We shall now expound Svasa hikka nidana – diagnosis of dyspnoea and hiccup; thus said Atreya and other great sages.
अथातः श्वासहिध्मानिदानं व्याख्यास्यामः । स्माहुरात्रेयादयो महर्षयः । इति ह
Svasa nidana – causes of dyspnoea
कासवृद्ध्या भवेच्छ्वासः पूर्वैर्वा दोषकोपनैः । आमातिसारवमथुविषपाण्डुज्वरैरपि रजोधूमानिलैर्मर्मघातादतिहिमाम्बुना ॥१॥
Svasa (dyspnoea) arises by increase of cough, or by causes described earlier which bring about aggravations of the dosas; also by diarrhoea due to indigestion, vomitting, poisons, anaemia, fever; exposure to dust, smoke, and breeze; injury to vital organs and drinking of very cold water.
Svasa bheda – types of dyspnoea
क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चमः ॥ २ ॥
Ksudra, Tamaka, Chinna, Mahan, and Urdhava-are its five kinds. 2b.
Svasa Samprapti (pathogenesis )
कफोपरुद्धगमनः पवनो विष्वगास्थितः । प्राणोदकान्नवाहीनि दुष्टः स्त्रोतांसि दूषयन् ॥ ३ ॥ उर:स्थ: कुरुते श्वासमामाशयसमुद्भवम् ।
Pavana (vata) obstructed in its movement by kapha, spreading in all directions, vitiates the channels of prana (respiration), udaka (water) and anna (food), located in the chest and produces svasa (dyspnoea) arising from the amasaya (stomach). 3-4a.
Svasa Purvarupa (premonitary symptoms)
प्राग्रूपं तस्य हृत्पार्श्वशूलं प्राणविलोमता ॥ ४ ॥ आनाहः शङ्खभेदश्च
Its premonitary symptoms are-pain in the region of the heart and flanks, upward movement of prana (respiration), flatulence and splitting pain in the temples (sides of the forehead). 4b-5a.
Svasa Rupa – Dyspnoea clinical features
Ksudra svasa
तत्रायासातिभोजनैः ।
प्रेरितः प्रेरयेत् क्षुद्रं स्वयं संशमनं मरुत् ॥ ५॥
Marut (vata) aggravated by exertion and overeating, produces Ksudra svasa, which subsides by itself (without any treatment). 5b.
Notes: This is heavy breathing on exertion, passes off soon by rest and not troublesome.
Tamaka svasaप्रतिलोमं सिरा गच्छन्नुदीर्य पवनः कफम्। परिगृह्य शिरोग्रीवपुर: पार्श्वे च पीडयन् ॥ ६ ॥
कासं घुघुरकं मोहमरुचिं पीनसं तृषम्। करोति तीव्रवेगं च श्वासं प्राणोपतापिनम् ॥ ७ ॥
प्रताम्येत्तस्य वेगेन निष्ठ्यूतान्ते क्षणं सुखौ। कृच्छ्राच्छयानः श्वसिति निषण्णः स्वास्थ्यमच्छति ॥ ८ ॥
उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान् । विशुष्कास्यो मुहुः श्वासी काङ्क्षत्युष्णं सवेपथुः ॥ ९ ॥
मेघाम्बुशीतप्राग्वातैः श्लेष्मलैश्च विवर्द्धते । सयाप्यस्तमकः, साध्यो नवो वा बलिनो भवेत् ॥ १० ॥
ज्वरमूर्च्छायुतः शीतैः शाम्येत्प्रतमकस्तु सः ।
Pavana (vata) getting aggravated begins to move in the upward direction in the siras (srotas or channels of respiration), aggravates the kapha also and produces svasa (dyspnoea), with catching pain in the head and neck, chest and flanks; cough accompanied with cracking sound, delusion,loss of taste/appetite, running in the nose, and thirst; the bouts of respiration are very forceful producing great distress to life, the patient goes into darkness (loses consciousness of the surroundings) by its force, finds momentary comfort after expectorations; in unable to breadth while lieing and finds comfort on sitting;
eyes are gazing up (wide open) forehead sweating, experiances great distress; mouth is dry, bouts of dysponea are frequent, desires hot comforts, and accompanied with tremors (shiverings); the conditions gets increased by accumulation of clouds in the sky, drinking cold water, cold breeze and ingestion of substances which cause increase of kapha. This Tamaka svasa is yapya (incurable but controllable, persists for long time), may be curable if of recent onset and in those who are strong. It is called Pratamaka (svasa) when associated with fever and fainting and subsiding by cold (foods, drinks etc.). 6-11a.
