Scientific Basis for Ayurvedic Therapies -16

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

An acute attack may lead

to delusions, loss of appetite, nasal discharge, and thirst. With increasing intensity of bouts,

the patient may become unconscious. The patient finds relief for a few moments after

expectoration of sputum, breathes with great difficulty while lying down, and finds

comfort while sitting. The patient’s eyes are wide open, and he or she perspires from the

forehead, suffers dryness of mouth, gets bouts of dyspnea (often with shivering), and

desires additional warmth. The disease greatly increases on cloudy days and in rain, cold,

or direct breeze and other factors that may cause an increase of

kapha

. In addition there

is throat irritation, vomiting, and anorexia. This description is quite similar to what we

understand today.

Tamaka svasa

has been classified into two varieties:

Tamaka svasa

vatapradhan

(

vata

dosa

is

predominant) and

Tamaka svasa shlesma pradhan

(

kapha

dosa

is predominant). The indicators

of the former are highly painful breathing with high frequency of noisy sounds, little

expectoration, difficulty in expectoration, and insomnia. The latter is characterized by high

vibrating noise in throat while breathing, coryza, easy and copious expectoration, and

painful fast breathing.

The clinical manifestations of asthma as we see it today include episodes of shortness

of breath, cough, wheezing, and chest tightness. Patients with more severe cases are likely

to have persistent symptoms, worsening at night and early mornings. Often the chest

congestion takes more than 10 days to clear up. The symptoms may be precipitated by

exposure to the various stimuli discussed above. Very often, exacerbations occur in the

absence of any well-defined exposure, particularly in patients with persistent disease.

These symptoms usually respond to bronchodilators; this response supports the diagnosis

of asthma.

The practitioners of Ayurveda confirm the diagnosis by a detailed case history of the

patient and objective examination to determine the imbalances between various constituents.

An evaluation is made about the patient’s body constitution, state of digestion, and

level of activity through interrogation. Interrogation also includes questions on precipitating

and pacifying factors and lifestyle. A detailed physical examination of all systems,

including checking the pulse and tongue, is done to identify the specific type of

dosa

involved in the pathology. Diagnosis is finally made based on the symptoms, which are

dependent on the location of morbid

dosa

and nature of pathology.

Currently, many practitioners use the modern techniques such as auscultation of the

chest with a stethoscope for confirming the diagnosis. As there is progress toward holistic

medicine, the Ayurvedic practitioners will benefit from the advances made in the diagnosis

of asthma.

In modern medicine, the diagnosis can often be made convincingly on the basis of

clinical history and physical examination. However, the examination of respiratory system

may be normal as the symptoms are variable. A physical examination is more likely to

be fruitful if the individual is examined in the symptomatic period.

Measurement of pulmonary function has an important place in diagnosis especially if

history and physical examination are inconclusive. In addition, there can be inaccuracies

in assessment of severity of symptoms by both patient and physician.

Measurement of airflow limitation (such as peak expiratory flow rate [PEFR] and forced

expiratory volume [FEV

1

]) and its reversibility are important in establishing a clear diagnosis

of asthma. Newer guidelines recommend serial measurements for monitoring the course of

asthma. The tests can be performed with ease in individuals older than 5 years.

On the basis of the symptomatology and the result of spirometry, asthma can be

classified into intermittent, mild persistent, moderate persistent, and severe persistent

types (Table 13.1).

13.7 Clinical Course and Prognosis

According to Ayurveda, of all the significant

svasa

disorders,

tamaka svasa

(asthma) is

yapya

(i.e., controllable).

1

It is not curable and symptoms are likely to persist. The only exceptions

to this may be disease of short duration in strong, healthy, young individuals and if the

disease severity is mild.

In the past few decades, a lot of research has been conducted to determine the natural

history of asthma. Asthma symptoms may disappear in one third to one half of children

at puberty.

38,39

Even though symptoms may be absent, abnormalities in lung function can

be demonstrated. However, symptoms may appear later in adulthood. Nearly two thirds

of children continue suffering from the disorder through adolescence and adulthood.

Asthma may have onset in adult life.

