Now, therefore, we shall explain the treatment (pratiṣedha) of śvāsa (breathlessness). Thus spoke Lord Dhanvantari. By the very same many causes by which hikkā arises, terrible śvāsa also arises in living beings.
The commentary says that after the chapter on hikkā, beginning śvāsa is fitting because the causes are alike; for that same reason Caraka states a single treatment for hikkā and śvāsa, owing to their shared quality of vāta going upward with force. 'By the very same' means by the burning foods and the like. 'Many' is said to indicate that śvāsa is of many kinds. Kārttikakuṇḍa considers this verse improper here, since the sameness of cause of hikkā and śvāsa was stated in the hikkā chapter itself; the commentator reads it as it was read by Jejjaṭa.
Key terms
śvāsa
Breathlessness, laboured breathing, as a classical disorder.
The commentary gives the pathogenesis. Prāṇa (vāyu) leaving its natural state, going upward and joined with kapha, makes one breathe; the wise call it śvāsa. Although only kapha is named with prāṇa, the other doṣas are also included, quoting another tantra: 'kṣudraka is from vāta; tamaka is where kapha predominates; chinna is where pitta predominates; the other two are from vāta aggravation'.
The commentary says that though śvāsa is one, it divides into five by the divisions kṣudraka and the rest. The word 'five' is stated even though the number is already given by the list, in order to prevent pratamaka, a sub-type of tamaka, from being counted separately.
Its premonitory signs are: pain in the heart, dislike of food, great restlessness, distension and pain in the two sides, and tastelessness of the mouth.
Mostly with thirst, sweat and vomiting, with a rattle (ghurghuri) in the throat; especially on a cloudy day he becomes distressed: that breathlessness is regarded as tamaka. A man seized with a great sound, with cough and kapha, who breathes weak, hating food, lying down troubled by tamaka: it subsides when kapha is reduced and increases in one who sleeps; when overcome by fainting and fever, it is to be known as pratamaka.
One who is unconscious, tormented by pain in the sides, with dry throat, very noisy, with fixed eyes, breathing as if bent double, is said to have mahān (great) śvāsa.
The commentary gives the signs of mahāśvāsa. Niḥsaṃjña means without consciousness; saṃrabdhanetra means with swollen eyes; 'as if bent double' means folded in two; 'great' here stands for the disease itself, by the identity of a thing and its locus.
The commentary gives the signs of ūrdhvaśvāsa. The vital points are the heart, bladder and head, being dragged; mūḍha means motionless; 'looking upward' means with a habit of gazing up; hataravaḥ means with lost voice.
Key terms
ūrdhva śvāsa (ūrdhvaśvāsa)
Upward breathlessness, with upward gaze and lost voice.
marma
Vital point.
Adhikarana 10 (14) · Śloka 14
kṣudraḥ sādhyatamastēṣāṁ tamakaḥ kr̥cchra ucyatē |
trayaḥ śvāsā na sidhyanti tamakō durbalasya ca ||14||
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क्षुद्रः साध्यतमस्तेषां तमकः कृच्छ्र उच्यते |
त्रयः श्वासा न सिध्यन्ति तमको दुर्बलस्य च ||१४||
Meaning of the śloka
Of these, kṣudra is the most curable; tamaka is curable with difficulty; three śvāsas are not cured; and tamaka in a weak person is not cured.
The commentary gives curability. Kṛcchra means curable with difficulty. The three (chinna, mahā and ūrdhva) are incurable. 'Tamaka in a weak person' means not cured; by the word 'and' the other tantra's statement adds 'in one with fever and fainting'.
The commentary says that although snehabasti was earlier forbidden in śvāsa, the repetition of the prohibition here is to prevent its use even in special stages. 'Upward cleansing' is emesis and 'downward' is purgation, both mild (not distressing). It is for the strong. The view of others is accepted because not forbidden.
The commentary says old ghṛta cooked with abhayā and the rest is praised in śvāsa and the others, for regular use. 'Old' means kept ten years; rāmaṭha is hiṅgu.
Old ghṛta prepared with sauvarcala, abhayā and bilva; or cooked with a paste of pippalī and the like, or in the first group (vidārigandhādi); with the five salts, the ghṛta drives out śvāsa and kāsa.
