2. SHVASA
•Shvasati Vayu iti Shvasah (Hem Chandra)
•Shvasiti Anena iti Shvasah (Shabda Kalpa Druma)
•Shvasiti Iti Shvasah
•Shvasa word is used to denote respiration and exchange of air in
the body. The Word Shvasa is used for both Physiological and
Pathological states.
•Shvasa Roga may be defined simply as a disease in which the
respiration and exchange of air is disturbed.
•Shvasa is classified in following
types:
1. Mahashvasa
2. Urdhvashvasa
3. Chinnashvasa
4. Tamakashvasa
5. Kshudrashvasa
3. ETYMOLOGY OF TAMAKA SHVASA:
•Tamaka Shvasa comprises of two words i.e. Tamaka and Shvasa.
•TAMAKA:
The word is derived from the Dhatu "Tamglanou" which means Sadness
(Panini)
1. The word "Tamaka" is derived from the root "Tam" means oppression
of chest (Monier Williams).
2. The Sanskrit English Dictionary by Vidyadhar Vamana (1926) shows
the different meanings of Tam i.e. to choke, to be suffocated, to be
exhausted, to be unease, and to be distressed.
3. Tamaka - Tamyati Atra Tama Vachaspatyama 3237 V IV.
It is described as a one variety of disease Shvasa in Vachaspatyama.
4. Tama Tamyati Anena Iti Tama - Halayudhakosha page 326.
The word Tama denotes Andhakara, Nishacharma, Divantaka,
Dinantarama, Andhakam.
10. 1. Pinasa: In this condition there is excessive secretion of shleshma (mucus)
in the pranvaha srotas. Nasal secretion increases & pinasa (coryza) develops.
This hinders the free flow of pranvayu.
2. Griva siriska sngraha: When prakupita vata moves in pratiloma marga, it
contracts the neck & head muscles because of which the patient feels if his head
& neck are tightly held by someone. It also indicates the use of extra respiratory
muscles during the attack.
3. Ghurghurkiam: It is a typical sound produced, when excessive secretion of
the kapha, obstructs the free flow of pranvayu.
4. Ativativra Vega shwasa: When the attack of shwasa comes, the heart rate
also increases as the respiration rate & heart rate is in a ratio of 1:4. When the
shwasa kriya increases, the heart rate also increases which causes sevre
discomfort. The excess secretion of mucus & sputum clogs the path of
pranvayu, this causes kasa & when unable to expectorate the thick, sticky sputum
it further aggravates the coughing & a sense of suffocation.
5. Pratamayati Ativegata: The pluging of the tract with the mucus and
sputum and continuous effort to expectorate causes severe dyspnoea, he sits up
frequently panting & feels if surrounded by darkness.
11. 6. Kaste Sanniruddtiyate: During severe coughing, the patient breath
withheld for a few seconds and becomes motionless.
7. Kasat Muhur Muhur Pramahom: Repeated coughing and paroxysmal
attacks ofdyspnoea and frequent panting, makes him feel if he is entering
into darkness & Distress.
8. Sleshma Amuchamane Bhrusam Dukhita: In a patient of tamak shwasa
the sputaum is thick, tenacious, and sticky in nature and is not easily
exporated. Thus situation is very distressing.
9. Slashmani Vimokshante Muhurtam Sukham: Once the sputum is
expectorated the frequency of coughing reduces and there is momentarily
relief due to easy flow of prana vayu.
10. Kanthodhvansa: Because of repeated coughing the patient develops
hoarseness of voice.
11. Kruchrat Bhasitam: During the shwasa Vega, the patient cannot
speak properly due to the tenacious mucus coated in the throat and vocal
cords get affected.
12. 12. Nachapi Nidra labhate Sayana Shwasa Piditam: Due to frequent
kasa & Shwasa patient cannot sleep and on lying, the flow of prana vayu is
obstructed and patient again sits on bed.
13. Parshva Tasyavagrhyate Sayansya Samiranaha: When the patient
lies in recumbent position, the space for air exchange reduces in lungs
which cause sudden pressure on the lungs due to raised diaphragm. The air
trapped cannot easily escapes and severe pain occurs.
14. Asinolabhata Saukhyam: On sitting position the diaphragm is lowered
and the space for air exchange increases and the pressure is also
reduced, this fecilitates the flow of pranavayu.
15. Ushnaabhinandti: The patient has inclination towards hot things like
tea; coffee, hot food because taking hot things gives relief to the patient.
16. Ucchritaksha: When there is diffciency of pranvayu & its path is
obstructed. The patient suffering from tamaka shwasa raise his face
upward to fascilitate easy entry of pranvayu. His eyes are wide open.
