Clinical assessment of doshaja kasa with special reference to haematological parameters

Introduction

The respiratory system remains in constant contact with the external environment from birth throughout life, making it highly susceptible to infections and hypersensitivity disorders. Kasa is a disease described in Ayurveda that presents with symptoms of respiratory tract involvement. Among various respiratory ailments, Kasa is a significant manifestation affecting the Pranavaha Srotas, and its rising prevalence today calls for greater attention. The term Kasanat Kasa denotes a condition characterized by a sudden expulsion or movement from the head and throat. Ayurveda describes three primary types of Kasa—Vataja, Pittaja, and Kaphaja. Although numerous subjective parameters exist for evaluating Kasa, incorporating objective parameters enhances diagnostic accuracy. Objective assessment holds equal importance as subjective evaluation in determining disease pathology. Hematology, the branch of medicine concerned with the study of blood, plays a crucial role in this regard. Despite the advancements in medical diagnostics, blood analysis remains a key tool in identifying various illnesses and disorders. A thorough examination of blood components provides essential insights for accurate diagnosis and management. Therefore, this study aims to evaluate the role of hematological investigations in the diagnosis of Doshaja Kasa (Vataja, Pittaja, and Kaphaja).

Aims and Objectives

• To diagnose Vataja, Pittaja, and Kaphaja Kasa on the basis of classical clinical manifestations.
• To determine the correlation between Vataja, Pittaja, and Kaphaja Kasa and hematological parameters, and to evaluate the significance of hematological investigations in the diagnosis of Doshaja Kasa.

Materials and Methods

Diagnostic criteria

Subjects of Kasa diagnosed with following Lakshanas and of acute origin of cough with duration less than 15 days were selected.

Selection of Subjects

Inclusion Criteria

• Individuals of both genders within the age range of 16 to 60 years were included in the study.
• Participants exhibiting symptoms of Vataja, Pittaja, or Kaphaja Kasa as described in classical Ayurvedic texts were selected for the research.

Exclusion Criteria

Other respiratory disorders like- Kshataja & Kshayaja Kasa, Bronchiectasis, Pleural effusion, Lung abscess, Pulmonary Tuberculosis.

Assessment Criteria

Subjective Criteria

1. Subjects fulfilling the diagnostic criteria.
2. Characteristics of sputum– (color, volume, odor,any other unusual findings

Objective Criteria

1. Hematological investigations– TC, DC
2. Absolute Eosinophil Count
3. Erythrocyte Sedimentation Rate

Study Design

• A total of 150 subjects meeting the inclusion criteria were selected for the study.
• Each participant underwent a detailed examination, and symptoms were evaluated based on the Lakshanas of Vataja, Pittaja, and Kaphaja Kasa as described in Ayurvedic classics.
• The study was conducted by assessing both subjective and objective parameters of Vataja, Pittaja, and Kaphaja Kasa.
• Venous blood samples of the subjects were analyzed for TC, DC, AEC, and ESR using standard laboratory methods.
• The findings obtained from the clinical assessments and hematological investigations were critically analyzed to evaluate Doshaja Kasa.

Statistical Analysis

• Data collected was entered in MS-Excel and analyzed using SPSS version 23.
• Data is represented as tables and graphs as relevant.
• Chi square test was applied for the data to assessthe association between subjective and objective parameters.
• Obtained results were interpreted statistically significant at p<0.05.

Grading Pattern

Each of the Doshaja Kasa were graded on severityin to low, moderate and high based on number ofLakshanas present i.e., for

Vataja Kasa

1-2 Lakhanas – low
3 – 4 – Moderate
>4 – Severe

Pittaja Kasa

1 – 3 – Low
4-6 – Moderate
More than 7– Severe

Kaphaja Kasa

1-3 Lakshanas – low
4 – 6- Moderate
More than 7– Severe

• The selected objective criteria’s (T.C, D.C, A.E.C,E.S.R) were also categorized in to low, normaland high based on their laboratory values.
• Now chi-square test is applied between (low,moderate and high) severity of Kasa and (lownormal and high) values of hematologicalinvestigations to assess the association betweenthe subjective and objective parameters and toknow the significance of the selectedhematological investigations in diagnosingDoshaja Kasa.

Discussion on Results

Significance of Neutrophils in Vataja Kasa

The crucial involvement of neutrophils in immune-related disorders, particularly those affecting the respiratory system, is undeniable. Both innate and adaptive immune components play significant roles in activating neutrophils during various respiratory conditions. Neutrophils frequently interact with lymphocytes, together forming a vast immune-regulatory network.

• Neutrophil sequestration serves as a vital defensive mechanism within the lungs, involving several sequential processes, such as:
  • Activation of transcription factors
  • Production of chemokines
  • Upregulation of cell adhesion molecules
  • Strengthening of cell-to-cell interactions
    These steps help elucidate the key molecular components of innate pulmonary defense.
• The accumulation of neutrophils is therefore essential for initiating an effective adaptive immune response within the host.
• Various environmental stimuli can trigger chemotactic activity that directs neutrophils toward inflammatory sites.
• Neutrophils act as the first responders among immune cells, initiating further immune processes by signaling lung-resident lymphoid cells through the release of primary cytokines.
• Moreover, neutrophils and the cytokines associated with their chemotaxis and activation may play a role in the pathogenesis of dry cough, which could explain the elevated neutrophil count observed in Vataja Kasa.

Significance of Eosinophils in Pittaja Kasa

Eosinophils are multifunctional leukocytes that play a key role in the pathogenesis of various inflammatory conditions.

