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|title=Hikka Shwasa Chikitsa
|title=Hikka Shwasa Chikitsa
|titlemode=append
|titlemode=append
|keywords=Shwasa, hikka, dyspnea, hiccups, tamaka shwasa, bronchial asthma, respiratory disorders, vamana, therapeutic emesis, virechana, therapeutic purgation, swedana, sudation
|keywords=Shwasa, hikka, dyspnea, hiccups, tamaka shwasa, bronchial asthma, respiratory disorders, vamana, therapeutic emesis, virechana, therapeutic purgation, swedana, sudation,Ayurveda, Indian system of medicine, charak samhita.
|description=Chikitsa Sthana Chapter 17. Management of Hikka (Hiccups) and Shwasa (Dyspnea)
|description=Chikitsa Sthana Chapter 17. Management of Hikka (Hiccups) and Shwasa (Dyspnea)
|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg
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<big>'''[[Chikitsa Sthana]] Chapter 17. Management of Hikka (Hiccups) and Shwasa (Dyspnea)</big>'''
<big>'''[[Chikitsa Sthana]] Chapter 17. Management of Hikka (Hiccups) and Shwasa (Dyspnea)</big>'''
{{Infobox
{{Infobox
|title = Hikka Shwasa Chikitsa
|title = Hikka Shwasa Chikitsa
|label5 = Other Sections
|label5 = Other Sections
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]
|label6 = Translator and commentator
|data6 = Rao M.
|label7 = Reviewer
|data7 = Ojha S.N., Mali P.
|label8 = Editors
|data8 = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]
|label9 = Year of publication
|data9 = 2020
|label10 = Publisher
|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]
|label11 = DOI
|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.018 10.47468/CSNE.2020.e01.s06.018]
}}
<big>''' Abstract </big>'''
<p style="text-align:justify;">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 principles 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. </p>
'''Keywords''': ''Shwasa, hikka,'' dyspnea, hiccups, ''tamaka shwasa,'' bronchial asthma, respiratory disorders, [[vamana]], therapeutic emesis, [[virechana]], therapeutic purgation, ''swedana'', sudation.
== Introduction ==
== Introduction ==
<div style="text-align:justify;">
<div style="text-align:justify;">
''Hikka'' (hiccups) and ''shwasa'' (dyspnea/shortness of breath) may be caused due to [[pandu]] roga with pathological signs of anemia (alpa rakta), abnormal fat metabolism(alpa medaska) and depletion of body constituents ([[dhatu]]-kshaya). [Chakrapani Cha.Sa.Chi. 17/1]. That is why this chapter follows the chapter on [[Pandu Chikitsa]]. The term 'Shwasa' denotes physiological process of respiration and pathological sign too. In physiological process, breathing without any distress is seen; however pathological signs can be diagnosed if person suffers any distress during breathing and has to take extra efforts for same.''Hikka'' and ''shwasa'' have common etiological factors (''karana'') like raja (pollen or dust particles), ''dhuma'' (smoke) etc., location (''sthana'') and treatment or ''mula''. For that reason, both conditions are described in the same chapter.
''Hikka'' (hiccups) and ''shwasa'' (dyspnea/shortness of breath) may be caused due to [[pandu]] roga with pathological signs of anemia (alpa rakta), abnormal fat metabolism(alpa medaska) and depletion of body constituents ([[dhatu]]-kshaya). [Chakrapani Cha.Sa. [[Chikitsa Sthana ]] 17/1]. That is why this chapter follows the chapter on [[Pandu Chikitsa]]. The term 'Shwasa' denotes physiological process of respiration and pathological sign too. In physiological process, breathing without any distress is seen; however pathological signs can be diagnosed if person suffers any distress during breathing and has to take extra efforts for same.''Hikka'' and ''shwasa'' have common etiological factors (''karana'') like raja (pollen or dust particles), ''dhuma'' (smoke) etc., 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 which can be presented at terminal stages of life and as complication of other diseases [Cha.Sa.Chi.17/6]. These 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 etiological factors related to food, regimen and mental faculties lead to the aggravation of ''vata'' in the ''pranavaha srotas'' and derangement of ''kapha'' situated in the chest region producing lethal blockage of ''prana vayu''.
