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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.

AIAPGET Points

–    When KASA gets greatly increased, it will produce YAKSHMA. Su.Ut.52/6

–    Kshavathu Vega Dharana is one of the most important Nidanas of Kasa.

–    Swarabheda is a symptom of Vataja Kasa.

–    Recipes and ghee preparations mentioned in treatment of Pittaja Kasa can also be used in treatment of Kshataja Kasa.

–    Acharya Sushruta has described AGASTYA AVALEHA or AGASTYA HARITAKI RASAYANA in the context of KASA PRATISEDHA.

–    Shatavari Ghrta and Nagabala Ghrta are indicated in the treatment of Kasa.

For More AIAPGET Points from this chapter and also for content and preparation, please join our SARATHI Program.

 

The 52nd chapter of Uttaratantra of Sushruta Samhita is named as Kāsa Pratiședha. This chapter deals with Treatment of Cough.

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

We will now expound käsa pratiṣedha – treatment of cough; as revealed

by the venerable Dhañvañtari.

Nidāna- samprapti- causes and pathogenesis

उक्ता ये हेतवो नॄणां रोगयोः श्वासहिक्कयोः |
कासस्यापि च विज्ञेयास्त एवोत्पत्तिहेतवः ||३||
धूमोपघाताद्रजसस्तथैव व्यायामरूक्षान्ननिषेवणाच्च |
विमार्गगत्वादपि भोजनस्य वेगावरोधात् क्षवथोस्तथैव ||४||
प्राणो ह्युदानानुगतः प्रदुष्टः सम्भिन्नकांस्यस्वनतुल्यघोषः |
निरेति वक्त्रात् सहसा सदोषः कासः स विद्वद्भिरुदाहृतस्तु ||५||

The same causative factors enumerated as causal for svasa – dyspnoea and hikka – hiccough are the same causative factors for kasa – cough also i.e. causative factors for dyspnoea, hiccough and cough are the same.

Below mentioned are the specific causes of Kasa –

–        excessive exposure to smoke and dust,

–        indulgence in excessive physical exercise,

–        excessive consumption of dry foods,

–        particles of food moving in wrong paths i.e. into the respiratory tract (trachea) and

–        suppression of urge for sneezing

Pathogenesis – Prana vata and Udana vata get aggravated due to the above said causes. These doshas come out of the mouth accompanied with loud sounds. The sound with which the doshas come out of the mouth resembles the sound of a broken bronze piece (bronze bell). Along with Prana and Udana Vata, the other doshas (pitta and kapha) are also expelled. Scholars describe this condition as Kasa (cough).

Kasa Vidha – types of cough

स वातपित्तप्रभवः कफाच्च क्षतात्तथाऽन्यः क्षयजोऽपरश्च |
पञ्चप्रकारः कथितो भिषग्भिर्विवर्धितो यक्ष्मविकारकृत् स्यात् ||६||

Kasa is said to be of five kinds –

–        one by each dosha – vataja, pittaja and kaphaja,

–        one due to injury to the chest / lungs – ksataja and

–        one due to loss / decrease of tissues – ksayaja kasa

When Kasa gets greatly increased (and managed at the right time), it would produce the disease Yaksma.

Pūrva rūpa – premonitory symptoms

भविष्यतस्तस्य तु कण्ठकण्डूर्भोज्योपरोधो गलतालुलेपः |
स्वशब्दवैषम्यमरोचकोऽग्निसादश्च लिङ्गानि भवन्त्यमूनि ||७||

Below mentioned are the premonitory symptoms of Kasa –

–        irritation of the throat,

–        hindrance to swallowing,

–        coating of throat and palate,

–        slight disorder of voice,

–        loss of taste,

–        weakness of digestive fire

Rūpa- clinical features

Vātaja kāsa

हृच्छङ्खमूर्धोदरपार्श्वशूली क्षामाननः क्षीणबलस्वरौजाः |
प्रसक्तमन्तःकफमीरणेन कासेत्तु शुष्कं स्वरभेदयुक्तः ||८||

Below mentioned are the symptoms of vataja kasa – cough produced by vata –

–        pain in the region of heart, temples, head, abdomen and flanks,

–        emaciation of the face,

–        decrease of strength, voice and valour,

–        cough and its bouts depend on the quantity of kapha accumulation inside the chest (lungs),

