Meaning, symptoms, treatment, prognosis, modern understanding

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Shwasa is a pathological condition wherein different patterns of breathing disorders marked with breathing difficulty or shortness of breath are explained. Urdhwa Shwasa is one among the five types of shwasa roga.

Urdhwa Shwasa is a type of Shwasa Roga i.e. breathing disorder wherein there is difficulty in breathing / dyspnea.

Meaning of Urdhwa Shwasa

The word Urdhwa Shwasa is made up of 2 terms, Urdhwa and shwasa.

Urdhwa – means upwards. Here this term explains the pattern of breathing. In this condition the patient will be able to ‘breathe out (expiration)’ for prolonged duration i.e. put the air out in the upward direction for a prolonged time. On the other hand he will not be able to push the air downwards (inspiration – towards the lungs). In short – the expiration will be prolonged and effortful and inspiration will be short and difficult due to the block in the respiratory passages by kapha. Therefore the word ‘urdhwa’ is used to describe the disease.

Shwasa – means difficulty in breathing

So putting these two terms together we can understand ‘urdhwa shwasa’ as a condition marked by difficulty in breathing wherein there is prolonged yet comparably easy (apparent and effortful) or compensatory expiration (pushing air upwards) while inspiration is shortened and difficult (pushing air downwards).

Rather it should have been Adha Shwasa because of difficulty to pull air in so as to satisfy the demand of the body. But here the even following it i.e. expiration or pushing the air out is prolonged because the body (lungs) is trying to compensate for the low input and hence allowing the lungs to accept and adjust to whatever amount of air is sent in. Though expiration looks easy, it takes extra effort. Therefore it is called Urdhwa Shwasa. So, we can take urdhwa shwasa as an apparent or responsive prolonged expiration following a short inspiration.

The shwasa krichrata i.e. difficulty in breathing in terms of expiration is in response to non-satisfactory and shortened inspiration. The same blocks caused by kapha in the channels or pathways of respiration which is causing the inspiration difficult, is also making the expiration prolonged and effortful.

In a way it is a kaphavrita vata i.e. ‘vata being enveloped by kapha’ condition occurring in respiratory passages, air entrapment and obstructed flow.

Urdhwa Shwasa

ऊर्ध्वं श्वसिति यो दीर्घं न च प्रत्याहरत्यधः।
श्लेष्मावृतमुखस्रोताः क्रुद्धगन्धवहार्दितः॥
ऊर्ध्वदृष्टिर्विपश्यंस्तु विभ्रान्ताक्ष इतस्ततः।
प्रमुह्यन् वेदनार्तश्च शुक्लास्योऽरतिपीडितः॥
ऊर्ध्वश्वासे प्रकुपिते ह्यधःश्वासो निरुध्यते।
मुह्यतस्ताम्यतश्चोर्ध्वं श्वासस्तस्यैव हन्त्यसून्॥च.चि.२१॥

Characteristic features of Urdhwa Shwasa –

Urdhwa Shwasa is marked by difficulty in breathing the air in while breathing out is prolonged, responsive and effortful.

Reason – The aggravated kapha causes blockage in the openings and passages of the pranavaha srotas – respiratory passages / airways. This in turn causes aggravation of vata. Also due to the blockage of the airways the air doesn’t pass in easily. After a short and strenuous / painful inspiration the person immediately throws out the air for a prolonged duration. The vata being blocked by kapha in the airways is responsible for the causation of all the signs and symptoms of urdhwa shwasa (described below).

Causative Factors / Etiological Factors of Urdhwa Shwasa

–        Excessive consumption of kapha aggravating foods
–        Excessive exposure to kapha aggravating etiological factors

Pathogenesis and presentation of Urdhwa Shwasa – In this person the kapha gets severely aggravated. This aggravated kapha occupies the channels belonging to the pranavaha srotas – airways and causes blockage in them. This eventually reduces the space in the airways. As a result there occurs an imbalance in the mechanisms of inspiration and expiration. Breathing becomes difficult due to the blockages in the airways. This further leads to the manifestation of urdhwa shwasa and its symptoms. The expiration is prolonged and easier in comparison to the inspiration which is difficult.  

Consumption of kapha aggravating foods and getting exposed to kapha aggravating factors
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Severe aggravation of kapha
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Aggravated kapha blocks openings and passages of the pranavaha srotas – airways & further blocks / obstructs vata (and its movements)
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The vata obstructed by kapha gets aggravated
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The patient finds difficulty in breathing the air in while he can push the air upwards and out
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It appears as if the person has prolonged expiration due to imbalance in mechanisms of inspiration and expiration
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Other symptoms like eyeballs moving upwards, fainting etc occur
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This condition is called ‘Urdhwa Shwasa’

Symptoms of Urdhwa Shwasa

Urdhwa Shwasa is a type of shwasa in which there is an imbalance between the input and output of air i.e. inspiration and expiration. The kapha blocks the channels (respiratory passages). As a result the vayu gets aggravated and causes Urdhwa Shwasa.

Prognosis of Urdhwa Shwasa

Since Urdhwa Shwasa presents with severe and life-threatening symptoms and also tends to cause quick death of the patient, this abnormal breathing pattern has bad prognosis i.e. it cannot be cured.

Development of complicated stages of the disease – Upward gaze, irregular eye movements, visual hallucinations – indicate severe respiratory distress and a situation of helplessness. Fainting and pallor indicate more advancement of the condition and inadequate oxygenation. Imbalance between expiration and inspiration indicate the conscious efforts one is putting to breath and push oxygen to all corners of the body. Going into a state of unconsciousness and feeling blackouts may suggest a more severe condition or even a pre-coma. Quick death is the ultimate outcome when the respiration has been compromised and the body can no longer sustain itself. Successive stages develop if timely and continued care is not taken. Even if taken, it becomes difficult to manage. These explanations point towards Urdhwa Shwasa being a clinical emergency which needs intensive care and it may help if the patient is lucky enough or has residue of life and association with it and when destiny favors the combined approach of four limbs of treatment.

Treatment of Urdhwa Shvasa

A condition of Urdhwa Shvasa cannot be ignored in spite of it being considered as an incurable condition. The intention of the treatment of any patient is to manage the condition with the best possible medicines, lifestyle changes, therapies and dietetic protocols enabling the patient to breathe as long as the prana energy or life force is intact. The general lines of ‘shwasa chikitsa’ and ‘management of pranavaha sroto dushti’ as per classical explanation shall be followed in dealing with urdhwa shwasa. Since the prognosis will be bad, the patient’s attendants need to be intimated before-hand and treatment initiated after having the consent.

Probable Modern Correlation

Urdhwa Shwasa can be closely correlated with ‘stertorous breathing’ or ‘failing respiration’ explained in modern medicine.

This is not a disease but is a symptom of many respiratory disorders including congestion of the lungs, consolidation of the lungs, pneumonia, lung abscess, gangrene of lungs, infarcts of lungs and many types of coma and apoplexy.