E-ISSN:2456-3110

Research Article

Bronchial Asthma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

A clinical study to evaluate the efficacy of Tekaraja Churna in the management of Tamaka Shwasa vis-a-vis Bronchial Asthma

Shrikanta.1*, Mytrhey R.2
DOI: http://dx.doi.org/10.21760/jaims.7.9.6

1* Shrikanta, Post Graduate Scholar, Department of PG Studies in Kayachikitsa, Govt. Ayurveda Medical College, Mysuru, Karnataka, India.

2 RC Mytrhey, Professor and HOD, Department of PG Studies in Kayachikitsa, Govt. Ayurveda Medical College, Mysuru, Karnataka, India.

Tamaka Shwasa is one among the five types of Shwasa. It is predominantly Kaphavataja Vyadhi originating from Pittasthana. Aggravated Vata leads to its Pratiloma Gati and enters Pranavaha Srotas afflicts the Kapha produces Peenasa, Ghurghuraka, Shwasakricchrata, Kasa, Pramoha, Parshvagraha, Vishuskasyata. This disease shows close resemblance with bronchial asthma. According to global initiative for asthma (GINA), asthma defined as a chronic inflammatory disorder of the airways which is associated with airway hyper responsiveness. It leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night and in early morning. Asthma affects both children and adults. It is estimated that as many as 300 million people of all ethnic backgrounds suffer from asthma. Prevalence of asthma in india is 2.5-5.0%. In this present study, Tekaraja Churna mentioned in Sahasrayoga was selected for the management of mild to moderate grade bronchial asthma.

Keywords: Tekaraja Churna, Tamaka Shwasa, Bronchial Asthma

Corresponding Author How to Cite this Article To Browse
Shrikanta, Post Graduate Scholar, Department of PG Studies in Kayachikitsa, Govt. Ayurveda Medical College, Mysuru, Karnataka, India.
Email: 		Shrikanta, RC Mytrhey, A clinical study to evaluate the efficacy of Tekaraja Churna in the management of Tamaka Shwasa vis-a-vis Bronchial Asthma. J Ayu Int Med Sci. 2022;7(9):43-48.
Available From
https://www.jaims.in/jaims/article/view/2074

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-31 2022-09-02 2022-09-09 2022-09-16 2022-09-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Shrikanta, RC Mytrheyand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Shrikanta et al: Tekaraja Churna management Tamaka Shwasa Vis-à-vis Bronchial Asthma

Introduction

In the modern urban world, many hazardous agents from the environment as well from the industries concentration of pollutants is increasing in the air.

Hazardous agents from the environment are producing wide variety of diseases in human beings, one such disease is bronchial asthma.

Studies have explored the potential role of indoor and outdoor allergens, microbial exposure, diet, vitamins, breast feeding, tobacco smoke, air pollution and obesity but no clear consensus has emerged. Many among asthmatics need daily medication. Doctrines and practice of any medicinal scheme does not claim effective treatment that can abolish this illness from the root. There is need of evolving more effective treatment which relieves human sufferings.

Hundreds of medicinal combinations are mentioned in the classics for the treatment of Tamaka Shwasa and are claimed to be effective. But very few of such medicinal measures are proved by method of randomized clinical study. Hence there is a dire requirement of exploring the efficacy of remaining therapeutic measures. In the current study, Tekaraja Churna which consists Bharangi, Pushkaramula, Maricha, Pippali, Haritaki, Bhrngaraja which are having Katu, Tikta, Kashaya Rasa, Ushna Virya, Katu Vipaka,Kapha-Vataghna and Shwasahara properties. Drugs such as Pippali and Haritaki has Rasayana property also. These properties may help in Samprapti Vighatana of the Tamaka Shwasa.

Researches on individual drugs of this formulation shows bronchodilator, anti-inflammatory and anti-oxidant action. Thus, with the background of theoretical and research studies, this formulation was selected for the study.

Objective of the Study

To evaluate the efficacy of Tekaraja Churna in the management of Tamaka Shwasa.

