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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.  

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.  

'''Keywords''': ''Shwasa, hikka,'' dyspnea, hiccups, ''tamaka shwasa,'' bronchial asthma, respiratory disorders, ''vamana'', therapeutic emesis, ''virechana'', therapeutic purgation, ''swedana'', sudation. </div>

'''Keywords''': ''Shwasa, hikka,'' dyspnea, hiccups, ''tamaka shwasa,'' bronchial asthma, respiratory disorders, [[vamana]], therapeutic emesis, [[virechana]], therapeutic purgation, ''swedana'', sudation. </div>

''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'' (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. [[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''.  

''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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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'' ===

*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'' ===