Article by Dr Raghuram Y.S. MD (Ayu)
Among the 5 types of Shwasa, Maha, Urdhwa and Chinna Shwasa are said to be incurable.
Kshudra Shwasa either needs no treatment (because it settles down on its own after a period of rest) or subsides with little treatment, basically correction of food and lifestyle practices. If kshudra shwasa is a chronic one, we need to look at some disorder at its backdrop (like anaemia etc). Treating the concerned disease will give relief from kshudra shwasa.
Tamaka Shwasa – asbronchial asthma or bronchitis is the only type of Shwasa which needs a prompt and timely management. Though it is said to be yapya (maintainable), treatment in the early conditions will help. In severe tamaka shwasa or chronic tamaka shwasa, regular periodic treatment in the form of cleansing treatments like vamana (therapeutic emesis), virechana (therapeutic purgation), disease modifying medicines and rasayanas (rejuvenators and immunmodulators) will be needed at various stages of the disease. Maintenance of the achieved relief is essential. Stringent dietetic and lifestyle protocols followed sincerely will help keep away the disease. Careless and negligent nature from the patient will evidently result in relapses and complications. A holistic approach is needed to cure Tamaka Shwasa.
To keep it simple, Shwasa treatment mainly covers the treatment of Tamaka Shwasa. Tamaka Shwasa is one of the leading cause of dyspnoea or shortness of breath.
Ayurvedic management of Shwasa not only covers the treatment line up of asthma but also is a remedy for wide array of disorders which present with dyspnoea. I have seen that the medicines and treatments advised for tamaka shwasa are also applicable as efficient remedies in many types of dyspnoea associated with other systemic disorders. Thus Shwasa Chikitsa is not limited to ‘cure asthma’. The treatment line up and concept of tamaka shwasa treatment shall be looked from a different platform and broader horizon. There is no harm in prescribing the medicines mentioned in Tamaka Shwasa in any case of dyspnoea. This will take care of symptomatic relief until we have made a proper diagnosis. When we find that the dyspnoea is secondary to another disease, we shall also implement the treatments and medicines (disease modifying) specified for the primary disease leading to dyspnoea. But as per my experience, even if the primary disease (causing dyspnoea) is not diagnosed accurately, there is no harm in prescribing the medicines advised to relieve shwasa. I have found many patients getting relief from this approach, which is the key to treatment of any condition.
Giving reason for this gross approach, I would like to credit the skill of Ayurveda scholars and teachers of ancient era for wonderfully combining the herbs in such a way that they are not only symptom specific or disease specific, but are also multi-directional and multi-dimensional, targeting many diseases or symptoms at a time.
Principles of management of Shwasa (Tamaka Shwasa) and best Panchakarma options
Snehana and Swedana
Snehana (oleation, intake of metered quantities of medicated ghee or oil) and Swedana (sudation, steaming therapy, sweating therapy, and fomentation) should be initially administered for the patient suffering from shwasa. Before swedana, abhyanga (massage with herbal oils) should be conducted.
Snehana and Swedana is given as pre-treatment procedures (purva karma) when shodhana (cleansing treatments) in the form of Vamana (therapeutic emesis) and or Virechana (therapeutic purgation) has been planned. These procedures shall be avoided if vamana or virechana is not in the treatment plan.
Shwasa with feeble symptoms or acute exaggeration of chronic shwasa, can be managed with small quantities of disease modifying medicines prescribed for short-duration. In these cases, snehana, swedana or shodhana (panchakarma measures) might not be necessary.
