Tamaka swasa

1. Dr.B.R.K.R GOVT. AYURVEDIC COLLEGE HYDERBAD. TAMAKA SWASA Gautham BAMS-3 rd sem.

2. SHVASA Shvasati Vayu iti Shvasah (Hem Chandra) Shvasiti Anena iti Shvasah ( Shabda Kalpa Druma ) Shvasiti Iti Shvasah Shvasa word is used to denote respiration and exchange of air in the body. The Word Shvasa is used for both Physiological and Pathological states. Shvasa Roga may be defined simply as a disease in which the respiration and exchange of air is disturbed. Shvasa is classified in following types: 1. Mahashvasa 2. Urdhvashvasa 3. Chinnashvasa 4. Tamakashvasa 5. Kshudrashvasa

3. ETYMOLOGY OF TAMAKA SHVASA: Tamaka Shvasa comprises of two words i.e. Tamaka and Shvasa . TAMAKA: The word is derived from the Dhatu " Tamglanou " which means Sadness (Panini) 1. The word " Tamaka " is derived from the root "Tam" means oppression of chest ( Monier Williams). 2. The Sanskrit English Dictionary by Vidyadhar Vamana (1926) shows the different meanings of Tam i.e. to choke, to be suffocated, to be exhausted, to be unease, and to be distressed. 3. Tamaka - Tamyati Atra Tama Vachaspatyama 3237 V IV. It is described as a one variety of disease Shvasa in Vachaspatyama . 4. Tama Tamyati Anena Iti Tama - Halayudhakosha page 326. The word Tama denotes Andhakara , Nishacharma , Divantaka , Dinantarama , Andhakam .

4. वात प्रकोपकर रुक्ष् विशमशन् द्वन्द्वाति योग विष अध्याशन अनशन शीतशन समशन विस्तम्भि पित्त प्रकोपकर तिल तैल विदाहि कटु उष्ण् आम्ल लवण कफ प्रकोपकर निश्पाव beans माष black gram पिष्टन्न flour preoparation सलुक tubers गुरु द्रव्य जलज मांस अनुप मांस दधि आमक्षीर पिन्यक श्लेश्मल अभिष्यन्दि उत्क्लेदि आहर

5. विहार वात प्रकोपकर रजस् धूम प्राग् वात शीत स्नान शीत अम्बु व्यायाम , ग्राम्म्य धर्म अति अपतर्पन शुद्धि अतियोग कण्ठ प्रतिघात उरः प्रतिघात , कर्म हत अध्वहत , स्त्री सेवन भार कर्षित , वेग निरोध वेग घात , अभिघात मर्म अभिघात , आयास जगरन , वेग उधीर्न पित्त प्रकोपकर उष्म कफ प्रपोकर अभिष्यन्दि उपचार दिवा स्वप्ना

6. निदानार्थकर रोग वात प्रकोपकर आनाह अतिसार अमप्रदोषज दौर्भल्य क्षत क्षय उदावर्त विसूचिक अलसक पान्दु रोग विष सेवन विष सेवन विबन्द धातु क्षय क्षय आवरन दोष पीदन पित्त प्रकोपकर रक्तपित्त ज्वर कफ प्रपोकर कास आमप्रदोशज आमातिसार चर्दि प्रतिश्याय [(Madhu Ma. M. 12/1-2), (Ch. Chi-17/11-16), (Su. ut. 50/3-5) (A.H.Ni- 4/2), (A.S.Ni-4/2-3)

7. आनाह पार्श्वशूल पीढनम् ह्रुदयस्य प्राण्स्य विलोमत भक्त द्वेष अरति वदनस्य वैरस्यम् आध्मान शंख निस्तोद शूल पूर्व रूप [(Madhu Ma. M. 12/16), (Ch. Chi-17/20), (Su. ut. 51/6)

8. रूप अतीव तीव्र वेग श्वास घुर्घुरुकं (कण्ठ घुर्घुरान्वित) कास आसीनो लभते सौख्यम् मुहुर्मुहुर् श्वास ललटे स्वेद मेघाम्बु शीत प्राग्वाते व्रिद्धि प्रान प्रपीडक श्वास रुद्ध श्वास प्रताम्यत्यतिवेग कासते सन्निरूध्यते मुहुर्मुहुर् कास मानश्च स गच्छति प्रमोहम् श्लेष्म्ण्यमुच्यमाने तु भ्रुशं भवति दुःखितः ..विमोक्षान्ते मुहूर्तं लबते सुखम्