40

The exact proportion of such patients is not

known. It is likely that exposure to allergens and development of atopy later in life are

responsible for late onset of asthma. The role of viral infections in causation in adults is

not clear; they may be a trigger for acute exacerbation.

The overall description of the prognosis of asthma in Ayurveda and the current practice

appear to be similar.

13.8 Management

13.8.1 Ayurvedic Approach

Management of asthma in Ayurveda judiciously encompasses herbal and herbomineral

drugs in addition to advising a healthy lifestyle and diet that are contrary to the cause of

disease and the disease itself. As the pathogenesis of this disorder involves an imbalance

between the

vata

and

kapha

, the therapy is directed at correcting this imbalance. In addition,

there are a few therapies for controlling the acute symptoms.

The texts recommend that the patients should be given sudation and steaming therapy

(

svedana

) after anointing their bodies with oils processed with salt.

2–5

With this method,

the solidified phlegm (

kapha

) adhering inside the channels gets liquefied and comes into

the alimentary tract. The channels become soft and

vata

attains its normal downward

TABLE 13.1

Classification of Asthma According to Severity

Severity Symptoms Nighttime Symptoms PEFR

Severe persistent Continuous, limited physical activity Frequent

£

60% predicted;

variability >30%

Moderate persistent Daily use of beta-2 agonist, daily

attack affects activity

>One time/week >60–80% predicted;

variability >30%

Mild persistent >One time/week but < one time/

day

>Two times/month

≥

80% predicted;

variability 20–30%

Intermittent <One time/week, asymptomatic and

normal PEFR between attack

£

Two times/month

≥

80% predicted;

variability <20%

movement. After sweating, the patient is advised to eat food rich in fats and food that

improves the secretion of mucus. In order to eliminate the pathological

kapha

, a therapeutic

emesis is induced with herbs such as

Piper longum

(

pippali

). With this, channels are cleared

and

vata

moves without any hindrances. Purgation therapy (v

irechana

) may also help in

a few patients. Because of the nature of these therapies, they should be avoided in young

children and pregnant women.

The purification (

shodhan

) can also be achieved by a more elaborate process:

panchakarma

.

Panchakarma

involves therapeutic vomiting and emesis (vamana), purgation (virechan),

enema (basti), elimination of toxins through the nose (nasya), and purification of the blood

(rakta mokshana). Rakta mokshana may be useful in patients with allergies. This purification

therapy should not be performed in debilitated individuals, the elderly, young children,

pregnant women, and frail women.

Various medications are described in Ayurveda.2–5 These include single drugs and com-

5,41 Some of them are listed below the table.

1. Krsnadi churna — Powder of Piper longum (pippali), Emblica officinalis (amlaka), and

Zingiber officinalis (sunthi) with honey and sugar added

2. Bharangyadi churna — nagaradi churna — Powder of bharangi (Clerodendrum serratum)

and sunthi (Zingiber officinalis) with hot water or powder of sunthi, sugar, and

sauvarcala

3. Srangydi churna — Pistacia chinensis (karkatasrngi), trikatu (combination of ginger

root, pippali berry, black pepper), triphala (combination of Emblica officinalis, Terminalia

chebula, and Terminalia bellirica), Solanum xanthocarpum (kantakari), Clerodendrum

serratum (bharangi), Inula racemosa (puskarmula), and five salts

4. Parnasapancaka — Decoction of Tinospora cordifolia (guduci), Zingiber officinalis

(sunthi), Rivea hypocrateriformis (phanji), Solanum xanthocarpum (kantakari), and Ocimum

sanctum (parnasa, tulsi) mixed with Piper longum (pippali) powder

5. Decoction of dasamula (a combination of ten roots: shonyaka, patala, kasmari, agnimantha,

brhati, mahabalam, guduci, kakoli, ananta) added with Inula racemosa (puskaramula)

6. Decoction of Dolichos biflorus (kulattha), Zingiber officinalis (sunthi), Solanum xanthocarpum

(kantakari), and Adhatoda vasica (vasa) added with Inula racemosa (puskuramala)

7. Use of jaggery with equal mustard oil

8. Powder of Pistacia chinensis (karkatasrngi), Zingiber officinalis (sunthi), Piper longum

(pippali), Cyperus rotundus (musta), Inula racemosa (puskarmula), Hedychium spicatum

