Post on 21-Nov-2014
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8-1-2008 doctorksrprasad@gmail.com 1
Management of Pranavaha srotas Diseases
“Ayurvedic Pulmonology”
Prof. Dr. K.Shiva Rama Prasad M.D (KC); MA, Ph.D (Jyotish) doctorksrprasad@gmail.com
8-1-2008 doctorksrprasad@gmail.com 2
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
8-1-2008 doctorksrprasad@gmail.com 3
•
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
LET -
Introduction
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Pranavaha srotas
• mÉëÉhÉuÉWûÉÌlÉÌiÉ
mÉëÉhÉxÉÇ¥ÉÉMüuÉÉiÉuÉWûÉlÉÉqÉç
LiÉŠ mÉëÉhÉÉZrÉÌuÉÍzɹxrÉxÉëÉåiÉ
– cÉUMü
ÌuÉqÉÉlÉ
5/8 cÉ¢ümÉÉÍhÉ
• mÉëÉhÉmÉuÉlÉ: mÉëÉhÉÉÌlÉsÉ: mÉëÉhÉÉÍ´ÉiÉÉå
uÉÉrÉÑËUÌiÉ– zÉÉ.xÉÇ.mÉÔ. 5/48 -AÉRûqÉssÉ
• 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
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Pranavaha Sroto Moola
• qÉÔsÉÍqÉÌiÉ
mÉëpÉuÉxjÉÉlÉqÉç
– cÉ.ÌuÉ.5/8 – cÉ¢ümÉÉÌlÉ• iɧÉ
mÉëÉhÉuÉWûÉlÉÉÇ
xÉëÉåiÉxÉÉÇ
WØûSrÉÇ
qÉÔsÉÇ
qÉWûÉxÉëÉåiɶÉ
– cÉ.ÌuÉ.5/8
• iÉrÉÉåqÉÔïsÉÇ
WØûSrÉÇ
UxÉuÉÉÌWûlrɶÉ
kÉqÉlrÉ: -
xÉÑ.zÉÉ.9/12
• 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
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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.
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Pranavata
xjÉÉlÉÇ
mÉëÉhÉxrÉ
qÉÔkÉÉåïU: MühPûÎeÉÀûÉxrÉlÉÉÍxÉMüɹÏuÉlɤÉuÉjÉÔªÉUμÉÉxÉÉWûÉUÉÌS MüqÉï
cÉ
– cÉ.ÍcÉ.28/6mÉëÉhÉÉå§ÉqÉÔkÉïaÉ: EU:MühPûcÉUÉå
oÉÑήWØûSrÉåÎlSìrÉ
ÍcɨÉ
SØMçüÌlɹÏuÉlÉ
¤ÉkÉÔªÉU
ÌlÉ:μÉÉxÉɳÉ
mÉëuÉåzÉM×üiÉç
– A.WØû.xÉÔ.12/
• 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”
• Promotes expulsion of phlegm, gas and intake of air and food.
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Vata
uÉÉ
aÉÌiÉaÉlkÉlÉrÉÉå
– xÉÑ.xÉÔ.21/5
• Vata defined as Gati – momentum = motor and Gandhana – sensory perceptional or said as information / knowledge transformation
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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.
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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.
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Vata can be calculated in terms
impulse transportation time
CMCT (Central Motor Conduction
Time)
Fundamentals of Neurology1sted 2006.Thieme.3HA
XAP, Mumenthaler
/ Mattle, pp 59
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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.
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•
Fundamentals of Neurology1sted 2006.Thieme.3HA
XAP, Mumenthaler
/ Mattle, pp 58
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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
mÉÑmTÑüxɶÉ; SͤÉhÉiÉÉå
rÉM×üiÉç
YsÉÉåqÉ
cÉåÌiÉ
YsÉÉåqÉÌiÉsÉMüqÉç
-xÉÑ.zÉÉ
4/31QûsWûhÉ
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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.
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Physiological appreciation of Lung unit
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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.
