DD Series: An effort to Analyse & Differentiate the types of 'Shwas-roga'.

 An effort to Analyse & Differentiate the types of  'Shwas-roga'

Sr. No	BHEDAKATVA	MAHA SHWAS	URDHVA SHWAS	CHINNA SHWAS	TAMAK SHWAS			KSUDHRA SHWAS
1	VYADHITVA	Independent Disease mentioned in Brihattrayi
2	NIDANA	रजसा धूमवाताभ्यां शीतस्थानाम्बुसेवनात्| व्यायामाद्ग्राम्यधर्माध्वरूक्षान्नविषमाशनात्||आमप्रदोषादानाहाद्रौक्ष्यादत्यपतर्पणात्|दौर्बल्यान्मर्मणो घाताद्द्वन्द्वाच्छुद्ध्यतियोगतः|| अतीसारज्वरच्छर्दिप्रतिश्यायक्षतक्षयात्|रक्तपित्तादुदावर्ताद्विसूच्यलसकादपि||पाण्डुरोगाद्विषाच्चैव प्रवर्तेते गदाविमौ|निष्पावमाषपिण्याकतिलतैलनिषेवणात्|| पिष्टशालूकविष्टम्भिविदाहिगुरुभोजनात्|जलजानूपपिशितदध्यामक्षीरसेवनात्||अभिष्यन्द्युपचाराच्च श्लेष्मलानां च सेवनात्|कण्ठोरसः प्रतीघाताद्विबन्धैश्च पृथग्विधैः [CH.CHI.17/11-15]
3	TYPES	None			2 -Pratamak and Santamak			None
4	DOSHA	Vata Pradhan Tridosha	Kapha Pradhan Tridosha	Pitta Pradhan tridosha	VataKapha Pradhan Tridosha			Vata
5	DUSHYA	Rasadi Sapta dhatu dushti	Rasadi Sapta dhatu dushti	Rasadi Sapta dhatu dushti	Rasa,Rakta onwards			Rasa
6	AGNI	Atimanda	Atimanda	AtiManda	Vishamagni/Mandaagni			Manda and vishamagni
7	SROTAS	Pranavaha Udakavaha Annavaha and onward	Pranavaha Udakavaha and onward	Pranavaha Udakavaha and onward	Pranavaha Rasavaha			Rasavaha,  Annavah Purishavah
8	SROTODUSHTI PRAKAR	Sanga	Vimargamana	Vimargamana	Sanga			Sanga
9	ROGAMARGA	Marma asthi sandhi & Kostha	Marma asthi sandhi & Kostha	Marma asthi sandhi & Kostha	Kostha			Kostha
10	ADHISTHANA	Sharir & Mana	Sharir & Mana	Sharir & Mana	Sharir			Sharir
11	VYAKTI STHANA	Uraha (Phuphusa) with Hridaya & Shira involvement	Uraha (Phuphusa) with Hridaya & Shira involvement	Uraha (Phuphusa) with Hriday Basti & Shira involvement	Uraha (Phuphusa) with Hridaya & Shira involvement			Kostha
12	ASHAYA	Amashaya	Amashaya	Amashaya	Amashaya			Amashaya
13	RESPIRATORY RHYTHM	Stridor-high pitched breath sound due to turbulent airflow in larynx or lower in bronchial tree     उच्चैः श्वसिति संरुद्धो मत्तर्षभ इवानिशम् Like a bull, deep forceful gasping	Wheezing- Characterized by prolonged expiration through an obstructed lower airway, bronchi, bronchioles etc.   दीर्घं श्वसिति यस्तूर्ध्वं न च प्रत्याहरत्यधः| श्लेष्मावृतमुखस्रोताः क्रुद्धगन्धवहार्दितः|| ऊर्ध्वश्वासे प्रकुपिते ह्यधःश्वासो निरुध्यते| Patient struggles to pull air in but cannot release it	Cheyne-Stokes respiration -Consists of rhythmical alteration of apnea & hyperpnea due to anoxemia   यस्तु श्वसिति विच्छिन्नं सर्वप्राणेन पीडितः|	Wheezing                  तेन रुद्धो घुर्घुरुकं तथा| अतीव तीव्रवेगं च श्वासं प्राणप्रपीडकम्||			Exertional dyspnea or Mild tachypnea          न सोऽत्यर्थं दुःखेनाङ्गप्रबाधकः|| हिनस्ति न स गात्राणि न च दुःखो यथेतरे|
14	POSSIBLE CORRELATION WITH CONTEMPORARY SCIENCE	Choanal stenosis, Vocal Cord Palsy, Laryngomalacia, Peritonsillar Abscess, Laryngeal tumor, Hemangioma, Massive hemorrhage, Advanced neurological disorder with presentation of Ardita.	Atelectasis , Bronchiectasis , Lung fibrosis & collapse,Emphysema , Lung cancer, Pneumonia , Pneumoconiosis.	Congestive Heart Failure, Brain stem injury, Stroke, Narcotic poisoning, Uremia, Diabetic Ketoacidosis.	Bronchial Asthma, Chronic & Acute Bronchitis, COPD.			Over eating, heavy exercise, Obstruction of flatus (flatulence}
