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|title=Kasa Chikitsa

|title=Kasa Chikitsa

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<big>'''[[Chikitsa Sthana]] Chapter 18. Management of Kasa (Cough of various origins) </big>'''  

<big>'''[[Chikitsa Sthana]] Chapter 18. Management of Kasa (Cough of various origins) </big>'''  

{{Infobox

{{Infobox

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|label6 = Translator and commentator

|label6 = Translator and commentator

|data6 =  Nesari T.,Mallya S.,Deole Y. S.

|data6 =  Nesari T., Mallya S., [[Yogesh Deole|Deole Y. S.]]

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Prasad B.S., Mali P.

|data7  = Prasad B.S., 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;">''Hikka, shwasa'' and ''kasa'' (hiccups, dyspnea and cough) are the three main diseases of ''pranavaha srotas'' (respiratory system). There are similarities in clinical presentation and management of these three. Therefore, these are described in sequence. ''Kasa'' is categorized in to five types based on its dominance of dosha and etiology. The vata dominant, pitta dominant and kapha dominant kasa are curable with proper medication. The other two types originating due to kshata (injury) and depletion of body constituents (kshaya) are palliable (yapya). Avoiding etiological factors (Nidana parivarjana), purification therapy ([[shodhana]]), pacification therapy ([[shamana]]), disease specific treatment (vyadhiahara [[rasayana]]) are principles of management for all types of ''kasa''. Administration of [[shodhana]] therapy is important. The reduction in persistent nature of illness with episodic exacerbation and the severity is possible if all modalities are followed in sequence.  

''Hikka, shwasa'' and ''kasa'' (hiccups, dyspnea and cough) are the three main diseases of ''pranavaha srotas'' (respiratory system). There are similarities in clinical presentation and management of these three. Therefore, these are described in sequence. ''Kasa'' is categorized in to five types based on its dominance of dosha and etiology. The vata dominant, pitta dominant and kapha dominant kasa are curable with proper medication. The other two types originating due to kshata (injury) and depletion of body constituents (kshaya) are palliable (yapya). Avoiding etiological factors (Nidana parivarjana), purification therapy ([[shodhana]]), pacification therapy ([[shamana]]), disease specific treatment (vyadhiahara [[rasayana]]) are principles of management for all types of ''kasa''. Administration of [[shodhana]] therapy is important. The reduction in persistent nature of illness with episodic exacerbation and the severity is possible if all modalities are followed in sequence.  

 

'''Keywords''': ''kasa'', cough, treatment of cough, respiratory diseases, kshataja, kshayaja, snehapana, [[vamana]], [[virechana]], vairechanika [[nasya]] (nasal catarrhal), [[dhumapana]] (medicated cigarettes).

'''Keywords''': ''kasa'', cough, treatment of cough, respiratory diseases, kshataja, kshayaja, snehapana, [[vamana]], [[virechana]], vairechanika [[nasya]] (nasal catarrhal), [[dhumapana]] (medicated cigarettes).

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</p>

 

== Introduction ==

== Introduction ==

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As ''rukshata'' will be more prominent in [[vata]]ja type of ''kasa'' it should be treated with ''snehika upacharas. Ghrita pana,'' [[basti]], peya , yusha, ksheera, mamsa rasa etc should be prepared with [[vata]]ghna dravyas and is to be administered properly.  

As dryness (rukshata) will be more prominent in [[vata]]ja type of ''kasa'', it should be treated with unctuous therapies (snehika upacharas). Ghrita pana,[[basti]], peya, yusha, ksheera, mamsa rasa etc. should be prepared with [[vata]]ghna dravya and is to be administered properly.

 

[[Abhyanga]], [[parisheka]] (sprinkling or pouring), snigdha sweda etc. should be followed appropriately.  

''Abhyanga, parisheka'' (sprinkling or pouring), ''snigdha sweda'' etc should be followed appropriately.  

If it is associated with constipation and flatulence should be treated with [[basti]]. If the person has dryness in the upper part of the body, and is associated with aggravated [[pitta]], then he should be given medicated [[ghrita]] after intake of food.  