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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 • Apart from the above many
categories are placed in URT pathology
• Common bronchial and pulmonary diseases – exposure to infectious pathogens and/or air, including tobacco smoke, causes the disorders shown
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Srotas Pathology
MÑüÌmÉiÉÉlÉÉÇ
ÌWû
SÉåwÉÉhÉÉÇ
zÉUÏUå
mÉËUkÉÉuÉiÉÉqÉçrɧÉ
xÉ…¡û: ZÉuÉæaÉÑhrÉÉSèurÉÉÍkÉxiɧÉÉåmÉeÉÉrÉiÉå
– xÉÑ.xÉÔ.24/10 AÌiÉmÉëuÉ×̨É: xÉ…¡ûÉå
uÉ
ÍxÉUÉhÉÉÇ
aÉëÎlkÉrÉÉåÅÌmÉ
uÉÉÌuÉqÉÉaÉïaÉqÉlÉÇ
cÉÉÌmÉ
xÉëÉåiÉxÉÉÇ
SÒ̹sɤÉhÉqÉç
–cÉ.ÌuÉ.5/24
Vitiated Dosha moving all the way in the body develops the disease where ever is obstructed in its channel -
Atipravrutti = Excited / hyper functional activity – HypercapniaSanga = Acute/chronic obstructive disorders - AsthmaVimargagamana = Abnormal passage / infiltration or
diverticular of srotas content – pulmonary fistulaSira-Granthi = vascular / abnormal mass tissue – makes the
extra luminal compression – Malignant Tumor
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Pranavaha srotodusti Hetu
¤ÉrÉÉiÉç
xÉÇkÉÉUhÉÉSìÉæ¤rÉÉiÉç
urÉÉrÉÉqÉÉiÉç
¤ÉÑÍkÉiÉxrÉ
cÉ
– mÉëÉhÉuÉÉÌWûÌlÉ
SÒwrÉÎliÉ
xÉëÉåiÉÉÇxrÉlrÉÉæ¶É
SÉÂhÉÉæ:
– cÉUMü
ÌuÉqÉÉlÉ
5/10
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)
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Pranavaha srotodusti Lakshana
AÌiÉxÉ×¹qÉÌiÉoÉ®Ç
MÑüÌmÉiÉqÉsmÉÉsmÉqÉpÉϤhÉÇ
uÉÉ xÉzÉoSzÉÔsÉqÉÑcduÉxÉliÉÇ
SØwOèuÉÉ
mÉëÉhuÉWûÉlrÉxrÉ
xÉëÉåiÉÉÇÍxÉ
mÉëSÒ¹ÉlÉÏÌiÉ
ÌuɱÉiÉç
– cÉUMü
ÌuÉqÉÉlÉ
5/8
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)
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Pranavaha sroto Abhighata Lakshana
iɧÉ
ÌuÉ®xrÉÉ¢üÉåzÉlÉ
ÌuÉlÉqÉlÉ
qÉÉåWlÉ
pÉëqÉlÉ
uÉåmÉlÉÉÌlÉ
qÉUhÉÇ uÉÉ
pÉuÉÌiÉ
– xÉÑ
zÉÉ
9/12û
Akroshana (loud grooming)Vinamana (deformation of the thoracic region)Mohana (loss of consciousness)Bhramana (illusion / giddiness)Vepana (tremors)Marana (death)
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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.
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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.
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Krichra swasa (Dyspnoea) cardinal symptom of Pranavaha srotodusti
euÉUWØûSìÉåaÉU£üÌmɨÉeÉsÉÉåSUqÉåSÉåUÉåaÉzÉÉååjÉAÌiÉxÉÉUmÉëqÉåWû
(qÉkÉÑqÉåWû)aÉsÉaÉlQûaÉÑsqÉAÉl§ÉuÉ×ήzÉÔsÉ
Common disease with Dyspnoea are -
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Symptoms of Importance qÉÂiÉ: mÉëÉhÉuÉÉWûÏÌlÉ xÉëÉåiÉÉÇxrÉÉÌuÉzrÉ
MÑümrÉÌiÉ
– EU:xjÉ
MüTüqÉÑ®ÕrÉ ÌWû‚üÉμÉxÉÉlÉç
MüUÉåÌiÉ
xÉ;
- cÉ ÍcÉ17/17rÉ: mÉëÉhÉuÉÉÌWûÌlÉ
xÉëÉåiÉÇxrÉluÉåÌiÉ
iÉålÉ
μÉÉxÉ: mÉëÌiÉzrÉÉrɶÉ
eÉÉrÉiÉå
–
cÉ
ÌlÉ
6/4
SwarabhedaUrah shoolaKasaRaktasteevanaHikkaSwasaPratishyaya
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Examination of PVS ailment
General Examination Vital data
Systemic ExaminationInspectionPalpation PercussionAuscultation
Instrumental Examination Imaging PEFRetc,
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PVS Diagnostic Instruments Pulmonary Function TestingPulmonary 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.
