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<big>'''Abstract </big>'''
<big>'''Abstract </big>'''
<div style="text-align:justify;">
<div style="text-align:justify;">
''Hikka, shwasa'' and ''kasa'' (hiccups, 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'', and ''vyadhihara rasayana'' are followed as treatment.
''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, virehna, 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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</div>
<div style="text-align:justify;">
<div style="text-align:justify;">
Now we shall expound the chapter "Kasa chikitsa"(Management of cough of various origins). Thus said Lord Atreya.[1-2]
Now we shall expound the chapter "Kasa chikitsa"(Management of cough of various origins). Thus said Lord Atreya.[1-2]
=== Types ===
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Following are the premonitory signs and symptoms of ''kasa'':
Following are the premonitory signs and symptoms of ''kasa'':
#Sensation as if throat and mouth are filled with ''shooka'' (thorns).
#Sensation as if throat and mouth are filled with ''shooka'' (thorns).
#Itching sensation in the throat.
#Itching sensation in the throat.
#Inability to swallow food.[3-4]
#Inability to swallow food.[3-4]
=== Pathophysiology of ''kasa'' ===
=== Pathophysiology ===
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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]
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'' ===
==== Etiological factors, clinical features of ''Vataja kasa'' ====
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Following are the causative factors of ''vatika'' type of ''kasa'':
Following are the causative factors of ''vatika'' type of ''kasa'':
#Intake of ''ruksha'' (dry), ''sheeta''(cold), ''kashaya'' (stringent) type of food.
#Intake of ''ruksha'' (dry), ''sheeta''(cold), ''kashaya'' (astringent) type of food.
#Intake of food in less quantity or much less quantity or not taking food at all.
#Intake of food in less quantity or much less quantity or not taking food at all.
#Excess indulgence in ''vyavaya''.
#Excess indulgence in ''vyavaya''.
#The upward movements increases ''vata'' after digestion of food.[10-13]
#The upward movements increases ''vata'' after digestion of food.[10-13]
=== ''Pittaja kasa'' ===
==== Etiological factors, clinical features of ''Pittaja kasa'' ====
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#Expectoration of sputum mixed with ''pitta''. [14-16]
#Expectoration of sputum mixed with ''pitta''. [14-16]
=== ''Kaphaja kasa'' ===
==== Etiological factors, clinical features of ''Kaphaja kasa'' ====
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#Feeling of fullness in the chest [17-19]
#Feeling of fullness in the chest [17-19]
=== ''Kshataja kasa'' ===
==== Etiological factors, clinical features of ''Kshataja kasa'' ====
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Excessive indulgence in ''vyavaya'', carrying excessive heavy load, walking excessively long distance, indulgence in fighting, excessive indulgence in restraining the movement of horses and elephants etc factors cause injury to the chest and bring about ''rukshata'' in the body and in turn causes aggravation of ''vata'' there by results in the manifestation of ''kshataja kasa''.
Excessive indulgence in ''vyavaya'', carrying excessive heavy load, walking excessively long distance, indulgence in fighting, excessive indulgence in restraining the movement of horses and elephants etc. factors cause injury to the chest and bring about ''rukshata'' in the body and in turn causes aggravation of ''vata'' there by results in the manifestation of ''kshataja kasa''.
