Shwasa-roga Series-6 : Approach to Oordhwa-chhinna-shwasa by Professor S. N. Ojha

dīrghaṁ śvasiti means Prolonged expiration which is observed in following diseases Asthma, Bronchietasis, Bronchitis, Collapse, COPD, Emphysema, Epiglottitis, Fibrosis, Foreign body, Good Pasture syndrome, Lung cancer, Meconium aspiration syndrome, Pneumoconiosis, Pneumonia, Pneumonia, eosinophilic, Rostan asthma, Sarcoidosis, Tuberculosis.

Airflow limitation during the expiratory phase in airway obstructive disease (ślēṣma āvr̥ta mukhasrōtāḥ) causes prolonged expiration, which is one of the hallmarks of COPD.

Acute respiratory acidosis occurs when an abrupt failure of ventilation occurs. This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, inability to ventilate adequately due to neuromuscular disease (e.g., myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation.

Thoracic examination of patients with obstructive lung disease may demonstrate diffuse wheezing, hyperinflation (i.e., barrel chest), decreased breath sounds, hyperresonance on percussion, and prolonged expiration. Rhonchi may also be heard.

Charakokta Chinnaśvāsa is an abnormal breathing pattern progressively deeper and sometimes faster breathing (shwasiti vicchina) followed by a gradual decrease (parikṣīṇaḥ śvasan) that result in a temporary stop in breathing called as apnea (na wa shwasiti). The pattern repeats (kshanaantena shwasiti) with each cycle usually taking 30 seconds to 2 minutes. It is the oscillation of ventilation between apnea and hyperpnea with a crescendo- diminuendo pattern.

The above explanation resembles Cheyne –Stokes respiration which involves apnea (since apnea is the prominent feature) while periodic breathing involves hypopnea (abnormally short but not absent breaths) the same explained by the words shwasiti vicchinna. It may be caused by damage to respiratory centers or by physiological abnormalities in chronic heart failure and is also seen in newborns with immature respiratory systems and in visitors new to high altitudes. Other condition may include strokes, hyponatremia, traumatic brain injuries and brain tumours. It can occur in all forms of toxic metabolic encephalopathy. It is a symptom of carbon monoxide poisoning alongwith syncope and coma. Hospices sometimes document the presence of Cheyne – Stokes breathing as a patient near deaths. (en.wikipedia.org/wiki/Cheyne-Stokes_respiration)

Biot’s respiration is another abnormal pattern of breathing characterized by groups of quick, shallow inspirations (parikṣīṇaḥ śvasan) followed by regular or irregular periods of apnea. It is caused by damage to pons due to strokes or trauma or by pressure on the pons due to uncal or tentorial herniation. It can also be caused by opiod use. (en.wikipedia.org/wiki/Biots%27s_respiration)

Ataxic respiration is an abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea. It is cause by damage to the medulla oblongata due to stokes and trauma. It generally indicates a poor prognosis and usually progresses to complete apnea. (en.wikipedia.org/wiki/Ataxic_respiration)

Dahyamānēna bastinā explains burning sensation which may be caused due to reduced urine output as Chakrapani says bastinirodh iti mutranirodh. Reduce urine output is due to reduce renal blood flow caused due to reduced cardiac output.

Raktaikalōcanaḥ symptom is caused due to vyadhi prabhava as per Chakrapani. It is also a symptom of hypertension which may occur due to COPD and other cardio-pulmonary disorders.

*************************************************************

Prof. Satyendra Narayan Ojha

MD PhD

(Kayachikitsa)
Director,

Yashwant Ayu. College & P.G.Training & Research Center,

Kodoli, Kolhapur, Maharashtra, India.

Mobile No.- +91 9822177155

email: drsnojha@rediffmail.com

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