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ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 46-50

Effectiveness of Abhaya Sunthi Churna and Snehana Swedana in Tamaka Shwasa: a randomized parallel group pilot study


Department of Kaumarabhritya, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission21-May-2020
Date of Decision24-May-2020
Date of Acceptance01-Jun-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Dr. Jyothy Kothanath Bhaskaran
Department of Kaumarabhritya, Mahatma Gandhi Ayurved College, Hospital & Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_51_20

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Keywords: Abhaya Sunthi Churna, childhood asthma, Tamaka Shwasa


How to cite this article:
Sankh S, Bhaskaran JK. Effectiveness of Abhaya Sunthi Churna and Snehana Swedana in Tamaka Shwasa: a randomized parallel group pilot study. J Indian Sys Medicine 2020;8:46-50

How to cite this URL:
Sankh S, Bhaskaran JK. Effectiveness of Abhaya Sunthi Churna and Snehana Swedana in Tamaka Shwasa: a randomized parallel group pilot study. J Indian Sys Medicine [serial online] 2020 [cited 2020 Aug 14];8:46-50. Available from: http://www.joinsysmed.com/text.asp?2020/8/1/46/288814




  Background Top


Shwasa (difficulty in breathing) is one of the manifestations of respiratory system which is well explained in detail by all ancient seers of Ayurveda. It is a clinical condition affecting Panavaha Srotas (channel of respiratory system) caused majorly by vitiation of Vata Dosha (body humor responsible for all movements) and Kapha Dosha (body humor responsible for oleation and nutrition) originating from the location of Pitta Dosha (body humor responsible for digestion and enzymatic reactions).[1]Shwasa in children has been mentioned by Acharya Kashyapa where he depicts the premonitory features of this disease in the view of diagnosis in young children.[2]Tamaka Shwasa is one among the five types of Shwasa explained in classical texts of Ayurveda.[3],[4] The pathophysiology explains that Vata Dosha moving in reverse direction pervades the channels of Prana vata, afflicts the neck and head region, and stimulates Kapha Dosha, which in turn obstructs the pathway of Vata Dosha, producing the signs and symptoms of Tamaka Shwasa.[5]

In the contemporary system of medicine, bronchial asthma can be clinically correlated with Tamaka Shwasa as the clinical features such as dyspnea, cough, and chest discomfort are similar in both the conditions. Both the diseases go hand in hand in case of some of the etiological factors such as exposure to smoke, dust, seasonal variation, and exposure to cold. According to the Global Initiative for Asthma (GINA), bronchial asthma is defined as chronic inflammatory disorder of airways which is associated with airway hyper-responsiveness. It leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or early morning. It may also lead to disrupted sleep due to cough and wheeze. There will be increased mucous production, which is thick, mucoid, and difficult to expectorate.[6]Tamaka Shwasa is said to be a disease that comes under the category of manageable disease. But it is also said that if it is of recent onset then it is curable.[7] Thus, there should be effective management strategies for this condition, especially in children. Even after the advancements of medical science in the present era, the prevalence of bronchial asthma among children in Indian population is 16.635% and 5.7% in urban and rural areas, respectively.[8] Irrespective of the use of modern as well as traditional medicines, 100–150 million people around the globe suffer from bronchial asthma. This number is continuously increasing and the mortality rate due to this condition is more than 180,000 annually worldwide. In India, there are an estimated 15–20 million population who are asthmatic.[9] According to WHO, 80% of asthma-related deaths occur in low and lower-middle income countries.[10] The increasing statistics of cases reveal the need for efficient treatment modalities in controlling bronchial asthma.

Many research studies on Tamaka Shwasa have been carried out in adults and a few in children.[11],[12],[13] But very few research studies have been carried out on Tamaka Shwasa in children. The trial formulation of Abhaya Sunthi Churna contains two easily available drugs, namely Haritaki (Terminalia chebula Retz.) and Sunthi (Zingiber officinalis Rose), and, when administered along with honey as Anupana (adjuvant), the churna will be easily accepted by children with respect to palatability. The administration of medicine in Shwasa should be Muhurmuhu[14] (of repeated frequency). To reduce discomfort caused by obstruction of secretions in respiratory tract, local Snehana (external oleation) and Swedana (sudation) are also advised in Ayurveda.[15] By considering the above facts, the present work has been undertaken to study the efficacy of Abhaya Sunthi Churna alone and along with Snehana and Swedana in the management of Tamaka Shwasa.

