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==([[Chikitsa Sthana]] Chapter 18, Chapter on the Management of cough of various origins) ==
=== Abstract ===
Hikka, shwasa and kasa (hiccup, dyspnea and cough) are the three main diseases of pranavaha srotas (respiratory system). There are clinical and treatment similarities between these three disease conditions that is why these diseases are being described together. kasa is categorized in to five kinds as vataja, pittaja, kaphaja, kshataja and kshayaja. The former three are curable with proper medication while the remaining two are yapya (palliable). Nidana parivarjana (avoidance of etiological factors), shodhana (purificatory therapy), shamana (palliative drugs), vyadhiahara rasayana (disease specific treatment) are the principles of treatment for all types of kasa. Administration of shodhana has been given importance. The reduction in persistent nature of illness with episodic exacerbation and the severity is possible if all modalities of management like shodhana, shamana, vyadhihara rasayana are followed as treatment.
'''Keywords''': kasa, cough, treatment of cough, respiratory diseases,kshataja, kshayaja, Snehapana, vamana, virehna, vairechanika nasya (nasal catarrhal) dhumapana (medicated cigaretes).
=== Introduction ===
Pranavaha srotas is a vital system of the body and although this srotas is more susceptible to abuse from little amount of smoke, allergens, adulterants, petrochemicals and many pollutants in atmospshere, there are a variety of disorders and diseases that are temporary and harmless, while others can be life threatening. In literature pranavaha srotas disorders are elaborated under the heading of shwaasa, kasa, hikka, rajayakshma and urakshata (kshata-kshina). Cough, expectoration, breathlessness, sore throat, chest pain are common clinical features of respiratory diseases. Kasa is one such disease, which is identified by the hoarse phonetic sound, produced due to the pathological process of doshadushti (vitiation of dosha), vimarga gamana (diverted movement) of pranavata and avarana (occlusions) of vayu by the kapha. The main pathology is in chest region with reduced functioning of the respiratory system.
Smoke, dust, and over exertion (dhumopaghata, raja, vyayama) are largely considered as causative factors (samanya nidana). These may cause direct damage to the harmony of the pranavaha srotas which occurs in all respiratory disorders. Apart from above said causative factors some in particular like guru (heavy), snigdha (unctuous), madhura (sweet), asatmya (unhabituated), paryushita ahara (rotten food) will cause vitiation of dosha, more specifically vata and kapha which will in turn have its impact on pranavaha srotas to cause structural and functional impairments (kha vaigunya). Improper diet will result in the improper digestion and absorption of ahara rasa which will in turn produce kasa. These can be considered as intrinsic factors for the pathogenesis.
Prodromal symptoms (purvarupa) are irritation of throat with pricking sensation, itching (kantha kandu) and inability to swallow (bhojyanam avarodha). These are very much similar with upper respiratory tract infection leading to condition of pharyngitis or pharyngotonsillitis and persistence of such upper respiratory tract infection will further spread to lower respiratory tract.
There are five types of kasa namely, vataja, pittaja, kaphaja, kshataja and kshayaja. Vatika kasa is more related to upper respiratory tract with swarabheda (hoarseness of voice) as its diagnostic feature and is unproductive. It resembles more to allergic rhinobronchitis, which may be selflimiting and curable. Paittika and kaphaj kasa involve lower respiratory tract and are productive in nature. While paittika kasa seems to be the result of inflammation, kaphaj kasa is due to mucosal hypertrophy of bronchial lining or chronic bronchitis. Kshyaja kasa is a state of chronic cough associated with emaciation. Charaka has mentioned that the disturbance in the action of jatharagni all the three doshas get vitiated, which causes emaciation of dhatus of the body either due to anulomana kshaya or pratiloma kshaya (Ch. Chi. 18/24). That makes it different from shosha, which is a tridoshaja disease manifests as a group of several diseases. Kshataja kasa is associated with break in integrity of lung parenchyma with shonita darshana (blood tinged mucous) as a symptom. There may or may not be shosha (emaciation).
Snehapana, vamana, virehna, vairechanika nasya (nasal catarrhal) dhumapana (medicated cigaretes) are indicated as treatment modalities in different types of kasa.