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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
Vitalograph spirometer
Micro Medical Micro Loop and Micro Lab spirometers
8-1-2008 doctorksrprasad@gmail.com 35
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 CO2production, 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.
8-1-2008 doctorksrprasad@gmail.com 36
Pleural/Pulmonary pathology diagnostic procedures
•
Thoracentesis•
Pleural Fluid Analysis
•
Pleural Biopsy•
Open Pleural Biopsy
•
Thoracoscopy
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Pulmonary Imaging•
Standard plain X-Ray PA & Lateral/ Apical Lordotic
Films
•
Chest Fluoroscopy•
COMPUTED TOMOGRAPHY
•
NUCLEAR IMAGING OF THE THORAX
•
PULMONARY ANGIOGRAPHY•
MAGNETIC RESONANCE IMAGING
•
INTERVENTIONAL PROCEDURES -
percutaneous
biopsy
Five important internal tissue types may be easily identified on CT or MRI scans:1. Gas (cavitation)2. Low-density material (lipid)3. High-density material (hemorrhage)4. Intermediate-density material (soft tissue)5. Calcification
8-1-2008 doctorksrprasad@gmail.com 38
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
8-1-2008 doctorksrprasad@gmail.com 39
• 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
8-1-2008 doctorksrprasad@gmail.com 43
Examination of PVS
• MåüÍcÉcNûUÏUÉmÉaÉiÉÉÈ
vÉoSÉÈ
xrÉÑxiɧÉ
´ÉÉå§ÉåhÉ
mÉUϤÉåiÉçcÉ.ÌuÉ. 4/7
Auscultation of the PVS is most important
• uÉhÉï
xÉÇxjÉÉlÉ
mÉëqÉÉhÉÉcNûÉrÉÉÈ
vÉUÏUmÉëM×üÌiÉÌuÉMüÉUÉæ, cɤÉëÑUçuÉæwÉÌrÉMüÉÍhÉ
rÉÉÌlÉ cÉÉlrÉÉlrÉÑ£üÉÌlÉ
iÉÉÌlÉ
cɤÉÑwÉÉ
mÉUϤÉåiÉ
| 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
8-1-2008 doctorksrprasad@gmail.com 44
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
Ayurvedic
• 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
• zÉoS
= ÌuÉzÉÏhÉïuÉÉMçü
/ xÉzÉoS
EcduÉÉxÉ• xmÉzÉï
= SåWû
zÉÏiÉ
xmÉzÉï
/ mÉëlɹ¥ÉÉlÉqÉç
• SØMçü
= iÉqÉÉåpÉÉuÉÇ
/ ÌuÉpÉëÉliÉsÉÉåcÉlÉqÉç
/ FkuÉïSØ̹
/ • AÉM×üÌiÉ
= SÏlÉ
/ AÉxÉÏlÉÉå
sÉpÉiÉå
xÉÑZÉÇ
Diagnostic tools
Management principles
•
Methods of Management –
Eliminative
–
Suppressive –
Palliative
–
Reductive •
Should under go either Volatile or Stable medicament management
•
Internal Environment –
Ushna
vs
Sheeta
–
Snigdha
vs
Rooksha•
Lung Disease is Suggested as Sheeta-Rooksha
Vyadhi requires Ushna-Snigdha
chikitsa
8-1-2008 doctorksrprasad@gmail.com 47
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DhoomopaghataAnna Vimarga gamanaAma Rasa Rookshanna sevanaKshayaVegadharanaVyayama
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aÉcNûiÉÏÌiÉ
CÌiÉ
MüÉxÉ-
uÉÉiÉeÉ
-
