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AIAPGET Points

–        In HIKKA, the person feels as if YAKRIT, PLIHA and ANTRANI are coming out of their mouth.

–        The five kinds of HIKKA are – Annaja, Yamala, Kshudra, Gambhira and Mahati.

–        Kshudra Hikka arises from JATRUMULA.

–        Gambhira Hikka begins from NABHI.

–        GAMBHIRA & MAHATI Hikka are incurable. (Su.Ut.50/15)

–        HIKKA can be cured by VAMANA in patients who are not very emaciated.

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The 50th chapter of Uttaratantra of Sushruta Samhita is named as Hikkā Pratiședha. This chapter deals with Treatment of Hiccup.

अथातो हिक्काप्रतिषेधं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Hikkā pratiṣedha- treatment of hiccups: as revealed by the venerable Dhanvantari.

Nidāna – causes

विदाहिगुरुविष्टम्भिरूक्षाभिष्यन्दिभोजनैः |
शीतपानासनस्थानरजोधूमानिलानलैः ||३||
व्यायामकर्मभाराध्ववेगाघातापतर्पणैः |
आमादोषाभिघातस्त्रीक्षयदोषप्रपीडनैः ||४||
विषमाशनाध्यनशनैस्तथा समशनैरपि |
हिक्का श्वासश्च कासश्च नृणां समुपजायते ||५||

Below mentioned are the causes for hiccup, dyspnoea and cough in human beings –

–        consumption of foods which cause heartburn,

–        foods which are hard / difficult for digestion,

–        foods which tend to cause constipation, which are dry and create more moisture inside the body tissues,

–        excessive drinking of cold water,

–        sitting on cold surfaces and staying in cold places,

–        exposure to dust, smoke, breeze and fire,

–        excessive indulgence in physical exercises,

–        lifting heavy weights in excess,

–        walking for long duration,

–        suppression of naturally manifested body urges,

–        malnutrition,

–        ama dosha i.e. excessive accumulation of undigested food in the body,

–        injury,

–        excessive indulgence in copulation,

–        decrease / depletion of body tissues,

–        aggravation of doshas in the body,

–        indulgence in consumption of food in wrong ways including – visamasana (eating food at improper time), adhyasana (consuming excessive quantity of food often), anasana (not taking food at all or eating food in very less quantity) and samasana (eating mixture of healthy and unhealthy foods)

Nirukti – definition

मुहुर्मुहुर्वायरुदेति सस्वनो यकृत्प्लिहान्त्राणि मुखादिवाक्षिपन् |
स घोषवानाशु हिनस्त्यसून् यतस्ततस्तु हिक्केति भिषग्भिरुच्यते ||६||

Vayu – mainly udana and prana vata would abnormally move in upward direction accompanied with sound. While in upward movement, this aggravated vata causes shaking of liver, spleen and intestines and the person would feel as if these organs are coming out of the mouth with a loud sound. This condition would cause troubles to life. Due to these events happening, this disease is called hikka – hiccup by the physicians.

Vidha – kinds

अन्नजां यमलां क्षुद्रां गम्भीरां महतीं तथा |
वायुः कफेनानुगतः पञ्च हिक्काः करोति हि ||७||

Vata (aggravation) followed by kapha (getting aggravated) produces five kinds of Hikka by names –

–        Annaja Hikka,

–        Yamala Hikka,

–        Ksudra Hikka,

–        Gambhira Hikka and

–        Mahati Hikka

Pūrvarūpa – premonitory symptoms

मुखं कषायमरतिर्गौरवं कण्ठवक्षसोः |
पूर्वरूपाणि हिक्कानामाटोपो जठरस्य च ||८||

Below mentioned are the premonitory symptoms of hiccup –

–        experiencing astringent taste in the mouth,

–        restlessness,

–        feeling of heaviness in the throat and chest and

–        gurgling noise in the abdomen

Rūpa – clinical features

Annaja hikkā

त्वरमाणस्य चाहारं भुञ्जानस्याथवा घनम् |
वायुरन्नैरवस्तीर्णः कटुकैरर्दितो भृशम् ||९||
हिक्कयत्यूर्ध्वगो भूत्वा तां विद्यादन्नजां भिषक् |१०|
Causes –

–        gulping food in hurry,

–        eating solid / hard foods in excess and

–        eating pungent foods in excess

Due to the above said causes, vata would get blocked by food and produce hiccups. This hikka is known as Annaja Hikka i.e. hiccup produced by food, by physicians.

Yamala hikka

चिरेण यमलैर्वेगैर्या हिक्का सम्प्रवर्तते ||१०||
कम्पयन्ती शिरोग्रीवं यमलां तां विनिर्दिशेत् |११|

Yamala means two or twin or pair. Hiccup which comes in pairs after long periods of time is called Yamala Hikka. This hikka causes shaking of head and neck.