(sati), Piper nigrum (marica), and sugar taken with a decoction of Tinospora cordifolia

(guduci), Adhatoda vasica (vasa), and pancamulla

9. Linctus made from Curcuma longa (haridra), Piper nigrum (marica), Vitis vinifera

(draksa), jaggery, Pluchea lanceolata (rasna), Piper longum (pippali), and Hedychium

spicatum (sati)

10. The powder of Terminalia bellirica (bibhitaka) fruit mixed with honey

11. Preparation made from ghee, milk, and the paste of Capparis sepiaria (himsra);

Embelia ribes (vidanga), Mentha spicata (putika); trikatu; triphala; and Plumbago zeylanica

(citraka)

12. Preparation made from ghee and paste of tegovati, Terminalia chebula (haritaki),

Piper longum (pippali), Strychnos potatorum (katuka), bhutika, Inula racemosa (puskara-

pound formulations (see Tables 13.2 and 13.3).

mula), Butea monosperma (palasa), Plumbago zeylanica (citraka), Hedychium spicatum

(sati), sauvarcala, Cinnamomum tamala (tamalaki), rock salt, Aegle marmelos (bilva),

Abies webbiana (talisapatra), Leptadenia reticulata (jivanti), Acorus calamus (vaca), and

Ferula foetida (hinga)

13. Preparation made from Clerodendrum serratum (bharangi) and dasamula, Terminalia

chebula (haritaki), jaggery, honey, trikatu, and trijata (powdered) and yavakasra

14. Preparation made from Dolichos biflorus (kulatha), dasamula, Clerodendrum serratum

(bharangi), jaggery, honey, Bambusa arundinacea (vamsalocana), Piper longum (pippali),

and trijata

The above medications are likely to have both therapeutic and preventive effects. It is

advised to continue any of these for a prolonged duration.

TABLE 13.2

Single Drugs Used in Ayurvedic Anti-Asthmatic Preparations

Adhatoda vasica

Aegle marmelos

Alangium salviifolium

Aquilaria agallocha

Arsenic rubrum

Benincasa hispida

Bhasma of horn of stag

Boerhavia diffusa

Calotropis procera

Cedrus deodara

Garcinia pedunculata

Clerodendrum serratum

Curcuma longa

Curcuma zedoria

Datura stramonium

Dolichos biflorus

Elettaria cardamomum

Fagonia cretica

Ferula narthex

Glycyrrhiza glabra

Gypsum

Honey

Inula racemosa

Jaggery

Leptadenia reticulata

Mica

Mucuna pruriens

Ocimum sanctum

Phyllanthus embica

Phyllanthus urinaria

Piper longum

Piper nigrum

Rhus succedanea

Solanum xanthocarpum

Terminalia bellirica

Vitis vinifera

White arsenic

Source: Modified from Goyal, H.R., Tamaka Shwasa (Bronchial Asthma): A

Clinical Study, Central Council for Research in Ayurveda and Siddha, New

Delhi, 1997.

For controlling acute symptomatology, inhalation of medicated smoke from the following

preparations have been described in Ayurveda2–4:

1. Inhalation of the smoke of the fruit, the stem, and leaves of Dhatura fastuosa from

a hooka. A paper dipped in water in which saltpetre has been dissolved is dried

in the sun and rolled up in the form of a cigar.

2. Paste of Cedrus deodara, Sida cordifolia, and Nardostachys jatamansi is dried in sun,

laced in ghee. Patient inhales the smoke from a hollow stick made out of this.

3. Leaves of haridra, root of Ricinus communis (eranda), Cocculus lack (laksa), Psidium

guajava (manassial), Cedrus deodara (devadaru), Elettaria cardamomum (ela), and mamsi

are all macerated and made into cigarette, which is smeared with ghee and

smoked.

After alleviating the intensity of asthmatic breathing, the following syrups may be used:

1. Peacock feathers are reduced to ashes in a slow fire. They are mixed with a quantity

of fruit of Piper longum reduced to powder. A syrup is then made with the aid of

honey. If licked occasionally, it alleviates the intensity of asthmatic breathing.