The commentary says the aged ghṛta cooked with sauvarcala and the others is applied in śvāsa and the rest. 'Pippalyādi-pratīvāpa' means cooked with a paste of pippalī and the like; the first group is vidārigandhādi, cooked with its decoction. 'With the five salts' means the five salts are added when it is drunk; the alternatives are named relative to the earlier yoga. Some take 'cooked with the five salts', which the commentators do not accept, because it conflicts with a similar tantra.
Ghṛta cooked with hiṃsrā, viḍaṅga, pūtīka, triphalā, vyoṣa and citraka, with twice the milk, sprinkled with four times water, taken in kola measure, drives out śvāsa and kāsa, piles, distaste for food, gulma, loose stool and wasting. Or ghṛta cooked in the whole vṛṣa (vāsā) decoction in four times measure, with its root and flowers added, cooled, mixed with honey.
The commentary says hiṃsrā is bṛhad-ahiṃsrā; pūtīka is cirabilva; 'twice milk' means milk in double measure; the ghṛta is a prastha; kola measure is half a karṣa (or a karṣa per others, since the paste is small). Some read a further passage 'or cook ghṛta with whole vṛṣa decoction'; Jejjaṭa does not accept it because vāsā ghṛta is stated later.
A prastha of ghṛta cooked by the wise in four times cold water, with equal parts of śṛṅgī, madhūlikā, bhārgī, dry ginger, tārkṣya, sugar, mustā, haridrā and yaṣṭyāhva, added properly, holds back śvāsa, kāsa and hikkā.
The commentary identifies śṛṅgī as karkaṭaśṛṅgī; madhūlikā a grass called 'markaṭa'; tārkṣya as rasāñjana; ambuda as mustā. The paste is added by suitable measure so the smell is not too strong, not necessarily a quarter of the ghṛta. 'Four times' is stated to prevent double the water from the later 'suvahā' yoga applying here. Niyacchati means prevents.
Suvahā, kālikā, bhārgī, śukākhyā, the fruit of naicula, kākādanī, ginger, varṣābhū and the two bṛhatīs, in kola measure; a prastha of ghṛta cooked with double water with these, drunk pungent and warm, destroys the disease of śvāsa.
The commentary identifies suvahā as godhāpadī; kālikā as kāleyaka; śukākhyā as carmakāra-vaṭa, or śukaśimbā per others; naicula fruit as jala-vetasa fruit; kākādanī as kākatinduka; varṣābhū as white punarnavā; the two bṛhatīs as large-fruited and chickpea-fruited. 'Kola measure' is half a karṣa; others say a karṣa, which is rejected by agreement with similar tantras. 'Double water' means twice the amount of water.
Ghṛta cooked with sauvarcala, barley-ash (yavakṣāra), kaṭukā, vyoṣa, citraka, vacā, abhayā and viḍaṅga, for pacifying śvāsa; another ghṛta cooked in the water of gopavallī (sārivā) in double measure.
The commentary says the ghṛta cooked with a paste or liquid of sauvarcala and the others, with unstated water, is drunk for calming breathlessness. Gopavallyudaka means sārivā decoction; the other ghṛta is cooked in double the ghṛta's measure of sārivā decoction.
Key terms
yavakṣāra
Barley alkali.
gopavallī
Sārivā.
Adhikarana 18 (27) · Śloka 27
pañcaitāni havīṁṣyāhurbhiṣajaḥ śvāsakāsayōḥ |27|
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पञ्चैतानि हवींष्याहुर्भिषजः श्वासकासयोः |२७|
Meaning of the śloka
These five ghṛtas (havis) are said to be for śvāsa and kāsa.
The commentary says this concludes, to establish that the five ghṛtas beginning with hiṃsrā are especially beneficial in śvāsa: the hiṃsrā, śṛṅgī, suvahā, sauvarcala and gopavallī ghṛtas.
Tālīśa, śatā, tāmalakī, ugrā, jīvantī, kuṣṭha and saindhava; bilva, puṣkara, bhūtīka, sauvarcala, kaṇā and agni; pathyā and tejovatī: ghṛta cooked with these, with four times water and a fourth of hiṅgu, is the best remover of all śvāsa. The vāsā ghṛta or the six-pala ghṛta is also beneficial here.
