Kasa Chikitsa

Chikitsa Sthana Chapter 18. Management of Kasa (Cough of various origins)

Kasa Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 18
Preceding Chapter	Hikka Shwasa Chikitsa
Succeeding Chapter	Atisara Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana
Translator and commentator	Nesari T., Mallya S., Deole Y. S.
Reviewer	Prasad B.S., Mali P.
Editors	Singh G., Goyal M., Deole Y.S., Basisht G.
Year of publication	2020
Publisher	Charak Samhita Research, Training and Skill Development Centre
DOI	10.47468/CSNE.2020.e01.s06.019

Abstract

Hikka, shwasa and kasa (hiccups, dyspnea and cough) are the three main diseases of pranavaha srotas (respiratory system). There are similarities in clinical presentation and management of these three. Therefore, these are described in sequence. Kasa is categorized in to five types based on its dominance of dosha and etiology. The vata dominant, pitta dominant and kapha dominant kasa are curable with proper medication. The other two types originating due to kshata (injury) and depletion of body constituents (kshaya) are palliable (yapya). Avoiding etiological factors (Nidana parivarjana), purification therapy (shodhana), pacification therapy (shamana), disease specific treatment (vyadhiahara rasayana) are principles of management for all types of kasa. Administration of shodhana therapy is important. The reduction in persistent nature of illness with episodic exacerbation and the severity is possible if all modalities are followed in sequence.

Keywords: kasa, cough, treatment of cough, respiratory diseases, kshataja, kshayaja, snehapana, vamana, virechana, vairechanika nasya (nasal catarrhal), dhumapana (medicated cigarettes).

Introduction

Pranavaha srotas is a vital system of the body and although this srotas is more susceptible to abuse from little amount of smoke, allergens, adulterants, petrochemicals and many pollutants in atmosphere, there are a variety of disorders and diseases that are temporary and harmless, while others can be life threatening. In literature, pranavaha srotas disorders are elaborated under the heading of shwasa, kasa, hikka, rajayakshma and urakshata (kshata-kshina). Cough, expectoration, breathlessness, sore throat, chest pain are common clinical features of respiratory diseases. Kasa is one such disease, which is identified by the hoarse phonetic sound, produced due to the pathological process of dosha dushti (vitiation of dosha), vimarga gamana (diverted movement) of pranavata and avarana (occlusions) of vayu by the kapha. The main pathology is in chest region with reduced functioning of the respiratory system.

Smoke, dust, and over exertion (dhumopaghata, raja, vyayama) are largely considered as causative factors (samanya nidana). These may cause direct damage to the harmony of the pranavaha srotas which occurs in all respiratory disorders. Apart from above said causative factors some in particular like guru (heavy), snigdha (unctuous), madhura (sweet), asatmya (unhabituated), paryushita ahara (rotten food) will cause vitiation of dosha, more specifically vata and kapha which will in turn have its impact on pranavaha srotas to cause structural and functional impairments (kha vaigunya). Improper diet will result in the improper digestion and absorption of ahara rasa which will in turn produce kasa. These can be considered as intrinsic factors for the pathogenesis.

Prodromal symptoms (purvarupa) are irritation of throat with pricking sensation, itching (kantha kandu)and inability to swallow (bhojyanam avarodha). These are very much similar with upper respiratory tract infection leading to condition of pharyngitis or pharyngotonsillitis and persistence of such upper respiratory tract infection will further spread to lower respiratory tract.

There are five types of kasa namely,vataja, pittaja, kaphaja, kshataja and kshayaja. Vatika kasa is more related to upper respiratory tract with swarabheda (hoarseness of voice) as its diagnostic feature and is unproductive. It resembles more to allergic rhinobronchitis, which may be self-limiting and curable. Paittika and kaphaja kasa involve lower respiratory tract and are productive in nature. While paittika kasa seems to be the result of inflammation, kaphaja kasa is due to mucosal hypertrophy of bronchial lining or chronic bronchitis. Kshyaja kasa is a state of chronic cough associated with emaciation. Charak has mentioned that the disturbance in the action of jatharagni all the three dosha get vitiated, which causes emaciation of dhatu of the body either due to anulomana kshaya or pratiloma kshaya [Cha.Sa. Chikitsa Sthana 18/24]. That makes it different from shosha, which is a tridoshaja disease manifests as a group of several diseases. Kshataja kasa is associated with break in integrity of lung parenchyma with shonita darshana (blood tinged mucous) as a symptom. There may or may not be shosha (emaciation).

Snehapana, vamana, virechana, vairechanika nasya (nasal catarrhal), dhumapana (medicated cigaretes) are indicated as treatment modalities in different types of kasa.

Sanskrit Text, Transliteration and English Translation

अथातः कासचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

athātaḥ kāsacikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2|

athAtaH kAsacikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter "Kasa chikitsa"(Management of cough of various origins). Thus said Lord Atreya.[1-2]

Types

तपसा यशसा धृत्या धिया च परयाऽन्वितः | आत्रेयः कासशान्त्यर्थं प्राह सिद्धं चिकित्सितम् ||३||

वातादिजास्त्रयो ये च क्षतजः क्षयजस्तथा | पञ्चैते स्युर्नृणां कासा वर्धमानाः क्षयप्रदाः ||४||

tapasā yaśasā dhr̥tyā dhiyā ca parayā'nvitaḥ| ātrēyaḥ kāsaśāntyarthaṁ prāha siddhaṁ cikitsitam||3||

vātādijāstrayō yē ca kṣatajaḥ kṣayajastathā| pañcaitē syurnr̥ṇāṁ kāsā vardhamānāḥ kṣayapradāḥ||4||

tapasA yashasA dhRutyA dhiyA ca parayA~anvitaH| AtreyaH kAsashAntyarthaM prAha siddhaM cikitsitam||3||

vAtAdijAstrayo ye ca kShatajaH kShayajastathA| pa~jcaite syurnRuNAM kAsA vardhamAnAH kShayapradAH||4||

Atreya, endowed with power of penance, fame and perseverance and super-intellect expounded the infallible therapies for the treatment of kasa. There are five types of kasa. If exacerbated they may cause kshaya. These five types are vataja, pittaja, kaphaja, kshataja and kshayaja. [3-4]

Premonitory signs

पूर्वरूपं भवेत्तेषां शूकपूर्णगलास्यता | कण्ठे कण्डूश्च भोज्यानामवरोधश्च जायते ||५||

pūrvarūpaṁ bhavēttēṣāṁ śūkapūrṇagalāsyatā| kaṇṭhē kaṇḍūśca bhōjyānāmavarōdhaśca jāyatē||5||

pUrvarUpaM bhavetteShAM shUkapUrNagalAsyatA| kaNThe kaNDUshca bhojyAnAmavarodhashca jAyate||5||

Following are the premonitory signs and symptoms of kasa:

1. Sensation as if throat and mouth are filled with shooka (thorns).
2. Itching sensation in the throat.
3. Inability to swallow food.[3-4]

Pathophysiology

अधःप्रतिहतो वायुरूर्ध्वस्रोतःसमाश्रितः | उदानभावमापन्नः कण्ठे सक्तस्तथोरसि ||६||

आविश्य शिरसः खानि सर्वाणि प्रतिपूरयन् | आभञ्जन्नाक्षिपन् देहं हनुमन्ये तथाऽक्षिणी ||७||

नेत्रे पृष्ठमुरःपार्श्वे निर्भुज्य स्तम्भयंस्ततः | शुष्को वा सकफो वाऽपि कसनात्कास उच्यते ||८||

adhaḥpratihatō vāyurūrdhvasrōtaḥsamāśritaḥ| udānabhāvamāpannaḥ kaṇṭhē saktastathōrasi||6||

āviśya śirasaḥ khāni sarvāṇi pratipūrayan| ābhañjannākṣipan dēhaṁ hanumanyē tathā'kṣiṇī||7||

nētrē pr̥ṣṭhamuraḥpārśvē nirbhujya stambhayaṁstataḥ| śuṣkō vā sakaphō vā'pi kasanātkāsa ucyatē||8||

adhaHpratihato vAyurUrdhvasrotaHsamAshritaH| udAnabhAvamApannaH kaNThe saktastathorasi||6||

Avishya shirasaH khAni sarvANi pratipUrayan| Abha~jjannAkShipan dehaM hanumanye tathA~akShiNI||7||

netre pRuShThamuraHpArshve nirbhujya stambhayaMstataH| shuShko vA sakapho vA~api kasanAtkAsa ucyate||8||

Vata being obstructed in the lower region of the body, moves upwards, afflicts the channels of circulation in the upper part of the body, takes over the function of udana vayu and gets localized in the throat and chest. Then entering all the cavities in the head, fills them up and causes hunching and convulsive movements of the body, jaws, sides of the neck and eyes. Thereafter this obstructed vata causes contraction and stiffness of the eyes, back, chest and sides of the chest, gives rise to kasa which may be dry or with phlegm because of which it is known as kasa.[6-8]

Specific features of kasa

प्रतिघातविशेषेण तस्य वायोः सरंहसः | वेदनाशब्दवैशिष्ट्यं कासानामुपजायते ||९||

pratighātaviśēṣēṇa tasya vāyōḥ saraṁhasaḥ| vēdanāśabdavaiśiṣṭyaṁ kāsānāmupajāyatē||9||

pratighAtavisheSheNa tasya vAyoH saraMhasaH| vedanAshabdavaishiShTyaM kAsAnAmupajAyate||9||

Specific variations in the pain and sound associated with different types of kasa are caused by the specific nature of the obstruction (by kapha, etc.) to the force fully moving vayu.[9]

Etiological factors, clinical features of Vataja kasa

रूक्षशीतकषायाल्पप्रमितानशनं स्त्रियः | वेगधारणमायासो वातकासप्रवर्तकाः ||१०||

हृत्पार्श्वोरःशिरःशूलस्वरभेदकरो भृशम् | शुष्कोरःकण्ठवक्रस्य हृष्टलोम्नः प्रताम्यतः ||११||

निर्घोषदैन्यस्तननदौर्बल्यक्षोभमोहकृत् | शुष्ककासः कफं शुष्कं कृच्छ्रान्मुक्त्वाऽल्पतां व्रजेत् ||१२||

स्निग्धाम्ललवणोष्णैश्च भुक्तपीतैः प्रशाम्यति | ऊर्ध्ववातस्य जीर्णेऽन्ने वेगवान्मारुतो भवेत् ||१३||

rūkṣaśītakaṣāyālpapramitānaśanaṁ striyaḥ| vēgadhāraṇamāyāsō vātakāsapravartakāḥ||10||

hr̥tpārśvōraḥśiraḥśūlasvarabhēdakarō bhr̥śam| śuṣkōraḥkaṇṭhavakrasya hr̥ṣṭalōmnaḥ pratāmyataḥ||11||

nirghōṣadainyastananadaurbalyakṣōbhamōhakr̥t| śuṣkakāsaḥ kaphaṁ śuṣkaṁ kr̥cchrānmuktvā'lpatāṁ vrajēt||12||

snigdhāmlalavaṇōṣṇaiśca bhuktapītaiḥ praśāmyati| ūrdhvavātasya jīrṇē'nnē vēgavānmārutō bhavēt||13||

rUkShashItakaShAyAlpapramitAnashanaM striyaH| vegadhAraNamAyAso vAtakAsapravartakAH||10||

hRutpArshvoraHshiraHshUlasvarabhedakaro bhRusham| shuShkoraHkaNThavakrasya hRuShTalomnaH pratAmyataH||11||

nirghoShadainyastananadaurbalyakShobhamohakRut| shuShkakAsaH kaphaM shuShkaM kRucchrAnmuktvA~alpatAM vrajet||12||

snigdhAmlalavaNoShNaishca bhuktapItaiH prashAmyati| UrdhvavAtasya jIrNe~anne vegavAnmAruto bhavet||13||

Following are the causative factors of vatika type of kasa:

1. Intake of ruksha (dry), sheeta(cold), kashaya (astringent) type of food.
2. Intake of food in less quantity or much less quantity or not taking food at all.
3. Excess indulgence in vyavaya.
4. Suppression of vega.
5. Excessive physical strain.

Its signs and symptoms are as follows:

1. Excruciating pain in the epigastric region, flanks, chest, and head.
2. Excessive hoarseness of the voice.
3. Dryness in the chest, throat and mouth.
4. Horripilation and fainting.
5. Resonant sound during coughing, looks hopeless, hollow sound during coughing.
6. weakness, agitated, illusive perceptions.
7. Dry cough
8. Expectorate scanty phlegm with pain.
9. The kasa gets alleviated by the food and drinks that are snigdha, amla, lavana and ushna.
10. The upward movements increases vata after digestion of food.[10-13]

Etiological factors, clinical features of Pittaja kasa

कटुकोष्णविदाह्यम्लक्षाराणामतिसेवनम् | पित्तकासकरं क्रोधः सन्तापश्चाग्निसूर्यजः ||१४||

पीतनिष्ठीवनाक्षित्वं तिक्तास्यत्वं स्वरामयः | उरोधूमायनं तृष्णा दाहो मोहोऽरुचिर्भ्रमः ||१५||

प्रततं कासमानश्च ज्योतींषीव च पश्यति | श्लेष्माणं पित्तसंसृष्टं निष्ठीवति च पैत्तिके ||१६||

kaṭukōṣṇavidāhyamlakṣārāṇāmatisēvanam| pittakāsakaraṁ krōdhaḥ santāpaścāgnisūryajaḥ||14||

pītaniṣṭhīvanākṣitvaṁ tiktāsyatvaṁ svarāmayaḥ| urōdhūmāyanaṁ tr̥ṣṇā dāhō mōhō'rucirbhramaḥ||15||

pratataṁ kāsamānaśca jyōtīṁṣīva ca paśyati| ślēṣmāṇaṁ pittasaṁsr̥ṣṭaṁ niṣṭhīvati ca paittikē||16||

kaTukoShNavidAhyamlakShArANAmatisevanam| pittakAsakaraM krodhaH santApashcAgnisUryajaH||14||

pItaniShThIvanAkShitvaM tiktAsyatvaM svarAmayaH| urodhUmAyanaM tRuShNA dAho moho~arucirbhramaH||15||

pratataM kAsamAnashca jyotIMShIva ca pashyati| shleShmANaM pittasaMsRuShTaM niShThIvati ca paittike||16||

Excessive intake of ushna, katu, vidahi, amla and kshara type of ahara; krodha, santapa , exposure to the heat of the fire and sun are the causative factors of pittaja kasa.

Signs and symptoms of pittaja kasa are as follows:

1. Yellowish sputum and eyes
2. Bitter taste in mouth
3. Voice disorders
4. Feeling of smoke is being vomited out of the chest
5. Morbid thirst, burning, illusive, anorexia and giddiness
6. Appearance of twinkling stars in front of the eyes while coughing continuously
7. Expectoration of sputum mixed with pitta. [14-16]

Etiological factors, clinical features of Kaphaja kasa

गुर्वभिष्यन्दिमधुरस्निग्धस्वप्नाविचेष्टनैः | वृद्धः श्लेष्माऽनिलं रुद्ध्वा कफकासं करोति हि ||१७||

मन्दाग्नित्वारुचिच्छर्दिपीनसोत्क्लेशगौरवैः | लोमहर्षास्यमाधुर्यक्लेदसंसदनैर्युतम् ||१८||

बहुलं मधुरं स्निग्धं निष्ठीवति घनं कफम् | कासमानो ह्यरुग् वक्षः सम्पूर्णमिव मन्यते ||१९||

gurvabhiṣyandimadhurasnigdhasvapnāvicēṣṭanaiḥ| vr̥ddhaḥ ślēṣmā'nilaṁ ruddhvā kaphakāsaṁ [1] karōti hi||17||

mandāgnitvārucicchardipīnasōtklēśagauravaiḥ| lōmaharṣāsyamādhuryaklēdasaṁsadanairyutam||18||

bahulaṁ madhuraṁ snigdhaṁ niṣṭhīvati ghanaṁ kapham| kāsamānō hyarug vakṣaḥ sampūrṇamiva manyatē||19||

gurvabhiShyandimadhurasnigdhasvapnAviceShTanaiH| vRuddhaH shleShmA~anilaM ruddhvA kaphakAsaM [1] karoti hi||17||

mandAgnitvArucicchardipInasotkleshagauravaiH| lomaharShAsyamAdhuryakledasaMsadanairyutam||18||

bahulaM madhuraM snigdhaM niShThIvati ghanaM kapham| kAsamAno hyarug vakShaH sampUrNamiva manyate||19||

Intake of heavy to digest, slimy, excessive sweets and oily foods ; excessive sleep and habitual inertia leads to aggravation of kapha and thereby obstructs the movement of vata which gives rise to kaphaja type of kasa.

The signs and symptoms of kaphaja type of kasa are as follows:

1. Lowered digestion process, anorexia, vomitng, nasal discharge, nausea and heaviness
2. Horripilation, stickiness and sweetness of the mouth
3. Expectoration of thick, sweet, slimy, phlegm in large quantity
4. Not feeling of pain in the chest while coughing
5. Feeling of fullness in the chest [17-19]

Etiological factors, clinical features of Kshataja kasa

अतिव्यवायभाराध्वयुद्धाश्वगजविग्रहैः | रूक्षस्योरः क्षतं वायुर्गृहीत्वा कासमावहेत् ||२०||

स पूर्वं कासते शुष्कं ततः ष्ठीवेत् सशोणितम् | कण्ठेन रुजताऽत्यर्थं विरुग्णेनेव चोरसा ||२१||

सूचीभिरिव तीक्ष्णाभिस्तुद्यमानेन शूलिना | दुःखस्पर्शेन शूलेन भेदपीडाभितापिना ||२२||

पर्वभेदज्वरश्वासतृष्णावैस्वर्यपीडितः | पारावत इवाकूजन् कासवेगात्क्षतोद्भवात् ||२३||

ativyavāyabhārādhvayuddhāśvagajavigrahaiḥ| rūkṣasyōraḥ kṣataṁ vāyurgr̥hītvā kāsamāvahēt||20||

sa pūrvaṁ kāsatē śuṣkaṁ tataḥ ṣṭhīvēt saśōṇitam| kaṇṭhēna rujatā'tyarthaṁ virugṇēnēva cōrasā||21||

sūcībhiriva tīkṣṇābhistudyamānēna śūlinā| duḥkhasparśēna śūlēna bhēdapīḍābhitāpinā||22||

parvabhēdajvaraśvāsatr̥ṣṇāvaisvaryapīḍitaḥ| pārāvata ivākūjan kāsavēgātkṣatōdbhavāt||23||

ativyavAyabhArAdhvayuddhAshvagajavigrahaiH| rUkShasyoraH kShataM vAyurgRuhItvA kAsamAvahet||20||

sa pUrvaM kAsate shuShkaM tataH ShThIvet sashoNitam| kaNThena rujatA~atyarthaM virugNeneva corasA||21||

sUcIbhiriva tIkShNAbhistudyamAnena shUlinA| duHkhasparshena shUlena bhedapIDAbhitApinA||22||

parvabhedajvarashvAsatRuShNAvaisvaryapIDitaH| pArAvata ivAkUjan kAsavegAtkShatodbhavAt||23||

Excessive indulgence in vyavaya, carrying excessive heavy load, walking excessively long distance, indulgence in fighting, excessive indulgence in restraining the movement of horses and elephants etc. factors cause injury to the chest and bring about rukshata in the body and in turn causes aggravation of vata there by results in the manifestation of kshataja kasa.

