एकपञ्चाशत्तमोऽध्यायः अथातः श्वासप्रतिषेधं व्याख्यास्यामः, यथोवाच भगवान् धन्वन्तरिः ॥ १ ॥
Now we shall discourse on the chapter which deals with the (symptoms and) medical treatment of Asthma (svasa – Pratisedha). 1.
यैरेव कारणैर्हिक्का बहुभिः संप्रवर्तते । तैरेव कारणैः श्वासो घोरो भवति देहिनाम् ॥ २ ॥ विहाय प्रकृतिं वायुः प्राणोऽथ कफसंयुतः । श्वासयत्यूर्ध्वगो भूत्वा तं श्वासं परिचक्षते ॥ ३ ॥ क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चधा | भिद्यते स महाव्याधिः श्वास एको विशेषतः ॥ ४ ॥
Etiology To the same group of exciting factors which bring in an attack of hiccough should be attbiruted the origin of that voilent disease which is known as Svasa (asthma). The vital Vayu known as the Prana-Vayu foregoing its normal function rises upward in unison with the deranged Kapha of the body and produces that gasping and laboured breathing which is called Svasa (asthma). This dreadful disease though virtually one in its nature and origin is divided into five spicific types, viz., Ksudra-svasa, Tamaka-svasa, Chinna-svasa, Maha-svasa and Urddhva-Svasa. 2-4.
Premonitory Symptoms of Asthma / Svasa
प्राग्रूपं तस्य हृत्पीडा भक्तद्वेषोऽरतिः परा । आनाहः पार्श्वयोः शूलं वैरस्यं वदनस्य च ॥ ५ ॥
Premonitory Symptoms – Pain in the region of the heart and at the sides, aversion to food as well as to all other pursuits, suppression of stool and urine and a bad taste in the mouth, may be regarded as the premonitory symptoms of the disease. 5
Specific Symptoms of Svasa
किञ्चिदारभमाणस्य यस्य श्वासः प्रवर्तते । निषण्णस्यैति शान्तिञ्च स क्षुद्र इति संज्ञितः ॥ ६॥ तृट्स्वेदवमथुप्रायः कण्ठघुघुरिकान्वितः | विशेषाद् दुर्दिने ताम्येच्छ्वासः स तमको मतः ॥ ७॥ घोषेण महताऽऽविष्टः सकासः सकफो नरः । यः श्वसित्यबलोऽन्नद्विट् सुप्तस्तमकपीडितः ॥ ८ ॥ स शाम्यति कफे हीने स्वपतश्च विवर्धते ॥ ९ ॥ मूर्च्छाज्वराभिभूतस्य ज्ञेयः प्रतमकस्तु सः ॥ १० ॥
Specific Symotoms – The type in which the least movement or exertion brings on an aggravation of the disease, and a distinct amelioration or relief is restored in a sitting posture, is called KsudraSvasa. The type which is accompained by such symptoms as thirst, perspiration, vomiting and a rattling sound in the throat and finds aggravation specially in cloudy weather is called Tamaka-Svasa. In a case of Tamaka-svasa the patient is weak and has a loud (wheezing) sound in the throat, as also cough, the symptoms of (bronchial) catarrh and an aversion to food. He is oppressed with difficult breathing even in sleep which abates only when the cough subsides and is aggravated when the patient sleeps. If a case of Tamaka-Svasa be attended with fever and fainting fits, it is then called Pratamaka. 6-10.
