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|title=Hikka Shwasa Chikitsa

|title=Hikka Shwasa Chikitsa

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<big>'''[[Chikitsa Sthana]] Chapter 17. Management of Hikka (Hiccups) and Shwasa (Dyspnea)</big>'''

<big>'''[[Chikitsa Sthana]] Chapter 17. Management of Hikka (Hiccups) and Shwasa (Dyspnea)</big>'''

{{Infobox

{{Infobox

|data7  = Ojha S.N., Mali P.

|data7  = Ojha S.N., Mali P.

|label8 = Editors

|label8 = Editors

|data8  = Singh G., Goyal M., Deole Y.S., Basisht G.

|data8  = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]]

|label9 = Year of publication  

|label9 = Year of publication  

|data9 =  2020

|data9 =  2020

<big>''' Abstract </big>'''

<big>''' Abstract </big>'''

<div style="text-align:justify;">

<p style="text-align:justify;">The chapter deals with the etio-pathogenesis and management of ''hikka'' (hiccups) and ''shwasa'' (dyspnea). The general causative factors include dietary and environmental pathogens and specific pathogenesis is due to involvement of [[vata]] and [[kapha]] as major [[dosha]]. Thus five types of ''hikka'' and ''shwasa'' are elaborated. The classification is based upon clinical presentation of disease and includes three types each of ''hikka'' and ''shwasa'' with bad prognostic signs pointing to imminent death. The description comprehends basic principles of management focused on removing obstruction of [[kapha]] and allowing proper flow of [[vata]] by means of purification therapies, sudation, nasal errhines, medicated smoking and various formulations. The management emphasizes on nourishment and pacification therapies to successfully treat and prevent ''shwasa'' and ''hikka'' conditions. Depletion therapies are strongly contra-indicated as they may worsen the condition of patient and disease. </p>

The chapter deals with the etio-pathogenesis and management of ''hikka'' (hiccups) and ''shwasa'' (dyspnea). The general causative factors include dietary and environmental pathogens and specific pathogenesis is due to involvement of [[vata]] and [[kapha]] as major [[dosha]]. Thus five types of ''hikka'' and ''shwasa'' are elaborated. The classification is based upon clinical presentation of disease and includes three types each of ''hikka'' and ''shwasa'' with bad prognostic signs pointing to imminent death. The description comprehends basic principles of management focused on removing obstruction of [[kapha]] and allowing proper flow of [[vata]] by means of purification therapies, sudation, nasal errhines, medicated smoking and various formulations. The management emphasizes on nourishment and pacification therapies to successfully treat and prevent ''shwasa'' and ''hikka'' conditions. Depletion therapies are strongly contra-indicated as they may worsen the condition of patient and disease.  

'''Keywords''': ''Shwasa, hikka,'' dyspnea, hiccups, ''tamaka shwasa,'' bronchial asthma, respiratory disorders, [[vamana]], therapeutic emesis, [[virechana]], therapeutic purgation, ''swedana'', sudation. </div>

'''Keywords''': ''Shwasa, hikka,'' dyspnea, hiccups, ''tamaka shwasa,'' bronchial asthma, respiratory disorders, [[vamana]], therapeutic emesis, [[virechana]], therapeutic purgation, ''swedana'', sudation.  

कफाधिकस्तथैवैको रूक्षो बह्वनिलोऽपरः ||८८||  

कफाधिकस्तथैवैको रूक्षो बह्वनिलोऽपरः ||८८||  

ककाधिके बलस्थे च वमनं सविरेचनम् |  

कफाधिके बलस्थे च वमनं सविरेचनम् |  

कुर्यात् पथ्याशिने धूमलेहादिशमनं ततः ||८९||

कुर्यात् पथ्याशिने धूमलेहादिशमनं ततः ||८९||

   

   

kaphādhikastathaivaikō rūkṣō bahvanilō'paraḥ||88||

kaphādhikastathaivaikō rūkṣō bahvanilō'paraḥ||88||

   

