A comparative study on samprapti of swasa roga

Department of Ayurveda Samhita & Siddhanta

1. A Comparative Study on Samprapti of Shwasa Roga WSR Bruhatrayi 9/1/2021 1

2. Presenter, DR KAVYA K 2 ND YEAR PG SCHOLAR DEPT OF AYURVEDA SAMHITA & SIDDHANTA GOVT. AYURVEDA MEDICAL COLLEGE & HOPSITAL, MYSURU Under the guidance of DR SHREEVATSA PROFESSOR & HEAD DEPT OF AYURVEDA SAMHITA & SIDDHANTA GOVT. AYURVEDA MEDICAL COLLEGE & HOPSITAL, MYSURU 9/1/2021 2

3. CONTENTS : Introduction References of Swasa roga Definition Udbhavastana Nidana Samprapti Samanya Vishesha Poorvarupa Types of Swasa roga Sadhyasadyata Tamaka Swasa Samprapti ghataka Conclusion Bibiliography . 9/1/2021 3

4. INTRODUCTION The word Shwasa refers to both Prakrut (normal) and Vikruta (abnormal) condition of ShwasaKriya . Since Vedic kala description of physiology of Shwasakriya , clearly indicates the path, structures through which the Shwashocchvasa Kriya take place. Here it is mentioned that air ( Vata ) in the form of Prana and Apana enters in the Nasika . Charak clearly indicates ShwasaKriya a varodha as the involvement of PranvahaSrotasa ( Charaka VI 5/18). The Mool of PranvahaSrotas is Hridaya and Mahasrotas (elementary canal- Charak Vi 5/18). 9/1/2021 4

5. ShwasaKriya (physiology of respiration): “ VatamPranenaApanenaNasike ”. (YAJ 15/12) Vata enters into the Nasa as Prana & Apana . This is the first description of ShwasaKriya in Vedic literature, which clearly indicates inspiration & expiration. The first breath of newly born till last breath, this process continues. And so to understand the physiology of ShwasaKriya , it is necessary to understand the PranvahaSrotas . The complete process of SwasaKriya mainly depends upon Pranvayu & Udanvayu . So the knowledge of different types of Vayu is necessary to understand the ShwasaKriya . 9/1/2021 5

6. DERIVATION OF SHWASA 1. The word Shwasa [SHWASA] is derived from SWASE DHATU after application of DHANJ PRATYAYA' which means Inspiration and Expiration of respiration and type of disease SHWASA = SWASE [ pul ] + DHANJ pratyaya (a) Vayu Vyapara (b) Rogabhedha 2. IN " SABDA STOMA MAHA NIDHI" the word SHWASA ' is derived from SHWASA dhatu by applying dhunj " pratyaya means both phases of respiration and type of disease". 9/1/2021 6

7. 3. According to ' AMARAKOSHA ' the word 'SHWASA is derived from “ Shwas pranane ”. Here SHWASA means air and respiration. The respiratory process and a type of discase is indicated. 4. According to " HALAYUDHA KOSHA " the word SHWASA is derived from " SHWASA is dhatu by adding LUT Pratyaya which Means inspiration and both phases of respiration SHWASA - SHWASA + LUT Means vayu , pavan . SHWASA SHWASA+LUT pratyaya By the above all derivations it can be stated that the word shwasa means act of respiration and a disease. 9/1/2021 7

8. Swasa as roga : In Ayurveda , Swasa has been described in detail as an independent disease entity and it has also been stated as one of the important clinical feature in many other disease also.   Mainly Swasa roga occurs in 2 forms: Swatantra Swasa Paratantra Swasa 9/1/2021 8

9. Swatantra Swasa : Where in swasa will get manifest as an independent vyadhi . The disease will have its own set of Nidana , Poorvarupa , Samprapti , laxanas & chikitsa . Paratantra swasa : Here swasa occurs as an effect of some other disease. Here swasa will be a laxana , Purvaroopa or Upadrava of another vyadhi . E.g.,: Swasa as Purvarupa (premonitory symptom) in – Rajayakshama (tuberculosis) 9/1/2021 9

10. Shwasa as Lakshana Vataja Apasmara , Apatantraka , Kaphaja and Vataja Arshas , Pureeshaja anaha , Amashaya gata vata , Kaphaja udara , Aharaja udavarta , Udgara nirodhaja udavarta , Kshataja kasa , Vataja grahani , Tridoshaja chardi , Antarvega jwara , Asthigata jwara , Gambhira jwara , Pachyamana jwara , Majjagata jwara , Sannipataja jwara , Talu shosha , Balasa , Vataja madatyaya , Medo roga , Pratinaha , Nasa shosha , Mutraghata ( kundalini ), Raktaja murcha , RajaYakshma , Pliha vidradhi , Yakrut vidradhi , Visha , Agni visarpa , Granthi visarpa , Tridoshaja nadi vrana .. etc 9/1/2021 10

11. Shwasa is seen as as upadrava (complication) in Atisara , Chardi , Trishna , Vataja prameha , Raktapitta , Vatarakta , Vrana .. etc Shwasa is mentioned as Asadhya Lakshana : Atisara , Kumbha kamala, Galaganda , Gulma , Chardi , Jwara , Masurika , Rajayakshma , Vidradhi , Visha , Tridoshaja nadi vrana , Shotha .. etc 9/1/2021 11

12. In Samhitas , Swasa has been said as five types. A detailed review of Nidanapanchaka (i.e . Nidana , Purvaroopa , Roopa , Upashaya and Samprapti ) will be helpful for clear understanding of minute aspects connected to disease. This aids in diagnosis and treatment of a disease with high precession. Therefore in this Presentation Nidana , Purvaroopa , Rupa & Samprapti of Swasa Roga has been reviewed from authoritative Ayurveda Samhitas and textbooks with rational approach to elucidate different attributes connected to Swasa Roga . 9/1/2021 12

13. Reference: Samhita Reference Adyaya Charaka Samhita C.Chi.17 Hikkaswasa Chikitsitam Sushrutha Samhita S.U.51 Swasa Pratisheda adhyaya Astanga Sangraha A.S.Ni.4 A.S.Chi.6 Swasahidma nidanaadya Swasahidma Chikitsa adhyaya Asatanga Hrudaya A.H.Ni.4 A.H.Chi.4 Swasahidma nidanam Swasahidma Chikitsitam 9/1/2021 13

14. Reason behind explaining Swasa & Hikka Roga in one chapter: हिक्काश्वासौ च समानकारणचिकित्सितत्वा देकाध्याये एवोक्तौ| -C.chi.17/1(com ) कफवातात्मकावेतौ पित्तस्थानसमुद्भवौ | हृदयस्य रसादीनां धातूनां चोपशोषणौ||८|| तस्मात् साधारणावेतौ मतौ परमदुर्जयौ| मिथ्योपचरितौ क्रुद्धौ हत आशीविषाविव||९|| -C.chi.17/8-9 9/1/2021 14