15	SIGN	विभ्रान्तलोचनः ,विकृताक्ष्याननो  , विशीर्णवाक् दीनः प्रश्वसितं चास्य दूराद्विज्ञायते भृशम्|	ऊर्ध्वदृष्टिर्विपश्यंश्च विभ्रान्ताक्ष इतस्ततः| प्रमुह्यन् वेदनार्तश्च शुष्कास्योऽरतिपीडितः|	विप्लुताक्षः परिक्षीणः श्वसन् रक्तैकलोचनः| विचेताः परिशुष्कास्यो विवर्णः प्रलपन्नरः||	उच्छ्रिताक्षो ललाटेन स्विद्यता भृशमर्तिमान्| विशुष्कास्यो मुहुः श्वासो मुहुश्चैवावधम्यते||			हिनस्ति न स गात्राणि न च दुःखो यथेतरे| न च भोजनपानानां निरुणद्ध्युचितां गतिम्||
16	PAIN INTENSITY	-	वेदनार्तश्च शुष्कास्योऽरतिपीडितः	न वा श्वसिति दुःखार्तो मर्मच्छेदरुगर्दितः|	पार्श्वे तस्यावगृह्णाति शयानस्य समीरणः|			पार्श्वे तस्यावगृह्णाति शयानस्य समीरणः|
17	COGNITIVE FUNCTIONS	Being terminal condition loss of intellectual integrity, Perceptual and visual disturbances occurs and at final stage patient loses all connection to external world eventually slipping into Syncope, Comatose or death			Not impaired			Not impaired
18	WEIGHT LOSS	Significant weight loss due to dhatu kshaya			May or may not be Depends on kala,Avastha & vaya of patient			-
19	SANGYA (LEVEL OF CONSCIOUSNESS)	प्रनष्टज्ञानविज्ञान Unconscious	प्रमुह्यन्  Clouded/ Disturbed / Confusion	विचेताः  Fluctuating due to pain [Periodic fainting]	प्रताम्यत्यतिवेगाच्च कासते सन्निरुध्यते| प्रमोहं कासमानश्च स गच्छति मुहुर्मुहुः|| Alert but feels darkness & restlessness paroxysmal.			नेन्द्रियाणां व्यथां नापि  काञ्चिदापादयेद्रुजम्| No mental or sensory  impairment
20	MALA MUTRA STHITI	बद्धमूत्रवर्चा Total autonomic nervous system failure	Not mentioned but it is to be understood that being possible involvement of Trimarma it would be disturbed, abrupt or impaired	आनाहस्वेदमूर्च्छार्तो दह्यमानेन बस्तिना| Burning micturition because directly marma [basti] is affected	Not mentioned but it may be as per condition of pratiloma vayu or condition of kostha.			न च भोजनपानानां  निरुणद्ध्युचितां गतिम्||
21	VYADHI-SWABHAV	Ashukari [fatal]	Ashukari [fatal]	Ashukari [fatal]	Chirkari [Chronic]			Ashukari[Transient]
22	SADHYASADHYATA	Asadhya	Asadhya	Asadhya	Yapya Sadhya [Nava Shwas]			Sadhya
23	OJA-AFFECTION	Result of Ojas dushti			May/may not be as per severity/chronicity of patient.			Not affected
24	SAMA/NIRAMA	Being terminal condition it may be considered as excessive Sama or excessive saamta, Dhatukshaya at level of trimarma			SAMA			SAMA
25	CHIKITSA	Asadhya, hence not indicated any thing.			हिक्काश्वासार्दितं स्निग्धैरादौ स्वेदैरुपाचरेत्| आक्तं लवणतैलेन नाडीप्रस्तरसङ्करैः|| तैरस्य ग्रथितः श्लेष्मा स्रोतःस्वभिविलीयते| खानि मार्दवमायान्ति ततो वातानुलोमता|| कासिने च्छर्दनं दद्यात् स्वरभङ्गे च बुद्धिमान्| वातश्लेष्महरैर्युक्तं तमके तु विरेचनम्|| उदीर्यते भृशतरं मार्गरोधाद्वहज्जलम्| यथा तथाऽनिलस्तस्य मार्गं नित्यं विशोधयेत्||			Deepan, Pachan &Vata anulomana.
26	UPSHAYA/ANUPSHAYA	Not mentioned as being terminal condition.				यत्किञ्चित् कफवातघ्नमुष्णं वातानुलोमनम्| भेषजं पानमत्रं वा तद्धितं श्वासहिक्किने|| वातकृद्वा कफहरं कफकृद्वाऽनिलापहम्| कार्यं नैकान्तिकं ताभ्यां प्रायः श्रेयोऽनिलापहम्|| सर्वेषां बृंहणे ह्यल्पः शक्यश्च प्रायशो भवेत् |नात्यर्थंशमनेऽपायो भृशोऽशक्यश्च कर्शने|| Upshaya-आसीनो लभते सौख्यमुष्णं चैवाभिनन्दति|| Anupshaya-मेघाम्बुशीतप्राग्वातैः श्लेष्मलैश्चाभिवर्धते|		Dipan, Pachan & Anuloman
27	PATHYA/APATHYA	Not mentioned as being terminal condition					Pathya - योजयेदन्नपानानि ससर्पिर्बिडहिङ्गुभिः| Apathya-निष्पावमाषपिण्याकतिलतैलनिषेवणात्||     पिष्टशालूकविष्टम्भिविदाहिगुरुभोजनात्| जलजानूपपिशितदध्यामक्षीरसेवनात्||

