Pranavaha srotas

Prana means vital force, and srotas means channels of transformation and transportation. The energies in the different biological settings are carried through the channels. Pranavaha srotas carries the vital force throughout the body. It is placed first in the sequence of all srotas [Chakrapani Cha.Sa.Vimana Sthana 5/6] as it is responsible for sustaining life since birth to death. [Cha.Sa. Vimana Sthana 5/6] The other reason for prioritizing pranavaha srotas is that it is more susceptible to disorders due to more frequent exposure to external environment than other constituent srotas. Prana is among the five types of vata dosha, whose main function is expiration (nishvasa). Thus, all the activities in which prana vayu is directly or indirectly involved denote life. Therefore, pranavaha srotas is the most important factor for longevity. This article describes the physiological and pathological aspects of pranavaha srotas.

Contributors

Section/Chapter/topic	Concepts/Srotas/Pranavaha srotas
Authors	Bhojani M. K.1 Sharma Raksha1 Deole Y.S.2
Reviewer & Editor	Basisht G.3,
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India Rheumatologist, Orlando, Florida, U.S.A. 3 Rheumatologist, Orlando, Florida, U.S.A.Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
Correspondence emails	meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	September 27, 2023
DOI	10.47468/CSNE.2023.e01.s09.150

Origin

Heart (hridaya) and mahasrotas (gastrointestinal tract) are the origins of pranavaha srotas.[Cha.Sa. Vimana Sthana 5/8] Acharya Sushruta described hridaya and the channels carrying nutrient fluids (rasavahini dhamani) as origin of pranavaha srotas.

1. Hridaya: Charak and Sushruta have considered hridaya as the origin of pranavaha and rasavaha srotas. The relationship of heart (hridaya), pranavaha and rasavaha srotas reflects the pulmonary and circulatory systems as per contemporary physiology.
2. Mahasrotas: It is a gastrointestinal tract-like structure. It is the abode of amashaya and pakwashaya (stomach, small intestine, and large intestine).
3. Dhamani: Dhamani carries the essence of digested food (rasa) all over the body and maintains the nutrition (poshana).

Other sites of prana

There are ten principal seats in which the life forces (prana) are established. The two temples (shankha), the three vital organs including heart (hridaya), the head region mainly brain (shira), the bladder including kidneys (basti), throat (kantha), rakta dhatu (blood), shukra dhatu (reproductive fluid), oja (the vital fluid) and the anus. [Cha.Sa.Sutra Sthana 29/3] These ten sites are related to pranavaha srotas. The disorders affecting these sites cause vitiation of pranavaha srotas.

Causes of abnormalities in pranavaha srotas (dushti nidana)

Wasting or degeneration of tissues (kshaya), suppression of natural urges (sandharana), excess exertion(vyayama), excess hunger (kshudhita), excessive dryness (ruksha), exposure to cold (sheeta) in lifestyle and dietary pattern with harmful regimens lead to abnormalities to pranavaha srotas. Suppression of thirst (pipasa dharana) also leads to vitiation of pranavaha srotas.

Clinical features of pranavaha srotas vitiation

There are four kinds of abnormalities in the functioning of srotas. These features can be observed as follows:

1. excess functioning (atipravritti)	Increased respiration/breathlessness
2. obstructed functions(sanga)	Due to phlegm/obstruction by foreign bodies
3. cystic formations (siragranthi)	It may be the engorgement of blood vessels or tumor
4. abnormal pathways (vimarga gamana)	Deviation from the normal direction of flow of air or misdirected flow of fluid

Specific features of vitiation of pranavaha srotas

• Too long breathing (atisrushtam shwasam)
• Too short breathing (atibadhdham shwasam)
• Frequent/interrupted breathing (alpam alpam shwasam)
• Difficult breathing (kupitam shwasam)
• Highly disturbed breathing pattern looking scary (abhikshnam shwasam)
• Abnormal sounds during breathing (sa shabd shwasam)
• Painful breathing (sa shula shwasam) [Cha.Sa.Vimana Sthana 05/07]

Clinical features of injury of pranavaha srotas

Following are the clinical features of injury to pranavaha srotas:

• Crying loudly (aakroshana)
• Bend down like a bow (vinamana)
• Perplexing (mohana)
• Vertigo (bhramna)
• Tremors (vepathu)
• Death (maranam) (due to respiratory failure) [Su.Sa.Sharira Sthana 09/12]

Diagnosis, Assessment and Management

Pranavaha srotas can be co-related with the respiratory system. It starts from the nostrils to nasal chambers, pharynx, trachea, bronchi, bronchioles, and finally to the alveolar sac, where the capillaries and veins surround it. The exchange of respiratory gases between lungs and blood takes place diffusion across alveolar and capillary walls. This process is totally passive; no ATP is required for this process. The gaseous exchange occurs in cardio-pulmonary circulation through the pulmonary veins and arteries. The oxygenated blood is then circulated to the body by the heart through the cardiovascular system. The oxygenated blood runs to the organs, then to tissues and cells. There, the exchange of oxygen and carbon dioxides occurs through the cellular pathways. The deoxygenated blood returns to the heart via veins. The same goes back to the lungs to get oxygen.reference needed This full path is included in pranavaha dhamani. In this whole process of cardio-pulmonary circulation, the heart plays a significant role. So, ayurveda scholars describe it as a site of origin for pranavaha srotas.

Assessment of functions and diagnosis

When this pranvaha srotas is vitiated, the following clinical features are assessed for diagnosis and prognosis:

• Increase or decrease in respiratory rate
• Irregular respiratory rhythm
• Added lung sounds like wheezes, crept, rhonchi, rales,
• Painful breathing
• Tightening of the chest

Four components of respiratory assessments

With inspection, palpitation, percussion and auscultation of the anterior and posterior thorax.

