Charaka Hikka Shwasa Chikitsa 17th Chapter

asthma

17th chapter of Charaka Samhita Chikitsasthana is called Hikka Shwasa Chikitsa. It deals with treatment for hiccups, asthma and respiratory disorders with difficulty in breathing.Treatment of Hiccup and Asthma
Let us explore the chapter on the treatment of Hikka – hiccough (Hiccup) an Shwasa(asthma). Thus, said Lord Atreya [1-2]

Serious Nature of hiccups and dyspnoea related respiratory disorders:
Agnivesha, the learned disciple with folded hands, asked Lord Punarvasu Atreya, the illustrious sage proficient in spiritual and sane knowledge, the following questions:
All diseases that are caused by Tridosha imbalance can be classified into two. The ones that can be cured and the other, incurable. Please elaborate in incurable diseases.
After having heard this query of Agnivesha, Lord Punarvasu, the wisest among the learned, was immensely pleased and made a decisive statement –
“It is true that there are several diseases which can kill a patient. But none of these is as deadly as asthma and hiccup that can kill a patient instantaneously. Even if the patient has been ailing with several other types of diseases, ultimately, at the time of death, he falls victim to hiccup and difficulty to breathing that are intensely painful”. [3-7]

Hikka Swasa pathogenesis

Pathogenesis of Hikka (hiccough) and Shwasa (respiratory disorders with difficulty in breathing):

Origin: From site of Pitta
Caused by: The simultaneous aggravation of Kapha and Vata
Afflicts: The cardiac region (hrudaya) and all the 7 Dhatus (Rasa, Rakta etc)
Curability: Difficult of cure and have common pathogenesis.
If these two diseases are not properly treated at the right time or if the patient indulges in unwholesome regimen, these diseases being exacerbated become fatal like the deadly snake-venom [8-9]

Types

Hikka and Shwasa Bheda, Nidana:
Types and causes of Hikka and Shwasa:
Each of these 2 diseases is described in the Roga- sangraha as of 5 types.
Etiology, signs and symptoms, and treatment (of these diseases) are being described here after.

Etiological factors:
Both Hikka – hiccups and Shwasa – respiratory disorders with difficulty in breathing is influenced by aggravated Vata and Kapha Dosha. Hence, all diet and activities that cause increase of these two Doshas may cause the above said two diseases.

Causes

Rajasa Dhooma Vatabhyam – Exposure to dust, smoke and wind
Residing in a cold place and use of cold water
Exercise, sexual intercourse and long walk beyond one’s capacity
Habitual intake of dry foods
Intake of food, deficient or excessive in quantity, and before or long after the meal time
Vitiation by Ama (product of improper digestion and metabolism)
Constipation associated with flatulence (Anaha)
Rooksahata – Dryness
Apatarpanaat – Fasting in excess
Weakness and injury to vital organs (Marmas)
Use of mutually contradictory ingredients
Shuddhi Atiyoga – Excessive administration of elimination therapies;
As a secondary affliction to Diarrhoea, fever, vomiting, Pratishyaya – coryza, phthisis, Depletion of body tissues, RaktaPitta (bleeding from different parts of the body), Udavarta (upward movement of the abdominal gases), Visuchika – Cholera, Alasaka (Intestinal torpor), Pandu (anemia) and poisoning.
Habitual intake of Nishpava – flat bean, black gram (masha), oil cake (Pinyaka) and excess consumption of sesame oil
Intake of Pastry (Pishta), Shaluka (Rhizome of lotus),
Vishtambhi – wind / gas forming ingredients,
Vidahi (ingredients which cause burning sensation in the abdomen and chest) and heavy food.
Intake of the meat of aquatic (Jalaja) and marshy animals (Anoopa)and birds (Pishita)
Intake of excess of curd and un-boiled milk (Ama Ksheera)
Intake of Abhisyandi (ingredients which cause obstruction to the channels of circulation)
Intake of kapha- aggravation ingredients
injury to throat and chest and
Different types of obstruction to the channels of circulation.[10-16]

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Hikka Shwasa Samprapti: Pathogenesis
Pathogenesis of Hikka and Shvas:
Vata Dosha located in the chest after afflicting the channels carrying vital energy (pranavaha- srotas), gets aggravated and stimulates Kapha.
This leads to the causation of these 2 deadly diseases viz, hiccup and Shwasa which are of 5 types each and which may lead to the death of the patient. [17 ½- ½ 18]

Hikka Swasa Poorvaroopa

The premonitory signs and symptoms of hiccup are as follows:
Kanta uru gurutvam – Heaviness of the chest and throat
Vadanasya kashaya – Appearance of astringent taste in the mouth and
Kukshi aatopa – Distension in the pelvic region (Kuksi)

