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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 27-34

Exploring potential of Kushmanda Avaleha in respiratory illness – A comprehensive review


Department of Rasashastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India

Date of Submission28-Jul-2021
Date of Acceptance19-Nov-2021
Date of Web Publication27-Jun-2022

Correspondence Address:
Dr. Sheetal Sharma
Department of Rasashastra and Bhaishajya Kalpana, All India Institute of Ayurveda, Sarita Vihar, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_84_21

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  Abstract 


Respiratory ailments represent over 10% of all disability-adjusted life-years, a statistic that reflects the measure of active and productive life lost owing to a condition. A large number of Confections (Avaleha) have been recommended in various authoritative treatises by ancient seers for different respiratory disorders. Kushmanda Avaleha is one such multi-ingredient Ayurvedic formulation, which is advocated for the first time in Ashtanga Sangraha for Cough, Hiccups, Fever, Dyspnea, etc. Its chief constituent is Benincasa hispida Thumb. It has also been included in the Essential drug list published by the Ministry of AYUSH. Thus, this article is emphasized on compiling and exploring various classical references as well as reported current literature in various scientific journals and online databases about the therapeutic potential of Kushmanda Avaleha as well as its ingredients with special reference to respiratory illness. All the information has been placed here in comprehensive manner. Moreover, a number of studies have also been conducted and published which established the efficacy of its all ingredients in diverse respiratory pathologies through manifold mechanisms such as Bronchodilator, Anti-tussive, Mucolytic, etc. Therefore, on meticulous appraisal, it can be inferred that Kushmanda Avaleha is a complete care and an effective medication for various respiratory disorders.

Keywords: Avaleha, Benincasa hispida, Bronchitis, Kushmanda, Respiratory disorders


How to cite this article:
Sharma S, Kaushik S, Yadav P, Ruknuddin G, Prajapati PK. Exploring potential of Kushmanda Avaleha in respiratory illness – A comprehensive review. BLDE Univ J Health Sci 2022;7:27-34

How to cite this URL:
Sharma S, Kaushik S, Yadav P, Ruknuddin G, Prajapati PK. Exploring potential of Kushmanda Avaleha in respiratory illness – A comprehensive review. BLDE Univ J Health Sci [serial online] 2022 [cited 2022 Aug 14];7:27-34. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/1/27/348280



Ayurveda being a holistic science of life imbibes within itself a couple of classical doctrines, i. e., Maintenance of healthy state of healthy individuals (Swasthasya Swasthasya Rakshanam) and Alleviation of ailments of diseased personnel (Aaturasya Vikaaraprashanam). To attain the twain doctrines, numerous medicinal preparations have been explicated in various traditional compendiums. The basic therapeutic components have been termed as Five Fundamental Preparations[1] (Panchvidha Kashaya Kalpana). However, these primary preparations have several drawbacks such as less palatability, shorter shelf life, prepared freshly each time, etc. Hence, secondary formulations were developed to prevail over these limitations, and sometimes, it provides better results too. Avaleha Kalpana is one of such popular formulations, semisolid in consistency and is prepared by using herbal medicinal drugs and food articles including sugar, ghee, honey, etc.[2] There are 13 avaleha possessing Rasayana attributes are mentioned in Charaka Samhita, Chikitsa Sthana. In addition, 32, 07, and 20 Confection (Avaleha) are laid down in Ayurvedic Formulary of India Part-1[3], Part-2[4] and Part-3,[5] respectively, which can be further modified into other dosage forms such as granular preparations (khanda), lickable preparation (lehya) which are nutrient to body and mind with adapto-immuno-neuro-endocrine-modulator property (Rasayana), paka, confection, etc., based on its consistency.

Respiratory illness particularly chronic obstructive pulmonary diseases (COPD), Asthma, tuberculosis imposes a huge global health impact.[6] Altogether, above 1 billion people suffer from either acute or chronic respiratory conditions. The stark truth is that 4 million people per year die prematurely from chronic respiratory disease.[7] A large number of Avaleha[8] have been recommended by ancient seers for various respiratory ailments. The present article is intended to throw light on one important Avaleha preparation i.e., Kushmanda Avaleha (hereafter referred as KA). It is a multi-ingredient Ayurvedic formulation advocated for the first time in Ashtanga Sangraha[9] for Cough (Kasa), Hiccups (Hikka), Fever (Jwara) Dyspnea (Swasha), Bleeding disorders (Raktapitta), Wound (Kshata), Emaciation (Kshaya), useful in thorax injury (Urasandhanajananam), promote intellect and memory (medhasmriti), improves physical strength (bala pradama). Its chief constituent is Benincasa hispida Thumb[10] (Kushmanda) which has been accounted in detail in Ayurvedic Materia Medica. It is also named as Shweta petha, ash gourd, white pumpkin, winter melon, etc. In the taxonomic classification, Benincasa hispida belongs to the Cucurbitaceae family. Under this family, approximately 30 varieties of pumpkins have been identified and categorized namely Cucurbita pepo, C. maxima, C. moschata.[11] Kushmanda (Benincasa hispida Thumb.) is widely utilized vegetable crop particularly in Asian communities for both nutritional and therapeutic benefits.[12] Its fruits have long been used as a diuretic (Mutravirechana), laxative (Malasodhaka) aphrodisiac (Vrisya), cardiotonic (Hridya) and in treatment for several respiratory, urinary, gastrointestinal ailments, etc.[13],[14],[15] A number of studies have been conducted and published which established the efficacy of its all ingredients in diverse respiratory diseases. It has also been included in the Essential drug list published by the Ministry of AYUSH.[16] Considering these facts, this article is emphasized on compiling and exploring various classical references as well as reported current literature about therapeutic potential of Kushmanda Avaleha as well as its ingredients with special reference to respiratory illness.