15. हिक्काप्रतिषेधानन्तरं तुल्यहेत्वादिसाम्यात् श्वासप्रतिषेधारम्भः -s.u.51/1(com) ……………………… हिक्का श्वासश्च कासश्च नृणां समुपजायते ||५|| -S.u.50/3-5 9/1/2021 15

16. Swasa Roga Definition : विहाय प्रकृतिं वायुः प्राणोऽथ कफसंयुतः | श्वासयत्यूर्ध्वगो भूत्वा तं श्वासं परिचक्षते ||४|| - S.U.51/4 Dalhana , while commenting on above shloka explains, प्राणो वायुः , प्रकृति विहाय विगुणो भूत्वेत्यर्थः, ऊर्ध्वगो भूत्वा तथा कफसंयुतः सन् यथा श्वासयति तं बुधा श्वां परिचक्षते कथयन्ति। 9/1/2021 16

17. Thus , Shwasa roga can be defined as a disorder of respiration where, the pranavayu is vitiated and obstructed by kapha , moves upward and because of the Pranavaha srotodusti , the inspired air fails to reach the lungs causing difficulty in breathing. This definition seems to be very scientific and describes all the aspects of dyspnoea. 9/1/2021 17

18. Vijayarakshita in madhukosha commentary of madhava nidana defines shwasa roga as " श्वासत्वं वेगवदूर्ध्ववातत्व।" "श्वासस्तु भस्त्रिकाध्मान समवातोर्ध्वगामितः।" Shwasa means disease in which " Gati " of Vayu is " Urdhwa ". The word Shwasa refers to expiration of the air, producing sound similar to the one generated while blowing the air with a blower by the blacksmith. This refers to the forceful labored breathing, probably with wheezing sound. The description conceals the pathological expression of breathing and is the cardinal symptom of Shwasa Roga . It can be compared to a pathological condition with increased respiratory effort. 9/1/2021 18

19. कफवातात्मकावेतौ पित्तस्थानसमुद्भवौ | हृदयस्य रसादीनां धातूनां चोपशोषणौ ||८|| तस्मात् साधारणावेतौ मतौ परमदुर्जयौ | मिथ्योपचरितौ क्रुद्धौ हत आशीविषाविव ||९|| - C.chi.17/9 9/1/2021 19

20. Swasa Roga occurs predominantly due to Kapha and Vata dosha , arises from the seat of Pitta and dry up the Hrudaya and the Dhatus such as Rasa etc. Hence it is regarded as very difficult ( Param durjaya ) to treat and if managed badly the doshas get aggravated further and kill the patient like serpents ( Asheevishha ). 9/1/2021 20

21. UDBHAVASTANA: कफवातात्मकावेतौ पित्तस्थानसमुद्भवौ |- C.Chi.17/8 पित्तस्थानसमुद्भवावित्यनेन पित्तस्योर्ध्वस्थानसम्बन्ध एव , नतु वातकफवदारम्भकत्वमिति दर्शयति ; पित्तस्थानशब्देनामाशयोऽभिप्रेतः |   उरःस्थः कुरुते श्वासमामाशयसमुद्भवम् |-A.H.Ni.4/4 तथा , उरसि तिष्ठतीत्युरःस्थः | किम्भूतं श्वासम् ? आमाशयसमुद्भवम् | आमाशयात् समुद्भवो-जन्म , यस्य तमाशयसमुद्भवम् | 9/1/2021 21

22. NIDANA: Nidana of swasa roga is divided into following 4 parts: Aharaja Viharaja Nidanartaka roga Vyanjaka hetu 9/1/2021 22

23. रजसा धूमवाताभ्यां शीतस्थानाम्बुसेवनात् | व्यायामाद्ग्राम्यधर्माध्वरूक्षान्नविषमाशनात् ||११|| आमप्रदोषादानाहाद्रौक्ष्यादत्यपतर्पणात् | दौर्बल्यान्मर्मणो घाताद्द्वन्द्वाच्छुद्ध्यतियोगतः ||१२|| अतीसारज्वरच्छर्दिप्रतिश्यायक्षतक्षयात् | रक्तपित्तादुदावर्ताद्विसूच्यलसकादपि ||१३|| पाण्डुरोगाद्विषाच्चैव प्रवर्तेते गदाविमौ | निष्पावमाषपिण्याकतिलतैलनिषेवणात् ||१४|| पिष्टशालूकविष्टम्भिविदाहिगुरुभोजनात् | जलजानूपपिशितदध्यामक्षीरसेवनात् ||१५|| अभिष्यन्द्युपचाराच्च श्लेष्मलानां च सेवनात् | कण्ठोरसः प्रतीघाताद्विबन्धैश्च पृथग्विधैः ||१६|| --C.Chi.17/11-16 9/1/2021 23

24. यैरेव कारणैर्हिक्का बहुभिः सम्प्रवर्तते | तैरेव कारणैः श्वासो घोरो भवति देहिनाम् ||३ || - S.u.51/3 विदाहिगुरुविष्टम्भिरूक्षाभिष्यन्दिभोजनैः | शीतपानासनस्थानरजोधूमानिलानलैः ||३|| व्यायामकर्मभाराध्ववेगाघातापतर्पणैः | आमादोषाभिघातस्त्रीक्षयदोषप्रपीडनैः [ १ ] ||४|| विषमाशनाध्यनशनैस्तथा समशनैरपि | हिक्का श्वासश्च कासश्च नृणां समुपजायते ||५|| -S.u.50/3-5 9/1/2021 24

25. कासवृद्ध्या भवेच्छ्वासः पूर्वैर्वा दोषकोपनैः | आमातिसारवमथुविषपाण्डुज्वरैरपि ||१|| रजोधूमानिलैर्मर्मघातादतिहिमाम्बुना | ---------------------------------------|२|- A.H.Ni.4/1 9/1/2021 25

26. Aharaja Nidana : Sl. No. Ahara C.S S.S A.S A.H VATA PRAKOPAKA         1. रुक्षान्न     - - 2. विशमाशन     - - 3. शीतान्न -   - - 4. अनशन -   - - 5. विष सेवन     - - 6. शीतम्बु पान -   - - 7. विष्टम्बि भोजन     - - 8. अध्यशन -   - - 9. द्वन्द्वातियोग   - - - 9/1/2021 26

27. Cont … PITTA PRAKOPAKA         1. तिलतैल   - - - 2. विदाहि     - - 3. कटु   - - - 4. उष्ण   - - - 5. अम्ल - -     6. लवण - -     9/1/2021 27