The premonitory signs and symptoms of asthma are as follows:
Anaha – Constipation with flatulence
Parshva shulam – Pain in the sides of the chest
Hridaya pidana – Pain in the cardiac region and
Reservation (vilomatva) of the preparatory functions (Prana). [18 ½ – 20]

Disease- Treatment Of Charaka Samhita Made Easy

Hikka Samprapti: Specific Pathogenesis of Hikka:
Vata along with Kapha, having obstructed the
1. Pranavaha Srotas – channels carrying vital breath
2. Udakavaha Srotas – channels carrying watery elements and
3. Annavaha Srotas – Anna-Vaha- Srotas causes hiccup.
The signs and symptoms of various types of hiccup will be described hereafter. [21]

Maha Hikka

A. Mahahikka – Samprapti, Lakshana:

Pathogenesis, Signs and Symptoms of Maha- Hikka:
Vata in association with Kapha suddenly afflicts the throat of the patient who has depleted muscle tissue, strength, Elan Vitae (Prana) and lustre. It causes hiccup with exceedingly loud as well as resonant sound. This variety of hiccup is characterized by 1, 2 or 3 bouts at time, continuously.

The Prana-vayu obstructs the channels of circulation, vital parts (marma) as well as the heart of the patient. It makes the patient unconscious, and brings about stiffness of the body. His obstructs the channels of food and drinks.
He loses memory; his eyes become full of tears, his eye- brows become displaced because of stiffness of the temple; he gets delirium accompanied by choked voice; and he does not get any relief whatsoever. This disease is known as Maha- Hikka.
It is exceedingly deep- rooted (Maha- mula); its attack is enormous (maha- vega); is causes the patient to produce exceedingly loud sound (Maha- shabda) and its attacks are very strong (maha- bala). It may cause death of the patient instantaneously. Thus, end the description of Maha- Hikka. [22-26]

Disease- Treatment Of Charaka Samhita Made Easy

Gambheera Hikka

The patient is usually aged, emaciated and dispirited
He frequently hiccups, and produces deep, painful and resonant sounds with his afflicted chest
He yawns, contracts and expands his body
He raises both the sides of his chest making murmuring sound, afflicted with stiffness and pain
He gets hiccup from the umbilical and gastric regions with pain all over the body
His body bends and he gets shivering
His expiration is obstructed and
There is impairment of strength and consciousness
This type of Gambhira- Hikka may cause death. [27-30]

Vyapeta Hikka

C. Vyapeta Hikka: Vyapeta type of hiccup is produced during the course of  intake of the 4 drinks.
It gets exceedingly aggravated after the digestion of food. Its signs and symptoms are.
Pralapa – Delirium, Vamya – Vomiting,
Atisara – Diarrhoea, Trushna – Morbid thirst
Jrumbha – Yawning,
Vipluta aksha – Tearful eyes,
Suskha aksha – dryness of the mouth and contraction of the body and
Flatulence all around the body
Origin: From the base of the clavicle and the attack does not continue for a long time.
This type of Hikka – hiccough is called Vyapeta, and it is injurious to life. [31-33]

Kshudra Hikka

D. Kshudra Hikka ; Minor hiccup:
When the Vayu, which is slightly aggravated in the gastro intestinal region, is pushed up by physical exercise and arrives at the throat region, it causes Kshudra- Hikka (minor type of Hiccup).
It is not very painful. It does not exceedingly afflict the chest, head or vital organs (Marma). It also does not obstruct the channels of breath, food and drinks.
It gets aggravated during the course of exertion, and it becomes milder immediately after the meals.
It subsides immediately after its onset by implication, it does not continue for a long period.
It is located in the cardiac region, Kloman (Lungs / pancreas), throat and palate in a mild form.
This is called Ksudra- Hikka – hiccough, and it is curable. [34-37]

Annaja Hikka

E. Annaja Hikka
Vata gets aggravated and moves upward in the Gastro intestinal tract because of the following:
Sudden intake of drinks and food in large quantity
Intake of excessively intoxicating alcohol and
Excessive anger, speech, long walk, laughter for a long time, and carrying heavy weight.
Being pressed by the drinks and food, this aggravated Vayu located in the Gastro- Intestinal tract quickly moves up to the channels in the chest and being located there, causes hiccup of Annaja type.
The Patient hiccups slowly and interruptions even while he sneezes. It does not cause and affliction of the vital spots (Marma) and sense organs. This type of hiccup gets alleviated by the intake of drinks and food. This is called Annaja Hikka – hiccough.
Thus, ends the description of Annaja- Hikka – hiccough. [38- 41]

Yamaka Hikka

Yamaka Hikka ; hiccough
Nidana: If the vitiated Doshas are accumulated in excess,
If there is weakness because of want of food,
If the body is emaciated on account of diseases,
If the patient is old, and
If a person over- indulges in sex,
He is liable to be afflicted by hiccup which can cause death instantaneously.
This is called Yamaka- Hikka – hiccough.
Signs and Symptoms: It is associated with
Pralapa – delirium,
Arti – pain,
Trushna – morbid thirst and
Moha – unconsciousness

