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AIAPGET Points

–    Prana Vayu and Kapha are the main doshas involved in causation of SHWASA.

–    The five types of Shwasa are – Kshudra, Tamaka, Chinna, Mahan and Urdhwa.

–    Shwasa, Kasa, Hikka and Hrdroga can be cured using PURANA GHRTA processed with Abhaya, Bida Lavana and Ramatha (Hingu). Su.Ut.51/16

–    TALISADI Ghrta, VASA Ghrta (described in Raktapitta) and SATPALA Ghrta (described in Vata Vyadhi) are beneficial to cure all kinds of Shwasa. Su.Ut.51/27-29

–    Formulations used for treating PANDU ROGA & SHOTHA should be used in the treatment of Shwasa and Kasa. Medicines prescribed for KASA are also used for treating Shwasa. (Su.Ut.51/43)

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The 51st chapter of Uttaratantra of Sushruta Samhita is named as Śvāsa Pratiședha. This chapter deals with Treatment of Dyspnoea.

अथातः श्वासप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Śvasa Pratiṣedha- treatment of Dyspnoea; as revealed by the venerable Dhañvañtari.

Nidāna- samprāpti-causes and pathogenesis

यैरेव कारणैर्हिक्का बहुभिः सम्प्रवर्तते |
तैरेव कारणैः श्वासो घोरो भवति देहिनाम् ||३||
विहाय प्रकृतिं वायुः प्राणोऽथ कफसंयुतः |
श्वासयत्यूर्ध्वगो भूत्वा तं श्वासं परिचक्षते ||४||

Svāsa which means difficulty in breathing or dyspnoea is a dreadful disease. It is produced by the same causes by which hikka – hiccup is produced (causes for hikka and svasa are the same).

Aggravated Pranavata combines with Kapha, leaves off its normalcy and begins to move in the upward direction. While doing so, it gives rise to increased bouts of respiration / breathing (exacerbated breathing patterns). This condition is called Svasa.

Bheda- kinds

क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चधा |
भिद्यते स महाव्याधिः श्वास एको विशेषतः ||५||

This Svasa is said to be a Maha Vyadhi i.e. a dreadful disease which is difficult to tolerate and cure. Though Svasa is only one, it is of five kinds. Below mentioned are the five kinds of Svasa –

–        Ksudra Svasa,

–        Tamaka Svasa,

–        Chinna Svasa,

–        Mahan Svasa and

–        Urdhva Svasa

Pūrvarupa- premonitory symptoms

प्राग्रूपं तस्य हृत्पीडा भक्तद्वेषोऽरतिः परा |
आनाहः पार्श्वयोः शूलं वैरस्यं वदनस्य च ||६||

Below mentioned are the premonitory symptoms of Svasa –

–        pain in the region of the heard,

–        aversion towards food,

–        restlessness,

–        flatulence,

–        pain in the flanks and

–        bad taste in the mouth

Rūpa- clinical features

Kşudraśvāsa – dyspnoea on effort

किञ्चिदारभमाणस्य यस्य श्वासः प्रवर्तते |
निषण्णस्यैति शान्तिं च स क्षुद्र इति सञ्ज्ञितः ||७||

Ksudra Svasa is a kind of Svasa characterized by the below mentioned features –

–        it arises when the person commences any physical work and

–        subsides when he sits or rests (without doing any work or task)

TamakaSvāsa – bronchial asthma

तृट्स्वेदवमथुप्रायः कण्ठघुर्घुरिकान्वितः |
विशेषाद्दुर्दिने ताम्येच्छ्वासः स तमको मतः ||८||
घोषेण महताऽऽविष्टः सकासः सकफो नरः |
यः श्वसित्यबलोऽन्नद्विट् सुप्तस्तमकपीडितः ||९||
स शाम्यति कफे हीने स्वपतश्च विवर्धते |
मूर्च्छाज्वराभिभूतस्य ज्ञेयः प्रतमकस्तु सः ||१०||

Svasa – dyspnoea generally associated with the below mentioned features is known as Tamaka Svasa –

–        thirst,

–        perspiration,

–        vomiting,

–        rumbling noise in the throat,

–        dyspnoea appears especially on cloudy days and in darkness

Breathing is accompanied with –

–        loud sound,

–        cough,

–        expectoration of sputum / phlegm and

–        debility,

–        aversion of food and

–        dyspnoea increasing when the patient lies down

Pratamaka Svasa is type of svasa which presents with below mentioned features –

–        it subsides when kapha decreases and

–        increases greatly when lying down and

–        is accompanied with fainting (loss of consciousness) and fever

Chinnaśvāsa – interrupted breathing; chyne-stokes respiration

आध्मातो दह्यमानेन बस्तिना सरुजं नरः |
सर्वप्राणेन विच्छिन्नं श्वस्याच्छिन्नं तमादिशेत् ||११||