28. KAPHA PRAKOPAKA         1. निष्पाव   - - - 2. मा ष   - - - 3. पिश्टान्न   - - - 4. शालुक   - - - 5. गुरुद्रव्य     - - 6. आनुप मांस   - - - 7. जांगल मांस   - - - 8. दधि   - - - 9. आम क्षीर   - - - 10. पीण्यक   - - - 11. श्लेश्मल द्रव्य   - - - 12. अभिष्यन्दि द्रव्य     - - 13. उत्क्लेद - - -   9/1/2021 28

29. Viharaja Nidana : Sl. No. Vihara C.S S.S A.S A.H Vata prakopaka         1. रजस्         2. धूम         3. प्रग्वात         4. शीहासन     - - 5. शीताम्बु         6. व्यायाम     - - 7. ग्राम्य धर्म   - - - 8. अतिअपतर्पण   - - - 9. शुद्यातियोग   - - - 9/1/2021 29

30. 10. कण्टप्रतिघात   - - - 11. उरप्रतिघात   - - - 12. कर्महत     - - 13. भारवहन   - - - 14. मर्माघात   - - - 15. वेग निरोध - - -   16. अद्व     - - 17. आयास - - -   18. जागरण - - -   9/1/2021 30

31. Pitta prakopaka         1. ऊश्म - - -   Kapha prakopaka         1. अभिषयन्दि उपचार   - - - 2. दिवास्वप्न - - -   9/1/2021 31

32. Nidanartaka Roga : Sl. No. Ahara C.S S.S A.S A.H 1. अपतर्पण -   - - 2. आमप्रदोष         3. आनाह   - - - 4. विबन्द   - - - 5. दातुक्शय   - - - 6. प्रतिश्याय   - - - 7. छर्दि   -     8. ज्वर   -     9/1/2021 32

33. 9. अतिसार   -     10. दौर्बल्य   - - - 11. पाण्डु रोग   -     12. उरक्शत   - - - 13. अलसक   - - - 14. उदावर्त   - - - 15. विशूचिक   - - - 16. रक्तपित्त   - - - 17. कास - -   - 9/1/2021 33

34. Vyanjaka Nidana Vyanjaka Hetu C.S S.S A.H मेघ   -   अम्बु   -   शीत   -   श्लेश्मकर   -   9/1/2021 34

35. Nidana : To Expalin the role of nidana in the Samprapti of swasa roga , nidana is classified as: Agantu Hetu ( bahya ) Nija Hetu ( Abhyantara ) Manasika Hetu 9/1/2021 35

36. Agantu Hetu ( bahya ): Raja, Prag-vata sevana , Marmaghata , Kanta-Urasah-Pratighata .. etc Nija Hetu ( Abhyantara ): Again divided into Vataprakopaka – Rukshanna , Sheetasana , Sheetambu , Vyayama , Advasevana … Kapha prakopaka – Jalaja , Anupa mmasa , Dadhi , Nispava , Masha, Pinyaka , Guru bhojana , Ksheera …. 9/1/2021 36

37. Amapradoshaja – Vishamasana , Dadhi , Abhishyandi , Amaksheera , Gurubhojana …. Khavaigunyakaraka – Raja, dhuma , Adhva sevana , Dwandva , kshatakshaya , Marmaghata ….. Nidanartaka roga – Pratishyaya , Kasa , Udavarta … Mulastana dustikara roga – Atisara , Jwara , chardi , Vishucika , Atisara , alasaka Manasika Hetu : Krodha , Bhaya , Shoka …. 9/1/2021 37

38. Hetu Dosha Dushya & Srotas Guna Samprapti Sheetastana/ Sheetapaana Vata , kapha Rasa Sheeta Sankocha pradana Rukshaanna Vata Rasa Ruksha Dhatukshaya Vishamahara Kapha Rasa Abhishyandi Kapha pradhana Guru ahara Kapha Rasa, Rakta Guru Kapha pradhana Vidaahi ahara Pitta Rasa, Rakta Vidahi Pitta prakopaka Jalaja & Anupa mamsa Kapha Rakta, Mamsa Guru Amajanya Abhishyandi ahara Kapha Rakta, Mamsa Guru Amajanya Tial taila Pitta Rasa, Rakta Ushna Pitta prakopaka Rajo dhuma sevana Vata, Kapha Pranavaha Ruksha Srotovaigunya Sheeta vihara Vata, Kapha Rasa, Pranavaha Sheeta Sankocha pradana Ativyayama, Adhwa Vata - Ruksha Dhatukshayaja, sankocha Atishodana Vata Rasa Ruksha Vataprakopaka 9/1/2021 38

39. Pandu roga is Karana for swasa roga :[ Nidanartakara Roga ] पाण्डुरोगकारणत्वाद्धिक्काश्वासयोः पाण्डुरोगानन्तरमभिधानम् | वक्ष्यति हि - “ पाण्डुरोगाद्विषाच्चैव प्रवर्तेते गदाविमौ ” इति | -C.chi.17/1 As Pandu roga is Rasapradoshaja vyadhi Swasa is Pranavaha srotovikara I.e., caused due to pranavaha srodusti . As pranavaha srotas & Rasavaha srotas is having same mula stana . So there is more chances fs rasavaha srotodusti which inturn is a nidana for pandu roga . 9/1/2021 39

40. i.e., तत्र प्राणवहानां स्रोतसां हृदयं मूलं महास्रोतश्च ; रसवहानां स्रोतसां हृदयं मूलं दश च धमन्यः |-C.vi.5/8 9/1/2021 40

41. Kasa roga is Karana for swasa roga :[ Nidanartakara Roga ] कासनिदानादनन्तरं श्वासनिदानारम्भोऽयं सम्बन्धः | कासादुपेक्षया श्वासो भवति | तथाऽनन्तरमुक्तम् ( हृ . नि . अ. ३|३८) - " कासाच्छ्वासक्षयच्छर्दि " इत्यादि | -A.H.Ni.4/1[com] हिक्काश्वासानन्तरं समानचिकित्सितत्वात् तथा हिक्काश्वासकासानां परस्परानुबन्धित्वाच्च ………..- c.chi.18/1(com)   श्वासप्रतिषेधानन्तरं वातकफप्राधान्यत्वसाम्यात्तुल्यचिकित्सित त्वाच्च कासप्रतिषेधारम्भः …………….- S.u.52/1(com) 9/1/2021 41

42. Similarity in Srotodusti Nidana & Swasa roga Prana , anna , Udaka & Rasavaha Srotodusti Nidanas & Few Srotodusti laxanas are similar to Swasa nidana . So there is a strong Relavence in involvement of Prana , anna , Udaka & Rasavaha srotas in manifestation of swasa vyadhi . i.e.,   क्षयात् सन्धारणाद्रौक्ष्याद्व्यायामात् क्षुधितस्य च| प्राणवाहीनि दुष्यन्ति स्रोतांस्यन्यैश्च दारुणैः ||१०|| -C.Vi.5/10 9/1/2021 42