Vis-à-vis Bronchial Asthma.

Materials and Methods

Materials: The Materials used in the study were:


Tekaraja Churna[1]

In the present study Tekaraja Choorna was selected, details of the drugs are detailed below.

Name of plant Botanical name Rasa Guna Virya Vipaka Karma
Bharangi Clerodendrum serratum Katu,Tikta, Kashaya Laghu Ruksa Ushna Katu Vatakaphahara, Deepana Pachana
Pushkaramula Inula racmosa Katu, Tikta Laghu Ushna Katu Kapha Vatajit
Maricha Piper nigram Katu, Tikta Laghu, Teekshna Ruksa Ushna Katu Deepana, Chedana, Ruchya, Kapha Vatajit
Pippali Piper longum Madhura, Katu, Tikta Laghu, Snigdha Anushna Madhura Deepana, Rasayana, Vrushya, Rechaka, Vatakaphahara
Hareetaki Terminalia chebula Madhura, Amla Katu, Tikta, Kashaya Laghu, Ruksa   Ushna Katu Deepana, Hridya, Medya, Anulomana, Rasayana
Bhringaraja Eclipta alba Katu, Tikta Laghu, Ruksa Ushna Katu Kaphavatahra Rasayana Keshya Balya
Saindhava Lavana - Lavana Sukshma Snigdha Laghu Anabhishyandi Shita Madhura Deepana Pachana Tridoshahara

Source of drugs and method of preparation

Tekaraja Churna were specifically prepared for the purpose of the study and procured from SN Pandit and sons Pharmacy (GMP Certified Unit), Shankar matt main road, opposite to Nataraja Choultry, Mysuru.

Methods

Source of the data: Subjects were selected from the OPD and IPD of Government Ayurveda Medical College and Hospital, Mysuru and Government Hi-Tech Panchakarma Hospital- a teaching hospital, Mysuru and special was also conducted for the study.

Sample size: The study was completed on 15 subjects of Tamaka Shwasa vis-à-vis Bronchial asthma. The selected subject’s detailed profile was prepared as per the preformed designed for the study.

Sampling method: It was a clinical study with pre post-test design.


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Inclusion Criteria

  • Subjects between the age group of 15-60 years were included irrespective of gender.
  • Subjects having Pratyatma Lakshana of Tamaka Shwasa e. Peenasa, Ghurghuraka, Shwasa, Kasa, Pramoha, Parshvagraha, Lalata Sweda, Vishushkasyata were included.
  • Subjects with classical signs and symptoms of bronchial asthma of mild to moderate nature as per GINA criteria were included.
  • Both fresh and treated cases presenting with the symptoms of Tamaka Shwasa vis-a-vis bronchial asthma were selected. (Fresh cases includes; freshly detected and untreated cases of Tamaka Shwasa vis-a-vis bronchial asthma and Treated cases includes; already diagnosed as Tamaka Shwasa vis-à-vis bronchial asthma) were included with flush out period of 7 days. (if they were on active treatment)

Exclusion Criteria

  • Subjects having bronchial asthma with infective conditions like pulmonary tuberculosis, pneumonia was excluded.
  • Subjects with uncontrolled diabetes mellitus and hypertension were excluded (RBS>300mg/dl, blood pressure>160/100mm of hg)
  • Pregnant and lactating mother were excluded.
  • Subjects with severe persistent bronchial asthma as per GINA criteria were excluded.

Diagnostic Criteria: Diagnosis was done on the basis of signs and symptoms, as mentioned in Ayurveda and contemporary Medical science and GINA criteria for bronchial asthma.

Assessment Parameters: Medicines were given for 30 days and grading of symptoms and PEFR assessment was done on 0th day, and 31st day.

