An effort to Analyse & Differentiate the types of 'Kasa-Roga'.

An effort to Analyse & Differentiate the types of 'Kasa-Roga'

Sr. No

Bhedakatva

Vataja Kasa

Pittaja Kasa

Kaphaja Kasa

Kshataja Kasa

Kshayaja Kasa

1

Vyadhitva

Independent Disease mentioned in Brihat-trayi.

2

Nirukti

कसति शिर:कंठादुर्ध्व गच्छति वायूरीतिकास: [माधव निदान कास निदान - आतङ्कदर्पण व्याख्या (वाचस्पति वैद्य कृत)]

3

Purvarupa

पूर्वरूपं भवेत्तेषां शूकपूर्णगलास्यता| कण्ठे कण्डूश्च भोज्यानामवरोधश्च जायते (Ch.Chi.18/5) भविष्यतस्तस्य तु कण्ठकण्डूर्भोज्योपरोधो गलतालुलेपः | स्वशब्दवैषम्यमरोचकोऽग्निसादश्च लिङ्गानि भवन्त्यमूनि (SU.U.52/7)

4

Vishesh Nidana

रूक्षशीतकषायाल्पप्रमितानशनं स्त्रियः|वेग धारणमायासो वातकासप्रवर्तकाः || (Ch.Chi.18/10)

कटुकोष्णविदाह्यम्लक्षाराणामतिसेवनम्|पित्तकासकरं क्रोधः सन्तापश्चाग्निसूर्यजः||(Ch.Chi.18/14)

गुर्वभिष्यन्दिमधुरस्निग्धस्वप्नाविचेष्टनैः|वृद्धः श्लेष्माऽनिलं रुद्ध्वा कफकासं करोति हि||(Ch.Chi.18/17)

अतिव्यवायभाराध्वयुद्धाश्वगजविग्रहैः| रूक्षस्यो रः क्षतं वायुर्गृहीत्वा कासमावहेत्|| (Ch.Chi.18/20)

विषमासात्म्य… नॄणां व्यापन्नेऽग्नौ त्रयो मलाः||कुपिताः क्षयजं कासं कुर्युर्देहक्षयप्रदम्|(Ch.Chi.18/24)

5.

Dosha

Vata (Prana-Udana vikruti) (chay/achay purvaka Dosha prakopa)

Pitta(chay/achay purvaka Dosha prakopa)

Kapha(chaya purvaka Dosha prakopa)

Vata,Pitta,Rakta (Achay purvaka Dosha prakopa)

Vata Pradhan Tridosha (chay purvaka Dosha prakopa)

6

Dushya

Rasa

Rasa

Rasa

Rasa, Rakta

Initially Rasa, Rakta, gradually up to the level of Sarva Dhatu.

7

Agni

Manda/ Visham

Sama/ Tikshna

Manda

Vishama/ Manda

Manda/ Vishama

8

Srotas

Pranavaha Annavaha Annavaha and onward

Pranavaha Annavaha

Pranavaha Annavaha Rasavaha

Initially Rasavaha , Rakta vaha, Pranavaha Paschat sarva Srotas

Rasavaha Raktadi srotas, Pranavaha, Manovaha

Reviewing Symptomatology of Various Kasa, Involvement of other Srotasas may Be there as per Symptomatology highlighted, like Purishavaha Srotas, Swedavaha Srotas, Mamsavaha Srotas. तेषां प्रकोपात् स्थानस्थाश्चैव मार्गगाश्च शरीरधातवःप्रकोपमापद्यन्ते, इतरेषां प्रकोपादितराणि च| (Ch.Vi 5/9)

9

Srotodushti Prakar

Sanga, Vimargamana

Sanga Vimargagamana

Sanga, Vimargagamana

Atipravrutti, Vimargagaman, Siragranthi

Sanga, Vimargagaman

10

Rogamarga

Kostha

Kostha

Kostha

Shakha

Shakha

11

Adhisthana

Sharir

Sharir

Sharir

Sharir

Sharir & Manas

12

Vyakti Sthana

Uraha

Uraha

Uraha

Uraha, Sarva Sharira

Uraha,Parshva, Sarva Sharira

13

Ashaya

Amashaya

Amashaya

Amashaya

Amashaya

Ama-Pakwashay

14

Samprapti

अधःप्रतिहतो वायु…कसनात्कास उच्यते||(Ch.Chi.18/6-8)

पित्तजेऽप्यस्मिञ् श्लेष्मनिष्ठीवनं व्याधेरुरःप्रभृतिकफस्थानभूतत्वेन श्लेष्मपित्तसंसर्गजतयेति ज्ञेयम् (Chakra. On Ch.Chi 18/14-16)