 

Conclusions

1] The concept of the five types of Shwasa Roga is a unique in Charaka Samhita because nomenclature of 5 types of shwasa roga excludes the doshaja pattern like vatika, pattika, shlaishmika etc. therefore, the term 'Sannipata' has not been used, even though the conditions certainly involve multiple doshas, dushyas etc. The specific nomenclature in shwasa roga and its background description suggests that Maha, Urdhwa and Chinna variants are categorised as advance, severe & terminal stages of almost all kind of pathogenesis including Nidan-arthakara rogas as  mentioned.

अन्यैरप्युपसृष्टस्य रोगैर्जन्तोः पृथग्विधैः|

अन्ते सञ्जायते हिक्का श्वासो वा तीव्रवेदनः||

[Cha.Chi.17/7]

2] So, We can say that all types of 'Sannipat'-manifestations in various other disorders always terminate in form of maha/urdhwa/chinna shwas.

3] The description of Nidan-arthakara Roga is accounted maximum in description of nidan of shwas roga. In Ayurveda, the progression of disease is described from Koshtha-Shakha and up to deeper levels such as Marma, Asthi, and Sandhi, which can be correlated with the involvement of vital functions in modern science.

4] The five types of Shwasa Roga should not be directly correlated with various pulmonary pathologies, including COPD etc. Out of the five types—Maha, Urdhva, Chinna, Tamaka, and Kshudra—three types (Maha, Urdhva, and Chinna) are considered terminal conditions and this is the reason that any kind of management is not instructed. They appear as severe clinical manifestations that occur prior to death and originate due to various underlying progressively worsening etiologies in the form of multi-organ failure or similar conditions.

