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Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 101-107

Management of allergic asthma with Shrishadi Agad followed by Amalaki Rasayana as add on treatment

1 Department of Kayachikits, All India Institute of Ayurveda, New Delhi, India
2 Medical Officer, CHC, Alwar, Rajasthan, India

Date of Submission13-Dec-2021
Date of Decision02-Mar-2022
Date of Acceptance04-Mar-2022
Date of Web Publication20-Feb-2023

Correspondence Address:
Pooja Sharma
Department of Kayachikits, All India Institute of Ayurveda, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AYUHOM.AYUHOM_58_21

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Allergic asthma (AA) is the most common form of asthma. An allergy is when the immune system mistakes a harmless substance, such as pollen, dust, and mites. The body releases chemicals to attack the substance and can lead to asthma symptoms such as wheezing, chest tightness, difficulty in breathing, and coughing that can vary over time. A 23-year-old female was diagnosed with AA since 2011 by an allopathic consultant in Delhi. She was regularly treated with short-acting bronchodilators (Levalbuterol) inhaler. Shrishadi Agad is a formulation described in the textbook of Shusruta Samhita which contains Shirish Chaal (Albizia lebbeck), Trikatu Churna, Madhu (∼Honey), and Saindhava lavan (∼Rock salt) which are in totality responsible for its Vishaghna (Anti-toxic) properties. The patient was considered suffering from Santamak Shwasa (∼AA) on the bases of International Classification of Diseases (ICDs)-11 and was treated with Shrishadi Agad twice a daily along with Haritaki Churna, bedtime for 1 month followed by Amalaki Rasayan in the dose of 3 g, twice a day for 2 months. On the basis of the same medication, regular follow-up was taken up to assess the health of the patient. After 3 months of treatment, the patient showed significant improvement in sneezing, breathlessness, cough, and generalized weakness. There is a significant decrease in the range of immunoglobulin E (from 3000 IU/ml to 1493 IU/ml), absolute eosinophil count (from 720/cu.mm. to 228/cu.mm.), and pulmonary parameters (i.e., forced expiratory volume in and forced vital capacity) also shows respective changes. This case shows that Shrishadi agad followed by Amalaki Rasayana is effective in the management of AA on the basis of ICD-11 diagnostic criteria AA modern and Ayurvedic diagnostic criteria.

Keywords: Allergic asthma, Amalaki Rasayan, Dushi Visha, Santamak Shwas

How to cite this article:
Sharma P, Sharma N, Kajaria D. Management of allergic asthma with Shrishadi Agad followed by Amalaki Rasayana as add on treatment. AYUHOM 2022;9:101-7

How to cite this URL:
Sharma P, Sharma N, Kajaria D. Management of allergic asthma with Shrishadi Agad followed by Amalaki Rasayana as add on treatment. AYUHOM [serial online] 2022 [cited 2023 May 30];9:101-7. Available from: http://www.ayuhom.com/text.asp?2022/9/2/101/370092

  Introduction Top

The word Shwasa is defined as “Shwasitianenaiti Shwasa” which means respiration. This derivation says about the physiological aspect of breathing. However, rapid or interrupted breathing is called Shw Roga and it is one of the Pranavaha Sroto Dusti Vikara (obstruction in the respiratory system).[1] Shwasa Roga is a cluster of all diseases having breathlessness as a presenting chief complaint. There are five types of Shwasa Roga, one among them is “Tamaka Shwasa.Tamaka Shwasa as per description is characterized by Ghurghuraka shabda (wheezing sound), Ativativravegam ca shwasampranaprapidakam (shortness of breath), Shayanah shwasa piditah (increase breathing distress in lying position), and Asino labhate Shukham (gets relief in the sitting position).[2] Tamaka Shwasa is again classified as Santamaka and Pratamaka types. Santamaka Shwasa is exclusively and separately described due to its unique etiology. Causative factors for Santamaka Shwasa include – Udavarta (hindered evacuation of natural urges), Ajirna (indigestion), Raja (dust particles), klinna[3] (old age), and Kayanirodhaja (with holding natural urges). These specific etiological factors produce endotoxins and cause breathing distress. Psychological[4] distress is the distinguishing characteristic features of Santamaka Shwasa. As per Ayurveda, indigestion produces Annavisha. Visha is defined as anything that can cause disease or immediate death. Thus, Dushi Visha is the latent poison that acts as endotoxin.[5] In the current scenario, improperly metabolized conventional medicines that are taken for the long duration and get accumulated in the circulation can also be considered as Dushi Visha. Most of the AA patients are habitual of taking anti-allergic medicines on/off or even continuously to subside their symptoms, even though they suffer from the side effects of these medicines like sedation, headache, drowsiness, insomnia, tachycardia, etc.[6] The antihistamine drugs (Cetirizine and levocetirizine) are not metabolized properly in the body.[7] In an effort to enumerate this hypothesis, it is decided to evaluate the efficacy of anti-toxin. These allergens come in contact with the human body either through inhalation, injection, or simple contact according to Dr. Subhash Rande (1999). The main cause of allergy is amalaki or toxins medicines known as Agad in Ayurveda in the management of AA produced by low digestive fire accordingly different symptoms are produced at different levels.[8]