2. Turmeric (Curcuma longa), black pepper (Piper nigrum), Uvoe passae, old molasses,

Vanda roxburghii, Piper longum, and Circuina zerumbet are reduced to a powder and

mixed with mustard oil.

3. A decoction of Tinospora cordifolia, dry ginger, Siphonanthus indica, Solanum xanthocarpum,

and Ocimum sanctum mixed with powdered Piper longum is made.

TABLE 13.3

Compound Preparations for the Management of Asthma

Name Instructions

Eladi churn 1–3 with 4–6 g of honey twice/day

Sitopalidi churn 1–3 with 4–6 g of honey twice/day

Srangydi churn 1–3 with 4–6 g of honey twice/day

Talisadi churn 1–3 with 4–6 g of honey twice/day

Dashmula kvath 14–28 ml twice/day

Kantaryadi kvath 14–28 ml twice/day

Srmgyadi kvath 14–28 ml twice/day

Vasadi kvath 14–28 ml twice/day

Agastya haritiki avaleha 12–24 g twice/day

Chavanprash avaleha 12–24 g twice/day

Chitraka haritiki avaleha 12–24 g twice/day

Vasa avaleha 12–24 g twice/day

Vyaghriharitiki avaleha 12–24 g twice/day

Draksharishta 14–28 ml with equal quantity of water twice/day after meals

Vasarishta 14–28 ml with equal quantity of water twice/day after meals

Kanakasva 5–10 ml with equal quantity of water twice/day after meals (due to its

potency, caution is advised)

Abhraka bhasma (plain) 120–150 mg with honey twice/day

Maygrapuccha bhasma 1–2 g with honey twice/day

Apamarga ksara 1 g with warm water twice/day

Arka lavana 1 g with warm water twice/day

Khadiradi vati 2–4 vati three times/day

Lavangadi vati 1 vati six times/day

Source: Modified from Swas roga, in Handbook of Domestic Medicine and Common Ayurvedic Remedies, Central

Council for Research in Ayurveda and Siddha, 1999. These preparations may be obtained from major

Ayurvedic pharmaceutical companies in India.

4. Parnasapancaka — A decoction of guduci, sunthi, phanji, kantakari, and parnasa (tulsi)

mixed with pippali powder is made.

5. A syrup made out of Curcuma zedoria (kachur), Inula racemosa (pushkarmool), Citrus

decumona (amla vetas), Elettaria cardamomum (choti Elaichi), Ferula narthex (hingu),

Ocimum sanctum (tulsi), Aquilaria agallocha (agar), Phyllanthus urinaria (bhumyamalki),

Leptadenia reticulata (jeewanti), and Santalum album (chanda) is recommended

as a bronchial antispamodic.

Although inhaling the smoke of various herbs may cause relief through the bronchodilatory

effect of the constituents such as dhatura, this practice has not been evaluated

scientifically to recommend its routine usage. In addition, the smoke may actually worsen

the bronchospasm. This form of therapy is neither feasible in children nor advisable.

13.8.1.1 Precautions

The drugs, diet, and practices that aggravate the disease should be avoided. These include

dust, smoke, residing in cold places, excessive use of cold water, seasonal changes, excessive

walking, excessive use of dry foods, astringent food, irregular dietary habits, indigestion,

trauma to vital organs, and habitual use of lablab-bean, black gram, til paste, and

other kapha-producing articles.

13.8.1.2 Diet

Foods and drinks that restore the normal course of vata are useful in treating asthma. If

the vata is greatly excited, syrup made up from old tamarind pulp is helpful. Sugar candy

with lemon (Citrus medica) juice is beneficial. Light foods should be eaten at night. Heavy

and rich foods, which are difficult to digest, foods that are dry, curds, fish, and chillies

should all be avoided.

13.8.1.3 Lifestyle

Staying awake at night, exercising, labor, exposing oneself to the heat of the sun or fire,

and anxieties, grief, wrath, and everything that disturbs peace of mind should be avoided.

A healthy lifestyle would have a preventive role.

13.8.1.4 Breathing Exercises

Breathing exercises, particularly pranayam, reduce the frequency and severity of symptoms,

42–44 improve exercise tolerance, and enhance lung function. Two systematic reviews

have highlighted the need for studying the beneficial aspects of various breathing exercises.