–        cough is dry in nature – there is no production of mucus / phlegm and

–        accompanied with broken voice

Pittaja kāsa

उरोविदाहज्वरवक्त्रशोषैरभ्यर्दितस्तिक्तमुखस्तृषार्तः |
पित्तेन पीतानि वमेत् कटूनि कासेत् स पाण्डुः परिदह्यमानः ||९||

Below mentioned are the symptoms of pittaja kasa – cough produced by pitta –

–        burning sensation in the chest,

–        fever,

–        dryness of the mouth,

–        bitter taste in the mouth,

–        thirst,

–        colour of vomited material – yellow,

–        taste of vomited material – pungent and

–        cough is accompanied with burning sensation in the throat

Kaphaja kāsa

प्र(वि)लिप्यमानेन मुखेन सीदन् शिरोरुजार्तः कफपूर्णदेहः |
अभक्तरुग्गौरवसादयुक्तः कासेत [१] ना सान्द्रकफं कफेन ||१०||

Below mentioned are the symptoms of kaphaja kasa – cough produced by kapha –

–        mouth is coated with kapha (mucus, sputum, phlegm),

–        kapha falls out of the mouth often (frequent expectoration or spitting of phlegm),

–        body is filled with kapha,

–        aversion to food,

–        feeling of heaviness of the body,

–        debility,

–        cough followed by expectoration of thick kapha (sputum, phlegm),

Kşataja kāsa

वक्षोऽतिमात्रं विहतं तु यस्य व्यायामभाराध्ययनाभिघातैः |
विश्लिष्टवक्षाः स नरः सरक्तं ष्ठीवत्यभीक्ष्णं क्षतजं [१] तमाहुः ||११||

Chest injury (injury to the lungs inside the chest) occurs due to the below mentioned causes –

–        excessive physical exercises / activities,

–        lifting heavy weights,

–        walking for long periods of time,

–        studying in loud pitch / reading loudly and

–        other kinds of assault

In this condition, the person coughs constantly. Sputum is expelled mixed with blood. This is called Ksataja Kasa – cough caused due to injury (to the chest or lung).

Kşayaja kasa

स गात्रशूलज्वरदाहमोहान् प्राणक्षयं चोपलभेत कासी |
शुष्यन् विनिष्ठीवति दुर्बलस्तु प्रक्षीणमांसो रुधिरं सपूयम् ||१२||
ससर्वलिङ्गं भृशदुश्चिकित्स्यं चिकित्सितज्ञाः क्षयजं वदन्ति |
वृद्धत्वमासाद्य भवेत्तु यो वै याप्यं तमाहुर्भिषजस्तु कासम् ||१३||

Below mentioned are the symptoms of Ksayaja Kasa – cough caused due to depletion of tissues –

–        cough is associated with pain in the body,

–        fever,

–        burning sensation,

–        delusion,

–        decrease of respiration,

–        emaciation,

–        debility,

–        great decrease of muscles,

–        cough and

–        expectoration of sputum mixed with blood and pus

Cough presenting with the above said symptoms is called Ksayaja Kasa by expert physicians. It becomes very difficult to treat this condition when it has all the above symptoms.

Cough is described by the physicians as manageable or incurable when it has greatly advanced.

General treatment of coughs: Käsa samañya cikitsa

शृङ्गीवचाकट्फलकत्तृणाब्दधान्याभयाभार्ग्यमराह्वविश्वम् |
उष्णाम्बुना हिङ्गुयुतं तु पीत्वा बद्धास्यमप्याशु जहाति कासम् ||१४||

Powder of the below mentioned ingredients should be prepared –

–        Srngi,

–        Vaca,

–        Katphala,

–        Kattrna,

–        Abda – Musta,

–        Dhanya,

–        Abhaya and

–        Bharngi

This powder is added with Hingu and consumed with warm water.

These quickly cure the cough which has been blocked in the mouth i.e. longstanding cough (alt – cures cough quickly though the cough is the one which causes blocking the mouth).

फलत्रिकव्योषविडङ्गशृङ्गीरास्नावचापद्मकदेवकाष्ठैः |
लेहः समैः क्षौद्रसिताघृताक्तः कासं निहन्यादचिरादुदीर्णम् ||१५||

Equal parts of the below mentioned herbs are taken and their powder is prepared –

–        Phalatrika,

–        Vyosa,

–        Vidanga,

–        Srngi,

–        Rasna,

–        Vaca,

–        Padmaka and

–        Devakastha

This powder is mixed with honey, sugar and ghee taken in a quantity equal to the powder. When consumed, it cures even chronic kinds of cough.