43. औष्ण्यादामाद्भयात् पानादतिशुष्कान्नसेवनात् | अम्बुवाहीनि दुष्यन्ति तृष्णायाश्चातिपीडनात् ||११|| -C.Vi.5/11 अतिमात्रस्य चाकाले चाहितस्य च भोजनात् | अन्नवाहीनि दुष्यन्ति वैगुण्यात् पावकस्य च||१२|| -C.Vi.5/12 गुरुशीतमतिस्निग्धमतिमात्रं समश्नताम् | रसवाहीनि दुष्यन्ति चिन्त्यानां चातिचिन्तनात् ||१३|| -C.Vi.5/13 9/1/2021 43

44. SAMPRAPTI यथादुष्टेन दोषेण यथा चानुविर्सपता निर्वृत्तिरामयस्यासौ सम्प्राप्तिंर्जातिरागतिः |॥१०|॥| -(वा. नि. अ. १) | Process of understanding the development of disease by vitiated doshas which are constantly circulating inside the body, it is also known as synonyms - Jati , Agati   अ(त)त्रैके व्याधिजन्ममात्रमन्त्यकारणव्यापारजन्यं सम्प्राप्तिमाहुः।। Ch.Ni 1/11 Factors which finally determines the manifestation of the disease is called samprapti . 9/1/2021 44

45. Samanya Samprapti acc. To charaka मारुतः प्राणवाहीनि स्रोतांस्याविश्य कुप्यति | उरःस्थः कफमुद्धूय हिक्काश्वासान् करोति सः ||१७|| घोरान् प्राणोपरोधाय प्राणिनां पञ्च पञ्च च|१८| - C.Chi.17/17-18 9/1/2021 45

46. According to this Samprapthi . Due to Nidana sevana , the vitiated vata enters in the pranavaha srotas (Respiratory Channels) and provokes the urastha kapha ( Kapha stagnating in chest). This provoked Kapha obstructs the pranavaha srotas (Respiratory Channels) and gives rise five types of Hikka and Shwasa Kaphamuddhuya has been commented by Gangadhara as " Kaphamuddhuya urdhwam neetwa anaha " which means kapha is moved upwards or towards pranavaha srotas from uras and thus leading to shwasa . 9/1/2021 46

47. 9/1/2021 47

48. VISHESHA SAMPRAPTI OF SWASA: यदा स्रोतांसि संरुध्य मारुतः कफपूर्वकः | विष्वग्व्रजति संरुद्धस्तदा श्वासान्करोति सः ||४५|| - C.Chi.17/45 When the vitiated Vayu along with Kapha (causes the obstruction to the respiratory channels, then vayu itself gets obstructed and spreads in the whole body making abnormal movements and producing Shwasa roga . 9/1/2021 48

49. The pranavayu which has lost its prakruthavashta when get obstructed by dominant kapha dosha , then attains vimargagathi , i.e., it will move in all directions in the uras there by impairing the respiration and thus leading to shwasa ." The word " vishwag vrajati " has been commented by Chakrapani as " Sarvato Gacchati ", while Arunadatta has restricted the movement only within ura s or chest . 9/1/2021 49

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51. Sushrutha : विहाय प्रकृतिं वायुः प्राणोऽथ कफसंयुतः | श्वासयत्यूर्ध्वगो भूत्वा तं श्वासं परिचक्षते ||४|| -s.u.51 9/1/2021 51

52. Astanga Hrudaya कफोपरुद्धगमनः पवनो विष्वगास्थितः | प्राणोदकान्नवाहीनि दुष्टः स्रोतांसि दूषयन् ||३|| उरःस्थः कुरुते श्वासमामाशयसमुद्भवम् | ----------------------|४|- A.H.Ni .$/3-4 Vagbhata explains that the place of origin of this vyadhi is amashaya , srotas involved here are prana , anna and udaka vaha , and the vyakta sthana being Ura which happens because of obstruction of normal movements of vata by kapha . 9/1/2021 52

53. 9/1/2021 53

54. PURVAROOPA These are the symptoms which occur prior to the manifestation of the disease proper. The onset of this stage takes place after doshadushya sammoorchana , ie .. sthanasamshraya ". The study of poorva roopa helps in e arly detection of a disease, which might play a significant role in the episodic disorder such as tamaka shwasa . 9/1/2021 54

55. आनाहः पार्श्वशूलं च पीडनं हृदयस्य च| प्राणस्य च विलोमत्वं श्वासानां पूर्वलक्षणम् ||२०|| - C.chi.17/20 प्राग्रूपं तस्य हृत्पीडा भक्तद्वेषोऽरतिः परा | आनाहः पार्श्वयोः शूलं वैरस्यं वदनस्य च ||६|| -S.u.51/6 प्राग्रूपं तस्य हृत्पार्श्वशूलं प्राणविलोमता ||४|| आनाहः शङ्खभेदश्च --------------------------| ----------------------------|५|-A.H.Ni.4/4 9/1/2021 55

56. Purvaroopa laxana Caraka Sushrutha Astanga Hrudaya आनाह       पार्श्वशूल       हृत्पीड       प्राणस्य विलॊमत्वं   -   भक्तद्वेष -   - अरति -   - वदन वैरस्य -   - शंख भेद - -   9/1/2021 56

57. TYPES of Swasa roga : :   क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चधा | भिद्यते स महाव्याधिः श्वास एको विशेषतः ||५|| -S.U.51/5 क्षुद्रकस्तमकश्छिन्नो महानूर्ध्वश्च पञ्चमः ||२|| -A.H.Ni.4/2 9/1/2021 57

58. Type of Swasa Dosha Pradhanata Maha Swasa Vata Urdhwa Swasa Vata Chinna Swasa Kapha + Vata Kshudra Swasa Vata Tamaka Swasa Kapha pradhana 9/1/2021 58

59. SADYASADYATA: एषां प्राणहरा वर्ज्या घोरास्ते ह्याशुकारिणः ||६८|| भेषजैः साध्ययाप्यांस्तु क्षिप्रं भिषगुपाचरेत् | उपेक्षिता दहेयुर्हि शुष्कं कक्षमिवानलः ||६९|| = C.Chi.17/68-69   क्षुद्रः साध्यतमस्तेषां तमकः कृच्छ्र उच्यते | त्रयः श्वासा न सिध्यन्ति तमको दुर्बलस्य च ||१४||-S.U.51/14 त्रयः श्वासाः छिन्नश्वासमहाश्वासोर्ध्वश्वासाः | तमको दुर्बलस्य चेति दुर्बलस्य पुंसस्तमकश्वासो न सिध्यतीत्यर्थः ; 9/1/2021 59

60. Type of Swasa Dosha Pradhanata Sadhyaasadyata Maha Swasa Vata Asadya Urdhwa Swasa Vata Asadya Chinna Swasa Kapha + Vata Asadya Kshudra Swasa Vata Sadya Tamaka Swasa Kapha pradhana Kruchrasadya 9/1/2021 60