Chinna Svasa is characterized by the below mentioned characteristic features –

–        person has flatulence and

–        burning sensation in the urinary bladder and has

–        painful and interrupted breathing

Mahatśvāsa

निःसञ्ज्ञः पार्श्वशूलार्तः शुष्ककण्ठोऽतिघोषवान् |
संरब्धनेत्रस्त्वायम्य यः श्वस्यात् स महान् स्मृतः ||१२||

Below mentioned are the features / symptoms of Maha Svasa –

–        unconsciousness,

–        pain in flanks,

–        dryness of throat,

–        breathes with loud sounds,

–        swollen eyes and

–        bending / stretching of body during breathing

Urdhvaśvāsa

मर्मस्वायम्यमानेषु श्वसन्मूढो मुहुश्च यः |
ऊर्ध्वप्रेक्षी हतरवस्तमूर्ध्वश्वासमादिशेत् ||१३||

Urdhva Svasa is marked by the presence of below mentioned symptoms –

–        stretching pain in vital organs (heart, head, urinary bladder),

–        person often faints after respiration,

–        has upward gaze and

–        loss of voice

क्षुद्रः साध्यतमस्तेषां तमकः कृच्छ्र उच्यते |
त्रयः श्वासा न सिध्यन्ति तमको दुर्बलस्य च ||१४||

Ksudra Svasa is easily curable. Tamaka Svasa is difficult to cure. The other three kinds of Svasa i.e. Maha Svasa, Urdhva Svasa and Chinna Svasa are incurable. Tamaka Svasa is also incurable in weak persons.

Svāsacikitsā – treatment of dyspnoea

स्नेहबस्तिं विना केचिदूर्ध्वं चाधश्च शोधनम् |
मृदु प्राणवतां श्रेष्ठं श्वासिनामादिशन्ति हि ||१५||

According to some authoritative opinions – purificatory therapies administered in both upward and downward routes, except anuvasana basti (unctuous enema) should be administered mildly, to strong patients suffering from svasa.

श्वासे कासे च हिक्कायां हृद्रोगे चापि पूजितम् |
घृतं पुराणं संसिद्धमभयाविडरामठैः ||१६||
सौवर्चलाभयाबिल्वैः संस्कृतं वाऽनवं घृतम् |
पिप्पल्यादिप्रतीवापं सिद्धं वा प्रथमे गणे ||१७||
सपञ्चलवणं सर्पिः श्वासकासौ व्यपोहति |१८|

Purana Ghrta – ghee which is old by some years – should be boiled and processed with Abhaya, Bida Lavana and Ramatha (Hingu) is very valuable in treatment of dyspnoea, cough and heart diseases.

Below mentioned recipes also cure dyspnoea –

–        old ghee cooked and processed with Sauvarcala, Abhaya and Bilva

–        ghee cooked and processed with decoction of first gana i.e. vidarigandhadi gana group of herbs, added with paste of herbs belonging to pippalyadi gana group and panca lavanas (five kinds of salts)

हिंस्राविडङ्गपूतीकत्रिफलाव्योषचित्रकैः ||१८||
द्विक्षीरं साधितं सर्पिश्चतुर्गुणजलाप्लुतम् |
कोलमात्रैः पिबेत्तद्धि श्वासकासौ व्यपोहति ||१९||
अर्शांस्यरोचकं गुल्मं शकृद्भेदं क्षयं तथा |

Ghee should be cooked with decoction and paste of below mentioned ingredients –

–        himsra,

–        vidanga,

–        putika,

–        triphala,

–        vyosa and

–        citraka and

–        two parts of milk

This ghee should be consumed in a dose of one kola (5 gm) quantity.

Benefits – Consumption of this ghee cures dyspnoea and cough. It also cures piles, anorexia, abdominal tumour, diarrhoea and consumption.

कृत्स्ने वृषकषाये वा पचेत् सर्पिश्चतुर्गुणे ||२०||
तन्मूलकुसुमावापं शीतं क्षौद्रेण योजयेत् |२१|

Ghee should be cooked with four parts of decoction of Vrsa (Vasa), added with paste of its roots and flowers. After the ghee gets cooled, honey is added to it and mixed. This ghee may also be consumed.