For abhyanga or massage, lavana taila (oils processed with salt and other medicinal herbs) is used. Following Abhyanga, Swedana is administered by one of the below mentioned methods (types) of swedana –
Nadi Sweda – tubular fomentation (steam or vapours coming out of a tube in a streamed way)
Prastara – slab fomentation (medicinal herbs, grains etc are boiled and spread over the slab of the dimension of the body of a person, the person who is subjected to abhyanga is made to lie on the slab on which herbs are spread and sudation given, the herbs shall be brought to tolerable temperature before providing fomentation)
Sankara Sweda – bolus fomentation (medicines made tolerably hot are tied in boluses and these boluses are used to provide fomentation to the massaged body
Benefits of Snehana and Swedana in Swasa Chikitsa:
Snehana will help in provoking the doshas (kapha and pitta, in shwasa) which are stagnant in the cells and channels, increases them proportionally and prepare them to move out of the cells and channels. Swedana, owing to its heat and penetrating property, further liquefies the doshas bulged by snehana and aid their flow towards koshta (gut, stomach). When the liquefied doshas reach the koshta, it becomes easy to eliminate them through cleansing measures i.e. Vamana or Virechana.
Due to the effect of snehana and swedana, the grathita shleshma sticking to the walls of the channels (consolidated phlegm) gets broken and liquefied, flows out of the channels. The channels, as a result get cleansed and the blocks are removed. The vayu, whose movements are blocked by vitiated kapha is set free. The vayu starts moving freely and gets eliminated from the body.
Preparation for shodhana
After proper administration of snehana and swedana the patient is prepared for shodhana or cleansing treatments (panchakarma treatments, mainly vamana and virechana).
For this, the patient after having undergone swedana, is given snigdha bhojana (unctuous or oil food). Fish, meat of pig, curds is given in large quantities so as to provoke and increase the kapha in the body. The kapha which has liquefied by snehana, swedana gets provoked further on intake of these foods and gets ready to get eliminated from the body.
Administration of Vamana (therapeutic emesis) –
After confirming that the kapha has been increased on administration of snehana, swedana and snigdha bhojana, after making the patient drink stomach full of milk, sugarcane juice or gruels or meat soup (on the day of administering vamana), and after learning that the patient is having vomiting reflexes , Vamana is administered by giving medicines which induce vomiting. For this, the paste of Pippali (Long pepper), Saindhava (rock salt) and Kshaudra (honey) is given.
Benefits of Vamana in Shwasa
Once the morbid kapha has been eliminated by administration of Vamana, the person starts feeling better and the shortness of breath gets relieved. The person starts breathing easily due to the removal of morbid kapha and the blocks in the channels. The free and unobstructed movements of vayu in the body (after the channels have been cleansed through vamana) further help the establishment of normal breathing process and providing relief from dyspnoea.
Dhumapana (medicated smoking) –
Even after the administration of Vamana, small quantities of kapha might still be stagnant in the channels of the body. The kapha adhering in the channels of the body may proportionally increase in due course of time and trigger shwasa yet again. To avoid this remaining kapha which is sticking in the walls of the channesl has to be eliminated. For this to happen, medicated smoking or dhumapana is administrated.
The medicinal herbs are made into paste and wicks are prepared from it. The wicks are smeared with ghee, kept in the smoking instrument (dhumapana yantra), and lit with fire. At the other end of the instrument the smoke is emitted through a long nozzle. The person is asked to intake the smoke.
Any one of the below mentioned dhumapanas can be used –
- Haridradi Dhumavarti – Wick is prepared from the paste of Haridra (turmeric), Yava (barley), Eranda mula (roots of castor plant), laksha (lac), Manashila (purified realgar), Devadaru (Cedrus deodara), Haratala (Orpiment), Jatamamsi (Nardostachys jatamansi)
- Yava dhumavarti – Wick prepared with Yava (barley) and ghee
- Madhuchishtadi varti – Wick prepared with Madhuchista (wax), Sarjarasa (resin of Shorea robusta) and ghee
- Sringadi dhumavarti – wick prepared from Go sringa (cow horn), baalam (hairs of cow) and snayu (ligaments of cow)
- Shyonakadi varti – wick made from shyonaka (Oroxylum indicum), eranda naadi (hollow stem of castor plant) and shushka kusha (dry grass) and ghee
- Padhmakashtadi varti – wick prepared from padhma kashta (stem of lotus), guggulu (Commiphora mukul), Agaru (Aquilaria agallocha), Shallaki (Boswellia serrata) and ghee
Virechana (therapeutic purgation) for Shwasa Roga:
Treatment of dyspnoea vis-à-vis shwasa will be incomplete without the administration of virechana. Shwasa is said to have its origin from Pitta sthana (location of pitta, gut, stomach or small intestine). Virechana is the best treatment for pitta and diseases manifested due to vitiated pitta or diseases having their origin from pitta sthana.
