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Research Article International Ayurvedic Medical Journal ISSN:2320 5091

HERBAL - A NEW APPROACH OF ADMINISTRATION Soni Gaurav1, Manohar. J2, Lahange Sandeep3 1PG Scholar, 2Assistant Professor, 3Lecturer, PG Department of Sharir Rachana, National Institute of Ayurveda, Jaipur, Rajasthan, India

ABSTRACT Ayurveda by itself can tackle the needs of health care today, though some adaptation can make it more valuable in today’s world. Ayurveda has a three tier structure i.e. Tatwa (Principle), Shastra (Theory) and Vyavahara (Practice). Vyavahara is the development of new applications according to particular problems that manifest differently. Medicinal re- quirement is not always fulfilled by systemic route so there is need to change the route to administer the drug. In Ayurveda proper Nebulization therapy has been not explained but the process of Dhumpana and Nasya may be analogous in some extent. Here in this work we had discussed various facts and factors for establishing new route of drug administration in form of herbal nebulizer. As we all know technique of nebulizer in form of aerosol through nebulization apparatus for herbal is better route for respiratory distress. Technique is tried on principle of Dhumpana and Nasya itself. Thus, this work gives the glimpse of con- cept of therapy described in Ayurvedic classics and establishment of newer con- cept of drug administration route i.e. through Nebulization. Yet a herculean work is needed for better and precise way of converting herbal drugs in form suitable for inhalation therapy. Key words—Inhalation therapy, Dhumpana, Nasya

INTRODUCTION Ayurveda is a thought process, an cines reveals the fact that Ayurveda has approach to understanding life, health and made enormous contributions to the man- disease. Classical Ayurveda by itself can ad- kind. Medicinal requirement is not always dress the needs of health care today though fulfilled by systemic route so there is need to some modification can be more effective change the route to administer the drug at and useful in today’s world. Ayurveda has a the site of pathology i.e. Local administra- three tier structure. Tatwa(Principle), Sha- tion; this provide advantage like less stra (Theory) and Vyavahara (Practice). The needed; least systemic and the Tatwas are relevant for all time periods. The highest surface area for absorption. In Ayur- Shastra is the new interpretation of the Tat- veda this route basically includes Nasya was according to the time and Vyavahara is karma1 (Errhine Therapy), Dhumpana,2 Si- the development of new applications accord- rodhara etc. ing to particular problems that manifest in This method arrived different times and places. History of medi- under the name of inhalation therapy in case Soni Gaurav et al: Herbal Nebulizer- A New Approach Of Drug Administration of respiratory diseases and its origins date 1. Literal review of Ayurvedic Classics and back to the name of Dhumapana in Ayurve- other relevant contemporary science lite- da in which fumes of drugs are inhaled for rature. required duration and with multiple frequen- 2. Internet material and research papers. cy based on disease severity. In Ayurveda proper Nebulization therapy has been not DISCUSSION explained but the process of Dhumpana, Route of drug administration: Dhoopan and Nasya may be comparable in Route of drug administration is mainly di- some extent. Herbal Nebulizer may likely to vided in- act on the required line of management in 1. Oral – the most convenient and most Swasha Roga3. As this therapy contains her- commonly used bal components, it may establish quite safe deal with the GI tract. Oral, Buccal. & without any side effects even after pro- 2. Parenteral - any route of administration longed use by the patients. other than the oral route don’t deal with The water soluble extract of herbal the GI tract. IV, SC, IM, Inhalation. drug4 having above properties can be used Selection of Route is determined by: for this purpose. The drugs will be adminis- The physical characteristics of the drug like- tered through nasal route in the form of 1. The speed which the drug is absorbed aerosol with the help of Nebulizer machine. and or released the need to bypass hepat- Here in this work we are going discuss vari- ic metabolism. ous facts and factors for establishing new 2. To achieve high conc. at particular sites way of drug administration in form of herbal Accuracy of dosage. nebulizer. 