The values of total leukocyte count, differential count, and absolute eosinophil count may rise in participants with bronchial asthma.[16] Many numbers of drugs including antibiotics are available for the treatment of the disease, but recurrence of the condition and development of bacterial resistance against drugs is nowadays a common issue. Besides, adverse effects of antibiotic therapies have also been reported time to time. So, the need for safe and effective alternative option for Tamaka Shwasa is high.[17]

The trial drug of the present study is Abhaya Sunthi Churna which is indicated in Shwasa Roga, but till date no research studies have been conducted on this drug in children with Tamaka Shwasa.[18]Abhaya Sunthi Churna, containing Haritaki (T. chebula Retz.) and Sunthi (Z. officinalis Rose), is a formulation, the efficacy of which has to be studied in Tamaka Shwasa in both children and adults.[19] These drugs are antitussive, carminative, and digestive in action which will be beneficial in Tamaka Shwasa.[20] In the treatment of Tamaka Shwasa, it is mentioned that the drugs which are having hot potency and pungent taste will pacify Kapha Dosha and relieves the symptoms of Tamaka Shwasa, especially Kasa (cough).[21] Also Swedana has been explained as one of the Pathya in Tamaka Shwasa.[22] Being in the churna form, acceptability of both the drugs in children is also expected to be high. Considering the above points, the present study was undertaken.


  Materials and Methods Top


Aim and Objectives

This study is aimed at evaluating the comparative efficacy of Abhaya Sunthi Churna and Snehana and Swedana in children suffering from Tamaka Shwasa. The objective is to study the effect of Abhaya Sunthi Churna on the clinical features of Tamaka Shwasa such as Peenasa (coryza), Ghurghurakatwa (wheezing), Kasa (cough), Kapha Nishthivana (expectoration), Asinolabhatesaukhyam (relieving while sitting posture), Shwasa Krichhrata (Difficulty in breathing) related to climate, Nidra (sleep), on adventitious sounds on auscultation and on the values of total leukocyte count (TLC), differential count (DC), and the absolute eosinophil count (AEC). The second objective was to study the effect of Abhaya Sunthi Churna along with local Snehana Swedana on the clinical features of Tamaka Shwasa as mentioned above along with objective parameters. The third objective was to compare the efficacy in both the groups on the same parameters of assessment.

Study Design and Settings

This study is designed as a randomized comparative parallel group pilot study. Diagnosed participants (known cases) attending the OPD and IPD of the Department of Kaumarabhritya, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha will be enrolled in the study randomly through computer-generated random number table into two groups [Figure 1]. Data will be recorded in special research proforma by personal interview and examination. Institutional Ethics Committee approval has been obtained with the IEC no. DMIMS(DU)/IEC/2017-18/7247 and the trial has been registered in CTRI with the reference no. CTRI/2020/01/022705.
Figure 1: Consort flow diagram

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Inclusion Criteria

Inclusion criteria is the known cases of Tamaka Shwasa in the age group of 3-15 years irrespective of caste, religion, sex, habits and socioeconomic status.

Exclusion Criteria

Exclusion criteria include severe persistent asthma which needs nebulization and inhalation of nasal spray (puffs), diagnosed cases of severe COPD, respiratory distress syndrome, pneumonia, pulmonary kochs, acquired immune deficiency syndrome, status asthmatics, and any other systemic disorders which may interfere with the trial.

Criteria for Discontinuing or Modifying Allocated Interventions

Participants will be withdrawn from the study if any untoward incidence, features of drug sensitivity, or any other disease or problems; the participants will be offered free treatment till the problem subside.

Primary Outcomes

The proposed primary outcome of the study is the comparative efficacy of the two groups on Peenasa, Ghurghurakatwa, Kasa, Kapha Nishthivana, Asinolabhatesaukhyam, Shwasa Krichhrata, Nidra, TLC, Differential Leukocyte count, AEC, and adventitious sounds.

Secondary Outcomes

The effect of the trial drug and the selected procedure individually, the recurrence of the attack and any adverse drug reaction in the follow-up period are the secondary outcomes of the study.

Statistical Analysis

The data will be analyzed by using paired t-test and unpaired t-test, Wilcoxon signed-rank test, and Wilcoxon rank-sum tests.

Time Duration and Interventions

Group A will include the participants as per inclusion criteria and will be given Abhaya Sunthi Churna orally in the dosage as per age [Table 1] from 1st to 14th day along with external application of Snehana (for 10 min) and Swedana over chest for a period of 7 days. Group B will include similar participants who will be administered with only Abhaya Sunthi Churna for 14 days. The results were reviewed on 7th day and post-trial on 14th day. Follow-up will be undertaken on the 14th day.
Table 1: Posology as per age groups and duration

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Sample Size

This study includes a sample size of 15 participants in each group. Assessment was done based on the criteria given below.