The commentary explains: tāmalakī is dalaphalikā; ugrā is vacā; jīvantī is a plant with leaves like paṭola, well known in the west, while in Lāṭa a different large vine; puṣkara is puṣkaramūla; bhūtīka is rohiṣa; kaṇā is pippalī; agni is citraka; tejovatī is kākamardanikā. 'A quarter of hiṅgu' means hiṅgu a quarter of one drug's measure. Some read the verse differently, not shown. The vāsā ghṛta is the one from the raktapitta chapter, for pitta-predominant śvāsa; the six-pala ghṛta is from the vāta-disease chapter, for vāta-predominant śvāsa.
The commentary says that after stating sneha for pitta- and vāta-predominant śvāsa, oil for the kapha-predominant one is given. 'Properly' means as suits each; so it may be used as pure drinking (acchapāna) or by other routes according to fitness; others say 'according to the disease'.
Key terms
bhṛṅgarāja
Eclipta (Eclipta alba).
yathānyāya (yathānyāyam)
Properly, as suits.
Adhikarana 21 (31) · Śloka 32
phalāmlā viṣkirarasāḥ snigdhāḥ pravyaktasaindhavāḥ |
ēṇādīnāṁ śirōbhirvā kaulatthā vā susaṁskr̥tāḥ ||31||
hanyuḥ śvāsaṁ ca kāsaṁ ca saṁskr̥tāni payāṁsi ca |32|
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फलाम्ला विष्किररसाः स्निग्धाः प्रव्यक्तसैन्धवाः |
एणादीनां शिरोभिर्वा कौलत्था वा सुसंस्कृताः ||३१||
हन्युः श्वासं च कासं च संस्कृतानि पयांसि च |३२|
Meaning of the śloka
Meat juices of viṣkira birds made sour with fruit, unctuous, with evident rock salt; or those of the heads of eṇa and similar animals; or well-prepared kulattha soups; and prepared milks: they destroy śvāsa and kāsa.
The commentary says fruit-sour means soured with pomegranate seeds or citron; viṣkira juices are meat juices of birds like lāva; 'evident rock salt' means much salt. 'Heads of eṇa and others' means heads of black deer etc., including golden deer, vāta-relieving meat juices. Prepared kulattha soups are cooked with kulattha. 'Prepared milks' are milks cooked with vāta-relieving drugs such as the pañcamūla.
Key terms
viṣkira
A class of scratching game birds.
kaulattha yūṣa (kaulatthā)
Kulattha (horse gram) soup.
Adhikarana 22 (32-35) · Śloka 35
timirasya ca bījāni karkaṭākhyā ca cūrṇitā ||32||
durālabhā'tha pippalyaḥ kaṭukākhyā harītakī |
śvāvinmayūrarōmāṇi kōlā māgadhikākaṇāḥ ||33||
bhārgītvak śr̥ṅgavēraṁ ca śarkarā śallakāṅgajam |
nr̥ttakauṇḍakabījāni cūrṇitāni tu kēvalam ||34||
pañca ślōkārdhikāstvētē lēhā yē samyagīritāḥ |
sarpirmadhubhyāṁ tē lēhyāḥ kāsaśvāsārditairnaraiḥ ||35||
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तिमिरस्य च बीजानि कर्कटाख्या च चूर्णिता ||३२||
दुरालभाऽथ पिप्पल्यः कटुकाख्या हरीतकी |
श्वाविन्मयूररोमाणि कोला मागधिकाकणाः ||३३||
भार्गीत्वक् शृङ्गवेरं च शर्करा शल्लकाङ्गजम् |
नृत्तकौण्डकबीजानि चूर्णितानि तु केवलम् ||३४||
पञ्च श्लोकार्धिकास्त्वेते लेहा ये सम्यगीरिताः |
सर्पिर्मधुभ्यां ते लेह्याः कासश्वासार्दितैर्नरैः ||३५||
Meaning of the śloka
Five licks, each stated in a half-verse, taken with ghṛta and honey by those afflicted with kāsa and śvāsa: (1) timira seeds and karkaṭī powder; (2) durālabhā, pippalī, kaṭukā and harītakī; (3) the hair of śvāvit and peacock, kola, māgadhikā and kaṇā; (4) bhārgī bark, ginger, sugar and the bone-ash of śallaka; (5) nṛttakauṇḍaka seeds, powdered alone.