Signs and symptoms of ''kshataja kasa'' are as follows:
Signs and symptoms of ''kshataja kasa'' are as follows:
#While coughing, sounds humming like pigeon. [20-23]
#While coughing, sounds humming like pigeon. [20-23]
=== ''Kshayaja kasa'' ===
==== Etiological factors, clinical features of ''Kshayaja kasa'' ====
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''Kshataja kasa'' is palliable if the patient is strong. If these two diseases(''kshataja'' and ''kshayaja'') are in their initial stage and if all four ''chikitsa chatushpada'' are endowed with efficiency, then both of these are curable. All types of ''kasa'' are however palliable if the patient is old. [24-30]
''Kshataja kasa'' is palliable if the patient is strong. If these two diseases(''kshataja'' and ''kshayaja'') are in their initial stage and if all four ''chikitsa chatushpada'' are endowed with efficiency, then both of these are curable. All types of ''kasa'' are however palliable if the patient is old. [24-30]
=== Prognosis ===
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Treatment of different types of ''kasa'' has been described here after.[31]
Treatment of different types of ''kasa'' has been described here after.[31]
=== Treatment ===
=== Management ===
=== Management of vata dosha dominant kasa ===
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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 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]
=== ''Kantakari ghrita'' ===
==== ''Kantakari ghrita'' ====
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Thirty ''pala'' of ''kantakari'' and ''guduchi kashaya'' each is to be boiled with ''ghrita'' to prepare 1 ''Prastha'' of ''ghrita''. This particular ''ghrita'' is beneficial in ''vatika kasa''. It promotes the power of digestion. Thus ends the description of ''kantakari ghrita''.[35]
Thirty ''pala'' of ''kantakari'' and ''guduchi kashaya'' each is to be boiled with ''ghrita'' to prepare 1 ''Prastha'' of ''ghrita''. This particular ''ghrita'' is beneficial in ''vatika kasa''. It promotes the power of digestion. Thus ends the description of ''kantakari ghrita''.[35]
=== ''Pippalyadi ghrita'' ===
==== ''Pippalyadi ghrita'' ====
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Thus ends the description of ''pipplyadi-ghrita''.[36-38]
Thus ends the description of ''pipplyadi-ghrita''.[36-38]
=== ''Tryushanadi ghrita'' ===
==== ''Tryushanadi ghrita'' ====
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Thus ends the description of ''tryushanadi ghrita''. [39-42]
Thus ends the description of ''tryushanadi ghrita''. [39-42]
=== ''Rasna ghritam'' ===
==== ''Rasna ghritam'' ====
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Thus ends the description of ''rasna- ghrita''.[43-46]
Thus ends the description of ''rasna- ghrita''.[43-46]
==== Various formulations ====
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Powder prepared out of ''vidanga, saindhava lavana, kushtha, vyosha, hingu, manahshila'' taken along with ''madhua'' and ''sarpi'' in the form of ''leha'' eradicates ''kasa, hikka'' and ''shwasa''.[47-52]
Powder prepared out of ''vidanga, saindhava lavana, kushtha, vyosha, hingu, manahshila'' taken along with ''madhua'' and ''sarpi'' in the form of ''leha'' eradicates ''kasa, hikka'' and ''shwasa''.[47-52]
=== ''Chitrakadi leha'' ===
==== ''Chitrakadi leha'' ====
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Thus ends the description of ''chitrakadi leha''.[53-56]
Thus ends the description of ''chitrakadi leha''.[53-56]
=== ''Agastya haritaki'' ===
==== ''Agastya haritaki'' ====
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Thus, ends the description of ''Agastya-haritaki''.[57-62]
Thus, ends the description of ''Agastya-haritaki''.[57-62]
=== Other formulations ===
==== Other formulations ====
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Intake of ''khadira saara'' along with ''madira'' or ''takra''; intake of ''pippali'' fried with ''ghrita'' mixed with ''saindhava'' is beneficial in ''vataja kasa''. [63-64]
Intake of ''khadira saara'' along with ''madira'' or ''takra''; intake of ''pippali'' fried with ''ghrita'' mixed with ''saindhava'' is beneficial in ''vataja kasa''. [63-64]
=== ''Dhuma'' (medicated smoking) formulations ===
==== ''Dhuma'' (medicated smoking) formulations ====
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''Peya'' prepared out of ''matsya, kukkuta, varaha mamsa'' by adding ''ghrita'' and ''saindhava lavana'' should be taken by a person suffering from ''vataja kasa''. Vegetables like ''vastuka, vayasi, mulaka, sunishannaka'' should be used in ''vataja kasa'' along with adequate quantity of ''sneha, kshera, ikshurasa'' and ''gud''. ''Aranala, amla phala, prasanna'' etc foods and drinks which are ''madhura, amla, lavana'' in nature are useful in ''vataja kasa''.[76-82]