3. Condition of the patient. MATERIALS AND METHODS Route for administration -Time of effect: [TABLE No. 1] S. No Route of Administration Time of Effect 1. Ingestion 30-90 Minutes 2. Intramuscular 10-20 minutes 3. Subcutaneous 15-30 minutes 4. Rectal 5-30 minutes 5. Sublingual 3-5 minutes 6. Endotracheal 2-3 minutes 7. Inhalation 2-3 minutes 8. Intravenous 30-60 seconds 9. (topical) Variable (mins - hrs). Site of Drug Action: The site of drug ac- tion (Dosha-Dhatu-Mala-Agni) is easy, but tion (Adhikarana) and mechanism of drug the precise determination of specific site and action (Dravya Prabhava & Guna Prabha- the mechanism of action of the drug va) are the two most fundamental and yet are difficult and often impossible. most complex problems in pharmacodynam- A drug may act at the point ics. Generalizing about the site of drug ac- of application (Nipata) during transportation 1326 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015 Soni Gaurav et al: Herbal Nebulizer- A New Approach Of Drug Administration in the body (Adhivasa) by reflex effects Nebulization: Etymology: L-nebula, cloud; through nerves by reaching a definite con- Gk, izein- to cause centration in a particular tissue. Drugs that Nebulization is the process of medi- act only at the site of application are said to cation administration via inhalation. It uti- have local or topical action (through Nipata lizes a nebulizer which transports medica- by Rasa & Virya). tions to the lungs by means of mist inhala- Herbal drugs which are Katu, Tikta tion. It is a method of administration of drug Rasaj, Ushna Virya, Laghu-Tikshna-Ruksha by spraying it into the respiratory passage of Guna, Katu-madhur Vipaka Kapha-Vata the patient. The may be given Shamaka and contain volatile oils can be use with or without oxygen to help carry it into in Nebulization therapy. Ushna Virya in- the lungs. use oxygen, com- creases the basal metabolic rate, oxygen pressed air or ultrasonic power to break up consumption and accelerates the breakdown medical and suspensions into small of fat at mitochondrial level. According to aerosol droplets that can be directly inhaled Ayurveda, Ushna Virya helps in pacifying from the mouthpiece of the device. The de- Kapha and Vata. finition of an aerosol is a "mixture of gas There are some Drugs having Bron- and particles," and the best example chodilator, Anti-asthmatic, Anti- of a naturally-occurring aerosol is mist, inflammatory, Anti-allergic, Analgesic and formed when small vaporized water par- Anti-oxidant activity which can be used in ticles mixed with hot ambient air are cooled the form of herbal nebulizer for the man- down and condense into a fine cloud of visi- agement of Tamak Shwasa (Bronchial ble airborne water droplets. Asthma). An aerosol is a mist of fine droplets. Nasal drug delivery Advantages: The Nebulizers (sometimes spelt 'nebulizer') are nasal cavity is covered by a thin mucosa used in the clinical treatment of conditions which is well vascular. Therefore, a drug like asthma, bronchitis, COPD, cystic fibro- molecule can be transferred quickly across sis and chest infections. The nebulizer is ac- the single epithelial cell layer directly to the tually the container into which the liquid systemic blood circulation without first-pass medication is loaded for conversion to an hepatic and intestinal metabolism. The effect aerosol. The nebulizer is connected to the is often reached within 5 min for smaller compressor outlet with a tube. drug molecules. Local therapeutic effects The aerosol mist created by this not well absorbed into the deeper layers of process rises from the top of the nebulizer, the skin or , lower risk of and is delivered to the patient either through side effects, Transdermal route offers steady a facemask, or a connector which fits into level of drug in the system. the mouth. The choice of facemask or Inhalation deliver very small mouthpiece is usually left to patient prefe- amounts of the medicine directly in the air rence - although a higher dose is delivered way. The dose in this form is reduced to with a mouthpiece. about 