Shwas-rog Series-1 understanding the mechanism of 'Pittasthan-samudbhou' by Prof. Satyendra Ojha

कफवातात्माकौ एतौ पित्तस्थानसमुद्भवौ  !!

                                                                   (च.चि.- 17/8)

आचार्य चक्रपाणि- पित्तस्थानसमुद्भवावित्यनेन पित्तस्योर्ध्वस्थानसंबन्ध एव, नतु वातकफवदारम्भकत्वमिति दर्शयति; पित्तस्थानशब्देनामाशयो अभिप्रेतः !!

Annavaha srotas mulasthan is amashaya whereas pranvahamula sthan is hridaya and mahasrotas. Here mahasrotas means the gastrointestinal tract whereas rasavahasrotas mulasthan is hridaya and dasadhamani. Thus one can find the relation or the interlink between the 3 srotas and their sthan thus if anyone of the 3 gets affected it has its impact on the other two.

When the food taken if not digested properly due to any reason causes ama which when propagated throughout the sharir by vyan vayu gets itself lodge where the kha vaigunya is available and creates the disease as per sthan. Therefore the aetiological factors may be classified into two types one which is leading to toxic substances called as ama and one which cause khavaigunya specific for that disease.

Aetiological factors like

"rajasā dhūmavātābhyāṁ śītasthānāmbusēvanāt" 

are kha vaigunyakar hetu whereas

"niṣpāva māṣa piṇyāka tilataila niṣēvaṇāt  piṣṭa śālūka viṣṭambhi vidāhi guru bhōjanāt  jalajānūpa piśita dadhyāmakṣīra sēvanāt abhiṣyandy  upacārācca  ślēṣmalānāṁ ca sēvanāt" !! 

are the hetu which are causative factors for ama and origin of such ama begins from the mahasrotas itself or in other words pittasthana when the jatharagni mandyata takes place.

The gastrointestinal system plays a central role in immune system homeostasis. It is the main route of contact with the external environment and is overloaded every day with external stimuli, sometimes dangerous as pathogens (bacteria, protozoa, fungi, viruses) or toxic substances, in other cases very useful as food or commensal flora. The crucial position of the gastrointestinal system is testified by the huge amount of immune cells that reside within it. Indeed, gut-associated lymphoid tissue (GALT) is the prominent part of mucosal-associated lymphoid tissue (MALT) and represents almost 70% of the entire immune system; moreover, about 80% of plasma cells [mainly immunoglobulin A (IgA)-bearing cells] reside in GALT.

The gastrointestinal system plays a key role in the complex mechanisms of immuno-regulation. The common embryonic matrix of entodermic derivation of respiratory and gastrointestinal tissues confers immunological peculiarities regarding the early sensitization and activation of tolerance mechanisms to the digestive system. Responses to the immune homeostasis to pathogens (bacteria, viruses, fungi and parasites), recognition and tolerance of self-antigens, tolerance to commensal flora, but also sensitization and desensitization to foods, take place in the gastrointestinal system. However, the gastrointestinal system may be the target of immune reactions such as allergic reactions of the anaphylactic type and autoimmune reactions, such as occurs in Behçet disease. 

In this disease lung involvement is typically in the form of hemoptysis, pleuritis, cough, or fever, and in severe cases can be life-threatening if the outlet pulmonary artery develops an aneurysm which ruptures causing severe vascular collapse and death from bleeding in the lungs. Nodules, consolidations, cavities and ground glass lesions are common in patients with pulmonary involvement. Pulmonary artery thrombosis may occur and in case of cardiac involvement Pericarditis is a frequent cardiac manifestation. Chronic aortic regurgitation due to aortic root disease may also be seen.

(Allergy and the gastrointestinal system G Vighi,* F Marcucci,‡ L Sensi,‡ G Di Cara,‡ and F Frati‡ Articles from Clinical and Experimental Immunology  2008 Sep; 153(Suppl 1): 3–6 )

Vasoactive intestinal peptide, also known as the vasoactive intestinal polypeptide or VIP, is a peptide hormone that is vasoactive. VIP is produced in many tissues of vertebrates including the gut, pancreas, and suprachiasmatic nuclei of the hypothalamus in the brain. The first evidence of association between VIP and CRTH2 in recruiting eosinophils was published by Amr E. El-Shazly and others in their research paper Novel Association between Vasoactive Intestinal Peptide and CRTH2 Receptor in Recruiting Eosinophils, A possible biochemical mechanism for allergic eosinophilic inflammation of the airways* (Dominique Y. Begon§, Gaelle Kustermans, Mohammad Arafa, Estelle Dortu, Monique Henket, Philippe P. Lefebvre, Renaud Louis and Philippe Delvenne).

The allergic inflamed airway contains a pool of mediators that compete as chemo-attractive signals to eosinophils. Accumulating evidence indicates an important neuro-immune interaction between the rich expression of VIP on the allergic nasal tissue and bronchial smooth muscle bundle and inflammatory cell recruitment. Furthermore, eosinophils from intestinal mucosa store and secrete VIP. All of this evidence indicates an important neuro-immuno-inflammatory axis between VIP and eosinophils. Vasoactive intestinal peptide (VIP) is one of the parasympathetic neurotransmitters involved in the regulation of airway mucus secretion. (http://www.ncbi.nlm.nih.gov/pubmed/21711977).

The demonstration that vasoactive intestinal peptides (V.I.P.) is a bronchodilator in asthmatics and ameliorates histamine induced bronchoconstriction has important implications for the pharmacology of asthma. (http://www.ncbi.nlm.nih.gov/pubmed/6382197).

Thus a role of pittasthana samudbhava and  shwas can be understood.

"rajasā dhūmavātābhyāṁ,"

 रजसा धूमवाताभ्यां (ch.chi.-17/11)

Air pollutants, such as sulfur dioxide, ozone, and diesel particulates, may trigger asthma symptoms. Indoor air pollution may be more important with exposure to nitrogen oxides from cooking stoves and exposure to passive cigarette smoke. There is some evidence that maternal smoking is a risk factor for asthma, but it is difficult to dissociate this association from an increased risk of respiratory infections.

Allergen: The increase in house dust mites in centrally heated poorly ventilated homes with fitted carpets has been implicated in the increasing prevalence of asthma in affluent countries. Domestic pets, particularly cats, have also been associated with allergic sensitization, but early exposure to cats in the home may be protective through the induction of tolerance. Pollens usually cause allergic rhinitis rather than asthma, but in thunderstorms, the pollen grains are disrupted and the particles that may be released can trigger severe asthma exacerbations (thunderstorm asthma).

Occupational Exposure Occupational asthma is relatively common and may affect up to 10% of young adults. Occupational asthma may be suspected when symptoms improve during weekends and holidays.

Dutch hypothesis. This suggests that asthma, chronic bronchitis, and emphysema are variations of the same basic disease, which is modulated by environmental and genetic factors to produce these pathologically distinct entities. The alternative British hypothesis contends that asthma and COPD are fundamentally different diseases: Asthma is viewed as largely an allergic phenomenon, whereas COPD results from smoking-related inflammation and damage. Rajasā dhūmavātābhyāṁ explains the approach of Charaka which explains both the hypothesis wherein allergic and inflammatory and damage factors have been explained together.

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Prof. Satyendra Narayan Ojha  

MD PhD

(Kayachikitsa)
Director

Yashwant Ayu. College & P.G.Training&Research Center 

Kodoli, Kolhapur, Maharashtra, India.

Mobile No.- +91 9822177155     

email: drsnojha@rediffmail.com