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fraternus Webster)
Institute of Medical Sciences, Banaras Hindu University, Varanasi- 5 (U. P.).
ABSTRACT : Tamakashvâsa as described in Âyurveda is a disease of Prânavaha Srotas (Respiratory system)
involving multiple etiopathogenesis. The clinical features are nearly similar to that of Bronchial asthma described
in Modern medicine. This study was designed to explore the therapeutic effect and synergistic action (if any) of a
plant Tâmalakî (Phyllanthus fraternus Webster). Tâmalakî is included in Shvâsahara and Kâsahara groups, used in
many formulations prescribed in Shvâsaroga in Âyurveda. Research works suggest its antihistaminic property in
experimental model and effective in non bacterial upper respiratory disorders. The present study comprises 3
groups (each 10 patients). Group A was treated with trial drug Ghanasattva of P. fraternus Webster, 500mg, thrice
daily, orally; while Group B was treated with modern standard drugs (a) Tab. Theo-asthalin, thrice daily, orally and
(b) Asthalin inhaler, SOS and Group C as combination of both therapies. Total duration of treatment was 45 days.
The observations reveal that, Group A has much better improvement in increasing Jaranashakti (t=7.57; p<0.001)
and Ruchi (t=9.86; p<0.001) in comparison to Group B and Group C. Moreover, Group C was found more effective
in reducing majority of sign-symptoms as such Breathlessness (t=9.00; p<0.001), Cough (t=6.47; p<0.001),
Expectoration (t=9.00; p<0.001) Wheezing (t=7.96; p<0.001), Rhonchi (t=7.96; p<0.001), Jaranashakti (t=4.71; p<0.01)
and Ruchi (t=6.68; p<0.001).
Key words : Tâmalakî, Phyllanthus fraternus Webster, Ghanasattva, Tamaka Shvâsa, Bronchial asthma,
Breathlessness, Jaranashakti.
tracheobronchial tree to a multiplicity of stimuli. It ismanifested physiologically by a widespread narrowing ‘Bhûmyâmalakî’. In Âyurvedic literatures Tâmalakî spontaneously or a result of therapy, and clinically by is included in many formulations used for the treatment paroxysms of dyspnoea, cough, and wheezing11. In of respiratory diseases1, 2, 3, 4. It is bitter, astringent, modern medicine, being affords by all means in the sweet, stomachic, febrifuge and antiseptic. It pacifies treatment of Bronchial asthma no satisfactory result Pitta -Kapha - Rakta Dosas and is indicated in is achieved till date. Prolonged use of agonists, steroids diseases like Shvâsa, Kâsa, Hikkâ, Kshata, Kshaya, etc. cause the side effects like hypertension, diabetes Meha, Mûtraroga etc 5, 6, 7. In practice, many species mellitus, immunosuppression and toxic effects to of Phyllanthus are used with the name Tâmalakî.
In this study Phyllanthus fraternus Webster (syn.
Phyllanthus niruri Linn.) of family Euphorbiaceae is In this study, an effort is made to treat the considered as the source plant of Tâmalakî. It is bronchial asthma with an attempt to minimize side found to have antihistaminic property in experimental effects and toxic effects of modern drugs, and to model 8 and effective in non bacterial upper increase the therapeutic efficacy of trial drug in respiratory disorders9. Out of 5 types of Shvâsa, Tamaka Shvâsa requires treatment irrespective of MATERIALS AND METHODS
etiopathogenesis, clinical manifestations, types and Preparation and Dose of trial drug :
treatment modalities were described separately10. It Fresh plants were collected from the surrounding simulates with the bronchial asthma. It is defined as of B.H.U. campus in the months of September -October a chronic inflammatory disease of airways that is and were identified by the experts of Department of characterized by increased responsiveness of the Dravyaguna and Department of Botany, B.H.U.,Varanasi. Then the plant material was cleaned and dried * Ph.D. Scholar, Department of Dravyaguna.
well in shadow, then crushed into yavakûta chûrna and ** Professor, Department of Dravyaguna.
collected into a vessel. Four times water was added & *** Professor, Department of Medicinal Chemistry.
kept for overnight. Next day morning the content was **** Professor, Department of Medicine.