आध्मातो दह्यमानेन बस्तिना सरुजं नरः । सर्वप्राणेन विच्छिन्नं श्वस्याच्छिन्नं तमादिशेत् ॥ ११ ॥ निःसंज्ञः पार्श्वशूलार्तः शुष्ककण्ठोऽतिघोषवान् । संरब्धनेत्रस्त्वायम्य यः श्वस्यात् स महान् स्मृतः ॥ १२॥ मर्मस्वायम्यमानेषु श्वसन् मूढो मुहुश्च यः । ऊर्ध्वप्रेक्षी हतरवस्तमूर्ध्वश्वासमादिशेत् ॥ १३ ॥
The case wherein the patient pants for breath and has tympanites and a burning sensation in the bladder, and wherein the breaths painful, detached and intermittent, is known as Chinna – Svasa case wherein the patient breathes heavily lying unconscious and with a loud rattling sound in his throat and with cramps at his sides, the lips and the throat being parched and the eyes riveted in a fixed gaze or stare, is known as Maha-Svasa. The case wherein a patient breathes hurriedly, lies unconsious with choked voice and upturned eyes and with his Marmans stretching out fully with each stroke of breath is called Urddhva-Svasa. 11-13
Prognosis of Asthma
क्षुद्रः साध्यतमस्तेषां तमकः कृच्छ्र उच्यते । त्रयः श्वासा न सिध्यन्ति तमको दुर्बलस्य च ॥ १४ ॥
Prognosis – Of these (five) types the one known as KsudraSvasa is easily curable, while the one known as Tamaka-Svasa is hard to cure, and the three remaining ones, as well as Tamaka, ocurring in a weak or enfeebled patient are regarded as incurable. 14.
General Treatment of Asthma
स्नेहबस्तिं विना केचिदूर्ध्वञ्चाधश्च शोधनम् । मृदु प्राणवतां श्रेष्ठं श्वासिनामादिशन्ति हि ॥ १५ ॥ श्वासे कासे च हिक्कायां हृद्रोगे चापि पूजितम् । घृतं पुराणं संसिद्धमभयाविडरामठैः ॥ १६ ॥ सौवर्चलाभयाबिल्वैः संस्कृतं वाऽनवं घृतम् । पिप्पल्यादिप्रतीवापं सिद्धं वा प्रथमे गणे ॥ १७ ॥ सपञ्चलवणं सर्पिः श्वासकासौ व्यपोहति ॥ १८ ॥
General Treatment – Several authorities prefer that mild emetics and purgatives (lit, upward and downward cleansing-Sodhana of the system) with the exception of the application of Snehabasti would be the chief remedies in cases of asthma, if the patient possesses sufficient vitality. Old and matured clarified butter duly cooked with Abhaya, Vit-salt and Hingu or with Sauvarcala, Abhaya and Bilva would be beneficial in cases of cough, asthma, hiccough and heart-disease. Similarly old and matured clarified butter duly cooked with the pulverised drugs of the Pippalyadi group as Kalka and with (the decoction of) the drugs of the first i.e. the Vidarigandhadi group and with the five officinal kinds of salt added to it by way of an afterthrow, relieves both cough and asthma. 15-18.
हिंस्त्राविडङ्गपूतीक – त्रिफलाव्योषचित्रकैः द्विक्षीरं साधितं सर्पिश्चतुर्गुणजलाप्लुतम् ॥ १९ ॥
कोलमात्रैः पिबेत् तद्धि श्वासकासौ व्यपोहति । अशस्यरोचकं गुल्मं शकृद्भेदं क्षयं तथा ॥ २० ॥
Himsradi Ghrita – Clarified butter should be duly cooked with a Kola (D. R. Karsa ) weight each of Himsra, Vidanga, Putika, Triphala, Vyosa and Chitraka and with milk twice as much and water four times as much as clarified butter. A draught of this medicated Ghrita relieves both cough and asthma and proves curative in cases of piles, aversion to food, Gulma, diarrhoea and consumption ( Ksaya). 19-20.
कृत्स्ने वृषकषाये वा पचेत् सर्पिश्चतुर्गुणे । तन्मूलकुसुमावापं शीतं क्षौद्रेण योजयेत् ॥ २१ ॥
A quantity of clarified butter, duly cooked with four times as much of the decoction of all the parts (viz. — leaves, branches, barks, flowers and roots) of Vasaka and with its roots and flowers as Kalka, should be used with honey when cold ( in case of asthama). 21.
