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Chapter 12 – Hikka Shvasa Nidanam

The 12th chapter of Madhava Nidana deals with Hikka Shvasa Nidana i.e., Hiccup and dyspnoea.

विदाहि – गुरु – विष्ठंभि – रुक्षाभिष्यन्दिभोजनैः |
शीतपानाशनस्थान – रजो – धूमातपानिलैः || १ ||
व्यायामकर्म – भाराध्व – वेगाघातापतर्पणैः |
हिक्का श्वासश्च कासश्च नृणां समुपजायते || २ ||

vidāhi – guru – viṣṭhambhi – rukṣābhiṣyandibhōjanaiḥ |
śītapānāśanasthāna – rajō – dhūmātapānilaiḥ || 1 ||
vyāyāmakarma – bhārādhva – vēgāghātāpatarpaṇaiḥ |
hikkā śvāsaśca kāsaśca nr̥ṇāṁ samupajāyatē || 2 ||

The following persons could easily become victim of hikka (hiccup), Shvasa (dyspnea) and Kasa (cough): those who indulge in eatables that generate heartburn, constipation, and dryness, eatables that are heavy and hard to digest, which block the pores of the body.

The hiccup also affect person who regularly drinks very cold water or other beverages; who regularly engages himself in fasting, who gets exposure to unaccustomed places and to dust, smoke, sunlight and breeze, who undergoes physical exertion, who lifts or carries heavy weights, walks long distances, and who frequently suppresses the natural urges and who suffers from malnutrition. 1-2

The main feature of Hikka –

मुहुर्मुहुर्वायुरुदेति सस्वनो यक्रुत्प्लिहान्त्राणि मुखादिवाक्षिपन् |
स घोषवानाशु हिनस्त्यसून यतस्ततस्तु हिक्केत्यभिधियते बुधैः || 3 ||

muhurmuhurvāyurudēti sasvanō yakrutplihāntrāṇi mukhādivākṣipan |
sa ghōṣavānāśu hinastyasūna yatastatastu hikkētyabhidhiyatē budhaiḥ || 3 ||

Vayu coming out of the mouth with peculiar hik hik sound starting from the region of liver, spleen and intestines and quickly producing tiredness to the person are the main symptom of Hikka recognized by the wise. 3

Pathogenesis and varieties of hikka –

अन्नजां यमलां क्षुद्रां गम्भीरां महती तथा |
वायुः कफेनानुगतः पञ्च हिक्काः करोति हि || ४ ||

annajāṁ yamalāṁ kṣudrāṁ gambhīrāṁ mahatī tathā |
vāyuḥ kaphēnānugataḥ pañca hikkāḥ karōti hi || 4 ||

The vata associated with kapha generates hikka that is of five types viz.,

  • Annaja
  • Yamala
  • Kshudra
  • Gambhira
  • Mahati

Prodromal features of Hikka –

कण्ठोरसोर्गुरुत्वं च वदनस्य कषायता |
हिक्कानां पुर्वरुपाणि कुक्षेराटोप एव च || ५ ||

kaṇṭhōrasōrgurutvaṁ ca vadanasya kaṣāyatā |
hikkānāṁ purvarupāṇi kukṣērāṭōpa ēva ca || 5 ||

Premonitory features of Hikka include –

  • Kantha Uras Guruta — Heaviness of the throat and chest
  • Vadanasya Kashayata — Astringent taste in the mouth
  • Kukshi Aatopa — Gurgling noise in the abdomen. 5

Annaja Type of Hikka –

पानान्नैरतिसंयुक्तैः सहसा पीडितो अनिलः |
हिक्कयत्यूर्ध्वगो भूत्वा तां विध्यादन्नजां भिषक् || ६ ||

pānānnairatisanyuktaiḥ sahasā pīḍitō anilaḥ |
hikkayatyūrdhvagō bhūtvā tāṁ vidhyādannajāṁ bhiṣak || 6 ||

Annaja Hikka is generated by vaata which moves upwards by the effect of taking excess quantities of drinks and eatables within short intervals. 6