9. मह्त् घोषवन् श्वास स कास स कफो आस्यो द्द्वंसते कण्ठः क्रुच्छ्राच्छ्क्नोति भाषितुम् न च अपि निद्रां लभते शयानः पार्श्वे तस्य अवग्रुह्णाति शयनस्य समीरणः उष्णं चैव अभिनन्दति उच्छिताक्षो भ्रुशमतिमान् शुष्कास्यो मुहु च एव अवधाम्यते श्लेश्मलै अभिवर्धते त्रुट्,वमतु प्रायः विशेषा दुर्दिने अबलो अन्न द्विट्(द्वेष) स शाम्यति कफे हीने स्व पतश्च वि’वर्धते उरः पीड करोति पीनसं

10. Pinasa : In this condition there is excessive secretion of shleshma (mucus) in the pranvaha srotas . Nasal secretion increases & pinasa ( coryza ) develops. This hinders the free flow of pranvayu . 2. Griva siriska sngraha : When prakupita vata moves in pratiloma marga , it contracts the neck & head muscles because of which the patient feels if his head & neck are tightly held by someone. It also indicates the use of extra respiratory muscles during the attack. 3 . Ghurghurkiam : It is a typical sound produced, when excessive secretion of the kapha , obstructs the free flow of pranvayu . 4. Ativativra Vega shwasa : When the attack of shwasa comes, the heart rate also increases as the respiration rate & heart rate is in a ratio of 1:4. When the shwasa kriya increases, the heart rate also increases which causes sevre discomfort. The excess secretion of mucus & sputum clogs the path of pranvayu , this causes kasa & when unable to expectorate the thick, sticky sputum it further aggravates the coughing & a sense of suffocation. 5. Pratamayati Ativegata : The pluging of the tract with the mucus and sputum and continuous effort to expectorate causes severe dyspnoea , he sits up frequently panting & feels if surrounded by darkness.

11. 6 . Kaste Sanniruddtiyate : During severe coughing, the patient breath withheld for a few seconds and becomes motionless. 7. Kasat Muhur Muhur Pramahom : Repeated coughing and paroxysmal attacks of dyspnoea and frequent panting, makes him feel if he is entering into darkness & Distress. 8. Sleshma Amuchamane Bhrusam Dukhita : In a patient of tamak shwasa the sputaum is thick, tenacious, and sticky in nature and is not easily exporated . Thus situation is very distressing. 9. Slashmani Vimokshante Muhurtam Sukham : Once the sputum is expectorated the frequency of coughing reduces and there is momentarily relief due to easy flow of prana vayu . 10. Kanthodhvansa : Because of repeated coughing the patient develops hoarseness of voice. 11. Kruchrat Bhasitam : During the shwasa Vega, the patient cannot speak properly due to the tenacious mucus coated in the throat and vocal cords get affected.

12. 12. Nachapi Nidra labhate Sayana Shwasa Piditam : Due to frequent kasa & Shwasa patient cannot sleep and on lying, the flow of prana vayu is obstructed and patient again sits on bed. 13. Parshva Tasyavagrhyate Sayansya Samiranaha : When the patient lies in recumbent position, the space for air exchange reduces in lungs which cause sudden pressure on the lungs due to raised diaphragm. The air trapped cannot easily escapes and severe pain occurs. 14. Asinolabhata Saukhyam : On sitting position the diaphragm is lowered and the space for air exchange increases and the pressure is also reduced, this fecilitates the flow of pranavayu . 15. Ushnaabhinandti : The patient has inclination towards hot things like tea; coffee, hot food because taking hot things gives relief to the patient. 16. Ucchritaksha : When there is diffciency of pranvayu & its path is obstructed. The patient suffering from tamaka shwasa raise his face upward to fascilitate easy entry of pranvayu . His eyes are wide open.