''Peya'' prepared out of ''matsya, kukkuta, varaha mamsa'' by adding ''ghrita'' and ''saindhava lavana'' should be taken by a person suffering from ''vataja kasa''. Vegetables like ''vastuka, vayasi, mulaka, sunishannaka'' should be used in ''vataja kasa'' along with adequate quantity of ''sneha, kshera, ikshurasa'' and ''gud''. ''Aranala, amla phala, prasanna'' etc foods and drinks which are ''madhura, amla, lavana'' in nature are useful in ''vataja kasa''.[76-82]
=== Management of ''pittaja kasa'' ===
=== Management of pitta dosha dominant kasa ===
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Thus ends the description of ''pittaja kasa''. [83-107]
Thus ends the description of ''pittaja kasa''. [83-107]
=== Management of ''kaphaja kasa'' ===
=== Management of kapha dosha dominant kasa ===
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Intake of the powder prepared out of ''souvarchala, abhaya, dhatri, pipplai, kshara'' and ''nagara'' taken along with ''ghrita'' cures ''kasa'' caused by ''vata'' and ''kapha''. [112-122]
Intake of the powder prepared out of ''souvarchala, abhaya, dhatri, pipplai, kshara'' and ''nagara'' taken along with ''ghrita'' cures ''kasa'' caused by ''vata'' and ''kapha''. [112-122]
=== ''Dashamuladi ghritam'' ===
==== Dashamuladi ghritam ====
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Thus ends the description of ''dashamooladi ghrita''. [123-124]
Thus ends the description of ''dashamooladi ghrita''. [123-124]
=== ''Kantakari ghritam'' ===
==== Kantakari ghritam ====
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Thus ends the description of ''kantakari-ghrita''.
Thus ends the description of ''kantakari-ghrita''.
=== ''Kulatthadi ghritam'' ===
==== Kulatthadi ghritam ====
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Thus ends the description of ''kulatthadi- ghrita''. [125-129]
Thus ends the description of ''kulatthadi- ghrita''. [125-129]
=== ''Dhuma formulations'' ===
==== ''Dhuma formulations'' ====
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''Dhuma yogas'' which have been mentioned at the context of ''vatajakasa'' can also be administered in ''pittaja kasa''. Specifically ''manshilla'' kept inside the ''koshataki phala majja'' is useful in the form of ''dhupana'' in ''kaphaja-kasa''. [130]
''Dhuma yogas'' which have been mentioned at the context of ''vatajakasa'' can also be administered in ''pittaja kasa''. Specifically ''manshilla'' kept inside the ''koshataki phala majja'' is useful in the form of ''dhupana'' in ''kaphaja-kasa''. [130]
=== Principles of treatment in various states of ''dosha'' ===
=== Principles of treatment in various states of [[dosha]] ===
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Thus ends the description of ''kaphaja kasa''.[131-134]
Thus ends the description of ''kaphaja kasa''.[131-134]
=== Management of ''kshataja kasa'' ===
=== Management of kshataja kasa (due to injury) ===
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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]
=== Management of ''kshayaja kasa'' ===
=== Management of kshayaja kasa (due to depletion)===
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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 ====
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Thus ends the description of ''dwi-pancha-mooladi-ghrita''.[158-160]
Thus ends the description of ''dwi-pancha-mooladi-ghrita''.[158-160]
=== ''Guduchyadi ghritam'' ===
==== Guduchyadi ghritam ====
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All the above mentioned ''ghrita'' will promote agni of the patient suffering from ''kshayajakasa''. These also cleanse the adhered ''doshas'' from the ''srotas'' of ''koshtha'' and ''uras''.[163-167]
All the above mentioned ''ghrita'' will promote agni of the patient suffering from ''kshayajakasa''. These also cleanse the adhered ''doshas'' from the ''srotas'' of ''koshtha'' and ''uras''.[163-167]
=== ''Haritaki leha'' ===
==== ''Haritaki leha'' ====
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Thus ends the description of ''haritaki-leha''. [168-169]
Thus ends the description of ''haritaki-leha''. [168-169]
=== ''Padmakadi leha'' ===
==== ''Padmakadi leha'' ====
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''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]
==== Principles of management ====
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