''Hikka'' and ''shwasa'' are two diseases of serious nature which can be presented at terminal stages of life and as complication of other diseases [Cha.Sa. [[Chikitsa Sthana]] 17/6]. These 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 etiological factors related to food, regimen and mental faculties lead to the aggravation of [[vata]] in the ''pranavaha srotas'' and derangement of [[kapha]] situated in the chest region producing lethal blockage of ''prana vayu''.
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 dyspnea) ''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 patients they are ''yapya'' (work as palliatives).
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 dyspnea) ''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 patients they are ''yapya'' (work as palliatives).
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''. All diseases of respiratory system and channels transporting vital breath (pranvaha srotas) are treated based on the principles of management of shwasa laid down in this chapter. [Cha. Sa.Vimana Sthana 5/26]
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''. All diseases of respiratory system and channels transporting vital breath (pranvaha srotas) are treated based on the principles of management of shwasa laid down in this chapter. [Cha. Sa.[[Vimana Sthana]] 5/26]
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</div>
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Agnivesha , an intelligent disciple, asked his doubt with modest salute of folded hands to Lord Atreya, who has the knowledge about the subject and principles of the 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]
Agnivesha , an intelligent disciple, asked his doubt with modest salute of folded hands to Lord Atreya, who has the knowledge about the subject and principles of the 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'' ===
=== Atreya’s reply and nature of disease of ''shwasa'' and ''hikka'' ===
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]
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'' ===
=== Predominance of [[dosha]] and affliction of [[dhatu]] ===
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<div class="mw-collapsible mw-collapsed">
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''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]
''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 [[dhatu]] like [[rasa dhatu]] 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]
=== Etiological factors ===
=== Etiological factors ===
*Regimen: Lack of exercise, excessive sexual intercourse, excess walking,
*Regimen: Lack of exercise, excessive sexual intercourse, excess walking,
*Diet: Intake of dry food, ''vishamashana'' (food in excessive or less quantity at irregular time)
*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, diarrhea, fever, vomiting, rhinitis, ''kshata'' (injury), ''kshaya'' (wasting), ''raktapitta'' (bleeding disorder), ''udavarta'' (upward movement of ''vata''), ''visuchika'' (enteritis), ''alasaka'' (sluggish bowel), ''pandu'' (anemia) and intake of poisons can result in ''hikka'' and ''shwasa''.
*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, diarrhea, fever, vomiting, rhinitis, ''kshata'' (injury), ''kshaya'' (wasting), ''raktapitta'' (bleeding disorder), ''udavarta'' (upward movement of [[vata]]), ''visuchika'' (enteritis), ''alasaka'' (sluggish bowel), ''pandu'' (anemia) 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''
*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
*Injury: Injury to throat and chest
*Others: Various types of ''vibandha'' (obstructions) [10-16]
*Others: Various types of ''vibandha'' (obstructions) [10-16]
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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 ''pranavayu'' and five types of dreadful ''hikka'' and ''shwasa''. [17-18]
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 ''pranavayu'' and five types of dreadful ''hikka'' and ''shwasa''. [17-18]
=== Premonitory symptoms ===
=== Premonitory symptoms ===
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*''Vishesha samprapti'': ''Vata'' along with ''kapha'' blocks the channels carrying ''prana, udaka'' and ''anna'' and produces ''hikka''.
*''Vishesha samprapti'': [[Vata]] along with [[kapha]] blocks the channels carrying ''prana, udaka'' and ''anna'' and produces ''hikka''.
A List of the signs and symptoms of many types is elaborated further:
A 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'').