13. 17. Lalateswada : During Asthamatic attack, patient continuously makes effort to take breath, is exhausted and this further increases his heart rate (Tachycardia). Severity of tamaka shwasa forces him to use accessory muscles for respiration and all this causes sweating on forehead. 18. Bhrusum Aratimana : Increased respiration rate, worsen his condition and he feels giddiness. 19. Vishuskasysta : Continuous rapid shwasa-prashwasa (respiration) process causes dryness of mouth due to excess loss of water from the body. 20. Muhuchiva Avadhamyate : Here the patient expires for a longer duration of produicing sound with a shorter phase of inspiration. In this condition the body trunk is raised and lowered alternately as explained by Gangadhar . 21. Muhur Muhur Shwasa : Patient respiration rate increases due to irritative cough, dyspnoea occurs time and again at short intervals. 22. Annadhvesa : In this there is agni dushti which leads to agni manda and this causes indigestion and production of Amarasa and this causes Annadhvesa .

14. 23. Meghambu Sita Pragavate Sleshmaischabhi Vardhyate : The condition of the shwasa is aggrevated by megha (clouds) Ambu (rainy season) Shita (Cold) Pragavate (winds coming directly) and Kapha vardhaka diet. 24. Uraha Pida : Due to vitated vayu dosha there is pain in chest.

15. संप्रप्ति 1 कफवातात्मकावेतौ पित्त स्थान समुद्भ्वौ । ह्रुदयस्य रसादीनां धतूनां चोपशोषणौ ॥ ch.chi.17/8. 2 ma रुतः प्राणवाहीनि स्रोतांस्य् आविश्य कुप्यति । उरः स्थः कफमुद्धूय हिक्का श्वासान् करोति सः ॥ ch.chi.17/17. 3 यदा स्रोतांसि संरुध्य मारुत: कफपूर्वकः । विष्वग्व्रजति संरूद्धस्तदा श्वासान्करोति सः ॥ म.नि-१२/१७ 4 विहाय प्रक्रुतिं वायु: प्राणो अथ कफसंयुत: । श्वासयत्यूर्ध्वगो भूत्वा तं श्वासं परिचक्ष्यते ॥ su.ut.51/4 5 कफोवरूद्धगमनः पवनो विष्वगास्थितः । प्राणोदकान्नवाहीनि दुष्ट: स्रोतांसिदुषित: ॥ उरस्थः कुरुते श्वासमामाशय समुद्भवम् । A.H.ni.4/3 .

16. Samprapthi ghatakas Dosha : Vata - Especially Prana Vayu , Udana , Samana ,( Apana and Vyana are also affected in due course.) Kapha - Kledaka and Avalambaka Kapha Dushya : Rasa, ( Rakta ),( udaka ) Mala : rasa mala kapha Agni : Mandagni , Vishamagni Ama : Rasa gata Dhatvagnimandya ( agni maandhya janya ama ) ( Mandagni janya Ama ) Srotas : Prana , Anna, Udakavaha Srotasa ,(rasa) Udbhavasthana : Pittasthana ( Charaka ) Adho Amashaya ( Chakrapani ) Aamashaya ( Vagbhat ) Adhistaana : urah,phupphusa ( kapha sthana ) Vyaktisthana : Urah Srotodusti : Sanga in pranavaha & anna vaha , Atipravritti in Udakavaha and Pranavaha and Vimarggamana in pranavaha   rogamarga : Abhyantara Vyadhi : Amashayotha

17. Nidana sevana Kapha prakopa Vata prakopa Ama formation Agni dusti Saama vata Ama yuktha rasa dathu Kledaka kapha vruddhi Adho aamasaya Yugapat Sarvato Vikshepa Mala rupa kapha utpatti Vyana Vikriti Avalambaka kapha vriddhi Kapha sanga (mucus plug) Kapha makes avarana to prana vayu uras Srotorodha, Shotha, Sankocha in Pranavaha Srotasa (Inflammation, Broncho constriction) Pratiloma gati of Pranavayu Utklesha of sthanika kapha Margavarana of Vata Vishamagni Tamaka swasa Udana vayu

