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| CASE REPORT |
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| Year : 2019 | Volume
: 7
| Issue : 3 | Page : 178-184 |
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Contribution of Ayurveda for the management of Swarabheda: A case study
Manju Mohan, Punam Sawarkar
Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, Maharashtra, India
| Date of Submission | 19-Dec-2019 |
| Date of Decision | 02-Jan-2020 |
| Date of Acceptance | 07-Jan-2020 |
| Date of Web Publication | 31-Jan-2020 |
Correspondence Address:
Dr. Manju Mohan
Department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, Maharashtra.
India
 Source of Support: None, Conflict of Interest: None  | 1 |
DOI: 10.4103/JISM.JISM_59_19
Background: Voice is a means of communicating verbal messages, which serves as a powerful carrier of personality and emotional, educational, and social status. Dysphonia (impaired voice production) is a very common ailment, affecting nearly one-third of the population at some point in their life. Hoarseness of voice can be correlated to Swarabheda in Ayurveda. The management provided by contemporary medicine for this condition is either conservative or surgical in nature, which is cost worthy. Aims and Objectives: The aim of this study was to assess the efficacy of Ayurvedic management of Swarabheda.Materials and Methods: A 35-year-old woman approached to Ayurvedic hospital with complaints of hoarseness of voice and difficulty and pain while deglutition and talking since 1 year. She was diagnosed with Vataj swarabheda and was treated with Panchakarma treatment including Marsha Nasya with Anutaila and Gandusha along with Shamana Chikitsa. The treatment was continued for consecutive 1 month. Results: Hoarseness of voice was assessed after 15 days with the help of Buffalo III Voice Profile and satisfactory outcome was found especially in the quality and loudness of voice, mental strength, and confidence of patient. Conclusion: The collaborative approach of the aforementioned therapy gives symptomatic relief in Swarabheda. Keywords: Buffalo III Voice Profile, dysphonia, Gandusha, Nasya, Shamana Chikitsa, Swarabheda
How to cite this article:
Mohan M, Sawarkar P. Contribution of Ayurveda for the management of Swarabheda: A case study. J Indian Sys Medicine 2019;7:178-84 |
| Introduction | |  |
Voice is the primary means of one’s communication. The human voice is an extraordinary attainment, which is capable of conveying not only complex thought but also refined emotion. Voice is the primary mechanism through which most of the people project their personalities and influence their environment. Vocal production is a multiplex behavioral act involving coordination between the systems of respiration, phonation, and articulation. These are influenced by an individual’s vocal technique and emotional status.
Hoarseness of voice is the most commonly occurring entity in voice disorders. Hoarseness (dysphonia) is defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Dysphonia is a broad clinical term, which refers to abnormal functioning of the voice.[1] Although hoarseness is used interchangeably with the term dysphonia, it is important to note that the two are not synonymous. Hoarseness is merely a subjective term to explain the perceptual quality (or sound) of a dysphonic voice,[2] whereas dysphonia characterizes impaired voice production as recognized by a clinician.[3]
Dysphonia, with the cardinal symptom of hoarseness, affects nearly one-third of the population at some point in their lives.[4] It occurs more frequently in females and the elderly.[5] Dysphonia primarily affects quality of life. Affected patients often experience social isolation, depression, anxiety, missed work, lost wages, and lifestyle changes.[6]
Hoarseness of voice includes pathological origin from irritants and inflammatory process due to systemic or local causes due to exposure to trauma (physical or mental) or any chemical exposure or any obstruction due to foreign or local entity (e.g., neoplasm) or any systemic disorders (e.g., thyroiditis and Hashimoto’s disease).[7] It is an important fact that benign lesions are numerically more common causes of hoarseness than malignant.[8] In most cases, it is a self-limiting condition but it may be progressive or serious in nature in advanced condition of disease. Hoarseness lasting longer than 2 weeks must be evaluated completely.[9] So it is essential to diagnose the condition first and then its radical cure to avoid further discomfort to the patient.
In Ayurvedic preview, hoarseness of voice can be correlated to Swarabheda, which had been described as separate entity by Sushruta.[10] It is further subclassified into six types according to the types of pathological and vitiation of Doshas. The voice affected by Vata becomes rough, feeble, and unstable and that affected by Pitta is associated with burning sensation in palate and throat and aversion to speaking. Due to Kapha, the voice becomes slow, obstructed, and stertorous. The voice obstructed by Rakta becomes depressed and rises with difficulty. Due to excessive impulse of cough, the voice damages the throat. Due to chronic coryza, it has predominance of Kapha and Vata.[11]
Till date the treatment remedies available for the hoarseness of voice in contemporary medicine are generally decided on the basis of the type and extent of pathology or causative factors, but it is quite expensive in nature and many patients are not willing to undergo surgery.[12] To overcome these lacunae, it will be novel to search a safe, cost-effective alternative therapy in ancient science such as Ayurveda. Through this paper, humble efforts are taken to focus over the utility of Ayurvedic treatment (Shodhana and Shamana) for the management of Swarabheda with a safe and effective manner.