वृद्धः श्लेष्माऽनिलं रुद्ध्वा कफकासं करोति हि || (Ch.Chi.18/17)

रूक्षस्योरः क्षतं वायुर्गृहीत्वा कासमावहेत्|| (Ch.Chi.18/20)

व्यापन्नेऽग्नौ त्रयो मलाः|कुपिताः क्षयजं कासं कुर्युर्देहक्षयप्रदम्| (Ch.Chi.18/24)

15

Shthivan (Expectoration)

शुष्ककास कफं शुष्कं कृच्छ्रान्मुक्त्वाऽल्पतां व्रजेत् | (Ch.Chi.18/12) महावेगरुजास्वनम्||(A.H.Ni.3/23)

पीतनिष्ठीवन.. प्रततं कासमानश्च ज्योतींषीव च पश्यति|श्लेष्माणंपित्तसंसृष्टं निष्ठीवति (Ch.Chi.18/16)

बहुलं मधुरं स्निग्धं निष्ठीवति घनं कफम् (Ch.Chi.18/19)

स पूर्वं कासते शुष्कं ततः ष्ठी वेत् सशोणित… (Ch.Chi.18/23)

दुर्गन्धं हरितं रक्तं ष्ठीवेत् पूयोपमं कफम् || (Ch.Chi.18/25)

16

Coughing Pattern

With dry cough, blackouts

With burning

With excessive sputum

With excruciating pain

While coughing, person feels as if the heart is being displaced

17

Coughing Frequency

++++

+++

++

+++

++

Episodes will depend upon Nidana, Rogi Bala and Ritu etc.

18

वय

Middle & Usually Geriatric

Middle

Children & young adult

Any age (heavy exertion/trauma)

Pre-existing Krusha/Durbala of any age.

19

वयोडहोरात्रि भुक्तानां……

Visible in एकदोषज

-

Vatika Pattern more common, Later based on Dosha dominance.

20

Swara

स्वरभेदकरो भृशम्| (Ch.Chi.18/11)

स्वरामयः (Ch.Chi.18/15)

Not mentioned but it must be understood as per kapha prakopa pattern.

वैस्वर्यपीडितः| पारावत इवाकूजन्(Ch.Chi.18/23)

स्वरभेदोऽनिमित्ततः (Ch.Chi.18/28)

21

Aasya(Taste In Mouth)

possibilities of कषायास्यता

तिक्तास्यत्वं

आस्यमाधुर्य

Not mentioned clearly, may be as per Dosha-pattern.

22

Possible Correlation with Contemporary Science

Allergic bronchitis, viral URTI, pulmonary eosinophilia, early asthma/bronchospasm

Acute infective bronchitis,GERD induced cough (reflux esophagitis,atypical pneumonia

chronic bronchitis,chronic obstructive pulmonary disease, post nasal drip

Non tuberculor hemoptysis,Traumatic lung injury,pulmonary embolism,bronchectasis

pulmonary tuberculosis (koch's disease, Lung abscess,pulmonary malignancy

23

Sign

शुष्कोरःकण्ठवक्रस्यहृष्टलोम्नः (Ch.Chi.18/11)

पीतनिष्ठीवनाक्षित्वं.. ज्वर श्वास..(Ch.Chi.18/15)

वक्षः सम्पूर्णमिव मन्यते||१९|| (Ch.Chi.18/19)

पारावत इवाकूजन् दुःखस्पर्शेनशूलेन भेदपीडा (Ch.Chi.18/22-23)

स्निग्धाच्छमुखवर्णत्वक् श्रीम द्दर्शनलोचनः।पाणिपादतलैः श्लक्ष्णैः ..ज्वरो दुर्बलः कृशः.. (Ch.Chi.18/26-27)

24

Pain Intensity

हृत्पार्श्वोरःशिरःशूल…प्रताम्यतः… (Ch.Chi.18/11)

Not mentioned

कासमानो ह्यरुग् (Ch.Chi.18/19)

कण्ठेन रुजताऽत्यर्थं विरुग्णेनेव चोरसा||सूचभिरिव तीक्ष्णाभिस्तुद्यमानेन शूलिना|दुःखस्पर्शेन शूलेन भेदपीडाभितापिना||पर्वभेद…(Ch.Chi.18/21-22)

स्थानादुत्कासमानश्च हृदयं मन्यते च्युतम् |…पार्श्वरुक्… (Ch.Chi.18/26 & 28)

25

Cognitive Functions

निर्घोषदैन्य…दौर्बल्यक्षोभमोहकृत् (Ch.Chi.18/12)impaired due to excessive cough reflex.