13. 17. Lalateswada: During Asthamatic attack, patient continuously makes
effort to take breath, is exhausted and this further increases his heart
rate (Tachycardia). Severity of tamaka shwasa forces him to use accessory
muscles for respiration and all this causes sweating on forehead.
18. Bhrusum Aratimana: Increased respiration rate, worsen his condition
and he feels giddiness.
19. Vishuskasysta: Continuous rapid shwasa-prashwasa (respiration)
process causes dryness of mouth due to excess loss of water from the body.
20. Muhuchiva Avadhamyate: Here the patient expires for a longer
duration of produicing sound with a shorter phase of inspiration. In this
condition the body trunk is raised and lowered alternately as explained by
Gangadhar.
21. Muhur Muhur Shwasa: Patient respiration rate increases due to
irritative cough, dyspnoea occurs time and again at short intervals.
22. Annadhvesa: In this there is agni dushti which leads to agni manda
and this causes indigestion and production of Amarasa and this causes
Annadhvesa.
14. 23. Meghambu Sita Pragavate Sleshmaischabhi Vardhyate: The
condition of the shwasa is aggrevated by megha (clouds) Ambu (rainy
season) Shita (Cold) Pragavate(winds coming directly) and Kapha
vardhaka diet.
24. Uraha Pida: Due to vitated vayu dosha there is pain in chest.
16. Samprapthi ghatakas
Dosha : Vata - Especially Prana Vayu , Udana, Samana,( Apana and Vyana
are also affected in due course.)
Kapha - Kledaka and Avalambaka Kapha
Dushya : Rasa, (Rakta),(udaka) Mala : rasa mala kapha
Agni : Mandagni, Vishamagni
Ama : Rasa gata Dhatvagnimandya(agni maandhya janya ama)
( Mandagni janya Ama)
Srotas : Prana, Anna, Udakavaha Srotasa,(rasa)
Udbhavasthana : Pittasthana (Charaka) Adho Amashaya (Chakrapani) Aamashaya
(Vagbhat)
Adhistaana : urah,phupphusa(kapha sthana)
Vyaktisthana : Urah
Srotodusti : Sanga in pranavaha & anna vaha , Atipravritti in Udakavaha and
Pranavaha and Vimarggamana in pranavaha
rogamarga : Abhyantara
Vyadhi : Amashayotha
17. Nidana sevana
Vata prakopa Kapha prakopa
Margavarana of Vata
Agni dusti
Vishamagni Ama formation
Saama vata
Ama yuktha rasa dathu
Kapha sanga(mucus plug)
Kapha makes avarana to Mala rupa kapha utpatti
prana vayu
Adho aamasaya Kledaka kapha vruddhi
Srotorodha, Shotha,
Sankocha in Pranavaha Vyana Vikriti Yugapat Sarvato Vikshepa
Srotasa (Inflammation,
Broncho constriction) Utklesha of sthanika kapha
Pratiloma gati of Pranavayu
Avalambaka kapha vriddhi
Tamaka
swasa
18. Pratamaka Shwasa:
•Patients suffering from Tamaka Shwasa when gets afflicted with
fever and fainting, the condition is called as Pratamaka Shwasa. It is
suggestive of involvement of Pittadosha in Pratamaka Shwasa.
•It is aggravated by Udavarta, dust, indigestion, humidity (Kleda),
suppression of natural urges, Tamoguna, darkness and gets alleviated
instantaneously by cooling regimens. Ch.chi-17/63
Santamaka Shwasa:
•When the patients of Pratamaka Shwasa feels submerged in
darkness, the condition is called as Santamaka Shwasa.Though
Chakrapani has mentioned these two as synonyms of each other
Charaka refers them as two different ailments representing two
different stages of Tamaka Shwasa,
•These two conditions differs from each other according to
intensity of attack. This can be taken as the severe stage of Pratamaka
ch.chi-17/64
19. SADHYASADHYATA :
•Tamakashvasa in general is described as Yapya (palliable) disease. However
in individual with recent origin of disease person Pravara bala or both said to
be Sadhya(Ch. Chi. 17/.62).
•While mentioning prognosis of any disease following characters are
mentioned in case of Yapya disease.
• Disease has affected the deep seated Dhatus
• Disease involving many Dhatus
• If affects vital organs and joints
• Affects patient continuously for longer period
• Disease is caused by two Doshas.
In disease Tamakashvasa Kapha and Vata Dosha are involved primarily.
