अथातः श्वासहिध्मानिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound the chapter Svasa-Hikka Nidanam diagnosis of Svasa (dyspnoea) and Hikka (hiccup); thus said Atreya and other great sages. (1)
Svasa nidana – causes
कासवृध्या भवेच्छवासः पूर्वैर्वा दोषकोपनैः । आमातिसारवमथुविषपाण्डुज्वरैरपि ॥२॥ रजोधूमानिलैर्मर्मघाता दतिहिमाम्बुना । क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चमः ॥३॥
Svasa (increased or difficult breathing, dyspnoea) develops from increase of kasa (cough), by causes enumerated earlier which bring about increase of doshas, from ama (undigested materials), atisara ( diarrhoea), vamathu (vomiting), visa (poison), pandu (anaemia),jvara (fever); by contact with air containing dust or smoke, injury to vital spots and use of very cold water. It is of five kinds Ksudraka, Tamaka, Chchinna, Mahan and Urdhva. (2-3) –
Samprapti – pathogenesis
कफोपद्धगमनः पवनो विष्वगास्थितः । प्राणोदकान्नवाहीनि दुष्टः स्रोतांसि दूषयन् ॥४॥
उरस्थः कुरुते श्वासमामाशयसमुद्भवम् ॥५॥
Vata getting increased and obstructed in its normal movements by kapha, begins to move in all directions, vitiates the channels of prana (respiration), anna (food) and udaka (water) located in the chest, produces svasa (dyspnoea) originating from amasaya (stomach, the recepticle of undigested food). (4-5)
Purvarupa – premonitory symptoms
प्राग्रूपं तस्य हृत्पार्श्वशूलं प्राणविलोमता । आनाहः शङ्खभेदश्च – ॥६॥
Its purvarupa (prodromal symptoms) are – pain in the region of heart and flanks, movement of prana (vata) in upward direction, distention of abdomen and cutting pain in the temples. (6)
Lakshana – clinical features
तत्रायासातिभोजनैः ।
प्रेरित: प्रेरयेत् क्षुद्रं स्वयंसंशमनं मरुत् ॥७॥
Ksudra svasa is caused by vata excited either by exertion or over-eating and subsides of its own accord. (7)
Tamaka svasa – asthma
प्रतिलोमं सिरा गच्छन्नुदीर्य पवनः कफम् । परिगृह्य शिरोग्रीवमुरः पार्श्वे च पीडयन् ॥ ८ ॥
कासं घुघुरकं मोहमरुचिं पीनसं तृषम् । करोति तीव्रवेगं च श्वासं प्राणोपतापिनम् ॥९॥
प्रताम्येत्तस्य वेगेन निष्ठ्यूतान्ते क्षणं सुखी । कृच्छ्राच्छयानः श्वसिति निषण्णः स्वास्थ्यमृच्छति ॥१०॥
उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान् । विशुष्कास्यो मुहुः श्वासी कांक्षत्युष्णं सवेपथुः ॥११॥
मेघाम्बुशीतप्राग्वातैः लेष्मलैश्च विवर्धते । स याप्यस्तमकः साध्यो नवो वा बलिनो भवेत् ॥ १२ ॥
ज्वरमूर्छायुतः शीतैः शाम्येत् प्रतमकस्तु सः ॥१३॥
Vata undergoing increase travels in upward direction in the passages, causes increase of kapha also, seizes the head and neck, produces pain in the chest and flanks, cough with ghur-ghur sound (from the throat and chest ) delusion, loss of appetite, running in the nose, and thirst, breathing is of great intensity endangering life, by its intensity (of bouts) the patient getsinto darkness (unconsciousness), finds relief for a few moments after expectoration of sputum, breathes with great difficulty while lying and finds comforts while sitting, eyes are wide open, perspires from the forehead, suffers great pain (discomfort ), dryness of the mouth, gets bouts of dyspnoea / often with shivering and desires warm comforts, the disease increases greatly on cloudy days, rain, cold or direct breeze and other factors causing increase of kapha. This is Tamaka svasa which is yapya (controllable but persisting for rest of life), curable if it is of recent onset and in strong persons. Its another kind is Pratamaka which is associated with fever and fainting and subsiding with cold comforts. (8-13)