=== ===
अथातः कासचिकित्सितं व्याख्यास्यामः ||१||
इति ह स्माह भगवानात्रेयः ||२||
athātaḥ kāsacikitsitaṁ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātrēyaḥ||2|
athAtaH kAsacikitsitaM vyAkhyAsyAmaH||1||
iti ha smAha bhagavAnAtreyaH||2||
Atreya said, we will now describe the chapter on the treatment of kasa.(1)
तपसा यशसा धृत्या धिया च परयाऽन्वितः |
आत्रेयः कासशान्त्यर्थं प्राह सिद्धं चिकित्सितम् ||३||
वातादिजास्त्रयो ये च क्षतजः क्षयजस्तथा |
पञ्चैते स्युर्नृणां कासा वर्धमानाः क्षयप्रदाः ||४||
tapasā yaśasā dhr̥tyā dhiyā ca parayā'nvitaḥ|
ātrēyaḥ kāsaśāntyarthaṁ prāha siddhaṁ cikitsitam||3||
vātādijāstrayō yē ca kṣatajaḥ kṣayajastathā|
pañcaitē syurnr̥ṇāṁ kāsā vardhamānāḥ kṣayapradāḥ||4||
tapasA yashasA dhRutyA dhiyA ca parayA~anvitaH|
AtreyaH kAsashAntyarthaM prAha siddhaM cikitsitam||3||
vAtAdijAstrayo ye ca kShatajaH kShayajastathA|
pa~jcaite syurnRuNAM kAsA vardhamAnAH kShayapradAH||4||
Atrey, endowed with power of penance, fame and perseverance and super-intellect expounded the infallible therapies for the treatment of kasa. There are five types of kasa. If exacerbated they may cause kshaya. These five types are, vataja, pittaja, kaphaja, kshataj and kshayaja. (3-4)
Premonitaory signs:
पूर्वरूपं भवेत्तेषां शूकपूर्णगलास्यता |
कण्ठे कण्डूश्च भोज्यानामवरोधश्च जायते ||५||
pūrvarūpaṁ bhavēttēṣāṁ śūkapūrṇagalāsyatā|
kaṇṭhē kaṇḍūśca bhōjyānāmavarōdhaśca jāyatē||5|| pUrvarUpaM bhavetteShAM shUkapUrNagalAsyatA|
kaNThe kaNDUshca bhojyAnAmavarodhashca jAyate||5||
Following are the premonitory signs and symptoms of kasa:
1. Sensation as if throat and mouth are filled with shooka (thorns).
2. Itching sensation in the throat.
3. Inability to swallow food.(3-4)
Pathophysiology of kasa:
अधःप्रतिहतो वायुरूर्ध्वस्रोतःसमाश्रितः |
उदानभावमापन्नः कण्ठे सक्तस्तथोरसि ||६||
आविश्य शिरसः खानि सर्वाणि प्रतिपूरयन् |
आभञ्जन्नाक्षिपन् देहं हनुमन्ये तथाऽक्षिणी ||७||
नेत्रे पृष्ठमुरःपार्श्वे निर्भुज्य स्तम्भयंस्ततः |
शुष्को वा सकफो वाऽपि कसनात्कास उच्यते ||८||
adhaḥpratihatō vāyurūrdhvasrōtaḥsamāśritaḥ|
udānabhāvamāpannaḥ kaṇṭhē saktastathōrasi||6||
āviśya śirasaḥ khāni sarvāṇi pratipūrayan|
ābhañjannākṣipan dēhaṁ hanumanyē tathā'kṣiṇī||7||
nētrē pr̥ṣṭhamuraḥpārśvē nirbhujya stambhayaṁstataḥ|
śuṣkō vā sakaphō vā'pi kasanātkāsa ucyatē||8||
adhaHpratihato vAyurUrdhvasrotaHsamAshritaH|
udAnabhAvamApannaH kaNThe saktastathorasi||6||
Avishya shirasaH khAni sarvANi pratipUrayan|
Abha~jjannAkShipan dehaM hanumanye tathA~akShiNI||7||
netre pRuShThamuraHpArshve nirbhujya stambhayaMstataH|
shuShko vA sakapho vA~api kasanAtkAsa ucyate||8||
Vata being obstructed in the lower region of the body, moves upwards, afflicts the channels of circulation in the upper part of the body, takes over the function of udana vayu and gets localized in the throat and chest. Then entering all the cavities in the head, fills them up and causes hunching and convulsive movements of the body, jaws, sides of the neck and eyes. Thereafter this obstructed vata causes contraction and stiffness of the eyes, back, chest and sides of the chest, gives rise to kasa which may be dry or with phlegm because of which it is known as kasa.(6-8)
