Changes

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

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

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

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

</div>

</div>

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

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

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

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

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

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

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

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

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

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

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

</div>

</div>

</div></div>

</div></div>

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

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

=== Premonitory signs ===

=== Premonitory signs ===

</div></div>

</div></div>

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

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

=== Specific features of ''kasa'' ===

=== Specific features of ''kasa'' ===

</div></div>

</div></div>

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

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

==== Etiological factors, clinical features of ''Vataja kasa'' ====

==== Etiological factors, clinical features of [[Vata]]ja kasa ====

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

#Expectorate scanty phlegm with pain.

#Expectorate scanty phlegm with pain.

#The ''kasa'' gets alleviated by the food and drinks that are ''snigdha, amla, lavana'' and ''ushna''.

#The ''kasa'' gets alleviated by the food and drinks that are ''snigdha, amla, lavana'' and ''ushna''.

#The upward movements increases ''vata'' after digestion of food.[10-13]

#The upward movements increases [[vata]] after digestion of food.[10-13]

==== Etiological factors, clinical features of ''Pittaja kasa'' ====

==== Etiological factors, clinical features of [[Pitta]]ja kasa ====

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

   

   

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

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

Signs and symptoms of ''pittaja kasa'' are as follows:

Signs and symptoms of [[pitta]]ja kasa'' are as follows:

#Yellowish sputum and eyes

#Yellowish sputum and eyes

#Bitter taste in mouth

#Bitter taste in mouth

#Morbid thirst, burning, illusive, anorexia and giddiness

#Morbid thirst, burning, illusive, anorexia and giddiness

#Appearance of twinkling stars in front of the eyes while coughing continuously

#Appearance of twinkling stars in front of the eyes while coughing continuously

#Expectoration of sputum mixed with ''pitta''. [14-16]

#Expectoration of sputum mixed with [[pitta]]. [14-16]

==== Etiological factors, clinical features of ''Kaphaja kasa'' ====

==== Etiological factors, clinical features of [[Kapha]]ja kasa ====

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

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

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

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

The signs and symptoms of [[kapha]]ja type of ''kasa'' are as follows:

#Lowered digestion process, anorexia, vomitng, nasal discharge, nausea and heaviness

#Lowered digestion process, anorexia, vomitng, nasal discharge, nausea and heaviness

#Horripilation, stickiness and sweetness of the mouth

#Horripilation, stickiness and sweetness of the mouth

</div></div>

</div></div>

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

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

Signs and symptoms of ''kshayaja kasa'' are as follows:

Signs and symptoms of ''kshayaja kasa'' are as follows: