Hikka Shwasa Chikitsa

Hikka Shwasa Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 17
Preceding Chapter	Pandu Chikitsa
Succeeding Chapter	Kasa Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 17, Chapter on Management of Hiccups and Dyspnea)

Abstract

The chapter deals with the etio-pathogenesis and management of hikka (hiccups) and shwasa (dyspnea). The general causative factors include dietary and environmental pathogens and specific pathogenesis is due to involvement of vata and kapha as major dosha. Thus five types of hikka and shwasa are elaborated. The classification is based upon clinical presentation of disease and includes three types each of hikka and shwasa with bad prognostic signs pointing to imminent death. The description comprehends basic priniciples of management focused on removing obstruction of kapha and allowing proper flow of vata by means of purification therapies, sudation, nasal errhines, medicated smoking and various formulations. The management emphasizes on nourishment and pacification therapies to successfully treat and prevent shwasa and hikka conditions. Depletion therapies are strongly contra-indicated as they may worsen the condition of patient and disease. Keywords: Shvasa, hikka, dyspnea, hiccups, tamaka shwasa, bronchial asthma, respiratory disorders, vamana, therapeutic emesis, virechana, therapeutic purgation, swedana, sudation.

Introduction

Hikka (hiccups) and shwasa (shortness of breath) may be caused due to pandu roga. (Chakrapani Cha. Chi 17/1). That is why this chapter follows pandu roga chapter. Hikka and shwasa have common etiological factors like raja (pollen or dust particles), dhuma (smoke) etc. (karana), location (sthana) and treatment or mula. For that reason, both conditions are described in the same chapter.

Hikka and shwasa are two diseases of serious nature and can cause death if not treated properly. The etiological factors, site, origin of both hikka and shwasa are same, and hence the line of treatment is also common. The aetiological factors related to food, regimen and mental faculties lead to the aggravation of vata in the pranavahasrotas and derangement of kapha situated in the chest region producing lethal blockage of pranavayu. The maha (severe form), gambhira (having depth) and vyapeta (originating after food and with complications) types of hikka are incurable. If the vyapeta or yamala hikka (with two hiccups together) is associated with symptoms of emaciation, delirium, pain, excess thirst and stupor then it is incurable for treatment, while it is curable in non emaciated and mentally strong individual with unimpaired dhatus and indriyas performing their normal function. Kshudra hikka (minor variety) and annaja hikka (due to improper food intake) are curable types of hikka. Maha (severe form), urdhva (shallow respiration) and chinna (irregular pattern dyspnoea) shwasa are incurable and lead to death very fast. Tamaka (with black outs) and kshudra shwasa (minor variety) are curable if patient is strong, and disease is in early stage. While in weak patient they are yapya (palliable). The patient suffering from hikka and shwasa should be treated with oleation, unctuous sudation to liquefy the accumulated kapha, soften the channels and to facilitate vatanulomana (movement of vata in its normal direction). This should be followed by the administration elimination therapy in the form of vamana (emesis therapy), virechana (purgation), nasya and following of wholesome diet and regimen. The palliative medications should be administered keeping in view the condition of patient and stage of disease. Avoiding the causative factors and following wholesome regimen is important to prevent progress of disease and to reverse the pathogenesis. In brief shodhana followed by brimhana therapy (nourishing therapy) and shamana treatment (palliative therapy) are the ideal management methods in hikka and shwasa. The chapter: अथातो हिक्काश्वासचिकित्सितं व्याख्यास्यामः ||१|| इति ह स्माह भगवानात्रेयः ||२|| athātō hikkāśvāsacikitsitaṁ vyākhyāsyāmaḥ||1|| iti ha smāha bhagavānātrēyaḥ||2|| athAto hikkAshvAsacikitsitaM vyAkhyAsyamaH ||1|| iti ha smAha bhagavAnAtreyaH ||2|| Now we shall expound the chapter on management of Hikka(hiccups) and Shwasa(dyspnoea). Thus said Lord Atreya. (1-2) Agnivesha’s query: वेदलोकार्थतत्त्वज्ञमात्रेयमृषिमुत्तमम् | अपृच्छत् संशयं धीमानग्निवेशः कृताञ्जलिः ||३|| य इमे द्विविधाः प्रोक्तास्त्रिदोषास्त्रिप्रकोपणाः | रोगा नानात्मकास्तेषां कस्को भवति दुर्जयः ||४|| vēdalōkārthatattvajñamātrēyamr̥ṣimuttamam| apr̥cchat saṁśayaṁ dhīmānagnivēśaḥ kr̥tāñjaliḥ||3|| ya imē dvividhāḥ prōktāstridōṣāstriprakōpaṇāḥ| rōgā nānātmakāstēṣāṁ kaskō bhavati durjayaḥ||4|| vedalokArthatattvaj~jamAtreyamRuShimuttamam | apRucchat saMshayaM dhImAnagniveshaH kRutA~jjaliH ||3|| ya ime dvividhAH proktAstridoShAstriprakopaNAH | rogA nAnAtmakAsteShAM kasko bhavati durjayaH ||4||

Agnivesha an intelligent disciple asked his doubt with modest salute of folded hands to supreme sage Bhagavan Atreya, who has the knowledge about the subject and principles of Vedas “The diseases are categorized under two categories (samanyaja and nanatmaja) of three dosha (vata, pitta and kapha) aggravated due to three factors (like unwholesome utilization of sense organs (asatmendriyartha samyoga), intellectual errors (pajnaparadha) and advent of maturity of time (parinama)). Which among these diseases is most difficult to cure?”(3-4) Atreya’s reply and nature of disease of shwasa and hikka: अग्निवेशस्य तद्वाक्यं श्रुत्वा मतिमतां वरः | उवाच परमप्रीतः परमार्थविनिश्चयम् ||५|| कामं प्राणहरा रोगा बहवो न तु ते तथा | यथा श्वासश्च हिक्का च प्राणानाशु निकृन्ततः ||६|| अन्यैरप्युपसृष्टस्य रोगैर्जन्तोः पृथग्विधैः | अन्ते सञ्जायते हिक्का श्वासो वा तीव्रवेदनः ||७|| agnivēśasya tadvākyaṁ śrutvā matimatāṁ varaḥ| uvāca paramaprītaḥ paramārthaviniścayam||5|| kāmaṁ prāṇaharā rōgā bahavō na tu tē tathā| yathā śvāsaśca hikkā ca prāṇānāśu nikr̥ntataḥ||6|| anyairapyupasr̥ṣṭasya rōgairjantōḥ pr̥thagvidhaiḥ| antē sañjāyatē hikkā śvāsō vā tīvravēdanaḥ||7|| agniveshasya tadvAkyaM shrutvA matimatAM varaH | uvAca paramaprItaH paramArthavinishcayam ||5|| kAmaM prANaharA rogA bahavo na tu te tathA | yathA shvAsashca hikkA ca prANAnAshu nikRuntataH ||6|| anyairapyupasRuShTasya rogairjantoH pRuthagvidhaiH | ante sa~jjAyate hikkA shvAso vA tIvravedanaH ||7|| After listening to Agnivesha, Lord Punarvasu, the most prudent among the sages was very delighted and made ultimate and conclusive statement. “In fact there are many diseases which can kill a patient. But none of the diseases is as lethal as shwasa and hikka as they can cause immediate death. The person suffering from any other disease can also get eventually afflicted with enormously painful hikka and shwasa at the time of death.”(3-7) Predominance of dosha and affliction of dhatu: कफवातात्मकावेतौ पित्तस्थानसमुद्भवौ | हृदयस्य रसादीनां धातूनां चोपशोषणौ ||८|| तस्मात् साधारणावेतौ मतौ परमदुर्जयौ | मिथ्योपचरितौ क्रुद्धौ हत आशीविषाविव ||९|| kaphavātātmakāvētau pittasthānasamudbhavau| hr̥dayasya rasādīnāṁ dhātūnāṁ cōpaśōṣaṇau||8|| tasmāt sādhāraṇāvētau matau paramadurjayau| mithyōpacaritau kruddhau hata āśīviṣāviva||9|| kaphavAtAtmakAvetau pittasthAnasamudbhavau | hRudayasya rasAdInAM dhAtUnAM copashoShaNau ||8|| tasmAt sAdhAraNAvetau matau paramadurjayau | mithyopacaritau kruddhau hata AshIviShAviva ||9|| Hikka and shwasa are mainly kapha and vata dominant in nature. They originate at the site of pitta (upper part of stomach). This results in further depletion of dhatus like rasa situated in heart. Hence generally they are extremely difficult to treat. After getting afflicted with this disease, if one indulges in unwholesome regimens, then disease gets aggravated and results in death just as from fatal snake venom. (8-9) Causative factors: पृथक् पञ्चविधावेतौ निर्दिष्टौ रोगसङ्ग्रहे | तयोः शृणु समुत्थानं लिङ्गं च सभिषग्जितम् ||१०|| रजसा धूमवाताभ्यां शीतस्थानाम्बुसेवनात् | व्यायामाद्ग्राम्यधर्माध्वरूक्षान्नविषमाशनात् ||११|| आमप्रदोषादानाहाद्रौक्ष्यादत्यपतर्पणात् | दौर्बल्यान्मर्मणो घाताद्द्वन्द्वाच्छुद्ध्यतियोगतः ||१२|| अतीसारज्वरच्छर्दिप्रतिश्यायक्षतक्षयात् | रक्तपित्तादुदावर्ताद्विसूच्यलसकादपि ||१३|| पाण्डुरोगाद्विषाच्चैव प्रवर्तेते गदाविमौ | निष्पावमाषपिण्याकतिलतैलनिषेवणात् ||१४|| पिष्टशालूकविष्टम्भिविदाहिगुरुभोजनात् | जलजानूपपिशितदध्यामक्षीरसेवनात् ||१५|| अभिष्यन्द्युपचाराच्च श्लेष्मलानां च सेवनात् | कण्ठोरसः प्रतीघाताद्विबन्धैश्च पृथग्विधैः ||१६|| pr̥thak pañcavidhāvētau nirdiṣṭau rōgasaṅgrahē| tayōḥ śr̥ṇu samutthānaṁ liṅgaṁ ca sabhiṣagjitam||10|| rajasā dhūmavātābhyāṁ śītasthānāmbusēvanāt| vyāyāmādgrāmyadharmādhvarūkṣānnaviṣamāśanāt||11|| āmapradōṣādānāhādraukṣyādatyapatarpaṇāt| daurbalyānmarmaṇō ghātāddvandvācchuddhyatiyōgataḥ||12|| atīsārajvaracchardipratiśyāyakṣatakṣayāt| raktapittādudāvartādvisūcyalasakādapi||13|| pāṇḍurōgādviṣāccaiva pravartētē gadāvimau| niṣpāvamāṣapiṇyākatilatailaniṣēvaṇāt||14|| piṣṭaśālūkaviṣṭambhividāhigurubhōjanāt| jalajānūpapiśitadadhyāmakṣīrasēvanāt||15|| abhiṣyandyupacārācca ślēṣmalānāṁ ca sēvanāt| kaṇṭhōrasaḥ pratīghātādvibandhaiśca pr̥thagvidhaiḥ||16|| pRuthak pa~jcavidhAvetau nirdiShTau rogasa~ggrahe | tayoH shRuNu samutthAnaM li~ggaM ca sabhiShagjitam ||10|| rajasA dhUmavAtAbhyAM shItasthAnAmbusevanAt | vyAyAmAdgrAmyadharmAdhvarUkShAnnaviShamAshanAt ||11|| AmapradoShAdAnAhAdraukShyAdatyapatarpaNAt | daurbalyAnmarmaNo ghAtAddvandvAcchuddhyatiyogataH ||12|| atIsArajvaracchardipratishyAyakShatakShayAt | raktapittAdudAvartAdvisUcyalasakAdapi ||13|| pANDurogAdviShAccaiva pravartete gadAvimau | niShpAvamAShapiNyAkatilatailaniShevaNAt ||14|| piShTashAlUkaviShTambhividAhigurubhojanAt | jalajAnUpapishitadadhyAmakShIrasevanAt ||15|| abhiShyandyupacArAcca shleShmalAnAM ca sevanAt | kaNThorasaH pratIghAtAdvibandhaishca pRuthagvidhaiH ||16|| Five types of hikka and shwasa, based on etiology, signs, symptoms and treatment are being elaborated here, listen to them carefully. Etiological Factors: Environmental factors: Dust, smoke and wind, residing in cold place, use of cold water. Regimen: Lack of exercise, excessive sexual intercourse, excess walking, Diet: Intake of dry food, vishamashana (food in excessive or less quantity at irregular time) Conditions: Accumulation of ama, anaha (constipation associated with flatulence), dryness in the body, excessive depletion (apatarpana), weakness, injury to marmas (vital points), rapid change in exposure to heat and cold, diarrhoea, fever, vomiting, rhinitis, kshata (injury), kshaya (wasting), raktapitta (bleeding disorder), udavarta (upward movement of vata), visuchika (enteritis), alasaka (sluggish bowel), pandu (anaemia) and intake of poisons can result in hikka and shwasa. Diet: Regular intake of nishpava (beans), masha (black gram), pinyaka (oil cake), tila taila (sesame oil), pishta (cakes and pastry), shaluka (lotus stem), vishtambhi anna (food aggravating vata), vidahi (food causing burning sensations), heavy to digest food, flesh of aquatic and marshy animals, curd, raw milk, abhishyandhi (ingredients leading to obstruction of channels), food aggravating kapha Injury: Injury to throat and chest Others: Various types of vibandha (obstructions) (10-16)