   

kakādhikē balasthē ca vamanaṁ savirēcanam|  

kaphādhikē balasthē ca vamanaṁ savirēcanam|  

kuryāt pathyāśinē dhūmalēhādiśamanaṁ tataḥ||89||  

kuryāt pathyāśinē dhūmalēhādiśamanaṁ tataḥ||89||  

kaphAdhikastathaivaiko rUkSho bahvanilo~aparaH ||88||  

kaphAdhikastathaivaiko rUkSho bahvanilo~aparaH ||88||  

kakAdhike balasthe ca vamanaM savirecanam |  

kaphAdhike balasthe ca vamanaM savirecanam |  

kuryAt pathyAshine dhUmalehAdishamanaM tataH ||89||  

kuryAt pathyAshine dhUmalehAdishamanaM tataH ||89||  

</div></div>

</div></div>

If purification therapy is administered in the ''hikka shwasa'' patients without aggravation of ''kapha'', in patients contraindicated for ''swedana'' or in very weak patients, then the aggravated ''vayu'' afflicts ''marma'' (vital points) and results in death instantaneously.  

If purification therapy is administered in the ''hikka shwasa'' patients without aggravation of [[kapha]], in patients contraindicated for [[swedana]] or in very weak patients, then the aggravated [[vayu]] afflicts ''marma'' (vital points) and results in death instantaneously.  

''Brimhana'' therapy in ''hikka shwasa'': Strong and sturdy patient with aggravated ''kapha'' should be administered with meat soup prepared from aquatic and marshy animals followed by ''swedana'' and ''vamana''. Weak patient without aggravation of ''kapha'' should be administered ''brimhana'' (nourishment therapy). [91-93]

''Brimhana'' therapy in ''hikka shwasa'': Strong and sturdy patient with aggravated [[kapha]] should be administered with meat soup prepared from aquatic and marshy animals followed by [[swedana]] and [[vamana]]. Weak patient without aggravation of [[kapha]] should be administered [[brimhana]] (nourishment therapy). [91-93]

=== Various formulations ===

=== Various formulations ===

''Bharngi nagaradi churna'': ''Bharngi'' and ''shunthi'' (Zingiber officinale Roxb.), ''maricha'' (Piper nigrum Linn.), ''yavakshara'' (alkali prepared from barley), ''pitadru'' (Berberis aristata DC.), ''chitraka'' (Plumbago zeylanica Linn.), ''asphota'' (Hemidesmus indicus R Br.) are used individually with hot water in ''hikka shwasa''.

''Bharngi nagaradi churna'': ''Bharngi'' and ''shunthi'' (Zingiber officinale Roxb.), ''maricha'' (Piper nigrum Linn.), ''yavakshara'' (alkali prepared from barley), ''pitadru'' (Berberis aristata DC.), ''chitraka'' (Plumbago zeylanica Linn.), ''asphota'' (Hemidesmus indicus R Br.) are used individually with hot water in ''hikka shwasa''.

   

   

''Utkarika'': ''Utkarika'' should be prepared from ''madhulika'' (finger millet), ''vamshalochana, shunthi'' (Zingiber officinale Roxb.), ''pippali'' (Piper longum Linn.) by cooking in ghee and used in ''shwasa'' associated with ''pitta''.  

''Utkarika'': ''Utkarika'' should be prepared from ''madhulika'' (finger millet), ''vamshalochana, shunthi'' (Zingiber officinale Roxb.), ''pippali'' (Piper longum Linn.) by cooking in ghee and used in ''shwasa'' associated with [[pitta]].  

The meat of ''shashvita'' or rabbit or blood of shallaka should be cooked with ''pippali ghrita'' should be used in ''shwasa'' associated with ''vata''.  

The meat of ''shashvita'' or rabbit or blood of shallaka should be cooked with ''pippali ghrita'' should be used in ''shwasa'' associated with [[vata]].  