Yamalaa Hikka (Dual Hiccup) –

चिरेण यमलैर्वेगैर्या हिक्का सम्प्रवर्तते |
कम्पयन्ती शिरोग्रीवं यमलां तां विनिर्दिशेत् || ७ ||

cirēṇa yamalairvēgairyā hikkā sampravartatē |
kampayantī śirōgrīvaṁ yamalāṁ tāṁ vinirdiśēt || 7 ||

That hiccup which comes up in two successive bouts at some interval and which shakes the head and the neck is called yamala hikka. 7

Kshudra Hikka (Minor Hiccup) –

प्रकृष्टकालैर्या वेगैर्मन्दैः समभिवर्तते |
क्षुद्रिका नाम सा हिक्का जत्रुमूलात् प्रधाविता || ८ ||

prakr̥ṣṭakālairyā vēgairmandaiḥ samabhivartatē |
kṣudrikā nāma sā hikkā jatrumūlāt pradhāvitā || 8 ||

Kshudra Hikka starts only from the base of the neck. It is mild in intensity and it continues only for a short time. 8

Gambhiraa Hikka (Deep Hiccup) –

नाभिप्रवृत्ता या हिक्का घोरा गम्भीरनादिनी |
अनेकोपद्रववती गम्भीरा नाम सा स्मृता || ९ ||

nābhipravr̥ttā yā hikkā ghōrā gambhīranādinī |
anēkōpadravavatī gambhīrā nāma sā smr̥tā || 9 ||

Gambhira Hikka is one that starts deep inside from the umbilicus, is very powerful and that makes heavy sound and is accompanied with several implications. 9

Mahati Hikka (Serious Hiccup) –

मर्मन्युत्पीडयन्तीव सततं या प्रवर्तते |
महाहिक्केति सा ज्ञेया सर्वगात्रविकम्पिनि || १० ||

marmanyutpīḍayantīva satataṁ yā pravartatē |
mahāhikkēti sā jñēyā sarvagātravikampini || 10 ||

That variety of hiccup that keeps on coming continuously as if afflicting the vital organs and shakes the entire body has been identified as Mahati hikka. 10

Incurability of Hikka –

आयम्यते हिक्कतो यस्य देहो दृष्टिः ऊर्ध्वं नाम्यते यस्य नित्यम् |
क्षीणो अन्नद्विट् क्षौति यश्चातिमात्रं तौ द्वौ चान्त्यौ वर्जयेद्धिक्कमानौ || ११ ||

āyamyatē hikkatō yasya dēhō dr̥ṣṭiḥ ūrdhvaṁ nāmyatē yasya nityam |
kṣīṇō annadviṭ kṣauti yaścātimātraṁ tau dvau cāntyau varjayēddhikkamānau || 11 ||

Patients of hikka who develop too much stretching of the body, whose gaze gets fixed up, whose body bends regularly, who is passing through emaciation, who is having aversion to eatables and suffers from too several sneezing and who has the last two types (gambhira and mahati) of Kasa are to be refused treatment. 11

अतिसञ्चितदोषस्य भक्तच्छेदकृशस्य च |
व्याधिभिः क्षीणदेहस्य वृद्धस्यातिव्यवायिनः || १२ ||
आसां या सा समुत्पन्ना हिक्का हन्त्याशु जिवितम् |
यमिका च प्रलापार्ति – मोह – तृष्णासमन्विता ||१३ ||
अक्षीणश्चाप्य दीनश्च स्थिरधात्विन्द्रियश्च यः |
तस्य साधयितुं शक्या यमिका हन्त्यतो अन्यथा || १४ ||

atisañcitadōṣasya bhaktacchēdakr̥śasya ca |
vyādhibhiḥ kṣīṇadēhasya vr̥ddhasyātivyavāyinaḥ || 12 ||
āsāṁ yā sā samutpannā hikkā hantyāśu jivitam |
yamikā ca pralāpārti – mōha – tr̥ṣṇāsamanvitā ||13 ||
akṣīṇaścāpya dīnaśca sthiradhātvindriyaśca yaḥ |
tasya sādhayituṁ śakyā yamikā hantyatō anyathā || 14 ||

Likewise, those in whom all the doshas have got excessively vitiated, who are unable to take eatables, who have got emaciated and debilitated by other diseases, who are very aged, who regularly indulge in excessive sexual intercourse, who are having yamala type of hikka, who have delirium, pain, delusion and thirst are going to succumb to hikka soon.