General Samprapti (pathogenesis): मारुतः प्राणवाहीनि स्रोतांस्याविश्य कुप्यति | उरःस्थः कफमुद्धूय हिक्काश्वासान् करोति सः ||१७|| घोरान् प्राणोपरोधाय प्राणिनां पञ्च पञ्च च |१८| mārutaḥ prāṇavāhīni srōtāṁsyāviśya kupyati| uraḥsthaḥ kaphamuddhūya hikkāśvāsān karōti saḥ||17|| ghōrān prāṇōparōdhāya prāṇināṁ pañca pañca ca|18|

mArutaH prANavAhIni srotAMsyAvishya kupyati | uraHsthaH kaphamuddhUya hikkAshvAsAn karoti saH ||17|| ghorAn prANoparodhAya prANinAM pa~jca pa~jca ca |18| By the above mentioned etiological factors the vata gets aggravated in the pranavahasrotas ( channels carrying prana) and deranges the kapha situated in the chest region producing lethal blockage of prana vayu and five types of dreadful hikka and shwasa. (17-18) Premonitory symptoms: उभयोः पूर्वरूपाणि शृणु वक्ष्याम्यतः परम् ||१८|| कण्ठोरसोर्गुरुत्वं च वदनस्य कषायता | हिक्कानां पूर्वरूपाणि कुक्षेराटोप एव च ||१९|| आनाहः पार्श्वशूलं च पीडनं हृदयस्य च | प्राणस्य च विलोमत्वं श्वासानां पूर्वलक्षणम् ||२०|| ubhayōḥ pūrvarūpāṇi śr̥ṇu vakṣyāmyataḥ param||18|| kaṇṭhōrasōrgurutvaṁ ca vadanasya kaṣāyatā| hikkānāṁ pūrvarūpāṇi kukṣērāṭōpa ēva ca||19|| ānāhaḥ pārśvaśūlaṁ ca pīḍanaṁ hr̥dayasya ca| prāṇasya ca vilōmatvaṁ śvāsānāṁ pūrvalakṣaṇam||20|| ubhayoH pUrvarUpANi shRuNu vakShyAmyataH param ||18|| kaNThorasorgurutvaM ca vadanasya kaShAyatA | hikkAnAM pUrvarUpANi kukSherATopa eva ca ||19|| AnAhaH pArshvashUlaM ca pIDanaM hRudayasya ca | prANasya ca vilomatvaM shvAsAnAM pUrvalakShaNam ||20|| Following are the premonitory symptoms of both the diseases. Heaviness in throat and chest, astringent taste in mouth, and distension of abdomen are the premonitory symptoms of hikka. Anaha (constipation with flatulence), pain in the flanks, pain in the cardiac region, abnormal movement of pranavayu are the premonitory symptoms of shwasa.(18-20) Specific pathogenesis of hikka: प्राणोदकान्नवाहीनि स्रोतांसि सकफोऽनिलः | हिक्का करोति संरुध्य तासां लिङ्गं पृथक् शृणु ||२१|| क्षीणमांसबलप्राणतेजसः सकफोऽनिलः | गृहीत्वा सहसा कण्ठमुच्चैर्घोषवतीं भृशम् ||२२|| करोति सततं हिक्कामेकद्वित्रिगुणं तथा | प्राणः स्रोतांसि मर्माणि संरुध्योष्माणमेव च ||२३|| सञ्ज्ञां मुष्णाति गात्राणां स्तम्भं सञ्जनयत्यपि | मार्गं चैवान्नपानानां रुणद्ध्युपहतस्मृतेः ||२४|| साश्रुविप्लुतनेत्रस्य स्तब्धशङ्खच्युतभ्रुवः | सक्तजल्पप्रलापस्य निर्वृतिं नाधिगच्छतः ||२५|| महामूला महावेगा महाशब्दा महाबला | महाहिक्केति सा नॄणां सद्यः प्राणहरा मता ||२६|| इति महाहिक्का |

prāṇōdakānnavāhīni srōtāṁsi sakaphō'nilaḥ| 

hikkāḥ karōti saṁrudhya tāsāṁ liṅgaṁ pr̥thak śr̥ṇu||21|| kṣīṇamāṁsabalaprāṇatējasaḥ sakaphō'nilaḥ| gr̥hītvā sahasā kaṇṭhamuccairghōṣavatīṁ bhr̥śam||22|| karōti satataṁ hikkāmēkadvitriguṇaṁ tathā| prāṇaḥ srōtāṁsi marmāṇi saṁrudhyōṣmāṇamēva ca||23|| sañjñāṁ muṣṇāti gātrāṇāṁ stambhaṁ sañjanayatyapi| mārgaṁ caivānnapānānāṁ ruṇaddhyupahatasmr̥tēḥ||24|| sāśruviplutanētrasya stabdhaśaṅkhacyutabhruvaḥ| saktajalpapralāpasya nirvr̥tiṁ nādhigacchataḥ||25|| mahāmūlā mahāvēgā mahāśabdā mahābalā| mahāhikkēti sā nr̥̄ṇāṁ sadyaḥ prāṇaharā matā||26|| iti mahāhikkā| prANodakAnnavAhIni srotAMsi sakapho~anilaH | hikkA karoti saMrudhya tAsAM li~ggaM pRuthak shRuNu ||21|| kShINamAMsabalaprANatejasaH sakapho~anilaH | gRuhItvA sahasA kaNThamuccairghoShavatIM bhRusham ||22|| karoti satataM hikkAmekadvitriguNaM tathA | prANaH srotAMsi marmANi saMrudhyoShmANameva ca ||23|| sa~jj~jAM muShNAti gAtrANAM stambhaM sa~jjanayatyapi | mArgaM caivAnnapAnAnAM ruNaddhyupahatasmRuteH ||24|| sAshruviplutanetrasya stabdhasha~gkhacyutabhruvaH | saktajalpapralApasya nirvRutiM nAdhigacchataH ||25|| mahAmUlA mahAvegA mahAshabdA mahAbalA | mahAhikketi sA nRUNAM sadyaH prANaharA matA ||26|| iti mahAhikkA | Vishesha samprapti: Vata along with kapha blocks the channels carrying prana, udaka and anna and produces hikka. List of the signs and symptoms of many types is elaborated further. Mahahikka: Vata along with kapha affects the throat of an individual whose mamsa (muscles), strength, prana and agni are depleted. It further produces remarkably loud and resonant hiccups occurring in bouts of two or three constantly. The blockage of pranavaha srotas (channels carrying prana). Vayu along with aggravated kapha obstructs the pranavaha srotas and marma jatharagni resulting in loss of consciousness, stiffness in the body and also obstructs the channels of food and drinks. There is impairement of memory, tears in the eyes and stiffness in the temples and displacement of eyebrows. He suffers from delirium along with obstruction of speech, which does not get relief by any means. Maha hikka is mahamula (deep rooted), mahavega (massive attack), mahashabda (very loud sound), maha bala (very strong). This can lead to death immediately, hence named as mahahikka. (21-26) Gambhira hikka: हिक्कते यः प्रवृद्धस्तु कृशो दीनमना नरः | जर्जरेणोरसा कृच्छ्रं गम्भीरमनुनादयन् ||२७|| सञ्जृम्भन् सङ्क्षिपंश्चैव तथाऽङ्गानि प्रसारयन् | पार्श्वे चोभे समायम्य कूजन् स्तम्भरुगर्दितः ||२८|| नाभेः पक्वाशयाद्वाऽपि हिक्का चास्योपजायते | क्षोभयन्ती भृशं देहं नामयन्तीव ताम्यतः ||२९|| रुणद्ध्युच्छ्वासमार्गं तु प्रनष्टबलचेतसः | गम्भीरा नाम सा तस्य हिक्का प्राणान्तिकी मता ||३०|| इति गम्भीरा हिक्का | hikkatē yaḥ pravr̥ddhastu kr̥śō dīnamanā naraḥ| jarjarēṇōrasā kr̥cchraṁ gambhīramanunādayan||27|| sañjr̥mbhan saṅkṣipaṁścaiva tathā'ṅgāni prasārayan| pārśvē cōbhē samāyamya kūjan stambharugarditaḥ||28|| nābhēḥ pakvāśayādvā'pi hikkā cāsyōpajāyatē| kṣōbhayantī bhr̥śaṁ dēhaṁ nāmayantīva tāmyataḥ||29|| ruṇaddhyucchvāsamārgaṁ tu pranaṣṭabalacētasaḥ| gambhīrā nāma sā tasya hikkā prāṇāntikī matā||30|| iti gambhīrā hikkā| hikkate yaH pravRuddhastu kRusho dInamanA naraH | jarjareNorasA kRucchraM gambhIramanunAdayan ||27|| sa~jjRumbhan sa~gkShipaMshcaiva tathA~a~ggAni prasArayan | pArshve cobhe samAyamya kUjan stambharugarditaH ||28|| nAbheH pakvAshayAdvA~api hikkA cAsyopajAyate | kShobhayantI bhRushaM dehaM nAmayantIva tAmyataH ||29|| ruNaddhyucchvAsamArgaM tu pranaShTabalacetasaH | gambhIrA nAma sA tasya hikkA prANAntikI matA ||30|| iti gambhIrA hikkA | Excessive aggravation of kapha and vayu in an aged, emaciated and mentally depressed individual leads to hikka. This hikka is characterised by deep and resonant sound, and affliction of the chest. He yawns, contracts and expands his body, and while respiring he contracts both the flanks making murmuring sounds, and suffers from stiffness and pain. In such a patient the hikka arises from the umbilicus or pakvashaya (intestines) with pain all over the body. During this time his body bends and he suffers from black outs, obstruction in the respiratory tract and loss of strength and unconsciousness. Such hikka is known as gambhira hikka which ultimately results in death. (27-30) Vyapeta hikka: व्यपेता जायते हिक्का याऽन्नपाने चतुर्विधे | आहारपरिणामान्ते भूयश्च लभते बलम् ||३१|| प्रलापवम्यतीसारतृष्णार्तस्य विचेतसः | जृम्भिणो विप्लुताक्षस्य शुष्कास्यस्य विनामिनः ||३२|| पर्याध्मातस्य हिक्का या जत्रुमूलादसन्तता | सा व्यपेतेति विज्ञेया हिक्का प्राणोपरोधिनी ||३३|| इति व्यपेता हिक्का | vyapētā jāyatē hikkā yā'nnapānē caturvidhē| āhārapariṇāmāntē bhūyaśca labhatē balam||31|| pralāpavamyatīsāratr̥ṣṇārtasya vicētasaḥ| jr̥mbhiṇō viplutākṣasya śuṣkāsyasya vināminaḥ||32|| paryādhmātasya hikkā yā jatrumūlādasantatā| sā vyapētēti vijñēyā hikkā prāṇōparōdhinī||33|| iti vyapētā hikkā| vyapetA jAyate hikkA yA~annapAne caturvidhe | AhArapariNAmAnte bhUyashca labhate balam ||31|| pralApavamyatIsAratRuShNArtasya vicetasaH | jRumbhiNo viplutAkShasya shuShkAsyasya vinAminaH ||32|| paryAdhmAtasya hikkA yA jatrumUlAdasantatA | sA vyapeteti vij~jeyA hikkA prANoparodhinI ||33|| iti vyapetA hikkA | Vyapeta hikka: The vyapeta hikka produced after the intake of four types of food (i.e. eatable, chewable, drinkable, lickable) and gets aggravated after food gets digested. He suffers from delirium, vomiting, diarrhoea, thirst and unconsciousness. There is yawning, watering of eyes, dryness of mouth and bending of the body, and adhmana (distension of the abdomen). This hikka originates from the root of the clavicle and attack is not continuous. hikka is injurious to life. (31-33) Kshudra hikka: क्षुद्रवातो यदा कोष्ठाद्व्यायामपरिघट्टितः | कण्ठे प्रपद्यते हिक्कां तदा क्षुद्रां करोति सः ||३४|| अतिदुःखा न सा चोरःशिरोमर्मप्रबाधिनी | न चोच्छ्वासान्नपानानां मार्गमावृत्य तिष्ठति ||३५|| वृद्धिमायस्यतो याति भुक्तमात्रे च मार्दवम् | यतः प्रवर्तते पूर्वं तत एव निवर्तते ||३६|| हृदयं क्लोम कण्ठं च तालुकं च समाश्रिता | मृद्वी सा क्षुद्रहिक्केति नृणां साध्या प्रकीर्तिता ||३७|| इति क्षुद्रहिक्का | kṣudravātō yadā kōṣṭhādvyāyāmaparighaṭṭitaḥ| kaṇṭhē prapadyatē hikkāṁ tadā kṣudrāṁ karōti saḥ||34|| atiduḥkhā na sā cōraḥśirōmarmaprabādhinī| na cōcchvāsānnapānānāṁ mārgamāvr̥tya tiṣṭhati||35|| vr̥ddhimāyasyatō yāti bhuktamātrē ca mārdavam| yataḥ pravartatē pūrvaṁ tata ēva nivartatē||36|| hr̥dayaṁ klōma kaṇṭhaṁ ca tālukaṁ ca samāśritā| mr̥dvī sā kṣudrahikkēti nr̥ṇāṁ sādhyā prakīrtitā||37|| iti kṣudrahikkā| kShudravAto yadA koShThAdvyAyAmaparighaTTitaH | kaNThe prapadyate hikkAM tadA kShudrAM karoti saH ||34|| atiduHkhA na sA coraHshiromarmaprabAdhinI | na cocchvAsAnnapAnAnAM mArgamAvRutya tiShThati ||35|| vRuddhimAyasyato yAti bhuktamAtre ca mArdavam | yataH pravartate pUrvaM tata eva nivartate ||36|| hRudayaM kloma kaNThaM ca tAlukaM ca samAshritA | mRudvI sA kShudrahikketi nRuNAM sAdhyA prakIrtitA ||37|| iti kShudrahikkA | Kshudra hikka: The vayu gets slightly aggravated in the koshtha (alimentary tract), due to the physical exercises and reaches the throat and produces kshudra hikka. This does not produce much pain and does not afflict the head and vital parts (hridaya marma). In this type of hikka, the doshas do not reside or get lodged in the channels of respiration, food and drinks. This gets aggravated on exertion and subsides on taking food. Hikka gets subsided by itself also. The doshas are situated in cardiac region, kloma, throat and palate. This mild form of hikka is curable and known as kshudra hikka. (35-37) Annaja hikka: सहसाऽत्यभ्यवहृतैः पानान्नैः पीडितोऽनिलः | ऊर्ध्वं प्रपद्यते कोष्ठान्मद्यैर्वाऽतिमदप्रदैः ||३८|| तथाऽतिरोषभाष्याध्वहास्यभारातिवर्तनैः | वायुः कोष्ठगतो धावन् पानभोज्यप्रपीडितः ||३९|| उरःस्रोतः समाविश्य कुर्याद्धिक्कां ततोऽन्नजाम् | तथा शनैरसम्बन्धं क्षुवंश्चापि स हिक्कते ||४०|| न मर्मबाधाजननी नेन्द्रियाणां प्रबाधिनी | हिक्का पीते तथा भुक्ते शमं याति च साऽन्नजा ||४१|| इत्यन्नजा हिक्का | Sahas ā'tyabhyavahr̥taiḥ pānānnaiḥ pīḍitō'nilaḥ| ūrdhvaṁ prapadyatē kōṣṭhānmadyairvā'timadapradaiḥ||38|| tathā'tirōṣabhāṣyādhvahāsyabhārātivartanaiḥ| vāyuḥ kōṣṭhagatō dhāvan pānabhōjyaprapīḍitaḥ||39|| uraḥsrōtaḥ samāviśya kuryāddhikkāṁ tatō'nnajām| tathā śanairasambandhaṁ kṣuvaṁścāpi sa hikkatē||40|| na marmabādhājananī nēndriyāṇāṁ prabādhinī| hikkā pītē tathā bhuktē śamaṁ yāti ca sā'nnajā||41|| ityannajā hikkā| sahasA~atyabhyavahRutaiH pAnannaiH pIDito~anilaH | urdhvaM prapadyate koShThAnmadyairvA~atimadapradaiH ||38|| tathA~atiroShabhAShyAdhvahAsyabhArAtivartanaiH | vAyuH koShThagato dhAvan pAnabhojyaprapIDitaH ||39|| uraHsrotaH samAvishya kuryAddhikkAM tato~annajAm | tathA shanairasambandhaM kShuvaMshcApi sa hikkate ||40|| na marmabAdhAjananI nendriyANAM prabAdhinI | hikkA pIte tathA bhukte shamaM yAti ca sA~annajA ||41|| ityannajA hikkA | Annaja hikka: The vayu gets aggravated and moves in the upward direction due to the intake of excess food or drinks in hurry or excess of alcohol, anger, talking, laughing, weightlifting etc. factors aggravate vayu in koshtha (alimentary tract) gets afflicted by food and drinks and move in the upward direction and get lodged in channels of chest and produce annaja hikka. This hikka occurs slowly and intermittently along with sneezing. The hikka that does not afflict vital points (marma) and organs and it subsides after drinking water or taking food is known as annaja hikka.(38-41) Prognosis of hikka:: अतिसञ्चितदोषस्य भक्तच्छेदकृशस्य च | व्याधिभिः क्षीणदेहस्य वृद्धस्यातिव्यवायिनः ||४२|| आसां या सा समुत्पन्ना हिक्का हन्त्याशु जीवितम् | यमिका च प्रलापार्तितृष्णामोहसमन्विता ||४३|| अक्षीणश्चाप्यदीनश्च स्थिरधात्विन्द्रियश्च यः | तस्य साधयितुं शक्या यमिका हन्त्यतोऽन्यथा ||४४|| atisañcitadōṣasya bhaktacchēdakr̥śasya ca| vyādhibhiḥ kṣīṇadēhasya vr̥ddhasyātivyavāyinaḥ||42|| āsāṁ yā sā samutpannā hikkā hantyāśu jīvitam| yamikā ca pralāpārtitr̥ṣṇāmōhasamanvitā||43|| akṣīṇaścāpyadīnaśca sthiradhātvindriyaśca yaḥ| tasya sādhayituṁ śakyā yamikā hantyatō'nyathā||44|| atisa~jcitadoShasya bhaktacchedakRushasya ca | vyAdhibhiH kShINadehasya vRuddhasyAtivyavAyinaH ||42|| AsAM yA sA samutpannA hikkA hantyAshu jIvitam | yamikA ca pralApArtitRuShNAmohasamanvitA ||43|| akShINashcApyadInashca sthiradhAtvindriyashca yaH | tasya sAdhayituM shakyA yamikA hantyato~anyathA ||44|| The hikka destroys a person suffering from excessive accumulation of doshas, emaciated due to fasting, emaciated due to disease, weak due to ageing or excessive indulgence in sex. The symptoms of delirium, pain, excess thirst and stupor in yamika hikka patient make it incurable for treatment. The yamika hikka is curable in an individual who is not emaciated, not weak mentally, the dhatus and indriyas are unaffected and performing their normal function. Otherwise in case if body is weak, it is incurable. (42-44) Specific pathogenesis of shwasa: यदा स्रोतांसि संरुध्य मारुतः कफपूर्वकः | विष्वग्व्रजति संरुद्धस्तदा श्वासान्करोति सः ||४५|| yadā srōtāṁsi saṁrudhya mārutaḥ kaphapūrvakaḥ| viṣvagvrajati saṁruddhastadā śvāsānkarōti saḥ||45|| yadA srotAMsi saMrudhya mArutaH kaphapUrvakaH | viShvagvrajati saMruddhastadA shvAsAnkaroti saH ||45|| The aggravated vayu along with vitiated kapha obstructs the channels (of prana, udaka and annavaha) and spreads throughout the body and produces shwasa. (45) Mahashwasa: उद्धूयमानवातो यः शब्दवद्दुखितो नरः | उच्चैः श्वसिति संरुद्धो मत्तर्षभ इवानिशम् ||४६|| प्रनष्टज्ञानविज्ञानस्तथा विभ्रान्तलोचनः | विकृताक्ष्याननो बद्धमूत्रवर्चा विशीर्णवाक् ||४७|| दीनः प्रश्वसितं चास्य दूराद्विज्ञायते भृशम् | महाश्वासोपसृष्टः स क्षिप्रमेव विपद्यते ||४८|| इति महाश्वासः |