शृङ्गीमधूलिकाभार्गीशुण्ठीतार्क्ष्यसिताम्बुदैः ||२१||
सहरिद्रैः सयष्ट्याह्वैः समैरावाप्य योगतः |
घृतप्रस्थं पचेद्धीमान् शीततोये चतुर्गुणे ||२२||
श्वासं कासं तथा हिक्कां सर्पिरेतन्नियच्छति |२३|

Equal parts of the below mentioned ingredients should be boiled and processed in four parts of water and reduced to a quarter so as to prepare its decoction –

–        Srngi,

–        Madhulika,

–        Bharngi,

–        Sunthi,

–        Tarksya,

–        Sita,

–        Ambuda,

–        Haridra and

–        Yasti

One prastha (640 gm) of ghee should be added to this decoction. Paste of the above mentioned herbs should also be added to it. All these are cooked together according to the procedure so as to prepare their medicated ghee. This ghee cures dyspnoea, cough and hiccup.

सुवहा कालिका भार्गी शुकाख्या नैचुलं फलम् ||२३||
काकादनी शृङ्गवेरं वर्षाभूर्बृहतीद्वयम् |
कोलमात्रैर्घृतप्रस्थं पचेदेभिर्जलद्विकम् ||२४||
कटूष्णं पीतमेतद्धि श्वासामयविनाशनम् |
सौवर्चलयवक्षारकटुकाव्योषचित्रकैः ||२५||
वचाभयाविडङ्गैश्च साधितं श्वासशान्तये |
गोपवल्ल्युदके सिद्धं स्यादन्यद्द्विगुणे घृतम् ||२६||
पञ्चैतानि हवींष्याहुर्भिषजः श्वासकासयोः |२७|

Below mentioned ingredients should be boiled with two parts of water and reduced to one-fourth so as to prepare its decoction –

–        Suvaha,

–        Kalika,

–        Bharngi,

–        Sukakhya,

–        Fruit of Nicula,

–        Kakadani,

–        Srngavera,

–        Varsabhu,

–        Two kinds of Brhati

One prastha (640 gm) of ghee is cooked with this decoction so as to prepare medicated ghee. This ghee should be consumed in the dose of one kola (5gm) along with pungent and hot herbs. This ghee cures dyspnoea.

Decoction is prepared from the below mentioned ingredients –

–        sauvarchala,

–        yava ksara,

–        katuka,

–        vyosa,

–        citraka,

–        vaca,

–        abhaya and

–        vidanga

Ghee is cooked and prepared with this decoction. This ghee, when used, is beneficial for mitigating svasa. Ghee prepared with two parts of decoction of Gopavalli is also used for the same purpose.

The above five medicated ghee have been advocated for dyspnoea and cough by physicians.

तालीशतामलक्युग्राजीवन्तीकुष्ठसैन्धवैः ||२७||
बिल्वपुष्करभूतीकसौवर्चलकणाग्निभिः |
पथ्यातेजोवतीयुक्तैः सर्पिर्जलचतुर्गुणम् ||२८||
हिङ्गुपादयुतं सिद्धं सर्वश्वासहरं परम् |
वासाघृतं षट्पलं वा घृतं चात्र हितं भवेत् ||२९||

Below mentioned ingredients are boiled in four parts of water and its decoction is prepared –

–        Talisa,

–        Tamalaki,

–        Ugra,

–        Jivanti,

–        Kustha,

–        Saindhava,

–        Bilva,

–        Puskaramula,

–        Bhutika,

–        Sauvarchala,

–        Kana,

–        Agni (Chitraka),

–        Pathya and

–        Tejovati

Ghee – 640 grams is cooked with this decoction adding Hingu, one fourth quantity of ghee and medicated ghee should be prepared. This ghee cures all kinds of svasa – dyspnoea.

Below mentioned ghee also are beneficial –

–        Vasa Ghrta – mentioned in raktapitta chapter (treatment) and

–        Satpala Ghrta – mentioned in vata vyadhi (treatment)

तैलं दशगुणे सिद्धं भृङ्गराजरसे शुभे |
सेव्यमानं यथान्यायं श्वासकासौ व्यपोहति ||३०||

Oil should be boiled and processed with ten parts of the juice of Bhringaraja. This oil should be consumed in a suitable manner. It cures svasa – dyspnoea and kasa – cough.