The Virechana can be administered in one or the other of the below mentioned forms –
Krama Virechana – After the administration of Vamana, samsarjana krama is administered. Samsarjana krama is a planned dietetic schedule planned to bring back the digestive fire which has become weak after vamana, to normalcy. Following this, snehana and swedana is administered. After proper snehana and swedana, virechana is administered.
Nitya Virechana – Virechana is administered in small metered doses on daily basis. In this, herbal laxatives are administered. This doesn’t need snehana and swedana as in krama virechana.
Types of Shwasa patients
Types of shwasa patients –
Patients suffering from Shwasa are of 2 types. They are –
Balavan / Kaphadhika rogi (strong patients in whom there is excessive vitiation or morbidity of kapha) – In these patients, shodhana can be readily given because the cleansing methods of treatment are well tolerated by patients who have good strength. Presence of excessive kapha in the system is another indication of shodhana. These patients naturally tend to vomit. Administration of Vamana helps in initiating that process of vamana to perfection.
For these patients, administration of Vamana, Virechana, Dhuma and Avaleha (confections) is an ideal choice.
Durbala / Vatadhika rogi (weak patients in whom there is excessive vitiation or morbidity of vata) – In these patients dryness naturally prevails owing to the dry and rough nature of Vayu. Shodhana in the form of Vamana and or virechana should never be administered to these patients as they have low tolerance. Shodhana can also produce complications in these people.
For these patients tarpana (nourishing or nutritional therapies) in the form of sneha (medicate oils or ghee which are disease modifying in terms of dyspnoea i.e. shwasa), yusha (soups), mamsa rasa (meat soups) etc shall be administered skilfully.
Brimhana (bulk promoting) treatments, medicines and foods are highly beneficial in this category of patients. The meat of animals and birds living in desert areas (jangala desha) like peacock, cock etc should be processed with decoction of Dashamula (10 roots) or Kulattha (horse gram) and given to the patient.
Recommended soups, gruels
Beneficial yusha, yavagu and peya (soups, gruels) in shwasa
Nidagdhikadi yusha – Soup prepared with Nidagdhika (Solanum xanthocarpum), Bilwa majja (pulp of fruit of Aegle marmelos), Karkatasringi (Pistacia integerrima), Duralabha (Fagonia cretica), Gokshura (Tribulus terrestris), Guduchi (Tinospora cordifolia), Kulattha (horse gram) and Chitraka (Plumbago zeylanica)
Hingwadi yavagu – Gruel made up of Hingu (asafoetida), sauvarchala lavana (sauchal salt), jeeraka (cumin seeds), vida lavana (black salt), Pushkaramula (Inula racemosa) and Chitrakamula (roots of Plumbago zeylanica)
Effective formulations for Shwasa from treatises
Sauvarchaladi churna – powder prepared from Sauvarchala lavana (sauchal salt), shunti (ginger), bharangi (Clerodendrum serratum), Sharkara (sugar) should be taken with hot water
Bharangyadi kalka – Paste of Bharangi (Clerodendrum serratum), Shunti (ginger), Maricha (pepper), Yava kshara (alkali derived from the whole plant of barley), Daruharidra (Berberis aristata), Chitrakamula (Roots of Plumbago zeylanica), Sariva (Hemidesmus indicus) and Murva (Argyreia nervosa)
Shatyadi churna – Powder of Shati (Hedychium spicatum) and Pushkaramula (Inula racemosa) should be taken with honey
Amalaki churna – powder of Emblica officinalis should be taken with honey
Kala loha churna – ash or powder of iron should be taken with honey
Kulattadi Kwatha – Decoction of Kulatta (horse gram), shunti (ginger), vyaghri (Solanum xanthocarpum) and Vasa (Adhatoda vasica)
Dashamuladi Kwatha – decoction of Dashamula (10 roots) mixed with powder of Pushkaramula (Inula racemosa)
Vasadi Kwatha – Decoction of Vasa (Adhatoda vasica), Haridra (turmeric), Dhanyaka (coriander), guduchi (Tinospora cordifolia), Bharangi (Clerodendrum serratum), Pippali (long pepper), Shunti (ginger) and Kantakari (Solanum xanthocarpum)
Gudavaleha – confection prepared using purana guda (old jaggery), katu taila (mustard oil)
Vardhamana Pippali – Long pepper treatment in which the powder, decoction or paste of long pepper (pippali) is given in an ascending way (increasing the dose gradually) and later tapered (gradually decreasing the dose and ending with the dose with which the treatment was started).