18. Pratamaka Shwasa: Patients suffering from Tamaka Shwasa when gets afflicted with fever and fainting, the condition is called as Pratamaka Shwasa. It is suggestive of involvement of Pittadosha in Pratamaka Shwasa. It is aggravated by Udavarta, dust, indigestion, humidity (Kleda), suppression of natural urges, Tamoguna, darkness and gets alleviated instantaneously by cooling regimens. Ch.chi-17/63 Santamaka Shwasa: When the patients of Pratamaka Shwasa feels submerged in darkness, the condition is called as Santamaka Shwasa.Though Chakrapani has mentioned these two as synonyms of each other Charaka refers them as two different ailments representing two different stages of Tamaka Shwasa , These two conditions differs from each other according to intensity of attack. This can be taken as the severe stage of Pratamaka ch.chi-17/64

19. SADHYASADHYATA : Tamakashvasa in general is described as Yapya (palliable) disease. However in individual with recent origin of disease person Pravara bala or both said to be Sadhya( Ch. Chi. 17/.62). While mentioning prognosis of any disease following characters are mentioned in case of Yapya disease. Disease has affected the deep seated Dhatus Disease involving many Dhatus If affects vital organs and joints Affects patient continuously for longer period Disease is caused by two Doshas . In disease Tamakashvasa Kapha and Vata Dosha are involved primarily. Both of them exhibit opposite qualities. Hence management will be also difficult as factors, which excite Vata, alleviate the Kapha Dosha and vice Versa. Rasaadi Dhatu gets involved in Tamaka Shvasa, which is suggestive of the involvement of more than one Dhatu. Pranavaha Srotasa is mainly involved. This Srotas is having direct exposure to environment hence persons are more exposed to Nidana like Raja, Dhuma etc.

20. Disease Tamakashvasa is having Multifactorial origin along with diet, environmental and meteorological factors like rains, cloudy weather, chilly wind etc & patients can not avoid this Nidana . Sushruta opines Kasa, Shvasa and Vilambika are very difficult to cure like setting in together of fire, wind and thunder. ( Su. Utt. 51/56) Regarding Tamaka Shvasa he says that it is a disease, which can be cured with much difficulty. If it is appears in a debilitated individuals its prognosis becomes very difficult ( Su. Ut. 51/15).

21. Management in tamaka swasa The management Shwasa in practical of Tamaka sense has two aspects : 1. Management of Vegavastha of Tamaka shwasa ; i.e. acute exacerbations, and 2. Chronic management of the avegavastha , where the frequency, duration and intensityof the attacks are minimised / totally cured to give a quality life to the patient. “focus on alleviating Vata without agitating kapha , and balance the kapha , liquefy it and expel it from the pranavaha srotas , without agitating vata .” Hence the drug of choice should be of Ushna veerya . 3 categories of therapies in treatment: Samana of k & v always preferred Samana of v but aggravates k preferred if essential in exceptional circumstances Samana of k but aggravates v is avoided

22. 1. Vegavastha : Snighdairadou -by lavana tailena , {In Snehadhaya ( Cha.Su . 13/98) Charaka has mentioned properties of Salavana Sneha } . It supervenes within short period of time because both of them are having Sukshma property hence having greater penetration power. It is also having Doshasanghata Vichedakara property. Taila is having Ushna property, and thus alleviates vata , and does not increase Kapha . There fore it is better for Abhyanga . ( Cha.Su.13/15 ) In Shwasa , Grathita Kapha (Mucous plug) is present; and Salavana Sneha is useful in vilayana of this grathitha kapha , thereby removing the sanga (Obstruction of airway). How this Sneha penetrates all Dhatu’s and pacifies Dosha is mentioned by Dalhana ( Su.Chi . 25/30, Dalhana ).

23. Then( Nadi Sweda ), ( Prastara ) sankara sweda is done. In infants and small children, hasta sweda is preferred . Swedana helps to dissolve this Kapha . Also heat applied by Sweda is carried from skin to internal organ through blood. Blood is the only medium in body to transfer heat from outer environment to internal organs. In response to the above-mentioned procedures, Kapha , which has become stagnated and get dried, thickened in the Srotas , gets softened and dissolved which is then eliminated from body by Shodhana procedure. After profuse perspiration by doing swedana . Then snigdha odna (Rice) or soup of fish, pork, meat or the supernantant of the curd should be given to increase the kapha dosha . Then vamana is done by pippali choorna , Saindhava lavana , honey, but the drugs used should not be antagonistic to vata . Thus the sputum ( Dusta Kapha ) is easily expectorated and free flow of prana vayu is maintained.