मोहोऽरुचिर्भ्रमः(Ch.Chi.18/15)impaired due to burning in throat and chest.

None

Not mentioned directly but severely impaired due to severe pain.

सततासूयको घृणी||…(Ch.Chi.18/27) Severely impaired.

26

Weight Loss

No possibility of significant weight loss in all acute cases but chronic condition may lead esp. in Vat-dominant.

Possible in chronic condition.

दुर्बलः कृशः.. (Ch.Chi.18/26) Significant weight loss due to Dhatu Kshaya.

27

Sangya (Level Of Consciousness)

प्रताम्यतः (Ch.Chi.18/11)

मोहो…भ्रम (Ch.Chi.18/15)

-

-

सततासूयको  घृणी… (Ch.Chi.18/27)

28

Mala Mutra Sthiti (Bladder bowel)

Not mentioned but it must be taken as per the Desha, Ritu, & Koshtha etc.

भिन्नसंहतवर्चस्त्वं..(Ch.Chi.18/28)

29

Vyadhi-Swabhav

Ashukari (Acute), or may be as a complication of other chronic disorders or drug-induced.

Ashukari (Acute) Chirkari [Chronic]

Chirkari [Chronic]

30

Sadhya- Asadhyata

Sadhya यस्तु दोषकृतः स साध्य एव भवतीति दर्शयति (Ch.Chi.18/30 चक्रपाणि टीका)

Yapya, Sadhya [Nava Kasa]

Asadhya. Jarakasa-yapya क्षयजकासभेदं…… जरया देहक्षयकारिकया कृतः स याप्यः (Ch.Chi.18/30 चक्रपाणि टीका)

31

Oja-Affection

Not affected in early stage but may be affected in later stage

Affected as per severity/ chronicity of patient.

Affected

32

Sama/Nirama

Niram

Sama/niram

Sama/niram

Sama

Sama

33

Chikitsa

रूक्षस्यानिलजं कासमादौ स्नेहैरुपाचरेत्|… (Ch.Chi.18/32-33)

पैत्तिके सकफे कासे वमनं सर्पिषा हितम्||… (Ch.Chi.18/83-85)

बलिनं …. कफकासिनम् |….कफघ्नैश्चाप्युपाचरेत् || (Ch.Chi.18/108)

क्षतकासाभिभूतानां वृत्तिः स्यात् पित्तकासिकी|……………… (Ch.Chi.18/138)

सम्पूर्णरूपं क्षयजंदुर्बलस्य विवर्जयेत्|…दीपनं बृंहणं चैव स्रोतसां च विशोधनम्|व्यत्यासा त्क्षयकासिभ्यो बल्यं…||(Ch.Chi.18/150 & 187)

34

Bhesaja Kalpana Vikalpa

भोज्यं पानानि सर्पींषि लेहाश्च सह पानकैः| क्षीरं सर्पिर्गुडा धूमाः कासभैषज्यसङ्ग्रहः|| (Ch.Chi.18/190)

35

Upshaya/Anupshaya

स्निग्धाम्ललवणोष्णैश्च भुक्तपीतैः प्रशाम्यति|ऊर्ध्ववातस्य जीर्णेऽन्ने..।(Ch.Chi.18/13)

Not mentioned but it should be understood as per general principles of Dosha-prakopa or dominance.

As per kshatakshina & kshataja kasa.

As per general principles.

36

Pathya-Apathya

ग्राम्यानूपौदकैः ….भोजयेद्धितान् || (Ch.Chi.18/76)

शालयः … पित्तकासे रसान् क्षीरं यूषांश्चाप्युपकल्पयेत् || (Ch.Chi.18/97-99)

लघून्यन्नानि …..मद्यं वा निगदं पिबेत् || (Ch.Chi.18-109-110)

As per kshatakshina,kshayaja kasa

वातघ्नौषधनिष्क्वाथं …. क्षयकासिने|| (Ch.Chi.18/185)

37

Sattva Dushti

Not affected

Initially unaffected,but later became weakened.

Initially unaffected,but later became weakened.

38

Dhatvagni

Not affected

Initially unaffected, but if left untreated,it leads to Dhatvagni Mandya.

Dhatvagni Mandya

39

Dhatu Poshana Krama

Not initially but later disturbed if not treated

Disturbed

Disturbed

40

Vyadhi Dhatu Gatatva

Rasa Rakta

Rasa Rakta

Rasa

Rasa,Rakta Asthi majja

Gradual involvement of all Dhatus.