The yamala hikka also kills the individuals soon, if it is associated with delirium, delusion, and thirst. If the individuals having the dual hiccup has not been emaciated, not depressed and has stable tissues and organs, he can be treated, otherwise, the disease is fatal. 12 – 14

Varieties of Shvasa (Dyspnoea) —

महोर्ध्वच्छिन्न – तमक – क्षुद्रभेदैस्तु पञ्चधा |
भिद्यते स महाव्याधिः श्वास एको विशेषतः || १५ ||

mahōrdhvacchinna – tamaka – kṣudrabhēdaistu pañcadhā |
bhidyatē sa mahāvyādhiḥ śvāsa ēkō viśēṣataḥ || 15 ||

The five varieties of Shvasa which is counted as a Maha Vyadhi that is dreadful disease are –

  • Mahati
  • Urdhva
  • Chinna
  • Tamaka
  • Kshudra. 15

(वाताधिको भवेत् क्षुद्रस्तमकस्तु कफोद्भवः |
कफ – वाताधिकश्च चैव संसृष्टः च्छिन्नसंज्ञकः |
श्वासो मारुत संसृष्टो महानूर्ध्वस्तथा मतः ||)

(vātādhikō bhavēt kṣudrastamakastu kaphōdbhavaḥ |
kapha – vātādhikaśca caiva sansr̥ṣṭaḥ cchinnasañjñakaḥ |
śvāsō māruta sansr̥ṣṭō mahānūrdhvastathā mataḥ ||)

Kshudra type of kasa is predominantly Vataja; the tamaka type of Kasa is predominantly kaphaja; the china type of kasa is kapha – vataja while mahat and urdhva types of kasa are also predominantly Vataja .

Prodromal features and pathogenesis of Shvasa —

प्राग्रुपं तस्य हृत्पीडा शूलमाध्मानमेव च |
आनाहो वक्त्रवैरस्यं शङ्खनिस्तोद एव च || १६ ||

prāgrupaṁ tasya hr̥tpīḍā śūlamādhmānamēva ca |
ānāhō vaktravairasyaṁ śaṅkhanistōda ēva ca || 16 ||

The premonitory features of dyspnea include –

  • Hrt Pida — Pain region of the heart
  • Shoola Aadhmana Aanaha — Abdominal colic and Distension and enlargement
  • Vaktra Vairasya — Bad taste in the mouth
  • Shankha Nistoda — Pain in the temples. 16

यदा स्रोतांसि संरुध्य मारुतः कफपूर्वकः |
विश्वग्व्रजति संरुद्धस्तदा श्वासान् करोति सः || १७ ||

yadā srōtānsi sanrudhya mārutaḥ kaphapūrvakaḥ |
viśvagvrajati sanruddhastadā śvāsān karōti saḥ || 17 ||

The vata associated with kapha obstructs the passages inside the lungs and begins to move in all directions producing the disease shvasa. 17

Maha Shvasa (Great Dyspnoea) –

उद्धूयमानवातो यः शब्धवद् दुःखितो नरः |
उच्चैः श्वसिति संरुद्धो मत्तर्षभ इवानिशम् || १८ ||
प्रनष्टज्ञान – विज्ञानस्तथा विभ्रान्तलोचनः |
विवृताक्ष्याननो बद्धमूत्र – वर्चा विशीर्णवाक् || १९ ||
दीनः प्रश्वसितं चास्य दूराद्विजायते बृशं |
महाश्वासोपसृष्टस्तु क्षिप्रमेव विपध्यते || २० ||

uddhūyamānavātō yaḥ śabdhavad duḥkhitō naraḥ |
uccaiḥ śvasiti sanruddhō mattarṣabha ivāniśam || 18 ||
pranaṣṭajñāna – vijñānastathā vibhrāntalōcanaḥ |
vivr̥tākṣyānanō baddhamūtra – varcā viśīrṇavāk || 19 ||
dīnaḥ praśvasitaṁ cāsya dūrādvijāyatē br̥śaṁ |
mahāśvāsōpasr̥ṣṭastu kṣipramēva vipadhyatē || 20 ||

Vata, having vitiated greatly, moves upward constantly with heavy sound and pain, like that of a powerful bull tied firmly to a peg. He loses his senses, has terrified looks with wide opened eyes and mouth, suffers from constipation and retention of urine, and speaks in feeble voice.