Signs and symptoms of kshataja kasa are as follows:

1. The cough will be dry in the beginning followed by blood tinged sputum
2. Excessive pain in the throat and feeling of cracking pain in the chest
3. Pricking type of pain as if pricked by sharp needles
4. Excruciating pain and discomfort by touch on chest, miserable appearance.
5. Pain in joints and fingers, fever, labored breath, thirst and altered voice
6. While coughing, sounds humming like pigeon. [20-23]

Etiological factors, clinical features of Kshayaja kasa

विषमासात्म्यभोज्यातिव्यवायाद्वेगनिग्रहात् | घृणिनां शोचतां नॄणां व्यापन्नेऽग्नौ त्रयो मलाः ||२४||

कुपिताः क्षयजं कासं कुर्युर्देहक्षयप्रदम् | दुर्गन्धं हरितं रक्तं ष्ठीवेत् पूयोपमं कफम् ||२५||

स्थानादुत्कासमानश्च हृदयं मन्यते च्युतम् | अकस्मादुष्णशीतार्तो बह्वाशी दुर्बलः कृशः ||२६||

स्निग्धाच्छमुखवर्णत्वक् श्रीमद्दर्शनलोचनः | पाणिपादतलैः श्लक्ष्णैः सततासूयको घृणी ||२७||

ज्वरो मिश्राकृतिस्तस्य पार्श्वरुक् पीनसोऽरुचिः | भिन्नसंहतवर्चस्त्वं स्वरभेदोऽनिमित्ततः ||२८||

इत्येष क्षयजः कासः क्षीणानां देहनाशनः | साध्यो बलवतां वा स्याद्याप्यस्त्वेवं क्षतोत्थितः ||२९||

नवौ कदाचित् सिध्येतामेतौ पादगुणान्वितौ | स्थविराणां जराकासः सर्वो याप्यः प्रकीर्तितः ||३०||

viṣamāsātmyabhōjyātivyavāyādvēganigrahāt| ghr̥ṇināṁ śōcatāṁ nr̥̄ṇāṁ vyāpannē'gnau trayō malāḥ||24||

kupitāḥ kṣayajaṁ kāsaṁ kuryurdēhakṣayapradam| durgandhaṁ haritaṁ raktaṁ ṣṭhīvēt pūyōpamaṁ kapham||25||

sthānādutkāsamānaśca hr̥dayaṁ manyatē cyutam [1] | akasmāduṣṇaśītārtō bahvāśī durbalaḥ kr̥śaḥ||26||

snigdhācchamukhavarṇatvak śrīmaddarśanalōcanaḥ [2] | pāṇipādatalaiḥ ślakṣṇaiḥ satatāsūyakō [3] ghr̥ṇī||27||

jvarō miśrākr̥tistasya pārśvaruk pīnasō'ruciḥ| bhinnasaṁhatavarcastvaṁ [4] svarabhēdō'nimittataḥ||28||

ityēṣa kṣayajaḥ kāsaḥ kṣīṇānāṁ dēhanāśanaḥ| sādhyō balavatāṁ vā syādyāpyastvēvaṁ kṣatōtthitaḥ||29||

navau kadācit sidhyētāmētau pādaguṇānvitau| sthavirāṇāṁ jarākāsaḥ sarvō yāpyaḥ prakīrtitaḥ||30||

viShamAsAtmyabhojyAtivyavAyAdveganigrahAt| ghRuNinAM shocatAM nRUNAM vyApanne~agnau trayo malAH||24||

kupitAH kShayajaM kAsaM kuryurdehakShayapradam| durgandhaM haritaM raktaM ShThIvet pUyopamaM kapham||25||

sthAnAdutkAsamAnashca hRudayaM manyate cyutam [1] | akasmAduShNashItArto bahvAshI durbalaH kRushaH||26||

snigdhAcchamukhavarNatvak shrImaddarshanalocanaH [2] | pANipAdatalaiH shlakShNaiH satatAsUyako [3] ghRuNI||27||

jvaro mishrAkRutistasya pArshvaruk pInaso~aruciH| bhinnasaMhatavarcastvaM [4] svarabhedo~animittataH||28||

ityeSha kShayajaH kAsaH kShINAnAM dehanAshanaH| sAdhyo balavatAM vA syAdyApyastvevaM kShatotthitaH||29||

navau kadAcit sidhyetAmetau pAdaguNAnvitau|

Intake of vishamashana and asatmya ahara, indulgence in vyavaya, suppression of vega, ghrina and shoka etc factors leads to vitiation of agni thereby aggravation of tridosha giving rise to kshayaja kasa.

Signs and symptoms of kshayaja kasa are as follows:

1. Expectoration of the kapha, which is greenish, red in colour, associated with pus and bad odor.
2. While coughing person feels as if the heart is displaced.
3. Feels suddenly afflicted with both hot and cold sensations.
4. Consumption of food in excessive quantity
5. Feeling of very weak, and emaciation
6. Clean and unctuous complexion of face, associated with gracious appearance of face and eyes.
7. Soft silky touch of hands and foot.
8. Person always finds fault with others and develops immensely hateful disposition.
9. Person suffers from diseases like jwara (having signs and symptoms of all dosha), nasal congestion, anorexia, painful flanks, altered voice.
10. Feces hard or loose frequently without apparent cause stool.

This is called kshayaja kasa which leads to the death of the patient if he is already very weak. If the patient is strong, then the disease can be cured.

Kshataja kasa is palliable if the patient is strong. If these two diseases(kshataja and kshayaja) are in their initial stage and if all four chikitsa chatushpada are endowed with efficiency, then both of these are curable. All types of kasa are however palliable if the patient is old. [24-30]

Prognosis

त्रीन्साध्यान्साधयेत्पूर्वान् पथ्यैर्याप्यांश्च यापयेत् | चिकित्सामत ऊर्ध्वं तु शृणु कासनिबर्हिणीम् ||३१||

trīnsādhyānsādhayētpūrvān pathyairyāpyāṁśca yāpayēt| cikitsāmata ūrdhvaṁ tu śr̥ṇu kāsanibarhiṇīm||31||

trInsAdhyAnsAdhayetpUrvAn pathyairyApyAMshca yApayet| cikitsAmata UrdhvaM tu shRuNu kAsanibarhiNIm||31||

The first three types of kasa (vataja, pittaja, kaphaja) should be treated as these are sadhya vyadhi. Whereas other two types (khataja and kshayaja) should be palliated with appropriate drugs and diet.

Treatment of different types of kasa has been described here after.[31]

Management

Management of vata dosha dominant kasa

रूक्षस्यानिलजं कासमादौ स्नेहैरुपाचरेत् | सर्पिर्भिर्बस्तिभिः पेयायूषक्षीररसादिभिः ||३२||

वातघ्नसिद्धैः स्नेहाद्यैर्धूमैर्लेहैश्च युक्तितः | अभ्यङ्गैः परिषेकैश्च स्निग्धैः स्वेदैश्च बुद्धिमान् ||३३||

बस्तिभिर्बद्धविड्वातं शुष्कोर्ध्वं चोर्ध्वभक्तिकैः | घृतैः सपित्तं सकफं जयेत् स्नेहविरेचनैः ||३४||

rūkṣasyānilajaṁ kāsamādau snēhairupācarēt| sarpirbhirbastibhiḥ pēyāyūṣakṣīrarasādibhiḥ||32||

vātaghnasiddhaiḥ snēhādyairdhūmairlēhaiśca yuktitaḥ| abhyaṅgaiḥ pariṣēkaiśca snigdhaiḥ svēdaiśca buddhimān||33||

bastibhirbaddhaviḍvātaṁ śuṣkōrdhvaṁ cōrdhvabhaktikaiḥ| ghr̥taiḥ sapittaṁ sakaphaṁ jayēt snēhavirēcanaiḥ||34||

rUkShasyAnilajaM kAsamAdau snehairupAcaret| sarpirbhirbastibhiH peyAyUShakShIrarasAdibhiH||32||

vAtaghnasiddhaiH snehAdyairdhUmairlehaishca yuktitaH| abhya~ggaiH pariShekaishca snigdhaiH svedaishca buddhimAn||33||

bastibhirbaddhaviDvAtaM shuShkordhvaM cordhvabhaktikaiH| ghRutaiH sapittaM sakaphaM jayet snehavirecanaiH||34||

As dryness (rukshata) will be more prominent in vataja type of kasa, it should be treated with unctuous therapies (snehika upacharas). Ghrita pana,basti, peya, yusha, ksheera, mamsa rasa etc. should be prepared with vataghna dravya and is to be administered properly.

Abhyanga, parisheka (sprinkling or pouring), snigdha sweda etc. should be followed appropriately.

If it is associated with constipation and flatulence should be treated with basti. If the person has dryness in the upper part of the body, and is associated with aggravated pitta, then he should be given medicated ghrita after intake of food.

If the person has dryness of the upper part of the body associated with kapha aggravation, then he should be treated with snigdha virechana.[32-34]

Kantakari ghrita

कण्टकारीगुडूचीभ्यां पृथक् त्रिंशत्पलाद्रसे | प्रस्थः सिद्धो घृताद्वातकासनुद्वह्निदीपनः ||३५||

इति कण्टकारीघृतम् |

kaṇṭakārīguḍūcībhyāṁ pr̥thak triṁśatpalādrasē| prasthaḥ siddhō ghr̥tādvātakāsanudvahnidīpanaḥ||35||

iti kaṇṭakārīghr̥tam| kaNTakArIguDUcIbhyAM pRuthak triMshatpalAdrase| prasthaH siddho ghRutAdvAtakAsanudvahnidIpanaH||35||

iti kaNTakArIghRutam|

Thirty pala of kantakari and guduchi kashaya each is to be boiled with ghrita to prepare 1 Prastha of ghrita. This particular ghrita is beneficial in vatika kasa. It promotes the power of digestion. Thus ends the description of kantakari ghrita.[35]

Pippalyadi ghrita

पिप्पलीपिप्पलीमूलचव्यचित्रकनागरैः | धान्यपाठावचारास्नायष्ट्याह्वक्षारहिङ्गुभिः ||३६||

कोलमात्रैर्घृतप्रस्थाद्दशमूलीरसाढके | सिद्धाच्चतुर्थिकां पीत्वा पेयामण्डं पिबेदनु ||३७||

तच्छ्वासकासहृत्पार्श्वग्रहणीदोषगुल्मनुत् | पिप्पल्याद्यं घृतं चैतदात्रेयेण प्रकीर्तितम् ||३८||

इति पिप्पल्यादिघृतम् |

pippalīpippalīmūlacavyacitrakanāgaraiḥ| dhānyapāṭhāvacārāsnāyaṣṭyāhvakṣārahiṅgubhiḥ||36||

kōlamātrairghr̥taprasthāddaśamūlīrasāḍhakē| siddhāccaturthikāṁ pītvā pēyāmaṇḍaṁ pibēdanu||37||

tacchvāsakāsahr̥tpārśvagrahaṇīdōṣagulmanut| pippalyādyaṁ ghr̥taṁ caitadātrēyēṇa prakīrtitam||38||

iti pippalyādighr̥tam| pippalIpippalImUlacavyacitrakanAgaraiH| dhAnyapAThAvacArAsnAyaShTyAhvakShArahi~ggubhiH||36||

kolamAtrairghRutaprasthAddashamUlIrasADhake| siddhAccaturthikAM pItvA peyAmaNDaM pibedanu||37||

tacchvAsakAsahRutpArshvagrahaNIdoShagulmanut| pippalyAdyaM ghRutaM caitadAtreyeNa prakIrtitam||38||

iti pippalyAdighRutam|

One prastha of ghrita is to be cooked by adding one adhaka of the decoction of dashamoola and the paste of one kola of each pippali, pippali-moola, chavya, chitraka, nagara, dhanyaka, patha, vacha, rasna, yashtimadhu, kshara, and hingu. Intake of one chaturthika (pala) of this ghrita along with peya, manda is beneficial in shwasa, kasa, hridroga, parshwashoola, grahani and gulma. This particular formulation is known as pipplyaadi ghrita and is propounded by Atreya.

Thus ends the description of pipplyadi-ghrita.[36-38]

Tryushanadi ghrita

त्र्यूषणं त्रिफलां द्राक्षां काश्मर्याणि परूषकम् | द्वे पाठे देवदार्वृद्धिं स्वगुप्तां चित्रकं शटीम् ||३९||

ब्राह्मीं तामलकीं मेदां काकनासां शतावरीम् | त्रिकण्टकं विदारीं च पिष्ट्वा कर्षसमं घृतात् ||४०||

प्रस्थं चतुर्गुणे क्षीरे सिद्धं कासहरं पिबेत् | ज्वरगुल्मारुचिप्लीहशिरोहृत्पार्श्वशूलनुत् ||४१||

कामलार्शोऽनिलाष्ठीलाक्षतशोषक्षयापहम् | त्र्यूषणं नाम विख्यातमेतद्धृतमनुत्तमम् ||४२||

इति त्र्यूषणाद्यं घृतम् |

tryūṣaṇaṁ triphalāṁ drākṣāṁ kāśmaryāṇi parūṣakam| dvē pāṭhē dēvadārvr̥ddhiṁ svaguptāṁ citrakaṁ śaṭīm||39||

brāhmīṁ [1] tāmalakīṁ mēdāṁ kākanāsāṁ śatāvarīm| trikaṇṭakaṁ vidārīṁ ca piṣṭvā karṣasamaṁ ghr̥tāt||40||

prasthaṁ caturguṇē kṣīrē siddhaṁ kāsaharaṁ pibēt| jvaragulmāruciplīhaśirōhr̥tpārśvaśūlanut||41||

kāmalārśō'nilāṣṭhīlākṣataśōṣakṣayāpaham| tryūṣaṇaṁ nāma vikhyātamētaddhr̥tamanuttamam||42||

iti tryūṣaṇādyaṁ ghr̥tam| tryUShaNaM triphalAM drAkShAM kAshmaryANi parUShakam| dve pAThe devadArvRuddhiM svaguptAM citrakaM shaTIm||39||

brAhmIM [1] tAmalakIM medAM kAkanAsAM shatAvarIm| trikaNTakaM vidArIM ca piShTvA karShasamaM ghRutAt||40||

prasthaM caturguNe kShIre siddhaM kAsaharaM pibet| jvaragulmAruciplIhashirohRutpArshvashUlanut||41||

kAmalArsho~anilAShThIlAkShatashoShakShayApaham| tryUShaNaM nAma vikhyAtametaddhRutamanuttamam||42||

iti tryUShaNAdyaM ghRutam|

One prastha of ghrita should be cooked by adding four prasthas of milk and the paste of one karsha each of tryushana, triphala, draksha, kashmari, parushaka, dve patha (patha, raja patha), devadaru, rddhi, swagupta, chitraka, shati, brahmi, tamalaki, meda, kakanasa, shatavari, trikantaka, vidari. This is an effective kasahara formulation. It also cures jwara, gulma, aruchi, pleeha, shirah shoola, hrit shoola, parshwa shoola, kamala, arshas, ashtheela, kshata, shosha, kshaya. This well known formulation is named as tryushanadi ghrita.

Thus ends the description of tryushanadi ghrita. [39-42]

Rasna ghritam

द्रोणेऽपां साधयेद्रास्नां दशमूलीं शतावरीम् | पलिकां माणिकांशांस्तु कुलत्थान्बदरान्यवान् ||४३||

तुलार्धं चाजमांसस्य पादशेषेण तेन च | घृताढकं समक्षीरं जीवनीयैः पलोन्मितैः ||४४||

सिद्धं तद्दशभिः कल्कैर्नस्यपानानुवासनैः | समीक्ष्य वातरोगेषु यथावस्थं प्रयोजयेत् ||४५||

पञ्चकासान् शिरःकम्पं शूलं वङ्क्षणयोनिजम् | सर्वाङ्गैकाङ्गरोगांश्च सप्लीहोर्ध्वानिलाञ्जयेत् ||४६||

इति रास्नाघृतम् |

drōṇē'pāṁ sādhayēdrāsnāṁ daśamūlīṁ śatāvarīm| palikāṁ māṇikāṁśāṁstu kulatthānbadarānyavān||43||

tulārdhaṁ cājamāṁsasya pādaśēṣēṇa tēna ca| ghr̥tāḍhakaṁ samakṣīraṁ jīvanīyaiḥ palōnmitaiḥ||44||

siddhaṁ taddaśabhiḥ kalkairnasyapānānuvāsanaiḥ| samīkṣya vātarōgēṣu yathāvasthaṁ prayōjayēt||45||

pañcakāsān śiraḥkampaṁ śūlaṁ vaṅkṣaṇayōnijam| sarvāṅgaikāṅgarōgāṁśca saplīhōrdhvānilāñjayēt||46||

iti rāsnāghr̥tam| droNe~apAM sAdhayedrAsnAM dashamUlIM shatAvarIm| palikAM mANikAMshAMstu kulatthAnbadarAnyavAn||43||

tulArdhaM cAjamAMsasya pAdasheSheNa tena ca| ghRutADhakaM samakShIraM jIvanIyaiH palonmitaiH||44||

siddhaM taddashabhiH kalkairnasyapAnAnuvAsanaiH| samIkShya vAtarogeShu yathAvasthaM prayojayet||45||

pa~jcakAsAn shiraHkampaM shUlaM va~gkShaNayonijam| sarvA~ggaikA~ggarogAMshca saplIhordhvAnilA~jjayet||46||

iti rAsnAghRutam|

In one drona of water, one pala of each of rasna, dashamoolas, one manika of each of kulattha, badara, yava and half tula of ajamamsa should be added and boiled till one fourth of water remains. To this decoction, one adhaka of each of ghrita, ksheera and one pala of each of ten drugs belonging to jivaneeya (dashemani) should be added and cooked. This prepared ghrita should be used in the form of nasya, pana and anuvasana, after proper assessment of the stages of vataroga. This cures five types of kasa, shirahshoola, kamparoga, vankshna and yoni roga, diseases afflicting whole body or only one limb of the body, pleeha roga, urdhwa vata.

Thus ends the description of rasna- ghrita.[43-46]

Various formulations

विडङ्गं नागरं रास्ना पिप्पली हिङ्गु सैन्धवम् | भार्गी क्षारश्च तच्चूर्णं पिबेद्वा घृतमात्रया ||४७||

सकफेऽनिलजे कासे श्वासहिक्काहताग्निषु | द्वौ क्षारौ पञ्चकोलानि पञ्चैव लवणानि च ||४८||

शटीनागरकोदीच्यकल्कं वा वस्त्रगालितम् | पाययेत घृतोन्मिश्रं वातकासनिबर्हणम् ||४९||

दुरालभां शटीं द्राक्षां शृङ्गवेरं सितोपलाम् | लिह्यात् कर्कटशृङ्गीं च कासे तैलेन वातजे ||५०||

दुःस्पर्शां पिप्पलीं मुस्तं भार्गीं कर्कटकीं शटीम् | पुराणगुडतैलाभ्यां चूर्णितं वाऽपि लेहयेत् ||५१||

विडङ्गं सैन्धवं कुष्ठं व्योषं हिङ्गु मनःशिलाम् | मधुसर्पिर्युतं कासहिक्काश्वासं जयेल्लिहन् ||५२||

viḍaṅgaṁ nāgaraṁ rāsnā pippalī hiṅgu saindhavam| bhārgī kṣāraśca taccūrṇaṁ pibēdvā ghr̥tamātrayā||47||

sakaphē'nilajē kāsē śvāsahikkāhatāgniṣu| dvau kṣārau pañcakōlāni pañcaiva lavaṇāni ca||48||

śaṭīnāgarakōdīcyakalkaṁ vā vastragālitam| pāyayēta ghr̥tōnmiśraṁ vātakāsanibarhaṇam||49||

durālabhāṁ śaṭīṁ drākṣāṁ śr̥ṅgavēraṁ sitōpalām| lihyāt karkaṭaśr̥ṅgīṁ ca kāsē tailēna vātajē||50||

duḥsparśāṁ pippalīṁ mustaṁ bhārgīṁ karkaṭakīṁ śaṭīm| purāṇaguḍatailābhyāṁ cūrṇitaṁ vā'pi lēhayēt||51||

viḍaṅgaṁ saindhavaṁ kuṣṭhaṁ vyōṣaṁ hiṅgu manaḥśilām| madhusarpiryutaṁ [1] kāsahikkāśvāsaṁ jayēllihan||52||

viDa~ggaM nAgaraM rAsnA pippalI hi~ggu saindhavam| bhArgI kShArashca taccUrNaM pibedvA ghRutamAtrayA||47||

sakaphe~anilaje kAse shvAsahikkAhatAgniShu| dvau kShArau pa~jcakolAni pa~jcaiva lavaNAni ca||48||

shaTInAgarakodIcyakalkaM vA vastragAlitam| pAyayeta ghRutonmishraM vAtakAsanibarhaNam||49||

durAlabhAM shaTIM drAkShAM shRu~ggaveraM sitopalAm| lihyAt karkaTashRu~ggIM ca kAse tailena vAtaje||50||

duHsparshAM pippalIM mustaM bhArgIM karkaTakIM shaTIm| purANaguDatailAbhyAM cUrNitaM vA~api lehayet||51||

viDa~ggaM saindhavaM kuShThaM vyoShaM hi~ggu manaHshilAm| madhusarpiryutaM [1] kAsahikkAshvAsaM jayellihan||52||

Intake of the powder prepared out of vidanga, nagara, rasna, pippali, hingu, saindhava lavana, bharangi and kshara along with appropriate quantity of ghrita is beneficial in vataja kasa, kaphaja kasa, shwasa, hikka and suppression of digestion power.

