The commentary says that after the chapter on chardi, the author announces the treatment of hikkā, because the number of topics is alike and because a few causes are shared.
From foods that are burning (vidāhi), heavy, constipating, dry or clogging; from cold drinks, seats and places, dust, smoke, wind and fire; from exertion, work, carrying loads, travel, suppression of urges, and depleting measures; from āma and doṣas, blows, loss of semen through women, and the afflictions of other faults; from irregular eating, from fasting and from eating too regularly: hikkā, breathlessness and cough arise in people.
The commentary gives the causes. Vidāhi foods are such as pepper, mustard and wine; heavy in quality and in digestion; viṣṭambhi (constipating) foods are such as karīra; dry ones are such as chickpea; abhiṣyandi are those that tend to flow toward and clog, such as fish, māṣa and jaggery. 'Cold' attaches to drinks, seats and places. Dust enters the nose like smoke. Exercise means such as drawing a bow; vegāghāta is holding back urges; apatarpaṇa is fasting. 'Affliction' attaches to each of āma-doṣa and the rest. Āma-doṣa is defined in a quoted verse as undigested first dhātu, spoiled and in the āmāśaya, called āma. Cough is repeated here to show it shares a single cause.
The vāyu rises again and again with sound, seeming to hurl the liver, spleen and intestines toward the mouth; noisy, it quickly harms the life-breaths; therefore it is called hikkā by physicians.
The commentary gives the nature and derivation of hikkā. Here vāyu is udāna, or prāṇa per others. 'Rises' means goes upward. The channels of prāṇa, water and food are meant by 'mouth'. Ghoṣavān means noisy; because the vāyu, noisily, quickly harms life, wise ones call it hikkā. 'Hikkā' is formed by an irregular derivation; grammarians say it is named for the sound 'hig' it makes.
Key terms
hikkā
Hiccup, named for its sound.
udāna
Upward-moving vāta.
asu
Life-breaths.
Adhikarana ४ (७) · Śloka ७
अन्नजां यमलां क्षुद्रां गम्भीरां महतीं तथा |
वायुः कफेनानुगतः पञ्च हिक्काः करोति हि ||७||
Meaning of the śloka
Vāyu, followed by kapha, produces five kinds of hikkā: annajā, yamalā, kṣudrā, gambhīrā and mahatī.
The commentary states the kinds and pathogenesis. Vāyu joined with kapha produces five, named annajā and so on. Yamalā is the same that Caraka calls vyapetā (because it arises when food and drink have passed off and are digested). Some read 'kaphenānugataḥ prāṇaḥ', where prāṇa means vāyu.
Key terms
annajā
Hiccup arising from food.
yamalā
Paired (double) hiccup.
kṣudrā
Minor hiccup.
gambhīrā
Deep hiccup.
mahatī
Great hiccup.
Adhikarana ५ (८) · Śloka ८
मुखं कषायमरतिर्गौरवं कण्ठवक्षसोः |
पूर्वरूपाणि हिक्कानामाटोपो जठरस्य च ||८||
Meaning of the śloka
An astringent (rough) taste in the mouth, restlessness, heaviness in the throat and chest, and distension of the abdomen are the premonitory signs of hikkās.
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हिक्कानां पूर्वरूपमाह- मुखमित्यादि| मुखं कषायं वातात्, नतु कफान्माधुर्यं, व्याधिप्रभावात्| अरतिः न कुत्रचिदवस्थितिश्चेतसः| केचित् पूर्वरूपं न पठन्ति, कफवातोद्भवस्य गौरवादेरनुमानग्राह्यत्वात्||८||
Meaning of the commentary
The commentary gives the premonitory signs. The mouth is astringent from vāta, not sweet from kapha, because of the nature of the disease. Arati is not settling anywhere, of the mind. Some do not read the premonitory signs, since heaviness and the like of kapha and vāta are known by inference.
In one who eats food in haste, or eats heavy (thick) food, vāyu, covered by the food and greatly pressed by pungent things, rises upward and causes hiccup; the physician should know that as annajā.
The commentary describes annajā. The curable kinds are named first because they are praised as curable. Vāyu is covered by food when one eats hastily or heavily, and is pressed by pungent items; it rises and hiccups. Although vāyu is the cause in annajā too, the name comes from pressure by food.
The commentary describes yamalā. Hikkā that arises in pairs after a long interval is yamalā; 'shaking head and neck' is illustrative, so, as Gayadāsa says, Caraka's signs of raving, vomiting, thirst, confusion, yawning, turned-up eyes and dry mouth are to be included. Though this kind is incurable, it may be cured in a strong person with firm dhātus, senses and mental strength.
The commentary describes kṣudrikā. It comes at long intervals and slowly, running from jatrumūla. Jejjaṭa says jatru is the junction of the neck and chest; Gayadāsa says jatru is the base of the neck, and by including it, the heart, kloma and throat are also included.