If it is associated with constipation and flatulence should be treated with [[basti]]. If  the person has dryness of upper part of the body, and is associated with aggravated [[pitta]], then he should be given medicated ''ghrita'' after intake of food. If the person has dryness of the upper part of the body associated with [[pitta]] aggravation then he should be treated with snigdha [[virechana]].[32-34]

If the person has dryness of the upper part of the body associated with [[kapha]] aggravation, then he should be treated with snigdha [[virechana]].[32-34]

==== Kantakari ghrita ====

==== Kantakari ghrita ====

Two palas of each among ''dashamoola, swayamgupta, shankahpushpi, shati, bala, hasti pippali, apamarga, pippalimoola, chitraka, bharangi, pushkaramoola'' should be added with one ''adhaka'' of water, these drugs should be cooked till the grains of ''yava'' becomes soft. And then decoction should be strained out. These hundred fruits of ''abhaya'' should be added with above mentioned decoction, one ''tula'' of ''guda'', one ''kudava'' of ''ghrita, taila'' and powder of ''pippali''. This is to be cooked and after attaining coldness one ''kudava'' of ''makshika'' is to be added.  

Two palas of each among ''dashamoola, swayamgupta, shankahpushpi, shati, bala, hasti pippali, apamarga, pippalimoola, chitraka, bharangi, pushkaramoola'' should be added with one ''adhaka'' of water, these drugs should be cooked till the grains of ''yava'' becomes soft. And then decoction should be strained out. These hundred fruits of ''abhaya'' should be added with above mentioned decoction, one ''tula'' of ''guda'', one ''kudava'' of ''ghrita, taila'' and powder of ''pippali''. This is to be cooked and after attaining coldness one ''kudava'' of ''makshika'' is to be added.  

Intake of two fruits of ''haritaki'' along with ''leha'' daily is considered as ''rasayana''. It removes ''vali, phalita''; increases ''varna, ayu'' and ''bala''. Beneficial in ''panchakasa, kshaya, shwaasa, hikka, vishamajwara, arshas, grahani, hridroga, aruchi, pinasa''. This excellent formulation is propounded by Agastya and is auspicious.

Intake of two fruits of ''haritaki'' along with ''leha'' daily is considered as [[rasayana]]. It removes ''vali, palita''; increases [[varna]], [[ayu]] and [[bala]]. Beneficial in ''panchakasa, kshaya, shwaasa, hikka, vishamajwara, arshas, grahani, hridroga, aruchi, pinasa''. This excellent formulation is propounded by Agastya and is auspicious.

Thus, ends the description of ''Agastya-haritaki''.[57-62]

Thus, ends the description of ''Agastya-haritaki''.[57-62]

''Kshatajakasa'' is a serious ailment. Keeping this in view the treatment of the patient should be initiated instantaneously with ''madhura'' and ''jivaniya dravyas'', which are promoters of ''bala'' and ''mamsa''.  

''Kshatajakasa'' is a serious ailment. Keeping this in view the treatment of the patient should be initiated instantaneously with ''madhura'' and ''jivaniya dravyas'', which are promoters of ''bala'' and ''mamsa''.  

The paste of one ''karsha'' of each of ''pippali, madhuka,'' one ''karsha'' of ''sitopala'', one ''prastha'' of each of cows milk, goats milk and ''ikshurasa'', one ''prastha'' of the powder of ''yava, godhuma, draksha'' and one ''prastha'' of each of the juice of ''amalaka'' and ''tilataila'' should be cooked over ''mridu agni''. Intake of this ''leha'' along with ''ghrita'' and ''madhu'' cures ''kshataja kasa, shwasa, hridroga'' and ''kshata''. It is also useful for old persons and those who have less semen.[134-137]

The paste of one ''karsha'' of each of ''pippali, madhuka,'' one ''karsha'' of ''sitopala'', one ''prastha'' of each of cows milk, goats milk and ''ikshurasa'', one ''prastha'' of the powder of ''yava, godhuma, draksha'' and one ''prastha'' of each of the juice of ''amalaka'' and ''tilataila'' should be cooked over mridu [[agni]]. Intake of this ''leha'' along with ''ghrita'' and ''madhu'' cures ''kshataja kasa, shwasa, hridroga'' and ''kshata''. It is also useful for old persons and those who have less semen.[134-137]

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The medicaments prescribed for the ''pittajakasa'' are also useful for ''kshatajakasa''. Generally milk, ghee and honey should be given to such patients. If two ''dosha'' are involved in the pathogenesis of this ailment then special therapies are required.

The medicaments prescribed for the [[pitta]]ja kasa are also useful for ''kshatajakasa''. Generally milk, ghee and honey should be given to such patients. If two [[dosha]] are involved in the pathogenesis of this ailment then special therapies are required.