45,46

13.8.1.5 Meditation

Meditation helps in reducing the stress and may check recurrence. Sahaja yoga is an Indian

system of meditation based on traditional yogic principles, which may be used for therapeutic

purposes. Clinical trials of this therapy in patients with asthma have found evidence

of improvement in lung function and reduced frequency of exacerbations.47

Some commercial Ayurvedic formulas are also available that may be useful in asthma.

Examples include Asmon (Herbochem Remedies, Kolkata) and Asmakure (Herbicure Pvt.

Ltd., Bishanpur, West Bengal).

13.8.2 Conventional Medicine Approach

There is no cure available for asthma in Western medicine. However, appropriate management

leads to control of the disorder. The goals of management are to:

1. Control the symptoms.

2. Prevent acute exacerbations.

3. Maintain normal or near normal pulmonary functions.

4. Maintain normal levels of activity.

5. Avoid adverse effects from medications.

6. Prevent mortality due to asthma.

Currently, therapy of asthma is guided by the fact that it is a chronic inflammatory

airway disorder; the control of airway inflammation is the key to effective control. Except

for mild intermittent asthma, the therapy includes regular use of anti-inflammatory medication

and bronchodilators (as required). In addition, environmental control to avoid

exposure to certain risk factors should improve the control of symptoms.

The first step in management after the diagnosis is made is the correct assessment of

The pharmacological therapy of bronchial asthma involves the use of drugs that relax

smooth muscle and dilate the airways and drugs that decrease inflammation and prevent

exacerbations. The medications used for long-term treatment of asthma include bronchodilators,

steroids, mast-cell stabilizers, leukotriene modifiers, and theophylline.48–75

alone in persistent asthma is not recommended, as this does not control the airway

inflammation and there is a false sense of security.

13.8.2.1 Immunotherapy

This therapeutic mode consists of gradually giving increasing quantities of an allergen

extract to a clinically sensitive subject to ameliorate the symptoms associated with subse-

TABLE 13.4

Stepwise Treatment of Asthma

Steps Long-Term Prevention

Step 4: Severe

persistent

Inhaled short-acting beta-agonist as required; inhaled corticosteroids:

Budesonide and Beclomethasone (400 mg twice/day) increase up to

2000 mg/day in selected cases; long-acting bronchodilator: long-acting

inhaled b2-agonist or sustained release theophylline; corticosteroids

tablets: low dose on alternate days (if no relief with above treatment)

Step 3: Moderate

persistent

Inhaled short-acting beta-agonist as required; inhaled corticosteroids:

Budesonide and Beclomethasone (400–800 mg divided twice/day);

long-acting bronchodilator (if needed): long-acting inhaled b2-agonist

salmeterol (50 mg once or twice/day or sustained release theophylline)

Step 2: Mild

persistent

Inhaled short-acting b-agonist as required; inhaled corticosteroids:

Budesonide and Beclomethasone (200–400 mg) or cromolyn or

sustained release theophylline or leukotriene modifiers

Step 1: Intermittent Inhaled short-acting b-agonist as required for symptoms relief; if they

are needed more than three times/week, move to step 2

Note: If Fluticasone is used, the dose is half that of Budesonide/Beclomethasome.

severity of asthma (Table 13.1).

Table

13.4 shows the treatment plan according to disease severity. The use of bronchodilators

quent exposure to a causative allergen. This is considered only occasionally in highly

selected children who are sensitive to a specific allergen such as grass pollen, mites, etc.

It is done only under specialist supervision and must usually be given for 3 years.76 Some

studies suggest that specific immunotherapy may induce a diminution of nonspecific

bronchial hyperresponsiveness and enable reduction of symptomatic treatment.77,78

13.8.2.2 Management of Acute Exacerbation

Severe exacerbations of asthma are life-threatening medical emergencies requiring hospitalbased

care. The aims of treatment are to reverse airflow obstruction and hypoxemia as

rapidly as possible. The severity of an acute exacerbation can be judged by clinical symptoms

and signs, lung function tests, and arterial blood gas analysis. Rapid-acting inhaled

bronchodilators, early introduction of systemic glucocorticoids, and supplemental oxygen

are the mainstay of treatment of acute exacerbations. Close monitoring of the patient’s

condition and response to therapy are mandatory. In addition, a plan should be formulated

to prevent future relapses.