Curability

Hikka is curable if ;
The patient is not emaciated (no depletion of muscle tissues),
If he has not lost his will power (mental stamina) and
If Dhatus (tissue elements) and Indriyas (senses) are not impaired,
Otherwise, it is fatal. [42- 44]

Pathogenesis of Shvasa roga

Vata predominantly associated with Kapha obstructs the channels of circulation, and circulates all over the body, gets itself obstructed in the circulatory course, this aggravated Vayu causes Shwasa. [45]

Maha Shwasa

Because of the upward movement of aggravated Vayu, patient takes deep breath associated with loud sound continuously, like an intoxicated bull, on account of obstruction to the respiratory channel.

Signs and symptoms:
Loss of physical and mental senses;
His eyes (eyeballs) become bewildered;
His eyes and face become distorted;
Anemia and constipation;
Voice becomes feeble;
Loses mental stamina, and
His deep inspiration becomes audible even from a distance.
Curability: The patient succumbs to death instantaneously.
Thus, ends the description of Maha Shvasa. [46-48]

Urdhwa Shwasa

B. Urdhwa Shwasa – signs and symptoms:
Dirgha shvasam – Prolonged expiration and inability to have inspiration
Sleshma Aavruta mukha srotas – Adhesion of the mouth and (breathing) channels with Phlegm
Kruddha vata – Affliction with aggravated Vayu
Urdhva Drishti – Looking with the eye- balls moved upwards.
Vibhranta aksha – Bewilder eyes
Pramuhyan – Unconsciousness
Vedana aarta – Affliction with excessive pain
Shushka aasya – Dryness of the mouth and
Dislike for everything
When the upward moving breath (expiration) is aggravated, obstruction is caused to the downward moving breath (inspiration), because of which the patient becomes unconscious with tremors in his body.
The ailment having the above mentioned signs and symptoms is called Urdhva- Shwasa, and it causes death (of the patient)
Thus, ends the description of Urdhva Shwasa. [49- 51]

Chinna Shwasa

C. Chinna Shwasa
The signs and symptoms of Chinna- Shwasa are as follows:
Shvasiti vichinnam sarva pranena piditah – Interruption of stoppage of breath on account of affliction of all the channels carrying vital air (Prana-vayu)
Dukharta – Great distress
Marma chheda – Affliction with pain as if a vital organ (Marman) is injured’
Affliction with constipation associated with flatulence (Anaha), Sweda (Sweating) and Murchha (fainting)
Basti Daha – Burning sensation in the region of the urinary bladder
Excessive tears in the eyes
Excessive emaciation
Raktaika lochana – One of the eyes becomes red while the patient struggles for breath
Mental bewilderment
Pari shushha aasya – Dryness in the mouth
Vivarna and Pralapa – Discoloration of skin and delirium and
Looseness of the joints.
The patient afflicted with Chinna-Shwasa, having the above mentioned signs and symptoms succumbs to death instantaneously.
Thus, ends the description of Chinna Shwasa.

Tamaka Shwasa

D. Tamakashwasa
Vata moving in the reverse order pervades Pranavaha Srotas – channels of vital breath, afflicts the neck and head, and stimulates phlegm to cause rhinitis.
This vayu, thus obstructed, produces the following signs and symptoms:
Ghurghuraka (wheezing or murmuring sound)
Dyspnoea of exceeding deep velocity which is immensely injurious to life
Because of acute spasms, the patient gets tremors and coughs, and becomes motionless
Pramoham – He faints again and again while coughing
Since the phlegm does not come out, he becomes very restless;
He is relieved of restlessness for some time soon after the phlegm comes out
His throat is choked because of which he is unable to speak freely
Lack of sleep. While lying down for sleep, the difficulty in breathing increases because the sides of chest in that position get afflicted by Vayu. But he is relieved of this discomfort in sitting posture.
He develops special liking for hot things.
His eye balls become prominent (project outside)
Excess sweating in forehead and restlessness, dry mouth
Frequent outbursts of dyspnoea and
The attack gets aggravated when clouds appear in the sky, when he is exposed to water, humidity and cloud when the easterly wind blows, and when he resorts to Kapha- aggravating food and regimes.
This disease Tamaka Shwasa is curable in early stages and generally palliable. [55-62]

Pratamaka Shwasa

If a patient suffering from Tamaka- Shwasa gets afflicted with fever and fainting, then the condition is called Pratamaka. This is caused by Udavarta ; bloating (upward movement of Vayu in the abdomen), dust, indigestion, Humidity (Kleda) and suppression of the natural urges (Kaya- nirodha) it gets aggravated in darkness (at night) and gets alleviated instantaneously by cooling regimen.