The commentary explains: timira is a plant with nail-like leaves known as 'tivariyā'; karkaṭākhya is karkaṭaśṛṅgī, or a grass per others; śvāvit is the porcupine (seḍhikā), its quills as 'hair'; kolā is cavya; māgadhikā-kaṇā is pippalī grain. Shallakāṅgaja is porcupine flake (śakala), or 'śallakī and nāgakesara' per others. Nṛttakauṇḍaka is markaṭaka, or laghu-kadamba seeds per others. The five licks are each in a half-verse.
The commentary says saptacchada is saptaparṇa; the powder is drunk with mastu. Dhānā is parched barley. Some connect 'with honey' to the parched barley.
A tarpaṇa of barley saturated many times with arka sprout decoctions, taken with honey by one afflicted by śvāsa; and the flowers of śirīṣa, kadalī and kunda with pippalī, drunk with rice water, overcome all śvāsas.
The commentary says the barley used for parched grain is of this kind: saturated many times with decoctions of arka leaf-buds and flowers. Tarpaṇa is flour drink. Kunda is an odourless white flower; taṇḍulāmbu is rice-washing water.
कोलमज्जां तालमूलमृष्यचर्ममसीमपि |
लिह्यात् क्षौद्रेण भार्गीं वा सर्पिर्मधुसमायुताम् ||३९||
नीचैःकदम्बबीजं वा सक्षौद्रं तण्डुलाम्बुना |४०|
Meaning of the śloka
He may lick honey with jujube kernel, tāla root, ṛṣya skin or asīma; or bhārgī with ghṛta and honey; or nīcaiḥkadamba seed with honey, with rice water.
The commentary says kolamajjā is the jujube kernel. Some read 'tālamūlī' for 'tālamūlam' and take it as muṣalī. Nīcaiḥkadamba seed is the seed of the small kadamba; 'to be drunk' is understood with rice water. Some read 'nīpa, kadamba and the red' and explain nīpa as the large kadamba fruit, the kadamba as the small kadamba fruit, and 'red' as meaning ripe ones, ground and given as a drink. Others connect 'drunk with rice water' with 'destroys severe śvāsas'. Where the earlier list of five licks reads nīcaiḥkadamba seeds, there is no repetition here, since that was a lick with honey and ghṛta and this is a drink with rice water.
The commentary says the juice of cow dung with pippalī, licked with honey and ghṛta, or the juice of horse dung with pippalī and honey and ghṛta, may be licked.
पाण्डुरोगेषु शोथेषु ये योगाः सम्प्रकीर्तिताः ||४३||
श्वासकासापहास्तेऽपि कासघ्ना ये च कीर्तिताः |४४|
Meaning of the śloka
The yogas stated in pāṇḍuroga and in swellings that remove śvāsa and kāsa, and those stated as cough-relieving, are also (applicable here).
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idānīṁ pāṇḍurōgādyuktayōgānatrāpyatidiśannāha- pāṇḍurōgēṣvityādi pāṇḍurōgādipratiṣēdhēṣu yē yōgāḥ kathitāstē'pi śvāsakāsāpahāḥ, kāsaghnā yē ca kīrtitāstē'pi| kēcidamuṁ pāṭhaṁ na paṭhanti||43||-
Meaning of the commentary
The commentary extends the applicability: the yogas stated in the treatments of pāṇḍuroga and śopha that relieve śvāsa and kāsa are also to be used here, and those stated as cough-relieving too. Some do not read this verse.
The commentary says talakoṭa is aṅkoṭha (Alangium); utkārikā is lapsikā (a thick porridge or cake). Some take the whole passage from 'bhārgī bark' to 'talakoṭa seeds' as the utkārikā formula.