सहरिद्रैः सयष्ट्याह्वैः समैरावाप्य योगतः ॥ २२ ॥ घृतप्रस्थं पचेद्धीमान् शीततोये चतुर्गुणे ।
श्वासं कासं तथा हिक्कां सर्पिरेतन्नियच्छति ॥ २३ ॥
Srngyadi-Ghrita — A Prastha measure of clarified butter duly cooked with Srngi, Madhulika, Bhargi, Sunthi, Rasanjiana, sugar, Ambuda, Haridra and Yasti-madhu all taken in equal parts as Kalka and with four times of water, would cure cases of cough, asthma and hiccough. 22-23.
सुबहा कालिका भार्गी शुकाख्या नैचुलं फलम् । काकादनी कोलमात्रैर्घृतप्रस्थं कटूष्णं पीतमेतद्धि शृङ्गवेरं वर्षाभूबृहतीद्वयम् ॥ २४ ॥ पचेदेभिर्जलद्विकम् । श्वासामयविनाशनम् ॥ २५ ॥
1. Some prescribe the Kalkas to be taken in the ordinary way and say that the dose would be one Kola weight.
Suvahadi Ghrita – A Prastha measure of clarified butter should be duly cooked with twice as much of water and with a Kola (one Tola D.R.— Karsa) weight each of Suvaha, Kalika, Bhargi, Sukanasa, fruits of Nicula, Kakadani, Srngavera, Varsabhu and the two kinds of Brhati. Taken hot after being made pungent (by the addition of some pungent drug e.g., Pippali ) it would cure all forms of asthma. 24-25.
सौवर्चलयवक्षार – कटुकाव्योषचित्रकैः 1 वचाभयाविडङ्गैश्च साधितं श्वासशान्तये ॥ २६ ॥ गोपवल्ल्युदके सिद्धं स्यादन्यद् द्विगुणे घृतम् ॥ पञ्चैतानि हवींष्याहुर्भिषजः श्वासकासयोः ॥ २७॥
Calrified butter duly cooked with the admixture of Souvarcala, Yava-Kshara, Katuka, Vyosa, Chitraka, Vaca, Abhaya and Vidanga, proves curative in a case of asthma. Similarly clarified butter duly cooked with the decoction of Gopa-valli (Sariva) weighing twice as much as the clarified butter is also prescribed. Physicians prescribe these five medicated Ghritas in cases of asthma and cough 1. 26-27.
तालीशतामलक्युग्रा- जीवन्तीकुष्ठसैन्धवैः । बिल्वपुष्करभूतीक-सौवर्चलकणाग्निभिः ॥ २८ ॥ पथ्यातेजोवतीयुक्तैः सपिर्जलचतुर्गुणम् । हिङ्गपादयुतं सिद्धं सर्वश्वासहरं परम् ॥ २९ ॥ वासाघृतं षट्पलं वा घृतञ्चात्र हितं भवेत् ॥ ३० ॥
Talisadi- Ghrita – Clarified butter mixed with Hingu weighing a quarter part of its own weight and duly cooked in combination with four times as much of water and with Talisa, Tamalaki and Ugra, Jivanti, Kustha, Saindhava, Bilva, Puskara, Putika, Souvarcala, Kana (Pippali), Agni (Chitraka), Pathya (Haritaki) and Tejovati as Kalka proves curative in all forms of asthma. The medicated Ghrita known as Vasa-Ghrita’ and Satpala – Ghrita 3 would likewise prove beneficial. 28-30.
1. Some editors add this sentence after the next (Talisadi) Ghrita. 2. Vasaa-Ghrita is mentioned in the treatment of Rukta-pitta (ch. XLV, 20, UttaraTantra). It should be prescribed in cases of asthma when Pitta predominates. 3. Satpala Ghrita is mentioned in the treatment of Vata-Vyadhi. It should be prescribed in Vayu prevail.