Santamaka Shwasa

Kshudra Shwasa

If such a patient feels as if he is submerged in darkness, then this condition is called Santamaka.
Thus, ends the description of Pratamaka and Santamaka types of Shvasa. [63-64]

E. Kshudra Shwasa
Vayu, mildly aggravated in the Kostha (gastro intestinal tract) on account of exertion and dry food and regimen, causes Kshudra- Shwasa (mild dyspnoea). It does not cause much discomfort in the body.
The body is not excessively afflicted thereby. It is not as painful as other forms of Shvasa (asthma). It does not obstruct the proper movement of food and drinks. It does not cause any pain or complication in the sense organs. This variety of dyspnoea is curable
All the other varieties of Shwasa (asthma) can also be cured if their signs and symptoms are not fully manifested and if the patient is strong (physically and mentally).
Thus, all the varieties of Shwasa (asthma) and Hikka ; hiccough (hiccup) are explained along with their signs and symptoms. [65- ½ 68]

Prognosis

Patients suffering from the varieties of asthma which are fatal because of their serious nature (ghora) and because of their acuteness (Ashukarin) are not treated.
On the other hand, the curable and palliable varieties of asthma should be treated with due care by medicines without loss of any time. For if ignored (in the beginning) even they can cause death, like fire spreading and burning out dry grass [68 ½ – 69]

Chikitsa Sutra

Line of treatment
The sages, on the basis of their experience, have prescribed the same line of treatment for both hiccup and Shwasa. This is because of the similarity in causative factors, location of pathology, Doshas involved and similar pathogenesis. Now, the details of their line of treatment are explained.

The physician should treat the patient afflicted with hiccup and Asthma, in the beginning, with –
Snigdha Sweda – unctuous fomentation therapies like Nadi- Sveda, Prastara- sweda, after anointing the body with oil, mixed with salt. This Snigdha Sweda dissolves knotted and granular Kapha. It makes sticky Kapha to detach from the respiratory channels (Pranavaha Srotas). It softens channels and causes normal movement of Vata Dosha by relieving obstruction.
As the snow melts over the creepers in the stable Kapha in the body gets dissolved on account of the hot rays of the sun, so does the stable Kapha in the body gets dissolved on account on the heat generated by these fomentation therapies.
After ascertaining that the patient is properly fomented, the patient should be given rice mixed with ghee, or soup of the fish or pork, followed by the cream of curd (Dadhi sara) to eat.
This causes aggravation of Kapha Dosha. The patient, is then be given emetic therapy, mixed with Pippali – long pepper, Saindhava – rock salt and honey. Care is taken that no Vata- aggravating ingredients are added to the recipe.
The patient gets relief after the vitiated Kapha is eliminated. When the channels of circulation are made clear (free from impediments) then Vayu moves in the channels at ease without any obstruction. [70-76]

Dhumapana

Dhumapana – Smoking- therapy:
If in spite of Snehana, Swedana and Vamana treatments, if the residual Doshas still remains to the channels, this is eliminated by the administration of Dhumapana smoking therapy.
For this purpose, a Varti (cigarette or elongated pill) should be prepared with the paste of turmeric, Patra, castor root, Laksha ; Laccifer lacca , Manahsila, Devadaru—Cedrus deodara, Ala (Haritala) and Jatamamsi. This cigarette (elongated pill) is smeared with ghee, and used for smoking. Alternatively, barley mixed with ghee can also be used for the smoking therapy.

Read more about how to do smoking therapy and benefits

Other recipes of smoking therapy which are also useful in these conditions are as follows:
Bees’s wax and sarja- Rasa (Gum resin from the tree called Sarja) mixed with ghee is covered all around with arsenic (Malla) and kept inside two earthen plates. The fume which comes out of it by application of the heat by fire below is used for smoking.
Inside the above mentioned Sarava- Samputa(two earthen plates), the horn, hair and sinew of cattle can be mixed with ghee and kept, surrounded by Malla. The fume which comes out by the application of the heat of fire can be used for this smoking
Padmaka, Guggulu, Aguru (Loha) and Shallaki may similarly be added with ghee, surrounded by Tala and kept inside the Sarava- Samputa. The fume which comes out of it by the application of heat below may be used in this smoking therapy.
The dried tender stems of Shyonaka ; Oroxylum indicum, castor ; Ricinus communis and Kusha grass ; Desmostachya pinnata are used as a pipe to enable the patient to smoke the fume of the above mentioned recipes placed inside the Sharava Samputa. [77-80]

Therapies to treat complications of Hikka and Shwasaroga:

If hiccup and asthma are associated with
Swara-Kshaya (thin voice or inability to speak),
Atisara – Diarrhoea,
Rakta Pitta (a disease characterised by from different parts of the body) and
Daha – burning sensation, then the patient is treated with ingredients which are sweet, unctuous, cooling etc. [81]