Kṣudra hikka

विकृष्टकालैर्या वेगैर्मन्दैः समभिवर्तते ||११||
क्षुद्रिका नाम सा हिक्का जत्रुमूलात् प्रधाविता |१२|

Below mentioned are the features of Ksudra Hikka –

–        hiccup appears at any time,

–        it has mild bouts and

–        arises from the base of the shoulders / neck

Gambhīrā hikkā

नाभिप्रवृत्ता या हिक्का घोरा गम्भीरनादिनी ||१२||
शुष्कौष्ठकण्ठजिह्वास्यश्वासपार्श्वरुजाकरी |
अनेकोपद्रवयुता गम्भीरा नाम सा स्मृता ||१३||

Below mentioned are the features / symptoms of Gambhira Hikka –

–        starts from umbilicus, deep inside,

–        accompanied with loud sounds,

–        causes dryness of lips, throat, tongue and mouth,

–        dyspnoea,

–        pain in flanks and

–        has many associated complications

Mahati hikka

मर्माण्यापीडयन्तीव सततं या प्रवर्तते |
देहमायम्य वेगेन घोषयत्यतितृष्यतः |
महाहिक्केति सा ज्ञेया सर्वगात्रप्रकम्पिनी ||१४||

Below mentioned are the features of Mahati Hikka –

–        it hurts the marmas – vital organs / fatal spots

–        bouts come up constantly,

–        bouts cause bending of the body,

–        hiccup is associated with loud sounds,

–        person has profound thirst and

–        shaking of whole body

आयम्यते हिक्काऽतोङ्गानि यस्य दृष्टिश्चोर्ध्वं ताम्यते यस्य गाढम् |
क्षीणोऽन्नद्विट् कासते यश्च हिक्की तौ द्वावन्त्यौ वर्जयेद्धिक्कमानौ ||१५||

The person suffering from Hikka should be refused (not to be treated) when hikka presents with the below mentioned features –

–        the person expands / stretches his body during the bouts of hiccup,

–        gaze of the person is fixed upward,

–        person becomes deeply unconscious and

–        is emaciated,

–        dislikes foods and

–        coughs frequently and

–        when he suffers from the last two kinds of hikka i.e. gambhira hikka and mahati hikka

Hikka cikitsā – treatment of hiccup

प्राणायामोद्वेजनत्रासनानि सूचीतोदैः सम्भ्रमश्चात्र शस्तः |१६|

Below mentioned are beneficial measures –

–        doing pranayama – controlling breathing patterns,

–        using harsh words and abusing the patient,

–        threatening the patient,

–        pricking the patient with needles and

–        causing agitation in the mind of the patient

यष्ट्याह्वं वा माक्षिकेणावपीडे पिप्पल्यो वा शर्कराचूर्णयुक्ताः ||१६||
सर्पिः कोष्णं क्षीरमिक्षो रसो वा नातिक्षीणे छर्दनं शान्तिहेतोः [१] |१७|

Avapida means nasal drops. In hiccups, the below mentioned recipes shall be used (instilled into the nose) as avapida –

–        yastimadhu mixed with honey or

–        pippali mixed with sugar powder, warm ghee, milk or sugarcane juice

In persons who are not very emaciated, hiccups can be cured by producing vomiting.

नारीपयःपिष्टमशुक्लचन्दनं घृतं सुखोष्णं च ससैन्धवं तथा ||१७||
चूर्णीकृतं सैन्धवमम्भसाऽथवा निहन्ति हिक्कां च हितं च नस्यतः |१८|

Below mentioned recipes put into the nose are also beneficial (in curing hikka) –

–        woman’s milk (breastmilk), paste of rakta candana, ghrta and saindhava lavana or

–        powder of saindhava lavana dissolved in water

युञ्ज्याद्धूमं शालनिर्यासजातं नैपालं वा गोविषाणोद्भवं वा ||१८||
सर्पिःस्निग्धैश्चर्मबालैः कृतं वा हिक्कास्थाने स्वेदनं चापि कार्यम् |१९|

Smoke of one of the below mentioned shall be inhaled by the patient –

–        sala niryasa – gum / resin of sala tree,

–        naipala – manassila or

–        horn, leather and hairs of cow mixed with ghee

At the site of origin of hiccup, fomentation should also be done.

क्षौद्रोपेतं गैरिकं काञ्चनाह्वं लिह्याद्भस्म ग्राम्यसत्त्वास्थिजं वा ||१९||
तद्वच्छ्वाविन्मेषगोशल्य(ल्ल)कानां रोमाण्यन्तर्धूमदग्धानि चात्र |
मध्वाज्याक्तं बर्हिपत्रप्रसूतमेवं भस्मौदुम्बरं तैल्वकं वा ||२०||
स्वर्जिक्षारं बीजपूराद्रसेन क्षौद्रोपेतं हन्ति लीढ्वाऽऽशु हिक्काम् |२१|

Below mentioned recipes should be mixed with honey and given to the patient for licking –

–        Svarna Gairika or

–        Ash of bones of domestic animals or

–        ash of hairs (thorns) of porcupine, ram, cow and hedgehog burnt in a closed pot

–        ash of feather of peacock licked with honey and ghee or

–        ash of udumbara licked with honey and ghee or

–        ash of tilvaka trees licked with honey and ghee or

–        sarji kshara mixed with juice of bijapura and honey

All these recipes would quickly cure hiccups.