uddhūyamānavātō yaḥ śabdavadduḥkhitō naraḥ| 

uccaiḥ śvasiti saṁruddhō mattarṣabha ivāniśam||46|| pranaṣṭajñānavijñānastathā vibhrāntalōcanaḥ| vikr̥tākṣyānanō baddhamūtravarcā viśīrṇavāk||47|| dīnaḥ praśvasitaṁ cāsya dūrādvijñāyatē bhr̥śam| mahāśvāsōpasr̥ṣṭaḥ sa kṣipramēva vipadyatē||48|| iti mahāśvāsaḥ|

uddhUyamAnavAto yaH shabdavadduHkhito naraH | uccaiH shvasiti saMruddho mattarShabha ivAnisham ||46|| pranaShTaj~jAnavij~jAnastathA vibhrAntalocanaH | vikRutAkShyAnano baddhamUtravarcA vishIrNavAk ||47|| dInaH prashvasitaM cAsya dUrAdvij~jAyate bhRusham | mahAshvAsopasRuShTaH sa kShiprameva vipadyate ||48|| iti mahAshvAsaH | The patient breathes with a loud noise during the night due to the upward movement of aggravated vayu like intoxicated bull. The vayu gets obstructed and the person becomes unconscious. The eyes get distorted and he cannot visualise properly. The eyes and face become abnormal and the elimination of urine and faeces is obstructed and the voice becomes feeble and the person looks tired and respiration could be heard from distance, such person suffering from mahashwasa succumbs to death very fast. (46-48) Urdhva shwasa: दीर्घं श्वसिति यस्तूर्ध्वं न च प्रत्याहरत्यधः | श्लेष्मावृतमुखस्रोताः क्रुद्धगन्धवहार्दितः ||४९|| ऊर्ध्वदृष्टिर्विपश्यंश्च विभ्रान्ताक्ष इतस्ततः | प्रमुह्यन् वेदनार्तश्च शुष्कास्योऽरतिपीडितः ||५०|| ऊर्ध्वश्वासे प्रकुपिते ह्यधःश्वासो निरुध्यते | मुह्यतस्ताम्यतश्चोर्ध्वं श्वासस्तस्यैव हन्त्यसून् ||५१|| इत्यूर्ध्वश्वासः | dīrghaṁ śvasiti yastūrdhvaṁ na ca pratyāharatyadhaḥ| ślēṣmāvr̥tamukhasrōtāḥ kruddhagandhavahārditaḥ||49|| ūrdhvadr̥ṣṭirvipaśyaṁśca vibhrāntākṣa itastataḥ| pramuhyan vēdanārtaśca śuṣkāsyō'ratipīḍitaḥ||50|| ūrdhvaśvāsē prakupitē hyadhaḥśvāsō nirudhyatē| muhyatastāmyataścōrdhvaṁ śvāsastasyaiva hantyasūn||51|| ityūrdhvaśvāsaḥ| dIrghaM shvasiti yastUrdhvaM na ca pratyAharatyadhaH | shleShmAvRutamukhasrotAH kruddhagandhavahArditaH ||49|| UrdhvadRuShTirvipashyaMshca vibhrAntAkSha itastataH | pramuhyan vedanArtashca shuShkAsyo~aratipIDitaH ||50|| UrdhvashvAse prakupite [1] hyadhaHshvAso nirudhyate | muhyatastAmyatashcordhvaM shvAsastasyaiva hantyasUn ||51|| ityUrdhvashvAsaH |

The vitiated kapha obstructs channels of respiration leading to aggravation of vata resulting in prolonged expiration and shallow inspiration (breath doesn’t get deeply inspired). The patient looks up with moving eye balls as if he is scared of something. When he gets afflicted with this type of shwasa he suffers from unconsciousness, dryness of mouth, restlessness. The upward movement of vayu is aggravated resulting in obstruction of downward movement and unconsciousness, black outs and he succumbs to death quickly. (49-51)

Chhinna shwasa: यस्तु श्वसिति विच्छिन्नं सर्वप्राणेन पीडितः | न वा श्वसिति दुःखार्तो मर्मच्छेदरुगर्दितः ||५२|| आनाहस्वेदमूर्च्छार्तो दह्यमानेन बस्तिना | विप्लुताक्षः परिक्षीणः श्वसन् रक्तैकलोचनः ||५३|| विचेताः परिशुष्कास्यो विवर्णः प्रलपन्नरः | छिन्नश्वासेन विच्छिन्नः स शीघ्रं प्रजहात्यसून् ||५४|| इति छिन्नश्वासः |

yastu śvasiti vicchinnaṁ sarvaprāṇēna pīḍitaḥ| 

na vā śvasiti duḥkhārtō marmacchēdarugarditaḥ||52|| ānāhasvēdamūrcchārtō dahyamānēna bastinā| viplutākṣaḥ parikṣīṇaḥ śvasan raktaikalōcanaḥ||53|| vicētāḥ pariśuṣkāsyō vivarṇaḥ pralapannaraḥ| chinnaśvāsēna vicchinnaḥ sa śīghraṁ prajahātyasūn||54|| iti chinnaśvāsaḥ| yastu shvasiti vicchinnaM sarvaprANena pIDitaH | na vA shvasiti duHkhArto marmacchedarugarditaH ||52|| AnAhasvedamUrcchArto dahyamAnena bastinA | viplutAkShaH parikShINaH shvasan raktaikalocanaH ||53|| vicetAH parishuShkAsyo vivarNaH pralapannaraH | chinnashvAsena vicchinnaH sa shIghraM prajahAtyasUn ||54|| iti chinnashvAsaH |

The patient suffering from chhinna shwasa has interrupted breath as the prana(vital centers referred in sutra sthana 29)  is afflicted. There is complete stoppage of breath, such individual suffers from intense pain as if cutting of the marma (vital parts), constipation with abdominal distension, sweating, unconsciousness, burning sensation in basti (bladder and urinary system), excessive tears in the eyes, emaciation of the body, the eyes become red when patient struggles to breath, mental disorientation, dryness of mouth, discolouration of skin, delirium, looseness of joints. An individual suffering from above said features of chhinna shwasa succumbs to death very quickly. (52-54)

Tamaka shwasa: प्रतिलोमं यदा वायुः स्रोतांसि प्रतिपद्यते | ग्रीवां शिरश्च सङ्गृह्य श्लेष्माणं समुदीर्य च ||५५|| करोति पीनसं तेन रुद्धो घुर्घुरुकं तथा | अतीव तीव्रवेगं च श्वासं प्राणप्रपीडकम् ||५६|| प्रताम्यत्यतिवेगाच्च कासते सन्निरुध्यते | प्रमोहं कासमानश्च स गच्छति मुहुर्मुहुः ||५७|| श्लेष्मण्यमुच्यमाने तु भृशं भवति दुःखितः | तस्यैव च विमोक्षान्ते मुहूर्तं लभते सुखम् ||५८|| अथास्योद्ध्वंसते कण्ठः कृच्छ्राच्छक्नोति भाषितुम् | न चापि निद्रां लभते शयानः श्वासपीडितः ||५९|| पार्श्वे तस्यावगृह्णाति शयानस्य समीरणः | आसीनो लभते सौख्यमुष्णं चैवाभिनन्दति ||६०|| उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान् | विशुष्कास्यो मुहुः श्वासो मुहुश्चैवावधम्यते ||६१|| मेघाम्बुशीतप्राग्वातैः श्लेष्मलैश्चाभिवर्धते | स याप्यस्तमकश्वासः साध्यो वा स्यान्नवोत्थितः ||६२|| इति तमकश्वासः |