पथ्यां सितामामलकानि लाजां समागधीं चापि विचूर्ण्य शुण्ठीम् |
सर्पिर्मधुभ्यां विलिहीत कासी ससैन्धवां वोष्णजलेन कृष्णाम् ||१६||

The below mentioned ingredients are pounded and their powder prepared –

–        Pathya,

–        Sita – sugar,

–        Amalaka,

–        Laja,

–        Magadhi and

–        Sunthi

This powder is mixed with ghee and honey and should be consumed. 

Alternatively, Pippali and Saindhava Lavana should be powdered together. It may be consumed with warm water.

खादेद्गुडं नागरपिप्पलीभ्यां द्राक्षां च सर्पिर्मधुनाऽवलिह्यात् |
द्राक्षां सितां मागधिकां च तुल्यां सशृङ्गवेरं मधुकं तुगां च ||१७||
लिह्याद्घृतक्षौद्रयुतां समांशां सितोपलां वा मरिचांशयुक्ताम् |
धात्रीकणाविश्वसितोपलाश्च सञ्चूर्ण्य मण्डेन पिबेच्च दध्नः ||१८||

Below mentioned recipes should be taken for the cure of cough –

–        jaggery mixed with nagara, pippali and draksha should be mixed with ghee and honey and licked,

–        draksha, sita (sugar) and magadhika (powder) should be licked with ghee and honey,

–        equal parts of srngavera, madhuka and tuga (vamsalocana) are taken, powdered and consumed with ghee and honey or

–        sitopala added with marica should be consumed along with scum of curd or

–        dhatri, kana, visva and sitopala should be powdered and consumed along with scum of curd

हरेणुकां मागधिकां च तुल्यां दध्ना पिबेत् कासगदाभिभूतः |
उभे हरिद्रे सुरदारुशुण्ठीं गायत्रिसारं च पिबेत् समांशम् ||१९||
बस्तस्य मूत्रेण सुखाम्बुना वा दन्तीं द्रवन्तीं च सतिल्वकाख्याम् |
भृष्टानि सर्पींष्यथ बादराणि खादेत् पलाशानि ससैन्धवानि ||२०||
कोलप्रमाणं प्रपिबेद्धि हिङ्गु सौवीरकेणाम्लरसेन वाऽपि |२१|

Below mentioned recipes should be consumed by person suffering from cough –

–        Harenuka and Magadhika – taken in equal parts and powdered should be consumed mixed with curds, or

–        Powder of two kinds of Haridra, Suradaru, Sunthi, Gayatrisara (resin of khadira) – taken in equal parts may be consumed along with goat urine or warm water or

–        powder of danti, dravanti, tilvaka – with warm water or

–        leaves of badara fried in ghee and added with saindhava lavana, or

–        hingu taken in a quantity of a kola (5gm) with sauviraka or juice of sour fruits or

–        powder of marica should be licked mixed with honey

क्षौद्रेण लिह्यान्मरिचानि वाऽपि भार्गीवचाहिङ्गुकृता च वर्तिः ||२१||
धूमे प्रशस्ता घृतसम्प्रयुक्ता वेणुत्वगेलालवणैः कृता वा |२२|

Smoke is inhaled using cigar or wick prepared with the below mentioned group of herbs / ingredients and smeared with ghee –

–        Bharngi, Vaca and Hingu, or

–        Bark of Venu, Ela and Lavana

These are best to be inhaled.

मुस्तेङ्गुदीत्वङ्मधुकाह्वमांसीमनःशिलालैश्छगलाम्बुपिष्टैः ||२२||
विधाय वर्तीश्च पयोऽनुपानं धूमं पिबेद्वातबलासकासी |
पिबेच्च सीधुं मरिचान्वितं वा तेनाशु कासं जयति प्रसह्य ||२३||

Patients of vataja and kaphaja kasa should use the wick (cigar) prepared with the paste of below mentioned ingredients macerated in goat’s urine, for the purpose of smoking –

–        Musta,

–        Bark of Ingudi,

–        Madhuka,

–        Mamsi,

–        Manassila

Following this, he should drink milk or sidhu added with marica. Coughs would get cured easily by all these recipes.

द्राक्षाम्बुमञ्जिष्ठपुराह्वयाभिः क्षीरं शृतं माक्षिकसम्प्रयुक्तम् |२४|
निदिग्धिकानागरपिप्पलीभिः खादेच्च मुद्गान्मधुना सुसिद्धान् ||२४||

Milk should be boiled with –

–        draksa,

–        ambu,

–        manjistha,

–        purahva – guggulu

This milk may be consumed with honey.