Management of Secondary Shwasa
If Shwasa or dyspnoea is due to some other primary disease at its backdrop, it can be treated by addressing the primary issue. Here in most cases, we might not require symptomatic treatment for dyspnoea. When the main disease causing dyspnoea goes away, the dyspnoea too would subside.
Other strategies of treatment –
Shwasa can be treated on the lines of treatment of –
Pranavah sroto dushti chikitsa – Shwasa or dyspnoea is a symptom of vitiation of Pranavaha Srotas (channels responsible for transportation of air in the body).
Read related: Pranavaha Srotas: Channels Carrying Vital Life Element – Oxygen
Pandu Roga Chikitsa (Anaemia and liver disorders) – Since shortness of breath is an essential part of anaemia most of the times, prompt treatment of anaemia would address the issue.
Read related: Pandu Roga Chikitsa
Shotha Chikitsa (swelling and inflammation) – Swelling and inflammation or airways is one of the chief causes of dyspnoea. Treatment and medicines advised in Shota chikitsa would reduce the swelling (inflammation or oedema) in the airways and relieve dyspnoea.
Read related: Shotha: Causes, Types, Treatment, Medicines
Pathya (beneficial and wholesome things) in Shwasa
- Vamana – therapeutic emesis
- Virechana – therapeutic purgation
- Swedana karma – sudation, fomentation, sweating/steaming treatment
- Dhumapana – herbal smoking
- Diwa swapna – sleeping during the day time
- Puratana shali – old rice / paddy
- Rakta shali – red rice
- Kulattha – horse gram
- Godhuma – wheat
- Yava – barley
- Mamsa – flesh / meat of rabbit, peacock, cock, parrot etc
- Dwija or andaja mamsa – meat of birds
- Purana ghrita – old ghee
- Aja dugdha – goat milk
- Aja ghrita – ghee derived from goat’s milk
- Sura – fermented alcoholic herbal drink
- Madhu – honey
- Patola – pointed gourd
- Vaartaaka – brinjal
- Lashuna – garlic
- Bimbi – Ivy gourd
- Jambeera – Citron fruit
- Tanduleeya – Amaranthus spinosus
- Vaastuka – Chenopodium album
- Draksha – raisins
- Ela – Cardamom
Apathya (non-beneficial and unwholesome things) in Shwasa
- Raktamokshana – bloodletting
- Purva vata – wind or breeze blowing from the east
- Purva bhojana – taking food facing east
- Purva pana – taking liquids facing east
- Mesha dugdha – sheep milk
- Mesha ghrita – ghee extracted from sheep milk
- Dushta jala – contaminated water
- Matsya – fish
- Kanda – tubers
- Sarshapa – mustard
- Ruksha annapana – dry foods
- Sheeta – cold things, foods and comforts
- Guru – foods which are heavy to digest
Single herbs useful in Shwasa vis-à-vis dyspnoea
- Vasa – Adhatoda vasica
- Pushkaramula – Inula racemosa
- Kantakari – Solanum xanthocarpum
- Pippali – Long pepper / Piper longum
- Maricha – Black pepper
- Shunti – Ginger
- Bharangi – Clerodendron serratum
- Chitraka – Plumbago zeylanica
- Dashamula – 10 roots
- Twak – Cinnamon
- Talisapatra – Abies webbiana
- Haritaki – Terminalia chebula
- Draksha – raisins
- Musta – Cyperus rotundus
- Karkatasringi – Pistacia integerrima