1/50th the dose delivered by or Concept of Nebulization in Ayurveda: 6 thus the action of medicine is faster The Indians dried the tobacco and and there are no general side effects5. chewed them. They rolled the dry leaves, lit 1327 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015 Soni Gaurav et al: Herbal Nebulizer- A New Approach Of Drug Administration them and inhaled or smoked them- calling ment etc. for nasal application. Pradhmana this practice “Sikar”. of Nasya can be correlated with aerosol of ne- drugs was indeed one of the chief proce- bulizer drug. dures under the Panchakarma therapy of According to Sushruta, Avapidaka Ayurveda. Charaka prescribed a number of Nasya and Pradhmana Nasya are the part of herbal formulations as , past, oint- Shirovirechan Nasya. Whereas according to ment and so on for nasal application. They Charaka, Avapidaka Nasya having two type were used as snuff, blown into the nose Shodhan and Stambhan Nasya. Acharya ex- through a special pipe, rubbed in the cavity plained use of Kashaya Skandh drugs like as a or ointment. Shirisha13, Bharangi and Pushkaramoola14 In modern science Nebulization is for Stambhan Nasya etc. Thus, inhalation the therapy mainly for the respiratory dis- therapy is not new for Ayurveda, as from eases like bronchial asthma, COPD etc. In very ancient time Ayurveda are using this Ayurveda Proper Nebulization therapy has route of drug administration in various dis- been not explained but the process of eases. Dhumpana, Dhoopan and Nasya are may be Now let’s see the Pradhmana Nasya similar in some extent. Dhoopana has been as described in classics. Pradhmana15 literal- followed as a tradition in various religious ly means throwing powdered drug i.e. procedures from the period of BC era. This throwing Churna in nostrils. For which a 6 tradition is based on sound scientific preven- Angula Nalika has to make as described in tive public health principle. According to classics with which Churna is inhaled Charaka after Vamana Karma if vitiated through nostrils. According to Vidhay a dif- Doshas remain stick to Srotas at that time ferent method is described which states that Dhoompan has been done for proper elimi- powdered drug in Shuktipramana is kept in nation of Doshas. Charaka explained many thin cloth and a Potali is made which is kept drugs for Dhoompana as; Manashil, Deoda- near nostrils from which it is inhaled. This ru, Haridra, Hartal, Jatamansi, Agar, Gug- procedure can be most nearest to the concept gulu etc7. Manashilaadi8, Dhoompana is of nebulizer of modern era. widely use for other respiratory diseases like In the process of Nebulization it is Kasa(Cough). Acharya Sushruta also ex- aimed at delivering the drugs to the site of plained Laksha, Eaanda9, Manashil, Deoda- action directly into . Therefore ru for Dhoompana. In Ayurveda nasal route the action of the drug is very quick. The is used as route of drug administration in drugs which can be used should have ca- Nasya Karma for Panchakarma therapy. pacity to restrain Vata, kapha Dosha, and The Nasya10 of Lashuna11 (Allium Sativa) for amending the Samprapti of Tamak Swarasa and milk mixed with Chandana Shwasa like Dhatura, Shirisha16, Pushkar- (Santalum Album) has been advised in acute mool, Haritkyadi Yoga, Madhu etc. stage of Tamak Shwasa. Nebulization can be Inhalation: Inhalation is one of the novel correlated with Avapidaka Nasya12 in which routes for the administration of drug espe- Swarasa or Kalka-rasa is given through cially when it is intended for the manage- nasal route. Charaka mention so many her- ment of respiratory disorders. However, this bal formulations like powder, paste, oint- route is as old as Ayurveda. Jivaka was the 1328 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015 Soni Gaurav et al: Herbal Nebulizer- A New Approach Of Drug Administration first in Ayurveda person who incorporate Preparation of Nebulization Fluid: The inhalation technique. Acharya Charaka (200 following methods are employed for prepa- B.C) has also mentioned various Vamaka ration of Nebulization drug- Yogas17 in which powder of drug had been 1. Though classical Ayurvedic decoction inhaled. Asthma drugs are preferably in- preparation method. haled, because this route minimized system- 2. Through Soxhlet process by