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¤ÉiÉeÉ
- ¤ÉrÉeÉ
8-1-2008 doctorksrprasad@gmail.com 48
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éú¿Áuõo
-
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xÉuÉÉïÍhÉ
mÉëÌiÉmÉÔUrÉlÉç
AÉpÉÉgeɳÉͤÉmÉlÉç
SåWÇû
WûlÉÑqÉlrÉå
iÉjÉÉÅͤÉhÉÏlÉå§É
mÉ׸qÉÑU:mÉÉμÉåï
ÌlÉpÉÑïerÉ
xiÉqpÉrÉÇxiÉiÉ:
zÉÑwMüÉå uÉÉ xÉ MüTåü uÉÉÅÌmÉ
MüxÉlÉÉiMüÉxÉ
EcrÉiÉå
– cÉ. ÍcÉ
18/6-8
MüÉxÉ
Cough reflex
8-1-2008 doctorksrprasad@gmail.com 50
Acute Bronchitis ICD 10 = J20 & J21
•
Include:•
bronchitis: · NOS, in those under l5 years of age· acute and subacute (with): · bronchospasm· fibrinous· membranous· purulent · septic· tracheitis
•
tracheobronchitis, acute
Exclude:•
bronchitis: · NOS, in those 15 years of age and above ( J40) · allergic NOS ( J45.0) · chronic: · NOS ( J42) · mucopurulent ( J41.1) · obstructive ( J44.-) · simple ( J41.0)
•
tracheobronchitis: · NOS ( J40) · chronic ( J42) · chronic obstructive ( J44.-)
ICD-9CM CODES = 466.0 Acute bronchites
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Chronic Bronchitis
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Bronchiectasis
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8-1-2008 doctorksrprasad@gmail.com 54
Kasa Chikitsa sutra
qÉÑWÒûqÉÑïWÒûÌuÉïwÉcNûÌSïÌWïûkqÉÉiÉ×Oèû
μÉÉxÉMüÍxÉwÉÑ
– A.WØû. xÉÔ. 13/-MåüuÉsÉÉÌlÉsÉÇ
MüÉxÉÇ
xlÉåWæûUÉSÉæmÉÉcÉUåiÉç
– A WØû
ÍcÉ
3/1
mÉæ̨ÉMåü
xÉMüTåü
MüÉxÉå
uÉqÉlÉÇ
xÉÌmÉïwÉÉ
ÌWûiÉÇ
– cÉ. ÍcÉ. 18/83mÉëcNûkÉïlÉÇ
MürÉÍzÉUÉåÌuÉUåMüÉxiÉjÉæuÉ
kÉÔqÉÉ: MüuÉsÉaÉëWû¶É
EwhɶÉ
sÉåWûÉ: MüOÒûMüÉ
ÌlÉWûliÉÑ: MüTÇü
ÌuÉzÉåwÉåhÉ
MüTüzÉÉåwÉhÉÇ
cÉ
– xÉÑ.E.52/28MüÉxÉqÉÉirÉÌrÉMÇü
qÉiuÉÉ
¤ÉiÉeÉÇ
iuÉUrÉÉ
eÉrÉåiÉç
qÉkÉÑUæeÉÏïuÉlÉÏrÉæ¶É
oÉsÉqÉÉÇxÉÌuÉuÉkÉïlÉæ: -
cÉ
ÍcÉ
18/138SÏmÉlÉÇ
oÉ×ÇWûhÉqÉåuÉÉSÉæ
MÑürÉÉïSalÉå¶É
SÏmÉlÉqÉç
urÉirÉÉxÉÉiÉç
¤ÉrÉMüÉÍxÉprÉÉå
oÉsrÉÇ
xÉuÉïÇ
ÌWûiÉÇ
pÉuÉåiÉç
– cÉ. ÍcÉ
18/187AaêrÉ
– ÌuÉSÎaSMüÉ
-
MülOûMüËU
(Solanum xanthocarpum)
MüxÉWûU
uÉaÉï
:-
SìɤÉpÉrÉÉqÉsÉMü
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)
8-1-2008 doctorksrprasad@gmail.com 57
Hikka- Swasa
u“MNˇÁ≈ƒÁÃ
“zoÏ
-
uƒtÁu“TϪuƒ…bu©ßøqÁuß…ÆuãtßÁz\å{: @
∆yoúÁåÁ∆åÀsÁå∫\ÁzáÓ™ÁoúÁuå¬{: @@1@@
√ÆÁÆÁ™Nˇ™îßÁ∫Á܃ƒzTÁVÁoÁúoúîm{: @
u“MNˇÁ
≈ƒÁÃ≈Y
NˇÁÃ≈Y
åwmÁÊ
ÙÏú\ÁÆoz
@@2@@
• 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
8-1-2008 doctorksrprasad@gmail.com 58
Swasa
≈ƒÁÃ
éú¿Áuõo
-
ÆtÁ
ÿÁzoÁÊuÃ
ÃʪÜÆ
™Áªo: Nˇ¢ˇúÓƒîNˇ: @
uƒ…ƒSƒ¿\uo
Ãʪt‚áÀotÁ
≈ƒÁÃÁå‚
Nˇ∫Ázuo
Ã: @@17@@Nidana
Vata • Prana vaha,
Udana vaha, Annavaha Srotoroodha
Kapha Ruddhopagamana = obliterated by it self
8-1-2008 doctorksrprasad@gmail.com 59
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.
