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Hikka (hiccups) and shwasa (dyspnea/shortness of breath) may be caused due to pandu roga. (Chakrapani Cha. Chi 17/1). That is why this chapter follows the chapter on Pandu Chikitsa. Hikka and shwasa have common etiological factors (karana) like raja (pollen or dust particles), dhuma (smoke) etc., location (sthana) and treatment or mula.[Indu commentary A.H chikitsa 4/1-2] For that reason, both conditions are described in the same chapter.[Su U 51/3 & ch.chi 17/70]
 
Hikka (hiccups) and shwasa (dyspnea/shortness of breath) may be caused due to pandu roga. (Chakrapani Cha. Chi 17/1). That is why this chapter follows the chapter on Pandu Chikitsa. Hikka and shwasa have common etiological factors (karana) like raja (pollen or dust particles), dhuma (smoke) etc., location (sthana) and treatment or mula.[Indu commentary A.H chikitsa 4/1-2] For that reason, both conditions are described in the same chapter.[Su U 51/3 & ch.chi 17/70]
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Which among these diseases is most difficult to cure?” [3-4] Cross ref: invincible ( Dukhena jetum Shakya:) & Ch.chi 27/6-9]
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Five types of hikka and shwasa, based on etiology, signs, symptoms and treatment are being elaborated here, listen to them carefully[10] [Cross ref.ch.su 11/]
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rapid change in exposure to heat and cold [1016] [Vangasena ref]
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verse 18:
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Vitiated kapha when lodged in the pranvaha Srotas produces obstruction to the normal functioning of vayu and is considered as the one of the factor to vitiate vayu. Acharya Charak described Samanya Samprapti of Śvāsa in Chikitsa Sthana. According to him, Nidana sevana leads to vitiation of Vāta gets propelled into Pranavaha srotas (Respiratory Channels) and provokes the Urastha Kapha (Kapha staging in chest). This provoked Kapha inturn obstructs the Pranavaha srotas (Respiratory Channels) and gives rise to five types of Hikka and Śvāsa.
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According to Vagbhata, vitiated kapha is responsible for obstruction, so that vayu is vitiated. Vitiated Vāta dosha which is Ruksha, Shuska and Laghu produces Ruksata, kathinnyata and sankocha in Pranvaha srotas. Udakavaha srotas & Annavaha srotas also get deranged.
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verse 18-20:
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Hrit peeda - Due to heavy mucus lodged in chest it causes congestion and tightness in chest and causes discomfort in the chest region. Increased respiration causes fatigue of the respiratory muscles thereby leading to chest pain.
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Shoola - Due to utilization of accessory respiratory muscles for fast respiration during episode and due to continuous cough and due to bronchial constriction ron muscles of chest, flanks, and abdomen get strained and lead into painful breathing.
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Arati, Bhaktadwesha and Vaktravairasya: Due to formation of ama or increase in kapha as a consequence of mandagni leads to these symptoms.
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Adhmana and anaha: Intake of viruddha ahara and Vihara causes agnimandya, formation of Ama which accumulates offering obstruction to the movement of vāta leading to difficulty in expulsion of mala and vāta resulting in anaha and distention of abdomen.
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Pranavilomata: Vitiated kapha due to Agnimandya and the inflammation in respiratory tract causes Viloma gati of Prana Vayu. This leads to difficulty in breathing, uneasiness, chest pain and exhaustion. There is arrhythmic respiration due to prana vāta viloma gati.
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Shankha bheda: Excess consumption of causative factors of Śvāsa roga causes Vāta prakopa which leads to the reverse course of Vāta due to this vitiated vāta patient feels severe pain at temporal region.