Both of them exhibit opposite qualities. Hence management will be also
difficult as factors, which excite Vata, alleviate the Kapha Dosha and vice
Versa.
•Rasaadi Dhatu gets involved in Tamaka Shvasa, which is suggestive of the
involvement of more than one Dhatu.
•Pranavaha Srotasa is mainly involved. This Srotas is having direct exposure
to environment hence persons are more exposed to Nidana like Raja, Dhuma
etc.
20. •Disease Tamakashvasa is having Multifactorial origin along with
diet, environmental and meteorological factors like rains, cloudy
weather, chilly wind etc & patients can not avoid this Nidana.
• Sushruta opines Kasa, Shvasa and Vilambika are very difficult to
cure like setting in together of fire, wind and thunder. (Su. Utt.
51/56) Regarding Tamaka Shvasa he says that it is a
disease, which can be cured with much difficulty. If it is appears
in a
debilitated individuals its prognosis becomes very difficult (Su.
Ut. 51/15).
21. Management in tamaka swasa
3 categories of therapies in treatment:
1. Samana of k & v always preferred
2. Samana of v but aggravates k preferred if essential in exceptional
circumstances
3. Samana of k but aggravates v is avoided
The management Shwasa in practical of Tamaka sense has two
aspects :
1. Management of Vegavastha of Tamaka shwasa; i.e. acute
exacerbations, and
2. Chronic management of the avegavastha, where the
frequency, duration and intensityof the attacks are minimised/
totally cured to give a quality life to the patient.
•“focus on alleviating Vata without agitating kapha, and balance
the kapha, liquefy it and expel it from the pranavaha
srotas, without agitating vata.”
•Hence the drug of choice should be of Ushna veerya.
22. 1. Vegavastha :
Snighdairadou -by lavana tailena ,
•{In Snehadhaya (Cha.Su. 13/98) Charaka has mentioned properties of
Salavana Sneha}. It supervenes within short period of time because both
of them are having Sukshma property hence having greater penetration
power. It is also having Doshasanghata Vichedakara property. Taila is
having Ushna property, and thus alleviates vata, and does not increase
Kapha. There fore it is better for Abhyanga. (Cha.Su.13/15)
•In Shwasa, Grathita Kapha (Mucous plug) is present; and Salavana Sneha is
useful in vilayana of this grathitha kapha, thereby removing the sanga
(Obstruction of airway). How this Sneha penetrates all Dhatu‟s and
pacifies Dosha is mentioned by Dalhana (Su.Chi.
25/30, Dalhana).
23. •Then(Nadi Sweda), (Prastara) sankara sweda is done. In infants
and small children, hasta sweda is preferred .
• Swedana helps to dissolve this Kapha. Also heat applied by
Sweda is carried from skin to internal organ through blood. Blood
is the only medium in body to transfer heat from outer
environment to internal organs. In response to the above-
mentioned procedures, Kapha, which has become stagnated and
get dried, thickened in the Srotas, gets softened and dissolved
which is then eliminated from body by Shodhana procedure.
•After profuse perspiration by doing swedana.
Then snigdha odna (Rice) or soup of fish, pork, meat or the
supernantant of the curd should be given to increase the kapha
dosha.
•Then vamana is done by pippali choorna, Saindhava
lavana, honey, but the drugs used should not be antagonistic to
vata. Thus the sputum (Dusta Kapha) is easily expectorated and
free flow of prana vayu is maintained.
24. •After vamana the residual doshas which are not completely eliminated
are cleared with help of dhumpana. For this haridra patra, Eranda
mula, lac, realgar, devdaru, orpiment, jatamansi powder is utilized along
with ghee.
•A varthi is made ,and is smeared with ghee & used .
• However, in children less than 7 years, mrdu vamana and Virechana
are to be performed if the Vega tivrata is very high. Instead, Shamana
drugs of ushna veerya, which pacify the vata-vatanulomaka- as well as
liquefying kapha (kapha vilayaka), making it flow out to its base in
Amashaya, where it can be pacified using kapha hara drugs.
25. 2. Avegavastha:
•In Avegavastha due consideration should be given to avoid pathogenesis
which further leads to exacerbations. Hence, particularly Deepana -
Paachana and Vatanulomaka treatment should be adopted; Deepana Paachana
treatments are useful in maintenance of Agni as Kapha Dosha
aggravation results due to Mandagni. Vitiation of Dosha doesn‟t occur if Agni
is in proper state. By Vatanulomaka treatment, Vayu traverses through its
own path.
• Vitiation of all these Dosha depends on the status of Agni (Cha.Chi. 5/136).