Fine vastragalita powder prepared out of dwou kshara(yava kshara & sarja kshara), pancha kola, pancha lavana, shati, nagara and udichya , taken along with appropriate quantity of ghrita cures vatika type of kasa.

Intake of the powder prepared out of duralabha, shati, draksha, shringavera, sitopala, karkata shringi along with mixed with taila and its licking will cure vataja kasa.

The powder of dusparsha, pippali, musta, bharangi, karkataki, and shati should be mixed with purana guda and taila.

Taken this powder in the form of leha is beneficial in vatika type of kasa.

Powder prepared out of vidanga, saindhava lavana, kushtha, vyosha, hingu, manahshila taken along with madhua and sarpi in the form of leha eradicates kasa, hikka and shwasa.[47-52]

Chitrakadi leha

चित्रकं पिप्पलीमूलं व्योषं हिङ्गु दुरालभाम् | शटीं पुष्करमूलं च श्रेयसीं सुरसां वचाम् ||५३||

भार्गीं छिन्नरुहां रास्नां शृङ्गीं द्राक्षां च कार्षिकान् | कल्कानर्धतुलाक्वाथे निदिग्ध्याः पलविंशतिम् ||५४||

दत्त्वा मत्स्यण्डिकायाश्च घृताच्च कुडवं पचेत् | सिद्धं शीतं पृथक् क्षौद्रपिप्पलीकुडवान्वितम् ||५५||

चतुष्पलं तुगाक्षीर्याश्चूर्णितं तत्र दापयेत् | लेहयेत् कासहृद्रोगश्वासगुल्मनिवारणम् ||५६||

इति चित्रकादिलेहः |

citrakaṁ pippalīmūlaṁ vyōṣaṁ hiṅgu durālabhām| śaṭīṁ puṣkaramūlaṁ ca śrēyasīṁ surasāṁ vacām||53||

bhārgīṁ chinnaruhāṁ rāsnāṁ śr̥ṅgīṁ drākṣāṁ ca kārṣikān| kalkānardhatulākvāthē nidigdhyāḥ palaviṁśatim [1] ||54||

dattvā matsyaṇḍikāyāśca ghr̥tācca kuḍavaṁ pacēt| siddhaṁ śītaṁ pr̥thak kṣaudrapippalīkuḍavānvitam||55||

catuṣpalaṁ tugākṣīryāścūrṇitaṁ tatra dāpayēt| lēhayēt kāsahr̥drōgaśvāsagulmanivāraṇam||56||

iti citrakādilēhaḥ|

citrakaM pippalImUlaM vyoShaM hi~ggu durAlabhAm| shaTIM puShkaramUlaM ca shreyasIM surasAM vacAm||53||

bhArgIM chinnaruhAM rAsnAM shRu~ggIM drAkShAM ca kArShikAn| kalkAnardhatulAkvAthe nidigdhyAH palaviMshatim [1] ||54||

dattvA matsyaNDikAyAshca ghRutAcca kuDavaM pacet| siddhaM shItaM pRuthak kShaudrapippalIkuDavAnvitam||55||

catuShpalaM tugAkShIryAshcUrNitaM tatra dApayet| lehayet kAsahRudrogashvAsagulmanivAraNam||56||

iti citrakAdilehaH|

In half tula of the decoction of nidigdhika(Solanum xanthocarpum), the powder or paste of one karsha of each of chitraka, pippalimula, vyosha, hingu, duralabha, shati, pushkaramoola, shreyasi, surasa, vacha, bharangi, chinnaruha, rasna, shringi, draksha should be added. To this twenty palas of matsyandika and one kudava of ghrita should be added and cooked, There after when it becomes cool, one kudava of each of madhu, pippali powder, four palas of the powder of tugakshiri should be added. This leha will cure kasa, hridroga, shwasa, gulma.

Thus ends the description of chitrakadi leha.[53-56]

Agastya haritaki

दशमूलीं स्वयङ्गुप्तां शङ्खपुष्पीं शटीं बलाम् | हस्तिपिप्पल्यपामार्गपिप्पलीमूलचित्रकान् ||५७||

भार्गीं पुष्करमूलं च द्विपलांशं यवाढकम् | हरीतकीशतं चैकं जले पञ्चाढके पचेत् ||५८||

यवैः स्विन्नैः कषायं तं पूतं तच्चाभयाशतम् | पचेद्गुडतुलां दत्त्वा कुडवं च पृथग्घृतात् ||५९||

तैलात् सपिप्पलीचूर्णात् सिद्धशीते च माक्षिकात् | लिह्याद्द्वे चाभये नित्यमतः खादेद्रसायनात् ||६०||

तद्वलीपलितं हन्ति वर्णायुर्बलवर्धनम् | पञ्चकासान् क्षयं श्वासं हिक्कां च विषमज्वरम् ||६१||

हन्यात्तथाऽर्शोग्रहणीहृद्रोगारुचिपीनसान् | अगस्त्यविहितं श्रेष्ठं रसायनमिदं शुभम् ||६२||

इत्यगस्त्यहरीतकी |

daśamūlīṁ svayaṅguptāṁ śaṅkhapuṣpīṁ śaṭīṁ balām| hastipippalyapāmārgapippalīmūlacitrakān||57||

bhārgīṁ puṣkaramūlaṁ ca dvipalāṁśaṁ yavāḍhakam| harītakīśataṁ caikaṁ jalē pañcāḍhakē pacēt||58||

yavaiḥ svinnaiḥ kaṣāyaṁ taṁ pūtaṁ taccābhayāśatam| pacēdguḍatulāṁ dattvā kuḍavaṁ ca pr̥thagghr̥tāt||59||

tailāt sapippalīcūrṇāt siddhaśītē ca mākṣikāt| lihyāddvē cābhayē nityamataḥ khādēdrasāyanāt||60||

tadvalīpalitaṁ hanti varṇāyurbalavardhanam| pañcakāsān kṣayaṁ śvāsaṁ hikkāṁ ca viṣamajvaram||61||

hanyāttathā'rśōgrahaṇīhr̥drōgārucipīnasān| agastyavihitaṁ śrēṣṭhaṁ rasāyanamidaṁ śubham||62||

ityagastyaharītakī| dashamUlIM svaya~gguptAM sha~gkhapuShpIM shaTIM balAm| hastipippalyapAmArgapippalImUlacitrakAn||57||

bhArgIM puShkaramUlaM ca dvipalAMshaM yavADhakam| harItakIshataM caikaM jale pa~jcADhake pacet||58||

yavaiH svinnaiH kaShAyaM taM pUtaM taccAbhayAshatam| pacedguDatulAM dattvA kuDavaM ca pRuthagghRutAt||59||

tailAt sapippalIcUrNAt siddhashIte ca mAkShikAt| lihyAddve cAbhaye nityamataH khAdedrasAyanAt||60||

tadvalIpalitaM hanti varNAyurbalavardhanam| pa~jcakAsAn kShayaM shvAsaM hikkAM ca viShamajvaram||61||

hanyAttathA~arshograhaNIhRudrogArucipInasAn| agastyavihitaM shreShThaM rasAyanamidaM shubham||62|| ityagastyaharItakI|

Two palas of each among dashamoola, swayamgupta, shankahpushpi, shati, bala, hasti pippali, apamarga, pippalimoola, chitraka, bharangi, pushkaramoola should be added with one adhaka of water, these drugs should be cooked till the grains of yava becomes soft. And then decoction should be strained out. These hundred fruits of abhaya should be added with above mentioned decoction, one tula of guda, one kudava of ghrita, taila and powder of pippali. This is to be cooked and after attaining coldness one kudava of makshika is to be added.

Intake of two fruits of haritaki along with leha daily is considered as rasayana. It removes vali, palita; increases varna, ayu and bala. Beneficial in panchakasa, kshaya, shwaasa, hikka, vishamajwara, arshas, grahani, hridroga, aruchi, pinasa. This excellent formulation is propounded by Agastya and is auspicious.

Thus, ends the description of Agastya-haritaki.[57-62]

Other formulations

सैन्धवं पिप्पलीं भार्गीं शृङ्गवेरं दुरालभाम् | दाडिमाम्लेन कोष्णेन भार्गीनागरमम्बुना ||६३||

पिबेत् खदिरसारं वा मदिरादधिमस्तुभिः | अथवा पिप्पलीकल्कं घृतभृष्टं ससैन्धवम् ||६४||

saindhavaṁ pippalīṁ bhārgīṁ śr̥ṅgavēraṁ durālabhām| dāḍimāmlēna kōṣṇēna bhārgīnāgaramambunā||63||

pibēt khadirasāraṁ [1] vā madirādadhimastubhiḥ| athavā pippalīkalkaṁ ghr̥tabhr̥ṣṭaṁ sasaindhavam||64||

saindhavaM pippalIM bhArgIM shRu~ggaveraM durAlabhAm| dADimAmlena koShNena bhArgInAgaramambunA||63||

pibet khadirasAraM [1] vA madirAdadhimastubhiH| athavA pippalIkalkaM ghRutabhRuShTaM sasaindhavam||64||

Intake of the powder of saindhava, pippali, bharangi, shringavera and duralabha along with lukewarm juice of sour dadima or the decoction of nagara cures vataja kasa.

Intake of khadira saara along with madira or takra; intake of pippali fried with ghrita mixed with saindhava is beneficial in vataja kasa. [63-64]

Dhumapana (medicated smoke inhalation) formulations

शिरसः पीडने स्रावे नासाया हृदि ताम्यति | कासप्रतिश्यायवतां धूमं वैद्यः प्रयोजयेत् ||६५||

दशाङ्गुलोन्मितां नाडीमथवाऽष्टाङ्गुलोन्मिताम् | शरावसम्पुटच्छिद्रे कृत्वा जिह्मां विचक्षणः ||६६||

वैरेचनं मुखेनैव कासवान् धूममापिबेत् | तमुरः केवलं प्राप्तं मुखेनैवोद्वमेत् पुनः ||६७||

स ह्यस्य तैक्ष्ण्याद्विच्छिद्य श्लेष्माणमुरसि स्थितम् | निष्कृष्य शमयेत् कासं वातश्लेष्मसमुद्भवम् ||६८||

śirasaḥ pīḍanē srāvē nāsāyā hr̥di tāmyati| kāsapratiśyāyavatāṁ dhūmaṁ vaidyaḥ prayōjayēt||65||

daśāṅgulōnmitāṁ nāḍīmathavā'ṣṭāṅgulōnmitām| śarāvasampuṭacchidrē kr̥tvā jihmāṁ vicakṣaṇaḥ||66||

vairēcanaṁ mukhēnaiva kāsavān dhūmamāpibēt| tamuraḥ kēvalaṁ prāptaṁ mukhēnaivōdvamēt punaḥ||67||

sa hyasya taikṣṇyādvicchidya ślēṣmāṇamurasi sthitam| niṣkr̥ṣya śamayēt kāsaṁ vātaślēṣmasamudbhavam||68||

shirasaH pIDane srAve nAsAyA hRudi tAmyati| kAsapratishyAyavatAM dhUmaM vaidyaH prayojayet||65||

dashA~ggulonmitAM nADImathavA~aShTA~ggulonmitAm| sharAvasampuTacchidre kRutvA jihmAM vicakShaNaH||66||

vairecanaM mukhenaiva kAsavAn dhUmamApibet| tamuraH kevalaM prAptaM mukhenaivodvamet punaH||67||

sa hyasya taikShNyAdvicchidya shleShmANamurasi sthitam| niShkRuShya shamayet kAsaM vAtashleShmasamudbhavam||68||

If there is pain in the shiras, nasa srava, arrhythmia of hridaya and pratishyaya in kasa then the physician should administer dhuma. A wise physician should keep the ingredients of the recipe which cause elimination of dosha from the head inside two earthen plates with their brims sealed with mud-smeared cloth. In the upper plate there should be a hole to which a tube, ten or eight angulas in length, should be inserted in slightly curved form. The patient suffering from kasa should smoke the fume emanating from this tube through his mouth. After the smoke pervades the entire chest, it should be smoked out through the mouth. Because of the sharpness of the ingredients used in this recipe, the phlegm located in the chest gets detached and forcibly thrown out as a result of which kasa caused by vayu and kapha gets alleviated. [65-68]

मनःशिलालमधुकमांसीमुस्तेङ्गुदैः पिबेत् | धूमं तस्यानु च क्षीरं सुखोष्णं सगुडं पिबेत् ||६९||

एष कासान् पृथग्दोषसन्निपातसमुद्भवान् | धूमो हन्यादसंसिद्धानन्यैर्योगशतैरपि ||७०||

प्रपौण्डरीकं मधुकं शार्ङ्गेष्टां समनःशिलाम् | मरिचं पिप्पलीं द्राक्षामेलां सुरसमञ्जरीम् ||७१||

कृत्वा वर्तिं पिबेद्धूमं क्षौमचेलानुवर्तिताम् | घृताक्तामनु च क्षीरं गुडोदकमथापि वा ||७२||

मनःशिलैलामरिचक्षाराञ्जनकुटन्नटैः | वंशलेखनसेव्यालक्षौमलक्तकरोहिषैः ||७३||

पूर्वकल्पेन धूमोऽयं सानुपानो विधीयते | मनःशिलाले तद्वच्च पिप्पलीनागरैः सह ||७४||

त्वगैङ्गुदी बृहत्यौ द्वे तालमूली मनःशिला | कार्पासास्थ्यश्वगन्धा च धूमः कासविनाशनः ||७५||

manaḥśilālamadhukamāṁsīmustēṅgudaiḥ pibēt| dhūmaṁ tasyānu ca kṣīraṁ sukhōṣṇaṁ saguḍaṁ pibēt||69||

ēṣa kāsān pr̥thagdōṣasannipātasamudbhavān| dhūmō hanyādasaṁsiddhānanyairyōgaśatairapi||70||

prapauṇḍarīkaṁ madhukaṁ śārṅgēṣṭāṁ samanaḥśilām| maricaṁ pippalīṁ drākṣāmēlāṁ surasamañjarīm||71||

kr̥tvā vartiṁ pibēddhūmaṁ kṣaumacēlānuvartitām| ghr̥tāktāmanu ca kṣīraṁ guḍōdakamathāpi vā||72||

manaḥśilailāmaricakṣārāñjanakuṭannaṭaiḥ| vaṁśalēkhanasēvyālakṣaumalaktakarōhiṣaiḥ [1] ||73||

pūrvakalpēna dhūmō'yaṁ sānupānō vidhīyatē| manaḥśilālē tadvacca pippalīnāgaraiḥ saha||74||

tvagaiṅgudī br̥hatyau dvē tālamūlī manaḥśilā| kārpāsāsthyaśvagandhā ca dhūmaḥ kāsavināśanaḥ||75||

manaHshilAlamadhukamAMsImuste~ggudaiH pibet| dhUmaM tasyAnu ca kShIraM sukhoShNaM saguDaM pibet||69||

eSha kAsAn pRuthagdoShasannipAtasamudbhavAn| dhUmo hanyAdasaMsiddhAnanyairyogashatairapi||70||

prapauNDarIkaM madhukaM shAr~ggeShTAM samanaHshilAm| maricaM pippalIM drAkShAmelAM surasama~jjarIm||71||

kRutvA vartiM pibeddhUmaM kShaumacelAnuvartitAm| ghRutAktAmanu ca kShIraM guDodakamathApi vA||72||

manaHshilailAmaricakShArA~jjanakuTannaTaiH| vaMshalekhanasevyAlakShaumalaktakarohiShaiH [1] ||73||

pUrvakalpena dhUmo~ayaM sAnupAno vidhIyate| manaHshilAle tadvacca pippalInAgaraiH saha||74||

tvagai~ggudI bRuhatyau dve tAlamUlI manaHshilA| kArpAsAsthyashvagandhA ca dhUmaH kAsavinAshanaH||75||

Intake of lukewarm milk along with guda after the dhumapana using manahshila, ala(haritala), madhuka, jatamansi, ingudi cures kasa of prthakdosha (three dosha individually) or sannipatika. This can cure such ailments which were not cured even after the treatment with hundred other recipes.

The paste prepared out of prapoundarika, madhuka, sharangeshta, manhashila, maricha, pippali, draksha, ela and surasa manjari(inflorescence of Ocimum sanctum), should be smeared on silk cloth and a varti should be prepared. This varti smeared with ghrita should be used for dhumapana, followed by intake of milk or jaggery mixed with water cures both ekadoshaja and sannipatika kasa.

Dhuma varti prepared out of manahshila, ela, maricha, kshara, anjana, kutannata, vamshalekhana, sevya, ala, kshouma, alakthaka, rohisha as per earlier mentioned procedure and should be administered along with prior said anupana, in kasa.

Similarly dhumavarti can be prepared out of manahshila, ala, pippali and nagara.

Dhuma therapy using bark of ingudi, brihati, kantakari, talamuli, manahshila, karpasasthi (Seeds of karpasa), ashwagandha cures kasa. [69-75]

Diet recipes

ग्राम्यानूपौदकैः शालियवगोधूमषष्टिकान् | रसैर्माषात्मगुप्तानां यूषैर्वा भोजयेद्धितान् ||७६||

यवानीपिप्पलीबिल्वमध्यनागरचित्रकैः | रास्नाजाजीपृथक्पर्णीपलाशशटिपौष्करैः ||७७||

स्निग्धाम्ललवणां सिद्धां पेयामनिलजे पिबेत् | कटीहृत्पार्श्वकोष्ठार्तिश्वासहिक्काप्रणाशिनीम् ||७८||

दशमूलरसे तद्वत्पञ्चकोलगुडान्विताम् | सिद्धां समतिलां दद्यात्क्षीरे वाऽपि ससैन्धवाम् ||७९||

मात्स्यकौक्कुटवाराहैरामिषैर्वा घृतान्विताम् | सिद्धां ससैन्धवां पेयां वातकासी पिबेन्नरः ||८०||

वास्तुको वायसीशाकं मूलकं सुनिषण्णकम् | स्नेहास्तैलादयो भक्ष्याः क्षीरेक्षुरसगौडिकाः ||८१||

दध्यारनालाम्लफलप्रसन्नापानमेव च | शस्यते वातकासे तु स्वाद्वम्ललवणानि च ||८२||

इति वातकासचिकित्सा |

grāmyānūpaudakaiḥ śāliyavagōdhūmaṣaṣṭikān| rasairmāṣātmaguptānāṁ yūṣairvā bhōjayēddhitān||76||

yavānīpippalībilvamadhyanāgaracitrakaiḥ| rāsnājājīpr̥thakparṇīpalāśaśaṭipauṣkaraiḥ||77||

snigdhāmlalavaṇāṁ siddhāṁ pēyāmanilajē pibēt| kaṭīhr̥tpārśvakōṣṭhārtiśvāsahikkāpraṇāśinīm||78||

daśamūlarasē tadvatpañcakōlaguḍānvitām| siddhāṁ samatilāṁ dadyātkṣīrē vā'pi sasaindhavām||79||

mātsyakaukkuṭavārāhairāmiṣairvā ghr̥tānvitām| siddhāṁ [1] sasaindhavāṁ pēyāṁ vātakāsī pibēnnaraḥ||80||

vāstukō vāyasīśākaṁ mūlakaṁ suniṣaṇṇakam| snēhāstailādayō bhakṣyāḥ kṣīrēkṣurasagauḍikāḥ||81||

dadhyāranālāmlaphalaprasannāpānamēva ca| śasyatē vātakāsē tu svādvamlalavaṇāni ca||82||

iti vātakāsacikitsā|

grAmyAnUpaudakaiH shAliyavagodhUmaShaShTikAn| rasairmAShAtmaguptAnAM yUShairvA bhojayeddhitAn||76||

yavAnIpippalIbilvamadhyanAgaracitrakaiH| rAsnAjAjIpRuthakparNIpalAshashaTipauShkaraiH||77||

snigdhAmlalavaNAM siddhAM peyAmanilaje pibet| kaTIhRutpArshvakoShThArtishvAsahikkApraNAshinIm||78||

dashamUlarase tadvatpa~jcakolaguDAnvitAm| siddhAM samatilAM dadyAtkShIre vA~api sasaindhavAm||79||

mAtsyakaukkuTavArAhairAmiShairvA ghRutAnvitAm| siddhAM [1] sasaindhavAM peyAM vAtakAsI pibennaraH||80||

vAstuko vAyasIshAkaM mUlakaM suniShaNNakam| snehAstailAdayo bhakShyAH kShIrekShurasagauDikAH||81||

dadhyAranAlAmlaphalaprasannApAnameva ca| shasyate vAtakAse tu svAdvamlalavaNAni ca||82||

iti vAtakAsacikitsA|

Intake of shashtikashali, shali, yava, godhuma along with the mamsa rasa or yusha prepared out of masha or Atmagupta is beneficial in vataja kasa. Peya prepared out of yavani, pippali, bilwa, nagara, chitraka, rasna, ajaji, prithakparni, palasha, shati and pushkaramoola by adding snigdha, amla and lavana dravyas is beneficial in vataja kasa. This particular peya is helpful in curing vataja kasa associated with shoola in kati, parshwa, koshta, hikka and shwasa.

