Role of Haridradi Avaleha in the Management of Tamaka Shwasa (Childhood Bronchial Asthma) – A Single Case Study

The word Shwasa is derived from the root ‘Shwasa Prinane’– which actually means difficulty in the entry of prana in the pranavaha srotas. Shwasa word indicates both physiological and pathological state of respiration. Tamaka Shwasa is one of the five types of disease shwasa. It is a disease of mainly pranavaha srotas. The sign and Symptoms and etiopathogenesis of Tamaka Shwasa explained in Ayurvedic literature have lot of similarities with the disease entity Bronchial Asthma. The goal of this study is to determine the efficacy of the formulation, Haridradi Avaleha in reducing the sign and symptoms of Childhood asthma. A 13 years old boy male Hindu patient from Limda village, Vadodara presented in the OPD of Kaumarbhritya department, Parul Ayurved Hospital, Parul University who presented clinical features of Tamaka Shwasa was treated by internal Ayurvedic formulation, Haridradi Avaleha showed marked improvement in the subjective parameters like breathlessness, cough, corzya, awakening in night etc and in objective parameters like ACT(Asthma Control Test), PEFR(Peak Expiratory Flow Rate) some hematological parameters viz. AEC (Absolute Eosinophil Count), ESR (Erythrocyte Sedimentation Rate), WBC Lymphocyte, Neutrophil, discussed here. All subjective and objective parameters were examined during 60 days of follow up-visits, and no instances of the above complaints were reported. Case Study Majumder et al.; JPRI, 33(40B): 255-260, 2021; Article no.JPRI.71824 256


INTRODUCTION
Bronchial asthma, the commonest chronic respiratory disease in childhood is characterized by recurrent Paroxysmal wheeze and respiratory distress, due to reversible and dynamic narrowing of airways. Although asthma can occur in people of any age, even infants, most children with the illness developed it by about the age of (5-16) years. Asthma seems to be more common in boys than in girls in early childhood [1]. The prevalence of Bronchial Asthma has increased continuously since the 1970s, and now affects an estimated 4 to 7% of the people worldwide [2]. Asthma is one of the most prevalent chronic disease of childhood, leads to disturbed sleep, restriction in day to day activity and also school absenteeism in school going children [3]. The disease appears as a multi factorial disorder including environmental factors & faulty dietary habits.
In Ayurveda, there are five types of Shwasa roga, Tamaka Shwasa being one of them. It is a type of Shwasa roga affecting the pranavaha srotas, which is significantly distressing and a fatal disorder of the present daylife [4]. Tamaka Shwasa is a disease of the pranavaha srotas, with other srotas being vitiated as well. Because of the impediment caused by Kapha, Vayu becomes vitiated and loses its normality. This vitiation leads to difficulty in breathing and produce other symptoms like cough, corzya, sputum expectoration etc. The drug combination selected in this case study has the ability to remove the obstruction made by Kapha in the pranavaha srotas and restore the normal function of Vayu. The Rasayana (immune modulator) qualities of the drugs in the formulation help to regulate Dhatwagni and also useful to prevent the recurrence of attacks and promoting the growth of children at the same time.

Case Presentation
A 13 years old male patient from Limda Village, Vadodara came in OPD of Kaumarbhritya department of Parul Ayurved Hospital, Parul University with complaints of cough and cold for 15-20 days and breathlessness since 1 year. He has difficulty in breathing due to the coughing, and irritates mostly at night cause night awakening. Patient has history of recurrent common cold since age of 6 years. Breathlessness is found since the age of 11 years. Immunity is very low because the patient gets easily infected with URTI during seasonal changes, cold, weather or in winter season.

Family History
Mother was also asthmatic symptoms. Patient was not having any relevant postnatal history.

Birth History
Full term normal delivery at Hospital, with weight-2.8 kg. H/O-NICU Admission.

Immunization History
All immunization was done as per Govt. Immunization Schedule.

Source of data
Patient suffering from above mentioned symptoms of Tamaka Shwasa is selected from O.P.D of Parul Ayurved Hospital, Parul University, Vadodara.

Study design
A single case study.