Key terms
kṣudrikā
Minor hiccup.
jatrumūla
Base of the jatru, the neck-chest junction.
Adhikarana ९ (१२-१३) · Śloka १३
नाभिप्रवृत्ता या हिक्का घोरा गम्भीरनादिनी ||१२||
शुष्कौष्ठकण्ठजिह्वास्यश्वासपार्श्वरुजाकरी |
अनेकोपद्रवयुता गम्भीरा नाम सा स्मृता ||१३||
Meaning of the śloka
The hikkā arising from the navel, fierce, of deep sound, causing dryness of the lips, throat, tongue and mouth, breathlessness and pain in the sides, and accompanied by many complications, is called gambhīrā.
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गम्भीरालक्षणमाह- नाभिप्रवृत्तेत्यादि| या हिक्का नाभिप्रवृत्ता नाभितः प्रवृत्तिर्यस्याः सा, अत एव अस्या गम्भीरात्वं; घोरा कष्टसाध्या| शुष्केत्यादि शुष्कशब्द ओष्ठादिभिश्चतुर्भिः सम्बन्धनीयः| तथा अनेकोपद्रववती अनेकोपद्रवैर्ज्वरश्वासतृष्णादिभिर्युक्ता, सा गम्भीरा नाम स्मृता; इयमसाध्या||१२-१३||
Meaning of the commentary
The commentary describes gambhīrā. It arises from the navel, hence its depth; ghorā means hard to cure. 'Dry' attaches to lips and the other three. It has many complications such as fever, breathlessness and thirst. This kind is incurable.
That which continues constantly as if pressing on the vital points, stretching the body, roaring with force in one greatly thirsty, and shaking the whole body, is to be known as mahāhikkā.
The commentary describes mahāhikkā. The vital points (marmas) are the bladder, heart and head, or per others navel, heart and breast root. Āyamya means stretching; some read 'āyasya' with the same sense. Ghoṣavatī means noisy. This kind is also incurable.
One who, while hiccupping, has the body stretched, whose eyes are turned up, and who is greatly tormented; one who is wasted, hates food and coughs: these last two who hiccup should be abandoned.
The commentary says that even among the curable kinds, in certain conditions hikkā becomes incurable. One whose body is stretched out and whose gaze turns upward and who is tormented (or, per an alternative reading, becomes confused) is one; the wasted, food-averse, sneezing (or coughing) one is the other. Of the curable ones, such a person should be abandoned; gambhīrā and mahatī, being incurable by nature, are also not treated. The commentary says variant readings and interpretive differences are not written here for fear of length.
Breath-holding (prāṇāyāma), startling, frightening, pricking with needles and agitation (sambhrama) are recommended here.
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इदानीं हिक्कानां चिकित्सितमाह- प्राणायामोद्वेजनेत्यादि| अत्र हिक्कासु, प्राणायामादि शस्तमिति सम्बन्धः| प्राणायामो वायोर्निरोधः| यद्यपि रेचकपूरककुम्भकभेदात् प्राणायामस्त्रिविधः, तथाऽप्यूर्ध्वगतिनिरोधात् कुम्भक एवात्र| त्रासनमल्पसत्त्वस्य भयोत्पादकैर्वाक्यैः| उद्वेजनं परुषवचनैः| सूचीतोदैः सम्भ्रमः सूचीव्यथाभिर्मनस आकुलीकरणम्| एतच्च प्रायः क्षुद्रायामन्नजायां च योजनीयम्|१६|-
Meaning of the commentary
The commentary begins the treatment of hikkā. Prāṇāyāma is stopping of breath; of the three kinds (exhaling, inhaling, retaining), here retaining (kumbhaka) is meant, because it stops the upward movement. Trāsana is frightening a person of little strength with fearful words; udvejana is with harsh words; sambhrama is upsetting the mind with needle pricks. This is mostly for kṣudrā and annajā kinds.
Key terms
prāṇāyāma
Breath control, here retention (kumbhaka).
trāsana
Frightening.
sambhrama
Agitation or startling, here with needle pricks.
Adhikarana १३ (१६) · Śloka १६
यष्ट्याह्वं वा माक्षिकेणावपीडे पिप्पल्यो वा शर्कराचूर्णयुक्ताः ||१६||
Meaning of the śloka
Yaṣṭīmadhu with honey is used as a nasal drop (avapīḍa), or pippalīs mixed with powdered sugar.
The commentary gives a nasal application. Yaṣṭyāhva is yaṣṭīmadhu; with honey, it is recommended in avapīḍa. Pippalīs with sugar powder are also recommended in avapīḍa.
Key terms
avapīḍa
A nasal instillation method.
pippalī
Long pepper.