Intake of peya prepared with dashamoola kashaya by adding the powder of panchakola and gud is specifically useful in vataja kasa. Similarly the peya prepared by adding equal quantity of tila and boiled by adding ksheera is also useful in this kasa.

Peya prepared out of matsya, kukkuta, varaha mamsa by adding ghrita and saindhava lavana should be taken by a person suffering from vataja kasa. Vegetables like vastuka, vayasi, mulaka, sunishannaka should be used in vataja kasa along with adequate quantity of sneha, kshera, ikshurasa and gud. Aranala, amla phala, prasanna etc foods and drinks which are madhura, amla, lavana in nature are useful in vataja kasa.[76-82]

Management of pitta dosha dominant kasa

पैत्तिके सकफे कासे वमनं सर्पिषा हितम् | तथा मदनकाश्मर्यमधुकक्वथितैर्जलैः ||८३||

यष्ट्याह्वफलकल्कैर्वा विदारीक्षुरसायुतैः | हृतदोषस्ततः शीतं मधुरं च क्रमं भजेत् ||८४||

पैत्ते तनुकफे कासे त्रिवृतां मधुरैर्युताम् | दद्याद्घनकफे तिक्तैर्विरेकार्थे युतां भिषक् ||८५||

स्निग्धशीतस्तनुकफे रूक्षशीतः कफे घने | क्रमः कार्यः परं भोज्यैः स्नेहैर्लेहैश्च शस्यते ||८६||

शृङ्गाटकं पद्मबीजं नीलीसाराणि पिप्पली | पिप्पलीमुस्तयष्ट्याह्वद्राक्षामूर्वामहौषधम् ||८७||

लाजाऽमृतफला द्राक्षा त्वक्क्षीरी पिप्पली सिता | पिप्पलीपद्मकद्राक्षा बृहत्याश्च फलाद्रसः ||८८||

खर्जूरं पिप्पली वांशी श्वदंष्ट्रा चेति पञ्च ते | घृतक्षौद्रयुता लेहाः श्लोकार्धैः पित्तकासिनाम् ||८९||

शर्कराचन्दनद्राक्षामधुधात्रीफलोत्पलैः | पैत्ते, समुस्तमरिचः सकफे, सघृतोऽनिले ||९०||

मृद्वीकार्धशतं त्रिंशत्पिप्पलीः शर्करापलम् | लेहयेन्मधुना गोर्वा क्षीरपं च शकृद्रसम् ||९१||

त्वगेलाव्योषमृद्वीकापिप्पलीमूलपौष्करैः | लाजामुस्तशटीरास्नाधात्रीफलबिभीतकैः ||९२||

शर्कराक्षौद्रसर्पिर्भिर्लेहः कासविनाशनः | श्वासं हिक्कां क्षयं चैव हृद्रोगं च प्रणाशयेत् ||९३||

पिप्पल्यामलकं द्राक्षां लाक्षां लाजां सितोपलाम् | क्षीरे पक्त्वा घनं शीतं लिह्यात् क्षौद्राष्टभागिकम् ||९४||

विदारीक्षुमृणालानां रसान् क्षीरं सितोपलाम् | पिबेद्वा मधुसंयुक्तं पित्तकासहरं परम् ||९५||

मधुरैर्जाङ्गलरसैः श्यामाकयवकोद्रवाः | मुद्गादियूषैः शाकैश्च तिक्तकैर्मात्रया हिताः ||९६||

घनश्लेष्मणि लेहास्तु तिक्तका मधुसंयुताः | शालयः स्युस्तनुकफे षष्टिकाश्च रसादिभिः ||९७||

शर्कराम्भोऽनुपानार्थं द्राक्षेक्षूणां रसाः पयः | सर्वं च मधुरं शीतमविदाहि प्रशस्यते ||९८||

काकोलीबृहतीमेदायुग्मैः सवृषनागरैः | पित्तकासे रसान् क्षीरं यूषांश्चाप्युपकल्पयेत् ||९९||

शरादिपञ्चमूलस्य पिप्पलीद्राक्षयोस्तथा | कषायेण शृतं क्षीरं पिबेत् समधुशर्करम् ||१००||

स्थिरासितापृश्निपर्णीश्रावणीबृहतीयुगैः | जीवकर्षभकाकोलीतामलक्यृद्धिजीवकैः ||१०१||

शृतं पयः पिबेत् कासी ज्वरी दाही क्षतक्षयी | तज्जं वा साधयेत् सर्पिः सक्षीरेक्षुरसं भिषक् ||१०२||

जीवकाद्यैर्मधुरकैः फलैश्चाभिषुकादिभिः | कल्कैस्त्रिकार्षिकैः सिद्धे पूतशीते प्रदापयेत् ||१०३||

शर्करापिप्पलीचूर्णं त्वक्क्षीर्या मरिचस्य च | शृङ्गाटकस्य चावाप्य क्षौद्रगर्भान्पलोन्मितान् ||१०४||

गुडान् गोधूमचूर्णेन कृत्वा खादेद्धिताशनः | शुक्रासृग्दोषशोषेषु कासे क्षीणक्षतेषु च ||१०५||

शर्करानागरोदीच्यं कण्टकारीं शटीं समम् | पिष्ट्वा रसं पिबेत्पूतं वस्त्रेण घृतमूर्च्छितम् ||१०६||

महिष्यजाविगोक्षीरधात्रीफलरसैः समैः | सर्पिः सिद्धं पिबेद्युक्त्या पित्तकासनिबर्हणम् ||१०७||

इति पित्तकासचिकित्सा |

paittikē sakaphē kāsē vamanaṁ sarpiṣā hitam| tathā madanakāśmaryamadhukakvathitairjalaiḥ||83||

yaṣṭyāhvaphalakalkairvā vidārīkṣurasāyutaiḥ| hr̥tadōṣastataḥ śītaṁ madhuraṁ ca kramaṁ bhajēt||84||

paittē tanukaphē kāsē trivr̥tāṁ madhurairyutām| dadyādghanakaphē tiktairvirēkārthē yutāṁ bhiṣak||85||

snigdhaśītastanukaphē rūkṣaśītaḥ kaphē ghanē| kramaḥ kāryaḥ paraṁ bhōjyaiḥ snēhairlēhaiśca śasyatē||86||

śr̥ṅgāṭakaṁ padmabījaṁ nīlīsārāṇi pippalī| pippalīmustayaṣṭyāhvadrākṣāmūrvāmahauṣadham||87||

lājā'mr̥taphalā drākṣā tvakkṣīrī pippalī sitā| pippalīpadmakadrākṣā br̥hatyāśca phalādrasaḥ||88||

kharjūraṁ pippalī vāṁśī śvadaṁṣṭrā cēti pañca tē| ghr̥takṣaudrayutā lēhāḥ ślōkārdhaiḥ pittakāsinām||89||

śarkarācandanadrākṣāmadhudhātrīphalōtpalaiḥ| paittē, samustamaricaḥ sakaphē, saghr̥tō'nilē||90||

mr̥dvīkārdhaśataṁ triṁśatpippalīḥ śarkarāpalam| lēhayēnmadhunā gōrvā kṣīrapaṁ [1] ca śakr̥drasam||91||

tvagēlāvyōṣamr̥dvīkāpippalīmūlapauṣkaraiḥ| lājāmustaśaṭīrāsnādhātrīphalabibhītakaiḥ||92||

śarkarākṣaudrasarpirbhirlēhaḥ kāsavināśanaḥ| śvāsaṁ hikkāṁ kṣayaṁ caiva hr̥drōgaṁ ca praṇāśayēt||93||

pippalyāmalakaṁ drākṣāṁ lākṣāṁ lājāṁ sitōpalām| kṣīrē paktvā ghanaṁ śītaṁ lihyāt kṣaudrāṣṭabhāgikam||94||

vidārīkṣumr̥ṇālānāṁ rasān kṣīraṁ sitōpalām| pibēdvā madhusaṁyuktaṁ pittakāsaharaṁ param||95||

madhurairjāṅgalarasaiḥ śyāmākayavakōdravāḥ| mudgādiyūṣaiḥ śākaiśca tiktakairmātrayā hitāḥ||96||

ghanaślēṣmaṇi lēhāstu tiktakā madhusaṁyutāḥ| śālayaḥ syustanukaphē ṣaṣṭikāśca rasādibhiḥ||97||

śarkarāmbhō'nupānārthaṁ drākṣēkṣūṇāṁ rasāḥ payaḥ| sarvaṁ ca madhuraṁ śītamavidāhi praśasyatē||98||

kākōlībr̥hatīmēdāyugmaiḥ savr̥ṣanāgaraiḥ| pittakāsē rasān kṣīraṁ yūṣāṁścāpyupakalpayēt||99||

śarādipañcamūlasya pippalīdrākṣayōstathā| kaṣāyēṇa śr̥taṁ kṣīraṁ pibēt samadhuśarkaram||100||

sthirāsitāpr̥śniparṇīśrāvaṇībr̥hatīyugaiḥ| jīvakarṣabhakākōlītāmalakyr̥ddhijīvakaiḥ||101||

śr̥taṁ payaḥ pibēt kāsī jvarī dāhī kṣatakṣayī| tajjaṁ vā sādhayēt sarpiḥ sakṣīrēkṣurasaṁ bhiṣak||102||

jīvakādyairmadhurakaiḥ phalaiścābhiṣukādibhiḥ| kalkaistrikārṣikaiḥ siddhē pūtaśītē pradāpayēt||103||

śarkarāpippalīcūrṇaṁ tvakkṣīryā maricasya ca| śr̥ṅgāṭakasya cāvāpya kṣaudragarbhānpalōnmitān||104||

guḍān gōdhūmacūrṇēna kr̥tvā khādēddhitāśanaḥ| śukrāsr̥gdōṣaśōṣēṣu kāsē kṣīṇakṣatēṣu ca||105||

śarkarānāgarōdīcyaṁ kaṇṭakārīṁ śaṭīṁ samam| piṣṭvā rasaṁ pibētpūtaṁ vastrēṇa ghr̥tamūrcchitam||106||

mahiṣyajāvigōkṣīradhātrīphalarasaiḥ samaiḥ| sarpiḥ siddhaṁ pibēdyuktyā pittakāsanibarhaṇam||107||

iti pittakāsacikitsā|

paittike sakaphe kAse vamanaM sarpiShA hitam| tathA madanakAshmaryamadhukakvathitairjalaiH||83||

yaShTyAhvaphalakalkairvA vidArIkShurasAyutaiH| hRutadoShastataH shItaM madhuraM ca kramaM bhajet||84||

paitte tanukaphe kAse trivRutAM madhurairyutAm| dadyAdghanakaphe tiktairvirekArthe yutAM bhiShak||85||

snigdhashItastanukaphe rUkShashItaH kaphe ghane| kramaH kAryaH paraM bhojyaiH snehairlehaishca shasyate||86||

shRu~ggATakaM padmabIjaM nIlIsArANi pippalI| pippalImustayaShTyAhvadrAkShAmUrvAmahauShadham||87||

lAjA~amRutaphalA drAkShA tvakkShIrI pippalI sitA| pippalIpadmakadrAkShA bRuhatyAshca phalAdrasaH||88||

kharjUraM pippalI vAMshI shvadaMShTrA ceti pa~jca te| ghRutakShaudrayutA lehAH shlokArdhaiH pittakAsinAm||89||

sharkarAcandanadrAkShAmadhudhAtrIphalotpalaiH| paitte, samustamaricaH sakaphe, saghRuto~anile||90||

mRudvIkArdhashataM triMshatpippalIH sharkarApalam| lehayenmadhunA gorvA kShIrapaM [1] ca shakRudrasam||91||

tvagelAvyoShamRudvIkApippalImUlapauShkaraiH| lAjAmustashaTIrAsnAdhAtrIphalabibhItakaiH||92||

sharkarAkShaudrasarpirbhirlehaH kAsavinAshanaH| shvAsaM hikkAM kShayaM caiva hRudrogaM ca praNAshayet||93||

pippalyAmalakaM drAkShAM lAkShAM lAjAM sitopalAm| kShIre paktvA ghanaM shItaM lihyAt kShaudrAShTabhAgikam||94||

vidArIkShumRuNAlAnAM rasAn kShIraM sitopalAm| pibedvA madhusaMyuktaM pittakAsaharaM param||95||

madhurairjA~ggalarasaiH shyAmAkayavakodravAH| mudgAdiyUShaiH shAkaishca tiktakairmAtrayA hitAH||96||

ghanashleShmaNi lehAstu tiktakA madhusaMyutAH| shAlayaH syustanukaphe ShaShTikAshca rasAdibhiH||97||

sharkarAmbho~anupAnArthaM drAkShekShUNAM rasAH payaH| sarvaM ca madhuraM shItamavidAhi prashasyate||98||

kAkolIbRuhatImedAyugmaiH savRuShanAgaraiH| pittakAse rasAn kShIraM yUShAMshcApyupakalpayet||99||

sharAdipa~jcamUlasya pippalIdrAkShayostathA| kaShAyeNa shRutaM kShIraM pibet samadhusharkaram||100||

sthirAsitApRushniparNIshrAvaNIbRuhatIyugaiH| jIvakarShabhakAkolItAmalakyRuddhijIvakaiH||101||

shRutaM payaH pibet kAsI jvarI dAhI kShatakShayI| tajjaM vA sAdhayet sarpiH sakShIrekShurasaM bhiShak||102||

jIvakAdyairmadhurakaiH phalaishcAbhiShukAdibhiH| kalkaistrikArShikaiH siddhe pUtashIte pradApayet||103||

sharkarApippalIcUrNaM tvakkShIryA maricasya ca| shRu~ggATakasya cAvApya kShaudragarbhAnpalonmitAn||104||

guDAn godhUmacUrNena kRutvA khAdeddhitAshanaH| shukrAsRugdoShashoSheShu kAse kShINakShateShu ca||105||

sharkarAnAgarodIcyaM kaNTakArIM shaTIM samam| piShTvA rasaM pibetpUtaM vastreNa ghRutamUrcchitam||106||

mahiShyajAvigokShIradhAtrIphalarasaiH samaiH| sarpiH siddhaM pibedyuktyA pittakAsanibarhaNam||107|| iti pittakAsacikitsA|

If pittaja kasa is associated with the aggravation of kapha, then vamana karma is to be advised with ghrita or using the kashaya prepared out of madana, kashmari, madhuka. Vamana can also be induced by using the klaka of madanaphal and madhuyashti along with vidari and ikshurasa. Once after the elimination of aggravated doshas he should be treated with sheeta and madhura aharas.

If in pittaja kasa the phlegm is thin then virechana is to be advised using trivrita mixed with madhura dravyas, followed by snigdha and sheeta ahara. Whereas if the phlegm is thick then trivrita is to be mixed with tiktha dravyas, followed by ruksha and sheeta dravyas.

After proper shodhana therapy person should be treated with snigdha leha kalpanas.

Following five formulations have been advised for pittaja kasa along with ghrita and kshoudra and made into the form of leha:

1. Shringataka, padma beeja, sara of nili, and pippali
2. Pippali, musta, yashtimadhu, draksha, murva, mahoushadha
3. Laja, amritapahala, draksha, tavaksheeri, pippali, sita
4. Pippali, padmaka, draksha, brihati phalarasa
5. Kharjuara, pippali, vamshalochana, shwadamshtra

If kasa is exclusively of pitta, then the patient should be given the combination of sharkara, chanadana, draksha, madhu, dhatriphala and utpala. If there is association of kapha, then he should administer this along with musta and maricha. If however, it is associated with vata, then it should be used with ghrita.

Fifty fruits of mridvika, thirty fruits of pippali and one pala of sugar should be added with madhu, and given to the patient suffering from pittaja kasa.

Administration of madhu either with cows milk or urine is beneficial in pittaja kasa. But during this therapy patient should drink only milk. The leha prepared out of twak, ela, shunthi, pippali, maricha, mridvika, pippalimula, pushkaramula, laja, musta, shati, rasna, dhatriphala and bibhitaka along with sharkara, madhu and ghrita cures kasa, shwasa, hikka, kshaya, hridroga. Pippali, amalaki, draksha, lakshai, laja and sitopala should be cooked by adding milk. When it becomes cool , one eighth part of madhu should be added. This is indicated in kasa. Intake of the liquid prepared out vidari, ikshu, mrinala, ksheera and sitopala mixed with madhu cures pittaja kasa effectively. Intake of yusha prepared out of shyamaka, yavaka, kodrava, mudga along with sweet jangal mamsa rasa along with tiktha shaka is beneficial in pittaja kasa. If the phlegm is thick then the patient should be administered with lehas prepared out of tiktha rasa dravyas along with madhu. If the phlegm is thin, then the patient should be given with shali and shashtika shali along with mamsa rasa.

In this pittaja kasa drink prepared out of sharkara, draksha, ikshurasa and milk are beneficial. All things which are madhura, sheeta and avidahi should be used.

Dishes like mamsa rasa, ksheera, yusha etc prepared out of kakoli, brihati, meda, mahameda, vasa and nagara are to be used in pittaja kasa. Similarly milk boiled with sharadi panchamoola(Trinapanchamoola), pippali, draksha along with madhu and sharkara should be taken in pittaja kasa.

Milk boiled with sthira, sita, prashniparni, sharavani, brihati, kantakari, jivaka, rshabhaka, kakoli, tamalaki, rddhi and jivaka is useful in the treatment of kasa, jwara, daha, kshata and kshaya.

The ghrita collected from the above mentioned should be added with milk, ikshu rasa and the paste of three karsas of each of the madhura dravya belonging to jivaneeya group, fruits of abhishuka etc and cooked. The ghrita should then be filtered out and made to cool. To this the powder of sharkara, pippali, tvak-kshiri, maricha , shringatak and madhu should be added. This paste should be added with wheat-flour and gud (sarpi gud) should be prepared out of it. Intake of this cures shukra and asrig dosha, shosha, kasa , kshataksheena etc.

Fine paste of sharkara, nagara, udeechya, kantakari, shati should be prepared and is to be filtered through a cloth. This liquid is to be used for the ghrita murchana. This murchita ghrita cures pittaja kasa.

Ghrita should be cooked with mahisha, aja and cows milk, along with dhatri phala rasa, all taken in equal quantity. Intake of this ghrita in appropriate quantity cures pittaja kasa.

