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Chapter 11 – Kasa Nidanam

The 11th chapter of Madhava Nidana deals with Kasa i.e,. diagnosis of cough.

धूमोपघाताद्रसतस्तथैव व्यायाम – रुक्षान्न निषेवणाच्च |
विमार्गंगत्वाच्च हि भोजनस्य वेगावरोधात् क्षवथोस्तथैव || १ ||
प्राणो ह्युदानानुगतः प्रदुष्टः स भिन्नकांस्यस्वनतुल्यघोषः |
निरेति वक्त्रात् सहसा सदोषो मनीषिभिः कास इति प्रदिष्टः || २ ||

dhūmōpaghātādrasatastathaiva vyāyāma – rukṣānna niṣēvaṇācca |
vimārgaṅgatvācca hi bhōjanasya vēgāvarōdhāt kṣavathōstathaiva || 1 ||
prāṇō hyudānānugataḥ praduṣṭaḥ sa bhinnakānsyasvanatulyaghōṣaḥ |
nirēti vaktrāt sahasā sadōṣō manīṣibhiḥ kāsa iti pradiṣṭaḥ || 2 ||

Due to intake of smoke that vitiate rasa (chyle), indulgence in the strenuous exercises, consumption of dry foods, reverse movement of food, suppression of natural urges and also due to suppression of sneeze, the pranavayu (that is responsible for respiration) gets mixed up with Udana Vayu (that is responsible for speech), gets vitiated and comes out at a stretch from the mouth along with impurities making a noise that is similar to the sound made by a broken bronze vessel. This symptom has been identified with Kasa (cough) by the wise. 1-2

Varieties of Kasa –

पञ्च कासाः स्मृता वात – पित्त – श्लेष्म – क्षत – क्षयैः |
क्षयायोपेक्षिताः सर्वे बलिनः च उत्तरोत्तरम् || ३ ||

pañca kāsāḥ smr̥tā vāta – pitta – ślēṣma – kṣata – kṣayaiḥ |
kṣayāyōpēkṣitāḥ sarvē balinaḥ ca uttarōttaram ||3||

Kasa is of five varieties; one each from Vata, pitta, kapha, kshata (injury to chest) and kshaya (loss of tissues). The first four, if neglected will lead to the fifth kind of Kshaya that is consumption. All the symptoms are dangerous in order of their appearance as above. 3

Prodromal features of Kasa –

पूर्वरूपं भवेत्तेषां शूकपूर्णगलास्यता |
कण्ठे कण्डुश्च भोज्यानामवरोधश्च जायते || ४ ||

pūrvarūpaṁ bhavēttēṣāṁ śūkapūrṇagalāsyatā |
kaṇṭhē kaṇḍuśca bhōjyānāmavarōdhaśca jāyatē || 4 ||

Premonitory symptoms of cough include the feeling of thorns pricking the throat, irritation, and blockage to movement of the food. 4

Vata Type of cough –

हृच्छङ्ख – मूर्धोदर – पार्श्वशूली क्षामाननः क्षीणबल – स्वरौजाः |
प्रसक्तवेगस्तु समीरणेन भिन्नस्वरः कासति शुष्कमेव || ५ ||

hr̥cchaṅkha – mūrdhōdara – pārśvaśūlī kṣāmānanaḥ kṣīṇabala – svaraujāḥ |
prasaktavēgastu samīraṇēna bhinnasvaraḥ kāsati śuṣkamēva || 5 ||

In the case of the vatika type of cough, there is pain in the pericardial and the temporal regions, head, abdomen, and the flanks. The face shows anxious appearance and there is a loss of strength, voice, and vitality. Bouts of cough are continuous, and the voice turns hoarse. 5

Pitta type of cough –

उरोविदाह – ज्वर – वक्त्रशोषैरभ्यर्दितस्तिक्तमुखस्तृषार्तः |
पित्तेन पीतानि वमेत् कटूनि कासेत् सपाण्डुः परिदह्यमानः || ६ ||

urōvidāha – jvara – vaktraśōṣairabhyarditastiktamukhastr̥ṣārtaḥ |
pittēna pītāni vamēt kaṭūni kāsēt sapāṇḍuḥ paridahyamānaḥ || 6 ||

In the case of the paittika type of cough there is

  • Uro vidaha — a burning sensation in the chest,
  • Jvara — fever,
  • Shosha Tikta Vaktra — dryness and the bitter taste in the mouth,
  • Trusharta — severe thirst
  • peeta and Katu Vami — yellowish and bitter vomit,
  • Sa pandu — yellowish – white complexion and
  • Paridaha — burning sensation inside the body. 6

Kapha Type of cough –

प्रलिप्यमानेन मुखेन सीदन् शिरोरुजार्तः कफपूर्णदेहः |
अभक्तरुग्गौरव – कण्डुयुक्तः कासेद्भृशं सान्द्रकफः कफेन || ७ ||

pralipyamānēna mukhēna sīdan śirōrujārtaḥ kaphapūrṇadēhaḥ |
abhaktaruggaurava – kaṇḍuyuktaḥ kāsēdbhr̥śaṁ sāndrakaphaḥ kaphēna || 7 ||

In the cases of kapha type of cough,

  • the mouth of the patient remains full with thick saliva
  • there is weakness of the body.