Gradation—Subjective Criteria

Ghurghurakatwa (wheezing) and Kapha Nishthivana (expectoration) were graded as 0 and 1 for their absence and presence, respectively. Peenasa (coryza) and Kasa (cough) were graded as 0, 1, and 2 for absence, occasional, and continuous presence, respectively. Rest of the parameters were graded as follows:

  1. Asinolabhatesaukhyam (relief in sitting position)
    • Grade 0—Comfortable in all postures


    • Grade 1—Temporarily feels better


    • Grade 2—Sitting posture gives relief and can sleep


    • Grade 3—Spontaneous sitting posture/cannot sleep


  2. Shwasa Krichhrata (difficulty in breathing) related to climate
    • Grade 0—Comfortable in all seasons


    • Grade 1—Breathing difficulty in rainy and winter/on exposure to cold and wind


  3. Nidra (sleep)
    • Grade 0—Sound sleep


    • Grade 1—Disturbed sleep due to Shwasa


Gradation of Objective Criteria

  1. Adventitious sounds (on auscultation)
    • Grade 0—Normal breathing sound heard


    • Grade 1—Adventitious sounds heard only on localized part/unilateral


    • Grade 2—Adventitious sound heard on all over lung field/bilateral


Changes in hematological and serological parameters will be assessed based on the values on 0th and 14th day of the trial.

Implementation

The principal investigator will be enrolled and will be allocated the participants. The data entry coding was also done by the same person.

Consent or Assent

The written informed consent was obtained from the participants before starting the study. During the study, the confidentiality of each participant will be maintained.

Dissemination Policy

The data will be disseminated by paper publication, authorship eligibility guidelines, and any intended use of professional writers.

Informed Consent Materials

A model consent form and other related documentations will be given to the participants and authorized surrogates with all the information.


  Discussion Top


The present study is on the disease named Tamaka Shwasa which has the pathological state of Vata and Kapha Dosha in dominance. The pediatric age group has been explained in Ayurved classics as a period where there is physiological dominance of Kapha Dosha which also contributes to disorders with the involvement of the same Dosha as in the condition of Tamaka Shwasa. As the disease ‘Bronchial Asthma’ is one among the highly prevalent diseases in children and is also specifically named as ‘Childhood Asthma’ when affected children, the selection of the topic of the study stands justifiable.

In this study, two modalities of interventions which are indicated in the management of Tamaka Shwasa have been compared in the same set of participants. One group will be administered with only internal medication as in the routine management protocol, whereas the other group will be given external oleation and sudation therapies which are a very unique contribution of Ayurveda in the management of Shwasa Roga. Snehana will be performed with Tila Taila (sesame oil) which is said to be having the properties of hot in potency, alleviating Vata Dosha and not increasing Kapha Dosha.[23] By virtue of its effect, Snehana itself is a modality of treatment to be adopted in Vata-dominant diseases.[24] The study proposes a probable reduction of the symptoms of Shwasa by the intervention of Snehana and Swedana.

Although the posology of the trial drug was taken from the standard drug doses of Ayurveda literature, it can be modified based on the age criteria of 3–9 years and 10–15 years for easier dispensation of the drug, that is, each dose was increased by 0.25 and 0.5mg, respectively, to achieve the target dose. The qualities of the drug chosen will anticipate the outcome in Tamaka Shwasa. The hot potency of the drugs will pacify the Dosha involved in the pathology of Tamaka Shwasa. This drug will also facilitate the normal movement of Vata with respect to respiration which would relieve dyspnea and difficulty in sleep. Reduction in the production of sputum and the absence of adventitious sound on auscultation of chest are also anticipated in the present study. Overall improvement in the condition of the children is also expected in the 14-day trial of the present study. Follow-up is intended to monitor any possible adverse drug reaction (ADR) and recurrence of the symptoms.


  Conclusion Top


The study shows the comparison between two treatment modalities of Ayurveda wherein the efficacy of Abhaya Sunthi Churna will be studied in comparison with external oleation and sudation therapy. This study also analyzes the efficacy of Ayurveda treatment modalities on hematological and biochemical parameters in bronchial asthma among children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agnivesha, Charaka, Dridhabala, Chakrapanidatta. Chikitsasthana, 3rd Part, 17/45. In: Banwari Lal G, editor. Charaka Samhita. 1st ed.New Delhi, India: Rashtriya Ayurveda Vidyapeetha;2014. p.930.  Back to cited text no. 1
    
2.
Vruddha Jivaka, Vatsya. Sutrasthana; Vedhanadhaya, 25/17.1. In: Tewari P. V. , editor (English translation).Kashyap Samhita. Reprint ed.Varanasi, India: Chaukhambha Visvabharati;2008. p. 54-5.  Back to cited text no. 2
    
3.
Ibid Charaka Samhita (1), Chikitsasthana, 17/17 . p. 922.  Back to cited text no. 3
    
4.
Sushruta, Dalhana. Uttaratantra, 51/05. In: Sharma P., editor. Sushrutha Samhita. Nibandhasangraha commentary. Reprint ed.Varanasi, India: Chaukhamba Orientalia;2015. p. 761-2.   Back to cited text no. 4
    