सर्पिःस्निग्धा घ्नन्ति हिक्कां यवाग्वः कोष्णग्रासाः पायसो वा सुखोष्णः ||२१||

Yavagu – thick gruel or Payasa – milk pudding should be consumed comfortably warm, added with ghee. This would cure hiccups. 

शुण्ठीतोये साधितं क्षीरमाजं तद्वत् पीतं शर्करासंयुतं वा |
आतृप्तेर्वा सेव्यमानं निहन्याद् घ्रातं हिक्कामाशु मूत्रं त्वजाव्योः ||२२||
सपूतिकीटं लशुनोग्रगन्धाहिङ्ग्वब्जमाचूर्ण्य सुभावितं तत् |२३|

Below mentioned recipes would quickly cure hikka –

–        goat’s milk boiled with decoction of sunthi, added with sugar and consumed,

–        inhaling smell of urine of goat or sheep for some minutes, till satisfaction,

–        powder of putikita (an insect emitting bad smell), lasuna, ugragandha, hingu and abja (kamala) soaked for many times in the urine of goat or sheep and inhaled

क्षौद्रं सितां वारणकेशरं च पिबेद्रसेनेक्षुमधूकजेन ||२३||
पिबेत् पलं वा लवणोत्तमस्य द्वाभ्यां पलाभ्यां हविषः समग्रम् |२४|

Varanakesara (Nagakesara) should be mixed with honey, sugar and juice of sugarcane and madhuka. It should be licked by the patient.

Likewise, the patient should consume one pala (40gm) of saindhava lavana mixed with two pala (80gm) ghee.

हरीतकीं कोष्णजलानुपानां पिबेद्घृतं क्षारमधूपपन्नम् ||२४||
रसं कपित्थान्मधुपिप्पलीभ्यां शुक्तिप्रमाणं प्रपिबेत् सुखाय ||२५||

For obtaining comfort from hikka, the patient should consume the below mentioned recipes –

–        Haritaki added with Yava Ksara and honey, followed by drinking warm water,

–        juice of Kapittha mixed with honey and pippali should be consumed in a quantity of one sukti (20gm)

कृष्णां सितां चामलकं च लीढं सशृङ्गवेरं मधुनाऽथवाऽपि |
कोलास्थिमज्जाञ्जनलाजचूर्णं हिक्का निहन्यान्मधुनाऽवलीढम् ||२६||

Below mentioned recipes are also useful –

–        powder of krishna, sita (sugar), amalaka and srngavera should be licked with honey or

–        powder of kernel of kola seeds, anjana (sauvira anjana) and laja (fried paddy) should be licked with honey

पाटलायाः फलं पुष्पं गैरिकं कटुरोहिणी |
खर्जूरमध्यं मागध्यः काशीशं दधिनाम च ||२७||
चत्वार एते योगाः स्युः प्रतिपादप्रदर्शिताः |
मधुद्वितीयाः कर्तव्यास्ते हिक्कासु विजानता ||२८||

Powder of below mentioned four formulae stated in quarter verses, would cure hiccup, if they are licked, added and mixed with honey –

–        fruits and flowers of patala or

–        gairika and katurohini or

–        seeds of kharjura and magadha or

–        kasisa and dadhinama (kapittha)

कपोतपारावतलावश(ल्ल)कश्वदंष्ट्रगोधावृषदंशजान् रसान् |
पिबेत् फलाम्लानहिमान् ससैन्धवान् स्निग्धांस्तथैवर्ष्यमृगद्विजोद्भवान् ||२९||

Soup of meat of the below mentioned animals and birds should be consumed warm, added with juice of sour fruits and saindhava lavana –

–        kapota – pigeon,

–        paravata – dove,

–        lava bird,

–        sallaik – porcupine,

–        svadamstra – mouse deer,

–        godha – iguana lizard,

–        vrsadamsa – jungle cat,

–        rsyamrga – black deer,

–        two kinds of animals i.e. jangala and viskira

विरेचनं पथ्यतमं ससैन्धवं घृतं सुखोष्णं च सितोपलायुतम् |
सदागतावूर्ध्वगतेऽनुवासनं वदन्ति केचिच्च हिताय हिक्किनाम् ||३०||

Below mentioned interventions are useful in persons having hiccup –

–        virecana – purgation,

–        ghee added with saindhava lavana and sitopala and consumed comfortably warm,

–        anuvasana basti – oil / unctuous enema – is the best for vata which has started moving upwards in patients of hikka (according to opinion of some others)

इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे हिक्काप्रतिषेधो नाम (द्वादशो-ऽध्यायः, आदितः) पञ्चाशत्तमोऽध्यायः।।५०।।

Thus ends the fiftieth chapter by name Hikka pratişedha in Uttarasthana of Suśruta Samhita.