One may also consume mudga cooked with nidigdhika, nagara and pippali added with honey.

उत्कारिकां सर्पिषि नागराढ्यां पक्त्वा समूलैस्त्रुटिकोलपत्रैः |
एभिर्निषेवेत कृतां च पेयां तन्वीं सुशीतां मधुना विमिश्राम् ||२५||

Utkarika – pan cake prepared with the below mentioned may be consumed –

–        more quantity of ghee,

–        nagara,

–        roots of truti and

–        leaves of kola

Peya – thin gruel prepared with the same ingredients shall also be consumed with honey.

Vataja käsa chikitsa – treatment of cough of vata origin

यत् प्लीह्नि सर्पिर्विहितं षडङ्गं तद्वातकासं जयति प्रसह्य |
विदारिगन्धादिकृतं घृतं वा रसेन वा वासकजेन पक्वम् ||२६||

Cough produced by aggravated vata is quickly cured by consuming Sadanga Sarpi (Satpala Ghrta) which has been mentioned in the treatment of Plihodara.

Alternatively, ghee prepared with herbs belonging to Vidarigandhadi Gana group or with juice of Vasaka shall be used in curing vataja type of cough.

विरेचनं स्नैहिकमत्र चोक्तमास्थापनं चाप्यनुवासनं च |
धूमं पिबेत् स्नैहिकमप्रमत्तः पिबेत् सुखोष्णं घृतमेव चात्र ||२७||
हिता यवाग्वश्च रसेषु सिद्धाः पयांसि लेहाः सघृतास्तथैव |२८|

Below mentioned treatments are also beneficial –

–        purgation with oily purgatives,

–        decoction enema,

–        unctuous enema,

–        inhaling lubricating smoke,

–        drinking of comfortably warm plain ghee,

–        yavagu – thick gruel prepared with meat soup,

–        milk boiled and prepared with vata mitigating herbs and

–        confections mixed with ghee

Kaphaja käsa cikitsa

प्रच्छर्दनं कायशिरोविरेकास्तथैव धूमाः कवलग्रहाश्च ||२८||
उष्णाश्च लेहाः कटुका निहन्युः कफं विशेषेण विशोषणं च |
कटुत्रिकं चापि वदन्ति पथ्यं घृतं कृमिघ्नस्वरसे विपक्वम् ||२९||
निर्गुण्डिपत्रस्वरसे च पक्वं सर्पिः कफोत्थं विनिहन्ति कासम् |

Below mentioned are the beneficial treatments for Kaphaja Kasa –

–        emesis,

–        purgation to the body,

–        purgation to the head,

–        inhalation of medicated smoke,

–        mouth gargles,

–        confections which are hot in potency and pungent in taste and

–        fasting (especially)

Cough produced by kapha is also cured by Katutrika and ghee boiled in juice or decoction of Krimighna or juice of leaves of Nirgundi.

पाठाविडव्योषविडङ्गसिन्धुत्रिकण्टरास्नाहुतभुग्बलाभिः ||३०||
शृङ्गीवचाम्भोधरदेवदारुदुरालभाभार्ग्यभयाशटीभिः |
सम्यग्विपक्वं द्विगुणेन सर्पिर्निदिग्धिकायाः स्वरसेन चैतत् ||३१||
श्वासाग्निसादस्वरभेदभिन्नान्निहन्त्युदीर्णानपि पञ्च कासान् |३२|

Decoction is prepared with the below mentioned ingredients –

–        patha,

–        bida,

–        vyosa,

–        vidanga,

–        sindhu (saindhava),

–        trikantaka,

–        rasna,

–        hutabuk – citraka,

–        bala,

–        srngi,

–        vaca,

–        ambodhara – musta,

–        devadaru,

–        duralabha,

–        bharngi, abhaya and sati

One part of ghee and two parts of juice of Nidagdhika are added to this decoction and cooked well so as to prepare the medicated ghee.

Benefits – This ghee cures dyspnoea, weak digestion, disorders of voice and five kinds of cough, though these conditions are greatly aggravated.