61. …………. धीमानग्निवेशः कृताञ्जलिः ||३|| य इमे द्विविधाः प्रोक्तास्त्रिदोषास्त्रिप्रकोपणाः | रोगा नानात्मकास्तेषां कस्को भवति दुर्जयः ||४|| …………………. कामं प्राणहरा रोगा बहवो न तु ते तथा | यथा श्वासश्च हिक्का च प्राणानाशु निकृन्ततः ||६|| अन्यैरप्युपसृष्टस्य रोगैर्जन्तोः पृथग्विधैः | अन्ते सञ्जायते हिक्का श्वासो वा तीव्रवेदनः ||७|| -C.Chi.17/3-7 9/1/2021 61

62. When Agnivesha asks question to lord Punarvasu Atreya i.e There are variety of diseases classifiable into 2 categories, viz., Samanya or Asamanya , which are produced by aggregation of 3 doshas or in their combined form. Cause for the aggravation of doshas are 3 karanas viz., Asatmendriyarta samyoga , Prajnaparadha & Parinama . Which of these are difficult of cure? After listening to agnivesha’s question, Lord Punarvasu atreya replies – “it’s true that there are Several dreadly diseases like shankaka , rohini etc., which can kill a patient. But none of these are dreadly as Hikka & Swasa which kills a patient instantaneously. Even if the patient has been suffering with other types of diseases, ultimately he/ she falls as a victim of hikka & Swasa that are immensely painful i.e., Hikka / Swasa occurs as the terminal ailment before death. 9/1/2021 62

63. Among 5 types of swasa , first 3 types i.e., Maha Swasa , Urdhwa swasa & china Swasa becomes asadya & Tamaka swasa is the one disease which is seen more prevalent among population. In this regard Tamaka Swasa is dealt indetail . 9/1/2021 63

64. TAMAKA SWASA : 9/1/2021 64

65. Derivation: Tamaka Shwasa consists of two words viz., Tamaka and Shwasa . TAMAKA: The word Tamaka is derived from the dhatu ‘ तुम् ग्लानौ’ which means Saddness . The Sanskrit-Engllish Dictionary by Vidhyadhar vaman- gives the different meanings of tama i.e., To choke, to be suffocated, To be Exhausted, To be Unease, To be Distressed . तमक - ताम्यति अत्र तम व वचस्पत्यम्. – it is described as one variety of disease in Swasa in vacaspatyam. तम ताम्यति अनेन इति तम – Halayudhakosha The word tama denotes Andhakara, Nishacharma, divantaka,.. 9/1/2021 65

66. SHWASA : Shwasitam vayu iti shwasah Inhalation and exhalation of air is Shwasa . Shwasiti Anena iti shwasah " The process by which exchange of air takes place that is SHWASA. Shwasiti iti shwasah ‘ Means the Physiology of respiration is Shwasa . 9/1/2021 66

67. Vishesha Nidana :[ Aggravating factor] मेघाम्बुशीतप्राग्वातैः श्लेष्मलैश्चाभिवर्धते | स याप्यस्तमकश्वासः साध्यो वा स्यान्नवोत्थितः ||६२|| इति तमकश्वासः | -C.chi.17/62 9/1/2021 67

68. SAMPRAPTI OF TAMAKA SHWASA The nidana leads to pratiloma gathi of Vaayu . This, in turn will vitiate the kapha dosha . As a result excessive kapha will be secreted leading to peenasa . Vata moving through the kapha avrutha pranavahasrotas will produce ghurghuraka , along with intense attacks. प्रतिलोमं यदा वायुः स्रोतांसि प्रतिपद्यते | ग्रीवां शिरश्च सङ्गृह्य श्लेष्माणं समुदीर्य च||५५|| करोति पीनसं तेन रुद्धो घुर्घुरुकं तथा | - C.chi.17/55 Diagram1 of Tamaka swasa 9/1/2021 68

69. Samprapti according to Kriyakala Sanchaya Stage I It is the stage of dosha sanchaya . It is the stage where the vata and kapha dosha accumulate due to their respective vata prakopaka and kapha prakopaka nidana . Sanchaya of vata occurs in pranavaha srotas and that of kapha in uras .   Prakopa Stage II It is the stage of dosha prakopa . sheeta kala,durdina etc. will provoke the sanchita doshas . As a result the vata dosha in pranavaha srotas and kapha in uras tries to move to other places. 9/1/2021 69

70. Prasara Stage III In this stage the kupitha doshas hampers the agni and causes agnimandya and in turn produces ama . Both vata and kapha begins to move all over their aashaya .   In the above 3 stages we may not get clear picture regarding dominant dosha . If these stages are continued then it will pass on to other stages of kriyakala where the pathological changes are clearly manifested resulting in clinically appreciable symptoms. 9/1/2021 70

71. Sthanasamsraya Stage IV It is the stage of dosha dushya sammurchana and sthana samshraya . The kupita vata moves in the uras and kapha from Amashaya tends to move into pranavaha srotas . There will be obstruction to the movement of vata and as a result of this, prodromal features of the disease are manifested. The aggravated dosha ie ., vata moving all over the body, as well in pranavaha srotas , will lead to the kha-vaigunyatha . The obstructed vata moves in all directions in pranavaha srotas ie . the tapped air in the bronchial tree over inflates the lungs, resulting in shwasakruchratha 9/1/2021 71

72. Vyakta Stage V Prakupita vata which is obstructed by kapha will attain pratiloma gati . This pratiloma gati of vata results in vimarga gamana of kapha from annavaha and udakavaha srotas . Peenasa and a sort of obstructive sound ie . Ghurghuraka are the first signs of shwasa . Furthermore , in progressive stage, the degree of obstruction increases to such an extent that to cope up the need of bahya prana ", body has to increases the rate of respiration. The obstruction goes on increasing and insufficiency of bahya prana occurs, which manifests;Tamo darshana , Pramoha , Sannirodha,etc ., 9/1/2021 72

73. Bheda Stage VI It is the stage of deerghakala anubhandhatwa . In the absence of proper treatment or insufficient treatment there will be permanent changes in the srotas and its moola resulting in complications. 9/1/2021 73

74. Lakshana of Tamaka swasa : Laxanas of vyadhi appears in the 5 th Kriyakala i.e., Vyaktavasta in which Sign & symptoms of a disease become completely manifested. The laxanas which are Alpavyakta in poorvaroopavasta becomes Vyakta in Roopvasta . 9/1/2021 74

75. The lakshana of Tamaka Shwasa has been explained with clinical course of the disease, Rather than listing of signs and symptoms. The appreciable lakshana of Tamaka Shwasa are Explained as - 1) Vishista or Prat yatma niyata lakshana : E.g., Shwasakrichrata , Kasa , and Ghurguraka etc 2) Upashayanupashaya rupi lakshana – Aggravating & relieving laxanas 3) Samanya lakshana – Depicted in table 9/1/2021 75