फलाम्ला विष्किररसाः स्निग्धाः प्रव्यक्तसैन्धवाः |
एणादीनां शिरोभिर्वा कौलत्था वा सुसंस्कृताः ||३१||
हन्युः श्वासं च कासं च संस्कृतानि पयांसि च |३२|

Below mentioned foods would cure dyspnoea and cough –

–        soup of meat of viskira birds – added with fats, juice of sour fruits and more quantity of saindhava lavana or

–        soup of deer’s head processed with spices, salt etc. and mixed with milk

–        soup of kulattha processed with spices, salt etc. and mixed with milk

These foods, when consumed, cures dyspnoea and cough.

तिमिरस्य [१] च बीजानि कर्कटाख्या च चूर्णिता ||३२||
दुरालभाऽथ पिप्पल्यः कटुकाख्या हरीतकी |
श्वाविन्मयूररोमाणि कोला मागधिकाकणाः ||३३||
भार्गीत्वक् शृङ्गवेरं च शर्करा शल्लकाङ्गजम् |
नृत्तकौण्डकबीजानि चूर्णितानि तु केवलम् ||३४||
पञ्च श्लोकार्धिकास्त्वेते लेहा ये सम्यगीरिताः |
सर्पिर्मधुभ्यां ते लेह्याः कासश्वासार्दितैर्नरैः ||३५||

Below ingredients mentioned in five half verses should be made into fine powder –

1. seeds of timira (markata trna / madayanti) and karkatasrngi or
2. duralabha, pippali, katuka and haritaki or
3. hairs of porcupine and peacock or kola and magadhika or
4. bark of bharngi, srngavera, sarkara and hairs of sallaka (hedgehog) or bark of sallaki tree or
5. seeds of nrtyakundaka (kapikacchu) alone

This powder should be licked mixed with ghee and honey and consumed by the person suffering from cough and dyspnoea.

सप्तच्छदस्य पुष्पाणि पिप्पलीश्चापि मस्तुना |
पिबेत् सञ्चूर्ण्य मधुना धानाश्चाप्यथ भक्षयेत् ||३६||

Flowers of saptachada and pippalis should be powdered. This powder should be consumed along with whey. Alternatively, dhana – fried pulses may be consumed mixed with honey.

अर्काङ्कुरैर्भावितानां यवानां साध्वनेकशः |
तर्पणं वा पिबेदेषां सक्षौद्रं श्वासपीडितः ||३७||

Yava – barley soaked in juice of sprouts or arka many times should be consumed by patients suffering from dyspnoea. Alternatively, he may drink tarpana – groats prepared from flour of corn added with honey.

शिरीषकदलीकुन्दपुष्पं मागधिकायुतम् |
तण्डुलाम्बुयुतं पीत्वा जयेच्छ्वासानशेषतः ||३८||

Powder of flowers of the below mentioned should be consumed along with rice-wash –

–        sirisa,

–        kadali,

–        kunda puspa and

–        magadhika

It cures dyspnoea without any residue.

कोलमज्जां तालमूलमृष्यचर्ममसीमपि |
लिह्यात् क्षौद्रेण भार्गीं वा सर्पिर्मधुसमायुताम् ||३९||
नीचैःकदम्बबीजं वा सक्षौद्रं तण्डुलाम्बुना |४०|

Powder of Kola fruit, Talamula (Musali) and ash of leather of Rsya (black deer) should be licked with honey.

The powder of Bharngi should be licked with ghee and honey.

Powder of seeds of Nicakadamba (laghu kadamba) added with honey should be consumed with rice-wash.

हरिद्रां मरिचं द्राक्षां गुडं रास्नां कणां शटीम् ||४१||
लिह्यात्तैलेन तुल्यानि श्वासार्तो हितभोजनः |४२|
Powder of the below mentioned ingredients should be prepared –

–        Draksa,

–        Haritaki,

–        Krishna,

–        Karkatasrngi and

–        Duralabha

This powder shall be licked with ghee and honey. It cures severe cases of dyspnoea.

हरिद्रां मरिचं द्राक्षां गुडं रास्नां कणां शटीम् ||४१||
लिह्यात्तैलेन तुल्यानि श्वासार्तो हितभोजनः |४२|

Powder of the below mentioned should be prepared –

–        Haridra,

–        Marica,

–        Draksa,

–        Guda,

–        Rasna,

–        Kana and

–        Sati

This should be mixed with equal quantities of sesame oil and licked. When this is consumed while taking only suitable foods, it cures dyspnoea.