Thus ends the description of pittaja kasa. [83-107]

Management of kapha dosha dominant kasa

बलिनं वमनैरादौ शोधितं कफकासिनम् | यवान्नैः कटूरूक्षोष्णैः कफघ्नैश्चाप्युपाचरेत् ||१०८||

पिप्पलीक्षारिकैर्युषैः कौलत्थैर्मूलकस्य च | लघून्यन्नानि भुञ्जीत रसैर्वा कटुकान्वितैः ||१०९||

धान्वबैलरसैः स्नेहैस्तिलसर्षपबिल्वजैः | मध्वम्लोष्णाम्बुतक्रं वा मद्यं वा निगदं पिबेत् ||११०||

पौष्करारग्वधं मूलं पटोलं तैर्निशास्थितम् | जलं मधुयुतं पेयं कालेष्वन्नस्य वा त्रिषु ||१११||

balinaṁ vamanairādau śōdhitaṁ kaphakāsinam| yavānnaiḥ kaṭurūkṣōṣṇaiḥ kaphaghnaiścāpyupācarēt||108||

pippalīkṣārikairyūṣaiḥ kaulatthairmūlakasya ca| laghūnyannāni bhuñjīta rasairvā kaṭukānvitaiḥ||109||

dhānvabailarasaiḥ snēhaistilasarṣapabilvajaiḥ| madhvamlōṣṇāmbutakraṁ vā madyaṁ vā nigadaṁ pibēt||110||

pauṣkarāragvadhaṁ mūlaṁ paṭōlaṁ tairniśāsthitam| jalaṁ madhuyutaṁ pēyaṁ kālēṣvannasya vā triṣu||111||

balinaM vamanairAdau shodhitaM kaphakAsinam| yavAnnaiH kaTurUkShoShNaiH kaphaghnaishcApyupAcaret||108||

pippalIkShArikairyUShaiH kaulatthairmUlakasya ca| laghUnyannAni bhu~jjIta rasairvA kaTukAnvitaiH||109||

dhAnvabailarasaiH snehaistilasarShapabilvajaiH| madhvamloShNAmbutakraM vA madyaM vA nigadaM pibet||110||

pauShkarAragvadhaM mUlaM paTolaM tairnishAsthitam| jalaM madhuyutaM peyaM kAleShvannasya vA triShu||111||

If the person suffering from kaphaja kasa is strong, then he should follow shodhana procedure by means of vamana. There after he should be given with yava and such other kaphaghna food which are katu, ruksha and ushna in nature.

The person should take laghu ahara with the yusha prepared out of kulattha, pippali, kshara, mulaka or with the mamsa rasa of animals of arid zone/ bilehsya etc. mixed with katu rasadravya, srashapataila and bilva.

Drinks such as madhu, amala rasa, warm water, butter milk or harmless madya are preferred in kaphaja kasa. Roots of pushkaramoola, argwadha, patola, tinisha should be kept in water for whole night. Next morning water should be strained out and added with madhu. This should be taken before, during and after food. [108-111]

कट्फलं कत्तृणं भार्गीं मुस्तं धान्यं वचाभये | शुण्ठीं पर्पटकं शृङ्गीं सुराह्वं च शृतं जले ||११२||

मधुहिङ्गुयुतं पेयं कासे वातकफात्मके | कण्ठरोगे मुखे शूने श्वासहिक्काज्वरेषु च ||११३||

पाठां शुण्ठीं शटीं मूर्वां गवाक्षीं मुस्तपिप्पलीम् | पिष्ट्वा घर्माम्बुना हिङ्गुसैन्धवाभ्यां युतां पिबेत् ||११४||

नागरातिविषे मुस्तं शृङ्गीं कर्कटकस्य च | हरीतकीं शटीं चैव तेनैव विधिना पिबेत् ||११५||

तैलभृष्टं च पिप्पल्याः कल्काक्षं ससितोपलम् | पिबेद्वा श्लेष्मकासघ्नं कुलत्थरससंयुतम् ||११६||

कासमर्दाश्वविट्भृङ्गराजवार्ताकजो रसः | सक्षौद्रः कफकासघ्नः सुरसस्यासितस्य च ||११७||

देवदारु शटी रास्ना कर्कटाख्या दुरालभा | पिप्पली नागरं मुस्तं पथ्याधात्रीसितोपलाः ||११८||

मधुतैलयुतावेतौ लेहौ वातानुगे कफे | पिप्पली पिप्पलीमूलं चित्रको हस्तिपिप्पली ||११९||

पथ्या तामलकी धात्री भद्रमुस्ता च पिप्पली | देवदार्वभया मुस्तं पिप्पली विश्वभेषजम् ||१२०||

विशाला पिप्पली मुस्तं त्रिवृता चेति लेहयेत् | चतुरो मधुना लेहान् कफकासहरान् भिषक् ||१२१||

सौवर्चलाभयाधात्रीपिप्पलीक्षारनागरम् | चूर्णितं सर्पिषा वातकफकासहरं पिबेत् ||१२२||

दशमूलाढके प्रस्थं घृतस्याक्षसमैः पचेत् |

kaṭphalaṁ kattr̥ṇaṁ bhārgīṁ mustaṁ dhānyaṁ vacābhayē| śuṇṭhīṁ parpaṭakaṁ śr̥ṅgīṁ surāhvaṁ ca śr̥taṁ jalē||112||

madhuhiṅguyutaṁ pēyaṁ kāsē vātakaphātmakē| kaṇṭharōgē mukhē śūnē śvāsahikkājvarēṣu ca||113||

pāṭhāṁ śuṇṭhīṁ śaṭīṁ mūrvāṁ gavākṣīṁ mustapippalīm| piṣṭvā gharmāmbunā hiṅgusaindhavābhyāṁ yutāṁ pibēt||114||

nāgarātiviṣē mustaṁ śr̥ṅgīṁ karkaṭakasya ca| harītakīṁ śaṭīṁ caiva tēnaiva vidhinā pibēt||115||

tailabhr̥ṣṭaṁ ca pippalyāḥ kalkākṣaṁ sasitōpalam| pibēdvā ślēṣmakāsaghnaṁ kulattharasasaṁyutam||116||

kāsamardāśvaviṭbhr̥ṅgarājavārtākajō rasaḥ| sakṣaudraḥ kaphakāsaghnaḥ surasasyāsitasya ca||117||

dēvadāru śaṭī rāsnā karkaṭākhyā durālabhā| pippalī nāgaraṁ mustaṁ pathyādhātrīsitōpalāḥ||118||

madhutailayutāvētau lēhau vātānugē kaphē| pippalī pippalīmūlaṁ citrakō hastipippalī||119||

pathyā tāmalakī dhātrī bhadramustā ca pippalī| dēvadārvabhayā mustaṁ pippalī viśvabhēṣajam||120||

viśālā pippalī mustaṁ trivr̥tā cēti lēhayēt| caturō madhunā lēhān kaphakāsaharān bhiṣak||121||

sauvarcalābhayādhātrīpippalīkṣāranāgaram| cūrṇitaṁ sarpiṣā vātakaphakāsaharaṁ pibēt||122||

kaTphalaM kattRuNaM bhArgIM mustaM dhAnyaM vacAbhaye| shuNThIM parpaTakaM shRu~ggIM surAhvaM ca shRutaM jale||112||

madhuhi~gguyutaM peyaM kAse vAtakaphAtmake| kaNTharoge mukhe shUne shvAsahikkAjvareShu ca||113||

pAThAM shuNThIM shaTIM mUrvAM gavAkShIM mustapippalIm| piShTvA gharmAmbunA hi~ggusaindhavAbhyAM yutAM pibet||114||

nAgarAtiviShe mustaM shRu~ggIM karkaTakasya ca| harItakIM shaTIM caiva tenaiva vidhinA pibet||115||

tailabhRuShTaM ca pippalyAH kalkAkShaM sasitopalam| pibedvA shleShmakAsaghnaM kulattharasasaMyutam||116||

kAsamardAshvaviTbhRu~ggarAjavArtAkajo rasaH| sakShaudraH kaphakAsaghnaH surasasyAsitasya ca||117||

devadAru shaTI rAsnA karkaTAkhyA durAlabhA| pippalI nAgaraM mustaM pathyAdhAtrIsitopalAH||118||

madhutailayutAvetau lehau vAtAnuge kaphe| pippalI pippalImUlaM citrako hastipippalI||119||

pathyA tAmalakI dhAtrI bhadramustA ca pippalI| devadArvabhayA mustaM pippalI vishvabheShajam||120||

vishAlA pippalI mustaM trivRutA ceti lehayet| caturo madhunA lehAn kaphakAsaharAn bhiShak||121||

sauvarcalAbhayAdhAtrIpippalIkShAranAgaram| cUrNitaM sarpiShA vAtakaphakAsaharaM pibet||122||

Decoction prepared by boiling drugs such as katphala, kuttrana, bharangi, musta, dhanyaka, vacha, abhaya, shunthi, parpata, shrungi and surahva is to be used in kasa associated with vata and kapha along with madhu and hingu. This is also beneficial in kantharoga, mukha roga, shoola, shwasa, hikka and jwara.

Patha, shunthi, shati, murva, gavakshi, musta and pippali paste taken along with hot water by adding hingu and saindhava cures kasa. Similarly administration of nagara, ativisha, musta, karkatashringi, haritaki and shati is also beneficial.

One aksha of the paste of pippali, fried with oil should be added with sitopala. Intake of this recipe along with kulattha yusha cures kaphaja kasa. The swarasa extracted out of kasamarda, stool of horse, bhringaraja, vartaka and black variety of surasa along with honey cures kaphaja kasa.

Powder prepared out of devadaru, shati, rasna, karkatashringi, duralabha taken along with madhu and taila is effective in vatanuga kaphaja kasa.

Pippali, nagara, musta, haritaki, amalaki and sitopala is to be taken along with madhu and taila is effective in vatanuga kaphaja kasa.

Pippali, pippalimula, chitraka and gaja pippali should be made into leha form by adding madhu. Intake of this cures kaphaja kasa.

Similarly pathya, tamalaki, dhatri, bhadra-musta and pippali combination taken along with madhu cures kaphajakasa. Vishala, pippali, musta, trivrit should be taken along with honey in kaphaja kasa.

Intake of the powder prepared out of souvarchala, abhaya, dhatri, pipplai, kshara and nagara taken along with ghrita cures kasa caused by vata and kapha. [112-122]

Dashamuladi ghritam

पुष्कराह्वशटीबिल्वसुरसव्योषहिङ्गुभिः ||१२३||

पेयानुपानं तत् पेयं कासे वातकफात्मके | श्वासरोगेषु सर्वेषु कफवातात्मकेषु च ||१२४||

इति दशमूलादिघृतम् |

daśamūlāḍhakē prasthaṁ ghr̥tasyākṣasamaiḥ pacēt| puṣkarāhvaśaṭībilvasurasavyōṣahiṅgubhiḥ||123||

pēyānupānaṁ tat pēyaṁ kāsē vātakaphātmakē| śvāsarōgēṣu sarvēṣu kaphavātātmakēṣu ca||124||

iti daśamūlādighr̥tam|

dashamUlADhake prasthaM ghRutasyAkShasamaiH pacet| puShkarAhvashaTIbilvasurasavyoShahi~ggubhiH||123||

peyAnupAnaM tat peyaM kAse vAtakaphAtmake| shvAsarogeShu sarveShu kaphavAtAtmakeShu ca||124||

iti dashamUlAdighRutam|

One prastha of dashamoola should be cooked by adding one adhaka of the decoction of dashamoola and the paste of one aksha each of pushkar-moola, shati, bilva, surasa, shunthi, pippali, maricha and hingu. Administration of this ghee followed by peya as anupana cure vata kaphaja kasa, shwasa roga.

Thus ends the description of dashamooladi ghrita. [123-124]

Kantakari ghritam

समूलफलपत्रायाः कण्टकार्या रसाढके | घृतप्रस्थं बलाव्योषविडङ्गशटिचित्रकैः ||१२५||

सौवर्चलयवक्षारपिप्पलीमूलपौष्करैः | वृश्चीरबृहतीपथ्यायवानीदाडिमर्धिभिः ||१२६||

द्राक्षापुनर्नवाचव्यदुरालम्भाम्लवेतसैः | शृङ्गीतामलकीभार्गीरास्नागोक्षुरकैः पचेत् ||१२७||

कल्कैस्तत् सर्वकासेषु हिक्काश्वासेषु शस्यते | कण्टकारीघृतं ह्येतत् कफव्याधिनिसूदनम् ||१२८||

इति कण्टकारीघृतम् |

samūlaphalapatrāyāḥ kaṇṭakāryā rasāḍhakē| ghr̥taprasthaṁ balāvyōṣaviḍaṅgaśaṭicitrakaiḥ||125||

sauvarcalayavakṣārapippalīmūlapauṣkaraiḥ| vr̥ścīrabr̥hatīpathyāyavānīdāḍimardhibhiḥ||126||

drākṣāpunarnavācavyadurālambhāmlavētasaiḥ| śr̥ṅgītāmalakībhārgīrāsnāgōkṣurakaiḥ pacēt||127||

kalkaistat sarvakāsēṣu hikkāśvāsēṣu śasyatē| kaṇṭakārīghr̥taṁ hyētat kaphavyādhinisūdanam||128||

iti kaṇṭakārīghr̥tam|

samUlaphalapatrAyAH kaNTakAryA rasADhake| ghRutaprasthaM balAvyoShaviDa~ggashaTicitrakaiH||125||

sauvarcalayavakShArapippalImUlapauShkaraiH| vRushcIrabRuhatIpathyAyavAnIdADimardhibhiH||126||

drAkShApunarnavAcavyadurAlambhAmlavetasaiH| shRu~ggItAmalakIbhArgIrAsnAgokShurakaiH pacet||127||

kalkaistat sarvakAseShu hikkAshvAseShu shasyate| kaNTakArIghRutaM hyetat kaphavyAdhinisUdanam||128||

iti kaNTakArIghRutam|

One adhaka of kantakari kashaya should be prepared using its root, fruit and leaves. This is to be processed with one prastha of ghrita by adding the paste of bala, shunthi, pippali, maricha, vidanga, shati, chitraka, sauvarchala, yavakshara, pippalimula, pushkarmoola, vrischira, brihati, pathya, yavani, dadima, riddhi, draksha, punaranava, chavya, duralabha, amlavetasa, shringi, tamalaki, bharangi, rasna and gokshuara. This is beneficial in all types of kasa, hikka and shwasa. This is known as kantakari ghrita and it cures all types of kaphaja diseases.

Thus ends the description of kantakari-ghrita.

Kulatthadi ghritam

कुलत्थरसयुक्तं वा पञ्चकोलशृतं घृतम् | पाययेत् कफजे कासे हिक्काश्वासे च शस्यते ||१२९||

इति कुलत्थादिघृतम् |

kulattharasayuktaṁ vā pañcakōlaśr̥taṁ ghr̥tam| pāyayēt kaphajē kāsē hikkāśvāsē ca śasyatē||129||

iti kulatthādighr̥tam|

kulattharasayuktaM vA pa~jcakolashRutaM ghRutam| pAyayet kaphaje kAse hikkAshvAse ca shasyate||129||

iti kulatthAdighRutam|

Ghrita cooked with the decoction of kulattha or with that of panchakola is useful in kaphaja kasa, hikka and shwasa.

Thus ends the description of kulatthadi- ghrita. [125-129]

Dhuma (medicated smmoke) formulations

धूमांस्तानेव दद्याच्च ये प्रोक्ता वातकासिनाम् | कोशातकीफलान्मध्यं पिबेद्वा समनःशिलम् ||१३०||

dhūmāṁstānēva dadyācca yē prōktā vātakāsinām| kōśātakīphalānmadhyaṁ pibēdvā samanaḥśilam||130||

dhUmAMstAneva dadyAcca ye proktA vAtakAsinAm| koshAtakIphalAnmadhyaM pibedvA samanaHshilam||130||

Dhuma yogas which have been mentioned at the context of vataja kasa can also be administered in pittaja kasa. Specifically manshilla kept inside the koshataki phala majja is useful in the form of dhupana in kaphaja-kasa. [130]

Principles of treatment in various states of dosha

तमकः कफकासे तु स्याच्चेत् पित्तानुबन्धजः | पित्तकासक्रियां तत्र यथावस्थं प्रयोजयेत् ||१३१||

वाते कफानुबन्धे तु कुर्यात् कफहरीं क्रियाम् | पित्तानुबन्धयोर्वातकफयोः पित्तनाशिनीम् ||१३२||

आर्द्रे विरूक्षणं, शुष्के स्निग्धं, वातकफात्मके | कासेऽन्नपानं कफजे सपित्ते तिक्तसंयुतम् ||१३३||

इति कफजकासचिकित्सा |

tamakaḥ kaphakāsē tu syāccēt pittānubandhajaḥ| pittakāsakriyāṁ tatra yathāvasthaṁ prayōjayēt||131||

vātē kaphānubandhē tu kuryāt kaphaharīṁ kriyām| pittānubandhayōrvātakaphayōḥ pittanāśinīm||132||

ārdrē virūkṣaṇaṁ, śuṣkē snigdhaṁ, vātakaphātmakē| kāsē'nnapānaṁ kaphajē sapittē tiktasaṁyutam||133||

iti kaphajakāsacikitsā|

tamakaH kaphakAse tu syAccet pittAnubandhajaH| pittakAsakriyAM tatra yathAvasthaM prayojayet||131||

vAte kaphAnubandhe tu kuryAt kaphaharIM kriyAm| pittAnubandhayorvAtakaphayoH pittanAshinIm||132||

Ardre virUkShaNaM, shuShke snigdhaM, vAtakaphAtmake| kAse~annapAnaM kaphaje sapitte tiktasaMyutam||133||

iti kaphajakAsacikitsA|

If kaphaja kasa is associated with tamaka(a type of shwasa) then at this stage of kasa, therapies prescribed for pittaja kasa should be administered.

If there is association kapha in vataja kasa the kaphahara measures should be administered.

If pitta is associated with vataja and kaphaja kasa then pittahara measures should be followed.

If vataja and kaphaja kasa are associated with expectoration of phlegm, then rukshana therapy should be followed, whereas if not associated with phlegm then snigdha therapy should be administered.

If kaphaja kasa is associated with pitta, then the patient should be given food and drinks mixed with tikta dravyas.

Thus ends the description of kaphaja kasa.[131-134]

Management of kshataja kasa (due to injury)

कासमात्ययिकं मत्वा क्षतजं त्वरया जयेत् | मधुरैर्जीवनीयैश्च बलमांसविवर्धनैः ||१३४||

पिप्पली मधुकं पिष्टं कार्षिकं ससितोपलम् | प्रास्थिकं गव्यमाजं च क्षीरमिक्षुरसस्तथा ||१३५||

यवगोधूममृद्वीकाचूर्णमामलकाद्रसः | तैलं च प्रसृतांशानि तत् सर्वं मृदुनाऽग्निना ||१३६||

पचेल्लेहं घृतक्षौद्रयुक्तः स क्षतकासहा | श्वासहृद्रोगकार्श्येषु हितो वृद्धेऽल्परेतसि ||१३७||

kāsamātyayikaṁ matvā kṣatajaṁ tvarayā jayēt| madhurairjīvanīyaiśca balamāṁsavivardhanaiḥ||134||

pippalī madhukaṁ piṣṭaṁ kārṣikaṁ sasitōpalam| prāsthikaṁ gavyamājaṁ ca kṣīramikṣurasastathā||135||

yavagōdhūmamr̥dvīkācūrṇamāmalakādrasaḥ| tailaṁ ca prasr̥tāṁśāni tat sarvaṁ mr̥dunā'gninā||136||

pacēllēhaṁ ghr̥takṣaudrayuktaḥ sa kṣatakāsahā| śvāsahr̥drōgakārśyēṣu hitō vr̥ddhē'lparētasi||137||

kAsamAtyayikaM matvA kShatajaM tvarayA jayet| madhurairjIvanIyaishca balamAMsavivardhanaiH||134||

pippalI madhukaM piShTaM kArShikaM sasitopalam| prAsthikaM gavyamAjaM ca kShIramikShurasastathA||135||

yavagodhUmamRudvIkAcUrNamAmalakAdrasaH| tailaM ca prasRutAMshAni tat sarvaM mRudunA~agninA||136||

pacellehaM ghRutakShaudrayuktaH sa kShatakAsahA| shvAsahRudrogakArshyeShu hito vRuddhe~alparetasi||137||

Kshatajakasa is a serious ailment. Keeping this in view the treatment of the patient should be initiated instantaneously with madhura and jivaniya dravyas, which are promoters of bala and mamsa.