Chinna svasa – inturrupted breathing
छिन्नाच्छ्वसिति विच्छिन्नं मर्मच्छेदरुजार्दितः । सस्वेदमूर्छ: सानाहो बस्तिदाहनिरोधवान् ॥१४॥
अधोदृग्विप्लुताक्षश्च मुह्यन् रक्तैकलोचनः । शुष्कास्यः प्रलपन्दीनो नष्टच्छायो विचेतनः ॥१५॥
In Chchinna svasa. the patient has interrupted respiration (discontinued in the middle), accompanied with severe cutting pain in the vital spots, perspiration, fainting, distention of the abdomen, burning sensation of the urinary bladder and obstruction (to micturition), eyes having a downward gaze and full of tears fainting, red colour / in one eye only, dryness of the mouth, delerium timidity, loss of complexion and loss of activity (or loss of consciousness). (14-15)
Mahasvasa
महता महता दोनो नादेन वसिति क्रथन् । उद्भूयमानः संरब्धो मत्तर्षभ इवानिशम् ॥१६॥
प्रणटज्ञानविज्ञानो विभ्रान्तनयनाननः । वक्षः समाक्षिपन् बद्धमूत्रवर्चा विशीर्णवाक् ॥१७॥ शुष्ककण्ठो मुहुर्मुहुन्कर्णशशिरोऽतिरुक् ॥१८॥
In Mahasvasa, the patient breathes with loud noise, peevish, produces constant sound through his nose like mighty bull, with loss of common sense and thinking, has fretful eyes and anxious face, convulsive (shaky) movements of the chest, non elimination of urine and faeccs, broken (husky) voice, dryness of the mouth, loss of consciousness often, severe pain in the ears, temples and head. (16-18) Urdhva svasa –
दीर्घमूर्ध्वं सित्यूर्ध्वान्त्र च प्रत्याहरत्यथः । श्रेष्यावृतमुखस्त्रोता: क्रुद्धगन्धवहार्दितः ॥१९॥
ऊर्ध्वदृग्वीक्षते भ्रान्तमक्षिणी परितः क्षिपन् । मर्मसु छिद्यमानेषु परिदेवी निरुद्धवाक् ॥२०॥
In Urdhva svasa, the patient has long, upward breathing (expiration) but is unable to take it downwards (inspiration), the mouth and other passages are covered with kapha (sputumn), it is companied with symptoms of increased vata. His eyes fixed up, looks around as though confused, experiences cutting pain in the vital spots and is unable to Speak. (19-20)
एते सिब्बेबुरव्यक्ता व्यक्ताः प्राणहरा ध्रुवम् ॥२१॥
All of these (svasa) respond to treatment favourably, if they are unmainfest (manifest with mild symptoms) and if manifest (with more severe symptoms) they are sure to take away life. (21)
Hikka nidana – diagnosis of hiccup
सैकहेतुप्राग्रूपसङ्ख्या प्रकृतिसंश्रयाः । हिष्णा भक्तोद्भवा क्षुद्रा यमला महतीति च ॥ २२ ॥ गम्भीरा च –
Hidhana (hiccup) is similar to Svasa (dyspnoea) in respect of causes, prodromal symptoms, mumber and site of origin, Its kinds are Bhaktodbhava (annaja), Ksudra, Yamala, Mahati and Gambhira. (22)
Annaja hikka
मरुत्तत्र त्वरयाऽयुक्तिसेवितैः । रूक्षतीक्ष्णखरासात्म्यैरनपानैः प्रपीडितः ॥२३॥