In the ''shwasa'' associated with ''vata'' and ''kapha'' should be administered combination of juice of ''sauvarchala'', milk, ghee and ''trikatu'' and ''shali'' variety of rice.  

In the ''shwasa'' associated with [[vata]] and [[kapha]] should be administered combination of juice of ''sauvarchala'', milk, ghee and ''trikatu'' and ''shali'' variety of rice.  

In ''shwasa'' associated with ''kaphapitta'' should be given juice of flowers of ''shirisha'' (Albizzia lebbeck Benth), or juice of ''saptaparna'' leaves (Alstonia scholaris R Br.) along with ''pippali'' powder (Piper longum Linn.).  

In ''shwasa'' associated with [[kapha]] [[pitta]] should be given juice of flowers of ''shirisha'' (Albizzia lebbeck Benth), or juice of ''saptaparna'' leaves (Alstonia scholaris R Br.) along with ''pippali'' powder (Piper longum Linn.).  

''Madhukadi yoga'': ''Madhuka'' (Glycyrrhiza glabra Linn.), ''pippalimoola'' (root of Piper longum Linn.), jaggery, juice of dungs of cow or horse, ghee, honey subsides ''kasa'' (cough), ''shwasa'' (dyspnea), ''hikka'' (hiccups) and ''abhishyanda'' (conjunctivitis).  

''Madhukadi yoga'': ''Madhuka'' (Glycyrrhiza glabra Linn.), ''pippalimoola'' (root of Piper longum Linn.), jaggery, juice of dungs of cow or horse, ghee, honey subsides ''kasa'' (cough), ''shwasa'' (dyspnea), ''hikka'' (hiccups) and ''abhishyanda'' (conjunctivitis).  

In ''shwasa'' with aggravated ''kapha'' the juice of dung of donkey, horse, camel or pig should be administered with honey.  

In ''shwasa'' with aggravated [[kapha]] the juice of dung of donkey, horse, camel or pig should be administered with honey.  

The alkali prepared from roots of ''ashvagandha'' (Withania somnifera Linn.) should be licked with honey and ghee. Alkali prepared stalk of feather of peacock, alkali of quills of fish, hair of ''shashvita'', alkali of bones of ''jandaka, chasha,'' or ''kurara'', skin, bones and hooves of ''shringi, ekashapha, dvishapha'' etc. animals are burnt into ash separately and alkali is prepared. This powder administered with honey and ghee results in cure of ''kasa'' (cough), ''hikka'' (hiccups) and ''shwasa'' (dyspnea).

The alkali prepared from roots of ''ashvagandha'' (Withania somnifera Linn.) should be licked with honey and ghee. Alkali prepared stalk of feather of peacock, alkali of quills of fish, hair of ''shashvita'', alkali of bones of ''jandaka, chasha,'' or ''kurara'', skin, bones and hooves of ''shringi, ekashapha, dvishapha'' etc. animals are burnt into ash separately and alkali is prepared. This powder administered with honey and ghee results in cure of ''kasa'' (cough), ''hikka'' (hiccups) and ''shwasa'' (dyspnea).

   

   

Above said ''kshara lehya'' (Alkaline linctus) clear the ''kapha'' in the obstructed respiratory tract and subsides the aggravated ''pranavayu''. Hence the alkaline linctus should be given to purify the channels obstructed by ''kapha'' if there is no obstruction by ''kapha'' it should not be administered. [105-120]

Above said ''kshara lehya'' (Alkaline linctus) clear the [[kapha]] in the obstructed respiratory tract and subsides the aggravated ''pranavayu''. Hence the alkaline linctus should be given to purify the channels obstructed by [[kapha]] if there is no obstruction by [[kapha]] it should not be administered. [105-120]

=== Guidelines for management of ''tamaka shwasa'' ===

=== Guidelines for management of ''tamaka shwasa'' ===

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</div></div>

An intelligent doctor in ''shwasa'' associated with cough and hoarseness of voice should be administered ''vamana'' and in ''tamaka shwasa virechana'' should be given with ''vata-kaphahara'' medicines.  