Moreover, there is

  • accumulation of kapha all over the body
  • anorexia
  • heaviness
  • irritation (in the throat)
  • Heavy cough followed by thick sputum. 7

Kshata Kasa (cough due to traumatic chest) –

अतिव्यवाय -भारध्व – युद्धाश्वगजविग्रहैः |
रुक्षस्योरःक्षतं वायुर्गृहित्वा कासमाचरेत् || ८ ||
स पूर्वं कासते शुष्कं ततः ष्टिवेत सशोणितं |
कण्ठेन रुजता अत्यर्थं विरुग्णेनेव चोरसा || ९ ||
सूचीभिरिव तीक्ष्णाभिस्तुध्यमानेन शूलिना |
दुःखस्पर्शेन शूलेन भेद – पीडाभितापिना || १० ||
पर्वभेद – ज्वर – श्वास – तृष्णा – वैस्वर्यपीडितः |
पारावत इवाकूजन कासवेगात् क्षतोद्भवात् || ११ ||

ativyavāya -bhāradhva – yuddhāśvagajavigrahaiḥ |
rukṣasyōraḥkṣataṁ vāyurgr̥hitvā kāsamācarēt || 8 ||
sa pūrvaṁ kāsatē śuṣkaṁ tataḥ ṣṭivēta saśōṇitaṁ |
kaṇṭhēna rujatā atyarthaṁ virugṇēnēva cōrasā || 9 ||
sūcībhiriva tīkṣṇābhistudhyamānēna śūlinā |
duḥkhasparśēna śūlēna bhēda – pīḍābhitāpinā || 10 ||
parvabhēda – jvara – śvāsa – tr̥ṣṇā – vaisvaryapīḍitaḥ |
pārāvata ivākūjana kāsavēgāt kṣatōdbhavāt || 11 ||

Persons who are weak and yet indulge in excessive sexual intercourse, who carry heavy weights, who walk long distances, who tame or fight with elephants, horses and the like and who get injury to the chest (lesion in the lungs) suffer from this type of cough.

He, first, has dry cough followed by expectoration of blood. There is a severe pain in the throat and he feels as if his chest has been pierced with sharp needles. There is a breaking pain in his chest and as such, he cannot tolerate even touch over the chest. He also suffers from breaking pain in the joints, fever, dyspnea, thirst and shrill voice. He makes sounds like that of a pigeon while coughing due to traumatic chest. 8 – 11

विषमासात्म्यभोज्यातिव्यव्याद् वेगनिग्रहात् |
घृणिनां शोचतां नृणां व्यापन्ने अग्नौ त्रयो मलाः |
कुपिताः क्षयजं कासं कुर्युर्देहक्षयप्रदम् || १२ ||

viṣamāsātmyabhōjyātivyavyād vēganigrahāt |
ghr̥ṇināṁ śōcatāṁ nr̥ṇāṁ vyāpannē agnau trayō malāḥ |
kupitāḥ kṣayajaṁ kāsaṁ kuryurdēhakṣayapradam || 12 ||

Indulgence in irregular and untimely meals, irregular foods, excessive sex, suppression of bodily urges, too much of jealousy, grief and the like generate increase of all the three doshas. This situation also destroys the digestive functions (of the patient of consumption). 12

Kshayaja Kasa (Cough due to pthisis) —

स गात्रशूल – ज्वर – दाह – मोहान् प्रणक्षयं चोपलभेत कासी |
शुष्यन विनिष्टिवति दुर्बलस्तु प्रक्षीणमांसो रुधिरं सपूयम् |
तं सर्वलिङ्गं बृश दुःचिकित्स्यं चिकित्सितज्ञाः क्षयजं वदन्ति || १३ ||

sa gātraśūla – jvara – dāha – mōhān praṇakṣayaṁ cōpalabhēta kāsī |
śuṣyana viniṣṭivati durbalastu prakṣīṇamānsō rudhiraṁ sapūyam |
taṁ sarvaliṅgaṁ br̥śa duḥcikitsyaṁ cikitsitajñāḥ kṣayajaṁ vadanti || 13 ||

The wise describes the kshayaja cough as the one in which the patient has bodyache, fever, burning sensation, bouts of fainting and loss of vitality. Such patient gradually emaciated, becomes weaker and weaker along with wasting of his muscles. The patient brings out sputum mixed with blood and pus. This disease with all the features is very hard to treat and proves fatal for the weak ones. 13

Curability and Incurability of Kasa (cough) –

इत्येष क्षयजः कासः क्षीणानां देहनाशनः |
साध्यो बलवतां वा स्याध्याप्यस्त्वेवं क्षतोथितः || १४ ||
नवौ कदाचित्सिध्येतामपि पादगुणान्वितौ |
स्थविराणां जराकासः सर्वो याप्यः प्रकीर्तितः |
त्रीन् पूर्वान् साधयेत् साध्यान् पथ्यैर्याप्यांस्तु यापयेत् || १५ ||

ityēṣa kṣayajaḥ kāsaḥ kṣīṇānāṁ dēhanāśanaḥ |
sādhyō balavatāṁ vā syādhyāpyastvēvaṁ kṣatōthitaḥ || 14 ||
navau kadācitsidhyētāmapi pādaguṇānvitau |
sthavirāṇāṁ jarākāsaḥ sarvō yāpyaḥ prakīrtitaḥ |
trīn pūrvān sādhayēt sādhyān pathyairyāpyānstu yāpayēt || 15 ||

Cough is curable if it is affecting persons who are strong. It is also curable if it is of a recent onset (at the time of the beginning of treatment). The prolonged cases of Kasa could be cured with suitable foods and medicines. The first three varieties are easily curable; the chronic cases of kasa are to be controlled with suitable eatables and the like. The first three types of cough are curable and they are to be treated. 14 – 15

इति श्रीमाधवकरविरचिते माधवनिदाने कासनिदानं समाप्तम् || 11 ||

iti śrīmādhavakaraviracitē mādhavanidānē kāsanidānaṁ samāptam || 11 ||

Thus concludes the chapter of Kasa.