The paste of one karsha of each of pippali, madhuka, one karsha of sitopala, one prastha of each of cows milk, goats milk and ikshurasa, one prastha of the powder of yava, godhuma, draksha and one prastha of each of the juice of amalaka and tilataila should be cooked over mridu agni. Intake of this leha along with ghrita and madhu cures kshataja kasa, shwasa, hridroga and kshata. It is also useful for old persons and those who have less semen.[134-137]

क्षतकासाभिभूतानां वृत्तिः स्यात् पित्तकासिकी | क्षीरसर्पिर्मधुप्राया संसर्गे तु विशेषणम् ||१३८||

वातपित्तार्दितेऽभ्यङ्गो गात्रभेदे घृतैर्हितः | तैलैर्मारुतरोगघ्नैः पीड्यमाने च वायुना ||१३९||

हृत्पार्श्वार्तिषु पानं स्याज्जीवनीयस्य सर्पिषः | सदाहं कासिनो रक्तं ष्ठीवतः सबलेऽनले ||१४०||

मांसोचितेभ्यः क्षामेभ्यो लावादीनां रसा हिताः | तृष्णार्तानां पयश्छागं शरमूलादिभिः शृतम् ||१४१||

रक्ते स्रोतोभ्य आस्याद्वाऽप्यागते क्षीरजं घृतम् | नस्यं पानं यवागूर्वा श्रान्ते क्षामे हतानले ||१४२||

स्तम्भायामेषु महतीं मात्रां वा सर्पिषः पिबेत् | कुर्याद्वा वातरोगघ्नं पित्तरक्ताविरोधि यत् ||१४३||

निवृत्ते क्षतदोषे तु कफे वृद्ध उरः क्षते | दाल्यते कासिनो यस्य स धूमान्ना पिबेदिमान् ||१४४||

द्वे मेदे मधुकं द्वे च बले तैः क्षौमलक्तकैः | वर्तितैर्धूममापीय जीवनीयघृतं पिबेत् ||१४५||

मनःशिलापलाशाजगन्धात्वक्क्षीरिनागरैः | भावयित्वा पिबेत् क्षौममनु चेक्षुगुडोदकम् ||१४६||

पिष्ट्वा मनःशिलां तुल्यामार्द्रया वटशुङ्गया | ससर्पिष्कं पिबेद्धूमं तित्तिरिप्रतिभोजनम् ||१४७||

भावितं जीवनीयैर्वा कुलिङ्गाण्डरसायुतैः | क्षौमं धूमं पिबेत् क्षीरं शृतं चायोगुडैरनु ||१४८||

इति क्षतजकासचिकित्सा |

kṣatakāsābhibhūtānāṁ vr̥ttiḥ syāt pittakāsikī| kṣīrasarpirmadhuprāyā saṁsargē tu viśēṣaṇam||138||

vātapittārditē'bhyaṅgō gātrabhēdē ghr̥tairhitaḥ| tailairmārutarōgaghnaiḥ pīḍyamānē ca vāyunā||139||

hr̥tpārśvārtiṣu pānaṁ syājjīvanīyasya sarpiṣaḥ| sadāhaṁ kāsinō raktaṁ ṣṭhīvataḥ sabalē'nalē||140||

māṁsōcitēbhyaḥ kṣāmēbhyō lāvādīnāṁ rasā hitāḥ| tr̥ṣṇārtānāṁ payaśchāgaṁ śaramūlādibhiḥ śr̥tam||141||

raktē srōtōbhya āsyādvā'pyāgatē kṣīrajaṁ ghr̥tam| nasyaṁ pānaṁ yavāgūrvā śrāntē kṣāmē hatānalē||142||

stambhāyāmēṣu mahatīṁ mātrāṁ vā sarpiṣaḥ pibēt| kuryādvā vātarōgaghnaṁ pittaraktāvirōdhi yat||143||

nivr̥ttē kṣatadōṣē tu kaphē vr̥ddha uraḥ [1] kṣatē| dālyatē kāsinō yasya sa dhūmānnā pibēdimān||144||

dvē mēdē madhukaṁ dvē ca balē taiḥ kṣaumalaktakaiḥ| vartitairdhūmamāpīya jīvanīyaghr̥taṁ pibēt||145||

manaḥśilāpalāśājagandhātvakkṣīrināgaraiḥ| bhāvayitvā pibēt kṣaumamanu cēkṣuguḍōdakam||146||

piṣṭvā manaḥśilāṁ tulyāmārdrayā vaṭaśuṅgayā| sasarpiṣkaṁ pibēddhūmaṁ tittiripratibhōjanam||147||

bhāvitaṁ jīvanīyairvā kuliṅgāṇḍarasāyutaiḥ| kṣaumaṁ dhūmaṁ pibēt kṣīraṁ śr̥taṁ cāyōguḍairanu||148||

iti kṣatajakāsacikitsā| kShatakAsAbhibhUtAnAM vRuttiH syAt pittakAsikI| kShIrasarpirmadhuprAyA saMsarge tu visheShaNam||138||

vAtapittArdite~abhya~ggo gAtrabhede ghRutairhitaH| tailairmArutarogaghnaiH pIDyamAne ca vAyunA||139||

hRutpArshvArtiShu pAnaM syAjjIvanIyasya sarpiShaH| sadAhaM kAsino raktaM ShThIvataH sabale~anale||140||

mAMsocitebhyaH kShAmebhyo lAvAdInAM rasA hitAH| tRuShNArtAnAM payashchAgaM sharamUlAdibhiH shRutam||141||

rakte srotobhya AsyAdvA~apyAgate kShIrajaM ghRutam| nasyaM pAnaM yavAgUrvA shrAnte kShAme hatAnale||142||

stambhAyAmeShu mahatIM mAtrAM vA sarpiShaH pibet| kuryAdvA vAtarogaghnaM pittaraktAvirodhi yat||143||

nivRutte kShatadoShe tu kaphe vRuddha uraH [1] kShate| dAlyate kAsino yasya sa dhUmAnnA pibedimAn||144||

dve mede madhukaM dve ca bale taiH kShaumalaktakaiH| vartitairdhUmamApIya jIvanIyaghRutaM pibet||145||

manaHshilApalAshAjagandhAtvakkShIrinAgaraiH| bhAvayitvA pibet kShaumamanu cekShuguDodakam||146||

piShTvA manaHshilAM tulyAmArdrayA vaTashu~ggayA| sasarpiShkaM pibeddhUmaM tittiripratibhojanam||147||

bhAvitaM jIvanIyairvA kuli~ggANDarasAyutaiH| kShaumaM dhUmaM pibet kShIraM shRutaM cAyoguDairanu||148||

iti kShatajakAsacikitsA|

The medicaments prescribed for the pittaja kasa are also useful for kshatajakasa. Generally milk, ghee and honey should be given to such patients. If two dosha are involved in the pathogenesis of this ailment then special therapies are required.

If this ailment is associated with vata and pitta and the person has pain all over the body then abhyanga should be given with ghee. If there is excessive vata aggravation, causing pain, then abhyanga should be given with taila prepared out of vatahara dravya.

The person suffering from kasa along with pain in hridaya and parshwa associated with burning sensation, hemoptysis and aggravation of vata should take jivaniya siddha ghrita.

If the person weak and habituated to take mamsa then the mamsarasa prepared out of lava is beneficial for him.

If he is suffering from trishna then he can take goats milk processed with trinapanchamoola.

If there is bleeding then he should take the ghee extracted out of this milk. Or this ghee can be administered in the form of nasya or as a drink.

If the patient of kshata is fatigued and weak, and if he has low power of digestion, then he should be given yavagu to eat.

If there is stambha and ayama then the patient should be given ghee in large quantity.

Thus all therapies which alleviate the vata, simultaneously which do not aggravate pitta and rakta should be followed in such persons.

After khsataja kasa treatment, after complete relief, still person is complaining of pain at the place of injury due to aggravation of kapha, should be given dhumapana chikitsa with following combination.

Meda, mahameda, madhuka, bala and mahabala should be made into paste and smeared over silk-cloth and varti is to be prepared. After the pana of this dhumavarti should be prepared by smearing a piece of silk cloth with the paste of manahshila, palasha, ajagandha, tavksheeri, and nagara. After dhumapana the person should drink ikshurasa and water mixed with jaggery.

Manhashila should be made into a paste by tritrating it with the vatashrunga. To this ghee should be added. After dhuma the person should be given tittiri pakshi mamsa rasa.

The silk cloth should be soaked with jivaniya gana dravyas or with egg yolk of kulinga. With this varti should be prepared and after dhumapana, the person should take the milk soaked with hot iron balls. This is beneficial in kshataja kasa.[138-148]

Management of kshayaja kasa (due to depletion)

सम्पूर्णरूपं क्षयजं दुर्बलस्य विवर्जयेत् | नवोत्थितं बलवतः प्रत्याख्यायाचरेत् क्रियाम् ||१४९||

तस्मै बृंहणमेवादौ कुर्यादग्नेश्च दीपनम् | बहुदोषाय सस्नेहं मृदु दद्याद्विरेचनम् ||१५०||

शम्पाकेन त्रिवृतया मृद्वीकारसयुक्तया | तिल्वकस्य कषायेण विदारीस्वरसेन च ||१५१||

सर्पिः सिद्धं पिबेद्युक्त्या क्षीणदेहो विशोधनम् | (हितं तद्देहबलयोरस्य संरक्षणं मतम् ) ||१५२||

पित्ते कफे च सङ्क्षीणे परिक्षीणेषु धातुषु | घृतं कर्कटकीक्षीरद्विबलासाधितं पिबेत् ||१५३||

विदारीभिः कदम्बैर्वा तालसस्यैस्तथा शृतम् | घृतं पयश्च मूत्रस्य वैवर्ण्ये कृच्छ्रनिर्गमे ||१५४||

शूने सवेदने मेढ्रे पायौ सश्रोणिवङ्क्षणे | घृतमण्डेन मधुनाऽनुवास्यो मिश्रकेण वा ||१५५||

जाङ्गलैः प्रतिभुक्तस्य वर्तकाद्या बिलेशयाः | क्रमशः प्रसहाश्चैव प्रयोज्याः पिशिताशिनः ||१५६||

औष्ण्यात् प्रमाथिभावाच्च स्रोतोभ्यश्च्यावयन्ति ते | कफं, शुद्धैश्च तैः पुष्टिं कुर्यात्सम्यग्वहन्रसः ||१५७||

sampūrṇarūpaṁ kṣayajaṁ durbalasya vivarjayēt| navōtthitaṁ balavataḥ pratyākhyāyācarēt kriyām||149||

tasmai br̥ṁhaṇamēvādau kuryādagnēśca dīpanam| bahudōṣāya sasnēhaṁ mr̥du dadyādvirēcanam||150||

śampākēna trivr̥tayā mr̥dvīkārasayuktayā| tilvakasya kaṣāyēṇa vidārīsvarasēna ca||151||

sarpiḥ siddhaṁ pibēdyuktyā kṣīṇadēhō viśōdhanam| (hitaṁ taddēhabalayōrasya saṁrakṣaṇaṁ matam [1] )||152||

pittē kaphē ca saṅkṣīṇē parikṣīṇēṣu dhātuṣu| ghr̥taṁ karkaṭakīkṣīradvibalāsādhitaṁ pibēt||153||

vidārībhiḥ kadambairvā tālasasyaistathā śr̥tam| ghr̥taṁ payaśca mūtrasya vaivarṇyē kr̥cchranirgamē||154||

śūnē savēdanē mēḍhrē pāyau saśrōṇivaṅkṣaṇē| ghr̥tamaṇḍēna madhunā'nuvāsyō [2] miśrakēṇa vā||155||

jāṅgalaiḥ pratibhuktasya vartakādyā bilēśayāḥ| kramaśaḥ prasahāścaiva prayōjyāḥ piśitāśinaḥ||156||

auṣṇyāt pramāthibhāvācca srōtōbhyaścyāvayanti tē| kaphaṁ, śuddhaiśca taiḥ puṣṭiṁ kuryātsamyagvahanrasaḥ||1 57||

sampUrNarUpaM kShayajaM durbalasya vivarjayet| navotthitaM balavataH pratyAkhyAyAcaret kriyAm||149||

tasmai bRuMhaNamevAdau kuryAdagneshca dIpanam| bahudoShAya sasnehaM mRudu dadyAdvirecanam||150||

shampAkena trivRutayA mRudvIkArasayuktayA| tilvakasya kaShAyeNa vidArIsvarasena ca||151||

sarpiH siddhaM pibedyuktyA kShINadeho vishodhanam| (hitaM taddehabalayorasya saMrakShaNaM matam [1] )||152||

pitte kaphe ca sa~gkShINe parikShINeShu dhAtuShu| ghRutaM karkaTakIkShIradvibalAsAdhitaM pibet||153||

vidArIbhiH kadambairvA tAlasasyaistathA shRutam| ghRutaM payashca mUtrasya vaivarNye kRucchranirgame||154||

shUne savedane meDhre pAyau sashroNiva~gkShaNe| ghRutamaNDena madhunA~anuvAsyo [2] mishrakeNa vA||155||

jA~ggalaiH pratibhuktasya vartakAdyA bileshayAH| kramashaH prasahAshcaiva prayojyAH pishitAshinaH||156||

auShNyAt pramAthibhAvAcca srotobhyashcyAvayanti te| kaphaM, shuddhaishca taiH puShTiM kuryAtsamyagvahanrasaH||157||

If kshayaja kasa is manifested with all the signs and symptoms, and if the patient is weak, then he should not be treated. However if the disease has recently occurred and if the patient is strong enough, then he may be treated even though the disease is incurable. In the beginning the person should be given brihmana therapy along with agni deepana. If dosha aggravation is more, then he can be given mild purgation therapy along with snigdha dravyas.

Ghee cooked with the decoction of shamapaka(fruit pulp of aragwadha), trivrit, mridvika rasa, tilvaka kashaya and vidari swarasa should be given in appropriate dosage for the shodhana of ksheena person. It protects the body as well as gives strength for the uras.

When pitta and kapha are reduced in quantity, along emaciation of dhatu, then the person should take the ghrita prepared out of karkatashringi, milk, bala and atibala.

If there is association of mutra vaivarnyata or krichchchrata, then he should be given the milk boiled with vidari, kadamba or with tender fruits of tala.

If there is swelling and pain in the medhra, payu, shroni and vankshana, then the person should be given the anuvasana prepared out of ghritamanda, madhu or with mishraka sneha.

After anuvasana the person should be fed with mamsa rasa prepared out of jangala, prasaha, bileshaya, and vartakas. Because of their ushnata, pramathi bhava these move properly in all srotas and cause dryness of kapha and simultaneously they nourish the srotas.[149-157]

Dvi-panchamuladi ghritam

द्विपञ्चमूलीत्रिफलाचविकाभार्गिचित्रकैः | कुलत्थपिप्पलीमूलपाठाकोलयवैर्जले ||१५८||

शृतैर्नागरदुःस्पर्शापिप्पलीशटिपौष्करैः | कल्कैः कर्कटशृङ्ग्या च समैः सर्पिर्विपाचयेत् ||१५९||

सिद्धैऽस्मिंश्चूर्णितौ क्षारौ द्वौ पञ्च लवणानि च | दत्त्वा युक्त्या पिबेन्मात्रां क्षयकासनिपीडितः ||१६०||

इति द्विपञ्चमूलादिघृतम् |

dvipañcamūlītriphalācavikābhārgicitrakaiḥ| kulatthapippalīmūlapāṭhākōlayavairjalē||158||

śr̥tairnāgaraduḥsparśāpippalīśaṭipauṣkaraiḥ| kalkaiḥ karkaṭaśr̥ṅgyā ca samaiḥ sarpirvipācayēt||159||

siddhē'smiṁścūrṇitau kṣārau dvau pañca lavaṇāni ca| dattvā yuktyā pibēnmātrāṁ kṣayakāsanipīḍitaḥ||160||

iti dvipañcamūlādighr̥tam|

dvipa~jcamUlItriphalAcavikAbhArgicitrakaiH| kulatthapippalImUlapAThAkolayavairjale||158||

shRutairnAgaraduHsparshApippalIshaTipauShkaraiH| kalkaiH karkaTashRu~ggyA ca samaiH sarpirvipAcayet||159||

siddhe~asmiMshcUrNitau kShArau dvau pa~jca lavaNAni ca| dattvA yuktyA pibenmAtrAM kShayakAsanipIDitaH||160||

iti dvipa~jcamUlAdighRutam|

Decoction should be prepared out of bilva, shyonaka, gambhari, patala, ganikarika, shalaparni, prashanaparni, brihati, kantakari, gokshuara, haritaki, bibhitaka, amalaki, chavika, bharangi, chitraka, kulattha, pippali moola, patha, kola and yava. To this decoction ghee and the paste prepared out of nagara, dusparsha, pippali, shati, karkatashringi and pushkara should be added and ghritapachana should be done. After proper paka powder prepared out of yavakshara, sarjakshara, saindhava-lavana, samudra-lavana, sauvarchala-lavana, vida-lavana and audbhida-lavana is to be added. Intake of this cures kshayajakasa.

Thus ends the description of dwi-pancha-mooladi-ghrita.[158-160]

Guduchyadi ghritam

गुडूचीं पिप्पलीं मूर्वां हरिद्रां श्रेयसीं वचाम् | निदिग्धिकां कासमर्दं पाठां चित्रकनागरम् ||१६१||

जले चतुर्गुणे पक्त्वा पादशेषेण तत्समम् | सिद्धं सर्पिः पिबेद्गुल्मश्वासार्तिक्षयकासनुत् ||१६२||

इति गुडूच्यादिघृतम् |

guḍūcīṁ pippalīṁ mūrvāṁ haridrāṁ śrēyasīṁ vacām| nidigdhikāṁ kāsamardaṁ pāṭhāṁ citrakanāgaram||161||

jalē caturguṇē paktvā pādaśēṣēṇa tatsamam| siddhaṁ sarpiḥ pibēdgulmaśvāsārtikṣayakāsanut||162||

iti guḍūcyādighr̥tam|

guDUcIM pippalIM mUrvAM haridrAM shreyasIM vacAm| nidigdhikAM kAsamardaM pAThAM citrakanAgaram||161||

jale caturguNe paktvA pAdasheSheNa tatsamam| siddhaM sarpiH pibedgulmashvAsArtikShayakAsanut||162||

iti guDUcyAdighRutam|

Guduchi, pippali, murva, haridra, shreyasi, vacha, nidigdhika, kasmarda, patha, chitraka and nagara are to be boiled with four times of water, till the quantity of water reduces to one-fourth. To this decoction equal quantity of ghrita should be added and cooked. Intake of this cures gulma, shwasa and kshayajakasa.