An intelligent doctor in ''shwasa'' associated with cough and hoarseness of voice should be administered [[vamana]] and in tamaka shwasa [[virechana]] should be given with [[vata]]-[[kapha]]hara medicines.  

If the path of flowing water is blocked the enhancing pressure of water breaks the dam similarly the path obstructed by ''kapha'' aggravates ''vata'' and causes harm, hence always the path of ''vayu'' should be cleaned by means of purification. [121-122]

If the path of flowing water is blocked the enhancing pressure of water breaks the dam similarly the path obstructed by [[kapha]] aggravates [[vata]] and causes harm, hence always the path of [[vayu]] should be cleaned by means of purification. [121-122]

=== ''Shatyadi churna'' ===

=== ''Shatyadi churna'' ===

Equal quantity of fine powders of ''shati'' (Hedychium spicatum Buch Ham.), ''pushkaramula'' (Inula racemosa Hook f.) or ''amalaki'' (Emblica officinalis Gaertn.) or ''loha bhasma'' ( iron ore) should be licked along with honey.  

Equal quantity of fine powders of ''shati'' (Hedychium spicatum Buch Ham.), ''pushkaramula'' (Inula racemosa Hook f.) or ''amalaki'' (Emblica officinalis Gaertn.) or ''loha bhasma'' ( iron ore) should be licked along with honey.  

==== ''Nasya formulations'' ====  

==== [[Nasya]] formulations ====  

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<div class="mw-collapsible mw-collapsed">

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Juice of ''tamalaki'' (Phyllanthus urinaria Linn.), ''draksha'' (Vitis vinifera Linn.), cow dung and horse mixed with sugar or equal quantities of jaggery, ginger should be used for licking or ''nasya''.  

Juice of ''tamalaki'' (Phyllanthus urinaria Linn.), ''draksha'' (Vitis vinifera Linn.), cow dung and horse mixed with sugar or equal quantities of jaggery, ginger should be used for licking or [[nasya]].  

At the time of severe attack of ''hikka'' and ''shwasa, nasya'' should be administered from juice of roots of ''lashuna'' (Allium sativum Linn.) or ''palandu'' (Allium cepa Linn.) or ''grinjana'' (Daucas carota Linn) or ''chandana'' (Santalum album Linn.) with human milk.  

At the time of severe attack of ''hikka'' and shwasa, [[nasya]] should be administered from juice of roots of ''lashuna'' (Allium sativum Linn.) or ''palandu'' (Allium cepa Linn.) or ''grinjana'' (Daucas carota Linn) or ''chandana'' (Santalum album Linn.) with human milk.  

The supernatant part of ghee mixed with ''saindhava lavana'' or juice of ''alaktaka'' along with bees’ feces or human milk should be given in the form of ''nasya''. Medicated ghee prepared from ''madhura varga'' should be given orally or in the form of ''nasya'' pacifies ''hikka'' and ''shwasa'' very quickly. Alternate oral consumption of hot and cold milk or usage in the form of ''nasya'' alleviates ''hikka'' quickly. [130-134]

The supernatant part of ghee mixed with ''saindhava lavana'' or juice of ''alaktaka'' along with bees’ feces or human milk should be given in the form of [[nasya]]. Medicated ghee prepared from ''madhura varga'' should be given orally or in the form of [[nasya]] pacifies ''hikka'' and ''shwasa'' very quickly. Alternate oral consumption of hot and cold milk or usage in the form of [[nasya]] alleviates ''hikka'' quickly. [130-134]