*''Mahahikka'': [[Vata]] along with [[kapha]] affects the throat of an individual whose [[mamsa dhatu]] (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 impairment 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]
*[[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 impairment 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'' ===
=== ''Gambhira hikka'' ===
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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]
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'' ===
=== ''Vyapeta hikka'' ===
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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]
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'' ===
=== Prognosis of ''hikka'' ===
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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 ''hikka'' destroys a person suffering from excessive accumulation of [[dosha]], 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]
The ''yamika hikka'' is curable in an individual who is not emaciated, not weak mentally, the [[dhatu]] and [[indriya]] are unaffected and performing their normal function. Otherwise in case if body is weak, it is incurable. [42-44]
=== Specific pathogenesis of ''Shwasa'' ===
=== Specific pathogenesis of ''Shwasa'' ===
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The aggravated ''vayu'' along with vitiated ''kapha'' obstructs the channels (of ''prana, udaka'' and ''annavaha'') and spreads throughout the body and produces ''shwasa''. [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'' ===
=== ''Mahashwasa'' ===
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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 visualize properly. The eyes and face become abnormal and the elimination of urine and feces 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]
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 visualize properly. The eyes and face become abnormal and the elimination of urine and feces 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'' ===
=== ''Urdhva Shwasa'' ===
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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]
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'' ===
=== ''Chhinna Shwasa'' ===
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The patient suffering from ''chhinna shwasa'' has interrupted breath as the prana(vital centers referred in [[Sutra Sthana]] Chapter 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, discoloration of skin, delirium, looseness of joints. An individual suffering from above said features of ''chhinna shwasa'' succumbs to death very quickly. [52-54]
The patient suffering from ''chhinna shwasa'' has interrupted breath as the prana(vital centers) [Cha. Sa. [[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, discoloration 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'' ===
=== ''Tamaka Shwasa'' ===
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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 behavior. The ''tamaka shwasa'' having above mentioned features is ''yapya'' (palliable) and in the initial stages it is curable disease. [55-62]
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 behavior. 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'' ===
=== Types of ''Tamaka Shwasa'' ===
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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]
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'' ===
=== ''Kshudra shwasa'' ===
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Due to intake of dry food and exertion, ''vata'' is mildly vitiated in ''koshtha'' and moves in the upward direction i.e respiratory 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]
Due to intake of dry food and exertion, [[vata]] is mildly vitiated in ''koshtha'' and moves in the upward direction i.e respiratory 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'' ===
=== Necessity of quick management of ''hikka'' and ''shwasa'' ===
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.
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''.
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 ([[vata]]nulomana). As the ice on the top of the mountain gets liquefied by the rays of the sun, the [[kapha]] accumulated in the srotas 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]
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'' ===
=== Treatment of remaining [[dosha]] ===
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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 [[dosha]] remaining after the administration of [[vamana]] treatment should be expelled by means of ''dhuma'' (medicated smoking). The ''haridra'' (turmeric), roots of ''eranda'' (Ricinus communis Linn), ''laksha'' (Ficus Lacor Buch-Ham), ''manahshila'' (realgar, 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 barley should be mixed with ghee and used for smoking.
==== Contra-indication for ''swedana'' in ''shwasa'' ====
==== 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).
The patient of ''shwasa'' and ''hikka'' suffering from burning sensation, bleeding, and excessive sweating, depleted [[dhatu]], loss of strength, dryness, and associated with condition of pregnancy or having [[pitta]] [[Prakriti]] should not be administered [[swedana]](sudation).
==== ''Mridu swedana'' (mild sudation) ====
==== ''Mridu swedana'' (mild sudation) ====
==== ''Utkarika''(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''.
''Utkarika'' is prepared with powders of sesame, black gram and wheat are mixed with [[vata]]hara sneha'' and gruel and [[swedana]] is done or warm gruel and milk are used for [[swedana]] in the form of ''parisheka''.
==== ''Vamana'' ====
==== ''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.