Adhikarana १४ (१७) · Śloka १७
सर्पिः कोष्णं क्षीरमिक्षो रसो वा नातिक्षीणे छर्दनं शान्तिहेतोः |१७|
Meaning of the śloka
Warm ghṛta, or milk, or sugarcane juice may be given, and, if the person is not much depleted, emesis for pacification.
The commentary says drinking ghṛta and the like is beneficial. Chardana is emesis. Some read 'and purgation' after 'pacification' and explain it as virecana; Jejjaṭācārya does not accept this reading, because purgation is not stated for hiccup in similar texts either.
Key terms
chardana
Induced vomiting.
sraṃsana
Purgation (a disputed variant).
Adhikarana १५ (१७) · Śloka १८
नारीपयःपिष्टमशुक्लचन्दनं घृतं सुखोष्णं च ससैन्धवं तथा ||१७||
चूर्णीकृतं सैन्धवमम्भसाऽथवा निहन्ति हिक्कां च हितं च नस्यतः |१८|
Meaning of the śloka
Red sandal ground in a woman's milk; lukewarm ghṛta with rock salt; or rock salt powdered in water: these, used as nasal drops, destroy hikkā and are beneficial.
The commentary lists three nasal yogas. First: red sandal ground in a woman's milk. Second: lukewarm ghṛta. Third: rock salt powdered in water. The three are to be chosen according to doṣa and other factors.
Key terms
nasya
Nasal administration.
nārīpayas
Human (women's) milk.
Adhikarana १६ (१८) · Śloka १९
युञ्ज्याद्धूमं शालनिर्यासजातं नैपालं वा गोविषाणोद्भवं वा ||१८||
सर्पिःस्निग्धैश्चर्मबालैः कृतं वा हिक्कास्थाने स्वेदनं चापि कार्यम् |१९|
Meaning of the śloka
One may use smoke from śāla resin, or smoke of naipāla (manaḥśilā), or from cow's horn, or from ghṛta-smeared hides and hair; and sweating should be done at the site of the hiccup.
The commentary says that, after nasal treatment, smokes are prescribed to remove lodged doṣa. Śāla-niryāsa is sarja resin; naipāla is the smoke of manaḥśilā (realgar); cow's horn smoke is from burning cow horn; hide and hair smoke is of the cow. Hikkā-sthāna means between the throat and breasts. Some prefer sweating with hide and hair.
Key terms
dhūma
Medicated smoke.
naipāla
Manaḥśilā (realgar), an arsenic mineral.
hikkāsthāna
The site of the hiccup, between the throat and breasts.
A gairika called kāñcana with honey may be licked; or ash of the bones of domestic animals; likewise the hair of śvāvit, sheep and cow, burnt in a closed pot with smoke inside; ash of peacock feathers with honey and ghṛta; likewise ash of udumbara or tailvaka (tilvaka) with honey and ghṛta; or svarjikṣāra with citron juice and honey: licked, they quickly destroy hikkā.
The commentary lists licks. Kāñcanāhvaya is golden red ochre with honey. 'Domestic animals' are cows and others; their bone-ash is licked with honey. Śvāvit is the porcupine (seḍhikā); its quills are burnt. Hair of these creatures is burnt inside a covered pot and the ash licked with honey. Peacock-feather ash, with honey and ghṛta, is not in equal parts, as a quoted line warns that equal honey and ghṛta becomes poisonous. Udumbara ash or tilvaka ash is treated like the peacock-feather ash. Because hikkā is from vāta in channels blocked by kapha, these licks are given to clear the channel.
Key terms
bhasma
Ash prepared by burning.
svarjikṣāra
An alkali.
śvāvit
Porcupine.
Adhikarana १८ (२१) · Śloka २१
सर्पिःस्निग्धा घ्नन्ति हिक्कां यवाग्वः कोष्णग्रासाः पायसो वा सुखोष्णः ||२१||
Meaning of the śloka
Ghṛta-rich gruels taken in lukewarm mouthfuls, or lukewarm pāyasa, destroy hikkā.
Goat's milk cooked in ginger water, drunk likewise; or with sugar, taken to satiety, destroys hikkā; and smelling the urine of goat or sheep quickly removes hikkā.
The commentary, following the topic of inhalation, gives an inhalation formula: powder of garlic through lotus, with pūtikīṭa powder (an insect known in the vernacular as 'bhonduliká'), saturated many times with goat or sheep urine, is sniffed and destroys hikkā.
Key terms
ghrāṇa (ghrāta)
Sniffed, inhaled.
pūtikīṭa
A foul-smelling insect used in the powder.
Adhikarana २१ (२३) · Śloka २३
क्षौद्रं सितां वारणकेशरं च पिबेद्रसेनेक्षुमधूकजेन ||२३||
Meaning of the śloka
One may drink honey, sugar and vāraṇakesara with sugarcane or madhūka juice.
