Bronchial asthma is a chronic allergic condition caused by the sensitivity of the body, especially the respiratory organs, to external allergens, which are often harmless agents such as dust, pollen, tem-perature, etc. As a result of this hyperreactivity of the bronchial tis-sues, there is a production of excess phlegm, swelling, and partial blockage of the bronchial passage resulting in wheezing and breath-lessness. The Ayurvedic concept and the pathogenesis of the disease are considered to be similar to that in Allopathy and these have been discussed.1The Ayurvedic term for bronchial asthma, tamaka swasa or less correctly kasa swasa, consists of the names of its two major symptoms—cough (kasa) and breathlessness (swasa). A number of plants recommended by Caraka are still in use today. There are 33 major herbs that have been listed1and 22 plants that have been tried out clinically and reviewed.2
Adhatoda vasica Nees (Family: Acanthaceae)
Latin:Adhatoda zeylanica Medicus,Justicia adhatoda Linn.
Hindi: Arusa
Sanskrit: Vasa Tamil: Adhatodai
English: Malabar Nut Tree
Adhatoda vasica is an evergreen perennial shrub found all over India up to an elevation of 600 m.3The name of the plant is derived from the Tamil (adu: goat, thodathu: will not touch) because the fetid smell of the leaves keeps goats away. Therefore, it is often used for fencing in villages, as it is safe from grazing animals, and also be-cause it is then readily available for use. Medicinally the use of the plant—leaves, roots, and flowers— has been known for over 2,000 years. The Caraka Samhita recommends its use for cough. The leaf of Adhatoda vasica is traditionally used in Ayurveda for the treat-ment of cold, cough, bronchitis, and asthma. It is considered an ex-pectorant, and aids in the liquefying and removal of phlegm.3,4Not
only is it used as a hemostatic agent in bleeding disorders, it also helps in the healing of wounds, in peptic ulcer (see Chapter 3), and in pyorrhea and bleeding gums (see Chapter 14).5The leaf of Adhatoda vasica has the official status in the Indian Herbal Pharmacopoeia, 2002, as a bronchodilator and an expectorant.6
Among the constituents of Adhatoda vasica are an essential oil containing limonene, flavonoids, resin, and several alkaloids of which the major alkaloid is vasicine (~1 percent),3which has been shown to possess brochodilatory activity.7Vasicinone, a minor alka-loid, has been shown in vitro to be a potent vasodilator.8 In vivo vasicinone was found to be as potent a bronchodilator as theophylline and 5,000 times less potent than isoprenaline.9
Adhatoda vascia showed antiallergic and antiasthmatic properties in guinea pigs. A fraction containing the minor alkaloid vasicinol and 20 percent vasicine inhibited ovalbumin- and PAF-induced allergic reactions at a dose level of 5 mg per animal by inhalation and 2.5 g⭈kg⫺1 by intragastric administration.10 Adhatoda vasica extract of flowers and leaves has been shown in guinea pigs to have an antitussive activ-ity similar to codeine against coughing induced by irritant aerosols.11
A double-blind clinical trial was conducted on “Wintry,” a product con-taining 25 mg of a mixture of vasicine and vasicinone per tablet, against placebo. One tablet was given thrice a day against the placebo for 4 weeks.
An equal number of 30 patients of asthmatic bronchitis received the drug and the placebo, respectively. All patients were given 250 mg amoxicillin for the first week. Out of the 30 patients who received Wintry 21 showed improvement both clinically and on spirometer tests for lung function, 6 of the patients remained unchanged, the condition of 3 patients deteriorated.
Of those on placebo, only 4 patients improved, whereas 10 remained un-changed and the condition of 16 patients deteriorated.12
The leaves of Adhatoda vasica are also commonly used to treat cold and are considered to be effective when administered at the first signs of the infection. Despite the long history of its use, there are no clinical trials to evaluate the full scope of the use of this plant, and this is an urgent requirement.