Thus ends the description of guduchyaadi-ghrita.[161-162]

कासमर्दाभयामुस्तपाठाकट्फलनागरैः | पिप्पलीकटुकाद्राक्षाकाश्मर्यसुरसैस्तथा ||१६३||

अक्षमात्रैर्घृतप्रस्थं क्षीरद्राक्षारसाढके | पचेच्छोषज्वरप्लीहसर्वकासहरं शिवम् ||१६४||

धात्रीफलैः क्षीरसिद्धैः सर्पिर्वाऽप्यवचूर्णितम् | द्विगुणे दाडिमरसे विपक्वं व्योषसंयुतम् ||१६५||

पिबेदुपरि भक्तस्य यवक्षारघृतं नरः | पिप्पलीगुडसिद्धं वा च्छागक्षीरयुतं घृतम् ||१६६||

एतान्यग्निविवृद्ध्यर्थं सर्पींषि क्षयकासिनाम् | स्युर्दोषबद्धकोष्ठोरःस्रोतसां च विशुद्धये ||१६७||

kāsamardābhayāmustapāṭhākaṭphalanāgaraiḥ| pippalīkaṭukādrākṣākāśmaryasurasaistathā||163||

akṣamātrairghr̥taprasthaṁ kṣīradrākṣārasāḍhakē| pacēcchōṣajvaraplīhasarvakāsaharaṁ śivam||164||

dhātrīphalaiḥ kṣīrasiddhaiḥ sarpirvā'pyavacūrṇitam| dviguṇē dāḍimarasē vipakvaṁ vyōṣasaṁyutam||165||

pibēdupari bhaktasya yavakṣāraghr̥taṁ naraḥ| pippalīguḍasiddhaṁ vā cchāgakṣīrayutaṁ ghr̥tam||166||

ētānyagnivivr̥ddhyarthaṁ sarpīṁṣi kṣayakāsinām| syurdōṣabaddhakōṣṭhōraḥsrōtasāṁ ca viśuddhayē||167||

kAsamardAbhayAmustapAThAkaTphalanAgaraiH| pippalIkaTukAdrAkShAkAshmaryasurasaistathA||163||

akShamAtrairghRutaprasthaM kShIradrAkShArasADhake| pacecchoShajvaraplIhasarvakAsaharaM shivam||164||

dhAtrIphalaiH kShIrasiddhaiH sarpirvA~apyavacUrNitam| dviguNe dADimarase vipakvaM vyoShasaMyutam||165||

pibedupari bhaktasya yavakShAraghRutaM naraH| pippalIguDasiddhaM vA cchAgakShIrayutaM ghRutam||166||

etAnyagnivivRuddhyarthaM sarpIMShi kShayakAsinAm| syurdoShabaddhakoShThoraHsrotasAM ca vishuddhaye||167||

One prastha of ghrita should be cooked by adding the paste of one aksha of each of kasamarda, abhaya, musta, patha, katphala, nagara, pippali, katuka, draksha, kashmarya and surasa; one adhaka of milk and one adhaka of grape juice. Thus prepared ghrita is considered as auspicious, and cures shosha, jwara, pleeha and kasa.

Dhatri phala or dhatriphala powder should be cooked with ksheera and ghrita for ghritapaka, yava-kshara-ghrita prepared by adding double the quantity of dadima-rasa and the powder of vyosha, and which should be taken at the end of a meal; ghrita cooked with the paste of pippali, gud and chaga dugdha;

All the above mentioned ghrita will promote agni of the patient suffering from kshayajakasa. These also cleanse the adhered doshas from the srotas of koshtha and uras.[163-167]

Haritaki leha

हरीतकीर्यवक्वाथद्व्याढके विंशतिं पचेत् | स्विन्ना मृदित्वा तास्तस्मिन् पुराणं गुडषट्पलम् ||१६८||

दद्यान्मनःशिलाकर्षं कर्षार्धं च रसाञ्जनात् | कुडवार्धं च पिप्पल्याः स लेहः श्वासकासनुत् ||१६९||

इति हरीतकीलेहः |

harītakīryavakvāthadvyāḍhakē viṁśatiṁ pacēt| svinnā mr̥ditvā tāstasmin purāṇaṁ guḍaṣaṭpalam||168||

dadyānmanaḥśilākarṣaṁ karṣārdhaṁ ca rasāñjanāt| kuḍavārdhaṁ ca pippalyāḥ sa lēhaḥ śvāsakāsanut||169||

iti harītakīlēhaḥ|

harItakIryavakvAthadvyADhake viMshatiM pacet| svinnA mRuditvA tAstasmin purANaM guDaShaTpalam||168||

dadyAnmanaHshilAkarShaM karShArdhaM ca rasA~jjanAt| kuDavArdhaM ca pippalyAH sa lehaH shvAsakAsanut||169||

iti harItakIlehaH|

Twenty fruits of haritaki should be boiled with one adhaka of yava kashaya. These boiled and soft fruits of haritaki are to be smashed. To this paste, six palas of purana gud, one karsha of rasanjana, half kudava of pippali should be added and cooked. This particular leha cures shwasa and kasa.

Thus ends the description of haritaki-leha. [168-169]

Padmakadi leha

श्वाविधः सूचयो दग्धाः सघृतक्षौद्रशर्कराः | श्वासकासहरा बर्हिपादौ वा क्षौद्रसर्पिषा ||१७०||

एरण्डपत्रक्षारं वा व्योषतैलगुडान्वितम् | लिह्यादेतेन विधिना सुरसैरण्डपत्रजम् ||१७१||

द्राक्षापद्मकवार्ताकपिप्पलीः क्षौद्रसर्पिषा | लिह्यात्त्र्यूषणचूर्णं वा पुराणगुडसर्पिषा ||१७२||

चित्रकं त्रिफलाजाजी कर्कटाख्या कटुत्रिकम् | द्राक्षां च क्षौद्रसर्पिर्भ्यां लिह्यादद्याद्गुडेन वा ||१७३||

पद्मकं त्रिफलां व्योषं विडङ्गं सुरदारु च | बलां रास्नां च तुल्यानि सूक्ष्मचूर्णानि कारयेत् ||१७४||

सर्वैरेभिः समं चूर्णैः पृथक् क्षौद्रं घृतं सिताम् | विमथ्य लेहयेल्लेहं सर्वकासहरं शिवम् ||१७५||

जीवन्तीं मधुकं पाठां त्वक्क्षीरीं त्रिफलां शटीम् | मुस्तैले पद्मकं द्राक्षां द्वे बृहत्यौ वितुन्नकम् ||१७६||

सारिवां पौष्करं मूलं कर्कटाख्यां रसाञ्जनम् | पुनर्नवां लोहरजस्त्रायमाणां यवानिकाम् ||१७७||

भार्गीं तामलकीमृद्धिं विडङ्गं धन्वयासकम् | क्षारचित्रकचव्याम्लवेतसव्योषदारु च ||१७८||

चूर्णीकृत्य समांशानि लेहयेत् क्षौद्रसर्पिषा | चूर्णात्पाणितलं पञ्च कासानेतद् व्यपोहति ||१७९||

इति पद्मकादिलेहः |

śvāvidhaḥ sūcayō dagdhāḥ saghr̥takṣaudraśarkarāḥ| śvāsakāsaharā barhipādau vā kṣaudrasarpiṣā||170||

ēraṇḍapatrakṣāraṁ vā vyōṣatailaguḍānvitam| lihyādētēna vidhinā surasairaṇḍapatrajam||171||

drākṣāpadmakavārtākapippalīḥ kṣaudrasarpiṣā| lihyāttryūṣaṇacūrṇaṁ vā purāṇaguḍasarpiṣā||172||

citrakaṁ triphalājājī karkaṭākhyā kaṭutrikam| drākṣāṁ ca kṣaudrasarpirbhyāṁ lihyādadyādguḍēna vā||173||

padmakaṁ triphalāṁ vyōṣaṁ viḍaṅgaṁ suradāru ca| balāṁ rāsnāṁ ca tulyāni sūkṣmacūrṇāni kārayēt||174||

sarvairēbhiḥ samaṁ cūrṇaiḥ pr̥thak kṣaudraṁ ghr̥taṁ sitām| vimathya lēhayēllēhaṁ sarvakāsaharaṁ śivam||175||

jīvantīṁ madhukaṁ pāṭhāṁ tvakkṣīrīṁ triphalāṁ śaṭīm| mustailē padmakaṁ drākṣāṁ dvē br̥hatyau vitunnakam||176||

sārivāṁ pauṣkaraṁ mūlaṁ karkaṭākhyāṁ rasāñjanam| punarnavāṁ lōharajastrāyamāṇāṁ yavānikām||177||

bhārgīṁ tāmalakīmr̥ddhiṁ viḍaṅgaṁ dhanvayāsakam| kṣāracitrakacavyāmlavētasavyōṣadāru ca||178||

cūrṇīkr̥tya samāṁśāni lēhayēt kṣaudrasarpiṣā| cūrṇātpāṇitalaṁ pañca kāsānētad vyapōhati||179||

iti padmakādilēhaḥ|

shvAvidhaH sUcayo dagdhAH saghRutakShaudrasharkarAH| shvAsakAsaharA barhipAdau vA kShaudrasarpiShA||170||

eraNDapatrakShAraM vA vyoShatailaguDAnvitam| lihyAdetena vidhinA surasairaNDapatrajam||171||

drAkShApadmakavArtAkapippalIH kShaudrasarpiShA| lihyAttryUShaNacUrNaM vA purANaguDasarpiShA||172||

citrakaM triphalAjAjI karkaTAkhyA kaTutrikam| drAkShAM ca kShaudrasarpirbhyAM lihyAdadyAdguDena vA||173||

padmakaM triphalAM vyoShaM viDa~ggaM suradAru ca| balAM rAsnAM ca tulyAni sUkShmacUrNAni kArayet||174||

sarvairebhiH samaM cUrNaiH pRuthak kShaudraM ghRutaM sitAm| vimathya lehayellehaM sarvakAsaharaM shivam||175||

jIvantIM madhukaM pAThAM tvakkShIrIM triphalAM shaTIm| mustaile padmakaM drAkShAM dve bRuhatyau vitunnakam||176||

sArivAM pauShkaraM mUlaM karkaTAkhyAM rasA~jjanam| punarnavAM loharajastrAyamANAM yavAnikAm||177||

bhArgIM tAmalakImRuddhiM viDa~ggaM dhanvayAsakam| kShAracitrakacavyAmlavetasavyoShadAru ca||178||

cUrNIkRutya samAMshAni lehayet kShaudrasarpiShA| cUrNAtpANitalaM pa~jca kAsAnetad vyapohati||179||

iti padmakAdilehaH|

Quills of svavit should be burnt. Intake of these ashes along with ghee, honey and ikshurasa cure kasa and shwasa. Intake of the ash prepared by burning the peacock leg, along with madhu and ghrita cures kasa and shwasa.

The kshara should be prepared out of eranda leaves. Intake of this along with shunthi, maricha, taila and gud cures kasa and shwasa.

Similarly kshara prepared out of eranda leaves and surasa can be used in above said manner.

The powder of draksha, padmaka, vartaka and pippali should be added with madhu and ghrita. Intake of this cures shwasa and kasa.

Intake of tryushana powder along with purana gud and srapi is also effective in kasa and shwasa.

The powder of chitraka, haritaki, bibhitaka, amalaka, ajaji, karkatashringi, shunthi, pippali, maricha and draksha should be mixed with madhu, ghrita and purana gud. Intake of these two cures kasa and shwasa.

Padmaka, triphala, vyosha, vidanga, suradaru, bala and rasna taken in equal quantity should be made into fine powder. To this powder equal quantity of madhu, ghrita and sugar should be added and mixed well. This cures all types of kasa.

Jivanti, madhuka, patha, tavaksheeri, triphala, shati, musta, ela, padmaka, draksha, brihati, kantakari, vitunnaka, sariva, pushkara, karkatashringi, rasanjana, punaranava, loha, rajatha, trayamana, yavanika, bharangi, tamalaki, riddhi, vidanga, dhanvayaasa, kshara, chitraka, chavya, amlavetasa, vyosha, and devadaru should be taken in equal quantity and a fine powder should be prepared. Intake of this powder in one panitala matra along with madhu and ghrita cures all five types of kasa.[170-179]

लिह्यान्मरिचचूर्णं वा सघृतक्षौद्रशर्करम् | बदरीपत्रकल्कं वा घृतभृष्टं ससैन्धवम् ||१८०||

स्वरभेदे च कासे च लेहमेतं प्रयोजयेत् | पत्रकल्कं घृतैर्भृष्टं तिल्वकस्य सशर्करम् ||१८१||

पेया चोत्कारिका च्छर्दितृट्कासामातिसारनुत् | गौरसर्षपगण्डीरविडङ्गव्योषचित्रकान् | साभयान् साधयेत्तोये यवागूं तेन चाम्भसा ||१८२||

ससर्पिर्लवणां कासे हिक्काश्वासे सपीनसे | पाण्ड्वामये क्षये शोथे कर्णशूले च दापयेत् ||१८३||

कण्टकारीरसे सिद्धो मुद्गयूषः सुसंस्कृतः | सगौरामलकः साम्लः सर्वकासभिषग्जितम् ||१८४||

वातघ्नौषधनिष्क्वाथं क्षीरं यूषान् रसानपि | वैष्किरप्रतुदान् बैलान् दापयेत् क्षयकासिने ||१८५||

क्षतकासे च ये धूमाः सानुपाना निदर्शिताः | क्षयकासेऽपि तानेव यथावस्थं प्रयोजयेत् ||१८६||

lihyānmaricacūrṇaṁ vā saghr̥takṣaudraśarkaram| badarīpatrakalkaṁ vā ghr̥tabhr̥ṣṭaṁ sasaindhavam||180||

svarabhēdē ca [1] kāsē ca lēhamētaṁ prayōjayēt| patrakalkaṁ ghr̥tairbhr̥ṣṭaṁ tilvakasya saśarkaram||181||

pēyā cōtkārikā ccharditr̥ṭkāsāmātisāranut| gaurasarṣapagaṇḍīraviḍaṅgavyōṣacitrakān| sābhayān sādhayēttōyē yavāgūṁ tēna cāmbhasā||182||

sasarpirlavaṇāṁ kāsē hikkāśvāsē sapīnasē| pāṇḍvāmayē kṣayē śōthē [2] karṇaśūlē ca dāpayēt||183||

kaṇṭakārīrasē siddhō mudgayūṣaḥ susaṁskr̥taḥ| sagaurāmalakaḥ sāmlaḥ sarvakāsabhiṣagjitam||184||

vātaghnauṣadhaniṣkvāthaṁ kṣīraṁ yūṣān rasānapi| vaiṣkirapratudān bailān dāpayēt kṣayakāsinē||185||

kṣatakāsē ca yē dhūmāḥ sānupānā nidarśitāḥ| kṣayakāsē'pi tānēva yathāvasthaṁ prayōjayēt||186||

lihyAnmaricacUrNaM vA saghRutakShaudrasharkaram| badarIpatrakalkaM vA ghRutabhRuShTaM sasaindhavam||180||

svarabhede ca [1] kAse ca lehametaM prayojayet| patrakalkaM ghRutairbhRuShTaM tilvakasya sasharkaram||181||

peyA cotkArikA ccharditRuTkAsAmAtisAranut| gaurasarShapagaNDIraviDa~ggavyoShacitrakAn| sAbhayAn sAdhayettoye yavAgUM tena cAmbhasA||182||

sasarpirlavaNAM kAse hikkAshvAse sapInase| pANDvAmaye kShaye shothe [2] karNashUle ca dApayet||183||

kaNTakArIrase siddho mudgayUShaH susaMskRutaH| sagaurAmalakaH sAmlaH sarvakAsabhiShagjitam||184||

vAtaghnauShadhaniShkvAthaM kShIraM yUShAn rasAnapi| vaiShkirapratudAn bailAn dApayet kShayakAsine||185||

kShatakAse ca ye dhUmAH sAnupAnA nidarshitAH| kShayakAse~api tAneva yathAvasthaM prayojayet||186||

The powder of maricha should be given with ghrita, madhu and sharkara. Badara leaves should be fried with ghee and this given with saindhava lavana. Both these formulations are beneficial in kasa and swarabheda.

The paste of the leaves of tilvaka should be sizzled with ghrita and made in to utkarika by adding sugar. Intake of this cures chhardi, trishna, kasa,and amatisaara.

White variety of sarshapa, gandira, vidanga, vyosha, chitraka and abhaya should be boiled with water and the decoction is to be prepared. With this decoction yavagu should be prepared. This yavagu administered along with ghrita and lavana is beneficial in kasa, hikka, shwasa, pinasa, pandu, kshaya, shotha and karnashoola.

Mudga yusha should be prepared by using kantakari decoction. Intake of this yusha along with goura amalaka and other amla dravyas cure all types of kasa.

Ksheera, yusha, mamsa rasa are preferred in kshayajakasa persons. For the preparation of mamasarasa vishkira, pratuda and bileshaya mamsa should be added. Always these food preparations should be prepared by vataghna drugs.

Dhumapana formulations mentioned in reference to kshatajakasa can also be administered to the patients suffering from kshayajakasa.[180-186]

Principles of management

दीपनं बृंहणं चैव स्रोतसां च विशोधनम् | व्यत्यासात्क्षयकासिभ्यो बल्यं सर्वं हितं भवेत् ||१८७||

सन्निपातभवोऽप्येष क्षयकासः सुदारुणः | सन्निपातहितं तस्मात् सदा कार्यं भिषग्जितम् ||१८८||

दोषानुबलयोगाच्च हरेद्रोगबलाबलम् | कासेष्वेषु गरीयांसं जानीयादुत्तरोत्तरम् ||१८९||

भोज्यं पानानि सर्पींषि लेहाश्च सह पानकैः | क्षीरं सर्पिर्गुडा धूमाः कासभैषज्यसङ्ग्रहः ||१९०||

dīpanaṁ br̥ṁhaṇaṁ caiva srōtasāṁ ca viśōdhanam| vyatyāsātkṣayakāsibhyō balyaṁ sarvaṁ hitaṁ bhavēt||187||

sannipātabhavō'pyēṣa kṣayakāsaḥ sudāruṇaḥ| sannipātahitaṁ tasmāt sadā kāryaṁ bhiṣagjitam||188||

dōṣānubalayōgācca harēdrōgabalābalam| kāsēṣvēṣu garīyāṁsaṁ jānīyāduttarōttaram||189||

bhōjyaṁ pānāni sarpīṁṣi lēhāśca [1] saha pānakaiḥ| kṣīraṁ sarpirguḍā dhūmāḥ kāsabhaiṣajyasaṅgrahaḥ||190||

dIpanaM bRuMhaNaM caiva srotasAM ca vishodhanam| vyatyAsAtkShayakAsibhyo balyaM sarvaM hitaM bhavet||187||

sannipAtabhavo~apyeSha kShayakAsaH sudAruNaH| sannipAtahitaM tasmAt sadA kAryaM bhiShagjitam||188||

doShAnubalayogAcca haredrogabalAbalam| kAseShveShu garIyAMsaM jAnIyAduttarottaram||189||

bhojyaM pAnAni sarpIMShi lehAshca [1] saha pAnakaiH| kShIraM sarpirguDA dhUmAH kAsabhaiShajyasa~ggrahaH||190||

Dipana, brihmana and srotoshodhana therapies should be followed alternatively in the patient suffering from kshyajakaasa. All such therapies which are balya are preferred in this condition.

Kshayajakasa is caused by sannipata. Therefore therapies which alleviate tridosha are to be administered for the treatment.

But still bala (strength) and abalata (weakness) of the disease is determined by the nature of aggravation of associated dosha. Keeping this in view, treatment should be administered.

The physician should know that among these five kasa, the succeeding ones are more serious than the preceding. Different formulations mentioned under Kasa Chikitsa adhyaya are as follows:

Bhojya, pana, sarpi, leha, panaka, ksheera, sarpiguda and dhuma.[187-190]

Summary

तत्र श्लोकः-

सङ्ख्या निमित्तं रूपाणि साध्यासाध्यत्वमेव च | कासानां भेषजं प्रोक्तं गरीयस्त्वं च कासिनः ||१९१||

tatra ślōkaḥ-

saṅkhyā nimittaṁ rūpāṇi sādhyāsādhyatvamēva ca| kāsānāṁ bhēṣajaṁ prōktaṁ garīyastvaṁ ca kāsinaḥ||191||

tatra shlokaH-

sa~gkhyA nimittaM rUpANi sAdhyAsAdhyatvameva ca| kAsAnAM bheShajaM proktaM garIyastvaM ca kAsinaH||191||

Sankhya (types of kasa), nimitta (etiological factors), rupa (signs and symptoms), sadhya-asadhyata (curability and incurability), kasa bheshaja (medicinal formulations), gariyastva (comparative seriousness of the disease) – have been discussed under this chapter. [191]

इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने कासचिकित्सितं नामाष्टादशोऽध्यायः ||१८||

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē kāsacikitsitaṁ nāmāṣṭādaśō'dhyāyaḥ||18||

cikitsAsthAne kAsacikitsitaM nAmAShTAdasho~adhyAyaH||18||

Thus ends the eighteenth chapter in Chikitsa Sthana dealing with treatment of kasa in the work of Agnivesha which was redacted by Charak and because of non-availability supplemented by Dridhabala.

