Ashtanga Hridayam Nidanasthanam Chapter 4:  Shvasa Hidhma Nidanam Adhyaya (Diagnosis of dyspnoea and hiccough) 

The 4th chapter of Nidanasthanam of Ashtanga Hridayam is named as Shvasa Hidhma Nidanam Adhyayah. This chapter deals with the explanation of ‘diagnosis of dyspnoea and hiccough’.

The topics covered in this chapter include –

–       Shvasa Nidana – causes of dyspnea
–       Shvasa bheda – kinds of dyspnea
–       Samprapti – pathogenesis of dyspnoea
–       Purvarupa – premonitory symptoms of dyspnea
–       Rupa – symptoms of Kshudra, Tamaka, Chinna, Maha and Urdhwa shvasa
–       Sadhyasadhyata – prognosis of dyspnea
–       Hidhma Nidana – diagnosis of hiccough
–       Rupa – symptoms of Annaja, Kshudra, Yamala, Maha and Gambhira Hikka
–       Sadhyasadhyata – prognosis of hiccough
–       Hiccough and dyspnea cause quick death among all diseases

Pledge by the author(s)       

अथातो श्वासहिध्मानिदानं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ॥
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘diagnosis of dyspnoea and hiccough’. Thus say (pledge) atreya and other sages.

Shvasa Nidana (causes of dyspnoea)

कासवृद्ध्या भवेच्छ्वासः पूर्वैर्वा दोषकोपनैः।
आमातीसार वमथु विषपाण्डुज्वरैरपि॥१॥
रजोधूमानिलैर्मर्मघातादतिहिमाम्बुना।
Shvasa (dyspnea) arises by increase of cough, or by causes described earlier which bring about aggravations of the Doshas. Also, by diarrhea due to indigestion, vomiting, poisons, anemia, fever; exposure to dust, smoke, and breeze; injury to vital organs and drinking of very cold water.

Shvasa Bheda (kinds)

क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चमः॥२॥
Kshudra, Tamaka, Chinna, Mahan, and Urdhva – are its five kinds

Samprapti (pathogenesis)

कफोपरुद्धगमनः पवनो विष्वगास्थितः।
प्राणोदकान्नवाहीनि दुष्टः स्रोतांसि दूषयन्॥३॥
उरःस्थः 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 (dyspnea) arising from the Amasaya (stomach).

Purvarupa (premonitory symptoms)

प्राग्रूपं तस्य हृत्पार्श्वशूलं प्राणविलोमता॥४॥
आनाहः शङ्खभेदश्च
Its premonitory 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).

Rupa (clinical features)

Kshudra Shvasa

तत्रायासातिभोजनैः।
प्रेरितः प्रेरयेत्क्षुद्रं स्वयं संशमनं मरुत्॥५॥
Marut (Vata) aggravated by exertion and overeating, produces Kshudra Shvasa, which subsides by itself (without any treatment)

Notes: This is heavy breathing on exertion, passes off soon by rest and not troublesome.

Tamaka Shvasa

प्रतिलोमं सिरागच्चन्नुदीर्यपवनः कफम्।
परिगृह्य शिरोग्रीवमुरः पार्श्वे च पीडयन्॥६॥
कासं घुर्घुरकं मोहमरुचिपीनसं तृषम्।
करोति तीव्रवेगं च श्वासं प्राणोपतापिनम्॥७॥
प्रताम्येत्तस्य वेगेन निष्ठ्यूतान्ते क्षणं सुखी।
कृच्छ्राच्छयानः श्वसितिनिषण्णः स्वास्थ्यमृच्चति॥८॥
उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान्।
विशुष्कास्यो मुहुःश्वासी काङ्क्षत्युष्णं सवेपथुः॥९॥
मेघाम्बुशीतप्राग्वातैः श्लेष्मलैश्चविवर्धते।
सयाप्यस्तमको साध्यो नवो वा बलिनो भवेत्॥१०॥
ज्वरमूर्छायुतः शीतैः शाम्येत्प्रतमकस्तुसः।
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 Shvasa – 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; is unable to breath while lying and finds comfort on sitting; eyes are gazing up (wide open) forehead sweating, experiences great distress; mouth is dry, bouts of dyspnea are frequent, desires hot comforts, and accompanied with tremors (shivering); the conditions gets increased by accumulation of clouds in the sky, drinking cold water, cold breeze, direct breeze and ingestion of substances which cause increase of Kapha. This TamakaSvasa 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.).

Notes: – This condition is identified as Bronchial Asthma in modern parlance.

Chinna Shvasa

छिन्नाच्छ्वसिति विच्छिन्नं मर्मच्छेद रुजार्दितः॥११॥
सस्वेदमूर्छः सानाहो वस्तिदाहनिरोधवान्।
अधोदृग्विप्लुताक्षश्च मुह्यन्रक्तैकलोचनः॥१२॥
शुष्कास्यः प्रलपन्दीनो नष्टच्छायोविचेतनः।
With Chinnasvasa the person breathes with interruptions, has cutting pain in the vital organs, accompanied with pain, 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 color, mouth dry, talks irrelevant; feels helpless (unable to do any thin, 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.