13.8.2.3 Complications of Therapy

Use of systemic (oral, parenteral) steroids over a prolonged period is associated with

significant side effects. However, the current day management relies more on inhalation

drugs. The main concern with the use of inhalation steroids is the effect on growth. An

approximate 20% reduction in the growth velocity during the first year of treatment with

inhaled steroids is reported. Subsequently, the growth velocity recovers and children

ultimately attain predicted adult height.56,57 Studies have also reported that children treated

with inhaled steroids were more likely to reach predicted adult height than children whose

asthma was not treated with preventive medication.57,58 These findings show that the

concern about adverse effect of inhaled steroids on growth is inappropriate.

The complications associated with beta-2 agonists are cardiovascular stimulation, skeletal

muscle tremor, hypokalemia, and irritability. These adverse effects are more commonly

seen with oral drugs than with inhaled medications.

If asthma severity is assessed properly and inhaled medications are used judiciously,

the benefits far outweigh the risks.

13.9 Scientific Basis

4

41 There is a

great deal of scientific literature available that supports the use of Ayurvedic preparations

in the management of asthma. Most of the data are experimental. These studies highlight

the anti-inflammatory and bronchodilatory activity in various medications. The following

list shows the evidence available for various herbs:

1. Picrorrhiza kurroa — P. kurroa is a widely used herb in the Ayurvedic system. It

belongs to the Scrophulariaceae family, and the active constituents are obtained

from the root and rhizomes.79 It is traditionally used in treatment of respiratory

conditions such as asthma and bronchitis. Studies on an alcoholic extract have

shown antioxidant and anti-inflammatory effects.80 In animal studies, antiallergic,

A large number of single drugs have been described for use in asthma (Table 13.2). In

addition there are quite a few compound preparations available (Table 13.3).

© 2004 by CRC Press LLC

Bronchial Asthma 221

antianaphylactic, anti-inflammatory, and immunomodulatory activities have been

demonstrated. The active ingredients include pikuroside II, picroliv (containing

iridoid glycoside fraction), and androsin.81–86

2. Adhatoda vasica — This is widely used in treatment of respiratory tract ailments.

Alkaloids from this herb have been shown to possess anti-inflammatory and

antiallergic properties.85,87,88 In addition, its extract has an antitussive effect.89

3. Albizzia lebbek — The decoction of the bark of A. lebbek is used in treatment of

asthma and eczema. Studies on animals show that A. lebbek has a significant

cromoglycate-like action on the mast cells. It also appears to inhibit the early

processes of sensitization and synthesis of reaginic-type antibodies.90,91

4. Solanum species — Powder of or a decoction made from the whole dry plant of

Solanum xanthocarpum or Solanum trilobatum is used in the treatment of asthma

and other respiratory disorders. The mechanism of action in asthma may involve

bronchodilation, reduction of bronchial mucosal edema, and reduction of airway

secretions.92–94

5. Tylophora indica — T. indica is widely used in Ayurvedic medications to provide

relief to patients with bronchial asthma. Studies have shown that alkaloids of

Tylophora indica suppress cellular immune response.95

6. Cedrus deodara — The wood oil of C. deodara has been shown to have anti-inflammatory

activity. This can be attributed to its mast-cell stabilizing activity and the

inhibition of leukotriene synthesis.96

7. Boswellia serrata — The gum resin of B. serrata contains boswellic acids which have

been shown to inhibit biosynthesis of leukotrienes.97

8. Phyllanthus urinaria — The extracts of the stems, leaves, and roots have been shown

to have a relaxant effect on the respiratory tract smooth muscle; involvement of

adenosine tri-phosphate- (ATP) sensitive potassium channels is postulated.98

9. Aquilaria agallocha — Aqueous extracts of stems of A. agallocha have been shown

to inhibit immediate hypersensitivity reaction by inhibition of histamine release

