Hikka and Shwasa Chikitsa According to Charaka: An Ayurvedic Perspective with Modern Correlation – a review article

Vol.01, Issue-05, November 2024

Author: Dr. Manish Singh Tomar, MD, PhD Ayurveda

Abstract

Hikka (hiccup) and Shwasa (dyspnea or asthma) are significant respiratory disorders described in the ancient Ayurvedic text Charaka Samhita. These conditions are attributed to the imbalance of Doshas, primarily Vata and Kapha, affecting the Pranavaha Srotas (respiratory channels). This article provides a comprehensive analysis of Hikka and Shwasa Chikitsa (treatment) as outlined by Acharya Charaka, correlating traditional Ayurvedic concepts with modern medical understanding of respiratory disorders such as hiccups, asthma, chronic obstructive pulmonary disease (COPD), and other dyspneic conditions. By exploring the etiology, pathogenesis, clinical features, and therapeutic approaches detailed in the Hikka Shwasa Chikitsa chapter, we aim to bridge the gap between ancient wisdom and contemporary medicine, offering insights into holistic management strategies.

Introduction

Respiratory disorders significantly impact the quality of life and can be life-threatening if not managed appropriately. In Ayurveda, the holistic system of medicine originating in India over 3,000 years ago, respiratory conditions are given considerable importance. Hikka (hiccup) and Shwasa (breathlessness) are two such disorders extensively discussed in the classical texts.

The Charaka Samhita, one of the foundational texts of Ayurveda attributed to Acharya Charaka, dedicates an entire chapter to the diagnosis and treatment of Hikka and Shwasa. These conditions are considered challenging due to their potential to cause rapid deterioration and even death if left untreated.

This article delves into the Ayurvedic understanding of Hikka and Shwasa as presented by Charaka, examining their relevance and correlation with modern respiratory medicine. By integrating classical Ayurvedic principles with contemporary medical knowledge, we aim to enhance understanding and promote integrative approaches to respiratory health.

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Understanding Hikka and Shwasa in Ayurveda

Hikka (Hiccup)

Definition

Hikka is described as a sudden, involuntary, and forceful contraction of the diaphragm and intercostal muscles, resulting in a characteristic sound due to the closure of the glottis. It is considered a Vata-Kapha disorder, primarily involving the Pranavaha Srotas (respiratory channels).

Types of Hikka

Charaka classifies Hikka into five types:

1. Mahahikka: The great hiccup, severe and life-threatening.
2. Gambhira Hikka: Deep hiccup originating from the abdomen.
3. Yapya Hikka (Vyapeta Hikka): Chronic hiccup that is difficult to cure but manageable.
4. Kshudra Hikka: Minor hiccup, mild and easily treatable.
5. Annaja Hikka: Hiccup caused by improper food intake.

Shwasa (Dyspnea/Breathlessness)

Definition

Shwasa refers to difficulty in breathing or breathlessness. It is considered a serious condition that can rapidly become fatal. Shwasa is also a Vata-Kapha disorder affecting the respiratory system.

Types of Shwasa

Charaka identifies five types of Shwasa:

1. Mahashwasa: Severe dyspnea, leading to imminent death.
2. Urdhva Shwasa: Upward breathing, indicating severe obstruction.
3. Chinna Shwasa: Interrupted breathing, with irregular breaths.
4. Tamaka Shwasa: Asthma, characterized by paroxysmal attacks.
5. Kshudra Shwasa: Mild dyspnea, manageable with treatment.

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Etiology (Nidana) of Hikka and Shwasa

Ayurvedic Perspective

The causative factors for Hikka and Shwasa are similar due to their shared pathogenesis involving Vata and Kapha Doshas.

Common Causes

1. Dietary Factors:
   • Intake of Cold and Heavy Foods: Consuming cold, oily, or heavy-to-digest foods increases Kapha.
   • Overeating: Excessive food intake leading to indigestion.
   • Consumption of Kapha-Vata Aggravating Substances: Legumes like black gram, excessive sweets, and cold drinks.
2. Lifestyle Factors:
   • Exposure to Cold Environment: Staying in cold places increases Kapha and Vata.
   • Suppression of Natural Urges: Especially suppressing the urge to breathe deeply or sneeze.
   • Excessive Physical Exertion: Overexertion depletes bodily strength and aggravates Vata.
3. Environmental Factors:
   • Exposure to Dust and Smoke: Irritants that affect the respiratory tract.
   • Inhalation of Dry or Cold Air: Aggravates Vata in the respiratory channels.
4. Psychological Factors:
   • Stress and Anxiety: Mental disturbances can imbalance Vata.