pratilōmaṁ yadā vāyuḥ srōtāṁsi pratipadyatē| 

grīvāṁ śiraśca saṅgr̥hya ślēṣmāṇaṁ samudīrya ca||55|| karōti pīnasaṁ tēna ruddhō ghurghurukaṁ tathā| atīva tīvravēgaṁ ca śvāsaṁ prāṇaprapīḍakam||56|| pratāmyaty ativēgācca kāsatē sannirudhyatē| pramōhaṁ kāsamānaśca sa gacchati muhurmuhuḥ||57|| ślēṣmaṇyamucyamānē tu bhr̥śaṁ bhavati duḥkhitaḥ| tasyaiva ca vimōkṣāntē muhūrtaṁ labhatē sukham||58|| athāsyōddhvaṁsatē kaṇṭhaḥ kr̥cchrācchaknōti bhāṣitum| na cāpi nidrāṁ labhatē śayānaḥ śvāsapīḍitaḥ||59|| pārśvē tasyāvagr̥hṇāti śayānasya samīraṇaḥ| āsīnō labhatē saukhyamuṣṇaṁ caivābhinandati||60|| ucchritākṣō lalāṭēna svidyatā bhr̥śamartimān| viśuṣkāsyō muhuḥ śvāsō muhuścaivāvadhamyatē||61|| mēghāmbuśītaprāgvātaiḥ ślēṣmalaiścābhivardhatē| sa yāpyastamakaśvāsaḥ sādhyō vā syānnavōtthitaḥ||62|| iti tamakaśvāsaḥ| pratilomaM yadA vAyuH srotAMsi pratipadyate | grIvAM shirashca sa~ggRuhya shleShmANaM samudIrya ca ||55|| karoti pInasaM tena ruddho ghurghurukaM tathA | atIva tIvravegaM ca shvAsaM prANaprapIDakam ||56|| pratAmyatyativegAcca kAsate sannirudhyate | pramohaM kAsamAnashca sa gacchati muhurmuhuH ||57|| shleShmaNyamucyamAne tu bhRushaM bhavati duHkhitaH | tasyaiva ca vimokShAnte muhUrtaM labhate sukham ||58|| athAsyoddhvaMsate kaNThaH kRucchrAcchaknoti bhAShitum | na cApi nidrAM labhate shayAnaH shvAsapIDitaH ||59|| pArshve tasyAvagRuhNAti shayAnasya samIraNaH | AsIno labhate saukhyamuShNaM caivAbhinandati ||60|| ucchritAkSho lalATena svidyatA bhRushamartimAn | vishuShkAsyo muhuH shvAso muhushcaivAvadhamyate ||61|| meghAmbushItaprAgvAtaiH shleShmalaishcAbhivardhate | sa yApyastamakashvAsaH sAdhyo vA syAnnavotthitaH ||62|| iti tamakashvAsaH | The vayu moves in the opposite direction due to the obstruction in the respiratory tract, stiffness in the neck, head aggravates the kapha and produces rhinorrhoea, and gurghuraka sound (rhonchi). Exceedingly severe attack afflicts the prana and enhances severity. During severe attack, the patient faints repeatedly, has severe cough and becomes unconscious. The patient finds it difficult to expectorate the phlegm and feels relieved for period of 1 muhurta (3 hours) after expectoration of phlegm. There is hoarseness of voice and patient speaks with difficulty, even he does not get proper sleep, and on lying down he suffers from dyspnea as his flanks are afflicted by vayu. He feels comfortable in the sitting position. He likes hot things. His eye balls are always prominent, there is sweat on the forehead, dryness of the mouth, gets repeated attacks of dyspnea, and it increases and subsides repeatedly. In gets aggravated when appearance of clouds in the sky, rains, cold weather, easterly winds and kapha enhancing food and behaviour. The tamaka shwasa having above mentioned features is yapya (palliable) and in the initial stages it is curable disease. (55-62) Types of tamaka shwasa: ज्वरमूर्च्छापरीतस्य विद्यात् प्रतमकं तु तम् | उदावर्तरजोऽजीर्णक्लिन्नकायनिरोधजः ||६३|| तमसा वर्धतेऽत्यर्थं शीतैश्चाशु प्रशाम्यति | मज्जतस्तमसीवाऽस्य विद्यात् सन्तमकं तु तम् ||६४|| इति प्रतमकसन्तमकश्वासौ | jvaramūrcchāparītasya vidyāt pratamakaṁ tu tam| udāvartarajō'jīrṇaklinnakāyanirōdhajaḥ||63|| tamasā vardhatē'tyarthaṁ śītaiścāśu praśāmyati| majjatastamasīvā'sya vidyāt santamakaṁ tu tam||64|| iti pratamakasantamakaśvāsau| jvaramUrcchAparItasya vidyAt pratamakaM tu tam | udAvartarajo~ajIrNaklinnakAyanirodhajaH ||63|| tamasA vardhate~atyarthaM shItaishcAshu prashAmyati | majjatastamasIvA~asya vidyAt santamakaM tu tam ||64|| iti pratamakasantamakashvAsau | In a patient of tamaka shwasa if jwara (fever) and unconsciousness are occurring as complication, then it is called as pratamaka shwasa. The shwasa produced due to udavarta (upward movement of vayu in koshtha), dust, indigestion, excessive liquid accumulation in the body (klinna kaya), and suppression of natural urges results in increase of tama. This gets relieved by following of cooling regimen. The person suffering from this shwasa feels as if he is submerged in darkness, thus it is known as santamaka.(63-64) Kshudra shwasa: रूक्षायासोद्भवः कोष्ठे क्षुद्रो वात उदीरयन् | क्षुद्रश्वासो न सोऽत्यर्थं दुःखेनाङ्गप्रबाधकः ||६५|| हिनस्ति न स गात्राणि न च दुःखो यथेतरे | न च भोजनपानानां निरुणद्ध्युचितां गतिम् ||६६|| नेन्द्रियाणां व्यथां नापि काञ्चिदापादयेद्रुजम् | स साध्य उक्तो बलिनः सर्वे चाव्यक्तलक्षणाः ||६७|| इति श्वासाः समुद्दिष्टा हिक्काश्चैव स्वलक्षणैः |६८| rūkṣāyāsōdbhavaḥ kōṣṭhē kṣudrō vāta udīrayan| kṣudraśvāsō na sō'tyarthaṁ duḥkhēnāṅgaprabādhakaḥ||65|| hinasti na sa gātrāṇi na ca duḥkhō yathētarē| na ca bhōjanapānānāṁ niruṇaddhyucitāṁ gatim||66|| nēndriyāṇāṁ vyathāṁ nāpi kāñcidāpādayēdrujam| sa sādhya uktō balinaḥ sarvē cāvyaktalakṣaṇāḥ||67|| iti śvāsāḥ samuddiṣṭā hikkāścaiva svalakṣaṇaiḥ|68| rUkShAyAsodbhavaH koShThe kShudro vAta udIrayan | kShudrashvAso na so~atyarthaM duHkhenA~ggaprabAdhakaH ||65|| hinasti na sa gAtrANi na ca duHkho yathetare | na ca bhojanapAnAnAM niruNaddhyucitAM gatim ||66|| nendriyANAM vyathAM nApi kA~jcidApAdayedrujam | sa sAdhya ukto balinaH sarve cAvyaktalakShaNAH ||67|| iti shvAsAH samuddiShTA hikkAshcaiva svalakShaNaiH |68|

Due to intake of dry food and exertion, vata is mildly vitiated in koshtha and moves in the upward direction i.e repiratory tract resulting in kshudra shwasa. The patient suffering from this type of shwasa does not have any affliction of various body parts and the functions are not affected. It is not very painful as it does not affect the channels of food and drinks nor does it cause pain to the sense organs. This is curable if the symptom is not completely manifested and the patient is strong. Thus all the types of hikka and shwasa are elaborated along with their signs and symptoms.(65-67) 