Despite a long safe history of the use of Adhatoda vasica in human beings, there has been concern on the possibility that vasicine exerts an abortifacient effect,6based on evidence from parenteral administration.13
An experimental study on rats,14on the possible abortive effect of oral administration of 325 mg⭈kg⫺1per day of the leaf extract, produced no abortion in treated animals. Further, after an extensive review of the liter-ature, it was concluded that there is no scientifically valid evidence for potentially harmful effects on human beings, including the effect during pregnancy.15Chronic toxicity studies in two species with vasicine hydro-chloride at dose levels ranging from 2.5 to 20 mg⭈kg⫺1body weight did not show any toxic effects. There was no difference in the body weight and the mortality of test animals and controls. Histopathology showed no abnormality of major organs.16Total extract of the plant, dissolved in water at 2-8 ml⭈kg⫺1for 90 days, showed no toxicity.17
Albizzia lebbeck Benth. (Family: Mimosaceae)
Sanskrit: Sirish(a) Tamil: Vagei
Hindi: Siris English: East Indian Walnut Tree,
Siris Tree
Albizzia lebbeck is a large deciduous, spreading tree found all over India, up to an elevation of 1,200 m. The bark, seeds, leaves, and flow-ers are used for medicinal purposes; however, the bark is considered in the classic literature as the best antidote to both plant and animal poi-sons. It is used both as a single drug and in combination with other drugs in the form of bark powder or decoction.18In Kerala, the bark powder, made into a paste, is rubbed on the body to soothe itching.19
The stem bark contains 7-11 percent condensed tannins; procyanidin B-2, procyanidin B-5, and procyanidin C-1: (-)-epicatechin; D-catechin;
and isomers of leucocyanidin. Also present in the bark are friedelin,
- sitosterol, cardenolide, and anthraquinone glycosides.20-22Three sapo-nins named albizziasaponin A, B, and C have also been isolated.22 The flowers contain, approximately, 4 percent of an essential oil and several saponins lebbekanin A-H.20,22
The flower and bark decoction of Albizzia lebbeck has been stud-ied experimentally for its general pharmacological properties, and especially for its antiasthmatic and antiallergic effect.23It has shown
immunomodulatory activity and mast-cell stabilization apart from its ability to prevent allergen-induced bronchospasm.
In sensitized guinea pigs, the bark decoction acted as a shield against horse serum antigen,23whereas both the bark and the flower decoction protected against histamine-induced bronchospasm. The bark decoction had significant cromoglycate-like activity, such as ac-tion on the mast cells, and appeared to inhibit the early process of sensitization and synthesis of reaginic-type antibodies.24,25It reduced the secretion of macrophage migration inhibition factors.25Albizzia lebbeck, when administered simultaneously with histamine, reduces the release of catecholamine at a dose of 100 mg⭈kg⫺1up to a maximum effective dose of 200 mg⭈kg⫺1 bodyweight of alcoholic extract.26,27 Fractions of stem bark of Albizzia lebbeck also reduced the passive cutaneous anaphylaxis and mast-cell degranulation in rats.28Hot wa-ter and butanol extracts of the bark adminiswa-tered, once daily for 1 week, to mice that were previously immunized by sheep’s red blood corpuscles, developed higher antibody titer that was comparable to the standard drug muramyl dipeptide (MDP).29
Bronchial Asthma
A few trials have been conducted with the bark of Albizzia lebbeck in bronchial asthma. A total of 60 patients were given 25 ml of the aqueous decoction, from 100 g of the bark, four times a day for 3 weeks. Excellent results were obtained in cases of not more than 2 years duration; however, in patients with a long history of the dis-ease, the outcome was variable. The decoction was found to relieve difficulty in breathing, reduce cough, and increase the breath holding time, improve the vital capacity and forced respiratory volume in bronchitis. The saponins were considered to be the main active prin-ciple behind all these actions.30
In an open trial, 19 patients with bronchial asthma were given 30 ml decoction of shirish bark thrice daily for 6 weeks. There was significant fall in eosinophil count and the erythrocyte sedimentation rate ESR and increase in peak expiratory flow rate (PEFR). Nearly all patients experienced symptomatic relief. There was also highly sig-nificant effect based on a total of 12 subjective and objective parame-ters of bronchial asthma such as breathlessness, cough, paroxysmal
attacks of dyspnea, wheezing, rhonchi, pulmonary function tests, etc.
assessed in all patients before start of the trial and subsequently four times during and beyond treatment at 15-day intervals.31
The flowers have been tried out for tropical pulmonary eosinophilia.32See later in this chapter. Considering the results ob-tained so far, further trials need to be carried out with standardized material, controls, and larger patient numbers.
It has been reported that in the experience of Ayurvedic physicians no serious toxicity has been seen clinically.24In the clinical trial, us-ing the flowers of shirish, no side effect or toxicity was seen.32LD50in albino rats was found to be 2 g⭈kg⫺1body weight and LD00.4 g⭈kg⫺1. Rats that were given 25 mg⭈kg⫺1of Albizzia lebbeck daily for 2 weeks showed no difference, from controls, in body weight, general behav-ior, and food intake. In addition, the mortality rate was similar in both groups.24
Boswellia serrata Roxb. ex Coleb (Family: Burseraceae)
In Ayurveda, Boswellia serrata (see Plate 2 in color gallery) has been used in a number of conditions. In respiratory tract conditions like cough, bronchitis, fever, and asthma it is used either by inhalation of the smoke or as a decoction.33,34When taken internally, it acts as a stim-ulant expectorant in pulmonary diseases.35
Research has shown that the gum resin of Boswellia serrata is use-ful in a number of inflammatory conditions in which leukotrienes play an important role in the causation and maintenance of diseases, such as inflammatory bowel diseases—Crohn’s disease and ulcer-ative colitis,—rheumatism, asthma, and in the reduction of edema in certain kinds of brain tumor.34See Chapters 3, 8, and 13. In asthma, leukotrienes are the important mediators of inflammation, which cause bronchoconstriction, mucosal edema, enhance mucous secre-tion, and raise eosinophil levels. Therefore, leukotrienes have be-come important targets for potential antiasthmatic drugs.36 The boswellic acids present in Boswellia serrata have been shown to inhibit leukotriene synthesis, and therefore are capable of playing a potentially useful role in the management of asthma.