He is depressed and his breathing can be heard from a distance. The patients undergoing such conditions are known to be suffering from Maha Shvasa; he might pass away within a short period. 18 – 20

Urdhva Shvasa (Upward dyspnoea) –

ऊर्ध्वं श्वसिति यो दीर्घं न च प्रत्याहरत्यधः |
श्लेष्मावृतमुखस्रोताः क्रुद्धगन्धवहार्दितः || २१ ||

ūrdhvaṁ śvasiti yō dīrghaṁ na ca pratyāharatyadhaḥ |
ślēṣmāvr̥tamukhasrōtāḥ kruddhagandhavahārditaḥ || 21 ||

Because of an accumulation of kapha the movement of air inside the upper part of the body is restricted and subsequently the air does not enter the lower tract of body even with difficulty. This is the condition of the prodromal features of urdhva shvasa or rapid and shallow respiration. 21

ऊर्ध्व दृष्तिर्विपश्यंस्तु विभ्रान्ताक्ष इतस्ततः |
प्रमुह्यन् वेदनार्तश्च शुक्लास्यो अरतिपिडितः || २२ ||
ऊर्ध्वश्वासे प्रकुपिते ह्यधःश्वासो निरुध्यते |
मुह्यतस्ताम्यतश्चोर्ध्वं श्वास्तस्यैव हन्त्यसून || २३ ||

ūrdhva dr̥ṣtirvipaśyanstu vibhrāntākṣa itastataḥ |
pramuhyan vēdanārtaśca śuklāsyō aratipiḍitaḥ || 22||
ūrdhvaśvāsē prakupitē hyadhaḥśvāsō nirudhyatē |
muhyatastāmyataścōrdhvaṁ śvāstasyaiva hantyasūna || 23 ||

The following could be noted as features of the fatal stage of urdhva shvasa:

  • Urdhva Drushti — Upward and agitated gaze
  • Vibhraanta Aksha — Rolling eyeballs
  • Arati Piditah — Distress
  • Urdhva Shvasa — Long expiration
  • Aasya Shukla — The mouth turning white in complexion
  • And an overall restlessness. 22 – 23

Chinna Shvasa (Interrupted dyspnoea) —

यस्तु श्वसिति विच्छिन्नं सर्वप्राणेन पीडितः |
न वा श्वसिति दुःखार्तो मर्मच्छेद रुगर्दितः || २४ ||
अनाह – स्वेद – मूर्च्छार्तो दह्यमानेन बस्तिना |
विप्लुताक्षः परिक्षीणः श्वसन् रक्तैकलोचनः || २५ ||
विचेताः परिशुष्कास्यो विवर्णः प्रलपन्नरः |
च्छिन्नश्वासेन विच्छिन्नः स शीघ्रं विजहात्यसून् || २६ ||

yastu śvasiti vicchinnaṁ sarvaprāṇēna pīḍitaḥ |
na vā śvasiti duḥkhārtō marmacchēda rugarditaḥ || 24 ||
anāha – svēda – mūrcchārtō dahyamānēna bastinā |
viplutākṣaḥ parikṣīṇaḥ śvasan raktaikalōcanaḥ || 25 ||
vicētāḥ pariśuṣkāsyō vivarṇaḥ pralapannaraḥ |
cchinnaśvāsēna vicchinnaḥ sa śīghraṁ vijahātyasūn || 26 ||

The fatal phase of the disease chinna shvasa is marked through the following features:

  • The respiration is often interrupted in the middle,
  • One feels a severe distress
  • One would not even attempt at respiration for fear of pain
  • And one has pain in all the vital organs.

In that final stage, one’s abdomen is enlarged. There is

  • Heavy perspiration
  • Fainting
  • Burning sensation in one’s urinary bladder
  • Whose eyes are filled with tears.

One would suffer from

  • Emaciation
  • Redness of one eye
  • Loss of consciousness
  • Severe dryness of the mouth
  • Discolouration
  • Delirium
  • Looseness of all the joints
  • And the like symptoms when one has reached fatal stage of the disease.