•How Agnimandya results into Dosha prakopa is explained by Chakrapani -
Agnimandya results into Avipaka, and Vidaaha leading to Kapha and Pitta
prakopa and due to absence of Dhatuposhaka rasa it results into Dhatu
kshaya further leads to Vataprakopa. Hence along with Deepana Paachana
therapy Brmhana therapy is also prescribed to increase the Bala of patient.
Brmhana dravya also improves the status of Dhatu.
27. ROLE OF VIRECHANA IN TAMAKA SHVASA :
1. The site of origin of shwasa roga is “Pitta Sthana Samudhbhava.” And
this pitta sthana is described by Chakrapani as Adho Amashya. This is
the region between the hridaya and nabhi. At this place the main
pathology of shwasa roga takes place and the pre-dominant dosha pitta
is present here. And to purify the site of origin virechana is advocated.
(Ch. Su.20/18)
2. The patient of tamaka shwasa is oftenly weak and in chronic
stage, hridya as the mula of pranavaha shrotas is also involved. In this
condition vamana is very difficult and complicated procedures & the
virechana is easily done with out threatening the life of the patient.
28. 3. Accumulation of Mala and Vayu in Udara leads to Apana vayu
vitiation, which is followed by vitiation of Prana Vayu leading to Shvasa. In
patients of Tamaka Shvasa Anaha like condition is often seen, Virechana by
ensuring purgation is expected to relive this condition and thus therapy is
more helpful in the treatment of Shvasa.
4. If Tamakashvasa presents due to Saama Vayu it leads to inflammation.
As per modern view Asthma is considered as chronic inflammatory
condition of airways. In the management of Shotha Virechana is having
prime importance, as Shotha results due to obstruction in natural path of
Vayu. Virechana overcomes this obstruction and reduces inflammatory
condition.
5. Udakavaha Srotasa is involved in pathogenesis of Shvasa. In deranged
state it results into excessive Kleda formation. Kleda is having Apa
Mahabhuta dominancy particularly in Kaphapradhana samprapti the
vitiated status of Kleda is observed. The excessive secretions in the
lungs are present at this stage. The word Virechana itself is formed from
„rech‟ Dhatu meant for secretion. Virechana removes this Kleda, thus it
reduces severity of Shvasa.
29. 6. ShvasaVyadhi is mentioned as Aamashaya samutha where
derangement of Agni leading to Agnimandya. In this case Virechana will
be helpful by maintaining proper status of Agni, which is the root cause
for almost many diseases.
7. Embryological development of Phupphusa occurs from Shonitaphena
i.e. main source is Shonita. In case of Shvasa Vyaktisthana is Urah
where Phupphusa is situated, hence Khavaigunya mainly occurs here
hence Virechana which is best treatment for purification of Rakta may
be useful for clearing the Khavaigunya in Phupphusa
30. Vamana is done in initial stages where there is pravrudda
kapha (ch.chi.17/76)& virechana is indicated after vamana.
In tamaka swasa spasm of diaphragm occurs ,which causes
aggravation of svasa krichrata.virechana alleviates spasm &
improves resp.movementsby reducing intra-abdominal pressure.
Virechana may also help in reducing the absorption of
histamine like substances & other toxic material from
intestine there by prevevts broncho spasm
As virechan is regarded as best treatment for
raktha & pitta .it is raktha prasaadaka,promotes
healthy raktha.hence it relives or atleast
reduces the sevierity of the effects of
allergy.thus reduces attaks of asthma.
31. GENERAL INSTRUCTION TO BE FOLLOWED:
•To take light diet according to Agni Bala.
•To avoid occupational Asthma, worker should use face mask, when they are
working in factories, cotton mills or at places where there is Dust, fumes etc.
•Deep breathing exercise should be followed.
•Diet during evening should be taken three hours before going to bed.
•Avoid direct exposure to external environment after use of Air conditioning.
•Use of warm clothes in winter season.
NOT TO BE FOLLOWED:
•Over eating and taking milk at bed time.
•Fried, chilly, too cold, sour, heavy preparations.
•Cold and damp places.
•Fasting for a longer period.
•Seating in frosty, smoky and congested places for a longer period.
•Rukshanna particularly toast, popcorn etc.
•Jalaja, Anupa, Mansa, Dadhi, Aamaksheera, due to Guru and Abhisyandi
property.
•Bread, Burger, Pizza, Cheezes, Paneera etc is used which are having
Srotorodhaka property.
•Contact with those pet animals, which do not suit the individual.
•Direct exposure to Prag-vata