Maha shvasa

महतामहतादीनो नादेन श्वसितिक्रथन्॥१३॥
उद्धूयमानः संरब्धो मत्तर्षभ इवानिशम्।
प्रणष्टज्ञानविज्ञानो विभ्रान्त नयनाननः॥१४॥
वक्षः समाक्षिपन्बद्धमूत्रवर्चाविशीर्णवाक्।
शुष्ककण्ठोमुहुर्मुह्यन्कर्णशङ्खशिरोऽतिरुक्॥१५॥
With Mahasvasa, the person has heavy breathing, feels helpless (unable to withstand the trouble), respirations are accompanied with sound like snoring (caused by sudden interruption of breath), trembling and agitated, he produces continuous sound of high pitch (from the nose) resembling that of a bull; common sense and intelligence are lost, eyes and face are unsteady; chest constricted / move violently; obstruction of urine and feaces, broken, voice, dryness of the throat, frequent delusions and severe pain in the ears, temples and head

Notes: – This condition also appears at the terminal stages of many diseases.

Urdhva Shvasa

दीर्घमूर्ध्वं श्वसित्यूर्ध्वान्न च प्रत्याहरत्यधः।
श्लेष्मावृतमुखस्रोताः क्रुद्धगन्धवहार्दितः॥१६॥
ऊर्ध्वदृग्वीक्षते भ्रान्तमक्षिणीपरितः 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 shleshma (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, the person is in grief (cries) and his speech choked

Sadhyasadhyata (prognosis)

एते सिध्येयुरव्यक्ताव्यक्ताः प्राणहरा ध्रुवम्।
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

Hidhma (Hikka) Nidana (diagnosis of hiccup)

श्वासैकहेतुप्राग्रूप सङ्ख्या प्रकृतिसंश्रयाः॥१८॥
हिध्माभक्तोद्भवा क्षुद्रा यमला महतीति च।
गम्भीरा च
Causes, premonitory symptoms, number (kinds), pathogenesis and place of Hidhma (hiccup) are the same as those of Svasa (dyspnoea). Hidhma (hiccup) is of five kinds; viz, that produced by food (Annaja), Ksudra, Yamala, Mahatiand Gambhira

Rupa (clinical features)

Annaja Hikka

मरुत्तत्रत्वरयायुक्तिसेवितैः॥१९॥
रूक्षतीक्ष्णखरासात्म्यैरन्नपानैः प्रपीडितः।
करोति हिध्मामरुजां मन्दशब्दां क्षवानुगाम्॥२०॥
शमं सात्म्यान्नपानेन या प्रयाति च सान्नजा।
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 is 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).

Kshudra Hikka

आयासात्पवनः क्षुद्रः क्षुद्रां हिध्मां प्रवर्तयेत्॥२१॥
जत्रुमूलप्रविसृतामल्पवेगां मृदुं च सा।
वृद्धिमायास्यतो याति भुक्तमात्रे च मार्दवम्॥२२॥
Pavana (Vata) undergoing slight increase from exertion, produces Kshudra Hidhma (minor hiccup) starting from the root (base) of the shoulders, with mild and soft bouts, increases by exertion and subsides immediately after consuming food.

Yamala Hikka

चिरेण यमलैर्वेगैराहारे या प्रवर्तते।
परिणामोन्मुखेवृद्धिं परिणामे च गच्छति॥२३॥
कम्पयन्तीशिरोग्रीवमाध्मातस्यातितृष्यतः।
प्रलापच्छर्द्यतीसार नेत्रविप्लुति जृम्भिणः॥२४॥
यमला वेगिनी हिध्मा परिणामवती च सा।
That, commencing a long time after taking food and increasing during the period of digestion and after digestion, bouts coming up in pairs, causing tremors of the head and neck, flatulence, severe thirst, irrelevant talk, vomiting, diarrhea, unsteady eyes and yawnings, is Yamala Hidhma also called Vegini, and Parinamavati Hikka (hiccup coming up in pairs) related to digestion.

Maha Hikka

स्तब्धभ्रूशङ्खयुग्मस्य सास्रविप्लुतचक्षुषः॥२५॥
स्तम्भयन्तीतनुं वाचं स्मृतिं सञ्ज्ञां च मुष्णती।
रुन्धती मार्गमन्नस्य कुर्वती मर्मघट्टनम्॥२६॥
पृष्ठतोनमनं शोषं महाहिध्माप्रवर्तते।
महामूला महाशब्दा महावेगा महाबला॥२७॥
Maha Hikka, manifests with rigidity (loss of movement) of the brows, temples and sides of the neck; eyes are red and full of tears, stiffness of the body (loss of movements of the body) loss of speech, memory 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 and powerful manifestation.

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 vibrating sound of hiccup is Gambhira Hikka.

Sadhyasadhyatha (prognosis)

तासु साधयेत्।
आद्येद्वे वर्जयेदन्त्ये सर्वलिङ्गां च वेगिनीम्॥२९॥
सर्वाश्च सञ्चितामस्य स्थविरस्य व्यवायिनः।
व्याधिभिः क्षीणदेहस्य भक्तच्छेदक्षतस्य वा॥३०॥
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 accumulation of Ama in their body, who are of old age, who indulging too much of sexual activity, who are emaciated by diseases and by absence of food.

Hiccough and dyspnea cause quick death among all diseases

सर्वेऽपि रोगानाशाय नत्वेवं शीघ्रकारिणः।
हिध्माश्वासौ यथा तौ हि मृत्युकाले कृतालयौ॥३१॥
All diseases are going to kill but not as quickly as hiccup and dyspnea; these two reside very close to the time of death

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहिताया तृतीये निदानस्थाने श्वासहिध्मानिदानं नाम चतुर्थोऽध्याय: ।।१॥
That ends the chapter SvasaHidhma Nidana the fourth in Nidana Sthana of Ashtanga Hrudaya Samhita composed by Sri MadVaghbhata son of Sri Vaidyapati Simha Gupta.