==== Ghee formulations and other therapies ====

==== Ghee formulations and other therapies ====

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''Tejovatyadi ghrita'': ''Tejovati'' (Zanthoxylun armatum DC.), ''abhaya'' (Terminalia chebula Retz.), ''kushtha'' (Saussurea lappa C.B. Clarke.), ''pippali'' (Piper longum Linn.), ''katukarohini'' (Picrorhiza kurroa Royle ex Benth), ''bhutika'' (Cymbopogon Citratus), ''paushkara mula'' (Inula recemosa Hook f.), ''palasha'' (Butea monosperma (Linn.) Kuntze.), ''chitraka'' (Plumbago zeylanica Linn.), ''shati'' (Hedychium spicatium Buch Ham.), ''sauvarchala'' (variety of salt), ''tamalaki'' (Phyllanthus urinaria Linn.), ''saindhava'' (rock salt), ''bilva'' (Aegle marmelos  Corr.), ''talisa patra'' (Abies webbiana Lindle.), ''jivanti'' (Leptadenia reticulate W & A.), each are taken in one ''karsha'' quantity and ''hingu'' (Ferula narthex Boiss.) in 1/4th quantity and ghee in one ''prastha'' quantity (4 parts) and ghee is prepared as per classics. This ghee should be taken as per ones strength to conquer ''hikka'' and ''shwasa''. It is also effective in edema ''vataja arsha'' (hemorrhoids), ''grahani'' (digestive disorders), ''hritparshva rija'' (pain in the cardiac region and flanks).[141-144]

''Tejovatyadi ghrita'': ''Tejovati'' (Zanthoxylun armatum DC.), ''abhaya'' (Terminalia chebula Retz.), ''kushtha'' (Saussurea lappa C.B. Clarke.), ''pippali'' (Piper longum Linn.), ''katukarohini'' (Picrorhiza kurroa Royle ex Benth), ''bhutika'' (Cymbopogon Citratus), ''paushkara mula'' (Inula recemosa Hook f.), ''palasha'' (Butea monosperma (Linn.) Kuntze.), ''chitraka'' (Plumbago zeylanica Linn.), ''shati'' (Hedychium spicatium Buch Ham.), ''sauvarchala'' (variety of salt), ''tamalaki'' (Phyllanthus urinaria Linn.), ''saindhava'' (rock salt), ''bilva'' (Aegle marmelos  Corr.), ''talisa patra'' (Abies webbiana Lindle.), ''jivanti'' (Leptadenia reticulate W & A.), each are taken in one ''karsha'' quantity and ''hingu'' (Ferula narthex Boiss.) in 1/4th quantity and ghee in one ''prastha'' quantity (4 parts) and ghee is prepared as per classics. This ghee should be taken as per ones strength to conquer ''hikka'' and ''shwasa''. It is also effective in edema [[vata]]ja arsha (hemorrhoids), ''grahani'' (digestive disorders), ''hritparshva rija'' (pain in the cardiac region and flanks).[141-144]

=== ''Manahshiladi'' ghee ===

=== ''Manahshiladi'' ghee ===

</div></div>

</div></div>

The food, drinks and drugs having ''kapha-vatahara'' and ''ushna'' (hot) property which facilitate the normal movement of ''vata'' (''vatanulomana'') should be given in the patient of ''hikka'' and ''shwasa''.

The food, drinks and drugs having [[kapha]]-[[vata]]hara and ''ushna'' (hot) property which facilitate the normal movement of [[vata]] ([[vata]]nulomana) should be given in the patient of ''hikka'' and ''shwasa''.

''Hikka shwasa'' treatment based on ''doshas'': The medicines or food that aggravate ''vata'' and destroy ''kapha'' or aggravate ''kapha'' and alleviate ''vata'' must never be used in the treatment.  

''Hikka shwasa'' treatment based on [[dosha]]: The medicines or food that aggravate [[vata]] and destroy [[kapha]] or aggravate [[kapha]] and alleviate [[vata]] must never be used in the treatment.  

However drugs that alleviate ''vata'' and aggravate ''kapha'' can be used in exceptional conditions.  

However drugs that alleviate [[vata]] and aggravate [[kapha]] can be used in exceptional conditions.  