Patients unsuitable for fomentation

Patients Unsuitable for Fomentation Therapy:
Patient afflicted with the following ailments are unsuitable for fomentation therapy
Daha – Burning sensation
Pitta roga – Diseases caused by Pitta
Ati rakta srava – Excessive bleeding
Ati sweda – Excessive sweating
Kshina dhatu bala – Feebleness of tissue element
Ruksha – Dryness in excess and
Garbhini – Pregnant woman and the patient who is of Pitta- Prakrti (Paittika constitution). [82]

Alternate Fomentation Therapy for Unsuitable Patients
Depending upon the description of physician, such patients could be given mild fomentation therapy for a moment in their chest and neck by sprinkling luke-warm oil (Sneha) mixed with sugar and thereafter, by applying Upanaha with Utkarika (recipe for fomentation which is warm and which is in paste form).

Utkarika (poultice) prepared with the powders of Vayu- alleviating ingredients like Tila – Sesamum indicum, Uma – Linseed and black gram, mixed with oil, and cooked with sour drugs or milk is useful for this type of fomentation. [83-84]

Management of complications

If the patient of hiccup and asthma suffers from fever (occurred recently) or Ama Dosha (ailments caused by Ama or uncooked products of food), then Rooksha Sweda (Dry type of fomentation) and fasting therapy – Langhana are administered.

After proper examination, such patient may also be given Vamana by administering saline water.
If Vata is increased due to excess Vamana treatment, then juice (decoction) of Vayu- alleviating herbs or massage with such ingredients as are neither very cold nor very hot (i.e Luke warm) is administered.

If the patient suffers from
Udavarta ; bloating (upward movement of Vayu) or
Adhmana (flatulence), then he is given food along with
Matulunga ; Citrus medica,
Amla-Vetasa – Garcinia pedunculata
Hingu ; Asafoetida
Pilu and
Bida salt
This type of food helps in the downward movement (Anulomana) of Vayu. [85-87]

Management of 4 Different Conditions of Patients
Patients suffering from hiccup and asthma are of 4 categories as follows:
Balavan – Strong
Durbala – weak
Kapha adhikyata -Kapha is Predominant
Vata adhikyata – Vata Dosha is predominant, and who are dry.

If Kapha is predominant and the patient has strength, then he is given wholesome food, Vamana and Virechana treatments, along with Dhumapana and Avaleha.

If Vata is aggravated, if the patient is weak, and if the patient is either an infant or old, then he or she is administered Vayu- alleviating medicines and nourishing recipes prepared of ghee (fat), Vegetable soup and meat soup. [88-99]

Contraindications for Panchakarma

If Shodhan therapy is administered to a patient whose Kapha is not loosened, who is not administered fomentation therapy and who is weak, the aggravated Vayu gets lodged in the vital spots (marma) like heart etc. and causes dryness, leading to instantaneous death. Therefore, a patient who is strong and who has aggravated Kapha, a wise physician should, first of all, administer fomentation therapy followed by the intake of soup of birds and animals living in marshy land (Anupa) and water (Varija).
This creates a sense of satisfaction (Trupti) because is administered to such patients.
If, however, the patient has aggravated Vayu, and if he is weak, then nourishing therapy is administered.
For this purpose, the meat of peacock, Tittiri (partridge), cock, and birds and animals inhabiting arid zone boiled with the decoction of Dasha-Mula or the soup of Kulattha is useful. [91-93]

Drinks

Soups and drinks for Hiccup and Asthma

Nidigdhika, the pulp of (unripe) bael, Karkata, Duralabha – Fagonia cretica / Alhagi pseudalhagi, Trikantaka – Tribulus, Guduchi ; Tinospora cordifolia, horse gram and Chitraka ; Plumbago zeylanica is boiled by adding water, and the liquid is filtered.
This liquid (decoction) is sizzled with Pippali ; Piper nigrum and ghee. Intake of this soup, by adding the powder of ginger and salt during meals is useful (for curing asthma and hiccup).

Rasna ; Alpinia galanga, Bala ; country mallow, SalaParni – Desmodium gangeticum, Prisni Parni – Uraria picta, Kantakari – Solanum surratense, Goksura – Tribulus terrestris, Mudga – green gram and Chitraka ; Plumbago zeylanica is boiled by adding water and the decoction is prepared. Soup of this decoction is prepared as mentioned above and given to the patient (suffering from hiccup and asthma) .