तैलं दशगुणे सिद्धं भृङ्गराजरसे शुभे । सेव्यमानं यथान्यायं श्वासकासौ व्यपोहति ॥ ३१ ॥
The proper use of oil duly cooked in combination with the expressed juice of Bhrnga-raja weighing ten times as much of oil, would relieve cough and asthma. 31.
Meat as Diet in Asthma
फलाम्ला विष्किररसाः स्निग्धाः प्रव्यक्तसैन्धवाः । एणादीनां शिरोभिर्वा कौलत्था वा सुसंस्कृताः। हन्युः श्वासञ्च कासञ्च संस्कृतानि पयांसि च ॥ ३२ ॥
Meat as Diet — Essence of any bird of the Viskira species (e.g. chicken, Lava etc.) charged with the juice of any acid fruit (e.g. pomegranate, Bijapura, etc.) and with clarified butter and salted with a profuse quantity of Saindhava, or the soup of Kulattha cereals, properly cooked with the heads of Ena deer, etc., as well as milk duly cooked with (Anti-asthmatic and Vayu subduing) drugs (e.g. Pancamula) would destroy cough and asthma. 32.
तिमिरस्य च बीजानि कर्कटाख्या च चूर्णिता । दुरालभाऽथ पिप्पल्यः कटुकाख्या हरीतकी ॥ ३३ ॥ श्वाविन्मयूररोमाणि कोला मागधिकाकणाः । भार्गीत्वक शृङ्गवेरञ्च शर्करा शल्लकाङ्गजम् | मृत्तकौण्डक-बीजानि चूर्णितानि तु केवलम् ॥ ३४ ॥ पञ्च श्लोकार्धिकास्त्वेते लेहा ये सम्यगीरिताः । सर्पिर्मधुभ्यां ते लेह्याः कासश्वासादितैर्नरः ॥ ३५ ॥
The Five Lambatives- A lambative composed of any of the following five groups of drugs mentioned in each hemistich, viz., Tinisaseeds, Karkata Srngi and Suvarcika (Jatuka-creeper), or Dura-labha, Pippali, Katuka and Haritaki; or porcupine’s hair, peocock’s feather, Kola (Cavya) Magadhika and Kanal, or Bhargi, Tvak, ( cinnamon), Srngavera, Sarkara (sugar) and Sallaka-bark, or the well-pounded seeds of Tri-kantaka alone, should be licked with honey and clarified butter by a patient suffering from cough and asthma. 33-35.
1. Maghadhika and Kana are synonyms and mean Pippali. Some, therefore, prescribe two parts of Pippali in the compound. Others prescribed one part of Pippali and one of Gaja-pippali.
सप्तच्छदस्य पुष्पाणि पिप्पलीश्चापि मस्तुना । पिबेत् सञ्चूर्ण्य मधुना धानाश्चाप्यथ भक्षयेत् ॥ ३६ ॥ अर्काङ्कुरैर्भावितानां यवानां साध्वनेकशः। तर्पणं वा पिबेदेषां सक्षौद्रं श्वासपीडितः ॥ ३७॥
Powders of Saptacchada flowers and Pippali should be taken with curd-cream (Mastu) or powders of fried barley grains (?) previously soaked for several times in the expressed juice of tender Arka-twigs together with honey should be taken. As an alternative, a patient suffering from asthma would drink the Tarpana (cordial) prepared with the above-mentioned barley-powder (by mixing it with a copious quantity of water and) with honey. 36-37.