76. प्रतिलोमं यदा वायुः स्रोतांसि प्रतिपद्यते | ग्रीवां शिरश्च सङ्गृह्य श्लेष्माणं समुदीर्य च||५५|| करोति पीनसं तेन रुद्धो घुर्घुरुकं तथा | अतीव तीव्रवेगं च श्वासं प्राणप्रपीडकम् ||५६|| प्रताम्यत्यतिवेगाच्च कासते सन्निरुध्यते | प्रमोहं कासमानश्च स गच्छति मुहुर्मुहुः ||५७|| श्लेष्मण्यमुच्यमाने तु भृशं भवति दुःखितः | तस्यैव च विमोक्षान्ते मुहूर्तं लभते सुखम् ||५८|| … 9/1/2021 76

77. ………………………………… अथास्योद्ध्वंसते कण्ठः कृच्छ्राच्छक्नोति भाषितुम् | न चापि निद्रां लभते शयानः श्वासपीडितः ||५९|| पार्श्वे तस्यावगृह्णाति शयानस्य समीरणः | आसीनो लभते सौख्यमुष्णं चैवाभिनन्दति ||६०|| उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान् | विशुष्कास्यो मुहुः श्वासो मुहुश्चैवावधम्यते | -C.Chi.17/55-61 Lakshana of tamaka swasa : 9/1/2021 77

78. Lakshana of tamaka swasa : Sl.No. Roopa C.S S.S A.S A.H 1. तीव्र वेग श्वास   -     2. प्राण प्रपीडक श्वास   -     3. मुहुर्मुहु श्वास   -     4. ऋद्द श्वास   - - - 5. घुर्घुरकम्         6. कास वेगतः प्रताम्यति   - - - 7. कासात् सन्निरुद्द्यते   - - - 8. कास जन्य प्रमोह   -     9. आसिनो लभते सौक्यम्   -     9/1/2021 78

79. 10. शयनान्ते श्वासाधिकम्         11. शयनान्ते पार्श्वग्रह   - - - 12. पीनस   -     13. महत् घोसवन् श्वास -   - - 14. श्लेष्मण्यमुच्य जन्य दुःख:   - - - 15. श्लेष्म विमोक्षजन्य सुखः   -     16. ग्रीव सिर संग्रहण   -   - 17. कण्टोध्वंस   - - - 18. ललाट स्वेद         19. उच्च्रिताक्शि   -     20. विशुषकास्य   -     9/1/2021 79

80. 21. वमन -   - - 22. तृष्ण -       23. भक्त द्वेश -   - - 24. अबल -   - - 25. उष्णाभिनन्धति   -     26. मेघाम्बुना वर्धते   -     27. शीतेन वर्धते   -     28. प्राग्वातेन वर्धते   -     29. दुर्दिन वर्धते -   - - 30. वेपथ् -   - - 31. उरः पीड - -     32. पर्श्व पीड - -     33. अरुचि - -     34. मोहम् - -     9/1/2021 80

81. Out of these Rupas , some appear in the Vegavastha of Tamaka Shvasa and some remain present in between the two attacks. With the help of above table, we can conclude that Acharya Charaka has given a detailed description of Tamaka Shvasa Lakshana in which he has emphasized more on the Vegavastha Lakshana while Sushruta has described both type of Lakshana , Vata as well as Kapha Dosha , Rasa Dhatu and Pranavaha Srotasa are the predominant factors involved in the pathogenesis of Tamaka Shvasa and for apparent reasons, these factors determine the course and clinical manifestation of the disease. Disturbed respiration with audibility is the cardinal symptom of the disease. 9/1/2021 81

82. Laxanas Depicting involvement of srotas in swasa roga : तत्र प्राणवहानां स्रोतसां हृदयं मूलं महास्रोतश्च , प्रदुष्टानां तु खल्वेषामिदं विशेषविज्ञानं भवति ; तद्यथा - अतिसृष्टमतिबद्धं कुपितमल्पाल्पमभीक्ष्णं वा सशब्दशूलमुच्छ्वसन्तं दृष्ट्वा प्राणवहान्यस्य स्रोतांसि प्रदुष्टानीति विद्यात् | उदकवहानां स्रोतसां तालुमूलं क्लोम च, प्रदुष्टानां तु खल्वेषामिदं विशेषविज्ञानं भवति ; तद्यथा - जिह्वाताल्वोष्ठकण्ठक्लोमशोषं पिपासां चातिप्रवृद्धां दृष्ट्वोदकवहान्यस्य स्रोतांसि प्रदुष्टानीति विद्यात् | 9/1/2021 82

83. अन्नवहानां स्रोतसामामाशयो मूलं वामं च पार्श्वं , प्रदुष्टानां तु खल्वेषामिदं विशेषविज्ञानं भवति ; तद्यथा - अनन्नाभिलषणमरोचकविपाकौ छर्दिं च दृष्ट्वाऽन्नवहान्यस्य स्रोतांसि प्रदुष्टानीति विद्यात् | -C.Vi.5 9/1/2021 83

84. Though there are 5 types mentioned in Shwasa roga in particular, Tamaka shwasa is the one which has got prime clinical importance as well as therapeutic importance. Charaka also classifies Shwasa and hikka into two types based on dosha pradhanyata , and they can be considered as two types of Tamaka shwasa along with Pratamaka and Santamaka because Tamaka Shvasa can be caused either through vitiation of vata or through awarodha of kapha . 1. Kaphadikya Shwasa 2. Vatadikya Shwasa 9/1/2021 84

85. Kaphapradhana Samprapti Vata is in normal state and Kapha is either vitiated with its own etiological factors like Shita , Guru, Dadhi , Amakshira etc , or Vishamashana , Vishtambhi Bhojana etc. can produce Mandagni Produces Ama Produces Malarupa Kapha This vitiated Kapha in the Uraha Pradesha causes the obstruction in the normal path of Vata ( Prana ) Avaranajanya Vata Prakopa and Pratiloma Gati of Vata Swasa 9/1/2021 85

86. Kaphadikya shwasa might be considered if the patient presents with lakshanas like Peenasa , Kasa , Ghurghurukata , kruchra bhashana and the one which gets aggravated by the use of sheeta and shleshmala ahara vihara . 9/1/2021 86