Necessity of quick management of hikka and shwasa: एषां प्राणहरा वर्ज्या घोरास्ते ह्याशुकारिणः ||६८|| भेषजैः साध्ययाप्यांस्तु क्षिप्रं भिषगुपाचरेत् | उपेक्षिता दहेयुर्हि शुष्कं कक्षमिवानलः ||६९|| ēṣāṁ prāṇaharā varjyā ghōrāstē hyāśukāriṇaḥ||68|| bhēṣajaiḥ sādhyayāpyāṁstu kṣipraṁ bhiṣagupācarēt| upēkṣitā dahēyurhi śuṣkaṁ kakṣamivānalaḥ||69|| eShAM prANaharA varjyA ghorAste hyAshukAriNaH ||68|| bheShajaiH sAdhyayApyAMstu kShipraM bhiShagupAcaret | upekShitA daheyurhi shuShkaM kakShamivAnalaH ||69|| Among them the fatal varieties (like maha hikka, gambhira hikka, vyapeta hikka, maha shwasa, urdhva shwasa, chhinna shwasa are incurable types) should not be treated. While the curable and controllable variety of hikka and shwasa should be treated with medicine quickly. If neglected then it destroys the prana of the patient as the fire burns away the dry grass very fast.(68-69) Guidelines for treatment of hikka and shwasa: कारणस्थानमूलैक्यादेकमेव चिकित्सितम् | द्वयोरपि यथादृष्टमृषिभिस्तन्निबोधत ||७०|| हिक्काश्वासार्दितं स्निग्धैरादौ स्वेदैरुपाचरेत् | आक्तं लवणतैलेन नाडीप्रस्तरसङ्करैः ||७१|| तैरस्य ग्रथितः श्लेष्मा स्रोतःस्वभिविलीयते | खानि मार्दवमायान्ति ततो वातानुलोमता ||७२|| यथाऽद्रिकुञ्जेष्वर्कांशुतप्तं विष्यन्दते हिमम् | श्लेष्मा तप्तः स्थिरो देहे स्वेदैर्विष्यन्दते तथा ||७३|| स्विन्नं ज्ञात्वा ततस्तूर्णं भोजयेत् स्निग्धमोदनम् | मत्स्यानां शूकराणां वा रसैर्दध्युत्तरेण वा ||७४|| ततः श्लेष्मणि संवृद्धे वमनं पाययेत्तु तम् | पिप्पलीसैन्धवक्षौद्रैर्युक्तं वाताविरोधि यत् ||७५|| निर्हृते सुखमाप्नोति स कफे दुष्टविग्रहे | स्रोतःसु च विशुद्धेषु चरत्यविहतोऽनिलः ||७६|| kāraṇasthānamūlaikyādēkamēva cikitsitam| dvayōrapi yathādr̥ṣṭamr̥ṣibhistannibōdhata||70|| hikkāśvāsārditaṁ snigdhairādau svēdairupācarēt| āktaṁ lavaṇatailēna nāḍīprastarasaṅkaraiḥ||71|| tairasya grathitaḥ ślēṣmā srōtaḥsvabhivilīyatē| khāni mārdavamāyānti tatō vātānulōmatā||72|| yathā'drikuñjēṣvarkāṁśutaptaṁ viṣyandatē himam| ślēṣmā taptaḥ sthirō dēhē svēdairviṣyandatē tathā||73|| svinnaṁ jñātvā tatastūrṇaṁ bhōjayēt snigdhamōdanam| matsyānāṁ śūkarāṇāṁ vā rasairdadhyuttarēṇa vā||74|| tataḥ ślēṣmaṇi saṁvr̥ddhē vamanaṁ pāyayēttu tam| pippalīsaindhavakṣaudrairyuktaṁ vātāvirōdhi yat||75|| nirhr̥tē sukhamāpnōti sa kaphē duṣṭavigrahē| srōtaḥsu ca viśuddhēṣu caratyavihatō'nilaḥ||76|| kAraNasthAnamUlaikyAdekameva cikitsitam | dvayorapi yathAdRuShTamRuShibhistannibodhata ||70|| hikkAshvAsArditaM snigdhairAdau svedairupAcaret | AktaM lavaNatailena nADIprastarasa~gkaraiH ||71|| tairasya grathitaH shleShmA srotaHsvabhivilIyate | khAni mArdavamAyAnti tato vAtAnulomatA ||72|| yathA~adriku~jjeShvarkAMshutaptaM viShyandate himam | shleShmA taptaH sthiro dehe svedairviShyandate tathA ||73|| svinnaM j~jAtvA tatastUrNaM bhojayet snigdhamodanam | matsyAnAM shUkarANAM vA rasairdadhyuttareNa vA ||74|| tataH shleShmaNi saMvRuddhe vamanaM pAyayettu tam | pippalIsaindhavakShaudrairyuktaM vAtAvirodhi yat ||75|| nirhRute sukhamApnoti sa kaphe duShTavigrahe | srotaHsu ca vishuddheShu caratyavihato~anilaH ||76|| The etiological factors, site, origin of both hikka and shwasa are same and hence the treatment is also same. Kindly listen attentively the treatment of hikka and shwasa as known by the seers. Initially the patient suffering from hikka and shwasa should be treated with massage with combination of rock salt and sesame oil over the chest region followed by administration of unctuous sudation by means of nadi sveda or prastara sveda or sankara sveda. By this the clogged kapha gets liquefied in the channels and the channels become soft and vata moves in the downward direction (vatanulomana). As the ice on the top of the mountain gets liquefied by the rays of the sun, the kapha accumulated in the srotasa get liquefied by swedana. After the administration snehana (oleation) and swedana (sudation), one has to give rice along with unctuous substances. The meat soup prepared from fish or pig or curds in large quantity should be taken in meals. When the kapha gets aggravated due to above mentioned means vamana (emesis therapy) should be administrated with powder of pippali (piper longum Linn), saindhava (rock salt) and honey. While selection of the drugs care should be taken not to administer the vata aggravating drugs. After the expulsion of vitiated kapha the patient feels relieved as the vata gets alleviated and moves in the normal direction as obstructed srotas are cleared. (70-76) Treatment of remaining dosha: लीनश्चेद्दोषशेषः स्याद्धूमैस्तं निर्हरेद्बुधः | हरिद्रां पत्रमेरण्डमूलं लाक्षां मनःशिलाम् ||७७|| सदेवदार्वलं मांसीं पिष्ट्वा वर्तिं प्रकल्पयेत् | तां घृताक्तां पिबेद्धूमं यवैर्वा घृतसंयुतैः ||७८|| मधूच्छिष्टं सर्जरसं घृतं मल्लकसम्पुटे | कृत्वा धूमं पिबेच्छृङ्गं बालं वा स्नायु वा गवाम् ||७९|| स्योनाकवर्धमानानां नाडीं शुष्कां कुशस्य वा | पद्मकं गुग्गुलुं लोहं शल्लकीं वा घृताप्लुतम् ||८०|| līnaścēddōṣaśēṣaḥ syāddhūmaistaṁ nirharēdbudhaḥ| haridrāṁ patramēraṇḍamūlaṁ lākṣāṁ manaḥśilām||77|| sadēvadārvalaṁ māṁsīṁ piṣṭvā vartiṁ prakalpayēt| tāṁ ghr̥tāktāṁ pibēddhūmaṁ yavairvā ghr̥tasaṁyutaiḥ||78|| madhūcchiṣṭaṁ sarjarasaṁ ghr̥taṁ mallakasampuṭē| kr̥tvā dhūmaṁ pibēcchr̥ṅgaṁ bālaṁ vā snāyu vā gavām||79|| syōnākavardhamānānāṁ nāḍīṁ śuṣkāṁ kuśasya vā| padmakaṁ gugguluṁ lōhaṁ śallakīṁ vā ghr̥tāplutam||80|| lInashceddoShasheShaH syAddhUmaistaM nirharedbudhaH | haridrAM patrameraNDamUlaM lAkShAM manaHshilAm ||77|| sadevadArvalaM mAMsIM piShTvA vartiM prakalpayet | tAM ghRutAktAM pibeddhUmaM yavairvA ghRutasaMyutaiH ||78|| madhUcchiShTaM sarjarasaM ghRutaM mallakasampuTe | kRutvA dhUmaM pibecchRu~ggaM bAlaM vA snAyu vA gavAm ||79|| syonAkavardhamAnAnAM nADIM shuShkAM kushasya vA | padmakaM gugguluM lohaM shallakIM vA ghRutAplutam ||80|| The doshas remaining after the administration of vamana treatment should be expelled by means of dhuma (medicated smoking). The haridra (turmeric), roots of eranda (Ricinis communis Linn), laksha (Ficus Lacor Buch-Ham), manahshila (realger an Arsenic compound), jatamansi (Nardostachys jatamansone BC), are powdered properly and wick is prepared. This wick is smeared with ghee and used for medicated smoking. The barley should be mixed with ghee and used for smoking. The bee wax, rala (exudate of Shorea robusta Gaertn.) and ghee are kept in inside two mud plates (mallaka samputa). The smoke coming out of it after application of heat should be inhaled for smoking. Cow’s horn, hair, ligaments are mixed and used for smoking by putting it in dhuma netra. shyonaka, roots of eranda (Ricinis communis Linn) and kusha (Desmostachya bipinnata Stapf.) should be filled with above mentioned drugs and used as a pipe for smoking. Padmaka (Prunus puddum), guggulu (Commiphora mukul (Hook ex Stocks), agaru (Aquallaria agollacha Roxb) and shallaki (Boswellia serrata Roxb.) are powdered and mixed with ghee and used for smoking. (77-80) Management of complications: स्वरक्षीणातिसारासृक्पित्तदाहानुबन्धजान् | मधुरस्निग्धशीताद्यैर्हिक्काश्वासानुपाचरेत् ||८१|| svarakṣīṇātisārāsr̥kpittadāhānubandhajān| madhurasnigdhaśītādyairhikkāśvāsānupācarēt||81|| svarakShINAtisArAsRukpittadAhAnubandhajAn | madhurasnigdhashItAdyairhikkAshvAsAnupAcaret ||81|| The hikka and shwasa patient accompanied with complications like feeble voice, diarrhoea, raktapitta (bleeding disorder) should be treated with medicines having properties of sweet, unctuous, and cold. (81) Precautions and guidelines for swedana (sudation): न स्वेद्याः पित्तदाहार्ता रक्तस्वेदातिवर्तिनः | क्षीणधातुबला रूक्षा गर्भिण्यश्चापि पित्तलाः ||८२|| कोष्णैः काममुरःकण्ठं स्नेहसेकैः सशर्करैः | उत्कारिकोपनाहैश्च स्वेदयेन् मृदुभिः क्षणम् ||८३|| तिलोमामाषगोधूमचूर्णैर्वातहरैः सह | स्नेहैश्चोत्कारिका साम्लैः सक्षीरैर्वा कृता हिता ||८४|| नवज्वरामदोषेषु रूक्षस्वेदं विलङ्घनम् | समीक्ष्योल्लेखनं वाऽपि कारयेल्लवणाम्बुना ||८५|| अतियोगोद्धतं वातं दृष्ट्वा वातहरैर्भिषक् | रसाद्यैर्नातिशीतोष्णैरभ्यङ्गैश्च शमं नयेत् ||८६|| उदावर्ते तथाऽऽध्माने मातुलुङ्गाम्लवेतसैः | हिङ्गुपीलुबिडैश्चान्नं युक्तं स्यादनुलोमनम् ||८७|| na svēdyāḥ pittadāhārtā raktasvēdātivartinaḥ| kṣīṇadhātubalā rūkṣā garbhiṇyaścāpi pittalāḥ||82|| kōṣṇaiḥ kāmamuraḥkaṇṭhaṁ snēhasēkaiḥ saśarkaraiḥ| utkārikōpanāhaiśca svēdayēn mr̥dubhiḥ kṣaṇam||83|| tilōmāmāṣagōdhūmacūrṇairvātaharaiḥ saha| snēhaiścōtkārikā sāmlaiḥ sakṣīrairvā kr̥tā hitā||84|| navajvarāmadōṣēṣu rūkṣasvēdaṁ vilaṅghanam| samīkṣyōllēkhanaṁ vā'pi kārayēllavaṇāmbunā||85|| atiyōgōddhataṁ vātaṁ dr̥ṣṭvā vātaharairbhiṣak| rasādyairnātiśītōṣṇairabhyaṅgaiśca śamaṁ nayēt||86|| udāvartē tathādhmānē mātuluṅgāmlavētasaiḥ| hiṅgupīlubiḍaiścānnaṁ yuktaṁ syādanulōmanam||87|| na svedyAH pittadAhArtA raktasvedAtivartinaH | kShINadhAtubalA rUkShA garbhiNyashcApi pittalAH ||82|| koShNaiH kAmamuraHkaNThaM snehasekaiH sasharkaraiH | utkArikopanAhaishca svedayen mRudubhiH kShaNam ||83|| tilomAmAShagodhUmacUrNairvAtaharaiH saha | snehaishcotkArikA sAmlaiH sakShIrairvA kRutA hitA ||84|| navajvarAmadoSheShu rUkShasvedaM vila~gghanam | samIkShyollekhanaM vA~api kArayellavaNAmbunA ||85|| atiyogoddhataM vAtaM dRuShTvA vAtaharairbhiShak | rasAdyairnAtishItoShNairabhya~ggaishca shamaM nayet ||86|| udAvarte tathA~a~adhmAne mAtulu~ggAmlavetasaiH | hi~ggupIlubiDaishcAnnaM yuktaM syAdanulomanam ||87|| Contra-indication for swedana in shwasa: The patient of shwasa and hikka suffering from burning sensation, bleeding, and excessive sweating, depleted dhatus, loss of strength, dryness, and associated with condition of pregnancy or having pitta prakriti should not be administered swedana (sudation). Mridu swedana (mild sudation): In such condition, if it is very essential then mild sudation should be given over chest and throat region for short duration, in the form of parisheka with warm oil or application of warm utkarika (a kind of poultice) mixed with sugar or upanaha(poultice). Utkarika(poultice): Utkarika is prepared with powders of sesame, black gram and wheat are mixed with vatahara sneha and gruel and swedana is done Or warm gruel and milk are used for swedana in the form of parisheka. Vamana: The patient suffering from fever of recent origin and ama dosha should be treated with ruksha sweda and langhana. Or vamana (emesis) should be induced by administering saindhavalavana (rock salt) and water. Meal should be taken along with vata alleviating meat soups etc. in condition of aggravation of vata due to excessive vamana. Alleviation of vata should also be done by massage with vatahara drugs which are not cold, nor hot in property. (82-87) Two types of patients as per dosha dominance: हिक्काश्वासामयी ह्येको बलवान् दुर्बलोऽपरः | कफाधिकस्तथैवैको रूक्षो बह्वनिलोऽपरः ||८८|| ककाधिके बलस्थे च वमनं सविरेचनम् | कुर्यात् पथ्याशिने धूमलेहादिशमनं ततः ||८९|| वातिकान् दुर्बलान् बालान् वृद्धांश्चानिलसूदनैः | तर्पयेदेव शमनैः स्नेहयूषरसादिभिः ||९०|| hikkāśvāsāmayī hyēkō balavān durbalō'paraḥ| kaphādhikastathaivaikō rūkṣō bahvanilō'paraḥ||88|| kakādhikē balasthē ca vamanaṁ savirēcanam| kuryāt pathyāśinē dhūmalēhādiśamanaṁ tataḥ||89|| vātikān durbalān bālān vr̥ddhāṁścānilasūdanaiḥ| tarpayēdēva śamanaiḥ snēhayūṣarasādibhiḥ||90|| hikkAshvAsAmayI hyeko balavAn durbalo~aparaH | kaphAdhikastathaivaiko rUkSho bahvanilo~aparaH ||88|| kakAdhike balasthe ca vamanaM savirecanam | kuryAt pathyAshine dhUmalehAdishamanaM tataH ||89|| vAtikAn durbalAn bAlAn vRuddhAMshcAnilasUdanaiH | tarpayedeva shamanaiH snehayUSharasAdibhiH ||90|| The patients suffering from hikka and shwasa are of two types i.e. one having strength and other weak. One has aggravation of kapha and other having dryness and vata predominance. Management of patient having strength: The patient of hikka and shwasa having kapha predominance and strength should be treated with therapeutic emesis and purgation along with wholesome food and regimen. Further alleviation should be done with medicated smoking and administration of lehya etc. Management of weak patient:The patient having aggravation of vata and weakness, children and elderly hikka, shwasa patients should be managed with vata alleviating medicines and nourishing sneha, soups, and meat soup. (88-90) Contra-indication for Purification therapy in hikka and shwasa patients: अनुत्क्लिष्टकफास्विन्नदुर्बलानां विशोधनात् | वायुर्लब्धास्पदो मर्म संशोष्याशु हरेदसून् ||९१|| दृढान् बहुकफांस्तस्माद्रसैरानूपवारिजैः | तृप्तान्विशोधयेत्स्विन्नान् बृंहयेदितरान् भिषक् ||९२|| बर्हितित्तिरिदक्षाश्च जाङ्गलाश्च मृगद्विजाः | दशमूलीरसे सिद्धाः कौलत्थे वा रसे हिताः ||९३|| anutkliṣṭakaphāsvinnadurbalānāṁ viśōdhanāt| vāyurlabdhāspadō marma saṁśōṣyāśu harēdasūn||91|| dr̥ḍhān bahukaphāṁstasmādrasairānūpavārijaiḥ| tr̥ptānviśōdhayētsvinnān br̥ṁhayēditarān bhiṣak||92|| barhitittiridakṣāśca jāṅgalāśca mr̥gadvijāḥ| daśamūlīrasē siddhāḥ kaulatthē vā rasē hitāḥ||93|| anutkliShTakaphAsvinnadurbalAnAM vishodhanAt | vAyurlabdhAspado marma saMshoShyAshu haredasUn ||91|| dRuDhAn bahukaphAMstasmAdrasairAnUpavArijaiH | tRuptAnvishodhayetsvinnAn bRuMhayeditarAn bhiShak ||92|| barhitittiridakShAshca jA~ggalAshca mRugadvijAH | dashamUlIrase siddhAH kaulatthe vA rase hitAH ||93|| If purification therapy is administered in the hikka shwasa patients without aggravation of kapha, in patients contraindicated for swedana or in very weak patients, then the aggravated vayu afflicts marma (vital points) and results in death instantaneously. Brumhana therapy in hikka shwasa: Strong and sturdy patient with aggravated kapha should be administered with meat soup prepared from aquatic and marshy animals followed by swedana and vamana. Weak patient without aggravation of kapha should be administered brumhana (nourishment therapy). (91-93) Various formulations: निदिग्धिकां बिल्वमध्यं कर्कटाख्यां दुरालभाम् | त्रिकण्टकं गुडूचीं च कुलत्थांश्च सचित्रकान् ||९४|| जले पक्त्वा रसः पूतः पिप्पलीघृतभर्जितः | सनागरः सलवणः स्याद्यूषो भोजने हितः ||९५|| रास्नां बलां पञ्चमूलं ह्रस्वं मुद्गान् सचित्रकान् | पक्त्वाऽम्भसि रसे तस्मिन् यूषः साध्यश्च पूर्ववत् ||९६|| पल्लवान्मातुलुङ्गस्य निम्बस्य कुलकस्य च | पक्त्वा मुद्गांश्च सव्योषान् क्षारयूषं विपाचयेत् ||९७|| दत्त्वा सलवणं क्षारं शिग्रूणि मरिचानि च | युक्त्या संसाधितो यूषो हिक्काश्वासविकारनुत् ||९८|| कासमर्दकपत्राणां यूषः शोभाञ्जनस्य च | शुष्कमूलकयूषश्च हिक्काश्वासनिवारणः ||९९|| सदधिव्योषसर्पिष्को यूषो वार्ताकजो हितः | शालिषष्टिकगोधूमयवान्नान्यनवानि च ||१००|| हिङ्गुसौवर्चलाजाजीबिडपौष्करचित्रकैः | सिद्धा कर्कटशृङ्ग्या च यवागूः श्वासहिक्किनाम् ||१०१|| दशमूलीशटीरास्नापिप्पलीमूलपौष्करैः | शृङ्गीतामलकीभार्गीगुडूचीनागराम्बुभिः ||१०२|| यवागूं विधिना सिद्धां कषायं वा पिबेन्नरः | कासहृद्ग्रहपार्श्वार्तिहिक्काश्वासप्रशान्तये ||१०३|| पुष्कराह्वशटीव्योषमातुलुङ्गाम्लवेतसैः | योजयेदन्नपानानि ससर्पिर्बिडहिङ्गुभिः ||१०४|| nidigdhikāṁ bilvamadhyaṁ karkaṭākhyāṁ durālabhām| trikaṇṭakaṁ guḍūcīṁ ca kulatthāṁśca sacitrakān||94|| jalē paktvā rasaḥ pūtaḥ pippalīghr̥tabharjitaḥ| sanāgaraḥ salavaṇaḥ syādyūṣō bhōjanē hitaḥ||95|| rāsnāṁ balāṁ pañcamūlaṁ hrasvaṁ mudgān sacitrakān| paktvā'mbhasi rasē tasmin yūṣaḥ sādhyaśca pūrvavat||96|| pallavānmātuluṅgasya nimbasya kulakasya ca| paktvā mudgāṁśca savyōṣān