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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.
8-1-2008 doctorksrprasad@gmail.com 61Tamaka Swasa
o™Nˇ≈ƒÁÃ
-
ú¿uo¬Áz™Ê
ÆtÁ
ƒÁÆÏ: ÿÁzoÁÊuÃ
ú¿uoú˘oz
@
T¿yƒÁÊ
u∆∫≈Y
ÃÊTw—Æ≈¬z…™ÁmÊÙÏtyÆîÊ
Y @@27@@
Nˇ∫Ázuo
úyåÃÊ
ozå
ªt‚áÁz
VÏVîÏ∫NÊˇ
osÁ
@
EoyƒÊ
oyƒ¿ƒzTÊ
Y ≈ƒÁÃÊ
ú¿Ámú¿úygNˇ™‚
@@28@@
ú¿oÁ©Æuo
à ƒzTzå
ow…Æoz
ÃuãåªÜÆoz
@
ú¿™Áz“Ê
NˇÁÙÁå≈Y
à TXZuo
™ÏÛ™ÏîÛ: @@29@@
≈¬{…™lÆ™ÏXÆ™Áåz
oÏ
ßw∆Ê
߃uo
tÏ:uQo: @
oÀÆ{ƒ Y uƒ™ÁzqÁãoz ™Ï˜oîÊ ¬ßoz ÃÏQ™‚ @@30@@
osÁDÀÆÁzt‚܃ÊÃoz
Nˇle: NwˇXZ~ÁXZMåÁzuo
ßÁu oÏ™‚
@
å
YÁuú
§oz
uå¸ÁÊ
∆ÆÁå: ≈ƒÁÃúyugo: @@31@@
úÁ≈ƒzî
oÀÆÁƒTw—mÁuo
∆ÆÁåÀÆ
Ùy∫m: @
EÁÃyåÁz ¬ßoz ÃÁ{PƙυmÊ Y{ƒÁußåãtuo @@32@@
GuXZ~oÁqÁz
¬¬Ábzå
uÀƒ˘oÁ
ßw∆™Áuoî™Áå‚
@
uƒ∆Ï…NˇÁÀÆÁz
™Ï“Ï: ≈ƒÁÃÁz
™ÏÛ≈YƒÁƒá©Æoz
@@33@@
™zVÁ©§Ï∆yoú¿ÁSƒÁo{: ≈¬z…™¬{≈Yuƒƒáîoz
@
à ÆÁõÆÀo™Nˇ: ≈ƒÁÃ: ÃÁÜÆÁz
ƒÁ
ÀÆÁãåƒÁzunso: @@34@@
•
Asthma is defined as intermittent, reversible airway obstruction in association with increased nonspecific bronchial reactivity. These physiologic changes are now known to exist in the context of airway inflammation. The addition of inflammation to the definition has shifted the understanding of asthma from a disease of airway nerves and smooth muscle to one that identifies inflammation as the driving force for the symptoms associated with the disease. This realization has led to a dramatic shift in the treatment of the disease in the past 10 years.
8-1-2008 doctorksrprasad@gmail.com 62
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
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Asthma
8-1-2008 doctorksrprasad@gmail.com 64
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 asthmaAllergic: · bronchitis NOS · rhinitis with asthma Atopic asthma Extrinsic allergic asthma Hay fever with asthma
J45.1 Nonallergic asthmaIdiosyncratic asthma Intrinsic nonallergic asthma
J45.8 Mixed asthmaCombination of conditions listed in J45.0 and J45.1
J45.9 Asthma, unspecifiedAsthmatic bronchitis NOS Late-onset asthma
J46 Status asthmaticus = Acute severe asthma
8-1-2008 doctorksrprasad@gmail.com 65
Areas of management interest in Tamaka Swasa