from mast cells.99

10. Calotropis procera — The latex of Calotropis procera has anti-inflammatory property

demonstrated in a rat paw edema model.100

11. Elettaria cardamomum oil — Anti-inflammatory and antispasmodic properties have

been demonstrated in a study on rats.101

12. Ocimum sanctum — Extracts of this widely used plant have been shown to possess

immunomodulatory potential and antioxidant and cyclooxygenase inhibitory

properties.102,103 Its fixed oils can inhibit enhancement of the vascular and capillary

permeability and leukocyte migration after inflammatory stimulus.104

13. Piper longum — Piperine, isolated from this plant, has anti-inflammatory potential.

105

13.9.1 Review of Clinical Trials

13.9.1.1 Picrorrhiza kurroa

Doshi et al.106 studied the efficacy of P. kurroa in a randomized, crossover, double-blind

trial. They enrolled 72 patients (ages 14 to 60) for a 14-week study. The patients were given

either P. kurroa root powder (300 mg three times/day) or an identical placebo. The study

had three arms: (1) group A had a long duration of 12 weeks and an active drug was

given from week 3 to week 14, (2) group B had a short duration of 3 weeks and an active

drug was given from week 3 to week 6 with placebo during the rest of the period, and

(3) group C had an intermediate duration of 6 weeks and an active drug was given from

week 3–6 and 9–12 with a placebo during intervening periods. The patients were asked

to maintain a symptom diary. Weekly pulmonary function tests were performed. The

authors did not observe any significant reduction in clinical exacerbation, need for bronchodilators,

or improvement in pulmonary function. Fifty patients dropped out of study

at different points during the trial. Significant side effects were seen in ten patients — four

experienced vomiting, three had anorexia, two had diarrhea, two experienced itching, one

had a skin rash, and one experienced giddiness. As this preparation is used frequently,

there is need for further studies.

13.9.1.2 Solanum spp.

Govindan et al.107 studied the efficacy of this herb in bronchial asthma. They enrolled 60

adults with bronchial asthma. Twenty patients each received 300 mg of dry powder of S.

xanthocarpum or S. trilobatum, whereas 10 patients each received salbutamol 4 mg or

deriphylline 200 mg. Pulmonary function tests were performed before and 2 h after drug

administration. S. xanthocarpum and S. trilobatum increased FEV1 by 65 and 67%, respectively,

at 2 h. This effect was less than that with salbutamol or deriphylline. Subjective

relief lasted 6 to 8 h.

Similar results have been reported in other studies as well; the response rates were

poor.108,109 In these studies the duration for which the drug was given was small; these

results may lead to an underestimation of the effects because most Ayurvedic herbal

preparations have their best action after about 2 weeks.

13.9.1.3 Tylophora indica

Shivpuri et al.110 conducted a double-blind, crossover study in 110 patients over 10 years

old. Fifty-three patients in the control group ate one spinach leaf daily. At the end of week

1, 62% in the T. indica group had moderate to complete relief of symptoms compared with

28% in the control group. At the end of the 12-week study period, improvements in the

two groups were 16 and 0%, respectively.

In another double-blind, crossover study,111 195 asthmatic patients received either alcoholic

tincture of T. indica or a placebo for 12 weeks. A daily dairy of symptoms scores was

maintained. After a week, 56% of the patients in T. indica group had moderate to complete

improvement in symptoms compared with 31.6% in the placebo group. After the crossover,

34.2% had improved with T. indica and 13.5% with placebo. At the end of study period,

14.8% in the T. indica group and 7.2% in the placebo group improved.

The efficacy of alkaloids extracted from T. indica was studied in a double-blind trial of

123 patients.112 The study group received alkaloid extract from T. indica in glucose, whereas

the control group received glucose colored with spinach. Lung-function tests were evaluated

along with symptom scores. The percentage of patients in whom FEV1 improved

by more than 15% was significantly greater in the study group than the control at 1, 2, 4,

8, and 12 weeks, peaking at 4 weeks. The symptom scores were significantly better in the

study group, with the peak at 1 week.

Thiruvengadam et al.113 studied the efficacy of dried T. indica in 30 asthmatic patients.