Tender leaves of Matulunga ; Citrus medica, neem and Kulaka is mixed with Mudga – green gram and boiled by adding water. To this decoction, salt, Kshara, Shigru ; Moringa oleifera and black pepper is cooked according to the prescribed appropriate quantity and the prescribed procedure. Intake of this alkaline soup (Ksara- Yusha) cures hiccup and Asthma.
The soup of the leaves of Kasamarda ; Cassia occidentalis or Shobhanjana or dry- radish cures hiccup and Asthma.
Similarly, the soup of Vartaka prepared along with curd, ginger, long pepper and black pepper and ghee is useful (in curing hiccup and Asthma)[ 94 ½ 100]

Diet, Yavagu

Diet and Yavagu for Hiccup and Asthma

The patient suffering from hiccup and Asthma should take food prepared of old Shali, Old Wheat or old barley.
The Yavagu (thick gruel) prepared by boiling with Hingu, Sauvarcala, Ajaji, Vida, Pauskara, Chitraka ; Plumbago zeylanica and Karkata-Srngi – Rhus succedanea is useful for the patient suffering from hiccup and Asthma.
Intake of the Yavagu prepared with the decoction of Dashamula, Shati – Hedychium spicatum, Rasna ; Alpinia galanga, Pippali- Mula ; Piper nigrum, Puskaramula – Inula racemosa, Srngi, Tamalaki ; Phyllanthus niruri, Bhargi, Guduchi ; Tinospora cordifolia and nagara ; Zingiber officinale

It is useful in;
Kasa – bronchitis,
Hrud roga -heart diseases,
Parshva shula – pain in the sides of the chest,
Hikka – hiccup and
Shvasa – asthma

Intake of the decoction alone of these drugs is also useful in the above mentioned diseases.

Foods and drinks of the patient suffering from hiccup and Asthma is given
Puskara (Puskara- Mula) ; Inula racemosa
Shati ; Hedychium spicatum
Sunthi—Zingiber officinale
Pippali ; Piper longum
Maricha ; Piper nigrum
Matulanga ; Citrus medica and
Amlavetasa – Garcinia pedunculata along with Ghee, Vida and Hingu [½ 100- 104]

Drinks for Hiccup and Asthma
If the patient suffering from hiccup and asthma is thirsty, then he should take (drink) the decoction of either Dasha-mula or Devadaru ; Cedrus deodara. He may also drink Madira(a type of alcoholics drink).
The physician should wash and crush
Patha – Cyclea peltata,
Madhurasa,
Rasna ; Alpinia galanga,
Sarala and
Devadaru ; Cedrus deodara and put these ingredients in Sura manda (a type of Alchoholic drink).
To this drink, small quantity of salt is added and given to the patient to drink .The recipe so prepared cures hiccup and asthma.
Hingu, Sauvarcala, Kola, Samanga, Pippali ; Piper longum and Bala ; Abution indicum is made to a paste by trituration them the juice of Matulunga ;Citrus medica. This paste is mixed with Aranala (a type of sour drink) intake of this drink cures hiccup and asthma.
Sauvarcala, Nagara ; Zingiber officinale and Bhargi is added with double the quantity of sugar. Intake of this potion along with warm water cures hiccup and Asthma.
The paste of Bhargi or Maricha ; Piper longm and Ksara(alkali preparation), or Pitadru, Chitraka ; Plumbago zeylanica, Asphota and Murva – Marsedenia tenacissima is mixed with warm water and given as a drink (to the patient suffering from hiccup and Asthma).
Utkarika (a preparation in paste form) is prepared of Madhulika, Tuga-Ksiri, Nagara ; Zingiber officinale and Pippali ; Piper longum by cooking with ghee. Intake of this recipe is useful when Asthma is cured by the association (Anubandha) of Pitta.

The meat of (Svavit Sallaka) or rabit or the blood of Sallaka is cooked with Pippali Ghruta. This recipe is useful when asthma is caused by the association (Anubandha) of Vayu.

The juice prepared with Sauvarchala – black salt, milk or ghee is mixed with the powder of Trikatu (pepper, long pepper and ginger). Intake of this as post prandial drink (Anupana) after taking the boiled Shali- rice is useful for the patient suffering from Asthma caused by the association (Anubandha) or Vata and Pitta.

Intake of the Juice of the flower of Shirisha ; Albizia lebbeck or Sapta Parna – Alstonia scholaris along with Pippali ; Piper longum and honey is useful for the patient suffering from Asthma caused in association (Anubhandha) of Kapha and Pitta.