शिरीषकदलीकुन्द-पुप्पं मागधिकायुतम् । तण्डुलाम्बुयुतं पीत्वा जयेच्छ्वासानशेषतः ॥ ३८ ॥ कोलमज्जां तालमूलमृष्यचर्ममसीभपि । लिह्यात् क्षौद्रेण भार्गी वा सर्पिर्मधुसमायुताम् ॥ ३९ । निम्बै: कदम्बबीजं वा सक्षौद्रं तण्डुलाम्बुना ॥ ४० ॥
A potion prepared with the flowers of Sirisa, Kadali, Kunda and with Magadhika dissolved in the washings of rice would completely cure all forms of asthma. The pith or inner pulp of Kola-stone, roots of Tala (palm) tree (D.R. – Tala-muli) and the burnt skin’ of a deer of the Rsya species, should be taken with honey; or Bhargi with honey and clarified butter, or Kadamba- seeds and Nimba in combination with honey and the washings of rice. 38-40.
द्राक्षां हरीतकीं कृष्णां कर्कटाख्यां दुरालभाम् । सर्पिर्मधुभ्यां विलिहन् हन्ति श्वासान् सुदारुणान् ॥ ४१ ॥ हरिद्रां मरिचं द्राक्षां गुडं रास्त्रां कणां शटीम्। लिह्यात् तैलेन तुल्यानि श्वासार्तो हितभोजनः ॥ ४२ ॥
1. The skin of the deer should be burnt in a covered earthen pitcher and the black contents should be used.
Draksa, Haritaki, Krsna, Karkata-srngi and and Duralabha in combination with honey and clarified butter, should be licked by a patient whereby he would get rid even of a violent attack of asthma. A lambative composed of the equal parts of Haridra Marica, Draksa, treacle, Rasna, Kana and Sathi should be given to be licked with oil by an asthma-patient, conforming to the regimen of wholesome diet. 41-42.
गवां पुरीषस्वरसं मधुसर्पिःकणायुतम्। लिह्यात् श्वासेषु कासेषु वाजिनां वा शकृद्रसम् ॥ ४३ ॥ पाण्डुरोगेषु शोथेषु ये योगाः सम्प्रकीर्तिताः । श्वासकासापहास्तेऽपि कासघ्ना ये च कीर्तिताः ॥ ४४ ॥ भार्गीत्वकत्र्यषणं तैलं हरिद्रां कटुरोहिणीम् । पिप्पलीं मरिचं चण्डां गोशकृद्रसमेव च ॥ ४५ ॥ तलकोटस्य बीजेषु पचेदुत्कारिकां शुभाम् । सेव्यमाना निहन्त्येषा श्वासानाशु सुदुस्तरान् ॥ ४६ ॥
The expressed liquid of cow-dung and horse-dung should be licked by the patient with honey and powdered Pippali in cases of cough and asthma. The medicinal remedies or compounds mentioned. in connection with Pandu-roga and edema (Sotha) or cough, may be employed with efficacy both in cough and asthma. A compound made of Bhargi, Tvak, Tryusana, oil, Haridra, Katurohini, Pippali, Marica, Canda and the expressed liquid of cow-dung should be given (to be licked). Utkarika should be prepared with Tala-keeta-bija’. Taken internally, it instantaneously subdues even a violent attack of asthma. 43-46.
पुराणसर्पिः पिप्पल्यः कौलत्था जाङ्गला रसाः। सुरा सौवीरकं हिङ्ग मातुलुङ्गरसो मधु । द्राक्षामलकबिल्वानि शस्तानि श्वासिहिक्किनाम् ॥ ४७ ॥
Articles recommended- Matured clarified, butter, Pippali, soups of Kulattha or of the flesh of any Jangala animal, Sura, Souviraka ( fermented rice boilings), Hingu the expressed juice of Matulunga, honey, Draksa, amalaki and Bilva are recommended (as diet) in cases of asthma and hiccough. 47.
1. We do not know what is Tala-keeta’. Some printed editions read “Talpa-keeta” which would evidently mean a “bug”. Dalhana is silent on the point.