  Methods for Literature Search Top


Extensive literature search pertaining to Kushmanda avaleha was performed through available classical treatises such as Charaka Samhita, Sushruta Samhita, Astanga Hridaya, Yogratnakara, etc., along with official standards namely, Ayurvedic Formulary of India and Ayurvedic Pharmacopoeia of India. Apart, relevant researches published in various scientific journals and online databases were also screened to gain contemporary insights about the benefit of this formulation primarily in respiratory disorders. All the information has been placed here in comprehensive manner.


  Results of Literature Search Top


In-depth meticulous appraisal of classical authoritative texts spotted that Kushmanda Avaleha has been documented in around 20 treatises under 12 different nomenclatures stated as Kushmanda Rasayana,[17],[18] Kushmandaka Rasayana,[19] Khanda kushmandaka,[20],[21],[22],[23] Khanda Kushmanda,[24] Khandakushmanda,[25],[26] Khandakushmandakavaleha,[27] Kushmanda avaleha,[28],[29],[30],[31],[32],[33],[34] Kushmanda Khanda,[35],[36] Brihat Kushmanda avaleha,[37] Kushmanda Paka Brihat,[38] Kushmanda Paka Mahan.[39] It is addressed as Kusmandaka Rasayana in AFI[40] and API.[41] The consolidated outlook of its integral constituents along with their quantity and part used is depicted in [Table 1]. Majority of the classical compendiums endorse this opinion whereas few of them recommended variations in either the number of components or their amount. Those additional peculiarities can be elucidated in [Table 2].
Table 1: Ingredients of Kushmanda Avaleha along with their part used and quantity

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Table 2: Variation in components of Kushmanda Avaleha

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The variable used by Ayurveda to explicate the pharmacological properties of medicine is Five factors of Substance (Rasapanchaka) which include Taste (Rasa), Properties (Guna), Potency (Virya), Rasa after digestion and metabolism (Vipaka), specific pharmacological effect (Prabhaba).[42] Conventional molecular model doesn't correspond with the ayurvedic postulates. Hence, the Rasapanchaka of its all ingredients is represented in [Table 3] to comprehend the pharmacokinetics of KA. Majority of its constituents are Sweet (Madhura), Pungent (Katu) Rasa, Light (Laghu), Dry (Ruksha) Guna, Hot (Ushna) Virya, and Sweet (Madhura) Vipaka. Looking over the accessible quotations pertaining to KA, it is also divulged that KA has been chiefly advocated for a lot of respiratory and bleeding disorders considering Kasa, Shwasa, Kshaya, Hikka, Raktapitta, Kshata, etc. Apart, it has been indicated as a potent nutrient taking terms namely, Providing strength (balakrita), Heaviness (brimhana), Aphrodisiac (vrishya), rasayana into account. Furthermore, it has also been prescribed for various other gastrointestinal and psychological disorders. All the therapeutic attributes of KA are enlisted in [Table 4]. It is advised to administer it orally in strength starting from 5 gm[22] to 48 gm[26] by different seers but, has been prescribed in dosage of 6–12 g along with cow milk or water as an adjuvant as per official standards.[40] In addition, Ayurveda Sara Sangraha[36] and Harita Samhita[33] mentioned goat milk and honey also as its vehicle, respectively.
Table 3: Rasa Panchaka of all ingredients of Kushmanda avaleha

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Table 4: Therapeutic attributes of Kushmanda avaleha as per different classics

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  Compilation of Published Researches Top