''Brimhana''(nourishment therapy) administered in ''hikka'' and ''shwasa'' and its complications make them curable. The ''shamana'' treatment (palliative therapy) prevents the complications. ''Karshana'' (depletion therapy) makes ''hikka'' and ''shwasa'' incurable.  

[[Brimhana]](nourishment therapy) administered in ''hikka'' and ''shwasa'' and its complications make them curable. The ''shamana'' treatment (palliative therapy) prevents the complications. ''Karshana'' (depletion therapy) makes ''hikka'' and ''shwasa'' incurable.  

Hence ''shamana'' (palliative) and ''brimhana'' (nourishment) therapy should be done in ''hikka'' and ''shwasa'' with or without purification of the body. [147-150]

Hence ''shamana'' (palliative) and ''brimhana'' (nourishment) therapy should be done in ''hikka'' and ''shwasa'' with or without purification of the body. [147-150]

== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

*''Hikka'' and ''shwasa'' originate at the site of ''pitta'' (upper part of stomach). The nature of disease is mainly ''kapha'' and ''vata'' dominant. The aggravation leads to depletion of ''dhatus'' like ''rasa'' situated in heart.

*''Hikka'' and ''shwasa'' originate at the site of [[pitta]] (upper part of stomach). The nature of disease is mainly [[kapha]] and [[vata]] dominant. The aggravation leads to depletion of [[dhatu]] like ''rasa'' situated in heart.

*The environmental pathogens like dust, pollen, smoke particles, improper diet and lifestyle regimen, and various other obstructions in channels carrying ''prana'' can cause the diseases.  

*The environmental pathogens like dust, pollen, smoke particles, improper diet and lifestyle regimen, and various other obstructions in channels carrying ''prana'' can cause the diseases.  

*''Hikka'' and ''shwasa'' can originate secondary to various conditions like ''ama, anaha'' (constipation associated with flatulence), excess dryness in the body, excessive depletion (''apatarpana''), weakness, injury to ''marmas'' (vital points), frequent exposure to heat and cold, diarrhea, fever, vomiting, rhinitis, ''kshata'' (injury), ''kshaya'' (wasting), ''raktapitta'' (bleeding disorder), ''udavarta'' (upward movement of ''vata''), ''visuchika'' (enteritis), ''alasaka'' (sluggish bowel), ''pandu'' (anemia) and intake of poisons. In this case, the treatment will focus on primary disease along with management of ''hikka'' and ''shwasa'' also.  

*''Hikka'' and ''shwasa'' can originate secondary to various conditions like ''ama, anaha'' (constipation associated with flatulence), excess dryness in the body, excessive depletion (''apatarpana''), weakness, injury to ''marmas'' (vital points), frequent exposure to heat and cold, diarrhea, fever, vomiting, rhinitis, ''kshata'' (injury), ''kshaya'' (wasting), ''raktapitta'' (bleeding disorder), ''udavarta'' (upward movement of [[vata]]), ''visuchika'' (enteritis), ''alasaka'' (sluggish bowel), ''pandu'' (anemia) and intake of poisons. In this case, the treatment will focus on primary disease along with management of ''hikka'' and ''shwasa'' also.  

*''Pranavaha srotasa'' (channels carrying ''prana'') are mainly involved in the pathogenesis of ''hikka'' and ''shwasa''.  

*''Pranavaha srotasa'' (channels carrying ''prana'') are mainly involved in the pathogenesis of ''hikka'' and ''shwasa''.  

*''Vayu'' along with ''kapha'' blocks the channels carrying ''prana, udaka'' and ''anna'' and produces ''mahahikka''.

*''Vayu'' along with [[kapha]] blocks the channels carrying ''prana, udaka'' and ''anna'' and produces ''mahahikka''.

*The protocol for management of ''shwasa'' includes:  

*The protocol for management of ''shwasa'' includes:  

**Liquefying ''kapha'' by ''snehana''( massage) with oil mixed with rock salt  

**Liquefying [[kapha]] by [[snehana]]( massage) with oil mixed with rock salt  

**Channelizing and further liquefying it to get expelled out by ''swedana'' (sudation)  

**Channelizing and further liquefying it to get expelled out by [[swedana]] (sudation)  

**Intake of unctuous food for increasing quantity of ''kapha'' (in order to make it convenient to get expelled out as seen in mucolyic drugs) and pacification of ''vata''.  