Then one is understood to have reached an incurable stage of the disease chinna shvasa. 24 – 26

Tamaka Shvasa (Bronchial asthma) —

प्रतिलोमं यदा वायुः स्रोतांसि प्रतिपध्यते |
ग्रीवां शिरश्च संगृह्य श्लेष्माणं समुदीर्य च || २७ ||
करोति पीनसं तेन रुद्धो घुर्घुरकं तथा |
अतीव तीव्रवेगं च श्वासं प्राणप्रपीडकम् || २८ ||
प्रताम्यति स वेगेन तृष्यते सन्निरुध्यते |
प्रमोहं कासमानश्च स गच्छति मुहुर्मुहुः || २९ ||
श्लेष्मण्यमुच्यमाने तु बृशं भवति दुःखितः |
तस्यैव च विमोक्षान्ते मुहूर्तं लभते सुखम् || ३० ||
तथा अस्योद्ध्वंसते कण्ठः कृच्छ्राच्छक्नोति भाषितुम् |
न चापि लभते निद्रां शयानः श्वासपीडितः || ३१ ||
पार्श्वे तस्यावगृह्णाति शयानस्य समीरणः |
आसीनो लभते सौख्यमुष्णं चैवाभिनन्दति || ३२ ||
उच्छ्रिताक्षो ललाटेन स्विध्यता बृशमार्तिमान् |
विशुष्कास्यो मुहुः श्वासो मुहुश्च्हैवावधम्यते || ३३ ||
मेघाम्बु – शीत – प्राग्वातैः श्लेष्मलैश्च विवर्धते |
स याप्यस्तमकः श्वासः साध्यो वा स्यान्नवोतिथः || ३४ ||

pratilōmaṁ yadā vāyuḥ srōtānsi pratipadhyatē |
grīvāṁ śiraśca saṅgr̥hya ślēṣmāṇaṁ samudīrya ca || 27 ||
karōti pīnasaṁ tēna ruddhō ghurghurakaṁ tathā |
atīva tīvravēgaṁ ca śvāsaṁ prāṇaprapīḍakam || 28 ||
pratāmyati sa vēgēna tr̥ṣyatē sannirudhyatē |
pramōhaṁ kāsamānaśca sa gacchati muhurmuhuḥ || 29 ||
ślēṣmaṇyamucyamānē tu br̥śaṁ bhavati duḥkhitaḥ |
tasyaiva ca vimōkṣāntē muhūrtaṁ labhatē sukham || 30 ||
tathā asyōddhvansatē kaṇṭhaḥ kr̥cchrācchaknōti bhāṣitum |
na cāpi labhatē nidrāṁ śayānaḥ śvāsapīḍitaḥ || 31 ||
pārśvē tasyāvagr̥hṇāti śayānasya samīraṇaḥ |
āsīnō labhatē saukhyamuṣṇaṁ caivābhinandati || 32 ||
ucchritākṣō lalāṭēna svidhyatā br̥śamārtimān |
viśuṣkāsyō muhuḥ śvāsō muhuśchaivāvadhamyatē || 33 ||
mēghāmbu – śīta – prāgvātaiḥ ślēṣmalaiśca vivardhatē |
sa yāpyastamakaḥ śvāsaḥ sādhyō vā syānnavōtithaḥ ||

When the vayu moves in the reverse direction in the respiratory channels, it grips the neck and the head and paves way for morbid increase of Kapha in the throat and head. Together they generate:

  • Running of nose
  • Bubbling sound in the throat
  • Intensely increased respiration in number as well as in intensity.

This condition subsequently produces –

  • A darkness of vision
  • Thirst
  • And bouts of severe cough.

The patient tries hard to bring out sputum but he finds only a momentary relief after its expulsion. He has an irritated throat and he speaks with great difficulty.

On lying,

  • he gets the bout of dyspnea and thus he cannot sleep.
  • He finds comfort in the sitting posture only, desires warm comfort.
  • His eyes remain wide open.
  • He has sweating on the forehead and he feels shaking of the body.
  • His mouth is dried and the patient is subjected to dyspnea repeatedly.