Primary Assessment Criteria

Peak Expiratory Flow meter Rate in Lit/m

Peak expiratory flow meter rate more than 300 Lit/m 0 (Normal)
Peak expiratory flow meter rate 200 –300 Lit/m 1 (Mild)
Peak expiratory flow meter rate 80—200 Lit/m 2 (Moderate)
Peak expiratory flow meter rate less than 80 Lit/m 3 (Severe)

Secondary Assessment Criteria

Grading was done for subjective symptoms of Tamaka Shwasa for the following complaints.[2]

1. Shwasakricchrata (Dyspnea)

2. Kasa (Cough)

3. Kapha Nishtivanam (expectoration)

4. Ghurghuraka (Wheezing)

5. Peenasa (Coryza)

6. Parshwagraha (chest tightness)

7. Aseeno labhate Soukhyam (comfortable in sitting posture)

8. Vishushkaasyata (Dryness of mouth)

Assessment Schedule: First assessment (Pre-test) was done before administering the intervention (0th day) and second assessment (Post-test) was done after completion of the intervention. i.e., on 30th day.

Investigation: Necessary investigations were conducted in required cases to rule out other systemic diseases or complications.

Intervention: 12 grams of Tekaraja Churna with honey as Anupana in three equally divided doses after food was administered in subjects.

Statistical Methods: The results were analyzed statistically by using the following statistical methods:

Descriptive statistics - Mean, Standard deviation, Frequency, Percent

Inferential testing-

  • Chi-square test
  • Repeated measures ANOVA
  • Paired sample and individual sample “T” test

All the statistical methods were done using SPSS for windows.

Observations

In the present study, a total of 15 subjects were registered for the study. The observations were made in all the registered subjects based on the parameters like age, gender, religion, education, Socioeconomic status, Occupation, locality, family history, history of atopy, Ahara, Shwasakricchrata, Kasa, Kapha Nistivana, Ghurghuraka, Peenasa, Parshwagraha, Aseeno Labhate Soukhyam, Shushkasyata, Purvarupa and Nidanarthakara


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Roga. The statistical analysis of the results were done using descriptive statistics and Chi square test analysis using Service product for statistical solution (SPSS) for windows software.

Among 15 patients, a maximum of 3 belonged to the age group of 20-30years, 6 belonged to the age group 31-40 years, 3 subjects were belonged to the age group 40-50 years and 3 belonged to age group 50-60years, 8 were male and 7 were female, 12 were Hindu, 3 belonged to Islam religion. Among 15 subjects, 3 were daily wage worker, 3 were students, 3 were factory workers, 5 subjects were homemakers, and 1 subject was bank employ.

Among 15 subjects, 13 were from urban area and 2 belonged to rural area. Among 15 individuals, 13 subjects had mixed food habits and 2 were vegetarians. It was observed that family history of Bronchial asthma was present in 10 individuals and absent in 5 individuals. In the present study, among 15 volunteer’s different sites of onset were observed. In majority, had childhood onset i.e., 9 subjects and 6 had adult onset bronchial asthma. All 15 subjects reported with worsening of symptoms in winter and rainy seasons.

Results

The data was collected from the subjects based on the scoring given to each of the symptoms as mentioned in the assessment criteria. The data was collected before and after the intervention of the study.

The results were analysed statistically and overall assessment was done. Since the data was following normal distribution pattern, Non parametric tests like Chi Square, Wilcoxon sign rank tests were used for the statistical analysis

1. PEFR: 11 subjects had improvement in PEFR reading, 3 subjects had same grade of PEFR and 1subject had worsening of PEFR after the completion of the intervention period.

2. Shwasakricchrata: 11 subjects had improvement in Shwasakricchrata, 4 subjects had same grade of Shwasakricchrata and none of them had increased Shwasakricchrata after the completion of the intervention period.

3. Kasa: 12 subjects had improvement in Kasa, 3 subjects had same grade of Kasa after the completion of the intervention period.

4. Kapha Nishtivana: 12 subjects had improvement in Kapha Nishtivana, 1 subject had same Kapha Nishtivana and 2 subjects had increased Kapha Nishtivana after the completion of the intervention period.

5. Ghurghuraka: 12 subjects had improvement in Ghurghuraka, 2 subjects had same Ghurghuraka and 1 subject had increased Ghurghuraka after the completion of the intervention period.

