Changes

The maha (severe form), gambhira (having depth) and vyapeta (originating after food and with complications) types of hikka are incurable.  If the vyapeta or yamala hikka (with two hiccups together) is associated with symptoms of emaciation, delirium, pain, excess thirst and stupor then it is incurable for treatment, while it is curable in non emaciated and mentally strong individual with unimpaired dhatus and indriyas performing their normal function. Kshudra hikka (minor variety)  and annaja hikka (due to improper food intake)  are curable types of hikka. Maha (severe form), urdhva (shallow respiration) and chinna (irregular pattern dyspnoea) shwasa are incurable and lead to death very fast. Tamaka (with black outs) and kshudra shwasa (minor variety) are curable if patient is strong, and disease is in early stage. While in weak patient they are yapya (palliable).  

The maha (severe form), gambhira (having depth) and vyapeta (originating after food and with complications) types of hikka are incurable.  If the vyapeta or yamala hikka (with two hiccups together) is associated with symptoms of emaciation, delirium, pain, excess thirst and stupor then it is incurable for treatment, while it is curable in non emaciated and mentally strong individual with unimpaired dhatus and indriyas performing their normal function. Kshudra hikka (minor variety)  and annaja hikka (due to improper food intake)  are curable types of hikka. Maha (severe form), urdhva (shallow respiration) and chinna (irregular pattern dyspnoea) shwasa are incurable and lead to death very fast. Tamaka (with black outs) and kshudra shwasa (minor variety) are curable if patient is strong, and disease is in early stage. While in weak patient they are yapya (palliable).  

The patient suffering from hikka and shwasa should be treated with oleation, unctuous sudation to liquefy the accumulated kapha, soften the channels and to facilitate vatanulomana (movement of vata in its normal direction).  This should be followed by the administration elimination therapy in the form of vamana (emesis therapy), virechana (purgation), nasya and following of wholesome diet and regimen. The palliative medications should be administered keeping in view the condition of patient and stage of disease. Avoiding the causative factors and following wholesome regimen is important to prevent progress of disease and to reverse the pathogenesis. In brief shodhana followed by brimhana therapy (nourishing therapy) and shamana treatment (palliative therapy) are the ideal management methods in hikka and shwasa.  

The patient suffering from hikka and shwasa should be treated with oleation, unctuous sudation to liquefy the accumulated kapha, soften the channels and to facilitate vatanulomana (movement of vata in its normal direction).  This should be followed by the administration elimination therapy in the form of vamana (emesis therapy), virechana (purgation), nasya and following of wholesome diet and regimen. The palliative medications should be administered keeping in view the condition of patient and stage of disease. Avoiding the causative factors and following wholesome regimen is important to prevent progress of disease and to reverse the pathogenesis. In brief shodhana followed by brimhana therapy (nourishing therapy) and shamana treatment (palliative therapy) are the ideal management methods in hikka and shwasa.  

 

 

अथातो हिक्काश्वासचिकित्सितं व्याख्यास्यामः ||१||  

अथातो हिक्काश्वासचिकित्सितं व्याख्यास्यामः ||१||  

इति ह स्माह भगवानात्रेयः ||२||

इति ह स्माह भगवानात्रेयः ||२||

iti ha smAha bhagavAnAtreyaH ||2||

iti ha smAha bhagavAnAtreyaH ||2||

Now we shall expound the chapter on management of Hikka(hiccups) and Shwasa(dyspnoea). Thus said Lord Atreya. (1-2)

Now we shall expound the chapter on management of Hikka(hiccups) and Shwasa(dyspnoea). Thus said Lord Atreya. (1-2)

Agnivesha’s query:

 

==== Agnivesha’s query ====

 

वेदलोकार्थतत्त्वज्ञमात्रेयमृषिमुत्तमम् |  

वेदलोकार्थतत्त्वज्ञमात्रेयमृषिमुत्तमम् |  

अपृच्छत् संशयं धीमानग्निवेशः कृताञ्जलिः ||३||  

अपृच्छत् संशयं धीमानग्निवेशः कृताञ्जलिः ||३||  

Agnivesha an intelligent disciple asked his doubt with modest salute of folded hands to supreme sage Bhagavan Atreya, who has the knowledge about the subject and principles of Vedas “The diseases are categorized under two categories (samanyaja and nanatmaja) of three dosha (vata, pitta and kapha) aggravated due to three factors (like unwholesome utilization of sense organs (asatmendriyartha samyoga), intellectual errors (pajnaparadha) and advent of maturity of time (parinama)). Which among these diseases is most difficult to cure?”(3-4)

Agnivesha an intelligent disciple asked his doubt with modest salute of folded hands to supreme sage Bhagavan Atreya, who has the knowledge about the subject and principles of Vedas “The diseases are categorized under two categories (samanyaja and nanatmaja) of three dosha (vata, pitta and kapha) aggravated due to three factors (like unwholesome utilization of sense organs (asatmendriyartha samyoga), intellectual errors (pajnaparadha) and advent of maturity of time (parinama)). Which among these diseases is most difficult to cure?”(3-4)

Atreya’s reply and nature of disease of shwasa and hikka:

 

==== Atreya’s reply and nature of disease of shwasa and hikka ====

 