If this ailment is associated with ''vata'' and ''pitta'' and the person has pain all over the body then ''abhyanga'' should be given with ghee. If there is excessive ''vata aggravation'', causing pain, then ''abhyanga'' should  be given with ''taila'' prepared out of ''vatahara dravya''.  

If this ailment is associated with [[vata]] and [[pitta]] and the person has pain all over the body then ''abhyanga'' should be given with ghee. If there is excessive [[vata]] aggravation, causing pain, then ''abhyanga'' should  be given with ''taila'' prepared out of [[vata]]hara dravya.  

The person suffering from ''kasa'' along with pain in ''hridaya'' and ''parshwa'' associated with burning sensation, hemoptysis and aggravation of ''vata'' should take ''jivaniya siddha ghrita.''

The person suffering from ''kasa'' along with pain in ''hridaya'' and ''parshwa'' associated with burning sensation, hemoptysis and aggravation of [[vata]] should take jivaniya siddha ghrita.

If the person weak and habituated to take ''mamsa'' then the ''mamsarasa'' prepared out of lava is beneficial for him.  

If the person weak and habituated to take mamsa then the ''mamsarasa'' prepared out of lava is beneficial for him.  

If he is suffering from ''trishna'' then he can take goats milk processed with ''trinapanchamoola''.

If he is suffering from ''trishna'' then he can take goats milk processed with ''trinapanchamoola''.

If there is bleeding then he should take the ghee extracted out of this milk. Or this ghee can be administered in the form of ''nasya'' or as a drink.

If there is bleeding then he should take the ghee extracted out of this milk. Or this ghee can be administered in the form of [[nasya]] or as a drink.

If the patient of ''kshata'' is fatigued and weak, and if he has low power of digestion, then he should be given ''yavagu'' to eat.

If the patient of ''kshata'' is fatigued and weak, and if he has low power of digestion, then he should be given ''yavagu'' to eat.

If there is ''stambha'' and ''ayama'' then the patient should be given ghee in large quantity.

If there is ''stambha'' and ''ayama'' then the patient should be given ghee in large quantity.

Thus all therapies which alleviate the ''vata'', simultaneously which do not aggravate ''pitta'' and ''rakta'' should be followed in such persons.

Thus all therapies which alleviate the [[vata]], simultaneously which do not aggravate [[pitta]] and [[rakta]] should be followed in such persons.

After ''khsataja kasa'' treatment, after complete relief, still person is complaining of pain at the place of injury due to aggravation of ''kapha'', should be given ''dhumapana chikitsa'' with following combination.

After ''khsataja kasa'' treatment, after complete relief, still person is complaining of pain at the place of injury due to aggravation of [[kapha]], should be given ''dhumapana chikitsa'' with following combination.

''Meda, mahameda, madhuka, bala'' and ''mahabala'' should be made into paste and smeared over silk-cloth and ''varti'' is to be prepared. After the ''pana'' of this ''dhumavarti'' should be prepared by smearing a piece of silk cloth with the paste of ''manahshila'', ''palasha, ajagandha, tavksheeri,'' and ''nagara''. After ''dhumapana'' the person should drink ''ikshurasa'' and water mixed with jaggery.

''Meda, mahameda, madhuka, bala'' and ''mahabala'' should be made into paste and smeared over silk-cloth and ''varti'' is to be prepared. After the ''pana'' of this ''dhumavarti'' should be prepared by smearing a piece of silk cloth with the paste of ''manahshila'', ''palasha, ajagandha, tavksheeri,'' and ''nagara''. After ''dhumapana'' the person should drink ''ikshurasa'' and water mixed with jaggery.

''Manhashila'' should be made into a paste by tritrating it with the ''vatashrunga''. To this ghee should be added. After ''dhuma'' the person should be given ''tittiri pakshi mamsa rasa''.

''Manhashila'' should be made into a paste by tritrating it with the vatashrunga. To this ghee should be added. After ''dhuma'' the person should be given ''tittiri pakshi mamsa rasa''.