  Case Report Top

Case presentation

A 23-year-old female patient was brought by her husband to All India Institute of Ayurveda, Sarita Vihar, Gautam Puri, New Delhi, India, in the outpatient department of Kayachikitsa, with complaints of difficulty in breathing, cough, and sneezing for 2016 on regular treatment with Levalbuterol Bronchodilator inhaler-1 capsule four times in a day. There was also difficulty in doing her household work such as brooming, difficulty in making food, and eating cold item like rice, Dahi (curd) and cold drinks. These problems started gradually patient noticed the dust and cold food allergy as mentioned in [Table 1].
Table 1: Timeline of events

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Past history

The patient past history showed the presence of sneezing, cough congestion, mild shortness of breath (dyspnea) while working and fatigue in the body which gradually due to prolonged period of time resulted in pulmonary symptoms as mentioned in her case reports examinations. There was no history of same illness in any of the family members.

Clinical finding

The patient had 42 kg weight along with a medium body frame, excessive perspiration with aggressive in nature, having a moderate appetite, good stamina but she was slow in physical activities. On examination, her Prakriti (body constitution) was Pitta-Kaphaja, Agni bala (digestive power), and Sharira bala (physique) was Avara (poor). Her BP was 130/70 mm of Hg, pulse 76/min, and SpO2 93% mm of Hg regular. No clubbing and cyanosis were found. On auscultation, wheezing was observed bilaterally (audible wheezing). Modified Medical Research Council (mMRC) Dyspnea Scale[9] showed in grade 3.

Diagnostic focus and assessment

She was subjected for allergic and hypersensitivity assessment conditions under International Classification of Diseases-11 diagnostic criteria for AA on the basis of modern and Ayurveda criteria. The patient reports showed hemoglobin 14.7 g/dl, erythrocyte sedimentation rate 8 mm/h, immunoglobulin E (IgE) 3000 IU/mL [Figure 1], and absolute eosinophil count (AEC) 720/cu.mm [Figure 2]. Spirometry showed an obstructive pattern (Forced expiratory volume in 1 s [FEV1], 1.45 L; forced vital capacity, 1.72 L and FEV1 78% respective investigations were done on September 4, 2019, periodically after 3 months the analysis was done on December 9, 2019.
Figure 1: Immunoglobulin E before treatment

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Figure 2: Absolute eosinophil count before treatment

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The patient was a known case of allergic asthma (AA). It was confirmed by previously done investigation as mentioned in the diagnostic criteria. Santamak Shwasa was considered as Ayurvedic diagnosis which is type of Tamak shwasa (∼Asthma). Bronchiectasis, chronic obstructive pulmonary disease (COPD), infectious etiologies, chronic rhinosinusitis and other disorders of the upper airway were the differential diagnosis for the case on the basis of subjective parameters (sign and symptoms of Santamak Shwasa)[10] and objective parameters (IgE, AEC, mMRC scale, and spirometry). The most important difference between asthma and COPD is the nature of inflammation which is primarily eosinophilic and CD4 driven in asthma, and neutrophilic and CD8 driven in COPD.[11],[12] This is a very important distinction because the nature of the inflammation affects the response to pharmacological agents. There is now ample evidence that inhaled corticosteroids are effective against the eosinophilic inflammation in asthma but largely ineffective against the primarily neutrophilic inflammation seen in COPD.[13]

Therapeutic intervention

According to Aacharya Charak, following three basic steps should be adopt while treating any disease, i.e., Nidana Parivarjana, Samshamana, and Samshodhana. Considering the patient's Pitta Kaphaja Prakriti and physical constitution, Shirishadi Agad[14] in the decocation form with Haritaki Churna used as Kostha Shuddhi followed by Amalaki Rasyana were given to the patients as on add on treatment. Considering the history, clinical examination and investigations, following treatment was given as mentioned in [Table 2].
Table 2: Oral medication

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Preparation of Kwatha

The dry bark of Shirisha (Albizzia lebbeck) was procured from the botanical garden of All India Institute of Ayurveda (AIIA) authenticated at the pharmacognocy laboratory, AIIA, bark of Shirisha crushed thoroughly in grinder, added with four parts of water and Trikatu churna 3 g, subjected to mild heat with infrequent stirring without covering its mouth. Reduction was done until the quantity reduced to 1/4th of its original volume and contents were filtered through double-folded clean cotton cloth in to a stainless-steel vessel and the residue was discarded. Will keep it to cool down. After that added Parkshepak dravya, Madhu 5 ml and Saindhav lavana 2 g. Drink it in 40 ml quantity.