Notes: This condition is identified as Bronchial asthma in modern parlance..
Chinna svasa
छिन्नाच्छुसिति विच्छिन्नं मर्मच्छेदरुजार्दितः ॥ ११ ॥
सस्वेदमूर्च्छ: सानाहो बस्तिदाहनिरोधवान् । अधोदृग्विप्लुताक्षश्च मुह्यन् रक्तैकलोचनः ॥ १२ ॥
शुष्कास्यः प्रलपन् दीनो नष्टच्छायो विचेतनः ।
With Chinnasvasa the person breathes with inturruptions, has cutting pain in the vital organs, accompained with sweating, fainting, flatulence, burning sensation and obstruction in the urinary bladder; gazes downward, eyes are unsteady (of full of tears), goes in for delusion (or coma), one eye is angry-red in colour, mouth dry, talks irrelevent; feels helpless (unable to do any thing, incapable to withstand) with loss of shade (complexion) and loss of consciousness.
Notes: This condition is identified as Cheyne-stokes respiration and appears usually at the terminal stages of many diseases.
Mahasvasa
महता महता दीनो नादेन श्वसिति क्रथन् ॥ १३ ॥ उद्भूयमानः संरब्धो मत्तर्षभ इवानिशम् ।
प्रणष्टज्ञानविज्ञानो विभ्रान्तनयनाननः ॥ १४ ॥ वक्षः समाक्षिपन् बद्धमूत्रवर्चा विशीर्णवाक् । शुष्ककण्ठो मुहुर्मुह्यन् कर्णशङ्खशिरोतिरुक् ॥ १५ ॥
With Maha svasa, the person has heavy breathing, feels helpless (unable to withstand the trouble), respirations are accompanied with sound, produces continous sound of high pitch from the nose resembling that of a bull in heat; commonsense and intellegence are lost, eyes and face are unsteady; chest constricted; obstruction of urine and feaces, broken voice, dryness of the throat, frequent delusions and 13b-15. severe pain in the ears, temples and head.
diseases. Notes: This conditions also appears at the terminal stages of many
Urdhva svasa
दीर्घमूर्ध्वं श्वसित्यूर्ध्वान्न च प्रत्याहरत्यधः । श्लेष्मावृतमुखस्त्रोताः कुद्धगन्धवहार्दितः ॥ १६ ॥ ऊर्ध्वदृग्वीक्षते भ्रान्तमक्षिणी परितः क्षिपन् । मर्मसु च्छिद्यमानेषु परिदेवी निरुद्धवाक् ॥१७॥
From Urdhva svasa, the person has prolonged upward breathings (expirations) but inability of bringing it downwards (inspirations), the mouth of the channels are covered with slesman ( kapha ); gandhvaha ( vata) being aggravated the patient has an upward gaze, rolling eye balls and a terrified look, has severe pain as though his vital organs are being cut and his speech choked. 16-17.
Sadhyasadhyata of svasa roga (prognosis)
एते सिद्धयेयुरव्यक्ता व्यक्ताः प्राणहरा ध्रुवम् । ।
इति श्वासनिदानम्
Success may result (by effective treatment) when these (Mahan, Urdhva and Chinna kinds) are not well manifest (appear with few mild symptoms) but when well manifest appear with all symptoms profoundly) are sure to take away the life. 18a.
Hikka nidana ( diagnosis of hiccup)
अथ हिध्मानिदानम् । श्वासैकहेतुप्रागूपसङ्ख्याप्रकृतिसंश्रयाः हिध्माः भक्तोद्भवा क्षुद्रा यमला महतीति च । गम्भीरा च ॥१८॥
Causes, premonitory symptoms, number ( kinds) and pathogenesis of hikka (hiccup) are the same as those of svasa (dyspnoea).
Hikka (hiccup ) is of five kinds; viz, that produced by food (Annaja), Ksudra, Yamala, Mahati and Gambhira. 18b-19a. Rupa (clinical features ) –
Annaja hikka
मरुत्तत्र त्वरयाऽयुक्तिसेवितैः ॥ १९ ॥ प्रपीडितः । रूक्षतीक्ष्णखरासात्म्यैरन्नपानैः करोति हिध्मामरुजां मन्दशब्दां क्षवानुगाम् ॥ २० ॥ शमं सात्म्यान्नपानेन या प्रयाति च साऽन्नजा।
Marut (vata) getting aggravated by consuming foods rapidly and improperly, by partaking foods and drinks which are dry, penetrating, rough (coarse) and unaccustomed, produces hiccup which painless, of mild sound, followed with sneezing, and subsiding with (the use of) accustomed foods and drinks is known as Annaja hikka (hiccup produced by food). 19b-21a.
