Introduction

Cough is the commonest respiratory symptom that has been experienced by every human being. In recent years there has been marked increase in the incidence related to respiratory system. Acharya Charaka has escribed kaasa as an independent disease. It has been observed as an independent disease as well as Symptom, complication and sequel in some diseases.[1] In Charaka samhita it is mentioned that one should treat according to severity of disease or according to dominance of doshas. kaphaja kaasa  is most important to treat which if mismanaged or left untreated may lead to dreadful diseases like kshataja kaasa, kshayaja kaasa or tamaka shwas,which are emergencies and are difficult to manage.[2] Kaasa is very shortly detoriating disease because, if not treated early can complicate further to shwas, kshay, chhardi, swarsad etc. In charaka samhita kaasa vyadhi is described mainly in its chikitsa sthana. In Sushruta samhita description of kaasa vyadhi and its treatment is mentioned in uttar tantra.[3]

Aetiology of Kaphaja kaasa: The causative factor of kaphaja type of kaasa includes intake of heavy food, abhishyandi ahar ,kapha gets vitiated due to above mentioned reasons  which causes obstruction to the channels of circulation sweet and unctuous ingredients (in excess) and Excessive sleep and indolence. The kapha gets aggravated because of the above-mentioned symptoms and obstructs the movement of vayu which gives rise to kaphaja type of kaasa.[4] Kaphaj Kasa symptoms are Suppression of the power of digestion, Anorexia, vomiting, Chronic bronchitis ,Nausea and feeling of heaviness in the body, sweetness and sticking in the mouth and asthenia, spitting of thick phlegm in large quantity which is sweet in taste and unctuous, Feeling of fullness in the chest.[5]

In modern medicine there is very narrow spectrum of treatment part for this condition  Antihistaminic, Anti-inflammatory ,and use of steroids in such conditions can lead to several side effects. Acharya Charaka has given different principles for treating kaasa like vamana, yavanna sevan, katu ruksha ushna upchaar ,under which he has given  four special yoga for treating kaphaja kaasa and one such kaasaharyog out of them, has been used in this study.[6,7]

Objectives:

1. To study the principle of management of kaphaja kaasa by katu ruksha ushna            kaphaghnaishcha upaacharet using kaasahar yog.
2. To study the efficacy of drug on parameter of kaphaja kaasa.

To compare the Kaasahar yog  and Trikatu churna in the  management of Kaphaja kaasa

Total 60 patients selected of Kasa from OPD of the hospital of  Government Ayurved Hospital. It was Randomised controlled study  and Method of Randomisation was Lottery method. Sampling Method was Simple Random Sampling.

Ethical clearance:  An institutional  ethical committee clearance report was obtained before initiation of the trial. A written consent of all patients included in the study in the language best understood by them was taken before screening.

Inclusion Criteria:

1. Patients having classical signs and symptoms of kaphajakaasa irrespective of sex, religion were selected for study.
2. Patient in the age group of 20-60 years having kasa from less than 10 days.
3. Patients having no infective pathology were selected for study.

Exclusion Criteria:

1. Patients already diagnosed or suspected of Chronic Obstructive bronchitis, Pleurisy,
2. Pulmonary tuberculosis, Bronchiectasis, Pneumonia, Lung abscess and asthama.
3. Patients with any other major systemic, metabolic disorders were excluded from study
4. Patient discontinuing the treatment were considered as drop out and excluded from the study.
5. Patients  participating in any other clinical trials (since last 6 months).

CRITERIA OF ASSESSMENT

Assessment was  done by Subjective criteria

1) Mandagni-

0- Prakrut agni.

1-feeling of hunger after interval of 6hrs from previous meal.

2-feeling of hunger after interval of 8hrsfrom previous meal

3-feeling of hunger after interval of 10hrs from previous meal.

2) Kaasa-

0- Mild.

1-Intermittent.

2- Moderate.

3-Worsened.

3) Utklesh-

0- No Utklesh

1-Utklesh only after meals

2-Utklesh on coughing

3-Continuous feeling of utklesh

4) Nishthivan-

0-No Kaphashtivan

1- Serrous expectoration

2- Moderately thick white expectoration

3- Thick large quantity of solid white sputum.

5) Pinas-

0-Absent

1-Mild intermitently

2-Moderate at specific time period.

3-Severe throughout day .

6) Aruchi-

   0- Normal desire for food

   1-Eating timely at much desire for specific food

   2-Desire of food only after long interval for most liking food.

   3- No desire at all

7)Gaurav-

  0- Absence of gaurav .

  1-Frequency of gaurav  2-3 times a day.

  2-Frequency of gaurav 4-5 times a day.

  3- Feeling of gaurav  throughout the day.

8) Asyamadhurya-

0- Only in morning.

1- Even after brushing.

2 - After meals.

3-Continuous     

Drugs: Kaasahar yog  contains Deodar, Haritaki, Musta, Pippali, Sunthi and Trikatu contains Sunthi, Mire and Pippali.

 

MANAGEMENT OF GROUPS:

Table No.1 Management of groups

	Trial group	Control group
Name of drug	Kaasahar yog	Trikatu  churna
Dose	3gm qid	3gm qid
Duration	14 days	14days
Anupan	Madhu	Madhu
No.of patient	30	30
Follow up	After every 7 days	After every 7 days

Results :

Age : In a study of total 60 patients 15 % were in age group 21-30,35% were in age group 31-40 ;    57% patients were of age group 41-50 ,10% of patients were of age group 51-60.

