Shwas-rog Series-2 Understanding the mechanism of Etiopathogenesis of Charakokta Shwas-rog by Prof. Satyendra Ojha

रजसा धूमवाताभ्यां शीतास्थानाम्बुसेवनात् !
व्यायामाद्-ग्राम्यधर्म-अध्व-रूक्षान्न-विशमाशनात् !!
आमप्रदोषात्-आनाहाद्रौक्ष्यादत्यपतर्पणात् !
दौर्बल्यात् मर्मणोघाताद् द्वन्द्वात् शुद्धि-अतियोगात्!!
अतिसार-ज्वर-च्छर्दि-प्रतिश्याय-क्षत-क्षयात् !
रक्तपित्तादुदावर्ताद्-विसूच्यलसकादपि !! 
    

(Ch.Chi.17/10-16)

Asthma is a heterogeneous disease with interplay between genetic and environmental factors. Several risk factors that predispose to asthma have been identified. These should be distinguished from triggers, which are environmental factors that worsen asthma in a patient with established disease.

Diet- The role of dietary factors is controversial. Observational studies have shown that diets low in antioxidants such as vitamin C and vitamin A, magnesium, selenium, and omega-3 polyunsaturated fats (fish oil) or high in sodium and omega-6 polyunsaturated fats are associated with an increased risk of asthma. Vitamin D deficiency may also predispose to the development of asthma. 

Rūkṣānna, niṣpāva, māṣa, piṇyāka, tilataila,  piṣṭa, śālūka, viṣṭambhi, vidāhi, are the food items with low nutritional values Food And diet.  There is little evidence that allergic reactions to food lead to increased asthma symptoms, despite the belief of many patients that their symptoms are triggered by particular food constituents. Exclusion diets are usually unsuccessful at reducing the frequency of episodes. Some foods such as shellfish and nuts may induce anaphylactic reactions that may include wheezing.

Further niṣpāva, māṣa, piṇyāka, tilataila, are also explained as hetu for raktadusti, Pandu and shwas explains the relation between raktavahasrotas, rasavahasrotas and pranvahasrotas. 

However, interventional studies with supplementary diets have not supported an important role for these dietary factors.

Obesity is also an independent risk factor for asthma, particularly in women, but the mechanisms are thus far unknown. (harrisons). Asthma occurs more frequently in obese people (body mass index >30 kg/m2) and is often more difficult to control. Although mechanical factors may contribute, it may also be linked to the pro inflammatory adipokines and reduced anti-inflammatory adipokines that are released from fat stores.

gurubhōjan, jalaja, ānūpapiśita, dadhi, āma kṣīrasēvanāt  abhiṣyandi are such food items which are responsible for sthaulya as well as mentioned as aetiological factors for shwas.  

rajasā dhūmavātābhyāṁ 

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 Caraka which explains both the hypothesis wherein allergic and inflammatory and damage factors have been explained together.

It may also be noted that Intrinsic Asthma: A minority of asthmatic patients (approximately 10%) have negative skin tests to common inhalant allergens and normal serum concentrations of IgE.

Virus infections Upper respiratory tract virus infections such as rhinovirus, respiratory syncytial virus, and coronavirus are the most common triggers of acute severe exacerbations and may invade epithelial cells of the lower as well as the upper airways.

Pharmacologic Agents Several drugs may trigger asthma. Betaadrenergic blockers commonly acutely worsen asthma, and their use may be fatal.

Vyāyāmād, adhva, dvandva: Exercise is a common trigger of asthma, particularly in children. The mechanism is linked to hyperventilation, which results in increased osmolality in airway lining fluid and triggers mast cell mediator release, resulting in bronchoconstriction. Exercise-induced asthma (EIA) typically begins after exercise has ended and resolves spontaneously within about 30 min. EIA is worse in cold, dry climates than in hot, humid conditions (śītasthānāmbusēvanāt). It is, therefore, more common in sports activities such as cross-country running in cold weather, overland skiing, and ice hockey than in swimming.

Śītasthānāmbusēvanāt: (Physical Factors): Cold air and hyperventilation may trigger asthma through the same mechanisms as exercise. Laughter may also be a trigger. Some asthmatics become worse when exposed to strong smells or perfumes, but the mechanism of this response is uncertain.

Hormones: Some women show premenstrual worsening of asthma, which can occasionally be very severe. The mechanisms are not completely understood, but are related to a fall in progesterone and in severe cases may be improved by treatment with high doses of progesterone or gonadotropin-releasing factors. Thyrotoxicosis and hypothyroidism can both worsen asthma, although the mechanisms are uncertain

Stress: Many asthmatics report worsening of symptoms with stress. Psychological factors can induce bronchoconstriction through cholinergic reflex pathways. Paradoxically, very severe stress such as bereavement usually does not worsen, and may even improve, asthma symptoms.

Marmaṇō ghātād: Disease of trimarma has an impact on the pulmonary system. Cardiac asthama explans hridaya and shwas relationship. Damage to the respiratory centre due head injury or cerebrovascular event and respiratory distress explains the relationship between shira and shwas whereas acute renal failure and respiratory distress explains relationship between basti and shwas. Similarly condition of CNS disorders like Stroke, Multiple sclerosis, Meningitis, tumour affecting the brain, encephalitis or a traumatic brain injury also is cause for hiccups explains relationship of shira marma with hikka. 

The vagus nerve irritation with subsequent hiccups may be caused by chest disorders (injury, surgery) and heart diseases (myocardial infarction) explains hridaya marmopaghata with hikka.

Renal failure is associated with hiccups by the following causes:  Reduced kidney function looses the ability of keeping balance of electrolytes in the body (discuss later) leading to hiccups. Secondly, renal failure leads to build up urea (a metabolite of protein) in the body, leading to hiccups.

There is an interaction between stroke and hiccups. Furthermore, stroke is also a complication of renal failure. Stroke can induce gastrointestinal tract bleeding caused by stress ulcer. In this case, gastric mucosa is stimulated and diaphragm muscle is involved. As a result, diaphragm muscle spasm causes its occurrence. Thus marmoghata is cause for hikka and shwas.

Atīsāra, jvara, cchardi, pratiśyāya, kṣata, kṣaya,  raktapitta, udāvarta, visūcika, alasaka, pāṇḍurōga, viṣā explains the srotamsi anyasya darunaihi relationship between pranvaha srotas and other srotas.

**************************************************************************************************************************

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