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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>

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 ==