24. After vamana the residual doshas which are not completely eliminated are cleared with help of dhumpana . For this haridra patra , Eranda mula , lac , realgar , devdaru , orpiment, jatamansi powder is utilized along with ghee. A varthi is made ,and is smeared with ghee & used . However, in children less than 7 years, mrdu vamana and Virechana are to be performed if the Vega tivrata is very high. Instead, Shamana drugs of ushna veerya , which pacify the vata- vatanulomaka - as well as liquefying kapha ( kapha vilayaka ) , making it flow out to its base in Amashaya , where it can be pacified using kapha hara drugs.

25. 2. Avegavastha : In Avegavastha due consideration should be given to avoid pathogenesis which further leads to exacerbations. Hence, particularly Deepana - Paachana and Vatanulomaka treatment should be adopted; Deepana Paachana treatments are useful in maintenance of Agni as Kapha Dosha aggravation results due to Mandagni . Vitiation of Dosha doesn’t occur if Agni is in proper state. By Vatanulomaka treatment, Vayu traverses through its own path. Vitiation of all these Dosha depends on the status of Agni ( Cha.Chi . 5/136). How Agnimandya results into Dosha prakopa is explained by Chakrapani - Agnimandya results into Avipaka , and Vidaaha leading to Kapha and Pitta prakopa and due to absence of Dhatuposhaka rasa it results into Dhatu kshaya further leads to Vataprakopa . Hence along with Deepana Paachana therapy Brmhana therapy is also prescribed to increase the Bala of patient. Brmhana dravya also improves the status of Dhatu .

26. कासिने च्छर्दनं दध्यात् स्वरभन्गे च बुद्धिमान् । “ वात श्लेश्म हरैर्युक्तं तमके तु विरेचनम् ॥ ” drug

27. ROLE OF VIRECHANA IN TAMAKA SHVASA : The site of origin of shwasa roga is “ Pitta Sthana Samudhbhava .” And this pitta sthana is described by Chakrapani as Adho Amashya . This is the region between the hridaya and nabhi . At this place the main pathology of shwasa roga takes place and the pre-dominant dosha pitta is present here. And to purify the site of origin virechana is advocated. (Ch. Su.20/18) 2. The patient of tamaka shwasa is oftenly weak and in chronic stage, hridya as the mula of pranavaha shrotas is also involved. In this condition vamana is very difficult and complicated procedures & the virechana is easily done with out threatening the life of the patient.

28. 3. Accumulation of Mala and Vayu in Udara leads to Apana vayu vitiation, which is followed by vitiation of Prana Vayu leading to Shvasa . In patients of Tamaka Shvasa Anaha like condition is often seen, Virechana by ensuring purgation is expected to relive this condition and thus therapy is more helpful in the treatment of Shvasa . 4. If Tamakashvasa presents due to Saama Vayu it leads to inflammation. As per modern view Asthma is considered as chronic inflammatory condition of airways. In the management of Shotha Virechana is having prime importance, as Shotha results due to obstruction in natural path of Vayu . Virechana overcomes this obstruction and reduces inflammatory condition. 5. Udakavaha Srotasa is involved in pathogenesis of Shvasa . In deranged state it results into excessive Kleda formation. Kleda is having Apa Mahabhuta dominancy particularly in Kaphapradhana samprapti the vitiated status of Kleda is observed. The excessive secretions in the lungs are present at this stage. The word Virechana itself is formed from ‘ rech ’ Dhatu meant for secretion. Virechana removes this Kleda , thus it reduces severity of Shvasa .