Intake of liquid prepared of Madhuka ; Madhuca longifolia, Pippalimula ; Piper longum, Jaggery, the juice of the dung of cow and horse, ghee and honey.
It is useful for the patient suffering from
Kasa – bronchitis,
Shwasa – Asthma,
Hikka – Hiccup and
Abhisyandi (name of one of eye- diseases i.e conjunctivitis; but in the present context, it refers to the obstruction of the channels of circulation by Ama)
If Kapha is aggravated in excess, then along with honey, the juice of the dungs of an ass, horse, camel, pig sheep or elephant is given to the patient [105-106]

Linctus recipes

Recipes of Linctus for Hiccup and Asthma
Intake of the Alkali- Preparation of Ashwagandha ; Withania somnifera along with honey and ghee, in linctus (Lehya) from is useful for the patients suffering from hiccup and asthma.
The stalk of Peacock feather, the quills of Sallaka, hair of Svavit, jandaka, Casa or Kurara, Skin, Bones and Hooves of horned animals, animals having one hoof or two hooves, all of these separately or together is reduced to ashes by burning.
Intake of these powders in these powders in the form of linctus by adding honey and ghee cures bronchitis, hiccup and serious types of asthma.
The above mentioned diseases (Viz, bronchitis, hiccup and asthma) are caused by aggravation of Prna- Vayu because of the obstruction to its path by Kapha. Therefore, to cleanse the channel (of Prana- vayu by alleviating Kapha), these recipes of linctus should be administered.
If however, Kapha is not involved in the causation of the diseases, then the above mentioned recipes of linctus should be administered. [117- 120]

Choice of Vamana and Virechana

PanchaKarma Therapy – choice of Vamana and Virechana:
If the patient suffering from hiccup and asthma get afflicted with Kasa – bronchitis, Swara bheda – hoarseness of voice, then they are given emetic therapy by a wise physician.
Patients suffering from Tamaka Shwasa (Asthma) are given purgation therapy. – Tamake Tu Virechanam.
The ingredients for emetic and purgation therapies should have qualities to alleviate Vayu and Kapha.
If the flowing of a river obstructed on its way, then the level of water rises further. Similarly, if the channels carrying mobile Vayu (in the chest) get obstructed, then the Vayu located at the point of obstruction gets very much aggravated. Therefore, the channels of Vayu should always be cleansed [by the elimination of obstructing Doshas]. [121-122]

Shatyadi Churna

Shati – Hedychium spicatum, Choraka, Jivanti- Leptadenia reticulata, Tvak, Musta ; Cyperus rotundus, Puskaramula ; Inula racemosa, Surasa, Tamalaki ; Phyllanthus niruri, Ela ; Ellattaria cardamum,Pippali ; Piper longum, Aguru ; Aquallaria agllocha and Balaka is taken in equal quantities and made to a powder.
To this powder, 8 parts of sugar is added. This recipe is always administered to the patient suffering from Tamaka ;Shwasa (Asthma) and hiccup. [123- 124]

Muktadya Churna

1 pani-tala of the powder of each of
Mukta – pearl
Pravala – coral
Vaidurya
Sankha – conch
Anjana,
Sasara-gandha (red variety of saindhava-Lavana),
Tamra-bhasma – calx of copper
Lauha- Bhasma – calx of Iron
Raupya- Bhasma,
Gandhaka,
Naga- Bhasma
Jatiphala – Myristica fragrans
Seeds of Sana and
Dehusked seeds of Apamarga ; Achyranthes aspera are mixed with honey and ghee in equal quantities. Intake of this linctus instantaneously cures hiccup and asthma.
Application of this recipe in the form of collyrium cures
Timira,
Kaca,
Nikika,
Puspaka,
Tamas,
Malya,
Kandu,
Abhisyanda and Arman.
Thus, ends the description of Muktadya-Churna [125- 128]

Recipes for Inhalation Therapy etc
The powders of ; Hedychium spicatum and Puskara- Mula ; Inula racemosa or Amalaki ; Phyllanthus emblica or Kala-loha is made to a linctus and taken by the patient suffering from hiccup and Asthma.
Tamalaki ; Phyllanthus niruri, Draksa ; Vitis vinifera and the juice of the dung of a cow and a horse mixed with sugar is given to the patient suffering from hiccup and Asthma.
Can be taken as a linctus or to be used for the purpose of inhalation therapy. Similarly, Jaggery and ginger, taken in equal quantities can be used for the same purpose.
Mixed with the breast milk of woman, garlic, onion , root of grnjanaka or Chandana ; Santalum album can be administered as inhalation therapy to a patient suffering from hiccup and asthma.
Lukewarm ghrita Manda (scum of ghee) sprinkled with the powder of rock salt may similarly be used for inhalation therapy.

The stool of flies mixed with the juice of Alaktaka, or cooked by adding woman’s breast milk or added with ghee medicated by boiling with drugs having sweet taste(belonging to Jivaniya group) can be given as a drink, or for inhalation therapy which instantaneously cures hiccup.