Tools needed for respiratory assessment

1. A stethoscope - for assessing the lung sounds
2. Pulse oximeter - for checking the oxygen saturation level
3. A peak flow meter is used for measuring lung functions.

Scale used for respiratory assessment

The respiratory Distress Observation Scale (RDOS) is the only known tool for assessing respiratory distress, when the patient is unable to give a dyspnea self-report.

• Radiological assessments through X-rays, and CT scan is done to check the pathological lesions in chest.
• Sputum examination is done to diagnose the presence of infectious micro-organisms like acid-fast bacilli to confirm the diagnosis of pulmonary tuberculosis.

Spirometry is done to assess lung functions.

Diseases of pranavaha srotas

Shwasa (dyspnea of various origins), kasa (cough), hikka (hiccups), rajayakshma (tuberculosis) are major diseases. The disorders of other prana sites are also considered pranavaha srotasa disorders.
Respiratory diseases are abnormalities that affect the air passages, the bronchi, and the lungs. They range from acute infections such as pneumonia and bronchitis to chronic condition such as Asthma and Chronic obstructive pulmonary diseases.
The Respiratory diseases can be classified on the basis of:

1. The organ involved
2. By the pattern involved
3. By the cause of the disease.

Obstructive lung diseases: The disease of the lung where the bronchial tubes become narrowed , making it difficult to inhale and exhale of the air.
Restrictive lung diseases: This is due to the loss of lungs compliance, causing incomplete lungs expansion and stiffness in lungs.
Respiratory tract infection: infection can affect any part of the respiration, either in the upper or lower respiratory tract. Upper respiratory tract infections include the common cold, sinusitis, tonsilitis, otitis media, pharyngitis, and laryngitis.
While lower respiratory tract infections include pneumonia and lung infections. The streptococcus pneumonia usually causes pneumonia; tuberculosis is a significant cause of pneumonia. Pneumonia may develop complications such as lung abscess, a round cavity in the lung caused by infection spread in the pleural cavity. Pulmonary tuberculosis and lung carcinoma are severe disorders affecting the respiratory system.

Management

The disorders of pranavaha srotasa are managed on the principles of management of shwasa disease. [Cha.Sa. Vimana Sthana 5/26] The treatment mainly included the pacification of kapha and vata dosha, use of hot therapies, and the therapies to regulate the functions of vata. [Cha.Sa.Chikitsa Sthana 17/147]
COnsidering the root and pathways of pranavaha srotas, the management principles of three diseases can be adopted in management of pranavaha srotas as per the state of the patient.

• Cardiovascular diseases (hridroga)
• Cough (kasa)
• Respiratory disorders (shwasa)[Cha. Sa. Vimana Sthana 05/26]
• Rajayakshma chikitsa
• Kshataksheena chikitsa

The following therapies are general guidelines for the management of pranavaha srotas:

1. Therapeutic massage (abhyanga) with medicated oil mixed with rock salt (saindhava), specifically on the chest
2. Fomentation
3. Therapeutic emesis(vamana)
4. Therapeutic purgation(virechana)
5. Brimhana (nourishing therapies)
6. Snehana(oleation)
7. Swedana(fomentation)

Previous research works

Some research thesis are carried out on the fundamental understanding of pranavaha srotas as below.

1. Pranavaha srotas vivechana (1988).National Institute of Ayurveda,Jaipur.
2. Pranavaha sroto dushti janya roga Rajyakshma ,Shwasa , kasa mein kapha ka pareekshanatmak adhyayan (1990) National institute of Ayurveda Jaipur.
   This study concluded that there is a close physiological interrelationship amongst ‘hrudaya’, ‘mahasrotas’ & ‘prana’, which is explored conceptually & is seen supported by outcomes of observational in coronary heart disease individuals.
3. Pranavaha srotas kriya vikritvijanya shvasa roga mein shvasahara mahakashaya ka prabhavatmak adhyayan (2001). National institute of Ayurveda Jaipur.
4. Clinical correlation of pranavaha srotas and its viddha lakshana with modern science by Shivanand Ganachari and Vishwanath.
   The conclusion of this study is that all the features of vitiation (pradustha lakshana) and injury (viddha lakshana) mentioned for pranavaha srotas can be seen in clinical conditions associated with pathology of respiratory tract.
5. Study of pranavaha srotas with reference to modern anatomy by Ramesh Kumar , Dinesh Chaudhary and Rajashri.
   In this review article, the mode of action of pranavaha srotas is compared with the respiratory system.
6. A conceptual study of hetu of pranvaha srotodushti with special reference to “ Srotansi Anyaishch Darunai “ by Tripti , Ankita , G. H. Kodwani ,and Meera.
   This study concludes that the concept of pranavaha srotodushti due to other sroto dushti is helpful in deciding the severity of disease , prognosis of disease , samprapti of disease.
7. A Study on pranavaha srotas and its moolasthana by Sarika Yadav and OM Prakash Dadhich
   The study concluded that the pranavaha srotas should not be studied only with respiratory system, but also with other major system like nervous system , cardio vascular system and alimentary canal (disease of pranavaha srotas like hikka, shwasa have their origin in mahasrotas).
8. Physiological study of pranavaha srotas as mentioned in Charak Samhita by Urmila Murya and Anjana Dixit
   The study explored that cardio-respiratory system have been taken as pranavaha srotas.
9. Conceptual study of pranavaha srotas with reference to modern anatomy by Budruk Pramod Appasaheb. As per this study pranavaha srotas can be correlated with the Respiratory system as mentioned by contemporary science.

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