Aims and Objectives
The aim of this study was to assess the efficacy of Ayurvedic management of Swarabheda including Shodhana and Shamana Chikitsa.
| Materials and Methods | | |
It is a single case study.
History of Present Illness
Demographic details of the patient are mentioned in [Table 1]. A 35-year-old woman was apparently healthy before 1 year, then she started complaints of hoarseness of voice, difficulty and pain while deglutition and talking, and dry cough[13] since 1 year. These chief complaints are mentioned in [Table 2]. Simultaneously, she also had complaints of feverish sensation (at evening only) since 7 months. Along with above complaints, she had symptoms of loss of appetite since 5 months and sticky motions (four to five times daily), unsatisfactory bowel habits, and pain in lower back region since 2 months. These associated complaints[13] are mentioned in [Table 3]. Patient had also taken allopathic medicine for hoarseness of voice from different private practitioners for consecutive 7 months, but there was no improvement in hoarseness of voice; difficulty and pain while deglutition was persisted, so she had stopped to take any type of medicine since 3 months. There was severe discomfort and increasing severity of symptoms. So, she approached to outpatient department of Panchakarma, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, for ayurvedic treatment and she was advised for admission and appropriate Panchakarma treatment was prescribed to her. Vitals examination and Astavidha pariksha of the patient are mentioned in [Table 4] and [Table 5], respectively. Patient had known case of hypertension since 1 year and on regular medication., , , ,
Past History
She had a history of fever (pyrexia of unknown origin [PUO]) before 12 months. She had no history of major medical illness, such as diabetes mellitus, bronchial asthma, hypothyroidism, and dengue, as well as no history of trauma/exposure to any chemical or surgical intervention.
Medication History
The patient had history of taking allopathic symptomatic medicine for hoarseness of voice (tab Eltocin-BR 500 mg twice a day [BD] and tab Ibuprofen 200 mg BD) and antihypertensive medicine (tab Amlodipine 5 mg once a day [OD]) since the last 1 year.
Menstrual History
Her past menstrual cycles were regular: 2–3 days cycle, moderate pain, and moderate flow.
Personal History
Food habits: Pure vegetarian with daily intake of stale food, twice a day, and irregular interval of food.
Sleep: Disturbed sleep due to dry cough
Addiction: No addiction
Family history: Not significant
Local Examination
Inspection: Nodular swelling over anterior part of neck and no any scar mark in the neck.
Oral cavity: Mouth opening––three fingers
Tongue––Coated
Teeth––Stained
Floor of mouth––Normal
Buccal mucosa––Normal
Palpation: Feeling of nodular hard swelling over anterior part of neck but no tenderness was there. Cervical lymphadenopathy was over the right side of the neck.
Nidana Panchak
Hetu (etiology or causative factors): Dietary products including poha, biscuits, roti, dal, rice, intake of spicy food, daily intake of stale food, and irregular timing of food intake.
Purvarupa (prodromal symptoms): Difficulty and pain while deglutition and talking
Rupa (manifestation): Hoarseness of voice, difficulty and pain while deglutition and talking, dry cough, sticky bowel habits, loss of appetite, and feverish sensation (at evening only).
Upashaya (relieving factors): Consuming lukewarm warm water.
Samprapti (pathophysiology of the disease): Above causative factors causes Avarodha (obstruction) of Rasavaha Srotas and generation of Aam (undigested morbid material), which leads the Vayu to moves upwards and results in afflicting the upper part of the body and which takes over the function of Udana Vayu (function of speech), then settles in the throat region and ultimately afflicts Swaravaha Srotas leads to hoarseness of voice which is Avarodha janya Vataj Swarabheda.[14]
| Factors Involved in Pathophysiology of the Disease | | |
In this clinical entity, there is obstructive pathology occurred in gastrointestinal tract that involves vitiation of Vata and Kapha Doshas due to severe hampering of biofire; it leads to the formation of various biotoxins and they are get saturated in alimentary canal. Basically, Kantha Pradesh is Kapha Sthana, so symptoms of disease occurred in this region which involves various circulatory channels along with disturbance in excretory system due to irregular bowel habit. Due to vitiation of all these channels, it further obstructs the proper movement of Prana and Udana Vayu, which ultimately reflects in symptoms.