The commentary says vāraṇakesara is nāgakesara; honey and the rest are drunk in sugarcane or madhūka juice. Because honey is a liquid, no powder-measure is set. For honey quantity it quotes: 'in vāta, pitta and kapha disorders, honey in a decoction should be a sixteenth, an eighth or a quarter; sugar the opposite'; sugarcane and madhūka juices are four times the lick. It also quotes rules on quantity of powders, pastes and pills to be licked or drunk.
Key terms
vāraṇakesara
Nāgakesara.
ikṣurasa
Sugarcane juice.
Adhikarana २२ (२४) · Śloka २४
पिबेत् पलं वा लवणोत्तमस्य द्वाभ्यां पलाभ्यां हविषः समग्रम् |२४|
Meaning of the śloka
One may drink a pala of rock salt with two palas of ghṛta, complete.
Harītakī followed by warm water; or ghṛta with kṣāra and honey; or kapittha juice with honey and pippalī in a śukti measure: these may be drunk for comfort.
The commentary lists three yogas. Harītakī with warm water is the first; ghṛta made warm, mixed with milk and honey (with kṣāra), is the second; the juice of kapittha with honey and pippalī is the third. 'Śukti measure' is half a pala or a handful; honey half a pala, pippalī one karṣa.
Kṛṣṇā (pippalī) and sugar licked; or āmalaka with ginger and honey; a lick of powder of jujube-stone kernel, añjana and parched rice with honey destroys hikkā.
The commentary says kṛṣṇā is pippalī, sitā is sugar, śṛṅgavera is dry ginger. Pippalī and sugar licked with honey is one yoga; āmalaka with ginger and honey is a second (Kārttikakuṇḍa reads the list as one yoga with the second as an alternative). Kolāsthimajjā is the seed of the jujube stone; añjana is sauvīrāñjana; lājā is parched grain. Honey is twice the powder.
Pāṭalā fruit and flower; gairika and kaṭurohiṇī; date pith and pippalīs; kāśīśa and dadhināma (kapittha): these are four yogas, each stated in a quarter-verse; they should be made with honey as the second ingredient by the knowing physician in hikkā.
The commentary says the four yogas are one per quarter-verse. First: pāṭalā fruit and flower with honey. Second: golden gairika and kaṭurohiṇī with honey. Third: date pith and pippalīs with honey; kharjūra-madhya is the marrow of the date's head, or the date stones per others. Fourth: kāśīśa (a named mineral) and dadhināma (kapittha) with honey; some read 'kāśīśaṃ dadhi nā saha' and explain it as a man (nā) licking kāśīśa and curd.
He may drink the meat juices of kapota (pigeon), pārāvata, lāva (quail), śvadaṃṣṭra, godhā and vṛṣadaṃśa, made sour with fruit, not cold, with rock salt and unctuous; and likewise those from ṛṣya, mṛga and dvija (birds).
The commentary says juices of birds such as kapota are meat juices, prepared with pomegranate and similar fruit and not cold, with rock salt and rich in ghṛta. Vṛṣadaṃśa is the wild cat; godhā is the five-clawed monitor (lizard). Likewise are juices of ṛṣya (antelope), and the game animals. The jaṅghāla and viṣkira birds are meant by mṛgadvija. Ṛṣya and lāvaka are listed separately to stress that they are especially beneficial for hikkā.
Purgation is most beneficial; ghṛta, lukewarm with rock salt and with sugar candy; and, when vāyu is going upward, some say an anuvāsana is beneficial for those with hikkā.
The commentary says this briefly gives the treatment described at length. Purgation, to move vāyu downward, is used for a strong patient; 'when vāyu is always going upward' refers to the anuvāsana. The view of some is accepted because it is not forbidden. Although basti is forbidden in hikkā, it is used when vāyu goes upward, depending on the stage. All these yogas, though stated generally, are to be applied according to doṣa excess and stage.
Key terms
virecana
Purgation.
anuvāsana
Oil enema.
ūrdhvagata vāta (ūrdhvagate vāyau)
Upward-moving vāta.
Adhikarana पुष्पिका · Śloka ५०
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे हिक्काप्रतिषेधो नाम (द्वादशोऽध्यायः, आदितः) पञ्चाशत्तमोऽध्यायः ||५०||
Meaning of the śloka
Thus ends the fiftieth chapter (the twelfth from the beginning of this section) in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
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इति श्रीडल्ह(ह्ल)णविरचितायां सुश्रुतव्याख्यायां निबन्धसङ्ग्रहाख्यायामुत्तरतन्त्रे हिक्काप्रतिषेधो नाम पञ्चाशत्तमोऽध्यायः||५०||
Meaning of the commentary
Thus ends the fiftieth chapter, named Hikkāpratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.