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]
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 [[vata]]hara drugs which are not cold, nor hot in property. [82-87]
=== Two types of patients as per ''dosha'' dominance ===
=== Two types of patients as per [[dosha]] dominance ===
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कफाधिकस्तथैवैको रूक्षो बह्वनिलोऽपरः ||८८||
कफाधिकस्तथैवैको रूक्षो बह्वनिलोऽपरः ||८८||
कफाधिके बलस्थे च वमनं सविरेचनम् |
कुर्यात् पथ्याशिने धूमलेहादिशमनं ततः ||८९||
कुर्यात् पथ्याशिने धूमलेहादिशमनं ततः ||८९||
kaphādhikastathaivaikō rūkṣō bahvanilō'paraḥ||88||
kaphādhikastathaivaikō rūkṣō bahvanilō'paraḥ||88||
kaphādhikē balasthē ca vamanaṁ savirēcanam|
kuryāt pathyāśinē dhūmalēhādiśamanaṁ tataḥ||89||
kuryāt pathyāśinē dhūmalēhādiśamanaṁ tataḥ||89||
kaphAdhikastathaivaiko rUkSho bahvanilo~aparaH ||88||
kaphAdhikastathaivaiko rUkSho bahvanilo~aparaH ||88||
kaphAdhike balasthe ca vamanaM savirecanam |
kuryAt pathyAshine dhUmalehAdishamanaM tataH ||89||
kuryAt pathyAshine dhUmalehAdishamanaM tataH ||89||
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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.
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 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]
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 ===
=== Contra-indication for Purification therapy in ''hikka'' and ''shwasa'' patients ===
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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.
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.
''Brimhana'' 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 ''brimhana'' (nourishment therapy). [91-93]
''Brimhana'' 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 [[brimhana]] (nourishment therapy). [91-93]
=== Various formulations ===
=== Various formulations ===
''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.
''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.
''Mudga yusha'': Rock salt, ''yavakshara'', seeds of drum stick and ''maricha'' (pepper) powder 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''.
''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''.
''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''.
''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), ''vamshalochana, shunthi'' (Zingiber officinale Roxb.), ''pippali'' (Piper longum Linn.) by cooking in ghee and used in ''shwasa'' associated with ''pitta''.
''Utkarika'': ''Utkarika'' should be prepared from ''madhulika'' (finger millet), ''vamshalochana, shunthi'' (Zingiber officinale Roxb.), ''pippali'' (Piper longum Linn.) by cooking in ghee and used in ''shwasa'' associated with [[pitta]].
The meat of ''shashvita'' or rabbit or blood of shallaka should be cooked with ''pippali ghrita'' should be used in ''shwasa'' associated with ''vata''.
The meat of ''shashvita'' 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 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.).
In ''shwasa'' associated with [[kapha]] [[pitta]] 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.), ''pippalimoola'' (root of Piper longum Linn.), jaggery, juice of dungs of cow or horse, ghee, honey subsides ''kasa'' (cough), ''shwasa'' (dyspnea), ''hikka'' (hiccups) and ''abhishyanda'' (conjunctivitis).
''Madhukadi yoga'': ''Madhuka'' (Glycyrrhiza glabra Linn.), ''pippalimoola'' (root of Piper longum Linn.), jaggery, juice of dungs of cow or horse, ghee, honey subsides ''kasa'' (cough), ''shwasa'' (dyspnea), ''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.
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 ''shashvita'', 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'' (dyspnea).
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 ''shashvita'', 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'' (dyspnea).
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]
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'' ===
=== Guidelines for management of ''tamaka shwasa'' ===
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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.
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]]-[[kapha]]hara 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]
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'' ===
=== ''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.
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 formulations'' ====
==== [[Nasya]] formulations ====
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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''.
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]].
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.
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’ feces 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. [130-134]
The supernatant part of ghee mixed with ''saindhava lavana'' or juice of ''alaktaka'' along with bees’ feces 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. [130-134]
==== Ghee formulations and other therapies ====
==== Ghee formulations and other therapies ====
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''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 one ''karsha'' quantity and ''hingu'' (Ferula narthex Boiss.) in 1/4th quantity and ghee in one ''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'' (hemorrhoids), ''grahani'' (digestive disorders), ''hritparshva rija'' (pain in the cardiac region and flanks).[141-144]
''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 one ''karsha'' quantity and ''hingu'' (Ferula narthex Boiss.) in 1/4th quantity and ghee in one ''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 [[vata]]ja arsha (hemorrhoids), ''grahani'' (digestive disorders), ''hritparshva rija'' (pain in the cardiac region and flanks).[141-144]
=== ''Manahshiladi'' ghee ===
=== ''Manahshiladi'' ghee ===
</div></div>
</div></div>
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''.