Investigations advised: Complete blood count (CBC), liver function test (LFT), Widal test, Peripheral Smear for Malaria Parasite, thyroid profile, Mantoux test, and ultrasonography (USG) of neck.
Investigations done: Color Doppler study of USG neck done on May 4, 2019 revealed sign of benign colloid cyst in both lobes of thyroid and bilateral cervical lymphadenopathy was found. Patient was not willing to do rest of advised pathological investigations due to economical crisis.
Diagnosis: Vataj Swarabheda
Treatment advised: Overviewing the above pathogenesis of disease in the patient, the following treatment plan was prescribed, which can be subclassified into two categories, that is, Shodhana and Shamana Chikitsa shown in [Table 6] and [Table 7], respectively.,
| Observations and Result | | |
The aforementioned Shodhana Chikitsa was continued to the patient for consecutive 15 days and Shamana Chikitsa was continued for whole 1 month, then assessment of patient was done after 15 days and to assess the voice quality of patient, audio recording of her voice was taken before starting of treatment and after 15 days of completion of treatment. Both recordings reflect that the nature and quality of voice was significantly improved. In addition, there was complete relief in symptoms such as feverish sensation, low backache, frequency and consistency of bowel habit, and difficulty and pain while deglutition and talking, which are assessed by subjective criteria shown in [Table 8]. Appetite was significantly improved, so the prescribed treatment regime was further continued for next 15 days.
Assessment of clinical symptoms: Her voice was assessed after 15 days and 1 month with the help of Buffalo III Voice Profile[15] shown in [Table 9].
| Discussion | | |
Taking into account all the factors associated with Nidanapanchak in this patient, the treatment principle of Vataj Swarabheda along with Anubandha of Aam was adopted by using the basic principle of Ayurveda and miraculous result was observed. As per classics, ideally Shodhana Chikitsa (Vamana, Virechana, and Vasti) with proper unction is advised in Swarabheda, which should be followed by Nasya, Avapidan, Mukhadhavana, Dhuma, Leha, and various types of Kavalgraha.[10] Because of financial crisis, patient was not willing for the purification therapy, so she was advised for Marsha Nasya and Gandusha. The probable mode of action of prescribed treatment can be explored as follows.
Shodhana Chikitsa
Sthanik Abhyanga followed by Nadisweda: Abhyanga (massage) acts on the roots of mamsavahasrotas (channels carrying muscle nutrients and waste), that is, Snayu, twak, and raktavahini. Swedana (sudation) is Sthambhaghna (removes stiffness), Sheetaghna (removes cold), Srotoshuddhikar (clears the micro channels), and Kapha-vata nirodhana (removes excess vata and kapha dosha). Snehana and Swedana, which are performed before Nasya procedure, dissolve the Doshas and can be dislodged by Nasya.[16]
Marsha Nasya with Anutaila: Swarabheda is one of the Urdhwajatrugata Vikara and Kanthagata Roga. Nasya is the prime Shodhana procedure preferred because this is a unique procedure, which can achieve Uttamanga shuddhi.[17]Nasya with Anutaila is Sukshma Srtotogami and has Vataghna, Brumhana, and Snehana properties.[17] Profuse secretions occur after administration of Anutaila Nasya. Chest, head, pallet, and throat are invaded with Kapha Dosha. Anutaila firstly reaches to minute channels, drives out the Kaphadi doshas from their site, then oleation and strengthening action takes place on ligaments and tendons of upper part of the body.[18] Regular use of Anutaila helps in clear perception of sense organs and clarity of voice.[19]
Gandusha with Triphala, Haridra Kwatha, and Saindhava lavana: Gandusha is a form of retention of fluid in the mouth for a stipulated period until the occurrence of lacrimation and nasal discharge, and then the patient is advised to spit out.[20] Regular use of Gandusha results in Swarabalam (strength to voice), Hanubalam (strength to jaws), strength to face, Ruchyam (better taste perception), Drudadantha (strong and healthy teeth), and resistance against Doshaja or Aaganthuja Mukharoga.