गवां पुरीषस्वरसं मधुसर्पिःकणायुतम् ||४२||
लिह्याच्छ्वासेषु कासेषु वाजिनां वा शकृद्रसम् |४३|

Juice of fresh dung of either cow or horse should be added and mixed with honey, ghee and powder of kana. When licked, this recipe cures dyspnoea and cough.

 

No shlokas and explanation from 43-48, I am writing explanation, shlokas to be added

 

The formulations which have been mentioned (explained) in the context of panduroga and sotha (to treat these conditions) will also be helpful in destroying (alleviating) svasa and kasa diseases. Medicines meant for treating kasa are also used for treating svasa. (43)

 

Bark of Bharngi, trysana (pippali, marica and sunti), tila taila, haridra, katuki, pippali, marica and canda – powder of these should be mixed in goshakrd rasa (juice of cow dung) and be given (to the patient suffering from svasa). (44)

 

Utkarika (a sort of sweetmeat) should be prepared with seeds of Talakota (Ankola) if consumed for a few days continuously to cure even dreadful svasa in quick time. (46)

 

Old ghee, pippali, kulattha, meat soup of animals and birds of arid regions / desert like regions, sura, sauviraka, hingu, juice of matulunga, madhu (honey), draksa, amalaka and bilva are said to be beneficial for patients suffering from dyspnoea and hiccup. (46-47)

 

The patients suffering from svasa (dyspnoea) and hikka (hiccup) should initially be given with oleation followed by sudation. Or sudation should be given after giving a massage (anointing the body of the patient) with lavanataila. By these procedures the solidified (consolidated) kapha gets liquefied and vata gets pacified. (48)

 

 

एतेसर्वेससर्पिष्काधूमाःकार्याविजानता।। SHLOKA????

 

The physician should determine that sudation has been done to satisfactory levels. He should be given food along with meat soup.

After this, smoke inhalation should be administered. Alternatively, smoking (medicated) may be done by the patient when there is obstruction of vata and kapha. For this, varti (smoking wick or cigar) prepared with the below mentioned ingredients in the usual way shall be used –

–        Manassila,

–        Devadaru,

–        Haridra,

–        Chandana (patra),

–        Amisa (guggulu),

–        Laksa and

–        Root of Urubuka

Similarly, wick prepared with below mentioned ingredients may also be used for smoking –

–        ghee,

–        yava – barley,

–        madhuccista – bee wax and

–        sala niryasa – gum of sala tree

 

Smoke of the below mentioned ingredients too shall be inhaled –

–        horn, hairs, hoof, ligaments and skin / leather of cow or ox or

–        turuska, sallaki, guggulu and padmaka

All the materials used for smoking as described above shall be mixed with ghee before inhalation.

बलीयसि कफग्रस्ते वमनं सविरेचनम् ||५३||
दुर्बले चैव रूक्षे च तर्पणं हितमुच्यते |
जाङ्गलोरभ्रजैर्मांसैरानूपैर्वा सुसंस्कृतैः ||५४||

Emesis and purgation should be administered when the patient of dyspnoea is strong.

Tarpana – nutritions foods should be administered for persons who are weak and dry, along with soup of meat of animals living in arid lands. Tarpana shall also be given with soup of meat of sheep or of animals living in marshy lands, properly processed with spices and salt.

निदिग्धिकां चामलकप्रमाणां हिङ्ग्वर्धयुक्तां मधुना सुयुक्ताम् |
लिहन्नरः श्वासनिपीडितो हि श्वासं जयत्येव बलात्र्यहेण ||५५||

Paste of Nidigdhika, of the size of Amalaka should be made with water. Hingu should be added in half of its quantity, mixed well with honey and consumed. This cures dyspnoea quickly within three days.

यथाऽग्निरिद्धः पवनानुविद्धो [१] वज्रं यथा वा सुरराजमुक्तम् |
रोगास्तथैते खलु दुर्निवाराः श्वासश्च कासश्च विलम्बिका च ||५६|| 

It is very difficult to overcome the fire combined with breeze or vajra – thunderbolt released by Suraraja i.e. Lord Indra. Similarly, diseases such as dyspnoea, cough and vilambika – a complication of indigestion are difficult to cure.

इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे हिक्काश्वासप्रतिषेधोनाम (त्रयोदशोऽध्यायः, आदितः) एकपञ्चाशत्तमोऽध्यायः।।५१।।

Thus ends the fifty-first chapter by name Svasa Pratiședha in Uttara Sthana of Suśruta Samhita.