On exploring various scientific journals and online databases, a small number of studies have been traced. Only three clinical trials and two analytical studies in apropos of KA have been found till date. A prospective, open-label multicentric study with Kushmandaka Rasayana in the strength of 10 g BD daily with lukewarm water on 193 patients of chronic bronchitis was carried out in three peripheral centers of the Central Council for Research in Ayurvedic Sciences (CCRAS).[55] Statistically, significant improvement was observed in clinical symptoms, forced expiratory volume in the first second, and clinical COPD questionnaire without any adverse drug reactions/adverse events. Another clinical trial was conducted to manage Hyperacidity (Amlapitta) in 25 patients in a dosage of 25 gm BD along with lukewarm milk (Sukhoshna Dugdha) in which results were found statistically significant.[56] One more Exploratory Clinical Trial to Evaluate Efficacy of Kushmanda kalpa for weight gain in 100 Malnourished Children (as per IAP classification of malnutrition) from various Aanganwadis has been reported.[57]. In this study, Kushmanda kalpa was found effective in improving physical strength (balya) in Malnourished children than regular standard diet in Aanganwadi. After the therapy of three months, weight of children has been significantly increased in the trial group than the control group. The research work done pertaining to the evaluation of its nutritive value[58] stated that 100 gm KA contains 4.44% of fats, 1.05% of proteins, 82.10% of carbohydrates, 60 mg of sodium and 11 mg of zinc which provides 372 Kcals energy to the body. Besides, its pharmaceutico-analytical profile[59] has also been generated in research. Moreover, numerous current researches substantiate the efficacy of its ingredients in copious respiratory ailments through manifold mechanisms such as Bronchodilator, Anti-tussive, Mucolytic, Anti-inflammatory, Anti-allergic, etc., which are placed in [Table 5].
Table 5: Reported studies of various constituents of Kushmanda Avaleha

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  Discussion Top


Respiratory ailments represent over 10% of all disability-adjusted life-years, a statistic that reflects the measure of active and productive life lost owing to a condition. Environmental allergens, Hereditary predisposition, indoor and outdoor air pollution, lower respiratory tract infection in childhood, airway microbiome composition, nutritional variables, and abnormal immunological responses may contribute to it. Furthermore, Asthma affects up to 334 million people globally[90] and its incidence has been rising for the past three decades.[91] It is responsible for 489,000 fatalities per year or more than 1300 deaths per day. There is a description of the disease itself becoming causative factor for some other disease (Nidanarthaka roga) in our ancient classical texts. It states-if Cough (Kasa) is not treated within certain time, then it will further lead to other diseases sequentially such as Cough (Kasa) to Bronchial Asthma (shwasa), Bronchial Asthma to Debility (kshaya roga), Debility to Vomiting (cchardi), Vomiting to Change in voice (swarabhedha) which eventually leads to Coryza (pratishaya). Hence, all these disorders are interlinked, caused by ignorance and owing to not treating them in meantime.

Avaleha is semi-solid dosage[92] form, that have a longer shelf-life[93] than primary dosage forms and is suitable for all three age groups, i.e., children (Bala), young (Yuva), and old (Vriddha).[94] In total, ten different methods for the preparation of avaleha including both with heat (Saagni) and without heat (Niragni) have been documented in our classical texts.[95] The fundamental components of this dosage form comprise liquid substance (Drava Dravya), sweet substance (Madhura Dravya), condiments (Prakshepa Dravya), and paste of drugs (Kalka Dravya). Kushmanda Avaleha is one such wonderful avaleha possessing Brimhana attribute which is extremely useful in treating respiratory ailments.[96] The major ingredients of Kushmanda Avaleha are Sweet Substances (Madhura dravya) namely, Kushmanda and Khanda. Madhura rasa masks the Tikta, Katu, Kashaya taste of the drug rendering it pleasant and more palatable. It also nourishes all tissues (Dhatus) as well as immunity (Oja).[97] Moreover, high percentage of sugar in the medicament along with licking mode of administration facilitate oral absorption, bring about the soothing effect in the throat, mitigating local irritation. Apart, Ghee (Ghrita) possess the virtues of Digestive (Agnidipana), Provides strength (Balakara), Aphrodiasic (Vrishya),[98] etc. It alleviates vata as well as pitta. In addition, Prakshepa Dravyas set out distinct characters to the formulation. They all own an aroma thus act as flavoring agents too and boost the acceptability of the product. Furthermore, Trikatu carry an active alkaloid i.e., piperine which accelerates the procedure of metabolism through rapid absorption of nutrients,[99],[100] Therefore act as bioavailability and bioefficacy enhancer of various phytoconstituents.[101] Honey is commended as the best catalyst (Yogavahi), i.e., any drug taken along with it will take over the therapeutic traits of the added drug. All these properties along with published facts about each constituent [Table 5] of Kushmanda Avaleha might aid in incepting possible mechanisms or its pharmacodynamics regarding respiratory care.


  Conclusion Top


This article provides synoptic review of a polyherbal formulation, Kushmanda Avaleha and its constituents pertaining to variation in their quantities along with various pharmacological properties and therapeutic attributes focussing on respiratory ailments chiefly. Looking into the literature available in various classics as well as scientific journals, it can be inferred that, Kushmanda Avaleha is a complete care and an effective medication for various respiratory disorders.

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Conflicts of interest

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