Old ghṛta, pippalīs, kulattha soups, jāṅgala meat juices, surā, sauvīraka, hiṅgu, citron juice, honey, drākṣā, āmalaka and bilva are recommended for those with śvāsa and hikkā.
The commentary says that after the special remedies, other beneficial things in śvāsa and hikkā are given. Kaulattha means made with kulattha; jāṅgala juices are meat juices of eṇa and similar; sauvīraka is as in the purgation-formulas section.
A person seized by śvāsa and hikkā should be treated with oily sweats; anointed with salt and oil, by these his hardened kapha, lodged in the channels, melts, and vāta is pacified.
The commentary says that, through the topic of śvāsa, the same remedy is stated for hikkā. Oily sweats are of the sālvaṇa (poultice) kind; 'anointed with salt and oil' means smeared with rock salt and sesame oil. By these oily sweats his thickened kapha, standing in the channels, becomes liquid.
When he is judged sweated, and after being fed rasa and rice, in obstruction by vāta and kapha, the physician should give a smoke (dhūma) made into wicks by rule of manaḥśilā, devadāru, haridrā, leaves, āmiṣa, lac, and urubūka root.
The commentary says that if the vāta-kapha involvement is not pacified even after sweating, the fitting smoke is given after feeding rasa and rice. Chadana is patra (leaf); āmiṣa is guggulu; urubūka root is red eraṇḍa root. The wicks are prepared and used by the method described in the chapters on smoke, nasya and gargling.
Key terms
dhūma
Medicated smoke.
manaḥśilā
Realgar, an arsenic sulphide.
varti
Wick.
Adhikarana 35 (51) · Śloka 51
sarpiryavamadhucchiṣṭaśālaniryāsajaṁ tathā ||51||
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सर्पिर्यवमधुच्छिष्टशालनिर्यासजं तथा ||५१||
Meaning of the śloka
Also smoke from ghṛta, barley, beeswax and śāla resin.
The commentary lists further smoke ingredients: the whole set from cow's horn to skin may be used for smoke. Snāyu is the sinew used for bow-strings, commonly known as 'nahāra'.
The commentary says tarpaṇa here means nourishing; the meats are jāṅgala (deer and game birds like quail), urabhra (sheep) and ānūpa (marsh animals like tortoise), well prepared by the method of the culinary treatise.
A person tormented by śvāsa who licks nidigdhikā (kaṇṭakārī) paste, in āmalaka measure, with half that measure of hiṅgu, well mixed with honey, overcomes śvāsa by force in three days.
The commentary says this is the most efficacious yoga in śvāsa. Nidigdhikā is kaṇṭakārī, made into a paste of āmalaka size, mixed with hiṅgu of half that measure and with honey; licking it, the patient quickly overcomes śvāsa in three days. This whole treatment of śvāsa, though general, should be adapted by considering the nature of the substance and the particular case.
यथाऽग्निरिद्धः पवनानुविद्धो वज्रं यथा वा सुरराजमुक्तम् |
रोगास्तथैते खलु दुर्निवाराः श्वासश्च कासश्च विलम्बिका च ||५६||
Meaning of the śloka
As a fire blown by wind, or as the thunderbolt released by the king of the gods, so these diseases, śvāsa, kāsa and vilambikā, are indeed hard to ward off.
The commentary says this is stated to show that śvāsa, and by its context kāsa and the rest, are hard to treat. 'Kindled' means blazing; 'wind-driven' means accompanied by vāta.
इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे हिक्काश्वासप्रतिषेधो नाम (त्रयोदशोऽध्यायः, आदितः) एकपञ्चाशत्तमोऽध्यायः ||५१||
Meaning of the śloka
Thus ends the fifty-first chapter (the thirteenth from the beginning of this section), named Hikkāśvāsapratiṣedha, in the Kāyacikitsā-tantra within the Uttaratantra of the Suśruta Saṃhitā.
Thus ends the fifty-first chapter, named Hikkāśvāsapratiṣedha, in the Kāyacikitsā of the Uttaratantra, in the Suśruta commentary called Nibandhasaṅgraha composed by Śrī Ḍalhaṇa.
Key terms
hikkāśvāsapratiṣedha
The chapter on measures against hiccup and breathlessness.