Specific Causes for Hikka

• Eating Dry and Rough Foods: Increases Vata.
• Eating Too Fast or Too Slow: Affects the normal functioning of the digestive system.
• Ingestion of Irritant Substances: Spices or substances causing throat irritation.

Specific Causes for Shwasa

• Excessive Physical Strain: Leading to depletion of Ojas (vital energy).
• Chronic Respiratory Diseases: Previous illnesses weakening the respiratory system.
• Allergens: Substances causing hypersensitivity reactions.

Sanskrit Reference:

• “Rajasā dhūmavātābhyāṁ śītasthānāmbusevanāt…” (Verses 11-16)

Modern Correlation

1. Hiccup (Singultus)
   • Causes:
     • Gastric distension due to overeating or carbonated drinks.
     • Sudden temperature changes in the stomach.
     • Irritation of the diaphragm or phrenic nerve.
     • Emotional stress.
2. Dyspnea and Asthma
   • Causes:
     • Asthma Triggers: Allergens, pollutants, exercise.
     • COPD Factors: Smoking, long-term exposure to irritants.
     • Infections: Respiratory infections causing airway inflammation.
     • Heart Conditions: Congestive heart failure leading to breathlessness.

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Pathogenesis (Samprapti) of Hikka and Shwasa

Ayurvedic Perspective

Dosha Involvement

• Vata Dosha: Predominantly responsible due to its movement property.
• Kapha Dosha: Causes obstruction in the channels (Srotas), leading to Vata aggravation.

Pathogenesis Sequence

1. Aggravation of Vata and Kapha Doshas: Due to etiological factors.
2. Obstruction of Pranavaha Srotas: Kapha blocks the respiratory channels.
3. Vata Prakopa: Vata becomes aggravated due to obstruction.
4. Manifestation of Symptoms: Hikka or Shwasa symptoms appear based on the severity and location of the Dosha imbalance.

Sanskrit Reference:

• “Mārutaḥ prāṇavāhīni srotāṁsyāviśya kupyati, uraḥsthaḥ kaphamuddhūya hikkāśvāsān karoti saḥ.” (Verse 17)

Modern Correlation

1. Hiccup Pathophysiology
   • Involuntary contractions of the diaphragm and intercostal muscles.
   • Irritation of the phrenic or vagus nerves.
   • Central nervous system triggers.
2. Asthma and Dyspnea Pathophysiology
   • Airway Inflammation: Due to allergens or irritants.
   • Bronchoconstriction: Narrowing of airways causing breathlessness.
   • Airway Hyperresponsiveness: Exaggerated response to stimuli.
   • Obstruction of Airflow: Mucus plugs and swelling obstruct air passages.

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Clinical Features (Lakshana) of Hikka and Shwasa

Hikka (Hiccup)

Mahahikka (Severe Hiccup)

• Forceful Hiccups: Strong and frequent contractions.
• Loss of Consciousness: Due to severe distress.
• Body Stiffness: Rigidity of limbs.
• Difficulty in Speech: Impaired verbal communication.
• Sanskrit Reference: “Mahāmūlā mahāvegā mahāśabdā mahābalā, mahāhikketi sā nṝṇāṁ sadyaḥ prāṇaharā matā.” (Verse 26)

Gambhira Hikka (Deep Hiccup)

• Originates from Abdomen: Deep-seated hiccup.
• Severe Pain: In the chest and abdomen.
• Disturbance in Vital Functions: Obstruction of breath and food pathways.

Vyapeta Hikka (Chronic Hiccup)

• Intermittent Hiccups: Occurs in episodes.
• Associated Symptoms: Diarrhea, thirst, delirium.
• Difficulty in Swallowing: Obstruction in the throat.

Kshudra Hikka (Minor Hiccup)

• Mild Symptoms: Less distressing.
• Easily Treatable: Responds well to simple interventions.
• Sanskrit Reference: “Mr̥dvī sā kṣudrahikkēti nṝṇāṁ sādhyā prakīrtitā.” (Verse 37)

Annaja Hikka (Food-induced Hiccup)

• After Eating or Drinking: Hiccups occur post ingestion.
• Relieved by Food: Eating or drinking alleviates symptoms.

Shwasa (Dyspnea)

Mahashwasa (Severe Dyspnea)

• Loud Breathing: Audible from a distance.
• Loss of Sensory Functions: Impaired consciousness.
• Cyanosis: Bluish discoloration due to hypoxia.
• Imminent Death: Rapid deterioration.

Sanskrit Reference: “Mahāśvāsōpasr̥ṣṭaḥ sa kṣipramēva vipadyatē.” (Verse 48)

Urdhva Shwasa (Upward Breath)

• Breathing Only Upwards: Inability to exhale properly.
• Severe Obstruction: Blockage in the lower respiratory tract.
• Restlessness: Due to air hunger.