The silk cloth should be soaked with ''jivaniya gana dravyas'' or with egg yolk of ''kulinga''. With this ''varti'' should be prepared and after ''dhumapana'', the person should take the milk soaked with hot iron balls. This is beneficial in ''kshataja kasa''.[138-148]

The silk cloth should be soaked with ''jivaniya gana dravyas'' or with egg yolk of ''kulinga''. With this ''varti'' should be prepared and after ''dhumapana'', the person should take the milk soaked with hot iron balls. This is beneficial in ''kshataja kasa''.[138-148]

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If ''kshayaja kasa'' is manifested with all the signs and symptoms, and if the patient is weak, then he should not be treated. However if the disease has recently occurred and if the patient is strong enough, then he may be treated even though the disease is incurable. In the beginning the person should be given ''brihmana'' therapy along with ''agni deepana''. If ''dosha'' aggravation is more, then he can be given mild purgation therapy along with ''snigdha dravyas''.

If ''kshayaja kasa'' is manifested with all the signs and symptoms, and if the patient is weak, then he should not be treated. However if the disease has recently occurred and if the patient is strong enough, then he may be treated even though the disease is incurable. In the beginning the person should be given [[brihmana]] therapy along with [[agni]] [[deepana]]. If [[dosha]] aggravation is more, then he can be given mild purgation therapy along with ''snigdha dravyas''.

Ghee cooked with the decoction of ''shamapaka''(fruit pulp of ''aragwadha''), ''trivrit, mridvika rasa, tilvaka kashaya'' and ''vidari swarasa'' should be given in appropriate dosage for the ''shodhana'' of ''ksheena'' person. It protects the body as well as gives strength for the ''uras''.  

Ghee cooked with the decoction of ''shamapaka''(fruit pulp of ''aragwadha''), ''trivrit, mridvika rasa, tilvaka kashaya'' and ''vidari swarasa'' should be given in appropriate dosage for the ''shodhana'' of ''ksheena'' person. It protects the body as well as gives strength for the ''uras''.  

When ''pitta'' and ''kapha'' are reduced in quantity, along emaciation of ''dhatu'', then the person should take the ''ghrita'' prepared out of ''karkatashringi'', milk, ''bala'' and ''atibala''.

When [[pitta]] and [[kapha]] are reduced in quantity, along emaciation of [[dhatu]], then the person should take the ''ghrita'' prepared out of ''karkatashringi'', milk, ''bala'' and ''atibala''.

If there is association of ''mutra vaivarnyata'' or ''krichchchrata'', then he should be given the milk boiled with ''vidari, kadamba'' or with tender fruits of ''tala''.

If there is association of ''mutra vaivarnyata'' or ''krichchchrata'', then he should be given the milk boiled with ''vidari, kadamba'' or with tender fruits of ''tala''.

If there is swelling and pain in the ''medhra, payu, shroni'' and ''vankshana'', then the person should be given the ''anuvasana'' prepared out of ''ghritamanda, madhu'' or with ''mishraka sneha''.

If there is swelling and pain in the ''medhra, payu, shroni'' and ''vankshana'', then the person should be given the ''anuvasana'' prepared out of ''ghritamanda, madhu'' or with ''mishraka sneha''.

After ''anuvasana'' the person should be fed with ''mamsa rasa'' prepared out of ''jangala, prasaha, bileshaya,'' and ''vartakas''. Because of their ''ushnata, pramathi bhava'' these move properly in all ''srotas'' and cause dryness of ''kapha'' and simultaneously they nourish the ''srotas''.[149-157]

After ''anuvasana'' the person should be fed with ''mamsa rasa'' prepared out of ''jangala, prasaha, bileshaya,'' and ''vartakas''. Because of their ''ushnata, pramathi bhava'' these move properly in all ''srotas'' and cause dryness of [[kapha]] and simultaneously they nourish the ''srotas''.[149-157]

==== Dvi-panchamuladi ghritam ====

==== Dvi-panchamuladi ghritam ====

''Mudga yusha'' should be prepared by using ''kantakari'' decoction. Intake of this ''yusha'' along with ''goura amalaka'' and other ''amla dravyas'' cure all types of ''kasa''.

''Mudga yusha'' should be prepared by using ''kantakari'' decoction. Intake of this ''yusha'' along with ''goura amalaka'' and other ''amla dravyas'' cure all types of ''kasa''.

''Ksheera, yusha, mamsa rasa'' are preferred in ''kshayajakasa'' persons. For the preparation of ''mamasarasa vishkira, pratuda'' and ''bileshaya mamsa'' should be added. Always these food preparations should be prepared by ''vataghna'' drugs.

''Ksheera, yusha, mamsa rasa'' are preferred in ''kshayajakasa'' persons. For the preparation of ''mamasarasa vishkira, pratuda'' and ''bileshaya mamsa'' should be added. Always these food preparations should be prepared by [[vata]]ghna drugs.