heated slowly till total quantity of content reduced up to Shvâsahara Karma of Tâmalakî (Phyllanthus fraternus Webster) Sen B. et. al. ¼th quantity. The water extract was filtered with cloth in each group were compared. Based on random for 3 times and then boiled again slowly till it's consistency distribution 30 patients were divided into 3 groups as became similar to honey. At this stage vessel was taken out from fire, content was collected into a tray and dispersed uniformly and dried in sunlight for 10 days to get the Ghanasattva. During preparation approximately 500gm of Ghanasattva was obtained from 5kg of crudedried sample. Hence, it can be calculated as: After that capsules were filled in a dose of 500 mg. We have recommended dose of the drug Ghanasattva as 1500 mg per day into three divided doses, which was administered after food with water for a period of 45 Parameters for assessment of the drugs response :
Selection of cases :
Subjective and objective parameters were taken The patient of Tamakashvâsa of either sex and into consideration for assessment of drug response in different age groups were selected according to each follow up of 15 days. The mean scores obtained at diagnostic, inclusion and exclusion criteria from O.P.D.
the end of 3rd follow up was considered as scores of & I.P.D., Department of Dravyaguna, O.P.D.of after treatment (AT), which were compared statistically Department of Medicine, Sir Sundar Lal Hospital, IMS, with scores of before treatment (BT).
BHU, Varanasi. Follow-up of the patients was done in Subjective parameters : Breathlessness, Cough, Wheezing, Expectoration, Rhonchi, Jaranashakti and Inclusion criteria :
Age : Patients in between 12-70 years.
Objective parameters : Forced Expiratory Volume in1st second (FEV ), Forced Vital Capacity (FVC), Peak Patient suffering from mild to moderate degree of Expiratory Flow Rate (PEFR), Differential Leucocyte Count for Eosinophil and Absolute Eosinophil Count Exclusion criteria :
Patients of age below 12 and above 70 years.
Therapeutic response on Symptomatic profile : Severely malnourished / debilitated patients.
In group A, statistically highly significant results Restrictive lung diseases (neuronal and skeletal were found in the symptoms of Breathlessness (t=4.13; p<0.01), Cough (t=9.00; p<0.001), Expectoration (t=4.58; Acute severe asthma (status asthmaticus).
p<0.01), Rhonchi (t=6.13; p<0.001), Jaranashakti (t=7.57;p<0.001) and Ruchi (t=9.86; p<0.001). But statistically Cardiac, renal and other type of breathlessness.
significant result was observed in Wheezing (t=3.21; Patients having diabetes mellitus, hypertension, tuberculosis, heart diseases, immuno-suppressive In group B patient also showed, statistically highly significant results in Breathlessness (t=8.57;p<0.001), Cough (t=4.74; p<0.01), Rhonchi (t=9.00; Grouping of patients :
p<0.001), Wheezing (t=5.01; p<0.01), Jaranashakti Based on random distribution, 42 patientss were (t=3.87; p<0.01) and Ruchi (t=4.74; p<0.01). Statistically registered. Out of them, 34 patients have came for regular non-significant result was observed in Expectoration follow-up. To prepare the accurate data only 10 patients In group C, patient showed statistically highly effective in reducing AEC. The other profiles showed signi fi cant r esul ts in r educi ng al most al l the statistically non-significant (p>0.05). Group B vs. Group symptomatic profiles. The mean score recorded as C showed statistically highly significant in Eosinophil Breathlessness (t=9.00; p<0.001), Cough (t=6.47; (t=3.88; p<0.01) and AEC (t=10.27; p<0.001). By p<0.001), Expectoration (t=9.00; p<0.001), Wheezing observing the differences of mean (BT-AT), Group C (t=7.96; p<0.001), Rhonchi (t=7.96; p<0.001), was found more effective in both the profiles. FVC Jaranashakti (t=4.71; p<0.01) and Ruchi (t=6.68; (t=2.87; p<0.02) was found statistically significant and the rest are non-significant (p>0.05). Group A vs.
Group C were found statistically non - significant In intergroup comparision of A vs B showed (p>0.05) in all profiles. The differences of mean (BT- statistically highly significant results in improving AT) imply that group C imparts better improvement.
Jaranashakti (t=3.09; p<0.01) and Ruchi (t=5.55;p<0.001), and all other profiles were found non- DISCUSSION
significant (p>0.05). Group B vs Group C, showed In the demographic profile, majority of the statistically highly significant result in Cough (t=3.28; patients were in age group of 51-60 yrs, male (66.64%), p<0.01), Rhonchi (t=3.39; p<0.01) and Ruchi (t=2.91; were registered in winter season (46.66%), which shows p<0.01), significant in Breathlessness (t=2.46; p<0.05), its aggravation during this period. The 33.33% had Expectoration (t=2.33; p<0.05), Wheezing (t=2.87; addiction of smoking and allergic tendency towards dust, p<0.02) and non-significant in Jaranashakti (t=1.41; gave the information as one of the causative factors.