Drug
Haridradi Avaleha was given orally in 32 gms total in 2 divided doses in the morning and evening with Anupana lukewarm water before meal for 60 days and 1 follow up was done after 60 days of total intervention. Patient was advised not to take any meal at least for 30 minutes after the medicine.

RESULTS
 On investigations, Haematological Parameters like WBC, Lymphocytes, Neutrophils, AEC count, ESR were decreased.  Peak Expiratory Flow Rate has increased from 210 to 330 L/min.  Results showed improvement in ACT (Asthma Control Test).  After 60 days of total follow up no episodes of above complaints have been reported.

DISCUSSION
As Children are the most vulnerable group of society, they require special attention when it comes to chronic disease management. Thus, special strategies are required for the management of Childhood Asthma, which is a chronic condition that interferes with a child's day-to-day activities. The treatment should be aimed to remove the obstruction made by kapha and normalize the function of vayu formulation used in this case study has Deepana, Pachana,Vata-Kapha hara, srotoshuddhikara and Rasayana properties which helped in Samprapti Vighatana of disease by increasing Agni(digestive power) and removing the Ama(toxin), helped to clear the Srotas Kapha shaman [10]. The results of both subjective and objective parameters have shown better improvement. Before the treatment patient was suffering with breathlessness many a times which was grade 2, but after the follow up there was no breathlessness seen in the patient which is grade 0. Before the treatment patient was suffering with cough which was grade 3, but after the follow up there was no cough seen in the 259 day activities. The treatment should be aimed to remove the obstruction made by kapha and normalize the function of vayu [9]. The formulation used in this case study has Deepana, Kapha hara, srotoshuddhikara perties which helped in Samprapti Vighatana of disease by increasing Agni(digestive power) and removing the Srotas and Vata-The results of both subjective and objective parameters have shown ment. Before the treatment patient was suffering with breathlessness many a times which was grade 2, but after the follow up there was no breathlessness seen in the patient which is grade 0. Before the treatment patient was rade 3, but after the follow up there was no cough seen in the patient which is grade 0. Before the treatment patient was suffering with night awakening many a times which was grade 1, but after the follow up there was no night awakening seen in the patient which is grade 0. Before the treatment patient was suffering with corzya which was grade 3, but after the follow up there was no night awakening seen in the patient which is grade 0. Further it also improved the Rasadi dhatu, which helped to increase Vyadhikhamatva of the patient. As a result, we can conclude that Tamaka Shwasa, a herbal combination of medicine used to treat the ailment, is a highly effective therapy without any adverse reaction. Anti-tussive, Anti Anti-histaminic, Anti-allergic, Bronchodialator, Mast cell stabilizer and Immunomodulatory properties are also present in this formulation patient which is grade 0. Before the treatment patient was suffering with night awakening many a times which was grade 1, but after the follow up there was no night awakening seen in the t which is grade 0. Before the treatment patient was suffering with corzya which was grade 3, but after the follow up there was no night awakening seen in the patient which is grade 0. Further it also improved the Rasadi dhatu, which helped to increase the Vyadhikhamatva of the patient. As a result, we can conclude that Tamaka Shwasa, a herbal combination of medicine used to treat the ailment, is a highly effective therapy without any tussive, Anti-inflammatory, allergic, Bronchodialator, Mast cell stabilizer and Immunomodulatory properties are also present in this formulation 11 .

Probable Mode of Action of the Drug
(Ayurvedic View)

Hetamological Changes
AEC and ESR count markedly decrease comparison to other parameters. The drug showed better effect on hematological changes in WBC, Neutrophils and Lymphocytes. Results has also shown improvement in ACT which is 17.39%, and PEFR 36.3%.

CONCLUSION
After evaluation of all the above parameters, it is concluded that Haridradi Avaleha is effective and a good choice on this case study of Tamaka Shwasa (Bronchial asthma) and gives better relief to the patient.

ACKNOWLEDGEMENT
The authors are thankful to all the managing trustees of Parul University, Vadodara for availing the infrastructure required for the study. Also thankful to staff of Pathology Laboratory and Pharmacy of Parul Institute of Ayurved,Vadodara.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.