Follow-up and outcomes

After the completion of the whole treatment as mentioned in [Table 3] the patient's condition was assessed for sneezing, running nose, breathlessness, and generalized body ache. The bilateral wheezing sound had substantially stopped and mMRC scales of dyspnea showed grade 0. The frequency of taking inhalers had also reduced from four times/day to 1 time/day and spirometry showed significant improvement as mentioned in [Table 4]. On the basis of treatments, the patient for while was on modern medications but only on a reduced dosage, gradually improved with the medications of Ayurveda, and her health became better on the basis of therapeutic interventions, respectively, with combined efforts of medications. There was a remarkable improvement in all the investigations as IgE was decreased from 3000 IU/ml to 1493 IU/ml, as mentioned in [Figure 3] and AEC was decreased from 720/cu.mm to 228/cu.mm, as mentioned in [Figure 4], and all the scoring of the symptoms is mentioned in [Table 5].
Table 3: After the whole course of treatment changes in subjective parameters and investigations

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Table 4: After the whole course of treatment changes in the objective parameter[15]

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Figure 3: Changes in immunoglobulin E after treatment

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Figure 4: Changes in absolute eosinophil count after treatment

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Table 5: Scoring Scale

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  Discussion Top

AA (Santamaka shwasa) is one of the most important distressing common diseases that affect an appropriate number of global populations. Allergens (internally and externally) such as environmental pollutants and unsuitable foods are believed to be the predisposing factors that disturb the immune system of the body and trigger the production of the antibody IgE.[16] This particularly results in sneezing, running nose, irritation of eyes, inflammation of bronchial mucosa, and wheezing. They provide relief from bronco spasm, airway blocks, sneezing, and running nose. The current analysis was aimed at proving the efficacy of Shirishadi agad and Amalaki Rasayan in AA.

Today, achieving asthma control is indicated as the main goal of asthma management by international guidelines. Although most asthma patients can be treated and controlled with inhaled steroids, some patients remain uncontrolled despite adequate asthma therapy. In our country, nearly one-half of patients with asthma were found uncontrolled in a multicenter survey.[17] With reference to Acharyas of Ayurveda that such disease can ever be originated without disturbed metabolism. In context of Shwasa roga, the etiological factors are divided into four categories viz. (1) Environmental factors (smoke, dust, fume, cold exposure, climate change, etc.), (2) endotoxins (Amajanya), (3) trauma to vital organs or vital organ failure (cardiac failure, respiratory failure, brain injury, stroke, etc.), and (4) secondary to other diseases such as anemia, hemorrhoids, bleeding diathesis, etc. These endotoxins are chronic is nature and have a tendency to accumulate. Basically, these are an unmetabolized substance that behaves like toxins. Furthermore, it has to be understood what makes an unmetabolized substance to behave like toxin. Ayurveda emphasizes on Srotorodha (obstruction of channels) in the manifestation of Swasa Roga. Srotorodha is the resultant of disturbance in the equilibrium of Vata and Kapha (both are humors responsible for physiological functions). Hence, drugs, which are beneficial in removing the obstruction and maintaining the physiological equilibrium of Vata and Kapha, are useful in this condition. Shirisha is used, it is emphasized to be the best Vishaghna (anti-allergic) and specifically recommended in Kasa and Shwasa (diseases of the respiratory tract) in Ayurveda.[18] Allergy is a resultant of this dysregulated immune system. Therefore, mere avoidance of the allergen or using anti-allergic medicines (e.g., antihistaminic, leukotriene antagonists, and thromboxane A2 inhibitors) gives no permanent cure to the patient and encourages them to seek help from alternative medicines. The pharmacokinetic properties of the drug-Shirisha as per Ayurveda (Madhura, Tikta, Kashaya Rasa, Anushana Veerya, and Katu Vipaka) will be beneficial in counteracting the exacerbated Kapha and Vata doshas. Its Vishaghna property helps in neutralizing the antigens and breaking the pathology at multiple levels. The three saponins of Shirisha, known as albiziasaponins are responsible for the anti-allergic activity of the drug.[19] Studies of recent past revealed anti-allergic,[20] anti-inflammatory,[21] anti-histaminic[22] expectorant action,[23] and immuno-modulatory activity[24] of Shirisha. Reduction in the eosinophil count during the treatment elucidated the anti-allergic activity of the formulation. Other components of the formulation such as Pippali also have immunomodulatory[25],[26] and anti-histaminic activities. Besides, Pippali enhances the bioavailability,[27] which helps in maintaining the major therapeutic principles in the systemic circulation for a longer duration. Other components reported to have multi-dimensional activities such as anti-bacterial,[28] anti-histaminic, broncho-dilating, anti-tubercular properties, etc. Probably, because of these activities, the combination showed the anti-asthmatic activity and Haritaki churna is Anulomana (laxative) in nature and Amalaki Rasayan also acts as a rejuvenating agent which helps in rehabilitation of the respiratory system along with the prevention of the recurrence of the disease.

Limitation of the study

As this is a case report, a similar study may be carried out on a large sample size.

  Conclusion Top

It can be concluded that Shirishadi Agad and Amalaki Rasayan have the potential to treat the case of AA. The regular follow-up has been taken after the treatments, and similarly, the patient for while is on modern medications but only on a reduced dosage, gradually healthy improved with the medication of Ayurveda. Further studies in this direction for longer durations are essential to conclude the probable mode of mechanism of the Shrishadi agad.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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