• In response to diverse stimuli such as immunoglobulins, cytokines, and components of the complement system, eosinophils become activated and migrate from the bloodstream to the site of inflammation. Once localized at the inflammatory focus, they influence immune activity by releasing several pro-inflammatory mediators.
• They are also involved in regulating cellular trafficking, vascular permeability, and mucus secretion.
• Eosinophilic cationic protein, secreted from eosinophil cytotoxic granules, suppresses T-cell proliferation, modulates immunoglobulin synthesis by B cells, induces mast cell degranulation, and stimulates mucus secretion within the respiratory tract.
• Since Paka (inflammatory process) and Shotha (swelling) are characteristic features of Pitta Vruddhi, the actions of eosinophils described above can be correlated with the pathophysiological mechanisms seen in Pittaja Kasa.

Significance of Lymphocytes in Kaphaja Kasa[12,13]

Lymphocytes play a vital role in the innate immune defense against viral, bacterial, and fungal infections, exhibiting rapid activation through cytokines and growth factors.

• There are three main types of lymphocytes: T cells, B cells, and natural killer (NK) cells.
• T lymphocytes act as immunomodulators and cytokine producers. Based on cytokine secretion patterns, helper T cells are categorized into Th1 and Th2 types. Th1 cells release IL-2, IFN-γ, and lymphotoxin, contributing primarily to antiviral immunity, while Th2 cells secrete IL-4, IL-5, IL-6, and IL-10, facilitating humoral responses. T cells recognize viral antigens present on the surface of infected cells, initiating targeted immune reactions.
• B cells are responsible for antibody production, which activates immune mechanisms to eliminate pathogens. They can identify surface antigens of both bacteria and viruses.
• Natural killer (NK) cells are cytotoxic lymphocytes capable of destroying infected or abnormal cells before extensive damage occurs. They form a crucial part of the body’s early defense against viral infections.

Given that lymphocytes are predominantly involved in immune responses to viral pathogens, the elevated lymphocyte count observed in Kaphaja Kasa may be attributed to the presence of viral infections.

Discussion on other Clinically Significant

Investigations

A.E.C was clinically significant in Vataja Kasa with 32% of the subjects of Vataja Kasa were recorded with higher ranges of A.E.C

Conclusion

• Vataja Kasa can be clinically identified by an increase in neutrophil and absolute eosinophil counts (AEC).
• The rise in AEC indicates the inflammatory activity of eosinophils, which is characteristic of Pittaja Kasa.
• The correlation between lymphocyte count and Kaphaja Kasa could not be conclusively established due to the limited sample size; hence, further detailed studies are required.
• Other hematological parameters such as basophils, monocytes, and total leukocyte count (T.C.) did not show any significant diagnostic relevance.

References

1. R.K.Sharma Bhagwan Dash. Charaka Samhita. Vol4. (Chikitsa Sthana). Varanasi; ChaukhambhaSanskrit Series; Reprint ed. 2015. p.158.
2. Sharma R.K & Bhagwan Das. Charaka Samhita.Vol 4. (Chikitsa Sthana). Varanasi; ChowkambhaSanskrit Samsthana; Reprint ed. 2015. p.159-161.
3. Srikanthamurthy K.R. Sushrutha Samhita. Vol 3.(Uttara Sthana). Varanasi; ChoukambhaOrientalia; Reprint ed. 2015. p.345.
4. Srikanthamurthy K.R. Ashtanga Hrudayam. Vol 2.(Nidana Sthana). Varanasi; ChowkhambhaKrishnadas Academy; Reprint ed. 2014. p.34.
5. Ann Craig 1, John Mai, Shanshan Cai, Samithamby Jeyaseelan. Neutrophil Recruitment to the Lungs during Bacterial Pneumonia. Infect Immun. 2009 Feb;77(2):568-75. doi: 10.1128/IAI.00832-08
6. Scott D. Kobayashi, Natalia Malachowa, and Frank R. DeLeo. Influence of Microbes on Neutrophil Life and Death. Frontiers in cellular and infection microbiology. 2017; 7; 159.
7. A Jatakanon, U G Lalloo, S Lim, K F Chung, P JBarnes. Increased neutrophils and cytokines,TNF-α and IL-8, in induced sputum of nonasthmatic patients with chronic dry cough.Thorax. 1999 Mar; 54(3): 234-7.
8. Rothenberg ME, Eosinophilic gastrointestinal disorders (EGID). The Journal of Allergy and Clinical Immunology, 113(1): 11-28; quiz 29.
9. H Kita, The eosinophil: A cytokine-producingcell?. The Journal of Allergy and ClinicalImmunology. 1996 Apr; 97(4):889-92.
10. Physiology and Pathology of Innate ImmuneResponse against Pathogens. Web of science https://api.intechopen.com/chapter/pdfpreview/56849
11. P Venge, J Bystrom, M Carlson, L Hakansson, M Karawacjzyk, C Peterson, L Seveus, A Trulson. Eosinophil cationic protein (ECP): molecular and biological properties and the use of ECP as a marker of eosinophil activation in disease. Clin Exp Allergy. 1999 Sep; 29(9):1172-86
12. Akiko Iwasaki, Ellen F. Foxman, Ryan D. Molony. Early local immune defenses in the respiratory tract. Nat Rev Immunol. 2017 Jan; 17(1): 7–20.
13. Harsh Mohan. Textbook of Pathology. Jaypeebrother Medical Publishers. 6th edition. p. 62-64.