Tattva Vimarsha (Fundamental Principles)

• Vata being obstructed in the lower region of the body, moves upwards, afflicts the channels of circulation in the upper part of the body, takes over the function of udana vayu and gets localized in the throat and chest, then enters and fills up all the cavities in the head.
• Udanavata plays key role in kasa. It is located in sinuses, throat and upper respiratory tract. Its main function is to exude out secretions from head and upper respiratory tract, effortlessly.
• Due to one group of etiological factors, sinuses and bronchial tree gets filled with secretions. Another group of factors like over exertion, weaken the functions of udanavata by over consuming it.
• Since udanavata is not available, the physiological mechanism of kasa (cough reflex) starts to work causing forceful, frictionful expectoration with sound.
• In order to prevent damage to delicate mucosa and avoid friction, treatment with good amount of ghee after meal is best.
• In contrast to hikka and shwasa, pitta is not involved kasa except paittic kasa.

Vidhi Vimarsha (Applied Inferences)

Diagnostic codes

National Ayurveda Morbidity Code: EA-3

ICD code: R05

Causes of kasa

Dietary:

• Excessive intake of dry, cold and astringent food
• Excess fasting
• Taking food in less quantity [Cha.Sa.Chikitsa Sthana 18/10]
• Excessive intake of hot, spicy, sour foods [Cha.Sa.Chikitsa Sthana 18/14]
• Intake of heavy to digest, slimy, sweet and oily foods [Cha.Sa.Chikitsa Sthana 18/17]

Lifestyle:

• Excessive indulgence in sex
• Excessive physical strain
• Suppression of natural urges [Cha.Sa.Chikitsa Sthana 18/10]
• Excessive exposure to heat [Cha.Sa.Chikitsa Sthana 18/14]
• Excessive sleep and inactivity [Cha.Sa.Chikitsa Sthana 18/17]
• Carrying a hefty load
• Walking excessively long distance
• Chest injury
• Indirect trauma due to excessive heavy exertional work like in bullfight, controlling mighty animals like horses and elephants as in occupational fieldworks [Cha.Sa.Chikitsa Sthana 18/20]

Psychological:

• Anger and grief [Cha.Sa.Chikitsa Sthana 18/14]

Acute exacerbating causes:

• Exposure to smoke and dust
• Entry of food into respiratory tract [Su.Sa.Uttara Sthana 52/4]

Classification

1. Vata dosha predominance
2. Pitta dosha predominance
3. Kapha dosha predominance
4. Traumatic injury (kshataja)
5. Depletion of body tissues (kshayaja) [Cha.Sa.Chikitsa Sthana 18/3-4]

Premonitory features

• Thorny feeling in mouth and throat
• Itching in throat
• Obstruction in deglutition [Cha.Sa.Chikitsa Sthana 18/4]
• Coating of mucous or sticky secretions in throat and palate
• Low raspy voice
• Anorexia
• Low digestive capacity [Su.Sa.Uttara Sthana 52/7]

Clinical features

General clinical features

The voice of patient resembles the sound that comes out of a broken bronze vessel. [Su.Sa.Uttara Sthana 52/5]

Dosha specific clinical features

Vata dominant kasa

• Excruciating pain in the epigastric region, flanks, chest, and head
• Excessive hoarseness of the voice
• Dryness in the chest, throat and mouth
• Horripilation and fainting
• Resonant sound during coughing, looks hopeless, hollow sound during coughing
• Weakness, agitated, illusive perceptions
• Dry cough
• Painful coughing with scanty expectoration
• Cough gets alleviated by the food and drinks that are unctuous, hot, salty and sour
• Increases after digestion of food [Cha.Sa.Chikitsa Sthana 18/10-13]

Pitta dominant kasa

• Yellowish sputum and eyes
• Bitter taste in mouth
• Abnormal voice or inflammation of vocal apparatus as in pharyngitis, laryngitis
• A feeling of smoke is being vomited out of the chest
• Morbid thirst, burning, illusive, anorexia and giddiness
• Appearance of twinkling stars in front of the eyes while coughing continuously
• Expectoration of sputum mixed with pitta [Cha.Sa.Chikitsa Sthana 15-16]

Kapha dominant kasa

• Poor digestion
• Anorexia, vomiting, nausea
• Nasal discharge
• Heaviness
• Horripilation, stickiness, and sweetness of the mouth
• Expectoration of thick, sweet, slimy phlegm in large quantity
• Painless coughing and smooth release of sputum is differentiating feature of kapha dominance
• Feeling of fullness in the chest [Cha.Sa.Chikitsa Sthana 18/18-19]

In a study, kaphakasa is compared with chronic bronchitis.

Kasa as a result of trauma (kshataja)

• Initial dry cough followed by blood-tinged sputum
• Excessive pain in the throat
• Cracking pain in the chest
• Sharp pricking pain
• Excruciating pain and discomfort on touching the chest
• Miserable appearance.
• Pain in joints and fingers, fever, labored breath, thirst, and altered voice
• While coughing, sounds humming like a pigeon. [Cha.Sa.Chikitsa Sthana 18/20-23]

Kasa due to depletion of body tissues (kshayaja)

• Expectoration of greenish, reddish sputum, associated with pus and bad odor.
• While coughing, the person feels as if the heart is displaced.
• Feels suddenly afflicted with both hot and cold sensations
• Weakness and emaciation even after taking food in excessive quantity
• The clean and unctuous complexion of the face, associated with the gracious appearance of face and eyes.
• The soft silky touch of hands and foot
• The person always finds fault with others and develops an immensely hateful disposition
• The person suffers from diseases like jwara (having signs and symptoms of all dosha), nasal congestion, anorexia, painful flanks, and altered voice
• Frequent hard or loose stools without apparent cause [Cha.Sa.Chikitsa Sthana 18/25-28]

Pathogenesis

Image 1: Samprapti of Kasa

• Dosha: Vata, Kapha
• Dushya: Rasa
• Srotasa: pranavaha, rasavaha
• Site of origin: amashaya (stomach)
• Site of manifestation/clinical presentation: Throat (kantha) and chest (uras)
• Type of pathogenesis: Obstruction (sanga), Movement of dosha in the wrong direction (vimargagamana)[Cha.Sa.Chikitsa Sthana 18/6-8]

Clinical examination

• Respiratory rate
• Pulse examination
• Chest examination by auscultation, palpation and percussion

Investigations

Radiological examinations:

• Chest X-Ray
• C.T.Scan of chest and thoracic region

Laboratory investigations:

• Sputum examination
• Absolute Eosinophil count

Prognosis

• Vata, pitta and kapha dominant kasa are curable.
• Cough due to trauma (kshataja) and cough due to depletion of body tissues (kshayaja) are curable initially and in strong individuals. In the chronic stage, they can be controlled and palliated with appropriate drugs and diet. [Cha.Sa.Chikitsa Sthana 18/29-31]

Poor prognostic features:

If the patient is weak, cough due to depletion of body tissues (kshayaja kasa) may cause death. All types are palliable in old patients.[Cha.Sa.Chikitsa Sthana 18/29-30]

Management

Principles of management

• Avoidance of etiological factors
• Purification therapy (shodhana) as per dominance of dosha
• Pacification therapy (shamana) as per dominance of dosha
• Disease-specific rejuvenation treatment (vyadhiahara rasayana)

Dosha specific treatment principles

Vata predominance

• Unctuous therapies (snehana)
• Dietary supplements like gruels, milk, meat etc. processed with vata alleviating medicines can be used. [Cha.Sa.Chikitsa Sthana 18/32-33]
• Therapeutic enema (basti) [Cha.Sa.Chikitsa Sthana 18/32]
• In association kapha or pitta, dosha-specific measures shall be used. [Cha.Sa.Chikitsa Sthana 18/132] When vata dominant kasa is associated with pitta, medicated ghee and milk after food is indicated. [A.Hr.Chikitsa Sthana 3/2]

Pitta predominance

• Therapeutic purgation (virechana) [Cha.Sa.Chikitsa Sthana 18/85]
• Other purification therapies as per quantity of dosha
• Unctuous electuaries [Cha.Sa.Chikitsa Sthana 18/86]

Kapha predominance

• Therapeutic emesis (vamana) [Cha.Sa.Chikitsa Sthana 18/108]
• Dry and light to digest foods
• The oil exuding out from burning log of Cedrus deodara (devadaru) is used in treatment. It is mixed with powders of Piper longum, Piper nigrum and Zingiber officinale (trikatu), and ash of Hordeum vulgare (yavakshara) as a first line of treatment. [A.Hr.Chikitsa Sthana 3/41]

Disease-specific treatment principles

Cough due to traumatic injury

• This acute condition should be treated immediately with drugs promoting strength and improving muscle tissues (mamsa dhatu). Sweet and life-promoting (jivaniya) drugs shall be used. [Cha.Sa.Chikitsa Sthana 18/134]
• Kerria lacca (laksha) mixed with honey with milk is advised. [A.Hr.Chikitsa Sthana 3/73]
• Medicines used for pitta dominant kasa are indicated.
• Milk, ghee, and honey are given in such patients. [Cha.Sa.Chikitsa Sthana 18/138]
• All therapies which alleviate vatadosha, and do not aggravate pitta and rakta should be followed in such persons.
• Ghee prepared with life-promoting (jivaniya) medicines.
• Meat, meat soup prepared out of common quail (lava)
• Goat’s milk processed with trinapanchamoola (combination of Desmostachyabipinnata, Saccharum spontaneum, Phragmites karka, Imperata cylindrical, Saccharum officinarum etc.) in case of morbid thirst (trushna)
• Ghee in the form of nasal administration (nasya) or as a drink in case of bleeding.
• In case of stiffness of body, ghee in larger quantity should be given.[Cha.Sa.Chikitsa Sthana 18/139-143]

Cough due to depletion of body tissues or degenerative conditions

In the initial stage, nourishing therapy (brimhana) with deepana (therapies that increase digestive capacity) should be given. [Cha.Sa.Chikitsa Sthana 18/150] These therapies and purification therapies (srotoshodana) shall be done alternatively. As all three doshas are vitiated in this type of kasa, the therapies aim to pacify and balance all three doshas. [Cha.Sa.Chikitsa Sthana 18/187-88]

If the amount of pitta and kapha are less, and associated with emaciation, then ghee processed with Pistacia chinensis (karkatakasringi), Sida cordifolia (bala), Sidarhombifolia (atibala) and milk should be given.

If kasa is associated with discoloration or difficulty in urination, then milk processed with Pueraria tuberose (vidari), Neolamarckia cadamba (kadamba) or with tender fruits of Flacourita jangomas (tall) should be given. [Cha.Sa.Chikitsa Sthana 18/153-54]

Panchakarma procedures with safety precautions

• Internal administration of unctuous substances (snehapana): In vatakasa [Cha.Sa.Chikitsa Sthana 18/32-33]
• Oil massage (abhyanga): It is indicated in vata dominant kasa [Cha.Sa.Chikitsa Sthana 18/32-33] and cough due to chest injury associated with vata and pitta. [Cha.Sa.Chikitsa Sthana 18/139]
• Fomentation: Unctuous fomentation is indicated in vata dominant kasa [Cha.Sa.Chikitsa Sthana 18/32-33]
• Therapeutic enema (basti): It is indicated in vata dominant kasa associated with constipation and flatulence [Cha.Sa.Chikitsa Sthana 18/32-33]
• Therapeutic purgation (virechana): Purgation with unctuous substance (like castor oil) shall be given in case of dryness and aggravation of kapha. [ [Cha.Sa.Chikitsa Sthana 18/34] In case of thin phlegm, then Operculina turpethum (trivrit) mixed with sweet substances is advised for purgation. In case of thick phlegm, Operculina turpethum (trivrit) mixed with bitter substances is advised for purgation. [Cha.Sa.Chikitsa Sthana 18/85] Mild purgation is advised to reduce aggravated dosha in kasa due to depletion of body tissues. [Cha.Sa.Chikitsa Sthana 18/150]
• Medicated smoke/fumigation (dhuma): It is indicated in case of headache and coryza associated with vata and kaphadosha. [Cha.Sa.Chikitsa Sthana 18/65-68]
• Therapeutic emesis (vamana): In pitta dominant kasa associated with kaphadosha, therapeutic emesis (vamana) is advised with decoction (kashaya) prepared out of Catunaregam spinosa (madana), Gmelina arborea (kashmari), Glycyrrhiza glabra (madhuka) etc. [Cha.Sa.Chikitsa Sthana 18/83] In kapha dominant kasa and strong person, therapeutic emesis shall be done first. [Cha.Sa.Chikitsa Sthana 18/108]
• Intra nasal drug administration (nasya): If bleeding is present in kasa (as a result of trauma), trinapanchamula ghee is used for nasya. It is prepared from milk processed with herbs of trinapanchamoola (combination of Desmostachyabi pinnata, Saccharum spontaneum, Phragmites karka, Imperata cylindrical, Saccharum officinarum etc.). [Cha.Sa.Chikitsa Sthana 18/142] In kapha dominant kasa, nasal instillation with medicines having purificatory properties (shirovirechana nasya) is advised. [Su.Sa.Uttara Sthana 52/28]
• Decoction enema (niruha basti): Therapeutic enema with decoction is indicated [Su.Sa.Uttara Sthana 52/27] in vata dominant kasa with constipation and flatulence. [A.Hr. Chikitsa Sthana 3/2]
• Medicated unctuous enema (anuvasana basti): Medicated unctuous enema (anuvasana) is advised if pain and swelling in loin, groin, anus or penile region are present in kasa (due to depletion of body tissue) patient. [Cha.Sa.Chikitsa Sthana 18/155]. It is indicated in vata dominant kasa. [Su.Sa.Uttara Sthana 52/27]

Medicines used in current practice

Herbs

Piper longam (pippali), Piper nigrum (maricha), Flacourtia jangomas (talisapatra), Solanum virginianum (kantakari), Inula racemosa (pushkaramula).

Herbal formulations

Agastya Haritaki [Cha.Sa.Chikitsa Sthana 18/ 57-62], Kushmandarasayana [A.Hr.Chikitsa Sthana 3/114-117], Vyaghriharitaki [B.R.15/169-172], Talisadichurna [B.R 15/36-40], Vasa arishta, Vasa avaleha [B.R.15/179-181], Sitopaladi churna, Lavangadivati [B.R.15/35], Khadiradi vati, Kanakasava.

Herbo-mineral formulations

Laxmivilasa rasa [B.R 15/130-37], Kasakuthara rasa, Svachandabhairava rasa, Hema garbha potalirasa, Rudraparpati, Bhutankusha rasa, Amritarnava rasa[B.R 15/60-61]

Wholesome diet

Meat soup along with wheat, barley, rice etc. and sweet, sour and salty foods are wholesome in kasa with vata predominance.[Cha.Sa.Chikitsa Sthana 18/76-82]

Dysphania ambrosioides (vastuka), Solanum americanum (vayasi), Senna occidentalis (kasaghna), fruits and leaves of Solanum virginianum (kantakari), dried tender Raphanus raphanistrum (mulaka), Sesamum indicum (tila) oil, edibles prepared from milk, sugarcane juice and jaggery, whey of curds, juice prepared from sour fruits and fermented beverages are wholesome in vatakasa. [A.Hr.Chikitsa Sthana 3/23-24]

In kasa with pitta predominance, sweet and cold things are advised. Shyamaka, Hordeum vulgare (yava), Paspalum scrobiculatum (kodrava), bitter vegetables etc. are wholesome. [B.R 15/8] [Cha.Sa.Chikitsa Sthana 18/98]

Hot and spicy food materials are wholesome in kasa with kapha predominance. [Cha.Sa.Chikitsa Sthana 18/108]

Drinks such as honey (madhu), warm water, buttermilk etc. are preferred in kasa with kapha predominance. [Cha.Sa.Chikitsa Sthana 18/110]

Piper longum, Piper nigrum and Zingiber officinale (trikatu)[Su.Sa.Uttara Sthana 52/29], barley, green gram, horse gram etc. are wholesome in kaphakasa.[A.Hr.Chikitsa Sthana 3/43]

Goat’s milk is good in all types of kasa.

Complications

If kasa is not appropriately treated, it leads to consumption (rajayakshma) due to aggravation of all three dosha and depletion of body tissues.[Su.Sa.Uttara Sthana 52/6]

Contemporary views

Case reports

Solanum xanthocarpum

The whole plant (panchanga) of Solanum xanthocarpum showed significant anti-tussive activity when compared to its roots. Administration of 10 gms of powder of drug for 10 days in 30 patients reported better action over kapha dominant kasa. The drug might be suppressing the central cough center by stimulating opioid receptors in the brain. It may be acting through protective ciliary activity in the respiratory tract. The action as demulcent can relieve cough.

Tribulus terrestris

An experimental study reported anti-tussive activity of root powder of Tribulus terrestris (laghu gokshura) in sulphur dioxide induced cough models. The number of cough episodes was significantly less in Tribulus terrestris (laghu gokshura) root administered group. While root of Pedalium murex (brihat gokshura) showed insignificant decrease in number of cough episodes. In a clinical study, administration of powder of Tribulus terrestris (laghu gokshura) root and root of Pedalium murex (brihat gokshura), 3gm twice a day in 28 patients of kasa is observed. It reported better effect in group administered with Tribulus terrestris. The effect was better in reducing vatakasa. This study also suggested effect of drug on central nervous system and its anti-inflammatory activity.

Combination of terminalia chebula and rock salt

In a study conducted on 19 patients, Terminalia chebula (haritaki) with Rock salt (saindava lavana) was found effective in reducing the symptoms of kaphakasa. There was 92.3% relief in cough with sputum and itching in throat. The action of haritaki on vata and kaphadosha due to its hot potency is observed as reason behind efficacy.

Kantakari-maricha leha

In a study, kantakari-marichaleha (ayurvedic formulation) was administered for 7 days in 30 children with symptoms of kaphakasa. It was found effective in reducing the signs and symptoms.

Samasharkara powder formulation

In another study on 60 patients with kaphakasa, 10gms of Samasarkarachurna for 15 days is found effective in reducing the signs and symptoms.

Bhrigarajasava as adjunct to anti tubercular treatment

In another study conducted on 60 patients with pulmonary tuberculosis (TB), administration of Bhrigarajasava along with the standard treatment was found effective in reducing the cough. The cough progressively diminished and became occasional and non-productive within 15 days of treatment.

Vyaghri-haritaki avaleha in chronic bronchitis

A study on 66 patients with chronic bronchitis reported that Vyaghri-haritaki avaleha effectively reduced the productive cough, which is the cardinal feature of chronic bronchitis.

In another study conducted on 25 patients of kasa, administration of vyaghri-haritaki avaleha for four weeks showed highly significant results signs and symptoms.

Unctuous enema in pertussis

Administration of unctuous enema (snehabasti) in pertussis patients of pediatric age group ( n=2) was studied. It was found very effective in reducing dry cough. Sesame oil in a dose of 10 - 20ml is used in basti for 14 days along with antimicrobial therapy. Initially, the intensity of cough was reduced, followed by a reduction in the frequency of cough episodes. Unctuous enema acts directly over the colon to restore normal functions of vatadosha.

Kasahara dashemani tablets

In 40 children with kasa, administration of Kasahara Dashemani vati for 60 days showed relief in all symptoms of kasa. Reduction in acute eosinophil count (AEC) and erythrocyte sedimentation rate (ESR) levels are noted. The decrease in IgE levels indicates the drug’s action against allergy. It is found effective in vata and pitta predominant kasa.

List of research works done

1. Mansukh S Parmar (2012): A comparative pharmacognostical, physicochemical and pharmacological study of moola and panchanga of Kantakari (Solanum xanthocarpum Schrad. & Wendl.) w.s.r. to its kasahara karma, Department of Dravyaguna Vigyan, IPGT&RA, Jamnagar
2. Chandrika N Methekar (2012): A comparative pharmacognostical and phyto pharmacological assessment of moola, panchanga of laghugokshura (Tribulus terrestris Linn.) and Brihatgokshura (Pedalium murex Linn.) w.s.r to its kasahara karma, Department of Dravyaguna Vigyan, IPGT&RA, Jamanagar

Abbreviations

Cha. = Charak, Su. = Sushruta, A. = Ashtanga, Hr. = Hridayam, Sa. = Samhita, B.R = Bhaishajya ratnavali

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