kṣārayūṣaṁ vipācayēt||97|| dattvā salavaṇaṁ kṣāraṁ śigrūṇi maricāni ca| yuktyā saṁsādhitō yūṣō hikkāśvāsavikāranut||98|| kāsamardakapatrāṇāṁ yūṣaḥ śōbhāñjanasya ca| śuṣkamūlakayūṣaśca hikkāśvāsanivāraṇaḥ||99|| sadadhivyōṣasarpiṣkō yūṣō vārtākajō hitaḥ| śāliṣaṣṭikagōdhūmayavānnānyanavāni ca||100|| hiṅgusauvarcalājājībiḍapauṣkaracitrakaiḥ| siddhā karkaṭaśr̥ṅgyā ca yavāgūḥ śvāsahikkinām||101|| daśamūlīśaṭīrāsnāpippalīmūlapauṣkaraiḥ| śr̥ṅgītāmalakībhārgīguḍūcīnāgarāmbubhiḥ||102|| yavāgūṁ vidhinā siddhāṁ kaṣāyaṁ vā pibēnnaraḥ| kāsahr̥dgrahapārśvārtihikkāśvāsapraśāntayē||103|| puṣkarāhvaśaṭīvyōṣamātuluṅgāmlavētasaiḥ| yōjayēdannapānāni sasarpirbiḍahiṅgubhiḥ||104|| nidigdhikAM bilvamadhyaM karkaTAkhyAM durAlabhAm | trikaNTakaM guDUcIM ca kulatthAMshca sacitrakAn ||94|| jale paktvA rasaH pUtaH pippalIghRutabharjitaH | sanAgaraH salavaNaH syAdyUSho bhojane hitaH ||95|| rAsnAM balAM pa~jcamUlaM hrasvaM mudgAn sacitrakAn | paktvA~ambhasi rase tasmin yUShaH sAdhyashca pUrvavat ||96|| pallavAnmAtulu~ggasya nimbasya kulakasya ca | paktvA mudgAMshca savyoShAn kShArayUShaM vipAcayet ||97|| dattvA salavaNaM kShAraM shigrUNi maricAni ca | yuktyA saMsAdhito yUSho hikkAshvAsavikAranut ||98|| kAsamardakapatrANAM yUShaH shobhA~jjanasya ca | shuShkamUlakayUShashca hikkAshvAsanivAraNaH ||99|| sadadhivyoShasarpiShko yUSho vArtAkajo hitaH | shAliShaShTikagodhUmayavAnnAnyanavAni ca ||100|| hi~ggusauvarcalAjAjIbiDapauShkaracitrakaiH | siddhA karkaTashRu~ggyA ca yavAgUH shvAsahikkinAm ||101|| dashamUlIshaTIrAsnApippalImUlapauShkaraiH | shRu~ggItamalakIbhArgIguDUcInAgarAmbubhiH ||102|| yavAgUM vidhinA siddhAM kaShAyaM vA pibennaraH | kAsahRudgrahapArshvArtihikkAshvAsaprashAntaye ||103|| puShkarAhvashaTIvyoShamAtulu~ggAmlavetasaiH | yojayedannapAnAni sasarpirbiDahi~ggubhiH ||104|| Nidigdhikadi yoga: Nidigdhika (Solanum surattense Burm. f), bilva (Aegle marmelos Corr.), karkta (Rhus succedania Linn.), duralabha (Fagonia cretica Linn.), trikanthaka (Tribulus terrestris Linn.), guduchi (Tinospora cordifolia Willd Miers ex Hook f. & Thoms ), chitraka (Plumbago zyelanica Linn.) and kulattha (horse gram- Dolicus lab lab) are taken in equal quantity and boiled in water as yusha and filtered. This filtrate is fried in ghee and taken with pippali (Piper longum Linn.), shunthi (Zingiber officinale Roxb.) and saindhava lavana (rock salt) is conducive to hikka shwasa patients. Rasnadi yusha: Rasna (Pluchea lanceolata C B Clarke), bala (Sida cordifolia Linn. ), laghupanchamula (Shalaparni- Desmodium gangeticum DC., prushniparni -Uraria picta Desv., Brihati- Solanum Indicum Linn., kanthakari – Solanum surattense Burm. f, gokshura- Tribulus terrestris Linn.) and chitraka (Plumbago zeylanica Linn.) are taken in equal quantity and boiled with mudga (green gram) and water as earlier described yusha. Matulungadi yusha: Leaves of matulunga (Citrus medica Linn.), nimba (Azadirachta indica A. Juss), kulaka are taken in equal quantity and mixed with mudga (green gram) and cooked in water as yusha. Further trikatu powder (maricha-Piper nigrum Linn, pippali- Piper longum linn. and shunthi-Zingiber officinale Roxb.) should be added at the time drinking in hikka shwasa patients. Mudga yusha: Rock salt, yavakshara, seeds of drum stick and maricha (pepper) power should be added to the already prepared mudga yusha and consumed in hikka shwasa patients. Yusha prepared from leaves of kasamarda (Senna occidentalis Linn), shobhanjana (drum stick- Moringa oleifera Lam.), and dry radish should also be given in hikka shwasa. The yusha prepared from juice or decoction of brihati (Solanum indica Linn.) should be mixed with ghee, curd, maricha, pippali and shunthi is conducive in hikka and shwasa disease. Old shali (Oriza sativa Linn.), shashthika (variety of rice maturing n 60 days), godhuma (wheat- Triticum aestivum Linn.), yava (Barley- Hordium vulgare Linn.) are pathya in hikka and shwasa. Hingvadi yavagu: The yavagu (gruel) prepared from hingu (Ferula narthex Boiss.), sauvarchala (variety of salt), ajaji (Cuminum cyminum Linn.), bida (variety of salt), pushkara (Inula racemosa Hook. f.), chitraka (Plumbago zeylanica Linn.) and karkataka shringi (Rhus succedania Linn.) is beneficial in hikka and shwasa patients. Dashamuladi yavagu: yavagu prepared from dashamula, shati (Hedychium spicatum Buch Ham.), rasna (Pluchea lanceolata C B Clarke), pippalimula (Piper longum Linn), pushkara (Inula racemosa Hook. f), karkata shringi (Rhus succedania Linn), amalaki (Emblica officinals Gaertn), bharngi (Clerodendrum serratum Linn. Moon.), gudcuhi (Tinospora cordifolia Wiild Miers ex Hook f. & Thoms), nagara (Zingiber officinale Roxb.) and water alleviates kasa (cough), hridgraha (heart problem), parshvarti (pain in the flanks), hikka (hiccough) and shwasa (dysnea). pushkaradi yavagu: Yavagu prepared from pushkara (Inula racemosa Hook f.), shati (Hedychium spicatum Buch Ham.), vyosha (maricha, pippali, shunthi), matulunga (Citrus medica Linn.), amlavetasa (Garcenia morella Desr) and hingu (Ferula narthex Boiss.) should be used in hikka shwasa patient. (94-104) दशमूलस्य वा क्वाथमथवा देवदारुणः | तृषितो मदिरां वाऽपि हिक्काश्वासी पिबेन्नरः ||१०५|| पाठां मधुरसां रास्नां सरलं देवदारु च | प्रक्षाल्य जर्जरीकृत्य सुरामण्डे निधापयेत् ||१०६|| तं मन्दलवणं कृत्वा भिषक् प्रसृतसम्मितम् | पाययेत्तु ततो हिक्का श्वासश्चैवोपशाम्यति ||१०७|| हिङ्गु सौवर्चलं कोलं समङ्गां पिप्पलीं बलाम् | मातुलुङ्गरसे पिष्टमारनालेन वा पिबेत् ||१०८|| सौवर्चलं नागरं च भार्गीं द्विशर्करायुतम् | उष्णाम्बुना पिबेदेतद्धिक्काश्वासविकारनुत् ||१०९|| भार्गीनागरयोः कल्कं मरिचक्षारयोस्तथा | पीतद्रुचित्रकास्फोतामूर्वाणां चाम्बुना पिबेत् ||११०|| मधूलिका तुगाक्षीरी नागरं पिप्पली तथा | उत्कारिका घृते सिद्धा श्वासे पित्तानुबन्धजे ||१११|| श्वाविधं शशमांसं च शल्लकस्य च शोणितम् | पिप्पलीघृतसिद्धानि श्वासे वातानुबन्धजे ||११२|| सुवर्चलारसो दुग्धं घृतं त्रिकटुकान्वितम् | शाल्योदनस्यानुपानं वातपित्तानुगे हितम् ||११३|| शिरीषपुष्पस्वरसः सप्तपर्णस्य वा पुनः | पिप्पलीमधुसंयुक्तः कफपित्तानुगे मतः ||११४|| मधुकं पिप्पलीमूलं गुडो गोश्वशकृद्रसः [१] | घृतं क्षौद्रं कासश्वासहिक्काभिष्यन्दिनां शुभम् ||११५|| खराश्वोष्ट्रवराहाणां मेषस्य च गजस्य च | शकृद्रसं बहुकफे चैकैकं मधुना पिबेत् ||११६|| क्षारं चाप्यश्वगन्धाया लिह्यान्ना क्षौद्रसर्पिषा | मयूरपादनालं वा शकलं शल्लकस्य वा ||११७|| श्वाविज्जाण्डकचाषाणां [२] रोमाणि कुररस्य वा | शृङ्ग्येकद्विशफानां [३] वा चर्मास्थीनि खुरांस्तथा ||११८|| सर्वाण्येकैकशो वाऽपि दग्ध्वा क्षौद्रघृतान्वितम् | चूर्णं लीढ्वा जयेत् कासं हिक्कां श्वासं च दारुणम् ||११९|| एते हि कफसंरुद्धगतिप्राणप्रकोपजाः [४] | तस्मात्तन्मार्गशुद्ध्यर्थं देया लेहा न निष्कफे ||१२०|| daśamūlasya vā kvāthamathavā dēvadāruṇaḥ| tr̥ṣitō madirāṁ vā'pi hikkāśvāsī pibēnnaraḥ||105|| pāṭhāṁ madhurasāṁ rāsnāṁ saralaṁ dēvadāru ca| prakṣālya jarjarīkr̥tya surāmaṇḍē nidhāpayēt||106|| taṁ mandalavaṇaṁ kr̥tvā bhiṣak prasr̥tasammitam| pāyayēttu tatō hikkā śvāsaścaivōpaśāmyati||107|| hiṅgu sauvarcalaṁ kōlaṁ samaṅgāṁ pippalīṁ balām| mātuluṅgarasē piṣṭamāranālēna vā pibēt||108|| sauvarcalaṁ nāgaraṁ ca bhārgīṁ dviśarkarāyutam| uṣṇāmbunā pibēdētaddhikkāśvāsavikāranut||109|| bhārgīnāgarayōḥ kalkaṁ maricakṣārayōstathā| pītadrucitrakāsphōtāmūrvāṇāṁ cāmbunā pibēt||110|| madhūlikā tugākṣīrī nāgaraṁ pippalī tathā| utkārikā ghr̥tē siddhā śvāsē pittānubandhajē||111|| śvāvidhaṁ śaśamāṁsaṁ ca śallakasya ca śōṇitam| pippalīghr̥tasiddhāni śvāsē vātānubandhajē||112|| suvarcalārasō dugdhaṁ ghr̥taṁ trikaṭukānvitam| śālyōdanasyānupānaṁ vātapittānugē hitam||113|| śirīṣapuṣpasvarasaḥ saptaparṇasya vā punaḥ| pippalīmadhusaṁyuktaḥ kaphapittānugē mataḥ||114|| madhukaṁ pippalīmūlaṁ guḍō gōśvaśakr̥drasaḥ [1] | ghr̥taṁ kṣaudraṁ kāsaśvāsahikkābhiṣyandināṁ śubham||115|| kharāśvōṣṭravarāhāṇāṁ mēṣasya ca gajasya ca| śakr̥drasaṁ bahukaphē caikaikaṁ madhunā pibēt||116|| kṣāraṁ cāpyaśvagandhāyā lihyānnā kṣaudrasarpiṣā| mayūrapādanālaṁ vā śakalaṁ śallakasya vā||117|| śvāvijjāṇḍakacāṣāṇāṁ [2] rōmāṇi kurarasya vā| śr̥ṅgyēkadviśaphānāṁ [3] vā carmāsthīni khurāṁstathā||118|| sarvāṇyēkaikaśō vā'pi dagdhvā kṣaudraghr̥tānvitam| cūrṇaṁ līḍhvā jayēt kāsaṁ hikkāṁ śvāsaṁ ca dāruṇam||119|| ētē hi kaphasaṁruddhagatiprāṇaprakōpajāḥ [4] | tasmāttanmārgaśuddhyarthaṁ dēyā lēhā na niṣkaphē||120|| dashamUlasya vA kvAthamathavA devadAruNaH | tRuShito madirAM vA~api hikkAshvAsI pibennaraH ||105|| pAThAM madhurasAM rAsnAM saralaM devadAru ca | prakShAlya jarjarIkRutya surAmaNDe nidhApayet ||106|| taM mandalavaNaM kRutvA bhiShak prasRutasammitam | pAyayettu tato hikkA shvAsashcaivopashAmyati ||107|| hi~ggu sauvarcalaM kolaM sama~ggAM pippalIM balAm | mAtulu~ggarase piShTamAranAlena vA pibet ||108|| sauvarcalaM nAgaraM ca bhArgIM dvisharkarAyutam | uShNAmbunA pibedetaddhikkAshvAsavikAranut ||109|| bhArgInAgarayoH kalkaM maricakShArayostathA | pItadrucitrakAsphotAmUrvANAM cAmbunA pibet ||110|| madhUlikA tugAkShIrI nAgaraM pippalI tathA | utkArikA ghRute siddhA shvAse pittAnubandhaje ||111|| shvAvidhaM shashamAMsaM ca shallakasya ca shoNitam | pippalIghRutasiddhAni shvAse vAtAnubandhaje ||112|| suvarcalAraso dugdhaM ghRutaM trikaTukAnvitam | shAlyodanasyAnupAnaM vAtapittAnuge hitam ||113|| shirIShapuShpasvarasaH saptaparNasya vA punaH | pippalImadhusaMyuktaH kaphapittAnuge mataH ||114|| madhukaM pippalImUlaM guDo goshvashakRudrasaH [1] | ghRutaM kShaudraM kAsashvAsahikkAbhiShyandinAM shubham ||115|| kharAshvoShTravarAhANAM meShasya ca gajasya ca | shakRudrasaM bahukaphe caikaikaM madhunA pibet ||116|| kShAraM cApyashvagandhAyA lihyAnnA kShaudrasarpiShA | mayUrapAdanAlaM vA shakalaM shallakasya vA ||117|| shvAvijjANDakacAShANAM [2] romANi kurarasya vA | shRu~ggyekadvishaphAnAM [3] vA carmAsthIni khurAMstathA ||118|| sarvANyekaikasho vA~api dagdhvA kShaudraghRutAnvitam | cUrNaM lIDhvA jayet kAsaM hikkAM shvAsaM ca dAruNam ||119|| ete hi kaphasaMruddhagatiprANaprakopajAH [4] | tasmAttanmArgashuddhyarthaM deyA lehA na niShkaphe ||120|| Drinks in hikka shwasa patients: The patient suffering from hikka shwasa should drink water prepared in dashamula or devadaru (Cedrus deodara (Roxb.) Loud.) or madira (variety of alcohol) on feeling thirst. Pathadyasava: patha (Cissampelos pareira Linn.), madhurasa (Marsdenia tenacissima Wight. & Am), rasna (Pluchea lanceolata C B Clarke), sarala (Operculina turpethum (Linn.) silva Manso) and devadaru (Cedrus deodara (Roxb.) Loud.) are washed and crushed and these ingredients should be put in suramanda (an alcoholic preparation). Small quantity of salt is added to this and administered in 1 prasrit dosage to alleviate hikka shwasa. Hingvadi dravya: Hingu (Ferula northex Boiss), sauvarchala (Variety of salt), kola (Zizipus jujube Lam), samanga (Rubia cordifolia Linn.), pippali (Piper longum Linn.), bala (Sida cordifolia Linn.) are taken in equal quantity and made in to fine paste in juice of matulunga (Citrus medica Linn.). This paste is mixed in aranala and given to hikka shwasa patient. Sauvarchaladi churna: Sauvarchala (variety of salt), nagara (zingiber officinale Roxb.), bharngi (Clerodendrum serratum Linn.) should be taken in equal quantity and mixed with double quantity of sharkara (sugar). This combination should be taken with hot water. Bharngi nagaradi churna: Bharngi and shunthi (Zingiber officinale Roxb.), maricha (Piper nigrum Linn.), yavakshara (alkali prepared from barley), pitadru (Berberis aristata DC.), chitraka (Plumbago zeylanica Linn.), asphota (Hemidesmus indicus R Br.) are used individually with hot water in hikka shwasa. Utkarika: Utkarika should be prepared from madhulika (finger millet), vamshalohcana, shunthi (Zingiber officinale Roxb.), pippali (Piper longum Linn.) by cooking in ghee and used in shwasa associated with pitta. The meat of shashvit or rabbit or blood of shallaka should be cooked with pippali ghrita should be used in shwasa associated with vata. In the shwasa associated with vata and kapha should be administered combination of juice of sauvarchala, milk, ghee and trikatu and shali variety of rice. In shwasa associated with kaphapitta should be given juice of flowers of shirisha (Albizzia lebbeck Benth), or juice of saptaparna leaves (Alstonia scholaris R Br.) along with pippali powder (Piper longum Linn.). Madhukadi yoga: Madhuka (Glycyrrhiza glabra Linn.), pippalimula (root of Piper longum Linn.), jaggery, juice of dungs of cow or horse, ghee, honey subsides Kasa (cough), shwasa (dyspnoea), hikka (hiccups) and abhishyanda (conjunctivitis). In shwasa with aggravated kapha the juice of dung of donkey, horse, camel or pig should be administered with honey. The alkali prepared from roots of ashvagandha (Withania somnifera Linn.) should be licked with honey and ghee. Alkali prepared stalk of feather of peacock, alkali of quills of fish, hair of shashvit, alkali of bones of jandaka , chasha, or kurara, skin, bones and hooves of shringi, ekashapha, dvishapha etc. animals are burnt into ash separately and alkali is prepared. This powder administered with honey and ghee results in cure of kasa (cough), hikka (hiccups) and shwasa (dyspnoea). Above said kshara lehya (Alkaline linctus) clear the kapha in the obstructed respiratory tract and subsides the aggravated pranavayu. Hence the alkaline linctus should be given to purify the channels obstructed by kapha if there is no obstruction by kapha it should not be administered. (105-120) Guidelines for management of tamaka shwasa: कासिने च्छर्दनं दद्यात् स्वरभङ्गे च बुद्धिमान् | वातश्लेष्महरैर्युक्तं तमके तु विरेचनम् ||१२१|| उदीर्यते भृशतरं मार्गरोधाद्वहज्जलम् | यथा तथाऽनिलस्तस्य मार्गं नित्यं विशोधयेत् ||१२२|| kāsinē cchardanaṁ dadyāt svarabhaṅgē ca buddhimān| vātaślēṣmaharairyuktaṁ tamakē tu virēcanam||121|| udīryatē bhr̥śataraṁ mārgarōdhādvahajjalam| yathā tathā'nilastasya mārgaṁ nityaṁ viśōdhayēt||122|| kAsine cchardanaM dadyAt svarabha~gge ca buddhimAn | vAtashleShmaharairyuktaM tamake tu virecanam ||121|| udIryate bhRushataraM mArgarodhAdvahajjalam | yathA tathA~anilastasya mArgaM nityaM vishodhayet ||122|| An intelligent doctor in shwasa associated with cough and hoarseness of voice should be administered vamana and in tamaka shwasa virechana should be given with vata-kaphahara medicines. If the path of flowing water is blocked the enhancing pressure of water breaks the dam similarly the path obstructed by kapha aggravates vata and causes harm, hence always the path of vayu should be cleaned by means of purification. (121-122) Shatyadi churna: शटीचोरकजीवन्तीत्वङ्मुस्तं पुष्कराह्वयम् | सुरसं तामलक्येला पिप्पल्यगुरु नागरम् ||१२३|| वालकं च समं चूर्णं कृत्वाऽष्टगुणशर्करम् | सर्वथा तमके श्वासे हिक्कायां च प्रयोजयेत् ||१२४|| śaṭīcōrakajīvantītvaṅmustaṁ puṣkarāhvayam| surasaṁ tāmalakyēlā pippalyaguru nāgaram||123|| vālakaṁ ca samaṁ cūrṇaṁ kr̥tvā'ṣṭaguṇaśarkaram| sarvathā tamakē śvāsē hikkāyāṁ ca prayōjayēt||124|| shaTIcorakajIvantItva~gmustaM puShkarAhvayam | surasaM tAmalakyelA pippalyaguru nAgaram ||123|| vAlakaM ca samaM cUrNaM kRutvA~aShTaguNasharkaram | sarvathA tamake shvAse hikkAyAM ca prayojayet ||124||