6. Peenasa: 8 subjects had improvement in Peenasa, 7 subjects had same grade of Peenasa after the completion of the intervention period.

7. Parshwagraha: 12 subjects had improvement in Parshwagraha 3 subjects had same grade of Parshwagraha after the completion of the intervention period.

8. Aseeno Labhate Soukhyam: 9 subjects had improvement in Aseeno Labhate Soukhyam 6 subjects had same grade of Aseeno Labhate Soukhyam after the completion of the intervention period.

9. Shushkasyata:  1 subjects had improvement in Shushkasyata.

Discussion

Probable mode of action of Tekaraja Churna

Tekaraja Churna is mentioned in Sahasrayoga Churna Prakarana. It contains 6 ingredients Bharangi, Pushkaramula, Maricha, Pippali, Haritaki and Saindhava Lavana. Main ingredient of this Churna is one Kudava (192 grams) of Maricha, which is boiled with Bhringaraja Swarasa till the complete evaporation of liquid. Then the remaining churna are added with the quantity of one Tola each. Formulations having Kapha-Vatahara, Ushna and Vatanulomana drugs are more suitable for Tamaka Shwasa.[3] Contents of Tekaraja Churna has all these properties, hence the formulation is suitable for Tamaka Shwasa. Drugs like Bharangi and Pushkaramula possess Shwasahara property. Bharangi is mentioned under Shwasahara Dashemani Gana in Charaka Samhita. It has Kapha Vatahara property and has Ushna Guna. It is a proven bronchodilator and mast cell stabilizing drug through various researches. Maricha and Pippali have the properties such as Katu, Tikta Rasa and Ushna Veerya.


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These drugs have Kaphahara property which acts as a mucolytic agent and helps to liquefy the accumulated mucus in the airways. Piperine which is the common phytoconstitutent in both Maricha and Pippali reduces Th2 cytokines (interlukin-4, interlukin-5) and histamine production. Both of them have Deepana, Pachana property which help to treat associated Agnimandya in Tamaka Shwasa. Pratiloma Gati of Vayu is said to be the root cause of Tamaka Shwasa. Haritaki has Vatanulomana property. It also has anti-inflammatory action by inhibiting nitric oxide synthesis. Saindhava Lavana has Kapha Vilayana and Kapha Chhedaka properties which help to prevent accumulation of mucus in airways. Sroto Shodhana action of Saindhava helps to keep airways patent in Tamaka Shwasa patients. Bhringaraja is of Ruksha and Ushna Guna which helps in causing the Shoshana of excess mucus in the airways. Its extracts are shown significant immunomodulatory action by increasing phagocytosis.

Conclusion

Tekaraja Churna was found effective in the management of Tamaka Shwasa vis-a-vis bronchial asthma both statistically and clinically. No severe adverse effects were observed during the course of intervention. Few subjects complained of burning sensation at epigastric region while taking this Churna. This might be due to underlying gastritis in them and all of them were belonged to Pitta Parkruti.

So, it is important to assess the Prakruti of individual before administering the Tekaraja Churna. Drugs like Maricha, Pippali may cause Pitta Prakopa in susceptible individuals. Reducing dose or changing the Anupana can be helpful in such patients.

Reference

1. Vaidyanath.R. Nisthteswar.K, editors, 2nd edition, Sahasrayoga, Churna prakarana, 14th churna, Varanasi, Choukhamba Sanskrit series office, p170.

2. Acharya Y T, editor, 2016, Ayurvedadipika commentary of Sri Chakrapanidatta on Charakasamhita of Agnivesha, chikitsa sthana; hikkashwasa chikitsitiy adhyaya : chapter 17, verse 55-61.Varanasi; Chaukamba orientalia, 2016.


3. Acharya Y T, editor, 2016, Ayurvedadipika commentary of Sri Chakrapanidatta on Charaka samhita of Agnivesha, chikitsa sthana; hikkashwasa chikitsitiyadhyaya : chapter 17, verse 147 Varanasi; Chaukamba orientalia, 2016.


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