Alternately, hot and cool milk mixed with sugar and honey is administered as a drink or for inhalation therapy to the patient suffering from hiccup. [129-134]

Recipes for hiccup:
Administration of the medicated ghee prepared by boiling purgative drugs instantaneously cures hiccup.
Similarly, the linctus prepared of Laja, Laksa, Madhu, draksa – Vitis vinifera , Pippali – Piper longum and the juice of the dung of a horse, or of Kola, Madhu, Draksa—Vitis vinifera, Pippali ;Piper longum and Nagara ; Zingiber officinale cures hiccup. [135-136]

Regimen to Avert Attacks of Hiccup
Subjecting the patient to sudden sprinkling of cold water, intimidation, distraction of memory and fear, and exposing him to anger, exhalation, love or anxiety averts the attack of hiccup. [137]

Avoiding the etiological factors
The etiological factors described to be responsible for the manifestation of hiccup and asthma is eschewed by the patients suffering from these diseases, if they want (to enjoy) good health. [138]

Administration of medicated Ghee
If the patient suffering from hiccup and asthma has the association (Anubandha) of Sushka uru, Kanta talu -dryness of the chest, throat and palate, and if he has dryness of the body by nature (Prakrti) then he is given recipes of medicated ghee. [139]

Dashamuladya Ghrita

Intake of the ghee boiled by adding the decoction of
Dashamula – group of 10 roots
Dadhi manda (Mastu)
Krishna,
Sauvarcala,
Vayashtha (Brahmi) ; Bacopa monnieri
Hingu
Choraka ; Angelica archangelica and
Kayastha (Surasa) cures Hiccup and asthma. [140- ½ 141]

Tejovatyadi Ghrta

1 Prastha of ghee is cooked by adding 4 Prastha of
Pippali ; Piper longum
Katurohini – Picrorhiza kurroa
Bhutika
Pushkaramula ; Inula racemosa
Palasha ; Butea monosperma
Chitraka ; Plumbago zeylanica
Shati ; Hedychium spicatum
Sauvarcala ; A kind of salt
Tamalaki ; Phyllanthus niruri
Saindhava
Pulp of (unripe) Bilva ; Aegle marmelos
Talisa-Patra,
Jivanti ; Leptadenia reticulata and
Vacha ; Acorus calamus and
1/4th Aksa of Hingu -asa foetida
Intake of this medicated ghee in a dose appropriated to the power of digestion cures
Hikka – hiccup,
Shvasa – asthma,
Shotha – oedema,
Vatika type of Arshas (piles),
Grahani – Malabsorption syndrome, Irritable Bowel Syndrome (sprue syndrome),
Hrud roga – heart- diseases and
Parshva pida – pain in the chest
Thus, ends the description of Tejovatyadi- ghrta. [141 ½- 144]

Manahsiladi Ghrita

1 Prastha of ghee is cooked by adding karsha of each of Manahsila
Sarja- rasa
Rajani – turmeric
Padmaka – Prunus cerasoides
Manjistha ; Rubia cordifolia and
Ela – Elettaria cardamomum Maton
Intake of this medicated ghee to linctus from by adding honey is useful in hiccup and asthma.
Similarly, ghee cooked by adding drugs belonging to Jivaniya- group (vide Sutra 4: 9) is taken along with honey.
Patient suffering from hiccup and asthma may also take Tryusana- Ghrta (vide Cikitsa 18: 39-42), Dadhika- Ghrta (vide Hapusadi Ghrita in Cikitsa 5: 71- 73) and vasa- Ghrta (vide Cikitsa 5: 126- 127) along with honey] [145- 146]

Line of treatment in General
Ingredients which cause alleviation of Vayu and Kapha, which are not in potency, and which cause downward movement of Vayu, (vatanulomana) are useful as medicines, drinks and food preparations for the patients suffering from hiccup and asthma
Ingredient, which excusably alleviate Vayu, but aggravate kapha, must never be used in treatment of hiccup and asthma.
Between these 2 categories of treatment, however, the latter category i.e the administration of ingredients which alleviate Vayu but any aggravate Kapha can, if necessary, be used in exception circumstances.
The patient suffering from hiccup and asthma can be given nursing therapy (Bhrumhana) and its adverse effects will be minimal and curable.
Alleviation therapies (Shamana) for such patients are free from any adverse efforts. But the administration of depletion therapy (Karshana) is likely to produce serious adverse effects which are difficult of cure.
Therefore the patient suffering from hiccup and asthma is generally be treated with nourishing(bhrumhana) or alleviating (Shamana) therapy, irrespective of the fact whether he has undergone elimination therapy (Suddha) or not (Asuddha). [147-150]
To sum up
The following topics are discussed in this chapter:
The grounds responsible for making hiccup and asthma difficult of cure
The origin or pathogenesis of hiccup and asthma
The grounds for the identity of treatment of hiccup and asthma
The signs and symptoms of (different varieties of) hiccup and asthma and
The wholesome regimen to be administered for the cure of hiccup and asthma. [151]

Thus, ends the 17th chapter in Chikitsa-sthana, dealing with the treatment of Hikka and Shwasa in the work of Agnivesha, redacted by Charaka and supplemented by Dridhabala.

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