In a double-blind placebo-controlled clinical trial, 80 patients of bronchial asthma were given either 300 mg of gum resin of Boswellia serrata or 300 mg lactose as a placebo thrice daily for 6 weeks. In the treated group, the mean duration of the disease was 9-15 years.
Seventy percent of the treated group showed improvement in symp-toms, such as difficulty in breathing, rhonchii, number of attacks, and lung function tests such as forced vital capacity, etc.,36leading the au-thors to believe that further studies, with a standardized product, are required to confirm the initial results obtained.
Boswellia serrata is usually well tolerated; however, it can give rise to gastrointestinal side effects in a small percentage of patients.
In the bronchial asthma trial, with 300 mg thrice daily, 2 out of 40 pa-tients complained of stomach pain, nausea, and hyperacidity.36 See also Chapter 3, section “Boswellia serrata.”
Curcuma longa Linn. (Family: Zingiberaceae)
Latin:Curcuma domestica Valeton
Hindi: Haldi
Sanskrit: Haridra Tamil: Manjal
English: Turmeric
Turmeric is a commonly used household remedy for cough and cold, taken mixed in hot milk. It is used, internally, in Ayurveda, to treat asthma, cold, cough, and fever,37usually along with other herbs and rarely ever alone.38
Curcumin, the main active principle and coloring matter in tur-meric, has been shown to have a spasmolytic effect on various spasmogens.39 Extracts of turmeric have been shown to have an antiallergic effect; the ethyl acetate extract being the most active in exerting anti-inflammatory and antiallergic effect.40,41In addition, the curcuminoids are considered to be very effective antiallergic compo-nents;40the activity of ethyl acetate extract and curcumin being owing to the inhibition of histamine release.42
Powdered rhizomes of Curcuma longa were given in increasing doses from 4 to 32 g daily for 15-45 days to 71 bronchitis patients,
13 bronchiestatis patients, 18 bronchial asthmatic patients, and 12 tropical eosinophilic patients. A significant relief in signs and symptoms was noticed in 11 out of 71 cases of bronchitis, 1 out of 13 cases of bronchiestatis, 5 out of 18 cases of bronchial asthma, and 6 out of 12 cases of tropical eosinophilia.43
Turmeric powder either as such or after frying in ghee—made from butter by heating until most of the water evaporates— was given in a dose of 6-12 g for 15-20 days to patients of asthma with differing
“humoral vitiation” according to Ayurvedic criteria based on symp-toms such as degree of dyspnea, phlegm, dryness of throat, rales, and ronchii. Sixty percent of the treated patients showed improvement with a decrease in the intensity of cough and dyspnea. In addition, there was a reduction in the amount of sputum. In this trial, the diag-nosis was an Ayurvedic diagdiag-nosis, and there was variation in the dos-age also.38
It would be worthwhile to conduct a trial to check the dosage re-quirements and the kind of clinical response that can be achieved considering the continued scientific support that turmeric receives from modern investigations.
For details on the safety of turmeric, a commonly used spice in Indian cooking, see Chapter 3. In the trial on patients with bronchial asthma, who were given 12 g⭈day⫺1of turmeric powder, a few patients complained of dryness of mouth and throat, and a mild headache miti-gated by the reduction in the dosage or changing the so-called “vehi-cle,”38which in Ayurveda, are hot water, milk or milk with clarified butter (ghee), used to aid in the absorption of the drug and in directing it to the required site.