Application of Sveda
श्वासहिक्कापरिगतं स्निग्धैः स्वेदैरुपाचरेत् । आक्तं लवणतैलाभ्यां तैरस्य ग्रथितः कफः । स्वस्थो विलयनं याति मारुतश्च प्रशाम्यति ॥ ४८ ॥ स्विन्नं ज्ञात्वा ततश्चैव भोजयित्वा रसौदनम् । वातश्लेष्मविबन्धे वा भिषग् धूमं प्रयोजयेत् ॥ ४९ ॥
Application of Sveda — Oily fomentation (Snigdha-Sveda) with the help of oil and salt should be applied to the patient suffering from asthma and hiccough, whereby the hardened Kapha (accumulated in the channels) would be liquefied and the deranged bodily Vayu pacified. If the Vayu and Kapha be not thereby pacified, the patient should be first treated with Sneha and then with a diet consisting of boiled rice cooked with meat-soup. Application of Dhuma-inhalation should then be resorted to. 48-49.
Application of Dhuma
मनः शिलादेवदारु – हरिद्राच्छदनामिषैः लाक्षोरुबूकमूलैश्च कृत्वा वर्तीर्विधानतः ॥ ५० ॥ सर्पिर्यवमधूच्छिष्ट शालनिर्यासजं तथा । शृङ्गबालखुरस्नायुत्वक् समस्तं गवामपि ॥ ५१ ॥ तुरुष्कशल्लकीनाञ्च गुग्गुलो: पद्मकस्य च | एते सर्वे ससर्पिष्का धूमाः कार्या विजानता ॥ ५२ ॥
Application of Dhuma – The stick (Varti) to be used in the process should be duly made of Manahsila, Deva-daru, Haridra, Patra, Guggulu, Laksa and Eranda-roots made into a paste. Compounds made of clarified butter, fresh wax and resin; or of cow’s horn, hairs, hoof, tendon and skin; or of Turuska (Sila-rasa), Sallaki (Moca-rasa), Guggulu and Padmaka should be pounded together (and made into sticks) with the addition of clarified butter. An intelligent physician should use these (sticks) for the purpose of smoke-inhalation in the disease. 50-52.
बलीयसि कफग्रस्ते वमनं सविरेचनम् । दुर्बले चैव रुक्षे च तर्पणं हितमुच्यते । जाङ्गलोरभ्रजैर्मांसैरानूपैर्वा सुसंस्कृतैः ॥ ५३ ॥
Purging and vomiting should be induced in a patient overwhelmed with the action of the deranged Kapha, while Tarpana measures with the administration of a potion of the well-cooked soup of mutton or the flesh of any Jangala or Anupa animal, should be prescribed in the case of a weak or enfeebled patient, or in respect of one suffering from an internal parched condition of the body. 53.
निदिग्धिकाञ्चामलकप्रमाणां हिङ्ग्ग्वर्धयुक्तां मधुना सुयुक्ताम् । लिहन् नरः श्वासनिपीडितो हि श्वासं जयत्येव बलात् त्र्यहेण ॥ ५४ ॥
A lambative should be prepared with Nidigdhika paste of the weight of an Amalaka, mixed with half as much of powdered Hingu and with a copious quantity of honey. Duly taken, it would per force conquer a paroxysm of astham within three days. 54.
यथाऽग्निरिद्धः पवनानुविद्धो वज्रं यथा वा सुरराजमुक्तम् । रोगास्तथैते खलु दुर्निवारा: श्वासश्च कासश्च विलम्बिका च ॥ ५५ ॥
Irresistible is an attack of asthma, caugh and Vilambika like that of a fire fed with heaps of fuel (D.R. fanned by the wind) or like that of the thunderbolt hurled by the wrathful Indra, the king of the gods. 55.
इति सुश्रुत संहितायामुत्तरतन्त्रे श्वासप्रतिषेधव्याख्यानामैकपञ्चाशत्तमोऽध्यायः ॥ ५१ ॥ –
Thus ends the fifty-first chapter in the Uttara-Tantra of the Susruta Samhita which deals with the (symptoms and) treatment of asthma.