करोति हिष्णामरुजां मन्दशब्दां क्षवानुमाम् । शमं सात्म्यानपानेन या प्रयातिच सान्त्रजा ॥ २४॥
Annaja Hikka is produced by vata which gets increased by sudden indulgence in unsuitable foods and drinks, such as dry, penetrating (into the tissues), hard and unaccustomed, it is painless of mild sound, following sneezing and subsides by taking accustomed foods and drinks. (23-24)
Ksudra hikka
आयासात् पवनः क्रुद्धः क्षुद्रां हिष्मां प्रवर्तयेत् । जत्रुमूलप्रविसृतामल्पवेगां मृदुं च सा ॥२५॥
वृद्धिमायास्यतो याति भुक्तमात्रे च मार्दवम् ॥२६॥
Vata getting increased by exertion, produces ksudra hdhma. It starts from the root of the shoulders, is of mild force, and soft, increases by exertion and subsides by taking food. (25-26)
Yamala hikka
चिरेण यमलैवेंगैराहारे या प्रवर्तते । परिणामोन्मुखे वृद्धिं परिणामे च गच्छति ॥२७॥ कम्पयन्ती शिरोग्रीवामाध्मातस्यातितृष्यतः । प्रलापच्छर्घतीसारनेत्रविप्लुतिजृम्भिणः ॥२८॥ यमला वेगिनी हिघ्मा परिणामवती च सा ॥२९॥
Hikka coming up in pairs (yamala) appear either during taking of food or its digestion and increases during digestion, produces shaking of the head and neck, flatulence, severe thirst, delerium, vomiting, diarrhoea, tears in the eyes and yawning, thus Yamala Hikka is also known as Vegini and Parinamavati. (27-29)
Maha hikka
ध्वस्त भ्रूशङ्खयुग्मस्य सास्त्रविप्लुतचक्षुषः । स्तम्भयन्ती तुनं वाचं स्मृतिं संज्ञां चमुष्णती ॥३०॥
रुन्धती मार्गमन्त्रस्य कुर्वती मर्मघट्टनम् । पृष्ठतो नमनं शोषं महाहिघ्या प्रवर्तते ॥ ३१ ॥ महामूला महाशब्दा महावेगा महाबला।
Bulging of the eyebrows and temples, eyes filled with blood and tears, body stiff, loss of speech, memory and sensation, obstruction to the passage of food, severe pain in the vital parts, bending of the body backwards, wasting (emacition) of the body- all these are produced by Maha Hikka, which has deep seat of origin, loud sound, powerful bouts and great strength. (30-31)
Gambhira hikka
पक्वाशयाद्वा नाभेर्वा पूर्ववद्या प्रवर्तते ॥३२॥
गम्भीरेणानुनादने गम्भीरा – तासुसाधयेत् । आद्येद्वेवर्जयेदन्त्ये सर्वलिङ्गांचवेगिनीम् ॥३३॥
सर्वाश्चसञ्चितामस्य स्थविरस्यव्यवायिनः । व्याधिभिः क्षीणदेहस्य भक्तच्छेदक्षतस्य वा ॥३४॥
Gambhira Hikka associated with a followon sound (vibration, echo), it starts either from pakvasaya (the large intestine) and nabhi (umbilicus) in the same way as the previous kind (Mahati), exhibits the same features, along with yawnings and stretchings of the body.
Among these (five kinds), the first two are to treated, the last two to be rejected, so also those which manifest, with all the symptoms and severe bouts, all kinds which arise from accumilation of ama, affecting the aged, in those who indulge in excess of sexual intercourse, who are emaciated by the (effect of) diseases or by not taking food. (32-34)
सर्वेऽपि रोगा नाशाय नत्वेवंशीघ्रकारिणः । हिध्माश्वासौ यथा तौ हि मृत्युकाले कृतालयौ ॥३५॥
All diseases destroy the body but not as quick as Hikka (hiccup) and svasa (dyspnoea), both these manifest invariably atthe time of death. (35)
॥ इति चतुर्थोऽध्यायः ॥
Thus ends the Fourth chapter.