Ocimum sanctum Linn. (Family: Lamiaceae)
Latin:Ocimum tenuiflorum Linn. Hindi: Tulsi
Sanskrit: Tulasi Tamil: Thulasi
English: Holy basil, Sacred basil
Sacred to the Hindus, the holy basil is a small herb with an aromatic smell found throughout India and commonly cultivated in gardens and
courtyards. There are two varieties of this herb: one with green stems called Sri Tulasi and the other with purple stems known as Krishna Tulasi, which is the preferred one in medicine. The leaves of the holy basil are a commonly used household remedy for cough, cold, bron-chitis, and asthma. The leaves have the official status in the Indian Herbal Pharmacopoeia, 2002, for their expectorant properties.44
The leaves contain 0.4-0.8 percent of an essential oil containing eugenol and-caryophyllene as major constituents.44In addition, the leaves contain tannins (4.6 percent); ursolic acid; several sterols, such as-sitosterol, campesterol, sigmasterol; flavonoids, such as apigenin, luteolin, and their 7-glucuronides, molludistin, orientin;44-46 and acids, such as gallic acid, caffeic acid, chlorogenic acid, and rosmarinic acid.47
Several phenolic compounds, isolated from fresh leaves and stems, exhibited antioxidant activity (e.g. apigenin, rosmarinic acid) and demonstrated COX-1 and COX-2 inhibitory activity (e.g., eug-enol, apigenin, rosmarinic acid).48The alcoholic extract of Ocimum sanctum leaves was found to be protective against histamine and Acacia arabica pollen–induced asthma in guinea pigs in a dose-dependent fashion.49In addition, it acted as an inhibitor against hista-mine-induced spasm in guinea pig tracheal chain preparation.49A 50-percent alcoholic extract and volatile oil from fresh leaves inhibited histamine and acetyl choline–induced preconvulsive dyspnea in guinea pigs, but the extract from dried leaves did not contain these properties.50,51
All the trials with Ocimum sanctum are of preliminary nature and further trials are urgently needed with standardized preparations, larger patient numbers, and better methodology.
Asthma
In an open trial with 20 patients of asthma, 500 mg of Ocimum sanctum extract, made into tablets, was given thrice daily for 1 week.
Relief was observed, within 3 days, in breathlessness and in vital capacity, but there was no change in the eosinophil count.52In another open trial, the leaves of Ocimum sanctum were tried in cases of bronchial asthma and stress-related hypertension, and were found to
be highly effective in these cases. Unfortunately, more details are not available.53
Viral encephalitis
In a preliminary clinical trial, 16 patients with acute viral encepha-litis were divided into two groups: one group of ten patients received steroids, whereas the remaining six patients were given dried aque-ous extract from 2.5 g of fresh leaves four times daily. The crude extract of Ocimum sanctum was found to be more effective than ste-roids in the treatment of patients with viral encephalitis. In the steroid group two patients dropped out, six died, and two patients had resid-ual paralysis, whereas in the Ocimum sanctum group one patient dropped out, one died, three recovered completely, and one had resid-ual paralysis.54
The holy basil is generally considered a very safe drug, and many Indians often consume a few leaves as part of their daily ritual.55This habit is often cited as one reason for lower birth rates in men consum-ing holy basil leaves on a long-term basis, which may have some ex-perimental evidence in the reversible antiandrogenic property of the leaves.56No side effects have been reported in the clinical trials.46,52 Constipation was the only side effect, in one trial where doses rang-ing from 5 to 27 g were taken by 120 patients for 3 months.55
Piper longum Linn. (Family: Piperaceae)
Sanskrit: Pippali Tamil: Tippali
Hindi: Pipli English: Indian Long Pepper
Piper longum is a slender aromatic climber found throughout the hotter parts of India.57The roots, the stem, and more importantly the fruiting spikes are used for medicinal purposes.58Piper longum is a powerful stimulant and has been used for a long time for digestive and respiratory disorders. The fruits and stem are therefore often mixed with the ingredients of a stimulant soup called “Tippili rasam”
in South India as a household remedy for cough and bronchial disor-ders. Piper longum has been mentioned in the Caraka Samhita as a prophylactic agent in asthma.59It is used in Ayurveda to treat cough, cold, asthma, bronchitis, laryngitis, gas, abdominal distention, and also arthritis and sciatica.60,62 Piper longum is considered a rejuve-native drug for the lungs, and is used as a milk decoction to treat asthma.60 The fruits have the official status in the Indian Herbal Pharmacopoeia, 2002, for their antiallergic, antiasthmatic, and hepa-toprotective properties.57
The fruits contain 1 percent of an essential oil and 4-5 percent of the pungent principle piperine. Other minor components include piplartine and piperlongumine, and a low melting waxy alkaloid N-isobutyldeca-trans-2-trans-4-dienamide, piperidine alkaloids, a lignan, sesamin, terpenoids, and dihydrostigmasterol.57
The petroleum ether extract of the fruits acts as a respiratory stimu-lant at lower doses. However, with higher doses, it causes convul-sions in several species of small animals.61,62Crude extracts as well as the alkaloid piplartine suppressed ciliary movements in the esopha-gus of frog; piplartine being more active than the aqueous or alco-holic extracts, suggesting that Piper longum may act by suppression of cough reflex.63
Piper longum fruit-milk extract reduced effectively passive cuta-neous anaphylaxis in rats64and protected guinea pigs against antigen
Piper longum fruit-milk extract reduced effectively passive cuta-neous anaphylaxis in rats64and protected guinea pigs against antigen