29. 6. ShvasaVyadhi is mentioned as Aamashaya samutha where derangement of Agni leading to Agnimandya . In this case Virechana will be helpful by maintaining proper status of Agni, which is the root cause for almost many diseases. 7. Embryological development of Phupphusa occurs from Shonitaphena i.e. main source is Shonita . In case of Shvasa Vyaktisthana is Urah where Phupphusa is situated, hence Khavaigunya mainly occurs here hence Virechana which is best treatment for purification of Rakta may be useful for clearing the Khavaigunya in Phupphusa

30. Vamana is done in initial stages where there is pravrudda kapha (ch.chi.17/76)& virechana is indicated after vamana . In tamaka swasa spasm of diaphragm occurs ,which causes aggravation of svasa krichrata.virechana alleviates spasm & improves resp.movementsby reducing intra-abdominal pressure. Virechana may also help in reducing the absorption of histamine like substances & other toxic material from intestine there by prevevts broncho spasm As virechan is regarded as best treatment for raktha & pitta .it is raktha prasaadaka,promotes healthy raktha.hence it relives or atleast reduces the sevierity of the effects of allergy.thus reduces attaks of asthma.

31. GENERAL INSTRUCTION TO BE FOLLOWED: To take light diet according to Agni Bala . To avoid occupational Asthma, worker should use face mask, when they are working in factories, cotton mills or at places where there is Dust, fumes etc. Deep breathing exercise should be followed. Diet during evening should be taken three hours before going to bed. Avoid direct exposure to external environment after use of Air conditioning. Use of warm clothes in winter season. NOT TO BE FOLLOWED: Over eating and taking milk at bed time. Fried, chilly, too cold, sour, heavy preparations. Cold and damp places. Fasting for a longer period. Seating in frosty, smoky and congested places for a longer period. Rukshanna particularly toast, popcorn etc. Jalaja , Anupa , Mansa, Dadhi , Aamaksheera , due to Guru and Abhisyandi property. Bread, Burger, Pizza, Cheezes , Paneera etc is used which are having Srotorodhaka property. Contact with those pet animals, which do not suit the individual. Direct exposure to Prag-vata

32. PATHYAPATHYA – PATHYA – Ahara – 1. Shuka varga – purana yava , godhooma , shashtika dhanya , raktashali 2. Shami dhanya – kulattha . 3. Mamsa varga – shasha , tittira , shuka , dvija (birds), daksha ( kukkuta ). 4. Shaka varga – patola , tanduliya , vastuka , vartaka . 5. Phala varga – dadima , jambira , draksha , amalaki , bimbiphala,bilva . 6. Madya varga – sura . 7. Gorasa varga – aja dugdha . 8. Kritanna varga – yava , saktu 9. Ahara upayogi varga – aja ghritam , purana ghritam , madhu , mamsa rasa, pippali , hingu , kanji, rasona . 10. Jala varga – ushna jala of pokhara . Vihara – Vamana karma, virechana karma, swedana and dhoomapana . Pathya varga : Purana sastik , Rakta Sali dhanya , wheat, Yava , Mudga , Meat of Rabbit, peacock, Titar , lava, Kukkuta , etc, Kantakari , Jeevantisaka , Bimbiphala , suksma ela , Marica , Sunti , Draksa , Lausun , Purana ghrta , Aja dudgha , Aja ghrta , Gomutra , Sura , hot water, honey, etc.

33. APATHYA – JARAM SINGH-KATPHALA-TAMAKA SHWASA-DG-2001 IPGT&R, JAMNAGAR, GUJARAT, PDF CREATED BY DR GIRISH KJ, [email protected] Ahara – 1. Mamsa varga – matsya . 2. Shaka varga – sarshapa . 3. Phala varga – kanda 4. Jala varga - dushita jala , cold drinks. 5. G orasa varga – bhedi dugdha & ghrita . 6. Kritanna varga – ruksha anna & pana , shitala & guru padartha . Vihara – Purva vata sevana , vegavarodha , raktamokshana , raja, dhooma and gramyadharma etc Apathya Varga : Beans, Anupa mamsa (fish), manda Saka (potato) mustard, Masa , unboiled milk, cold water, curd, Tail, fried food , etc as ahara . Supression of Mutravega , long journey, lifting heavy weight, cinta etc as vihara

34. Yogaasanas Jala nethi Sootra nethi Kapalabathi Vamana douthi Ardha chakrasana Paschimottasana Bhujangasana Danuraasana Surya bhedan pranayam

35. Tadasan Vajrasan Shavasan sashankasan

36. Thanks to all…