An equal quantity of the fine powders of shati (Hedychium spicatum Buch Ham.), choraka (Angelica glauca Edgew), jivanti (Leptadenia reticulate W & A.), tvak (Cinnamomum zeylanica Breyn), musta (Cyperus rotundus Linn.), pushkara mula (Inula recimosa Hook f.), surasa (Ocimum sanctum Linn.), tamalaka (Phyllanthus urinaria Linn.), pippali (Piper longum Linn.), agaru (Aquilaria agollacha Roxb.), nagara (Zingiber officinale Roxb.), balaka (Vetiveria zizinioidis (Linn.) Nash.) is mixed with 8 parts of sugar should be kept and us in tamaka shwasa and hikka. (123-124)

Muktadi churna: मुक्ताप्रवालवैदूर्यशङ्खस्फटिकमञ्जनम् | ससारगन्धकाचार्कसूक्ष्मैलालवणद्वयम् [१] ||१२५|| ताम्रायोरजसी रूप्यं ससौगन्धिकसीसकम् [२] | जातीफलं शणाद्बीजमपामार्गस्य तण्डुलाः ||१२६|| एषां पाणितलं चूर्णं तुल्यानां क्षौद्रसर्पिषा | हिक्कां श्वासं च कासं च लीढमाशु नियच्छति ||१२७|| अञ्जनात्तिमिरं काचं नीलिकां पुष्पकं तमः | मल्यं [३] कण्डूमभिष्यन्दमर्म चैव प्रणाशयेत् ||१२८|| इति मुक्ताद्यं चूर्णम् | muktāpravālavaidūryaśaṅkhasphaṭikamañjanam| sasāragandhakācārkasūkṣmailālavaṇadvayam [1] ||125|| tāmrāyōrajasī rūpyaṁ sasaugandhikasīsakam [2] | jātīphalaṁ śaṇādbījamapāmārgasya taṇḍulāḥ||126|| ēṣāṁ pāṇitalaṁ cūrṇaṁ tulyānāṁ kṣaudrasarpiṣā| hikkāṁ śvāsaṁ ca kāsaṁ ca līḍhamāśu niyacchati||127|| añjanāttimiraṁ kācaṁ nīlikāṁ puṣpakaṁ tamaḥ| malyaṁ [3] kaṇḍūmabhiṣyandamarma caiva praṇāśayēt||128|| iti muktādyaṁ cūrṇam| muktApravAlavaidUryasha~gkhasphaTikama~jjanam | sasAragandhakAcArkasUkShmailAlavaNadvayam [1] ||125|| tAmrAyorajasI rUpyaM sasaugandhikasIsakam [2] | jAtIphalaM shaNAdbIjamapAmArgasya taNDulAH ||126|| eShAM pANitalaM cUrNaM tulyAnAM kShaudrasarpiShA | hikkAM shvAsaM ca kAsaM ca lIDhamAshu niyacchati ||127|| a~jjanAttimiraM kAcaM nIlikAM puShpakaM tamaH | malyaM [3] kaNDUmabhiShyandamarma caiva praNAshayet ||128|| iti muktAdyaM cUrNam |

Equal quantities of the bhasmas of mukta (pearls), pravala (coral), vaidurya (cat’s aye gem), shankha (conch), sphatika (crystal quartz), anjana (lead),  sasara (potent crystals of abovementioned drugs), gandhaka (sulpher), arka (Calotropis procera  (Ait) R Br.), sukshmaila (Elettaria cardomum Maton), lavana dvayam (sauvarchala and saindhava), Tamra (copper), ayas (iron), rajata (silver), saugandhika (variety of manikya -ruby), jatiphala (Myristica fragrans Houtt), seeds of shana, apamarga (Achyranthes aspera Linn. ) are given in the dose of one panitala (karsha-12gms) along with ghee and honey. The administration of this powder cures hikka, shwasa and kasa. On application in the form of anjana (collyrium) to eyes destroys timira (blindness), kacha(glaucoma), nilika, pushpaka, vision defects, itching of eyes, abhishyanda (conjunctivitis) and arma (pterigium).(125-128)

शटीपुष्करमूलानां चूर्णमामलकस्य च | मधुना संयुतं लेह्यं चूर्णं वा काललोहजम् ||१२९|| सशर्करां तामलकीं द्राक्षां गोश्वशकृद्रसम् | तुल्यं गुडं नागरं च प्राशयेन्नावयेत्तथा ||१३०|| लशुनस्य पलाण्डोर्वा मूलं गृञ्जनकस्य वा | नावयेच्चन्दनं वाऽपि नारीक्षीरेण संयुतम् ||१३१|| सुखोष्णं घृतमण्डं वा सैन्धवेनावचूर्णितम् | नावयेन्माक्षिकीं विष्ठामलक्तकरसेन वा ||१३२|| नारीक्षीरेण सिद्धं वा सर्पिर्मधुरकैरपि | पीतं नस्तो निषिक्तं वा सद्यो हिक्कां नियच्छति ||१३३|| सकृदुष्णं सकृच्छीतं व्यत्यासाद्धिक्किनां पयः | पाने नस्तःक्रियायां वा शर्करामधुसंयुतम् ||१३४|| śaṭīpuṣkaramūlānāṁ cūrṇamāmalakasya ca| madhunā saṁyutaṁ lēhyaṁ cūrṇaṁ vā kālalōhajam||129|| saśarkarāṁ tāmalakīṁ drākṣāṁ gōśvaśakr̥drasam| tulyaṁ guḍaṁ nāgaraṁ ca prāśayēnnāvayēttathā||130|| laśunasya palāṇḍōrvā mūlaṁ gr̥ñjanakasya vā| nāvayēccandanaṁ vā'pi nārīkṣīrēṇa saṁyutam||131|| sukhōṣṇaṁ ghr̥tamaṇḍaṁ vā saindhavēnāvacūrṇitam| nāvayēnmākṣikīṁ viṣṭhāmalaktakarasēna vā||132|| nārīkṣīrēṇa siddhaṁ vā sarpirmadhurakairapi| pītaṁ nastō niṣiktaṁ vā sadyō hikkāṁ niyacchati||133|| sakr̥duṣṇaṁ sakr̥cchītaṁ vyatyāsāddhikkināṁ payaḥ| pānē nastaḥkriyāyāṁ vā śarkarāmadhusaṁyutam||134|| shaTIpuShkaramUlAnAM cUrNamAmalakasya ca | madhunA saMyutaM lehyaM cUrNaM vA kAlalohajam ||129|| sasharkarAM tAmalakIM drAkShAM goshvashakRudrasam | tulyaM guDaM nAgaraM ca prAshayennAvayettathA ||130|| lashunasya palANDorvA mUlaM gRu~jjanakasya vA | nAvayeccandanaM vA~api nArIkShIreNa saMyutam ||131|| sukhoShNaM ghRutamaNDaM vA saindhavenAvacUrNitam | nAvayenmAkShikIM viShThAmalaktakarasena vA ||132|| nArIkShIreNa siddhaM vA sarpirmadhurakairapi | pItaM nasto niShiktaM vA sadyo hikkAM niyacchati ||133|| sakRuduShNaM sakRucchItaM vyatyAsAddhikkinAM payaH | pAne nastaHkriyAyAM vA sharkarAmadhusaMyutam ||134|| Shatyadi churna: Equal quantity of fine powders of shati (Hedychium spicatum Buch Ham.), pushkaramula (Inula racemosa Hook f.) or amalaki (Emblica officinalis Gaertn.) or Loha bhasma ( iron ore) should be licked along with honey. Nasya: Juice of tamalaki (Phyllanthus urinaria Linn.), draksha (Vitis vinifera Linn.), cow dung and horse mixed with sugar or equal quantities of jaggery, ginger should be used for licking or nasya. Nasya: At the time of severe attack of hikka and shwasa, nasya should be administered from juice of roots of lashuna (Allium sativum Linn.) or palandu (Allium cepa Linn.) or grinjana (Daucas carota Linn) or chandana (Santalum album Linn.) with human milk. The supernatant part of ghee mixed with saindhava lavana or juice of alaktaka along with bees’ faeces or human milk should be given in the form of nasya. Medicated ghee prepared from madhura varga should be given orally or in the form of nasya pacifies hikka and shwasa very quickly. Alternate oral consumption of hot and cold milk or usage in the form of nasya alleviates hikka quickly. (129-134) अधोभागैर्घृतं सिद्धं सद्यो हिक्कां नियच्छति | पिप्पलीमधुयुक्तौ वा रसौ धात्रीकपित्थयोः ||१३५|| लाजालाक्षामधुद्राक्षापिप्पल्यश्वशकृद्रसान् | लिह्यात् कोलमधुद्राक्षापिप्पलीनागराणि वा ||१३६|| शीताम्बुसेकः सहसा त्रासो विस्मापनं भयम् | क्रोधहर्षप्रियोद्वेगा हिक्काप्रच्यावना मताः ||१३७|| हिक्काश्वासविकाराणां निदानं यत् प्रकीर्तितम् | वर्ज्यमारोग्यकामैस्तद्धिक्काश्वासविकारिभिः ||१३८|| हिक्काश्वासानुबन्धा [१] ये शुष्कोरःकण्ठतालुकाः | प्रकृत्या रूक्षदेहाश्च सर्पिर्भिस्तानुपाचरेत् ||१३९|| दशमूलरसे सर्पिर्दधिमण्डे च साधयेत् | कृष्णासौवर्चलक्षारवयःस्थाहिङ्गुचोरकैः ||१४०|| कायस्थया च तत् पानाद्धिक्काश्वासौ प्रणाशयेत् |१४१| adhōbhāgairghr̥taṁ siddhaṁ sadyō hikkāṁ niyacchati| pippalīmadhuyuktau vā rasau dhātrīkapitthayōḥ||135|| lājālākṣāmadhudrākṣāpippalyaśvaśakr̥drasān| lihyāt kōlamadhudrākṣāpippalīnāgarāṇi vā||136|| śītāmbusēkaḥ sahasā trāsō vismāpanaṁ bhayam| krōdhaharṣapriyōdvēgā hikkāpracyāvanā matāḥ||137|| hikkāśvāsavikārāṇāṁ nidānaṁ yat prakīrtitam| varjyamārōgyakāmaistaddhikkāśvāsavikāribhiḥ||138|| hikkāśvāsānubandhā [1] yē śuṣkōraḥkaṇṭhatālukāḥ| prakr̥tyā rūkṣadēhāśca sarpirbhistānupācarēt||139|| daśamūlarasē sarpirdadhimaṇḍē ca sādhayēt| kr̥ṣṇāsauvarcalakṣāravayaḥsthāhiṅgucōrakaiḥ||140|| kāyasthayā ca tat pānāddhikkāśvāsau praṇāśayēt|141| adhobhAgairghRutaM siddhaM sadyo hikkAM niyacchati | pippalImadhuyuktau vA rasau dhAtrIkapitthayoH ||135|| lAjAlAkShAmadhudrAkShApippalyashvashakRudrasAn | lihyAt kolamadhudrAkShApippalInAgarANi vA ||136|| shItAmbusekaH sahasA trAso vismApanaM bhayam | krodhaharShapriyodvegA hikkApracyAvanA matAH ||137|| hikkAshvAsavikArANAM nidAnaM yat prakIrtitam | varjyamArogyakAmaistaddhikkAshvAsavikAribhiH ||138|| hikkAshvAsAnubandhA [1] ye shuShkoraHkaNThatAlukAH | prakRutyA rUkShadehAshca sarpirbhistAnupAcaret ||139|| dashamUlarase sarpirdadhimaNDe ca sAdhayet | kRuShNAsauvarcalakShAravayaHsthAhi~ggucorakaiH ||140|| kAyasthayA ca tat pAnAddhikkAshvAsau praNAshayet |141| The administration of ghee prepared by boiling adhobhagahara (purgatives) drugs instantly cures hikka. Administration of pippali (Piper longum Linn.) along with honey or juice of Dhatri (Emblica officinalis Gaertn.), and Kapittha (Limonia acidissima L.) alleviates hikka quickly. Laja (puffed rice), laksha (Ficus lacor Buch Ham.), madhu (honey), draksha (Vitis vinifera Linn.), pippali (Piper longum Linn.), juice of horse dung or kola (Zizipus jujube Lam.), draksha (Vitis vinifera Linn.), pippali (Piper longum Linn.), nagara (Zingiber officinale Roxb.) should be licked along with honey by patient suffering from hikka. Sudden sprinkling of water, intimidation, distraction from thoughts, fear, anger, happiness, love, anxiety alleviate hikka. The individual suffering from hikka and shwasa should refrain from aetiological factors if he wants to get relief. The patient of hikka and shwasa having associated with complications like dryness of chest, throat, and palate or having dryness of body by nature should be administered medicated ghee preparations. Dashamuladi ghrita: Medicated ghee prepared from boiling dashamula kashaya, dadhimanda (supernatant part of curd), krishna (Piper nigrum Linn.), and sauvarchala (Variety of salt), yava kshara (alkali made of barley), vayastha (Bacopa monnieri), hingu (Ferula narthex Boiss), choraka (Angelica glauca Edgew), kayastha (Ocimum sanctum) are used internally in hikka and shwasa.(135-140) Tejovatyadi ghee: तेजोवत्यभया कुष्ठं पिप्पली कटुरोहिणी ||१४१|| भूतीकं पौष्करं मूलं पलाशश्चित्रकः शटी | सौवर्चलं तामलकी सैन्धवं बिल्वपेशिका ||१४२|| तालीसपत्रं जीवन्ती वचा तैरक्षसम्मितैः | हिङ्गुपादैर्घृतप्रस्थं पचेत्तोये चतुर्गुणे ||१४३|| एतद्यथाबलं पीत्वा हिक्काश्वासौ जयेन्नरः | शोथानिलार्शोग्रहणीहृत्पार्श्वरुज [१] एव च ||१४४|| इति तेजोवत्यादिघृतम् | tējōvatyabhayā kuṣṭhaṁ pippalī kaṭurōhiṇī||141|| bhūtīkaṁ pauṣkaraṁ mūlaṁ palāśaścitrakaḥ śaṭī| sauvarcalaṁ tāmalakī saindhavaṁ bilvapēśikā||142|| tālīsapatraṁ jīvantī vacā tairakṣasammitaiḥ| hiṅgupādairghr̥taprasthaṁ pacēttōyē caturguṇē||143|| ētadyathābalaṁ pītvā hikkāśvāsau jayēnnaraḥ| śōthānilārśōgrahaṇīhr̥tpārśvaruja [1] ēva ca||144|| iti tējōvatyādighr̥tam|