The food, drinks and drugs having [[kapha]]-[[vata]]hara and ''ushna'' (hot) property which facilitate the normal movement of [[vata]] ([[vata]]nulomana) 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.
''Hikka shwasa'' treatment based on [[dosha]]: 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.
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]
Hence ''shamana'' (palliative) and ''brimhana'' (nourishment) therapy should be done in ''hikka'' and ''shwasa'' with or without purification of the body. [147-150]
== Tattva Vimarsha (Fundamental Principles) ==
== Tattva Vimarsha (Fundamental Principles) ==
*''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.
*''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 [[dhatu]] like ''rasa'' situated in heart.
*The environmental pathogens like dust, pollen, smoke particles, improper diet and lifestyle regimen, and various other obstructions in channels carrying ''prana'' can cause the diseases.
*The environmental pathogens like dust, pollen, 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, diarrhea, fever, vomiting, rhinitis, ''kshata'' (injury), ''kshaya'' (wasting), ''raktapitta'' (bleeding disorder), ''udavarta'' (upward movement of ''vata''), ''visuchika'' (enteritis), ''alasaka'' (sluggish bowel), ''pandu'' (anemia) and intake of poisons. In this case, the treatment will focus on primary disease along with management of ''hikka'' and ''shwasa'' also.
*''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, diarrhea, fever, vomiting, rhinitis, ''kshata'' (injury), ''kshaya'' (wasting), ''raktapitta'' (bleeding disorder), ''udavarta'' (upward movement of [[vata]]), ''visuchika'' (enteritis), ''alasaka'' (sluggish bowel), ''pandu'' (anemia) 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''.
*''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''.
*''Vayu'' along with [[kapha]] blocks the channels carrying ''prana, udaka'' and ''anna'' and produces ''mahahikka''.
*The protocol for management of ''shwasa'' includes:
*The protocol for management of ''shwasa'' includes:
**Liquefying ''kapha'' by ''snehana''( massage) with oil mixed with rock salt
**Liquefying [[kapha]] by [[snehana]]( massage) with oil mixed with rock salt
**Channelizing and further liquefying it to get expelled out by ''swedana'' (sudation)
**Channelizing and further liquefying it to get expelled out by [[swedana]] (sudation)
**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''.
**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]].
**Therapeutic emesis to expel out vitiated ''kapha dosha''
**Therapeutic emesis to expel out vitiated [[kapha]] [[dosha]]
**Medicated smoking with drugs having hot potency to remove remaining ''kapha dosha''
**Medicated smoking with drugs 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''.
*''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)
*''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.
*In ''tamaka shwasa, [[virechana]] (therapeutic purgation) should be given with [[vata]]-[[kapha]]hara medicines.
*It is always required to keep the path of ''vata'', clean (respiratory tract) by frequent purification therapies and removing obstruction.
*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.
*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''.
*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.
*''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.
=== Origin of diseases ===
=== Origin of diseases ===
The origin of hikka shwas diseases occurs at the site of Pitta dosha (Pitta sthana) which is lower part of stomach and duodenum from undigested food substances. [Chakrapani Cha.Sa. [[Chikitsa Sthana]] 17/8] The upper part of stomach is referred to as the site for kapha dosha,.[Chakrapani Cha.Sa. [[Sutra Sthana]] 20/8]. Therefore the lower end of stomach and duodenum is considered as the site of origin of shwasa and hikka. Derangement of digestion and metabolism is an important basic pathological event leading to vitiation of kapha and its manifestation (vyakti sthana) in chest.
The origin of hikka shwas diseases occurs at the site of [[Pitta]] [[dosha]] ([[Pitta]] sthana) which is lower part of stomach and duodenum from undigested food substances. [Chakrapani Cha.Sa. [[Chikitsa Sthana]] 17/8] The upper part of stomach is referred to as the site for kapha dosha,.[Chakrapani Cha.Sa. [[Sutra Sthana]] 20/8]. Therefore the lower end of stomach and duodenum is considered as the site of origin of shwasa and hikka. Derangement of digestion and metabolism is an important basic pathological event leading to vitiation of kapha and its manifestation (vyakti sthana) in chest.