5] Tamaka Shwasa is an exclusive pulmonary pathology among the five types of Shwas-roga, and its variant Pratamak Shwas is closer to advanced condition of status asthamaticus while Santamaka Shwasa is closer to a condition like GERD, with a predominance of Pitta.

6] Kshudra Shwasa is basically related to initial gastrointestinal pathology, where dyspnea appears as a  symptom due to the mechanism of Pratiloma Vata. If this condition is not properly managed or treated, there is a possibility of the development of other Pranavaha Srotas etc  disorders, as mentioned in 'Charaka Chikitsa Sthana Chapter 26'.

7] On careful observation of the classical texts, it can be concluded that Maha Shwasa, Urdhva Shwasa, and Chinna Shwasa are conditions that are closer to the three causes of death.

Maha Shwasa → resembles a state similar to coma

Urdhva Shwasa → resembles asphyxia

Chinna Shwasa → resembles syncope

8] Various pulmonary pathologies described in contemporary science may show similarities, but direct correlation doesn't seem possible practically as well as clinically in these five types of the 'Swasaroga'. 'Yakshma', 'Kshataksheena', 'Urah-kshata', 'Kasa' etc are other chapters in Charak -samhita' that deals with pulmonary pathogenesis.

9] The concept of 'Uttana and Gambhira' (Vatashonit) or 'Abhyantar-Bahya' or 'Antarmargi/ vegi-Bahirmargi/vegi' (Jwar, Visarp) in the description of various disease pathogenesis is based on the involvement of Pranvah srotasa and Hrid-Marma too along with 'Dhatugatatva' pattern of progress of the disease, So the students are advised that Shwaskrichchata or Dyspnea sign must be evaluated clinically that whether it is concerned to Koshtha only or Shakha-Dushti or deepest Marma Pathology. 

If we look at the 'Purvaroopas' of Shwasa-roga carefully, we find that majority of signs & symptoms are concerned to Mahasrotas(G.I.T.) and that to be understood that Mahasrotas is one of the Moolasthan of Pranvah-srotas along with Hridaya(Heart). This must be remembered that Acharya Charak didn't described any 'Purvaroopa' of Hridaya-roga(Ch.Su.-17, Ch.Chi.-26 & Ch.Si.-9) and Shwas-roga Purvaroopa may be considered as Purvaroopa of Heart diseases too being similar Moola-sthan.

10] Even though the management of Sannipatika Variants of diseases has been instructed widely and precisely, but Maha, Urdhwa and Chinna variants of Shwasa roga has  been heralded as Not treatable.

11] So we can conclude that these 3 types are terminal conditions that usually lead to death. In other words all kind of Sannipata terminate in these 3 types of variants, That’s why these 3 types are closure to 3 causes of death as tabulated above.

 

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The above analysis is based on the 'Swas-roga-series' available on this Blog, and this is the great contribution to subject Kayachikisa by late Prof. Satyendra Narayan Ojha Sir. We pay our sincere gratitude to him.

Important 'Swas-roga-series' Link given below-

 1. https://kayachikitsagau.blogspot.com/2016/11/shwasa-roga-series-6-approach-to.html

2. https://kayachikitsagau.blogspot.com/2016/10/approach-to-mahashwasa-by-professor-s-n.html

3. https://kayachikitsagau.blogspot.com/2016/11/approach-to-santamak-pratamak-shwasa.html

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Presented by

Dr.Vaishali Lalwani

BAMS

MD 2nd year scholar 

PG Dept. of Kayachikitsa

Government Akhandanad Ayurved College, Bhadra, Ahmedabad, Gujarat, India.

Email: vaishalilalwani93137@gmail.com

Guided by 

Prof. Surendra A. Soni

MD,PhD [Kayachikitsa]

H.O.D.

P.G. Dept. of Kayachikitsa

Government Akhandanad Ayurved College, Bhadra, Ahmedabad, Gujarat, India

email: kayachikitsagau@gmail.com