87. Vatapradhana Samprapti Vata is vitiated through its own etiological factors like Apatarpana , Raja, Dhuma , Vegavarodha etc and by Dhatukshaya (due to chronic disorders), vitiated Vata causes contraction of Pranavaha Srotasa , which further produces Pratishyaya by excitation of Kapha Dosha . Thus, leading to the presentation of Shvasa Vatadhikya shwasa might be considered if the patient presents with lakshanas pertaining to shwasa as teevravega yukta shwasa , pranaprapeedaka , moha , tamo darshana , shayane shwasa peedita , aaseeo labhate sukham , ucchritaksha , swedana , shulayukta , muhu shwasa , muhu avadhamyate and the one which gets aggravated during meghaachadita and varsha kaala , and by the use of sheeta ahara vihara . 9/1/2021 87

88. Understanding Udavarta Samprapti in Swasa Roga : कषायतिक्तोषणरूक्षभोज्यैः सन्धारणाभोजनमैथुनैश्च [ १ ] | पक्वाशये कुप्यति चेदपानः स्रोतांस्यधोगानि बली स रुद्ध्वा ||५|| करोति विण्मारुतमूत्रसङ्गं क्रमादुदावर्तमतः सुघोरम् | रुग्बस्तिहृत्कुक्ष्युदरेष्वभीक्ष्णं सपृष्ठपार्श्वेष्वतिदारुणा स्यात् ||६|| आध्मानहृल्लासविकर्तिकाश्च तोदोऽविपाकश्च सबस्तिशोथः | वर्चोऽप्रवृत्तिर्जठरे च गण्डान्यूर्ध्वश्च [ २ ] वायुर्विहतो गुदे स्यात् ||७|| कृच्छ्रेण शुष्कस्य चिरात् प्रवृत्तिः स्याद्वा तनुः स्यात् खररूक्षशीता | ततश्च रोगा ज्वरमूत्रकृच्छ्रप्रवाहिकाहृद्ग्रहणीप्रदोषाः ||८|| वम्यान्ध्यबाधिर्यशिरोऽभितापवातोदराष्ठीलमनोविकाराः | तृष्णास्रपित्तारुचिगुल्म कासश्वासप्रतिश्या र्दितपार्श्वरोगाः ||९|| अन्ये च रोगा बहवोऽनिलोत्था भवन्त्युदावर्तकृताः सुघोराः | चिकित्सितं चास्य यथावदूर्ध्वं प्रवक्ष्यते तच्छृणु चाग्निवेश !||१०| -C.Chi.26/5-10 9/1/2021 88

89. Types of Samprapti concerning to Tamaka Shwasa may be considered as follows: Sankhya Samprapti – Considering the disease Shwasa as a whole, it is of 5 types, Tamaka shwasa in particular is of two types, and can also be classified into three types based on the doshic involvement. Pradhanya Samprapti – Both Kapha and Vata are given equal importance in the Samprapti of Shwasa along with Pitta dosha in terms of udbhava sthana and its involvement in the disease while explaining the types of Tamaka shwasa . 9/1/2021 89

90. Vikalpa Samprapti – Being the type of Samprapti to understand the amshamsha kalpana of the particular dosha type, in Tamaka shwasa , Prana vata is the pradhana dosha and with further involvement of other types of Vata and Avalambaka kapha as the prime kapha type. Pachaka pitta being the sthanika dosha of utpatti sthana is the pradhana pitta dosha involved. Vidhi Samprapti – Nija vyadhi in most cases, with agantuja as preraka hetu in the Samprapti . Bala Samprapti – The disease is more balavan due to the age factors in Bala and Vruddha and is more common in them. Kala Samprapti – With the involvement of Vata and Kapha , the disease is more common in Sheeta kala and as a preraka hetu it is also observed in the Vasanta rutu kala . 9/1/2021 90

91. TYPES OF TAMAKA SHVASA: Charaka has further mentioned two different stages of Tamaka Shvasa as further complication of disease, viz. Pratamaka and Santamaka Shvasa . Both differ from each other on the basis of intensity of attacks. Sushruta and Vagbhata have only mentioned the term Pratamaka , which also includes clinical manifestation of Santamaka . 9/1/2021 91

92. ज्वरमूर्च्छापरीतस्य विद्यात् प्रतमकं तु तम् | उदावर्तरजोऽजीर्णक्लिन्नकायनिरोधजः ||६३|| तमसा वर्धतेऽत्यर्थं शीतैश्चाशु प्रशाम्यति | मज्जतस्तमसीवाऽस्य विद्यात् सन्तमकं तु तम् ||६४|| इति प्रतमकसन्तमकश्वासौ | -C.Chi.17/63-64 9/1/2021 92

93. 1. Pratamaka Shvasa : When a patient of Tamaka Shvasa suffers with fever and fainting, then the condition is called as Pratamaka Shvasa . Tamaka Shvasa is a Kaphapradana Vyadhi but whenever which is suggestive of involvement of Pittadosha in it, Pratamaka Shvasa can be considered. 2. Santamaka Shvasa : When the patient of Tamaka Shvasa feels submerged in darkness, the condition is called as Santamaka Shvasa . This can be taken as the severe stage of Pratamaka , 9/1/2021 93

94. These both conditions are aggravated by Udavarta , dust, indigestion, humidity in body. and suppression of natural urges. Though cooling regimen is one of the causative Factors of Tamaka swasa but in Pratamaka & Santamaka Swasa , the patient gets relief by administering cooling agents due to Pitta Dosha Involvement. 9/1/2021 94

95. SAMPRAPTI GHATAKA: Dosha – Vata : Pranavayu [ Pradhana ], udana & vyana vata Kapha : Kledaka & Avalambaka kapha Dushya - Rasa Agni – Mandagni & vishamagni Ama – Jataragni , Rasa dhatwagni mandyajanya Srotas – Prana , Anna, udaka , Rasavaha 9/1/2021 95

96. Srotodusti – Sanga , Atipravrutti & Vimarga gamana Udbhavastana – Ch : Pittastana Vag : Amashaya Vyakta stana – Aasya , Greeva , Prusta , Parshwa , Uras Sanchara stana – Pranavaha sroto avayava Rogamarga – Abhyantara Vyadhi swabhava – Chirakaari Sadhya-asadhyata - Navina : KruchraSadya Purana : Yapya [ ch ], Kruchrasadya [ su ] 9/1/2021 96

97. Analysis of samprapti ghataka : DOSHA: According to Acharya Charaka , Kapha and Vata are main dosha for the causation of Shwasa and Hikka Roga . He said that vitiated vata enters in the pranavaha srotas and provokes the urastha Kapha giving rise to five types of Hikka and Shwasa . Sushruta mentioned the involvement of kapha and vata dosha in the samanya samprapti of Shwasa " but Dalhana has mentioned the involvement of pranavayu , ". According to Arunadatta , importance should be given to both doshas . Thus we conclude that kapha and vata are main Doshas involved in Tamaka Shwasa . 9/1/2021 97