=== Pathogenesis ===
=== Pathogenesis ===
Derangement of digestion and metabolism (agnimandya) causes malformation and nourishment of all body tissues ([[dhatu]]). This further leads to vitiation of kapha and pitta dosha resulting in increase in vata dosha. [Chakrapani Cha.Sa. [[Sutra Sthana]] 6/34]
Derangement of digestion and metabolism (agnimandya) causes malformation and nourishment of all body tissues ([[dhatu]]). This further leads to vitiation of [[kapha]] and [[pitta]] [[dosha]] resulting in increase in [[vata]] [[dosha]]. [Chakrapani Cha.Sa. [[Sutra Sthana]] 6/34]
===Causes of shwasa ===
===Causes of shwasa ===
The etiological factors of shwasa can be classified as:
The etiological factors of shwasa can be classified as:
#Vata vitiating causes: food with dry properties (ruksha aahara), cold water and drinks (sheeta ambu sevan), exercise (vyayama), excess walking (adhva sevana)
#Vata vitiating causes: food with dry properties (ruksha aahara), cold water and drinks (sheeta ambu sevan), exercise (vyayama), excess walking (adhva sevana)
#Kapha vitiating causes: Meats of marshy and aquatic animals (jalaja-anup mamsa), curd (dadhi), Nishpav, black gram (masha), sesame paste (pinyak), heacy to digest food (guru-bhojana), milk (ksheera).
#Kapha vitiating causes: Meats of marshy and aquatic animals (jalaja-anup mamsa), curd (dadhi), [https://en.wikipedia.org/wiki/Lablab Lablab purpurens L.](nishpav), black gram (masha), sesame paste (pinyak), heavy to digest food (guru-bhojana), milk (ksheera).
#Metabolic toxins provoking factors (aam pradoshaja hetu): irregular diet (vishamashana), curd (dadhi), food causing obstruction in channels (abhishyandi), improperly boiled milk (aam ksheera), heavy to digest food (guru bhojana)
#Metabolic toxins provoking factors (aam pradoshaja hetu): irregular diet (vishamashana), curd (dadhi), food causing obstruction in channels (abhishyandi), improperly boiled milk (aam ksheera), heavy to digest food (guru bhojana)
'''Factors causing defective body systems (Khavaigunyakar):'''
Pollen (raja), fumes (dhuma), excess walking (adhvasevana), wrestling (dvandva), chest injury (kshatakshaya), injury to vital organs (marma ghata).
'''Co-morbid conditions (nidanarthakara roga):'''
Rhinitis (pratishyaya), cough(kasa) and disorders due to reverse functions of vata (udavarta).
'''Diseases causing defects in site of origin (mula sthana dushtikar vyadhi):'''
Diarrhoea (atisara), fever (jwara), vomitting (Chchardi), cholera (visuchika),and sluggish bowel (alasaka)
'''Disease provoking factors (preraka hetu):'''
Cloudy atmosphere(meghambu), cold exposure and consumption (sheet sevana),direct exposure to air(prak-vata ), exposure to pollen and pollutants (raja), fumes(dhuma) and physical exertion (vyayama).
'''Complication of kasa:'''
Shwasa results due to chronicity/complication of [[kasa]]. [A.H.NI.4/1]
=== 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 runaddhi). Severe and prolonged hiccups 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.
Pranvaha srotas includes the respiratory center in the brain (prano atra murdhaga) along with 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 site of origin (mula sthana) for rasavaha srotas. Rasa and [[rakta dhatu]] are part and parcel of udakvaha srotas. The content of udakvahasrotas is decided by the gastrointestinal tract. Thus one can understand why mahasrotas has been mentioned as mulasthana of pranvahasrotas.