Swasahara
Deepaneya & Hrudya
Kasahara
Parshwashoolahara
Shothahara
Swasa / Tamaka swasa Chikitsa • MüÉUhÉ
xjÉÉlÉ
qÉÔsÉæYrÉÉSåMüqÉåuÉ
ÍcÉÌMüÎixÉiÉqÉç
– cxÉç.ÍcÉ.17/70
• xlÉåWûuÉÎxiÉÇ
ÌuÉlÉÉ
MåüÍcÉSÕ²ïcÉÉkɶÉ
zÉÉåkÉlÉqÉç
qÉ×SÒmÉëÉhÉuÉiÉÉÇ
´Éå¹Ç μÉÉÍzÉlÉÉqÉÉÌSzÉÎliÉ
– xÉÑ.E.51/15
• rɲÌmÉ
μÉÉxÉå
xlÉåWûuÉÎxiÉ
mÉëÉÍgÉÌwÉ®: -
QûsWûhÉ• iÉmÉïrÉåSåuÉ
zÉqÉlÉæ: xlÉåWûrÉÔwÉUxÉÉÌSÍpÉ: -
cÉ. ÍcÉ. 17/90
• rÉÎiMÇüÍcÉiÉç
MüTüuÉÉiÉblÉqÉÑwhÉÇ
uÉÉiÉÉlÉÑsÉÉåqÉlÉqÉç• pÉåwÉeÉÇ
mÉÉlÉqɳÉÇ
uÉÉ
iÉήiÉÇ
μÉÉxÉÌWûÌ‚ülÉå
– cÉ. ÍcÉ. 17/147
• xÉuÉåïwÉÉÇ
oÉ×ÇWûhÉÉå½smÉ: zÉYrɶÉ
mÉëÉrÉzÉÉåpÉuÉåiÉç
-
-
-iÉxqÉÉcNÒû®ÉlÉ
zÉÑ®ÉǶÉ
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
8-1-2008 doctorksrprasad@gmail.com 67
Swasa yogaKarpuradi chrna (SY)Shatyadi churna (VC)
Vidangadi churna (VC)Shrungyadi churna
Dashamoola katutrayadi kwathaVasadi kwatha
VasaghrutaTrushana ghruta
Talisa ghrutaBharngi guda haritaki (VC)
Abhraka bhasmaSwasa kuthara ras
Swasakasa chintamaniSwasa kaleshwara ras (VC)
Sameerapannaga rasRasamanikya
Aswagandha ksharaMayurapincha bhasma
•
962 yogas for Swasa Hikka Chikitsa •
102 Ghruta yoga •
283 rasa yoga
•
Vasa•
Pushkaramoola•
Bharangi•
Kantakari•
Sunthi – Haritaki (BR)•
Gandhaka + Maricha (BR)
Vasa
Ghruta yoga
• oÉëͼ
bÉ×iÉ• aÉÑSÕcrÉÉÌS
bÉ×iÉ
• aÉÑaaÉÑsÉÑmÉÇcÉÌiÉ£üMüqÉç
bÉ×iÉ• aÉÑaaÉÑsÉÑ
ÌiÉ£üMü
bÉ×iÉ
• MülOûMüÉËU
bÉ×iÉ• sÉzÉÑlÉ
bÉ×iÉ
• ÌlÉÇoÉÉÌS
bÉ×iÉ• ÍxÉÇWûÉqÉ×iÉ
bÉ×iÉ
• qÉWûÉMÔüwqÉÉlQûMü
bÉ×iÉ• iÉÉÍVûxÉÉÌS
bÉ×iÉ
• uÉÉxÉÉ
bÉ×iÉ• ÌuÉSÉËU
bÉ×iÉ
Panchatikta
ghruruta
of Yogaratnakara
has Vasa
and Pushkaramoola
that are swasahara
and the Brumhana -
Ghruta
pÉUÎlaÉ bÉ×iÉ
rÉÉåaÉ
cÉÇaÉåËU
bÉ×iÉMülOûMüÉËU
bÉ×iÉ
MÑüÍsÉjÉwÉOèTüsÉ
bÉ×iÉlÉÉaÉUɱÇ
bÉ×iÉ
mÉÇcÉaÉurÉÇ
bÉ×iÉAqÉ×iÉmÉëÉzÉ
bÉ×iÉ
kÉluÉliÉUÇ
bÉ×iÉoÉ×WûiÉç
MülOûMüÉËU
bÉ×iÉ
Pushkara
Moola Ghruta
Yoga
MülOûMüËU
bÉ×iÉmÉlcÉÌiÉ£ü
bÉ×iÉ
SzÉqÉÔsÉ
bÉ×iÉmÉlcÉaÉurÉÇ
bÉ×iÉ
zÉPûɱÇ
bÉ×iÉμÉSl·íÉÌS
bÉ×iÉ
kÉluÉliÉUÇ
bÉ×iÉiÉåeÉÉåuÉirÉÉÌS
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)
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Note This is
Not an end But a big start !
•
Dr. K. Shiva Rama Prasad•
doctorksrprasad@gmail.com