5.
Ibid Charaka Samhita (1), Chikitsa Sthana, 17/55, p. 933.  Back to cited text no. 5
    
6.
Munjal YP. Pulmonary medicine. In: API Textbook of Medicine, Virendra Singh and Ajeet Singh, Vol. I, 9th ed.Mumbai, India: The Association of Physicians of India. 2012; p.1706.  Back to cited text no. 6
    
7.
Ibid Charaka Samhita (1), Chikitsa Sthana, 17/62, p. 933.  Back to cited text no. 7
    
8.
Parthasarthy A. Bronchial asthma. In: IAP Textbook of Paediatrics. A Parthasarathy Vol.I, 4th ed., Chapter 12.13.New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd; 2010, p.594.  Back to cited text no. 8
    
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World Health Organization, Fact sheet - Asthma [Internet]. 2020. Updated 2020 May; cited 2020 May 28. Available from https://www.who.int/news-room/fact-sheets/detail/asthma, last accessed on 2020 June 5.  Back to cited text no. 9
    
10.
World Health Organization. Newsroom. Asthma [Internet]. Updated on 2020 May 15. Available from https://www.who.int/news-room/q-a-detail/asthma, last accessed on 2020 May 5.  Back to cited text no. 10
    
11.
Aparna, Yadav CR, Dadhich OP. Clinical evaluation of efficacy of Shatyadi churna in the management of Tamaka Shwasa. J Pharmacognosy Phytochem 2018;7:3375-82.  Back to cited text no. 11
    
12.
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. Ayu2011;32(1):82-9.  Back to cited text no. 12
    
13.
Jadav R, Dave A, Varsakiya J . A clinical study of Shunthyadi churna in the management of Tamaka shwasa W.S.R. to bronchial asthma. J Ayu Herb Med2018;4(2):48-52.  Back to cited text no. 13
    
14.
Vagbhata. Sutrasthana, 23/20. In: Gupta KL. Ashtanga Sangraha. Reprint ed.Varanasi, India: Chaukhamba Krishnadas Academy;2011. p. 181.   Back to cited text no. 14
    
15.
Ibid Charaka Samhita (1), Chikitsa Sthana, 17/71, p. 937.  Back to cited text no. 15
    
16.
Acharya S, Shukla S, Gadewar P, Gupta M, Mahajan SN. Acute eosinophilic pneumonia with eosinophilic leukemoid reaction: a rare hematologic presentation. Indian J Hematol Blood Transfus 2015;31:311-13.  Back to cited text no. 16
    
17.
Jose M. Antibiotic and antibiotic resistance genes in natural environments. Science 2008;321:356-67.  Back to cited text no. 17
    
18.
Sen KG. Hikka Shwasa Rogaadikari Adhaya, Chapter 16, Verse 11. In: Bhaisajya Ratnavali. Siddhiprada Hindi commentary by Siddhi Nandan Mishra. Reprint ed.Varanasi, India: Chaukhamba Surbharti Prakashan;2007. p. 459.  Back to cited text no. 18
    
19.
Priyavrata S, editor. Chakradatta Sanskrit text with English translation. Delhi, India: Chaukhambha Orientalia;2016. p. 139.  Back to cited text no. 19
    
20.
Bhavamishra , Bhavprakasha Nighantu ; Adhaya Harityakadi Varga; In:Mishra B, Vaisya R, editor. 1st ed.Varanasi, India: Chaukhambha Sanskrit Bhawan, 2012. p.13.  Back to cited text no. 20
    
21.
Chunekar KC. BhavmisraBhavaprakasaNighantu commentary by, A.M.S., B.h.u.Varanasi: 2016SL162-164 p86 SL178, 179 p98 SL182 183 p.101.  Back to cited text no. 21
    
22.
Sen KG. Hikka Shwasa Rogaadikari Adhaya, Chapter 16/132, Verse 11. In: Bhaisajya Ratnavali. Siddhiprada Hindi commentary by Siddhi Nandan Mishra. Reprint ed.Varanasi, India;Chaukhamba Surbharti Prakashan;2007. p. 470.  Back to cited text no. 22
    
23.
Agnivesha, Charaka, Dhridhabala. Sutrasthana, Chapter, Verse 15. In: Gulabkunverba Ayurvedic Society (Jamnagar).Charaka Samhita. Dwitiya Khanda;2014, p. 202.  Back to cited text no. 23
    
24.
Agnivesha, Charaka, Dhridhabala. Chikitsasthana, Chapter 28, Verse 75-76. In: Gulabkunverba Ayurvedic Society (Jamnagar).Charaka Samhita. Dwitiya Khanda;2014, p. 2388.  Back to cited text no. 24
    


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