Come rains or monsoon, the Asthama patients waits to take a magic ayurvedic fish medicine in Hyderabad by Bathini family every year. Crowds wait eagerly at the exhibition grounds. Their frenzy and faith are palpable. The prospect of an asthma-free life is too tantalising for the thousands who have travelled from different parts of the country for a dose of the Bathini fish prasadam (an offering in a religious ritual).

It is going to be a long wait but the belief that relief is near keeps people’s spirits up. Even the Ministry of AYUSH, which deals with alternative medicinal traditions, has refused to classify the Bathini fish prasadam as an Ayurvedic cure and prefers calling it folk medicine instead.

Eight-year-old Kishore has come from Karimnagar to Hyderabad, about 160 km, with his father to receive the remedy. He is surrounded by hordes of adults and children. Every now and then, a child bawls at the sight of a silvery slithering fish dangling over her mouth.

Soon enough, it is Kishore’s turn, and he panics and squirms. A well-meaning volunteer holds the neck of the fish between two fingers and Kishore’s jaw open with the other hand. He slides the fish’s tail down into the back of Kishore’s throat, clamps the jaw shut and closes the lad’s nostrils for an added push.

Every person in the queue goes through this, and it goes on for 24 hours, without a break. This year, the camp began at 6 pm on June 8, with over a lakh in attendance.

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It has been organised ever since the 19th century by the Bathini Goud family. According to the camp’s website, a holy man passed on an herbal remedy to Veeranna Goud in 1845 as a cure for asthma (the fish mouths are stuffed with this paste). Family members have fiercely guarded its recipe even as they have passed it down through generations. Vishwanath Goud and Harinath Goud – Veeranna’s great-grandsons – and some of their relatives are currently responsible for preparing and distributing it.

The family announces the dates of the camp on the day of the Mrigashira Karthi nakshatra, which is around the onset of the southwest monsoon. On the evening before the first day, family members begin preparing the secret recipe in their Doodh Bowli house.

While the herbal concoction is provided at no cost, Telangana’s Department of Fisheries provides the murrel fish (Channa striata) for Rs 25 apiece. Vegetarians can swallow the paste along with a lump of jaggery. In his 2011 book Following Fish, Samanth Subramanian wrote that the paste had a strong aftertaste of asafoetida. The receivers go home with three additional doses of the ‘medicine’, to be taken once a fortnight, and some dietary instructions.

The camp itself is a mammoth operation, with thousands of volunteers as well as the government’s help with security, crowd-control and traffic management.

Dr Sumeet Singhania, respiratory consultant at Kokilaben Dhirubhai Ambani Hospital, Mumbai, explained that when inherently sensitive airways are exposed to a trigger factor, they get constricted, and it becomes difficult to breathe.

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“Hyper-responsive immunity is the hallmark of asthma. The body’s [immune system] overreacts to the slightest of triggers and the lungs are the battleground,” Dr Satyanarayana Mysore, the head of the department of pulmonology and sleep medicine at Manipal Hospital, Bangalore, said.

This in turn, according to Dr Singhania, has perpetuated a stigma associated with being asthmatic and using inhalers, and pushed people towards quick fixes. As Dr Mysore put it, “The helplessness of an asthma patient is such that [she] is gullible to try out anything promising relief.”

The Central Drug Research Institute, Lucknow, was able to get a sample of the herbal paste and wasn’t able to find any curative properties, according to Subramanian’s book. However, it reported finding no steroids or dangerous amounts of heavy metals either. Interestingly, the Ministry of AYUSH, which deals with alternative medicinal traditions, refused to classify the Gouds’ paste as an Ayurvedic cure and preferred calling it folk medicine instead.

That said, researchers haven’t conducted any clinical trials to ascertain its curative properties. One of the biggest barriers is finding people who had consumed the paste. The remedial camps don’t exactly maintain records of attendees and their contact details.

What works for the Bathini fish remedy is its 174-year-old legacy, free distribution, herd mentality, word of mouth and, of course, the placebo effect. Many people have claimed that the ‘treatment’ cured them of their asthma, but it could well be the effect, which has been known to have positive outcomes.

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“The molecular pathology of asthma is highly complex, involving inflammatory cells and products released from them. All these lead to excess mucus production, thickening of lung tissue and distortion of airways,” according to Dr Mysore. “How is it possible to come up with a cure for a disease without understanding the disease itself?”

Money could also be a factor. Inhalers, the most common way to deal with the problem, cost Rs 250-300 a month, and this is lower than how much hospitalisation could cost acute exacerbation.

Patient education, most of all, goes the longest in helping people manage asthma in both rural and urban areas. “In India, it is very difficult for doctors to challenge such remedies,” Dr Mysore said. “The best thing we can do is educate our patients and allow them to make an informed decision.”

The prasadam isn’t without adverse effects. Dr Singhania’s colleagues have treated people with bones lodged in their airways as a result of the fish slipping into their windpipes. Ironically, because the fish is a foreign object, it could lead to the accumulation of granulation tissue and wheezing.

The Gouds’ website warns of another problem: ersatz remedies, sold for Rs 100-500 apiece by vendors who have popped up around the country. #KhabarLive