CRITICAL REVIEW OF TAMAKA SHAWASA (ASTHMA) CHIKITSA

Asthma is known as reactive airway disease. This hyperresponsiveness manifests itself as bronchoconstriction following exercise, on natural exposure to strong as irritant fumes such as sulphur dioxide, tobacco smoke or cold air and an intentional exposure in the laboratory to inhalations of histamine or parasympathamimetic agent such as methacholine. In Ayurveda it can be correlated with Tamaka Shwasa. Tamaka Shwasa is one of the diseases where Nidana parivarjana and samprati vighatana plays an important role. The detailed study of Nidana panchaka is helpful in better understanding of the disease and for the proper treatment. As Kapha and Vata are the pre-dominant Doshas, so the medicines and the dietetic regimen which controls the Kapha and Vata due to their Ushna guna and are Vataanulomaka in action must be utilized in the treatment of Shwasa roga. While The patient with Kapha and Vata dominance and of strong build should be given Samshodhan therapy i.e. vaman & Virechana.


INTRODUCTION
Tamaka Shwasa is one of the five verities of Shwasa roga, explained in almost all the classics of Ayurveda. The term 'Tamaka Shwasa' consists of two words Tamaka and Shwasa. The word Tamaka' is derived from the dhatu (root) Tamuglanou with 'kwip' pratyaya (syllable). It means to choke, be suffocated, darkness. 1 'Tamyati iti Tamaka'Tama eva Tamaka' i.e. where Tama occurs is Tamaka. 2 Tama means Darkness. The word 'Shwasa' is derived from the dhatu 'shwas' with 'ghai' pratyaya. 'Shwasti iti Shwasah' it means to breathe, by which the respiratory movements take place. 3 The term Tamakaswasa is formed by Karmadharaya samasa as "Tamakascha asauShwasascha Tamaka Shwasaha" It means difficulty in breathing, which mainly occurs during night time. Sushruta defined TamakaShwasa as "Visheshad durdine tamyeti shwashasa tamako matah". 4 The attack of Shwasa with tamapravesha occurs specially during Durdina. No commentator has mentioned the meaning of the word Durdina. Acharya Charaka explained that Tamaka Shwasa gets aggravated when one is exposed to cloudy atmosphere, cold water, cold weather, and wind blowing from eastern direction, Kapha aggravating food and regimen. 5

Avoidance of Triggers / Aggrevators
Physical Factors: The physical factors, which can cause symptoms in asthmatic children, are exercise, strong smell, cold air, changes in weather etc. In majority of cases the patient or parents easily identify these factors. For the better management of asthmatic children, it is necessary to avoid the exposure to these factors.  Pillow and bed is to be covered with mite proof covers.

(a) Allergens
 Woollen clothing's and bedding are better to avoid because they may harbour dust and house dust mite. Carpets in the bedroom are better to remove.
 Whenever practical, bedding should be exposed to the sun which kills mites. In the prior category Shodhana can be adopted and Shamana in the later where as Nidana parivarjana is mandatory in both categories 2) SAMSHODHANSA: Great importance has been given for the Shodhana karma in the management of Shwasa, which helps in eliminating the vitiated Doshas from the body. Vamana, virechana and nasya are advised to adopt for Tamaka Shwasa Chikitsa.

a) Deepana And Pachana
It is said that "Rogah sarve api managanow". 11 Agnimandya and ama play an important role in the production of T.S. Hence in order to normalize the Agni and to remove ama, deepana and pachana should be given first. 12

Out of all the Vatahara treatment is better.
In all cases of Shwasa if brimhana is done, then the Shwasa becomes prataha sukhasadhya even though it is associated with upadravas. In the same if shamana treatment is adopted then it is always sukhasadhya for treatment. If karshana treatment is adopted, then Shwasa roga becomes asadhya for treatment. Brinhana is not a complete treatment so it should be done with shamana Chikitsa but karshana therapy should not be advised especially in case of children.

CONCLUSION:
In Ayurveda avoidance of causative factors is first line of treatment for any diseases. Tamaka Swasa is a Vata Kapha Pradhan Vyadhi, In the management of Tamaka Swasa, when Vata is obstructed by Kapha, just by increasing Vata, Kapha will automatically alleviate and Vata will be free to move in its course. When Vata is much aggravated than Kapha, treatment to increase Kapha will help to correct Vata. Charaka samhita emphasized that patient having good Aturabala with the dominance of Kapha should be treated with Vamana and Virechana therapy.