p>0.05). Group C vs Group A showed statistically The 53.33% had chronicity of the disease between 1-5 significant effect in Breathlessness (t=2.41; p<0.05), Cough (t=2.21; p<0.05) Expectoration (t=2.47;p<0.05), Wheezing (t=2.74; p<0.02), Rhonchi (t=2.15; p<0.05), and Ruchi (t=2.25; p<0.05) and non - subjective and objective parameters. From the significant in Jaranashakti (t=1.34; p>0.05).
observations and results, the trial drug in combinationwith modern drugs was found more effective in The statistical data (BT-AT) obtained from the reducing majority of sign-symptoms. The trial drug intragroup and intergroup analysis, revealed that trial alone showed better improvement in Jaranashakti and drug imparts better improvement in symptoms of Ruchi in comparison to other groups. On this basis the Jaranashakti and Ruchi than the standard and mode of action may be postulated as, in combination combination groups. Whereas, the combined group they exert synergistic action. The trial drug is Tikta in showed better results in all profiles.
Rasa predominantly (Tikta is said to have Dîpanîya Response on objective parameters : and Pâchanîya property), so acts at Agni level andstimulates the digestive power and increases the Group A showed statistically results in FEV1 appetite. It pacifies the degree of Breathlessness, (t=5.13; p<0.01), FVC (t=5.11; p<0.01), Eosinophil Rhonchi, Wheezing, Expectoration, probably due to (t=3.66; p<0.01) and AEC (t=7.94; p<0.001), whereas Ruksha guna (Ruksha guna possesses the best drying PEFR (t=2.03; p>0.05) was found non-significant.
up property). It has also antihistaminic property, thus In Group B, statistically highly significant proved effective in reducing Eosinophil and AEC.
results were observed in FEV (t=19.73; p<0.001), CONCLUSION
FVC (t=12.66; p<0.001) and AEC (t=4.36; p<0.01),whereas significant in Eosinophil (t=2.60; p<0.05) and The effect of therapy after completion of 45 days PEFR (t=1.10; p>0.05) was found non-significant.
duration was encouraging. The trial drug alone showedmuch better result especially in improving Jaranashakti Group C showed statistically highly significant (t=7.57; p<0.001) and Ruchi (t=9.86; p<0.001). In result in all profiles. FEV (t=13.09; p<0.001), FVC combination, it was observed statistically highly (t=11.81; p<0.001), PEFR (t=4.04; p<0.01), Eosinophil significant in reducing Breathlessness (t=9.00; (t=9.12; p<0.001) and AEC (t=18.25; p<0.001).
p<0.001), Cough (t=6.47; p<0.001), Expectoration Intergroup comparision of Group A with Group (t=9.00; p<0.001) Wheezing (t=7.96; p<0.001), Rhonchi B, showed statistically highly significant in AEC (t=7.96; p<0.001), Jaranashakti (t=4.71; p<0.01) and (t=5.01; p<0.001). The difference of mean (BT-AT) Ruchi (t=6.68; p<0.001), which shows the synergistic was highest in Group A, signified trial drug more Shvâsahara Karma of Tâmalakî (Phyllanthus fraternus Webster) Sen B. et. al. Scale of Asthmatic sign-symptoms :
Grading criteria
Absent on normal breathing, but few on forced breathing Few scattered bilateral on normal deep breathing In between Score 1 and Score 3 on normal breathing Innumerable high pitched bilateral on normal breathing Equally willing towards all the Âhâra Rasas Willing towards some specific Âhâra Rasas Willing towards only one Âhâra Rasa Acknowledgement :
3. Sharma S.P., Ashtâñga Samgraha of Vrddha Vâgbhata, (with ‘Úasilekhâ’ commentary by Indu), Chowkhamba Sanskrit The authors wish to pay special regards and Series Office, Varanasi, 2006, Sûtra-Sthâna 15/7; Chikitsâ- thanks to Lt. Prof P. V. Sharma for his inestimable suggestions and valuable references provided during the 4. Paradakar H.S., Astâñga Hrdayam of Vâgbhata, (with commentaries ‘Sarvâñgasundarâ’ of Arunadatta & course of study. They also extend thanks to Prof. V. K.
‘Âyurvedarasâyana’ of Hemâdri), Chaukhamba Orientalia, Joshi, Prof. K. N. Dwivedi and Dr. A. K. Singh Varanasi, 2005, Chikitsâ-Sthâna 3/95; 4 /44, 46, 53; 5/17.
Department of Dravyaguna, IMS, BHU for their valuable 5. Sharma P. V. & Sharma G. P., Kaiyadeva Nighantu of Kaiyadeva, concerns. They are also thankful to all the patients and Chaukhambha Orientalia, Varanasi, 1979, Aushadhi Varga /247- other members related to this study.