Dhatugatatva is useful for determining the progression of a disease, and treatment should be administered according to the depth to which the disesase has penetrated.

41

Upadrava

कासाच्छ्वासक्षयच्छर्दिस्वरसादादयो गदाः| भवन्त्युपेक्षया यस्मात्तस्मात्तं त्वरया जयेत् (A.H.NI.3/38) निदानार्थकरो रोगो रोगस्याप्युपलभ्यते || तद्यथा- ज्वरसन्तापाद्रक्तपित्तमुदीर्यते| रक्तपित्ताज्ज्वरस्ताभ्यां शोषश्चाप्युपजायते || प्लीहाभिवृद्ध्या जठरं जठराच्छोथ एव च| अर्शोभ्यो जठरं दुःखं गुल्मश्चाप्युपजायते || प्रतिश्यायाद्भवेत् कासः कासात् सञ्जायते क्षयः| क्षयो रोगस्य हेतुत्वे शोषस्याप्युपलभ्यते || (ch.ni.8/16-19)

 

v Conclusive Remarks:

 

1.      कास or coughing Reflex is mainly concerned to the प्राणवह स्रोतस Disorders but other Srotasas like रसवह, रक्तवह, अन्नवह, पुरीषवह, मूत्रवह etc. may lead to कासरोग by affecting the प्राणवह स्रोतस as per principle- तेषां प्रकोपात् स्थानस्थाश्चैव मार्गगाश्च शरीरधातवःप्रकोपमापद्यन्ते, इतरेषां प्रकोपादितराणि च| (ch.vi 5/9).

 

2.      During the Description of वातकर्म, Acharya Charak instructed that "ष्ठीवन क्षवथु उद्गार श्वासआहारादि कर्म च" are the main functions of प्राणवायु that has two types of main actions…

a.      To intake something in the body in downward direction like inspiration & food intake.

b.      To expel the metabolic waste “मल” like ष्ठीवन क्षवथु उद्गार etc.

उदान वायु has upward movement mainly. "वाक्प्रवृत्तिप्रयत्न ऊर्जा बलवर्णादि कर्म च" As instructed by Acharya Charak.

 

3.      Acharya Sushruta more precisely described the clash between प्राण & उदान because of opposite direction, one being downward & other in upward direction in प्राणवह स्रोतस Resulting in coughing Reflex as a Kas.

 

4.      Contemporary science describes coughing Reflex as a sign of pulmonary as well as cardiovascular system mainly. Similarly, Ayurveda also describes Kasa or coughing Reflex as a Multiple स्रोतस involving condition As Mentioned in point No. 1.

 

 

5.      Kasa Disease / रोग is primarily a Disease of GI Disturbance. As we see the various intrinsic causative factors Described by Acharya, later on, pulmonary or circulatory system get involved if not treated timely as well as properly.

 

6.      कास रोग Description by Acharya Charak is not only include cough Reflex  but also Resembles with various pulmonary pathologies.

 

 

7.      The symptomatology of कास रोग includes various other Diseases or clinical presentations as a sign or symptom, and these are also enlisted & dedicated as separate chapter by Acharya Charak, so sometime it may be confusing for Ayurveda students whether the patient is of कासरोग or ज्वररोग or छर्दिरोग or दाहरोग etc... So, it must be remembered that as per निदान पंचक what kind of Nidanas has been indulged? What were the पूर्वरूप & what is the history etc that lead to actual disease manifested in the Patients. Sometime Kasa present as a Swatantra vyadhi (independent disease) that has been discussed above, sometime as a Symptom/sign of other disease, sometime as a complication.

 

8.      If कास is not properly treated with root eradication management & follow up Brunhana, then it may act as निदानार्थकर रोग leading to क्षतक्षीण-यक्ष्मा-शोष etc.

9. Acharya Charak has classified almost all kinds of disorders as per either Doshaja or Sannipat or Tridoshaja but it's not applied in Kasa-roga but Khataja-kasa may be taken as 'Tridoshaja-kasa' being localised Shleshma-sthan pathology & 'Abhighataja' (traumatic) associated 'Vat & Rakta Prakopa.' Sannipat variant also not applied because of possibility of 'Shosha or Yakshma' etc in advanced severe condition.

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

Presented by

Dr.Alpa Kaba

BAMS

MD 2nd year scholar 

PG Dept. of Kayachikitsa

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

Email: alpakaba0803@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