==== Matta rishabha eva nisha (like a bull)====
Nasal flaring (Matta rishabha eva nisha) occurs when a person is having severe difficulty in breathing or respiratory distress. It is most commonly seen in children and infants; Respiratory distress is observed in 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 ===
=== Management ===
The management protocol for ''hikka'' and ''shwasa'' includes following:
The management protocol for hikka and shwasa includes following:
#''Snehana'' (local massage on chest region including ventral, both lateral and dorsal side of chest)with hot sesame oil or ''mahanarayana'' oil mixed with rock salt
#[[Snehana]](unction or oleation): Chest massage on the front, back and sides) with hot sesame oil or mahanarayana oil mixed with rock salt
#''Swedana'' (sudation) with ''dashamula kwatha'' or ''erandamula kwatha'' vapors by means of ''bashpa'' (steam) or ''nadi'' (through tube) on chest
#[[Swedana]] (sudation): Fomentation with dashamula kwatha or erandamula kwatha vapors by means of steam (bashpa) or through a tube (nadi).
#''Vamana'' (therapeutic emesis) with mixture of ''pippali'', rock salt and honey, decoction of ''yasthtimadhu'' and ''madanaphala'' are also used.
#[[Vamana]] (therapeutic emesis) with mixture of piper (pippali), rock salt and honey, decoction of yasthtimadhu and madanaphala are also used.
#''Virechana'' with ''eranda taila'' (castor oil),''draksha kwatha'' and ''triphala kwatha''
#[[Virechana]](therapeutic purgation) with eranda taila (castor oil),draksha kwatha and triphala kwatha
#''Shamana'' medicines: Following drugs are used in treatment of ''hikka'' and ''shwasa'':
#Shamana medicines: Following drugs are used in treatment of hikka and shwasa:
##''Pippali''
##Pippali
##''Dhattura''
##Dhattura
##''Arka''
##Arka
##''Malla''
##Malla
##''Abhraka''
##Abhraka
##''Maricha''
##Maricha
##Vasa
##Vasa
##Yashtimadhu
##Yashtimadhu
#Decoctions: ''Dashamula kwatha, Bharangyadi kwatha'', Yastimadhu decoction, Dashamula katutrayadi kashayam
#Decoctions: Dashamula kwatha, Bharangyadi kwatha, Yastimadhu decoction, Dashamula katutrayadi kashayam
#Powder formulations: ''Sitopaladi churna, talisadi churna, karpuradi churna'',Chausashta prahar pippali, Tankana
#Powder formulations: Sitopaladi churna, talisadi churna, karpuradi churna,Chausashta prahar pippali, Tankana
#Other formulations: ''Shvasakuthara rasa, Suvarna malini vasanta rasa, laghu malini vasanta'',Lakshmivilas rasa, Kumarkalyan rasa (in children).
#Other formulations: Shvasakuthara rasa, Suvarna malini vasanta rasa, laghu malini vasanta,Lakshmivilas rasa, Kumarkalyan rasa (in children).
#''Asava-arishta'': ''Kanakasava, dashamularishta, draksharishta, vasavaleha.''
#Asava-arishta: Kanakasava, dashamularishta, draksharishta, vasavaleha.
===Current researches===
===Current researches===
===Experience based views===
===Experience based views===
In chronic cases of Shwasa internal administration of unctuous substance (snehapana) in pure form or medicates formulation like dashamula ghrita is useful to control vata dosha. This reduces dryness (kharatva) of respiratory tract (pranavah srotas) and pacifies movement of vata (vatanulomana). In chronic stage of svasa, vata becomes more dominant while in new cases Kapha dominancy is observed.<ref> Personal email communication by Dr. Mali Pawan, dt. January 03, 2020 </ref>
In chronic cases of Shwasa, internal administration of unctuous substance (abhyantara [[snehana]]) in pure form or medicates formulation like dashamula ghrita is useful to control [[vata]] [[dosha]]. This reduces dryness (kharatva) of respiratory tract (pranavah srotas) and pacifies movement of [[vata]] (vatanulomana). In chronic stage of svasa, [[vata]] becomes more dominant while in new cases [[Kapha]] dominancy is observed.<ref> Personal email communication by Dr. Mali Pawan, dt. January 03, 2020 </ref>
Drugs prescribed for [[Pandu]], [[Shotha]] and [[Kasa]] may be used in the management of Shwasa(Su.Utt 51/43). Drugs prescribed for [[Kasa]], Kshaya, chhardi and hikka can be used for Shwasa.(A.H.ch.59)
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== References ==
== References ==