[21] The active ingredients and chemical constituents of the medicated liquid stimulate the chemo receptors and mechanoreceptors in the mouth to send stimuli to salivary nuclei in the brain stem. As a result, the parasympathetic nervous system activity increases and impulses sent via motor fibers in facial and glossopharyngeal nerves. They produce forcefully increased output of salivary secretion which predominantly watery (serous). The metabolic waste (toxins), food debris and depositions as well as microorganisms present in the oral cavity get dislodged and mixed with retained medicated liquid and removed from the oral cavity.[22]Gandusha with Triphala acts as a good oral cleansing method and also helps in maintaining good pH balance in the oral cavity and has anti-inflammatory, anti-allergic, antibacterial, analgesic, and antipyretic properties and immunomodulatory effect.[23]Haridra is useful in inflammation, cough, asthma, and anorexia and has anti-inflammatory, expectorant, and anti-allergic properties.[24]
Shamana Chikitsa
Dadimashataka Churna: It[25] pacifies Agni and regulates Jatharagni. Its Katu and Tikta Rasa pacify vitiated Kapha, whereas Ushna Virya helps in balancing Vata Dosha. It clears all the Sroto avrodha and also havs Ama-nashaka properties that maintain equilibrium of Rasa Raktadi Dhatus.[26]
Mahasudarshan Kwatha: It is an antipyretic medicine that corrects the Rasadushti and breaks the further generation of Aam and has Tridosha Shamaka properties. It also corrects appetite and maintains the strength of the body. The decoction prepared with Tikta Rasatmak Dravya such as Musta, Parpata, and Shunthi has Aampachaka property, is effective in Samavastha of Jwaras, and helps to open up the microchannels in the body, which induces sweating and lowers the fever.[27]
Sanjivani Vati: It[28] is Grahi in nature so corrects Saam Mala and decreases the frequency of unformed stool. It has Ushna virya and has Agni Dipana and Vata kaphahar properties. It has analgesic, antispasmodic, carminative, antidiarrhoeal, antitussive, stimulant, stomachic, antimicrobial, antipyretic, and immunomodulator properties.[29]
Laxmivilas Rasa: It[30] is a herbo-mineral combination, which is mainly indicated in Shiroroga, Dushta Pratishyaya, Kasa, Shwasa, and Rajyakshma, and acts as Kapha vatahara and Kledahara. It helps to destroy the vitiated Kapha and rejuvenates the Prakruta Kapha.[30]
Kanthasudharak Vati: It is an Ayurvedic medicine manufactured by Unjha Ayurvedic Pharmacy, Gujarat, India which is the best medicine for the throat problems. The main ingredients are Yashtimadhu (Glycyrrhiza glabra), Pudina (Menth piperata), Kapoor (Cinnamomum comphora), Ela (Elettaria caradamomum), Lavanga (Syzygium aromaticum), and Jatiphala (Myristica fragrans). It is mainly indicated in hoarseness of voice, sore throat, and cough. It is Vata Kapha Shamaka and Shwasa Kasahara and has Agnideepana property. It withdraws the sputum from respiratory tract, gives freshness, and improves the appetite.[31]
Lukewarm Yashtimadhu Phanta: Yashtimadhu (Glycyrrhiza glabra) is sweet, soothing, and has antioxidant, immunostimulatory, antitussive, demulcent, and expectorant properties.[32] Therefore, it improves the quality of voice and also useful for treating cough, sore throat, and bronchial catarrh. It is mentioned by Sushruta to consume Yashtimadhu mula Churna with Ksheera in Swarabheda.[10]
Sitopaladi Churna with honey: It is mainly indicated in Shwasa, Kasa, Kapha disorders, Suptajivha, Arochaka, Mandagni, and Parshwa shula. It acts as appetizer and digestive stimulant and also has immunomodulatory, antitussive, bronchodilator, antihistaminic, and anti-allergic properties.[11]
Taking into account all the above discussions that the overall effect of all treatment regime planned in this patient induces Vatakaphaghna, Aam Nashaka, Srotoshuddhikar, Kasa Shwasahar, and Swarabalam effects, it can be used as an excellent anti-inflammatory, antitussive, bronchodilator, antihistaminic, and immunomodulator therapy, which improves the quality of voice.
| Conclusion | | |
The patient was admitted for 15 days and got satisfactory relief in symptoms of Swarabheda. The results revealed that Swarabheda can be cured effectively with collaborative approach of Panchakarma procedures including Marsha Nasya, Gandusha along with Shamana Chikitsa without causing any adverse events. Till date there is no need for patient to undergo any modern medical or surgical intervention. This study is about the presentation of the single case only. Further study in large sample size must be recommended for establishing good and standard outcome.
Financial Support and Sponsorship
Nil.
Conflicts of Interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]
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