Pittaja käsa cikitsa

विदारिगन्धोत्पलसारिवादीन् निष्क्वाथ्य वर्गं मधुरं च कृत्स्नम् ||३२||
घृतं पचेदिक्षुरसाम्बुदुग्धैः काकोलिवर्गे च सशर्करं तत् |
प्रातः पिबेत् पित्तकृते च कासे रतिप्रसूते क्षतजे च कासे ||३३||

Decoction is prepared from the below mentioned groups of herbs –

–        vidarigandhadi gana group of herbs,

–        utpaladi gana group of herbs,

–        sarivadi gana group of herbs,

–        madhur (kakolyadi) gana group of herbs

Ghee, sugarcane juice, milk and paste of herbs belonging to Kakolyadi Gana group are added to this decoction, processed and medicated ghee is prepared.

This ghee should be added with sugar and consumed in the morning.

It cures cough produced by pitta (pittaja kasa) and also that produced due to injury to the lungs (ksataja kasa).

खर्जूरभार्गीमगधाप्रियालमधूलिकैलामलकैः समांशैः |
चूर्णं सिताक्षौद्रघृतप्रगाढं त्रीन् हन्ति कासानुपयुज्यमानम् ||३४||

Nice powder of equal parts of the below mentioned ingredients should be prepared –

–        Kharjura,

–        Bharngi,

–        Magadha,

–        Priyala,

–        Madhulika,

–        Ela,

–        Amalaka

This powder is mixed with more sugar, honey and ghee and should be consumed. This recipe cures the three types of coughs.

Kşataja and kşayaja käsa chikitsa

रक्ताहरिद्राञ्जनवह्निपाठामूर्वोपकुल्या विलिहेत् समांशाः |
क्षौद्रेण कासे क्षतजे क्षयोत्थे पिबेद्घृतं चेक्षुरसे विपक्वम् ||३५||
चूर्णं पिबेदामलकस्य वाऽपि क्षीरेण पक्वं सघृतं हिताशी |३६|

Powder of equal parts of the below mentioned should be licked with honey in Ksayaja and Ksataja Kasa –

–        Rakta i.e. Manjistha,

–        Haridra,

–        Anjana,

–        Vahni i.e. Chitraka,

–        Patha,

–        Murva and

–        Upakulya – pippali

Ghee processed with sugarcane juice may be consumed.

Alternatively, powder of Amalaka boiled and processed in milk should be consumed, added with ghee, by a person who is desirous of good benefits.

चूर्णानि गोधूमयवोद्भवानि काकोलिवर्गश्च कृतः सुसूक्ष्मः ||३६||
कासेषु पेयस्त्रिषु कासवद्भिः क्षीरेण सक्षौद्रघृतेन वाऽपि |
गुडोदकं वा क्वथितं पिबेद्धि क्षौद्रेण शीतं मरिचोपदंशम् ||३७||

Nice powder of the below mentioned should be prepared –

–        godhuma,

–        yava and

–        herbs belonging to kakolyadi gana group

This powder should be consumed along with milk or honey and ghee.

Alternatively, honey and powder of marica added and mixed in jaggery water may be consumed.

Kalyāṇaka guda

प्रस्थत्रयेणामलकीरसस्य शुद्धस्य दत्त्वाऽर्धतुलां गुडस्य |
चूर्णीकृतैर्ग्रन्थिकचव्यजीरव्योषेभकृष्णाहपुषाजमोदैः ||३८||
विडङ्गसिन्धुत्रिफलायवानीपाठाग्निधान्यैश्च पिचुप्रमाणैः |
दत्त्वा त्रिवृच्चूर्णपलानि चाष्टावष्टौ च तैलस्य पचेद्यथावत् ||३९||
तं भक्षयेदक्षफलप्रमाणं यथेष्टचेष्टस्त्रिसुगन्धियुक्तम् |
अनेन सर्वे ग्रहणीविकाराः सश्वासकासस्वरभेदशोथाः ||४०||
शाम्यन्ति चायं चिरमन्तरग्नेर्हतस्य पुंस्त्वस्य च वृद्धिहेतुः |
स्त्रीणां च वन्ध्यामयनाशनः स्यात् कल्याणको नाम गुडः प्रतीतः ||४१||

Three prastha (1920 ml) of amalaka rasa (fresh juice of gooseberry fruits) and half tula (2kg) of pure guda (jaggery) are cooked together.

When they are getting boiled, eight pala (320 gm) of sesame oil should be added.

Likewise, powder of one picu (10gm) each of the below mentioned ingredients are added –

–        granthika,

–        cavya,

–        jiraka,

–        vyosa,

–        ibhakrsna (gaja pippali),

–        hapusa,

–        ajamoda,

–        vidanga,

–        sindhu,

–        triphala,

–        yavani,

–        patha,

–        agni and

–        dhanyaka

Also added to it is eight pala (320gm) of Trivrt powder.