**Intake of unctuous food for increasing quantity of [[kapha]] (in order to make it convenient to get expelled out as seen in mucolyic drugs) and pacification of [[vata]].  

**Therapeutic emesis to expel out vitiated ''kapha dosha''

**Therapeutic emesis to expel out vitiated [[kapha]] [[dosha]]

**Medicated smoking with drugs having hot potency to remove remaining ''kapha dosha''

**Medicated smoking with drugs having hot potency to remove remaining [[kapha]] [[dosha]]

*''Anulomana'' (treating ''vata'' to move in normal direction) is the principle of management for obstructed ''vata'' in case of ''hikka'' and ''shwasa''.

*''Anulomana'' (treating [[vata]] to move in normal direction) is the principle of management for obstructed [[vata]] in case of ''hikka'' and ''shwasa''.

*''Shwasa'' associated with cough and hoarseness of voice should be treated with ''vamana'' (therapeutic emesis)  

*''Shwasa'' associated with cough and hoarseness of voice should be treated with [[vamana]] (therapeutic emesis)  

*In ''tamaka shwasa, virechana'' (therapeutic purgation) should be given with ''vata-kaphahara'' medicines.  

*In ''tamaka shwasa, [[virechana]] (therapeutic purgation) should be given with [[vata]]-[[kapha]]hara medicines.  

*It is always required to keep the path of ''vata'', clean (respiratory tract) by frequent purification therapies and removing obstruction.

*It is always required to keep the path of [[vata]], clean (respiratory tract) by frequent purification therapies and removing obstruction.

*Purification therapies like ''vamana'' and ''virechana'' shall be administered after assessing ''bala''(strength)of patient.   

*Purification therapies like [[vamana]] and [[virechana]] shall be administered after assessing ''bala''(strength)of patient.   

*The food, drinks and drugs having ''kapha-vata'' alleviating properties, ''ushna'' (hot) potency and facilitating normal movement of ''vata'' (''vatanulomana'') should be given in the patient of ''hikka'' and ''shwasa''.

*The food, drinks and drugs having [[kapha]]-[[vata]] alleviating properties, ''ushna'' (hot) potency and facilitating normal movement of [[vata]] (''vatanulomana'') should be given in the patient of ''hikka'' and ''shwasa''.

*''Brimhana'' (nourishment therapy) administered in ''hikka'' and ''shwasa'' and its complications make them curable. The ''shamana'' treatment (palliative therapy) prevents the complications. ''Karshana'' (depletion therapy) makes ''hikka'' and ''shwasa'' incurable.  

*''Brimhana'' (nourishment therapy) administered in ''hikka'' and ''shwasa'' and its complications make them curable. The ''shamana'' treatment (palliative therapy) prevents the complications. ''Karshana'' (depletion therapy) makes ''hikka'' and ''shwasa'' incurable.  

=== Origin of diseases ===

=== Origin of diseases ===

The origin of hikka shwas diseases occurs at the site of Pitta dosha (Pitta sthana) which is lower part of stomach and duodenum from undigested food substances. [Chakrapani Cha.Sa. [[Chikitsa Sthana]] 17/8] The upper part of stomach is referred to as the site for kapha dosha,.[Chakrapani Cha.Sa. [[Sutra Sthana]] 20/8]. Therefore the lower end of stomach and duodenum is considered as the site of origin of shwasa and hikka. Derangement of digestion and metabolism is an important basic pathological event leading to vitiation of kapha and its manifestation (vyakti sthana) in chest.