Specific features of kasa:
प्रतिघातविशेषेण तस्य वायोः सरंहसः |
वेदनाशब्दवैशिष्ट्यं कासानामुपजायते ||९||
pratighātaviśēṣēṇa tasya vāyōḥ saraṁhasaḥ|
vēdanāśabdavaiśiṣṭyaṁ kāsānāmupajāyatē||9||
pratighAtavisheSheNa tasya vAyoH saraMhasaH|
vedanAshabdavaishiShTyaM kAsAnAmupajAyate||9||
Specific variations in the pain and sound associated with different types of kasa are caused by the specific nature of the obstruction (by kapha etc.) to the force fully moving vayu.(9)
Etiological factors, clinical features of vataja kasa:
रूक्षशीतकषायाल्पप्रमितानशनं स्त्रियः |
वेगधारणमायासो वातकासप्रवर्तकाः ||१०||
हृत्पार्श्वोरःशिरःशूलस्वरभेदकरो भृशम् |
शुष्कोरःकण्ठवक्रस्य हृष्टलोम्नः प्रताम्यतः ||११||
निर्घोषदैन्यस्तननदौर्बल्यक्षोभमोहकृत् |
शुष्ककासः कफं शुष्कं कृच्छ्रान्मुक्त्वाऽल्पतां व्रजेत् ||१२||
स्निग्धाम्ललवणोष्णैश्च भुक्तपीतैः प्रशाम्यति |
ऊर्ध्ववातस्य जीर्णेऽन्ने वेगवान्मारुतो भवेत् ||१३||
rūkṣaśītakaṣāyālpapramitānaśanaṁ striyaḥ|
vēgadhāraṇamāyāsō vātakāsapravartakāḥ||10||
hr̥tpārśvōraḥśiraḥśūlasvarabhēdakarō bhr̥śam|
śuṣkōraḥkaṇṭhavakrasya hr̥ṣṭalōmnaḥ pratāmyataḥ||11||
nirghōṣadainyastananadaurbalyakṣōbhamōhakr̥t|
śuṣkakāsaḥ kaphaṁ śuṣkaṁ kr̥cchrānmuktvā'lpatāṁ vrajēt||12||
snigdhāmlalavaṇōṣṇaiśca bhuktapītaiḥ praśāmyati|
ūrdhvavātasya jīrṇē'nnē vēgavānmārutō bhavēt||13||
rUkShashItakaShAyAlpapramitAnashanaM striyaH|
vegadhAraNamAyAso vAtakAsapravartakAH||10||
hRutpArshvoraHshiraHshUlasvarabhedakaro bhRusham|
shuShkoraHkaNThavakrasya hRuShTalomnaH pratAmyataH||11||
nirghoShadainyastananadaurbalyakShobhamohakRut|
shuShkakAsaH kaphaM shuShkaM kRucchrAnmuktvA~alpatAM vrajet||12||
snigdhAmlalavaNoShNaishca bhuktapItaiH prashAmyati|
UrdhvavAtasya jIrNe~anne vegavAnmAruto bhavet||13||
Following are the causative factors of vatika type of kasa
1. Intake of ruksha [dry], sheeta[cold], kashaya [stringent] type of food.
2. Intake of food in less quantity or much less quantity or not taking food at all.
3. Excess indulgence in vyavaya.
4. Suppression of vega.
5. Excessive physical strain.
.It’s signs and symptoms are as follows;
1. Excruciating pain in the epigastric region, flanks, chest, and head.
2. Excessive hoarseness of the voice.
3. Dryness in the chest, throat and mouth.
4. Horripillation and fainting.
5. Resonant sound during coughing, looks hopeless, hollow sound during coughing.
6. weakness, agitated, illusive perceptions.
7. Dry cough
8. Expectorate scanty phlegm with pain.
9. The kasa gets alleviated by the food and drinks that are snigdha, amla, lavana and ushna.
10. The upward movements increases vata after digestion of food.(10-13)
==== ''Pippalyadi ghrita'' ====
==== ''Pippalyadi ghrita'' ====