''Dhumapana'' formulations mentioned in reference to ''kshatajakasa'' can also be administered to the patients suffering from ''kshayajakasa''.[180-186]

''Dhumapana'' formulations mentioned in reference to ''kshatajakasa'' can also be administered to the patients suffering from ''kshayajakasa''.[180-186]

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''Dipana, brihmana'' and ''srotoshodhana'' therapies should be followed alternatively in the patient suffering from ''kshyajakaasa''. All such therapies which are ''balya'' are preferred in this condition.  

[[Dipana]], [[brihmana]] and ''srotoshodhana'' therapies should be followed alternatively in the patient suffering from ''kshyajakaasa''. All such therapies which are ''balya'' are preferred in this condition.  

''Kshayajakasa'' is caused by ''sannipata''. Therefore therapies which alleviate ''tridosha'' are to be administered for the treatment.

''Kshayajakasa'' is caused by ''sannipata''. Therefore therapies which alleviate tri[[dosha]] are to be administered for the treatment.

But still ''bala'' (strength) and ''abalata'' (weakness) of the disease is determined by the nature of aggravation of associated ''dosha''. Keeping this in view, treatment should be administered.

But still ''bala'' (strength) and ''abalata'' (weakness) of the disease is determined by the nature of aggravation of associated [[dosha]]. Keeping this in view, treatment should be administered.

The physician should know that among these five kasa, the succeeding ones are more serious than the preceding.  

The physician should know that among these five kasa, the succeeding ones are more serious than the preceding.  

== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

*''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 enters and fills up all the cavities in the head.  

*[[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 enters and fills up all the cavities in the head.  

*''Udanavata'' plays key role in ''kasa''. It is located in sinuses, throat and upper respiratory tract. Its main function is to exude out secretions from head and upper respiratory tract, effortlessly.  

*Udana[[vata]] plays key role in ''kasa''. It is located in sinuses, throat and upper respiratory tract. Its main function is to exude out secretions from head and upper respiratory tract, effortlessly.  

*Due to one group of etiological factors, sinuses and bronchial tree gets filled with secretions. Another group of factors like over exertion, weaken the functions of ''udanavata'' by over consuming it.

*Due to one group of etiological factors, sinuses and bronchial tree gets filled with secretions. Another group of factors like over exertion, weaken the functions of udana[[vata]] by over consuming it.

*Since ''udanavata'' is not available, the physiological mechanism of ''kasa'' (cough reflex) starts to work causing forceful, frictionful expectoration with sound.

*Since udana[[vata]] is not available, the physiological mechanism of ''kasa'' (cough reflex) starts to work causing forceful, frictionful expectoration with sound.

*In order to prevent damage to delicate mucosa and avoid friction, treatment with good amount of ghee after meal is best.

*In order to prevent damage to delicate mucosa and avoid friction, treatment with good amount of ghee after meal is best.

*In contrast to ''hikka'' and ''shwasa, pitta'' is not involved ''kasa'' except ''paittic kasa''. </div>

*In contrast to ''hikka'' and shwasa, [[pitta]] is not involved ''kasa'' except ''paittic kasa''. </div>

 

== Vidhi Vimarsha (Applied Inferences) ==

== Vidhi Vimarsha (Applied Inferences) ==

*The soft silky touch of hands and foot

*The soft silky touch of hands and foot

*The person always finds fault with others and develops an immensely hateful disposition

*The person always finds fault with others and develops an immensely hateful disposition

*The person suffers from diseases like [[jwara]] (having signs and symptoms of all [[dosha]]s), nasal congestion, anorexia, painful flanks, and altered voice

*The person suffers from diseases like [[jwara]] (having signs and symptoms of all [[dosha]]), nasal congestion, anorexia, painful flanks, and altered voice

*Frequent hard or loose stools without apparent cause [Cha.Sa.[[Chikitsa Sthana]] 18/25-28]

*Frequent hard or loose stools without apparent cause [Cha.Sa.[[Chikitsa Sthana]] 18/25-28]

Cha. = Charak, Su. = Sushruta, A. = Ashtanga, Hr. = Hridayam, Sa. = Samhita, B.R = Bhaishajya ratnavali

Cha. = Charak, Su. = Sushruta, A. = Ashtanga, Hr. = Hridayam, Sa. = Samhita, B.R = Bhaishajya ratnavali

== References ==

== References ==