The patients were enrolled into a four-arm, double-blind randomized clinical trial for 16

days. Dried T. indica powder was compared with standard drugs and a placebo. Pulmonary

function tests and symptom scores were evaluated. Among all the parameters, nocturnal

dyspnea was the only one that showed significant improvement with T. indica.

A placebo-controlled double-blind study114 on 135 asthmatic patients was conducted to

evaluate the efficacy of powdered T. indica. The drug or placebo was given for 1 week

with another 2 weeks of follow-up. Pulmonary function tests and symptoms scores were

evaluated. There were no differences between the two groups.

13.9.1.4 Boswellia serrata

The gum resins of B. serrata (salai guggul) have been used in asthma. Gupta et al.115

compared the effect of gum resins of B. serrata with placebo in a double-blind, randomized

trial on 80 adult asthmatic patients. Pulmonary function tests were evaluated serially. A

significant increase in FEV1 was reported in the test group compared with the placebo

group.

13.9.1.5 Miscellaneous Herbs

Iyenger et al.116 studied the effect of a combination of five plants — Adhatoda vasica, Solanum

xanthocarpum, Albizzia lebbek, Glycyrrhiza glabra, and Picrorrhiza kurroa — in 14 adult patients

with asthma. All the patients showed clinical improvement with prevention of recurrence

and reduction in severity of symptoms. However, the medication was not effective during

acute exacerbation.

Shanker et al.117 conducted a clinical trial on 15 patients with bronchial asthma using

Gardenia turgida and Gardenia latifola. The results were unimpressive.

Sharma et al.118 reported significant improvement in one third of the 15 patients they

treated with Euphorbia prostrata for a period of 2 weeks.

Swamy et al.119 evaluated the efficacy of sirisa twak kvatha (Albizzia lebbek) in 19 patients

with asthma. They reported significant improvement in symptoms in most patients.

Trivedi et al.120 reported bronchodilatory, antispasmodic, and antiasthmatic effects of

vibhitakphal churna (Terminalia bellirica) in a trial on 93 patients.

In another trial,5 240 cases of bronchial asthma were administered naradeeya lakshmi vilas

rasa and godanti bhasma in a dose of 0.5 and 1.0 g, respectively, three times/day with honey

for a varying period of 4 to 12 weeks. Ninety-six patients received 100% relief, 27 patients

received 75% relief, 50 patients received 50% relief, 18 cases received 25% relief, and 28

remained unchanged; 21 cases left against medical advice. In the second group of this

study, 210 cases received shvasa kesari tablets (500 mg) made from Solanum xanthocarpum

and Godanti bhasma three times/day for 2 to 12 weeks. Seventy-five cases showed complete

relief, 49 cases showed 75% relief, 26 cases showed 50% relief, 25 cases showed 25% relief,

and 24 did not respond to therapy; 10 cases left against medical advice.

As can be judged from these studies, most trials have demonstrated some benefit. When

analyzing the available literature and Ayurvedic texts, we conclude that more clinical

research is still required before these therapies can be routinely used. Although there are

good experimental data to justify use of Ayurvedic preparations in asthma, issues about

doses, combinations, and duration of therapy are still to be resolved. In addition, these

preparations do not seem to offer effective medications for acute exacerbations of asthma,

which can be life threatening. There are plenty of Ayurvedic preparations with anti-inflammatory

and immunomodulatory effects (vide supra). Further research is required to determine

the optimal combinations that will help in reducing the airway inflammation and

therefore lead to better control of symptoms. It appears that a judicious mix of Ayurvedic

medications and modern medicine may be able to improve the control of this common

respiratory disorder.

13.10 Areas of Research

Further research is needed to:

1. Establish efficacy of various Ayurvedic preparations used in asthma by good

quality randomized controlled trials.

2. Determine the active principles in various Ayurvedic medications.

3. Evaluate the impact of Ayurvedic medications on the natural history.

4. Evaluate the role of immunomodulator medications available in Ayurveda.

13.11 Conclusions

The review of literature highlights need for more research in utility of Ayurvedic preparations

in bronchial asthma. At present, the medications and the management are not well

standardized. As a large number of experimental studies have documented the presence

of anti-inflammatory properties in various Ayurvedic preparations, there is potential for

discovering new compounds useful in the management of asthma.

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Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)