Chinna Shwasa (Interrupted Breath)

• Irregular Breathing: Gasping or interrupted breaths.
• Associated with Pain: Severe chest discomfort.

Tamaka Shwasa (Asthma)

• Paroxysmal Attacks: Sudden onset of breathlessness.
• Wheezing Sound: Due to airway obstruction.
• Relieved in Sitting Position: Difficulty in lying down.
• Sanskrit Reference: “Tamakaśvāsaḥ.” (Verses 62)

Kshudra Shwasa (Mild Dyspnea)

• Mild Symptoms: Less severe breathlessness.
• Manageable: Responds to treatment.

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Diagnosis

Ayurvedic Approach

1. Clinical Examination (Rogi Pariksha)
   • Inspection (Darshana): Observing breathing patterns, sound, posture.
   • Palpation (Sparshana): Feeling for chest vibrations.
   • Questioning (Prashna): Inquiring about onset, duration, triggers.
2. Assessment of Doshas
   • Determining the predominant Dosha involved based on symptoms.
3. Examination of Srotas
   • Checking for obstruction in Pranavaha Srotas.

Modern Diagnostic Methods

1. Medical History and Physical Examination
   • Assessing symptoms, triggers, and medical history.
   • Observing respiratory rate, effort, and auscultation for wheezing.
2. Pulmonary Function Tests
   • Spirometry: Measuring lung volumes and airflow.
   • Peak Flow Meter: Monitoring peak expiratory flow rate.
3. Imaging Studies
   • Chest X-ray: Identifying structural abnormalities.
   • CT Scan: Detailed imaging for complex cases.
4. Laboratory Tests
   • Arterial Blood Gas Analysis: Assessing oxygenation and ventilation.
   • Complete Blood Count: Identifying infections or anemia.
5. Electrocardiogram (ECG)
   • To rule out cardiac causes of dyspnea.
6. Allergy Testing
   • Identifying specific allergens in asthma.

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Prognosis (Sadhya-Asadhya) of Hikka and Shwasa

Ayurvedic Perspective

• Curable (Sadhya): Kshudra Hikka and Kshudra Shwasa, mild cases with manageable symptoms.
• Manageable (Yapya): Vyapeta Hikka and Tamaka Shwasa, chronic but controllable with treatment.
• Incurable (Asadhya): Mahahikka and Mahashwasa, severe cases with poor prognosis.

Sanskrit Reference: “Ubhayōḥ pūrvarūpāṇi śr̥ṇu vakṣyāmyataḥ param.” (Verse 18)

Modern Correlation

• Good Prognosis: Mild asthma or hiccups responding to treatment.
• Chronic Conditions: Asthma requiring long-term management.
• Poor Prognosis: Severe COPD, status asthmaticus, or persistent hiccups due to serious underlying conditions.

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Treatment (Chikitsa) of Hikka and Shwasa

Ayurvedic Principles

1. Shodhana (Purification Therapies)
   • Vamana (Emesis): To eliminate aggravated Kapha.
   • Virechana (Purgation): Clearing Pitta and Kapha from the body.
   • Niruha Basti (Decoction Enema): To pacify Vata.
2. Shamana (Palliative Therapies)
   • Herbal Formulations: Using specific herbs to balance Doshas.
   • Rasayana (Rejuvenation): Strengthening the respiratory system.
3. Svedana (Sudation Therapy)
   • Fomentation: Applying heat to liquefy Kapha and relieve Vata.
4. Ahara (Dietary Management)
   • Light and Warm Foods: To reduce Kapha and Vata.
   • Avoiding Cold and Heavy Foods: Preventing aggravation of Doshas.
5. Vihara (Lifestyle Modifications)
   • Avoiding Exposure to Cold and Irritants: Reducing triggers.
   • Breathing Exercises: Pranayama to strengthen respiratory function.

Specific Ayurvedic Treatments

Svedana (Sudation Therapy)

• Procedure: Application of heat to the chest and throat using medicated oils and decoctions.
• Benefits: Liquefies Kapha, facilitates its expulsion, and relieves Vata-induced spasms.

Sanskrit Reference: “Hikkāśvāsārditaṁ snigdhair ādau svedair upācaret.” (Verse 71)

Vamana (Emesis Therapy)

• Indications: For patients with strong Kapha involvement.
• Medications Used: Pippali (long pepper), Saindhava (rock salt), honey.

Sanskrit Reference: “Vamanaṁ pāyayet tu tam, pippalīsaindhavakṣaudrair yuktaṁ vātāvirodhi yat.” (Verse 75)

Herbal Formulations

1. Dashamoola Decoction
   • Ingredients: Roots of ten herbs including Bilva, Agnimantha, Shyonaka.
   • Benefits: Balances Vata and Kapha, acts as an expectorant.
2. Pippali (Long Pepper)
   • Usage: As a powder or in formulations to relieve bronchospasm.
3. Haridra (Turmeric)
   • Benefits: Anti-inflammatory and antioxidant properties.