98. DUSHYA: The involvement of Dushya is not mentioned clearly in Shwasa roga , Charaka says that Rasadi Dhatus gets dried in these diseases. In Tamaka Shwasa , kapha dusti is found, and malarupa Kapha is produced from Rasa Dhatu Dusti . So we conclude that Rasa dhatu is involved in Tamaka Shwasa .   SROTAS & SROTODUSTI LAKSHANA: (1) Pranavaha Srotas : Ati Srusta / Ati Baddhah / Shabda / Sashulam / Abhikshna / Moha / Brahma (2) Udakavaha Srotas Jihvatalukantha Shosha (3) Annavaha Srotas : Anannabhilasha / Aaruchi / Avipaka / Chardi / Aadhmana (4) Rasavaha Srotas : Ashraddha / Aruchi / Mukhavairasya / Hrullasa , gaurava / Tandra / Jwara / Panduta 9/1/2021 98

99. SROTAS: The main seat of origin of Shwasa and Hikka Roga in Pranavaha srotas . In Samanya (general) pathogenesis of Shwasa roga , Chakrapanidatta has given the meaning of "SROTANSI" as prana and Udakavaha Srotas . Acharya Charaka has considered Prana , Udaka and Annavaha Srotas in Samprapti of Hikka and Shwasa are described to be originated from same causes, so Shwasa roga may also have the involvement of same Srotas . Acharya Sushruta has also shown the Dusti of same Srotas . According to Vaghbhata , Dusti of Annavaha Srotas along with Pranavaha and Udakavaha takes place. In this way we may conclude that Prana , Udaka , and Annavaha Srotas are affected in Shwasa roga . 9/1/2021 99

100. TYPES OF SROTODUSTI: Charaka has clearly mentioned in the Tamaka Shwasa vitiated Vayu mixed with Kapha and caused obstruction in Pranavaha Srotas . It leads to the movement of vata in various directions. Thus, there is sanga in Srotas , which leads vimarga gamana and Atipravritti of vata , Acharya Sushruta is also of the same opinion. 9/1/2021 100

101. UDABHAVA STHANA: Charaka has mentioned that TamakaShwasa is produced due to involvement of vata and Kapha and is originated in the seat of Pitta ( Pittasthana ). Chakrapani has opined that Adhoamasaya should be taken as Pittasthana ". Chakrapani while explaining Pittasthana Samudbhavam mentions that lower part of the stomach should be taken in this context. Vagbhata has given Amashya as the Udbhavasthana of Shwasa in place of Pittasthana   9/1/2021 101

102. ADHISTANA : In general pathogenesis of Shwasa roga , Charaka has given that when Vayu enters the Prana Vaha Srotas and gets vitiated, it aggravates the Kapha in Uraha and gives rise to five types of Hikka and Shwasa . The same has been described in Astanga Sangraha . Thus Uraha (Chest) is the adhistana of Tamak Shwasa . 9/1/2021 102

103. AGNI : Mandagni is the root of cause of all the disease. Due to various Nidanas like Aahara and vihara it affects on the Jatharagni as result Jatharagnimandya occurs which is said to be the initiator of all the pathogenesis in the body. While describing the common Nidana of Hikka and Shwasa , " Vishamashana " shows that the Agni become vishama ie . sometimes it increases, some times it decreases. Moreover the disease being the vata and Kapha predominant, sometime, Agni increases due to vata and gets decreased due to kapha . The same has been described by Sushruta ' Thus, Agni remains vishama in Tamaka Shwasa . 9/1/2021 103

104. AMA : Charaka has mentioned the " Ama Pradosha " as one of the etiological factors of Hikka and Shwasa . In Tamaka Shwasa , Agni remains vishama . The Ama is formed during mandagni . The Ama formed vitiates the Rasa Dhatu and the pathogenetic chain starts giving rise to Shwasa roga . 9/1/2021 104

105. CONCLUSION : The disease is predominantly caused by Pranavaha Sroto Dushti along with considerable involvement from anna vaha and udaka vaha srotas . Acharyas have given the list of nidanas which are Vata and Kapha prakopaka , sroto dushaka and also cause disturbances to agni . Few nidanarthakara rogas are also mentioned in which shwasa is found in later stages of that disease. Tamaka Shvasa is the Vyadhi of Krichra sadya & Yapya nature and has a tendency of recurrence whenever exposed to the Preraka Hetu . So the due response should be given to Nidana parivarjana in the treatment of Tamaka shwasa . 9/1/2021 105

106. Agni in its vikruta form being responsible for the production of aama holds a key factor in the Samprapti . Prakruti with Vata and Kapha dosha pradhanyata are more prone to Tamaka shwasa as the disease itself is Vata and Kapha pradhana . Pratiloma Vayu is responsible for shwasa krucchrata . The disease being Vata and Kapha pradhana , even the nidana and Samprapti can happen in two different mechanisms viz. Avarana-janya and Swanidana Prakopa janya . 9/1/2021 106

107. In the process of Avarana , Vata is in its normal state and Kapha is vitiated due to its own etiological factors, this vitiated Kapha causes the obstruction in the normal path of Vayu and vitiates the Vayu . This is Kapha pradhana Samprapti . In the second way of Samprapti , Vata is vitiated due to its own etiological factors and reaches the Urah Pradesha , gets obstructed by Kapha . This is Vata pradhana Samprapti . 9/1/2021 107

108. In both processes, vitiation of Vata and Kapha Dosha is a cyclic procedure that’s why Tamaka shwasa is a Vata - Kaphatmaka Vyadhi . In some conditions, when Vata and Kapha Prakopaka Hetus are equally dominant, a complex Samprapti involving both mechanisms can be seen and so is difficult for treatment. 9/1/2021 108

109. REFERENCES: Acharya Y T, editor, 2019, Ayurvedadipika Commentary of Sri Cakrapanidatta on Charaka Samhita of Agnivesha , Chikitsa sthana ; Hikkaswasachikitsa : chapter 17,. Varanasi: Chaukhamba orientalia , 2019; Acharya J T, editor, 2015, Nibandhasangraha Commentary of Sri Dalhanacharya on Sushrutha Samhita of Sushrutha Uttara Tantra : Swasa pratishedadyaya ; chapter 51 , Varanasi: Chaukhamba Sanskrit Sansthan , 2015, p116. Bhisagacharya HPV, editor, 2010, Sarvanga Sundari commentary of Arunadatta and Ayurveda rasayana commentary of Hemadri on Astanga hridayam of Vagbhata , Sutra sthana ; Swasahidma nidana ; chapter 4, Varanasi: Chaukhambha Sanskrit sansthan,2014. 9/1/2021 109

110. Sharma S, editor, 2019, Shashilekha commentary of Indu on Astanga sangraha of Vruddha Vagbhata , Nidana sthana ; Swasahikkanidana : chapter4, Varanasi:Chowkamba Sanskrit series office, 2019. Various articles related to Swasa roga . Google scholar. 9/1/2021 110

111. Disscussion 9/1/2021 111

112. THANKYOU 9/1/2021 112