Shwas-rog Series-4 Understanding Samprapti(pathogenesis) of 'TAMAK-SHWASA' by Prof. Satyendra Ojha

प्रतिलोमं यदा वायु स्रोतांसि प्रतिपद्यते !
ग्रीवां शिरश्च संग्रह्य श्लेष्माणं समुदीर्य च !!
(Ch. Chi.-17 / 55 )

Charakokta Tamaka shvaasa 

pratilōmaṁ yadā vāyu i.e. normal gati of vata is hampered. A specific movement of gases takes place in the alveoli from high pressure to low pressure. Oxygen moves from alveoli into blood whereas CO2 moves from blood to alveoli from where it is expired out. This movement of gases is coordinated normally by vata but when its channels are obstructed by either excessive secretion or reduced absorption of kapha (mucus), vata gets vitiated and exchange of gases does not takes place.

The symptoms are presented firstly with upper respiratory tract involvement. Pinasa is the prior symptoms followed by wheezing sound (ghurghurukaṁ). The presentation explains allergic diasthesis. 
Allergic rhinitis is prodormal symptom in EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA). 

करोति पीनसं तेन रूद्धो घुर्घुरकं तथा !
अतीव तीव्रवेगं च श्वासं प्राणप्रपीडकम् !! 
(Ch. Chi. - 17 / 56)
In addition cough, dyspnea and sinusitis is common. Various occupational diseases with general environmental factors do begin with sinusitis and rhinitis and later converting into dyspnea.

प्रताम्यति अतिवेगाच्च कासते सन्निरुध्यते !
प्रमोहं कासमान: च स गच्छति मुहुर्मुहु: !! 
(Ch. Chi. - 17 / 57)

Ativēgācca kāsatē explains the phase of chronic bronchitis which is one of the process of COPD alongwith emphysema and small airways disease, a condition in which small bronchioles are narrowed. Chronic bronchitis without chronic airflow obstruction is not included within COPD, it has inclusion under kasa whereas COPD is present only if chronic airflow obstruction occurs.

श्लेष्मणमुच्यमाने तु भृशं भवति दुःखितः !
तस्यैव विमोक्षान्ते मुहूर्त्तं लभते सुखम् !!
अथास्योद्ध्वंसते कण्ठः कृच्छ्रात् शक्नोति भाषितम् !न चापि निद्रां लभते शयान: श्वासपीडितः !!
 (Ch. Chi. - 17 / 58-60)

Asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment. Common finding in fatal asthma is occlusion of the airway lumen by a mucous plug, which is comprised of mucous glycoproteins secreted from goblet cells and plasma proteins from leaky bronchial vessels. 

Symptoms may be worse at night (na cāpi nidrāṁ labhatē śayānaḥ śvāsapīḍitaḥ), and patients typically awake in the early morning hours. Patients may report difficulty in filling their lungs with air. 

Kasa: Cigarette smoking often results in mucus gland enlargement and goblet cell hyperplasia, leading to cough and mucus production that define chronic bronchitis, but these abnormalities are not related to airflow limitation. Goblet cells not only increase in number but in extent through the bronchial tree.

The major site of increased resistance in most individuals with COPD is in airways ≤2 mm diameter. Characteristic cellular changes include goblet cell metaplasia, with these mucus-secreting cells replacing surfactant-secreting Clara cells resulting in mucus secretion in excess (ślēṣmaṇyamucyamānē tu bhr̥śaṁ ). Smooth-muscle hypertrophy may also be present. These abnormalities may cause luminal narrowing by fibrosis, excess mucus, edema, and cellular infiltration.

पार्श्वे तस्यावगृह्णाति शयानस्य समीरण: !
आसीनो लभते सौख्यमुष्णं चैवाभिनन्दति !!
उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान् !
विशुष्कास्यो मुहु: श्वासो  मुहुश्चैवाधम्यते !
मेघाम्बुशीतप्राग्वातै: श्लेष्मलैश्चाभिवर्धते !!
स याप्य: तमकश्वास: साध्यो वा स्यान्नवोत्थितः !!

(Ch. Chi. - 17 / 58-60)

āsīnō labhatē saukhyam: Patients with severe airflow obstruction may also exhibit use of accessory muscles of respiration, sitting in the characteristic “tripod” position to facilitate the actions of the sternocleidomastoid, scalene, and intercostal muscles.

sa yāpyastamakaśvāsaḥ sādhyō vā syānnavōtthitaḥ: Advanced disease may be accompanied by cachexia, with significant weight loss, bitemporal wasting, and diffuse loss of subcutaneous adipose tissue. This syndrome has been associated with both inadequate oral intake and elevated levels of inflammatory cytokines (TNF-α). Such wasting is an independent poor prognostic factor in COPD.

atīva tīvravēgaṁ: Exacerbations are a prominent feature of the natural history of COPD. Exacerbations are episodes of increased dyspnea (śvāsaṁ prāṇaprapīḍakam) and cough (ativēgācca kāsatē) and change in the amount and character of sputum. They may or may not be accompanied by other signs of illness, including fever, myalgias, and sore throat (ddhvaṁsatē kaṇṭhaḥ). 

mēghāmbuśītaprāgvātaiḥ: The symptoms increase during rainy seasons etc. which explains Atopic Asthama. Allergic or atopic asthma (sometimescalled extrinsic asthma) is due to an Allergytoantigens; usually the offending allergens are suspended in the air in the form of  pollen, dust, smoke, automobile exhaust, or animal dander. More than half of the cases of asthma in children and young adults are of this type.

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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