CLINICAL OBSERVATIONS:

Effect of Therapy on Symptoms of kaphaja kaasa in Group A and B Statistically:

All symptoms mentioned in tables  and graphs  given below were graded as per the  assessment criteria described. All the symptoms which do not follow the normal distribution hence non-parametric test such as Wilcoxon’s Ranked Sign test was used to evaluate difference between two treatments or conditions where the samples are correlated or repeated measurements on a single sample.

Assessment of Mandagni : In the study of total 60 patients  Mean score of patients having  complaint of mandagni in group A was 0.86 and Group B was 1.2  after treatment which was reduced to 0.63 and 0.8 in group A and Group B respectively. After statistical analysis  Z was 2.646 at P-0.0082 ,indicates significant reduction in mandagni while in group B  Z value is 3.153 at P-0.0016 which also indicates significant reduction in mandagni.

Assessment of kaasa : Mean score of patients complaining of kaasa in group A  was 1.96  which was reduced to 0.56 after treatment and the Z value is 4.818 at P 0.0001 which indicates significant reduction in the symptom kaasa in group A .In  group B the mean score was 2.06 wich was reduced to 0.33 after treatment and Z value 4.901 at P-0.0001, which shows that the changes were highly significant in both the groups.

Assessment of Utklesh : In group A regarding the symptom utklesh the mean score was 0.83 before treatment which was changed to 0.33 after treatment and the Z value  was 3.445 at P -0.0006 which indicates highly significant change in group A . In group B mean score is 0.83 before treatment  which was reduced to 0.13  after treatment ,Z value is 3.475 at p-0.0005 which means the changes are highly significant  .

Assessment of Nishthivan : In group A mean score of symptom Nishthivan was 1.43 which  reduced to 0.30 after treatment  and Z value is 4.743 at P-0.0001  ,while in group B  mean score was 1.67 which changed to 0.20  after treatment and the value of Z is 4.895 at p- 0.0001 which proves that the change is highly significant in both the groups.

Assessment of Pinas : In group A mean score of symptom Pinas is 0.63 which reduced to 0.06, after statistical analysis of mean scores  Z value is found as 0.63 at  P –0.0002 which proves that the changes are highly significant, while in group A mean score was 1.06 before treatment which was reduced  to 0.10 after treatment  after statistical analysis  of the score Z value was found to be 4.737 at P-0.0001 which indicates  significant reduction in Pinas .

Assessment of Aruchi : In group A mean  score of   patients  with Aruchi was 0.73 before treatment  which was  0.5 after treatment. After statistical analysis the Z value is 2.447 at P- 0.0144 which shows significant reduction in Aruchi While in group B  mean score of patients  with Aruchi was 0.93 which reduced to 0.46 after statistical analysis Z value was found  3.066 at p-0.0022  which means there is highly significant reduction in the score of Aruchi in group B.

Assessment of  Gaurav : In group A  while grading symptom Gaurav  mean score was 1.03 before treatment which was then reduced to 0.73 after treatment . On statistical analysis of the mean score Z was 2.641 at P -0.0083 which is highly significant and shows significant reduction in the symptom Gaurav in group A . In group B the mean score of symptom Gaurav was 0.93  before  treatment which was reduced to  0.46.  After statistical analysis the Z value is found to be 2.641 at P- 0.0083 which is highly significant and shows marked reduction in the symptom gaurav.

Assessment of Asyamadhurya : In group A the mean score of symptoms asyamadhuryata was 1.36 before treatment which was reduced to 0.9 after treatment  ,after applying statistical test the Z value is found to be 3.301 at P-0.0010 which is highly significant  and in Group B the mean value is 0.93 which was reduced to 0.36 after treatment  after applying statistics the Z value is 2.990 at P- 0.002 which is highly significant.  

For the purpose of evaluation of better drug in the comparison of both groups in this study, Mann-Whitney test was applied on the   scores of Symptoms. While comparing the drugs in this study such as Drug in Group A and Group B, Mean score in  the table indicates   that Group  B drug had better result on Mandagni, kaasa, Utklesh ,Aruchi,Pinas Gaurava, Nishthivan, while Drug in group A had better result on Asyamadhuryata.But after statistical analysis the all the parameters were found insignificant except pinas.

Discussion

Age wise in a study of total 60 patient 15 % were in age group 21-30,35% were in age group 31-40, 57% patients were of age group 41-50 ,10% of patients were of age group 51-60. Gender wises Out of total 60 patients 45% were males, and remaining 55% were females. Out of total 60 patients in study 14 patients were vegetarian and 46 patients were having mixed type of  diet .

In group A, 6.7% patients were having complete remission, 10% patients were having marked improved, 30% patients were having moderate improved, 40% patients were having Mild improved, 13.3 patients were unchanged. In group B, 10% patients were having complete remission, 13.3% patients were having marked improved, 46.7% patients were having moderate improved, 10 % patients were having mild improved.  In the study of whole 60 patients  6.7% were unchanged ,25% showed minor improvement, 38.33% showed Moderate improvement ,whereas 21.66% showed  marked improvement and 8.33% patients showed complete remission. After statistical analysis it is found highly significant and shows that the overall therapy was very effective and showed marked improvement in the patients of kaphaja kaasa and the study proved to be equivalent type.

Conclusion

Maximum number of subjects were of age group, 41-50 years that is out of total 60 patients 45% were males, and remaining 55% were females. Mean score in the table indicates  that Group  B drug had better result on Mandagni, kaasa, Utklesh, Aruchi, Pinas, Gaurava, Nishthivan while Drug in group A had better result on Asyamadhuryata. But after statistical analysis to compare the effect of both the drugs on parameters of kaphaja kasa  the changes  were insignificant  except the parameter pinas was significant. It shows that the overall therapy was very effective and showed marked improvement in the patients of kaphaja kaasa hence the study proved to be equivalent.