This disease, called tamaka shvasa, is increased by clouds, rains, and cold and east ward winds and by foods that produce kapha. Treatment of this can only be a prolonged one, but the disease can be cured if the treatment starts immediately and if the case is fresh. 27 – 34

Pratamaka shvasa and santamaka shvasa –

ज्वर – मूर्च्छापरीतस्य विध्यात् प्रतमकं तु तम् |
उदावर्त – रजो अजीर्ण – क्लिन्न – कायनिरोधजः || ३५ ||

jvara – mūrcchāparītasya vidhyāt pratamakaṁ tu tam |
udāvarta – rajō ajīrṇa – klinna – kāyanirōdhajaḥ || 35 ||

If the above signs and symptoms (of tamaka shvasa) are associated with fever and fainting, it is known as pratamaka shvasa. It is caused by symptoms such as

  • Udavarta
  • Dust particles
  • Indigestion
  • Drenching of the body
  • Old age
  • Respiratory obstruction. 35

तमसा वर्धते अत्यर्थं शीतैश्चाशु प्रशाम्यति |
मज्जतस्तमसीवास्य विध्यात् संतमकं तु तम् || ३६ ||

tamasā vardhatē atyarthaṁ śītaiścāśu praśāmyati |
majjatastamasīvāsya vidhyāt santamakaṁ tu tam || 36 ||

Tamaka shvasa which is due to increase of tamas (darkness, cloudy weather inactivity) makes the patient to go deep into darkness. He finds comfort by cold things quickly. This condition has been identified as the Santamaka. 36

Kshudra Shvasa (Mild dyspnoea) –

रूक्षायासोद्भवः कोष्टे क्षुद्रो वात उदीरयन् |
क्षुद्रश्वासो न सो अत्यर्थं दुःखेनाङ्गप्रबाधकः || ३७ ||
हिनस्ति न स गात्राणि न च दुःखो यथेतरे |
न च भोजन – पानानां निरुन्द्धयुचितां गतिम् || ३८ ||
नेन्द्रियाणां व्यथां नापि काञ्चिदापादयेद्रुजम् |
स साध्य उक्तो बलिनः सर्वे चाव्यक्तलक्षणाः || ३९ ||

rūkṣāyāsōdbhavaḥ kōṣṭē kṣudrō vāta udīrayan |
kṣudraśvāsō na sō atyarthaṁ duḥkhēnāṅgaprabādhakaḥ || 37 ||
hinasti na sa gātrāṇi na ca duḥkhō yathētarē |
na ca bhōjana – pānānāṁ nirunddhayucitāṁ gatim || 38 ||
nēndriyāṇāṁ vyathāṁ nāpi kāñcidāpādayēdrujam |
sa sādhya uktō balinaḥ sarvē cāvyaktalakṣaṇāḥ || 39 ||

By consuming dry foods and indulging in physical strain, the vata in the alimentary canal is raised. This situation causes kshudra shvasa (the minor type or mild type of dyspnoea) which is not so troublesome. It does not emaciate the body nor is it so painful as the other types of shvasa.

It does not hinder the consumption of foods and drinks and there is no problem to the senses nor does it create any other pain. This disease is considered as curable. The other three types of Shvasa are curable when they are mild and affecting strong persons. 37 – 39

क्षुद्रः साध्यो मतस्तेषां तमकः कृच्छ्र उच्यते |
त्रयः श्वासा न सिध्यन्ति तमको दुर्बलस्य च || ४० ||

kṣudraḥ sādhyō matastēṣāṁ tamakaḥ kr̥cchra ucyatē |
trayaḥ śvāsā na sidhyanti tamakō durbalasya ca || 40 ||

Kshudra shvasa is curable, tamaka shvasa is difficult to manage while in the case of the weak persons it proves to be incurable; the other three types of shvasa are incurable. 40

कामं प्राणहरा रोगा बहवो न तु ते तथा |
यथा श्वासश्च हिक्का च हरतः प्राणमाशु च || ४१ ||

kāmaṁ prāṇaharā rōgā bahavō na tu tē tathā |
yathā śvāsaśca hikkā ca harataḥ prāṇamāśu ca || 41 ||

इति माधवकरविरचिते माधवनिदाने हिक्का – श्वासनिदानं समाप्तम् ||12||

iti mādhavakaraviracitē mādhavanidānē hikkā – śvāsanidānaṁ samāptam ||12||

Thus concludes the chapter on shvasa – hikka.