tejovatyabhayA kuShThaM pippalI kaTurohiNI ||141|| bhUtIkaM pauShkaraM mUlaM palAshashcitrakaH shaTI | sauvarcalaM tAmalakI saindhavaM bilvapeshikA ||142|| tAlIsapatraM jIvantI vacA tairakShasammitaiH | hi~ggupAdairghRutaprasthaM pacettoye caturguNe ||143|| etadyathAbalaM pItvA hikkAshvAsau jayennaraH | shothAnilArshograhaNIhRutpArshvaruja [1] eva ca ||144|| iti tejovatyAdighRutam | Tejovatyadi ghrita: Tejovati (Zanthoxylun armatum DC.), abhaya (Terminalia chebula Retz.), kushtha (Saussurea lappa C.B. Clarke.), pippali (Piper longum Linn.), katukarohini (Picrorhiza kurroa Royle ex Benth), bhutika (Cymbopogon Citratus), paushkara mula (Inula recemosa Hook f.), palasha (Butea monosperma (Linn.) Kuntze.), chitraka (Plumbago zeylanica Linn.), shati (Hedychium spicatium Buch Ham.), sauvarchala (variety of salt), tamalaki (Phyllanthus urinaria Linn.), saindhava (rock salt), bilva (Aegle marmelos Corr.), talisa patra (Abies webbiana Lindle.), Jivanti (Leptadenia reticulate W & A.), each are taken in 1 karsha quantity and hingu (Ferula narthex Boiss.) in 1/4th quantity and ghee in 1 prastha quantity (4 parts) and ghee is prepared as per classics. This ghee should be taken as per ones strength to conquer hikka and shwasa. It is also effective in edema vataja arsha (haemorrhoids), grahani (digestive disorders), hritparshva ruja (pain in the cardiac region and flanks). (141-144) Manahshiladi ghee: मनःशिलासर्जरसलाक्षारजनिपद्मकैः | मञ्जिष्ठैलैश्च कर्षांशैः प्रस्थः सिद्धो घृताद्धितः ||१४५|| जीवनीयोपसिद्धं वा सक्षौद्रं लेहयेद्धृतम् | त्र्यूषणं दाधिकं वाऽपि पिबेद्वासाघृतं तथा ||१४६|| इति मनःशिलादिघृतम् | manaḥśilāsarjarasalākṣārajanipadmakaiḥ| mañjiṣṭhailaiśca karṣāṁśaiḥ prasthaḥ siddhō ghr̥tāddhitaḥ||145|| jīvanīyōpasiddhaṁ vā sakṣaudraṁ lēhayēddhr̥tam| tryūṣaṇaṁ dādhikaṁ vā'pi pibēdvāsāghr̥taṁ tathā||146|| iti manaḥśilādighr̥tam| manaHshilAsarjarasalAkShArajanipadmakaiH | ma~jjiShThailaishca karShAMshaiH prasthaH siddho ghRutAddhitaH ||145|| jIvanIyopasiddhaM vA sakShaudraM lehayeddhRutam | tryUShaNaM dAdhikaM vA~api pibedvAsAghRutaM tathA ||146|| iti manaHshilAdighRutam | Manashila (realgar), sarja rasa (exudate of Shorea robusta Gaertn.), laksha (Ficus lacor Buch Ham.), rajani (Curcuma longa Linn), padmaka (Nelumbo nucifera Gaertn.), manjishtha (Rubia cordifolia Linn.), alai (Haratala- yellow orpiment), are each taken in 1 karsha (12 gm) quantity and ghee in 1 prastha quantity and ghee is prepared in classical way. (145-146) Ghee prepared in jjvaniya gana drugs is licked with honey or trishna (maricha, pippali, shunthi) or dadhika ghrita or vasa ghrita shuld be consumed in hikka andshwasa. General guidelines for prevention and management: यत्किञ्चित् कफवातघ्नमुष्णं वातानुलोमनम् | भेषजं पानमत्रं वा तद्धितं श्वासहिक्किने ||१४७|| वातकृद्वा कफहरं कफकृद्वाऽनिलापहम् | कार्यं नैकान्तिकं ताभ्यां प्रायः श्रेयोऽनिलापहम् ||१४८|| सर्वेषां बृंहणे ह्यल्पः शक्यश्च प्रायशो भवेत् | नात्यर्थं शमनेऽपायो भृशोऽशक्यश्च कर्शने ||१४९|| तस्माच्छुद्धानशुद्धांश्च शमनैर्बृंहणैरपि | हिक्काश्वासार्दिताञ्जन्तून् प्रायशः समुपाचरेत् ||१५०|| yatkiñcit kaphavātaghnamuṣṇaṁ vātānulōmanam| bhēṣajaṁ pānamatraṁ vā taddhitaṁ śvāsahikkinē||147|| vātakr̥dvā kaphaharaṁ kaphakr̥dvā'nilāpaham| kāryaṁ naikāntikaṁ tābhyāṁ prāyaḥ śrēyō'nilāpaham||148|| sarvēṣāṁ br̥ṁhaṇē hyalpaḥ śakyaśca prāyaśō bhavēt| nātyarthaṁ [1] śamanē'pāyō bhr̥śō'śakyaśca karśanē||149|| tasmācchuddhānaśuddhāṁśca śamanairbr̥ṁhaṇairapi| hikkāśvāsārditāñjantūn prāyaśaḥ samupācarēt||150|| yatki~jcit kaphavAtaghnamuShNaM vAtAnulomanam | bheShajaM pAnamatraM vA taddhitaM shvAsahikkine ||147|| vAtakRudvA kaphaharaM kaphakRudvA~anilApaham | kAryaM naikAntikaM tAbhyAM prAyaH shreyo~anilApaham ||148|| sarveShAM bRuMhaNe hyalpaH shakyashca prAyasho bhavet | nAtyarthaM [1] shamane~apAyo bhRusho~ashakyashca karshane ||149|| tasmAcchuddhAnashuddhAMshca shamanairbRuMhaNairapi | hikkAshvAsArditA~jjantUn prAyashaH samupAcaret ||150|| The food, drinks and drugs having kapha-vatahara and ushna (hot) property which facilitate the normal movement of vata (vatanulomana) should be given in the patient of hikka and shwasa. Hikka shwasa treatment based on doshas: The medicines or food that aggravate vata and destroy kapha or aggravate kapha and alleviate vata must never be used in the treatment. However drugs that alleviate vata and aggravate kapha can be used in exceptional conditions. Brimhana (nourishment therapy) administered in hikka and shwasa and its complications make them curable. The shamana treatment (palliative therapy) prevents the complications. Karshana (depletion therapy) makes hikka and shwasa incurable. Hence shamana (palliative) and brimhana (nourishment) therapy should be done in hikka and shwasa with or without purification of the body. (147-150) Summary: तत्र श्लोकः- दुर्जयत्वे समुत्पत्तौ क्रियैकत्वे च कारणम् | लिङ्गं पथ्यं च हिक्कानां श्वासानां चेह दर्शितम् ||१५१|| tatra ślōkaḥ- durjayatvē samutpattau kriyaikatvē ca kāraṇam| liṅgaṁ pathyaṁ ca hikkānāṁ śvāsānāṁ cēha darśitam||151|| tatra shlokaH- durjayatve samutpattau kriyaikatve ca kAraNam | li~ggaM pathyaM ca hikkAnAM shvAsAnAM ceha darshitam ||151|| इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने हिक्काश्वासचिकित्सितं नाम सप्तदशोऽध्यायः ||१७|| ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē hikkāśvāsacikitsitaṁnāma saptadaśō'dhyāyaḥ||17|| ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsAsthAne hikkAshvAsacikitsitaM nAma saptadasho~adhyAyaH ||17|| In the chapter of hikka and shwasa the reason for explaining them together, their similarity in causes, treatment, the features and pathyas are explained. Thus in the treatise by agnivesha, redacted by Charaka and completed by Dridhabala, hikka shwasa Chikitsa named 17th chapter is concluded. Tattva Vimarsha • Hikka and shwasa originate at the site of pitta (upper part of stomach). The nature of disease is mainly kapha and vata dominant. The aggravation leads to depletion of dhatus like rasa situated in heart. • The environmental pathogens like dust, pollens, smoke particles, improper diet and lifestyle regimen, and various other obstructions in channels carrying prana can cause the diseases. • Hikka and shwasa can originate secondary to various conditions like ama, anaha (constipation associated with flatulence), excess dryness in the body, excessive depletion (apatarpana), weakness, injury to marmas (vital points), frequent exposure to heat and cold, diarrhoea, fever, vomiting, rhinitis, kshata (injury), kshaya (wasting), raktapitta (bleeding disorder), udavarta (upward movement of vata), visuchika (enteritis), alasaka (sluggish bowel), pandu (anaemia) and intake of poisons. In this case, the treatment will focus on primary disease along with management of hikka and shwasa also. • Pranavaha srotasa (channels carrying prana) are mainly involved in the pathogenesis of hikka and shwasa. • Vayu along with kapha blocks the channels carrying prana, udaka and anna and produces mahahikka. • The protocol for management of shwasa includes: 1. Liquefying kapha by snehana( massage) with oil mixed with rock salt 2. Channelizing and further liquefying it to get expelled out by swedana (sudation) 3. Intake of unctuous food for increasing quantity of kapha ( in order to make it convenient to get expelled out as seen in mucolyic drugs) and pacification of vata 4. Therapeutic emesis to expel out vitiated kapha dosha 5. Medicated smoking with durgs having hot potency to remove remaining kapha dosha • Anulomana (treating vata to move in normal direction) is the principle of management for obstructed vata in case of hikka and shwasa. • Shwasa associated with cough and hoarseness of voice should be treated with vamana (therapeutic emesis) • In Tamaka shwasa, virechana (therapeutic purgation) should be given with vata-kaphahara medicines. • It is always required to keep the path of vata, clean (respiratory tract) by frequent purification therapies and removing obstruction. • Purification therapies like vamana and virechana shall be administered after assessing bala(strength) of patient. • The food, drinks and drugs having kapha-vata alleviating properties, ushna (hot) potency and facilitating normal movement of vata (vatanulomana) should be given in the patient of hikka and shwasa. • Brimhana (nourishment therapy) administered in hikka and shwasa and its complications make them curable. The shamana treatment (palliative therapy) prevents the complications. Karshana (depletion therapy) makes hikka and shwasa incurable. Hence strong medicines and therapies leading to depletion of tissues should never be administered in hikka and shwasa patients.

Vidhi Vimarsha Hikka: Continuous stimulation of diaphragm causes bouts of hiccups. Due to which the air is expelled out with loud sound (mahasabdha) and due to continuous diaphragmatic movement the patient is unable to eat (margam chaivannapananam runaddhy). Severe and prolonged hiccup may lead to exhaustion, fatigue, malnutrition, weight loss, dehydration and even death in the extreme situations. The hyperventilation due to hiccups can lead to hypocapnia i.e. reduced level of CO2 in blood leading to cerebral vasoconstriction, leading to cerebral hypoxia and this can cause transient dizziness (upahatasmruteh), visual disturbances, and anxiety. Pranvahasrotas involves the respiratory centre in the brain (prano atra murdhaga) alongwith respiratory tract from nasal cavity till the alveoli. Role of hridaya is also significant. The cardio-pulmonary relationship can be easily understood in diseases like left ventricular failure with marked decrease in ejection fraction and pulmonary congestion leading to respiratory distress. Hridaya is mulasthan for rasavahasrotas. Rasa and rakta dhatu are part and parcel of udakvahasrotas. The content of udakvahasrotas is decided by the gastro intestinal tract. Thus one can understand why mahasrotas has been mentioned as mulasthan of pranvahasrotas. Matta rishabha eva nisha (like a bull): explains the nasal flares. Nasal flaring is when the nostrils widen while a person is breathing. It is a sign that the person is having difficulty breathing. It is most commonly seen in children and infants; in those cases nasal flaring can indicate respiratory distress. Respiratory distress occurs in connection with various physical ailments, such as acute respiratory distress syndrome, a serious reaction to various forms of injuries to the lung, and infant respiratory distress syndrome, a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Management: The management protocol for hikka and shwasa includes following: 1. Snehana (local massage on chest region)with hot sesame oil or mahanarayana oil mixed with rock salt 2. Swedana (sudation) with dashamula kwatha or erandamula kwatha vapours by means of bashpa (steam) or nadi (through tube) on chest 3. Vamana (therapeutic emesis) with mixture of pippali, rock salt and honey, decoction of yasthtimadhu and madanaphala are also used. 4. Virechana with eranda taila (castor oil),draksha kwatha and triphala kwatha 5. Shamana medicines: Following drugs are used in treatment of hikka and shwasa: 1. Pippali 2. Dhattura 3. Arka 4. Malla 5. Abhraka 6.Maricha Decoctions: Dashamula kwatha, Bharangyadi kwatha Powder formulations: Sitopaladi churna, talisadi churna, karpuradi churna Other formulations: Shvasakuthara rasa, Suvarna malini vasanta rasa, laghu malini vasanta. Asava-arishta: Kanakasava, dashamularishta, draksharishta, vasavaleha.