Dietary Recommendations

• Warm Soups and Decoctions: Prepared from pulses like horse gram (Kulatha) and spices like ginger.
• Avoidance of Cold Foods: Such as ice creams, cold drinks.

Sanskrit Reference: “Svinnam jñātvā tatastūrṇaṁ bhojayet snigdha modanam.” (Verse 74)

Lifestyle Modifications

• Avoidance of Triggers: Dust, smoke, allergens.
• Breathing Exercises: To improve lung capacity.

Modern Correlation

1. Hiccup Management
   • Treating Underlying Causes: Gastroesophageal reflux, infections.
   • Pharmacotherapy: Chlorpromazine, metoclopramide for persistent hiccups.
   • Non-Pharmacological Methods: Breath-holding, stimulating the vagus nerve.
2. Asthma Management
   • Bronchodilators: Short-acting beta-agonists for immediate relief.
   • Inhaled Corticosteroids: For long-term control.
   • Avoidance of Triggers: Allergen control measures.
3. COPD Management
   • Smoking Cessation: Essential for slowing disease progression.
   • Pulmonary Rehabilitation: Exercise training, nutrition counseling.
   • Oxygen Therapy: In advanced stages.
4. Emergency Management
   • Acute Asthma Attacks: Nebulized bronchodilators, systemic steroids.
   • Mechanical Ventilation: In cases of respiratory failure.

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Discussion

The Ayurvedic descriptions of Hikka and Shwasa correspond closely with modern medical understanding of hiccups, asthma, and dyspnea. The classification into various types based on severity and symptomatology allows for tailored therapeutic approaches.

Key Correlations:

• Mahahikka and Mahashwasa: Represent severe, life-threatening conditions similar to status asthmaticus or persistent hiccups due to central nervous system disorders.
• Tamaka Shwasa: Clearly correlates with bronchial asthma, including features like episodic attacks, wheezing, and relief in upright position.
• Kshudra Hikka and Kshudra Shwasa: Correspond to minor hiccups and mild dyspnea, respectively.

Ayurvedic Treatment Principles:

• Holistic Approach: Emphasizes balancing the Doshas, removing obstructions, and strengthening the respiratory system.
• Use of Herbs and Diet: Natural remedies with anti-inflammatory, bronchodilatory, and expectorant properties.
• Preventive Measures: Avoidance of known triggers, promoting a healthy lifestyle.

Modern Medicine:

• Targeted Therapies: Use of specific medications to relieve bronchospasm, reduce inflammation.
• Symptomatic Relief: Addressing immediate symptoms to prevent complications.
• Chronic Management: Long-term medications and lifestyle changes to control symptoms.

Integrative Potential:

• Complementary Use of Herbs: Certain Ayurvedic herbs like turmeric (Haridra) and ginger (Shunthi) have scientifically proven benefits.
• Lifestyle Modifications: Yoga and breathing exercises can improve respiratory function.
• Dietary Advice: Aligns with modern recommendations to avoid irritant foods.

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Conclusion

The management of Hikka and Shwasa as outlined by Charaka provides valuable insights into treating respiratory disorders holistically. The emphasis on understanding the underlying Dosha imbalance, combined with specific therapeutic interventions, offers a comprehensive approach.

Correlating Ayurvedic concepts with modern medical understanding reveals significant overlaps, particularly in recognizing the multifactorial nature of respiratory conditions. Integrative approaches that combine the strengths of both traditional and contemporary medicine can enhance patient outcomes.

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References

1. Charaka Samhita, Chikitsa Sthana, Chapter 17: Hikka Shwasa Chikitsa.
2. Sharma, P. V. (1981). Charaka Samhita: Text with English Translation. Chaukhambha Orientalia.
3. Lad, V. (2002). Textbook of Ayurveda. Ayurvedic Press.
4. Global Initiative for Asthma (GINA). (2021). Global Strategy for Asthma Management and Prevention.
5. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). Global Strategy for the Diagnosis, Management, and Prevention of COPD.
6. National Heart, Lung, and Blood Institute (NHLBI). (2020). Asthma.
7. Barnes, P. J. (2008). Immunology of asthma and chronic obstructive pulmonary disease. Nature Reviews Immunology, 8(3), 183-192.
8. Sharma, R. K., & Dash, B. (2007). Caraka Samhita: Text with English Translation and Critical Exposition Based on Cakrapani Datta’s Ayurveda Dipika. Chaukhambha Sanskrit Series Office.