- Katuki – Picrorrhiza kurroa
- Shati – Hedychium spicatium
- Haridra – Turmeric
- Daruharidra – Berberis aristata
- Rasna – Alpinia galangal
- Ela – cardamom
- Vacha – Acorus calamus
- Kulattha – horse gram
- Jeeraka – Cumin seeds
- Yava kshara – alkali of the full plant of barley
- Amalaki – Emblica officinalis
- Loha – iron
- Guduchi – Tinospora cordifolia
- Duralabha – Fagonia cretica
Classical Ayurvedic medicines for Shwasa
Kashayam (herbal decoction) –
- Vyaghryadi Kashayam
- Dashamula Kashayam
- Dashamula Katutrayadi Kashayam
- Nayopayam Kashayam
- Elakanadi Kashayam
- Punarnavadi Kashayam
Asava Arishtam (fermented herbal drinks) –
Leham / Rasayanam (confections, immune modulators) –
- Kantakari avaleham
- Talisapatradi leham
- Mridvikadi leham
- Agastya haritaki rasayanam
- Kushmanda rasayanam
- Chitraka haritaki leham
- Dashamula rasayanam
- Ela dashamula rasayanam
Churnam / Vatakam (herbal powders, granules) –
- Talisadi churnam
- Sitopaladi churnam
- Yashtimadhu churnam
- Haridra khandam
- Vyoshadi vatakam
Vati, Gulikas, Bhasmas and Rasa aushadhas (tablets, pills, ashes and herbo-mineral preparations) –
- Shwasananda gulika
- Kasa-shwasa chintamani rasa
- Shwasa kutara rasa
- Eladi vati
- Rasa sindura
- Malla sindura
- Vyoshadi Guggulu
- Shringa bhasma
- Abhraka bhasma
- Loha bhasma
Proprietary medicines –
- AJ-Rasayana (Kumar)
- Cap Branchozen (ZEN)
- Cap Broncap (Capro)
- Tab / Syrup Bronto (Anuja)
- Chandramrit Rasayana (Nanjangud)
- Tab Desma (J & J)
- Tab Ephenin (Sandu)
- Cap Fizzle (Ayulabs)
- Kanaka Lepa (Nanjangud)
- Kankushtasav liquid (Rajashree)
- Powder Pankajakasturi (Pankajakasturi)
- Cap Pulmoflex (Envin)
- Liquid Pushkaramrith (Swadeshi)
- Tab / Syrup Respidac (Cadila)
- Granules Rhinex (Pentacare)
- Tab Shwas Kalp (Baidyanath)
- Cap Shwasankush (Pavaman)
- Cap Shwasi (Dhanwantri)
- Syrup Somakalpa (Unjha)
- Syrup Spasma (Charak)
- Syrup Tussnil (KAPL)
- Syrup Adulsa (Arya)
- Syrup Crux (BAN)
- Syrup Kofend (Gufic)
- Syrup Kofex (Nanjangud)
- Syrup Zeal (Vasu)
- Chaitanya Rasayana (Chaitanya)
My clinical experience with Dyspnoea
In my 20 years of clinical practice I have encountered many cases of dyspnoea and breathlessness. Majority of them were cases of asthma or asthmatic bronchitis.
The next in the list are anaemia, nutritional disorders, obesity, cardiac disorders, anxiety neurosis, few cases of hysteria and some due to ageing. I have found shortness of breath also presenting as associated complaint of some acute diseases also including fever, acute bronchitis, cold congestion, etc. These conditions respond to the treatment given to the primary condition.
Asthma and anaemia topped the list because the people having dyspnoea associated with other conditions came for treatment of some primary diseases, wherein dyspnoea was not presented as chief compliant. In these cases, the treatment of the main diseases for which the patients were seeking help would take care of shortness of breath associated with them.