All these are boiled and processed together so as to prepare its confection in the usual procedure. This recipe is known as Kalyanaka Guda.

Dose – This recipe should be consumed in the dose of one aksa (10 gms), added with Trisugandhi (tvak, patra and ela) powder.

Benefits –

–        this recipe cures all duodenal disorders, dyspnoea, cough, hoarseness and dropsy,

–        increases digestive fire in spite of it being weak since long period,

–        increases semen and

–        cures infertility in women

Agastyavaleha / Agastyaharītaki rasayana

द्विपञ्चमूलेभकणात्मगुप्ताभार्गीशटीपुष्करमूलविश्वान् |
पाठामृताग्रन्थिकशङ्खपुष्पीरास्नाग्न्यपामार्गबलायवासान् ||४२||
द्विपालिकान् न्यस्य यवाढकं च हरीतकीनां च शतं गुरूणाम् |
द्रोणे जलस्याढकसंयुते च क्वाथे कृते पूतचतुर्थभागे ||४३||
पचेत्तुलां शुद्धगुडस्य दत्त्वा पृथक् च तैलात् कुडवं घृताच्च |
चूर्णं च तावन्मगधोद्भवाया देयं च तस्मिन्मधु सिद्धशीते ||४४||
रसायनात् कर्षमतो विलिह्याद्द्वे चाभये नित्यमथाशु हन्यात् |
तद्राजयक्ष्मग्रहणीप्रदोषशोफाग्निमान्द्यस्वरभेदकासान् ||४५||
पाण्ड्वामयश्वासशिरोविकारान् हृद्रोगहिक्काविषमज्वरांश्च |
मेधाबलोत्साहमतिप्रदं च चकार चैतद्भगवानगस्त्यः ||४६||

Ingredients –

Two pala (80gm) each of the below mentioned herbs should be taken –

–        herbs belonging to both pancamulas (ten herbs comprising of dasamula),

–        ibhakana (gajapippali),

–        atmagupta,

–        bharngi,

–        sati,

–        puskaramula,

–        visvapatha,

–        amrta,

–        granthika,

–        sankhapuspi,

–        rasna,

–        agni,

–        apamarga,

–        bala,

–        yavasa

Also should be taken –

–        one adhaka (2.56 kg) of yava and

–        haritaki fruits – one hundred in number

All these are boiled and processed in one drona (10.24kg) of water and reduced to one fourth so as to prepare its decoction. The decoction is filtered.

To it is added –

–        one tula (4kg) of pure guda (jaggery),

–        one kudava (160gm) each of taila (sesame oil), ghrta (ghee) and powder of magadodbhava (pippali)

All these are processed and the confection is prepared in the usual way. Honey is added to the confection after it gets cooled.

Dose – This confection should be consumed in one karsa (10gm )dosage. After consuming it, the person should eat two fruits of abhaya (haritaki), every day.

Benefits – This medicine cures depletion of tissues / pulmonary tuberculosis, duodenal disorders, dropsy, weak digestive fire, hoarseness of voice, cough, anaemia, dyspnoea, headache, heart diseases, hiccup and intermittent fevers.

It also bestows intelligence, strength, enthusiasm and mental stamina. This medicine has been formulated by the venerable sage Agastya. 

कुलीरशुक्तीचटकैणलावान्निष्क्वाथ्य वर्गं मधुरं च कृत्स्नम् |
पचेद्घृतं तत्तु निषेव्यमाणं हन्यात् क्षतोत्थं क्षयजं च कासम् ||४७||
शतावरीनागबलाविपक्वं घृतं विधेयं च हिताय कासिनाम् ||४८||

Decoction of the below mentioned is prepared –

–        meat of crab,

–        insect of cowri shell,

–        sparrow,

–        deer and

–        lava bird (common quail) and

–        herbs belonging to madhura / kakolyadi gana group

Ghee is processed with this decoction and medicated ghee is prepared. When consumed, this ghrta cures cough caused by injury to lungs and consumption.

Decoction of Satavari and Nagabala is prepared. Ghee processed with this decoction should be given to the patients of cough.

इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे कासप्रतिषेधो नाम (चतुर्दशोऽध्यायः, आदितः) द्विपञ्चाशत्तमोऽध्यायः ||५२||

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