavaha Sroto Avarodha

Vimarga gamana Sanga of Pranavata

Kloma Nalika Shaka

Tamaka Shwasa

Asthma


J45-Asthma
Excludes:
acute severe asthma ( J46)
chronic asthmatic (obstructive) bronchitis ( J44.-)
chronic obstructive asthma ( J44.-)
eosinophilic asthma ( J82)
lung diseases due to external agents ( J60-J70)
status asthmaticus ( J46)
J45.0 Predominantly allergic asthma
Allergic:
· bronchitis NOS
· rhinitis with asthma
Atopic asthma
Extrinsic allergic asthma
Hay fever with asthma
J45.1 Nonallergic asthma
Idiosyncratic asthma
Intrinsic nonallergic asthma
J45.8 Mixed asthma
Combination of conditions listed in J45.0 and J45.1
J45.9 Asthma, unspecified
Asthmatic bronchitis NOS
Late-onset asthma
J46 Status asthmaticus = Acute severe asthma

Areas of management interest in
Tamaka Swasa
Kasahara

Swasahara

Parshwashoolahara

Shothahara Deepaneya & Hrudya

Swasa / Tamaka swasa Chikitsa
• MüÉUhÉ xjÉÉlÉ qÉÔsÉæYrÉÉSåMüqÉåuÉ ÍcÉÌMüÎixÉiÉqÉç – cxÉç.ÍcÉ.17/70
• xlÉåWûuÉÎxiÉÇ ÌuÉlÉÉ MåüÍcÉSÕ²ïcÉÉkÉ¶É zÉÉåkÉlÉqÉç qÉ×SÒmÉëÉhÉuÉiÉÉÇ ´Éå¹Ç
μÉÉÍzÉlÉÉqÉÉÌSzÉÎliÉ – xÉÑ.E.51/15
• rÉ²ÌmÉ μÉÉxÉå xlÉåWûuÉÎxiÉ mÉëÉÍgÉÌwÉ®: - QûsWûhÉ
• iÉmÉïrÉåSåuÉ zÉqÉlÉæ: xlÉåWûrÉÔwÉUxÉÉÌSÍpÉ: - cÉ. ÍcÉ. 17/90
• rÉÎiMÇüÍcÉiÉç MüTüuÉÉiÉblÉqÉÑwhÉÇ uÉÉiÉÉlÉÑsÉÉåqÉlÉqÉç
• pÉåwÉeÉÇ mÉÉlÉqÉ³ÉÇ uÉÉ iÉÎ®iÉÇ μÉÉxÉÌWûÌ‚ülÉå – cÉ. ÍcÉ. 17/147
• xÉuÉåïwÉÉÇ oÉ×ÇWûhÉÉå½smÉ: zÉYrÉ¶É mÉëÉrÉzÉÉåpÉuÉåiÉç - - -
iÉxqÉÉcNÒû®ÉlÉ zÉÑ®ÉÇ¶É zÉqÉlÉæoÉ×ïÇWûhÉæUÌmÉ – cÉ.ÍcÉ. 17/149-150
• mÉÉhQÒûUÉåaÉåwÉÑ zÉÉåkÉåwÉÑ LrÉÉåaÉÉ: xÉqmÉëMüÐÌiÉïiÉÉ:
• μÉÉxÉMüÉxÉÉmÉWûliÉåÅÌmÉ MüxÉblÉÉrÉåcÉ MüÐÌiÉïiÉÉ – xÉÑ.E. 51/43-44
• ÌuÉUåcÉlÉ xuÉåSlÉ kÉÔqÉëmÉÉlÉ mÉëcNûSïlÉÉÌlÉ xuÉmÉlÉÇÌSuÉÉlÉç – uÉæ±ÍcÉliÉÉqÉÍhÉ

Swasa yoga
• 962 yogas for Swasa Hikka Chikitsa Karpuradi chrna (SY)
Shatyadi churna (VC)
• 102 Ghruta yoga Vidangadi churna (VC)
• 283 rasa yoga Shrungyadi churna
Dashamoola katutrayadi kwatha
Vasadi kwatha
• Vasa Vasaghruta
• Pushkaramoola Trushana ghruta
Talisa ghruta
• Bharangi
Bharngi guda haritaki (VC)
• Kantakari Abhraka bhasma
• Sunthi – Haritaki (BR) Swasa kuthara ras
Swasakasa chintamani
• Gandhaka + Maricha (BR) Swasa kaleshwara ras (VC)
Sameerapannaga ras
Rasamanikya
Aswagandha kshara
Mayurapincha bhasma


• oÉëÍ¼ bÉ×iÉ
• aÉÑSÕcrÉÉÌS bÉ×iÉ
• aÉÑaaÉÑsÉÑmÉÇcÉÌiÉ£üMüqÉç bÉ×iÉ
• aÉÑaaÉÑsÉÑ ÌiÉ£üMü bÉ×iÉ
• MülOûMüÉËU bÉ×iÉ Vasa Ghruta
• sÉzÉÑlÉ bÉ×iÉ
• ÌlÉÇoÉÉÌS bÉ×iÉ
yoga
• ÍxÉÇWûÉqÉ×iÉ bÉ×iÉ
• qÉWûÉMÔüwqÉÉlQûMü bÉ×iÉ
• iÉÉÍVûxÉÉÌS bÉ×iÉ Panchatikta ghruruta of
Yogaratnakara has Vasa and
• uÉÉxÉÉ bÉ×iÉ Pushkaramoola that are
• ÌuÉSÉËU bÉ×iÉ swasahara and the Brumhana -
Ghruta

pÉUÎlaÉ bÉ×iÉ rÉÉåaÉ
cÉÇaÉåËU bÉ×iÉ
MülOûMüÉËU bÉ×iÉ
MÑüÍsÉjÉwÉOèTüsÉ bÉ×iÉ
lÉÉaÉUÉ±Ç bÉ×iÉ
mÉÇcÉaÉurÉÇ bÉ×iÉ
AqÉ×iÉmÉëÉzÉ bÉ×iÉ
kÉluÉliÉUÇ bÉ×iÉ
oÉ×WûiÉç MülOûMüÉËU bÉ×iÉ

MülOûMüËU bÉ×iÉ
Pushkara Moola mÉlcÉÌiÉ£ü bÉ×iÉ
SzÉqÉÔsÉ bÉ×iÉ
Ghruta Yoga mÉlcÉaÉurÉÇ bÉ×iÉ
zÉPûÉ±Ç bÉ×iÉ
μÉSl·íÉÌS bÉ×iÉ
kÉluÉliÉUÇ bÉ×iÉ
iÉåeÉÉåuÉirÉÉÌS bÉ×iÉ
uÉ×WûMülOûMüÉËU bÉ×iÉ

Tamaka Swasahara rasa Aushadhi

• ¤ÉrÉMÑüsÉÉliÉMü UxÉ
• sÉbÉÑÍzÉuÉ aÉÑÌOû
• ÍzÉsÉÎeÉiÉÑ uÉÌOûMü
• xÉÔrÉïmÉëpÉ aÉÑÌOûMü

Points to observe at PVS Management
• Transport of oxygen and carbon dioxide
(Ambara peeyusha)
• Regulation of Acid base balance
(Niramleekarana – Nirlavaneekarana)

• Control of breathing (Kumbhaka – Rechaka
Pranayama)
• Regulating the water balance in the body
(Ambu)

Note
This is
Not an end
But a big start !
• Dr. K. Shiva Rama Prasad
• doctorksrprasad@gmail.com


Management of Pranavaha srotas Diseases “Ayurvedic Pulmonology”

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