अग्निवेशस्य तद्वाक्यं श्रुत्वा मतिमतां वरः |  

अग्निवेशस्य तद्वाक्यं श्रुत्वा मतिमतां वरः |  

उवाच परमप्रीतः परमार्थविनिश्चयम् ||५||  

उवाच परमप्रीतः परमार्थविनिश्चयम् ||५||  

ante sa~jjAyate hikkA shvAso vA tIvravedanaH ||7||

ante sa~jjAyate hikkA shvAso vA tIvravedanaH ||7||

After listening to Agnivesha, Lord Punarvasu, the most prudent among the sages was very delighted and made ultimate and conclusive statement. “In fact there are many diseases which can kill a patient. But none of the diseases is as lethal as shwasa and hikka as they can cause immediate death. The person suffering from any other disease can also get eventually  afflicted with enormously painful hikka and shwasa at the time of death.”(3-7)

After listening to Agnivesha, Lord Punarvasu, the most prudent among the sages was very delighted and made ultimate and conclusive statement. “In fact there are many diseases which can kill a patient. But none of the diseases is as lethal as shwasa and hikka as they can cause immediate death. The person suffering from any other disease can also get eventually  afflicted with enormously painful hikka and shwasa at the time of death.”(3-7)

Predominance of dosha and affliction of dhatu:

 

==== Predominance of dosha and affliction of dhatu ====

 

कफवातात्मकावेतौ पित्तस्थानसमुद्भवौ |  

कफवातात्मकावेतौ पित्तस्थानसमुद्भवौ |  

हृदयस्य रसादीनां धातूनां चोपशोषणौ ||८||  

हृदयस्य रसादीनां धातूनां चोपशोषणौ ||८||  

mithyopacaritau kruddhau hata AshIviShAviva ||9||

mithyopacaritau kruddhau hata AshIviShAviva ||9||

Hikka and shwasa are mainly kapha and vata dominant in nature. They originate at the site of pitta (upper part of stomach). This results in further depletion of dhatus like rasa situated in heart. Hence generally they are extremely difficult to treat. After getting afflicted with this disease, if one indulges in unwholesome regimens, then disease gets aggravated and results in death just  as from fatal snake venom.  (8-9)

Hikka and shwasa are mainly kapha and vata dominant in nature. They originate at the site of pitta (upper part of stomach). This results in further depletion of dhatus like rasa situated in heart. Hence generally they are extremely difficult to treat. After getting afflicted with this disease, if one indulges in unwholesome regimens, then disease gets aggravated and results in death just  as from fatal snake venom.  (8-9)

Causative factors:

 

==== Causative factors ====

 

पृथक् पञ्चविधावेतौ निर्दिष्टौ रोगसङ्ग्रहे |  

पृथक् पञ्चविधावेतौ निर्दिष्टौ रोगसङ्ग्रहे |  

तयोः शृणु समुत्थानं लिङ्गं च सभिषग्जितम् ||१०||  

तयोः शृणु समुत्थानं लिङ्गं च सभिषग्जितम् ||१०||  

Others: Various types of vibandha (obstructions)  (10-16)

Others: Various types of vibandha (obstructions)  (10-16)

General Samprapti (pathogenesis):

==== General Samprapti (pathogenesis) ====

 

मारुतः प्राणवाहीनि स्रोतांस्याविश्य कुप्यति |  

मारुतः प्राणवाहीनि स्रोतांस्याविश्य कुप्यति |  

उरःस्थः कफमुद्धूय हिक्काश्वासान् करोति सः ||१७||  

उरःस्थः कफमुद्धूय हिक्काश्वासान् करोति सः ||१७||  

ghorAn prANoparodhAya prANinAM pa~jca pa~jca ca |18|

ghorAn prANoparodhAya prANinAM pa~jca pa~jca ca |18|

By the above mentioned etiological factors the vata gets aggravated in the pranavahasrotas ( channels carrying prana) and deranges the kapha situated in the chest region producing lethal blockage of prana vayu and five types of dreadful hikka and shwasa. (17-18)

By the above mentioned etiological factors the vata gets aggravated in the pranavahasrotas ( channels carrying prana) and deranges the kapha situated in the chest region producing lethal blockage of prana vayu and five types of dreadful hikka and shwasa. (17-18)

Premonitory symptoms:

 

==== Premonitory symptoms ====

 

उभयोः पूर्वरूपाणि शृणु वक्ष्याम्यतः परम् ||१८||  

उभयोः पूर्वरूपाणि शृणु वक्ष्याम्यतः परम् ||१८||  

कण्ठोरसोर्गुरुत्वं च वदनस्य कषायता |  

कण्ठोरसोर्गुरुत्वं च वदनस्य कषायता |  

Heaviness in throat and chest, astringent taste in mouth, and distension of abdomen are the premonitory symptoms of hikka.   

Heaviness in throat and chest, astringent taste in mouth, and distension of abdomen are the premonitory symptoms of hikka.   

Anaha (constipation with flatulence), pain in the flanks, pain in the cardiac region, abnormal movement of pranavayu are the premonitory symptoms of shwasa.(18-20)

Anaha (constipation with flatulence), pain in the flanks, pain in the cardiac region, abnormal movement of pranavayu are the premonitory symptoms of shwasa.(18-20)

Specific pathogenesis of hikka: 

 

==== Specific pathogenesis of hikka ====

 

प्राणोदकान्नवाहीनि स्रोतांसि सकफोऽनिलः |  

प्राणोदकान्नवाहीनि स्रोतांसि सकफोऽनिलः |  

हिक्का करोति संरुध्य तासां लिङ्गं पृथक् शृणु ||२१||  

हिक्का करोति संरुध्य तासां लिङ्गं पृथक् शृणु ||२१||