6. Bhattacharya A. & Bhattacharya N., Râja Nighantu of Pt REFERENCES
Narahari, Pt Shri Ashubodh Vidyabhushan Bhattacharya, 1. Acharya J.T., Charaka Samhitâ of Agnivesha (with ‘Âyurveda- Calcutta, 1933, Parpatâdi Varga/91-93.
Dîpikâ’ commentary by Cakrapânidatta), Chaukhamba 7. Mishra B.S. & Vaishya R.L., Bhâvaprakâsha of Shri Bhâva Surbharati Prakashan, Varanasi, 2000, Sûtra-Sthâna 4 /16(36), Mishra, (with ‘Vidyotini’ Hindi commentary, Notes & 16(37); Chikitsâ-Sthâna 1-I /63; 8 /70; 11 /37; 17 /102, 123, Appendix), Chaukhambha Sanskrit Sansthan, Varanasi, 1999, 2. Acharya J.T. & Acharya N.R., Sushúruta Samhitâ of Sushruta 8. Mishra R.B.,1978, Studies on Tâmalakî (Phyllanthus niruri (with ‘Nibandhasañgraha’ commentary by Dalhana), Linn.), M.D.(Ay.), Thesis ,Dravyaguna, I. M. S.; B.H.U., Chaukhamba Surbharati Prakashan, Varanasi, 2003, Uttara- 9. Yeolekar M.E., Shahani S., Desouza A., Ghai H. and Chawda Chaukhamba Surbharati Prakashan, Varanasi, 2000, Chikitsâ- M.B., 2005, Evaluation of Efficacy and Safety of Tab. Nirocil® in Non-Bacterial Upper Respiratory Disorders, Solumiks 11. Braunwald E., Fauci A. S., Kasper D. S., Hauser S. L., Longo Herbaceuticals Limited, Ayurvani®, Vol 1, Issue 2, 1-2.
D. L. and Jameson J. L., Harrison’s Principles of Internal 10. Acharya J.T., Charaka Samhitâ of Agnivesha (with Medicine, McGraw-Hill Medical Publishing Division, New ‘Âyurveda-Dîpikâ’ commentary by Chakrapânidatta), o à I · w v K w ²v S Ã Æ Y } w v I Ö É } Ñ w v G ú Þ Þ A < l A Þ Æ ²A , Ñ Æ . s >] . Z dl ², è ] . É ] . < Æ |Y Ñ è | w ²v . < Ú É Ã Ù >] o à I · w v K w v à ² " µ ê× Þ Ã I · w v K ' A à I Æ ² à A à à o à Y ¤, ó Æ w v à @ „ ²x G Ã Þ tè ²ÖZ I ²* S Ã Æ } à ²Ç w ²v < · Ñ É LÞ t¯ v < è < µ õ Þ Ã ²Ç à ²* I ²* ª w v Þ Ã Ç Þ Ã Y ¤ $ G à p t< A w v < è å à A é ó Æ Æ ² Phyllanthus w v K É L à < o Ç LY J w v } o ² Y ¤* $ ó Æ G ú Þ Þ A I ²* Phyllanthusfraternus Webster w v à ² < · Þ Ã Ç Þ Ã Y ¤ $ Ñ w v · Ó A Æ Í è o E à G à p t< A w v G à ¤B < p Ñ è | Z à ²A à ²* w v Ã Æ |Þ t¯ v á v É I ²* o I w v S Ã Æ ;(Bronchial asthma) w ²v 3 4 } à ²< Ç Þ Ã ²* É } w tv · 6 Æ ä à Y o w v G ú Þ Þ A ª w v Þ Ã Ç Þ Ã $ · à ´ < J w v ¢ è á v É I ²* ó Æ w ²v G b { >² Ñ è |@ M Æ Ã Y è p Öw v É ª } J à I É Là ä Y øÑ $ Æ Í è è Ç Ö- G I ²* } J _ < ¯ v (t=7.57; p<0.001) Ñ è | ï < ë (t=9.86; p<0.001)ó A Z à ²A à ²* · ´ J à ²* É } Æ l Æ ² G < p w v É ª } J à I É Là ä Y øG à $ Æ |Þ t¯ v è Ç Ö- Æ ] I ²* · Ç µ Ç Æ µ ] · ´ J à ²* I ²* · à µ < I · à $ ó Æ G ú Þ Þ Aw ²v É ª } J à I Æ ² Þ Y < A ~ w v B Ö < A w v · o à Y ¤ ª w v o I w v S Ã Æ w v K < ë ª w v M Æ Ã I ²* o à I · w v K w v Ã É LÞ Ã ²Ç G ^ Þ S Ã Æ Y } G à p t< A w v G à ¤B < p Þ Ã ²*w ²v Æ Ã E G < p w v · à µ Z Ã Þ w v Y à ² Æ w v o à Y ¤ $


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