Ksudra hikka
आयासात्पवनः क्षुद्रः क्षुद्रां हिमां प्रवर्तयेत् ॥ २१ ॥
जत्रुमूलप्रविसृतामल्पवेगां मृदुं च सा। वृद्धिमायास्यतो याति भुक्तमात्रे च मार्दवम् ॥ २२ ॥
Pavana (vata) undergoing slight increase from exertion, produces Ksudra hikka (minor hiccup) starting from the root (base) of the shoulders, with mild and soft bouts, increases by excertion and subsides after consuming food. 21b-22.
Yamala hikka
चिरेण यमलैर्षेगैराहारे या प्रवर्तते । परिणामोन्मुखे वृद्धि परिणामे च गच्छति ॥ २३ ॥
कम्पयन्ती शिरोग्रीवमाध्मातस्यातितृष्यतः । । ॥ २४॥
प्रलापच्छर्द्यतीसारनेत्रविप्लुतिजृम्भिणः यमला वेगिनी हिध्मा परिणामवती च सा ।
That, commencing a long time after taking food and increasing during the period of digestion, coming up in pairs, causing tremors of the head and neck, flatulence, severe thirst, irrelevent talk, vomitting, diarrhoea, unsteady eyes and yawnings, is Yamala hikka also called Vegini, and Parinamavati hikka (hiccup coming up in pairs) related to digestion. 23-25a.
Maha hikka
सास्त्रविप्लुतचक्षुषः ॥ २५ ॥
स्तब्ध भ्रूशङ्खयुग्मस्य स्तम्भयन्ती तनुं वाचं स्मृतिं संज्ञां च मुष्णती । रुन्धती मार्गमन्नस्य कुर्वती मर्मघट्टनम् ॥ २६ ॥
पृष्ठतो नमनं शोषं महाहिध्मा प्रवर्तते । महामूला महाशब्दा महावेगा महाबला ॥ २७ ॥
Maha hikka, manifest with rigidity ( loss of movement) of the brows, temples and sides of the neck; eyes are red and full of tears, loss of movements of the body, speech, memeory and general awareness, obstructing the passage of food, producing a feeling of vital organs being hit, bending of the body backwards and emaciation; it arises from deep inside, with great sound and forceful bouts. 25b-27.
Gambhira hikka
पक्वाशयाद्वा नाभेर्वा पूर्ववद्या प्रवर्तते । तद्रूपा सा मुहुः कुर्याज्जृम्भामङ्गप्रसारणम् ॥ २८ ॥ गम्भीरेणानुनादेन गम्भीरा
That which starts either from pakvasaya (large intestine) or nabhi (umbilicus ), similar to the previous type (maha hikka) in its features producing more yawnings and expansion of the body frequently with a viberating sound (of hiccup ) is Gambhira hikka. 28-29a.
Sadhyasadhyata of Hikka (prognosis)
तासु आद्ये द्वे, वर्जयेदन्त्ये सर्वलिङ्गां च वेगिनीम् ॥ २९ ॥ साधयेत् ।
सर्वाश्च सञ्चितामस्य स्थविरस्य व्यवायिनः । व्याधिभिः क्षीणदेहस्य भक्तच्छेदक्षतस्य वा ॥ ३० ॥ इति हिध्मानिदानम् ।
Among these, the first two kinds should be treated, the last two rejected; so also the vegini (yamala) which has all its features; all the kinds ( should be rejected) in persons who have accumilation of ama in their body, who are of old age, who indulge in too much of sexual intercourse, who are emaciated by diseases and by absence of food. 29b-30.
सर्वेऽपि रोगा नाशाय न त्वेवं शीघ्रकारिणः । हिध्माश्वासौ यथा तौ हि मृत्युकाले कृतालयौ ॥ ३१ ॥
All diseases are going to kill but not as quick as hiccup and dyspnoea; these two reside very close to the time of death. 31.
इति श्री वैद्यपतिसिंहगुप्तसूनुश्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां तृतीये निदानस्थाने श्वासहिध्मानिदानं नाम चतुर्थोऽध्यायः ॥ ४ ॥
Thus ends the chapter Svasahikka nidana-the fourth in Nidana sthana of Astanga hrdaya samhita composed by Srimad Vagbhata son of Sri Vaidyapti Simhagupta.