hot percola- ic absorption and thus, improves the ratio of tion method. the therapeutic benefit to the potential side- 3. Extraction of volatile oil through steam effects. These used at the min- distillation. imum dose and frequency required to main- Decoction Method: First of all of prepare tain acceptable asthma control. The respira- decoction as per need or as described in tory tract, which includes the nasal mucosa, classics. The extract was filtered and the re- hypo pharynx, and large and small airway maining mixture was again mixed with 16 structures, provides a large mucosal surface times of water and boiled to obtain one for drug absorption. The nasal mucosa is the fourth of decoction. The procedure was re- only location in the body that provides a di- peated till the mixture was totally exhausted. rect connection between the central nervous The final extract was then put in water bath system and the atmosphere. The term Aero- after complete evaporation of water obtained sol has a specific meaning denoting a fine was 22 ml. According to Ayurveda principle dispersion of liquid or particle in a gas of drug formation, 5% of alcohol i.e. 3ml of where the particle size is in 5-50 µm in di- ethanol was added to final volume of drug ameter looks as mist or smoke. was 22ml to which 3ml of alcohol was add- Aerosol: Aerosol therapy refers to the deli- ed and stored. very of a drug to the body via the airways by Soxhlet Process of Drug Extraction: The delivering it in an aerosolized form. Whe- drug was made by continuous hot percola- reas the aerosolized drug may be intended tion process known as Soxhlet process in for systemic use utilizing the vast surface which small volume of hot menstrum was area for absorption provided by the respira- passed over the drug by the time, as gain and tory tract, the overwhelming majority of the again to dissolve out the active constituents aerosols are meant for topical use. This form until the drug was exhausted. 100gm of of therapy has revolutionized the manage- crude drug in fine powdered form was taken ment of patients with various pulmonary in extraction chamber of Soxhlet and mois- diseases. Physical characteristics of aerosol tened with water and alcohol in the ratio of particles including the size (diameter), den- 2:1 for few hours until the drug was totally sity, electrical charge, hygroscopy, shape moistened. Thimble made of filter paper was and the velocity of the aerosol have an im- then placed into the wider part of the extrac- pact on the deposition of the aerosol.5,6 tor. The vapors are allowed to pass through These characteristics are dependent on sev- the side tube to the condenser where they are eral factors, namely the drug being used, its condensed and fall on the packed drug formulation and the device or the aerosol through which it percolates and extract out generator. the active constituents. On further heating, the menstrum vaporizes while the dissolved 1329 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015 Soni Gaurav et al: Herbal Nebulizer- A New Approach Of Drug Administration active constituents remain behind in the dis- standing its mode of action through pharma- solved active constituents till the drug is ex- cological studies. Few of these scientific hausted. Thus the same quantity of men- studies have already been done by the re- strum was made to percolate repeatedly, searchers but accuracy and effectiveness of about 14 to 15 times through the drug and which are yet to be interpreted. This work the active constituent were collected in the only gives the glimpse of concept of inhala- flask. tion therapy described in Ayurvedic classics The extract carried out by this method was and newer concept of drug administration then dried to know the solid mass. Out of route i.e. through Nebulization. A herculean 100 gm of crude drug, 30 gm of dried solid work is needed for better and precise way of extract was obtained. This extract was then converting herbal drugs in form suitable for dissolved in 2 liter of distilled water and 1 inhalation therapy. liter of absolute alcohol. REFERENCES RESULTS: 1. Agnivesa: Caraka Samhita:Rev. by Ca- Inhalation as a route for the administra- raka and Dradhabala with commentary tion of drug especially for the management by Cakrapanidatta: Chaukhamba San- of respiratory disorders is as old as Ayurve- skrit Samsthana: Varanasi, Sidhi Sthana da. Preparation of herbal Nebulization drug chapter9 can be by- a) Classical Ayurvedic decoction 2. Susruta: Susruta Samhita: with commen- preparation method. b) Soxhlet process. taries Nibandhasamgraha by Dalhana Technique of nebulizer in form of aero- and Nyayacandrika by Gayadasa : sol through Nebulization apparatus for her- Chaukhamba Orientalia, Varanasi : 5th bal drugs is better route for respiratory dis- Ed. (reprint 1992), Cikitsa Sthana chap- tress. ter 40/3 3. Agnivesa: Caraka Samhita:Rev. by Ca- CONCLUSION raka and Dradhabala with commentary This paper has been prepared with a by Cakrapanidatta: Chaukhamba San- sole aim of presenting the broad approach skrit Samsthana: Varanasi, Cikitsa on routes of herbal drug administration. Sthana chapter17 Here technique of nebulizer in form of aero- 4. Bhavprakash by Krichandra Chunekar, sol through Nebulization apparatus has been Chaukhambha Sanskrit Sansthan, 2006 p discussed for herbal drugs. An effort to 7, 15, 17. manage acute asthma through herbal drugs 5. Dr.Vikram Jaggi, Hindustan times Sun- can be given in the form of aerosol through day magazine, Dec 3;2006 herbal drugs mainly in condition where res- 6. Clinical Evalution of Role of Herbal Ne- piratory distress leads to loss of conscious- bulizer in the Management of Tamaka ness. Shwasa W.S.R. to Bronchial Asthma. It is also an approach to expand the know- (Dr. Divya kajariya,journal of ayurve- ledge of Ayurveda with the help of available da,vol.iv-2,april-june, 2010, page 27- modern techniques. Yet lot of work has to 33). be done for standardization of drug, under-

1330 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015 Soni Gaurav et al: Herbal Nebulizer- A New Approach Of Drug Administration 7. Ayurvedic /Nebulizers-An inno- Twak Kwatha in the Management of vative approach for the management of Tamaka Shwasa, J.R.A.S.,Vol. XXVI, Tamaka Shwasa. (Dileep K.S., Jobin Ja- No.1-2, (2005) pp.52-58. cob., Keshava and Debajit Battacha- 15. Agnivesa: Caraka Samhita:Rev. by ryya.). Global Ayurveda Festival,Kerala, Caraka and Dradhabala with commen- 9-12 February, 2012. tary by Cakrapanidatta: Chaukhamba 8. Agnivesa: Caraka Samhita:Rev. by Ca- Sanskrit Samsthana: Varanasi, Cikitsa raka and Dradhabala with commentary Sthana chapter17/123-124 by Cakrapanidatta: Chaukhamba San- 16. Agnivesa: Caraka Samhita:Rev. by skrit Samsthana: Varanasi, Cikitsa Caraka and Dradhabala with commen- Sthana chapter17/77-80 tary by Cakrapanidatta: Chaukhamba 9. Agnivesa: Caraka Samhita:Rev. by Ca- Sanskrit Samsthana: Varanasi, Sidhi raka and Dradhabala with commentary Sthana chapter9/107 by Cakrapanidatta: Chaukhamba San- 17. Agnivesa: Caraka Samhita:Rev. by Ca- skrit Samsthana: Varanasi, Cikitsa raka and Dradhabala with commentary Sthana chapter18/146 by Cakrapanidatta: Chaukhamba San- 10. Susruta: Susruta Samhita: with commen- skrit Samsthana: Varanasi, Sutra Sthana taries Nibandhasamgraha by Dalhana chapter 25 and Nyayacandrika by Gayadasa : 18. Agnivesa: Caraka Samhita:Rev. by Chaukhamba Orientalia, Varanasi : 5th Caraka and Dradhabala with commen- Ed. (reprint 1992), Uttara tantra chapter tary by Cakrapanidatta: Chaukhamba 51/50 Sanskrit Samsthana: Varanasi, Cikitsa 11. Agnivesa: Caraka Samhita:Rev. by Ca- Sthana chapter17/123-124 raka and Dradhabala with commentary by Cakrapanidatta: Chau Agnivesa: CORRESPONDING AUTHOR Caraka Samhita:Rev. by Caraka and Dr. Soni Gaurav Dradhabala with commentary by Ca- PG Scholar, PG Department of Sharir Ra- krapanidatta: chana, National Institute of Ayurveda, Jai- 12. Chaukhamba Sanskrit Samsthana: Vara- pur, Rajasthan, India nasi, Cikitsa Sthana chap- Email- [email protected] ter17/131khamba Sanskrit Samsthana: Varanasi, Sutra Sthana chapter2/3-5 Source of support: Nil 13. Susruta: Susruta Samhita: with commen- Conflict of interest: None Declared taries Nibandhasamgraha by Dalhana and Nyayacandrika by Gayadasa : Chaukhamba Orientalia, Varanasi : 5th Ed. (reprint 1992), Cikitsa Sthana chap- ter 40/44 14. Acharya JT. CharakaSamhita of Agnive- sa, Reprint ed. Varanasi: Chaukhamba Surbharati Prakash an; 2005. p.540. A Clinical Trial on the Efficacy of Shirisa 1331 www.iamj.in IAMJ: Volume 3; Issue 5; May - 2015