The origin of hikka shwas diseases occurs at the site of [[Pitta]] [[dosha]] ([[Pitta]] sthana) which is lower part of stomach and duodenum from undigested food substances. [Chakrapani Cha.Sa. [[Chikitsa Sthana]] 17/8] The upper part of stomach is referred to as the site for kapha dosha,.[Chakrapani Cha.Sa. [[Sutra Sthana]] 20/8]. Therefore the lower end of stomach and duodenum is considered as the site of origin of shwasa and hikka. Derangement of digestion and metabolism is an important basic pathological event leading to vitiation of kapha and its manifestation (vyakti sthana) in chest.

=== Pathogenesis ===

=== Pathogenesis ===

Derangement of digestion and metabolism (agnimandya) causes malformation and nourishment of all body tissues ([[dhatu]]). This further leads to vitiation of kapha and pitta dosha resulting in increase in vata dosha. [Chakrapani Cha.Sa. [[Sutra Sthana]] 6/34]

Derangement of digestion and metabolism (agnimandya) causes malformation and nourishment of all body tissues ([[dhatu]]). This further leads to vitiation of [[kapha]] and [[pitta]] [[dosha]] resulting in increase in [[vata]] [[dosha]]. [Chakrapani Cha.Sa. [[Sutra Sthana]] 6/34]

===Causes of shwasa ===

===Causes of shwasa ===

The management protocol for hikka and shwasa includes following:

The management protocol for hikka and shwasa includes following:

#Snehana (unction or oleation): Chest massage on the front, back and sides) with hot sesame oil or mahanarayana oil mixed with rock salt

#[[Snehana]](unction or oleation): Chest massage on the front, back and sides) with hot sesame oil or mahanarayana oil mixed with rock salt

#Swedana (sudation): Fomentation with dashamula kwatha or erandamula kwatha vapors by means of steam (bashpa) or  through a tube (nadi).

#[[Swedana]] (sudation): Fomentation with dashamula kwatha or erandamula kwatha vapors by means of steam (bashpa) or  through a tube (nadi).

#Vamana (therapeutic emesis) with mixture of piper (pippali), rock salt and honey, decoction of yasthtimadhu and madanaphala are also used.  

#[[Vamana]] (therapeutic emesis) with mixture of piper (pippali), rock salt and honey, decoction of yasthtimadhu and madanaphala are also used.  

#Virechana(therapeutic purgation) with eranda taila (castor oil),draksha kwatha and triphala kwatha  

#[[Virechana]](therapeutic purgation) with eranda taila (castor oil),draksha kwatha and triphala kwatha  

#Shamana medicines: Following drugs are used in treatment of hikka and shwasa:

#Shamana medicines: Following drugs are used in treatment of hikka and shwasa:

##Pippali  

##Pippali  

===Experience based views===  

===Experience based views===  

In chronic cases of Shwasa internal administration of unctuous substance (snehapana) in pure form or medicates formulation like dashamula ghrita is useful to control vata dosha. This reduces dryness (kharatva) of respiratory tract (pranavah srotas) and pacifies movement of vata (vatanulomana). In chronic stage of svasa, vata becomes more dominant while in new cases Kapha dominancy is observed.<ref> Personal email communication by Dr. Mali Pawan, dt. January 03, 2020 </ref>

In chronic cases of Shwasa, internal administration of unctuous substance (abhyantara [[snehana]]) in pure form or medicates formulation like dashamula ghrita is useful to control [[vata]] [[dosha]]. This reduces dryness (kharatva) of respiratory tract (pranavah srotas) and pacifies movement of [[vata]] (vatanulomana). In chronic stage of svasa, [[vata]] becomes more dominant while in new cases [[Kapha]] dominancy is observed.<ref> Personal email communication by Dr. Mali Pawan, dt. January 03, 2020 </ref>

 

Drugs prescribed for [[Pandu]], [[Shotha]] and [[Kasa]] may be used in the management of Shwasa(Su.Utt 51/43). Drugs prescribed for Kasa, Kshaya, chchardi and hikka can be used for Shwasa.(A.H.ch.59)

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== References ==

== References ==