Panchakarma – Yes!! Whenever we deal any case in Ayurveda, Panchakarma or cleansing set of treatments come as the first line of choice of management. It is a boon especially in chronic cases. An Ayurvedic doctor would definitely not put away his thoughts from these highly effective treatments. But I am little conservative about using Panchakarma treatments and pushing my clients into the treatments when things can be handled by efficient medicines. I have always kept Panchakarma as my final weapon. It is also true that the corporate patients find it difficult to allot their time for shodana / panchakarma schedules (unless pressed by doctors).
Having said that, I would still state that Panchakarma is the best option especially if the condition demands. If the patient can fit into the treatment protocol, there is no harm in giving a small course of vamana and or virechana. Later it shall be followed up by administration of disease modifying medicines and immune-modulators.
I have taken to Panchakarma in very chronic and stubborn cases of dyspnoea (related with asthma, anaemia or obesity). In kapha predominant cases, I have preferred advising Vamana, but has always ended my treatment with Virechana. I would suggest that the treatment shall be concluded with virechana or nitya virechana for better results. In people fit for vamana and or virechana, the treatment shall be given once or twice in a year, even though they are symptom free. This will help in overcoming the problem and developing immunity to the disease.
I have always taken care about vata predominant people and have kept Panchakarma options away from these people. Snigdha type of virechana (purgation with medicated oils or ghee) to take control of the vitiated vayu and administration of rasayanas (immune modulators) and brimhana (bulk promoting) and balya (strengthening) medicines in the later period has worked.
I always felt double confident handling even worst of dyspnoea cases. In cases of Pandu vis-à-vis anaemia, a just focussed on enhancing the quality and quantity of blood. In hridroga (heart disease induced dyspnoea), I have always concentrated on medicines strengthening the heart and it’s functioning. In either case, virechana in one or the other form was the secret of my success in handling these cases.
Asthma or bronchial problems causing dyspnoea were always easier to handle. I would confess to have got very good results in managing asthma (with or without Panchakarma). The wide range of herbs and classical formulations has made the doctor’s job easy. The key is to diagnose the cause of dyspnoea.
I have focussed my suggestions on lifestyle modifications, avoiding trigger and causative factors, diet corrections, developing seasonal compatibility and regular intake of immune-modulating medicines so as to prevent recurrences.
One more interesting thing that I have found out in my clinical practice is that lot of ama (metabolic toxins or intermediate products of digestion in circulation) is the cause of many diseases and also dyspnoea. Medicines which correct the metabolic process and aid proper digestion relieve dyspnoea related to diseased gut.
Constipation is another common accompaniment of dyspnoea. Snigdha virechanas and correction of apana vayu functions have come in handy to relieve constipation and related dyspnoea.
Limitations of Ayurveda in handling Shwasa
Options and success rates of treating Shwasa with Ayurvedic treatments and medicines is unlimited. This statement of mine and whatever I discussed in the ‘My experience’ section would make little sense of me trying to explain the limitations of Ayurveda in handling shwasa. Ayurvedic medicines have been successfully been administered in shwasa patients of all ages, including infants.
Care should be taken while administering medicines to infants, pregnant women and feeding woman.
Some medicines may have stronger ingredients which are intolerable in these sensitive groups. Many formulations consists of herbs which are ‘micro-cleansing’ in nature, have some laxatives which keep detoxifying on daily basis. This may be inconvenient in the mentioned set of patients. Old age group of patients are another set which need to be looked at caution.
Acute, sudden, severe and complicated types of dyspnoea are anyhow out of equation of Ayurveda management because the patients any how would opt out for emergency medicines and immediate attention. Ayurveda too has lot of emergency medicines towards handling complicated dyspnoea cases including heart related shortness of breath. But it would be a risk factor to take chances when some other system would provide good relief and equipped better towards emergency management.
Dyspnoea should be promptly diagnosed and the cause behind it should be found out in right time. This helps in early intervention. This article provides you a wide array of options to get rid of your dyspnoea.
Breathe naturally and easily with the help of Ayurvedic remedies!!
Click to Consult Dr Raghuram Y.S. MD (Ayu)