Respiratory Disease.
Respiratory diseases in Ayurveda is a bit different from the modern concept. Dyspnoea (breathlessness or difficult respiration or asthma) and cough are much interrelated diseases.The former is termed svaasa in Ayurveda and the latter is termed kaasa.These are mere symptoms in modern medicine. In Ayurveda also there are many diseases with these symptoms, but they are also designated as independent diseases.
Ayurveda, diseases are primary (independent) or secondary (dependent). Cough and breathlessness may occur secondary to fever (jvara), and many other diseases. Cough and dyspnoea are diseases of the lower part of the respiratory tree including the lungs.
Cough is the effort of tuberculosis.This disease is termed as raaja-yakshmaa in Sanskrit, which means the disease of the king or king of diseases. Mythology states that the king of stars, the moon, contracted consumption because of a curse.The cause was invited through his special attachment to one of his wives ‘Rohini’. Over indulgence with sex is considered as one of the etiological factors for pulmonary tuberculosis by Ayurveda.
Pulmonary tuberculosis (raaja- yakshmaa), cough (kaasa),and asthma (svaasa) are three diseases mainly affecting the lower respiratory tract.
Rhinorrhea or running nose (pratisyaaya or peenasa) is considered as the precursor of raaja-yakshmaa. It is categorically stated that on increase of running nose, one might develop raaja-yakshmaa. In our experience, upper respiratory infection gradually descent and become lower respiratory tract infection. A chronic inflammatory state of the respiratory system is conducive to the development of pulmonary tuberculosis. A running nose as in common cold is indicative of low immunological status which again is conducive to the development of pulmonary tuberculosis.
Respiration is a very primary function of life. Diseases of the respi-ratory system essentially tamper the function. Respiration has two aspects – a) supply of oxygen to the body and b) excretion. The second function is usually understood as limited to the excretion of carbon dioxide. But that is not all. Expulsion of water as water vapor is mostly done by the respiratory system. Unwanted metabolites are also expelled as gases through this system. For example, in consumption of alcohol, a good amount of it is expelled through breath.
So is the acetylene generated eczema may turn bronchial asthma and a suppressed bronchial asthma may manifest as eczema. Both, when suppressed, will turn out to be nephritis and even claim the life of the patient.
Diseases like pneumonia, where there is severe inflammation of the lungs and respiratory tree are considered by Ayurveda among fevers (jvara), since fever also is a cardinal symptom in such conditions.
Heart diseases may cause difficulty in breathing. It is usually referred to as cardiac asthma.This condition requires a different approach and is mentioned separately in the
Context of asthma (svaasa).The heart and lungs depend on each other for their function. Hence a defective lung may cause defects in the function of heart and voice versa.
by the excessive lipid metabolism. That is why the breath of those suffering from diabetic keto-acidosis is having the smell of rotten fruits.
This excretory aspect of the respiratory system is more important from the pathologic aspect. When the respiratory system is impaired, the efficiency of the body to eliminate junks from the body is highly reduced. The other excretory organs are the kidneys and the skin.This triad – lung, kidney and skin – works interrelated. Kidneys and skin eliminate water soluble wastes. Lungs eliminate the gaseous wastes.
This means that the relation of respiratory system with the humor vaata, the only gaseous humor is pronounced. In the phenomenon of breathlessness and cough, the role of vaata as a motive force and one could appreciate the role of vaata in the pathodynamics of both the diseases. Whenever the free flow of wind is is expressed. Both are expressions of the obstruction to the natural free flow of wind.This relation is well identified by Ayurveda obstructed, it rebounds with added strength and operates vigorously and pathologically.
Diseases of kidney and skin have a direct relation with the diseases of the respiratory system. Physicians might have noted that suppressing skin diseases with remedies tend to precipitate asthma. Suppressing both skin diseases and asthma may generate problems of kidney. This phenomenon is due to the fact that these three instruments -the integument, respiratory apparatus and the kidneys function as a group. When filth is trying to go out of the body through any of these outlets, if we interfere and arrest the elimination, then the body will have to try another outlet. Hence, a suppressed heart and vice versa.
Yet another disease connected with asthma and cough is hiccup. In Ashtaangga-hrdaya asthma and hiccup are dealt with together in the same chapter. Another important thing to note is that the book deals with the pathology of cough appended to bleeding diseases (rakta-pitta). Cough is considered as the most acute and quick acting complication of bleeding disorders. Such relations are not directly drawn in modern medicine.
Cough
There are five types of cough according to the ayurvedic classification. They are cough due to
1) vaata, 2) pitta, 3) kapha, 4) trauma of chest and 5) phthisis (wasting or tuberculosis)
Itching of the throat, anorexia and fleeing of arils stuck to the throat are the premonitory symptoms of cough. So if you have an itching or pain in the throat (pharyngitis) it is the sign of the cough in the greenroom. Hence it is better to have some medicine in this stage itself so that you may not develop laryngitis and pulmonary infection.
The wind that is suppressed down due to blockage of path works upwards, reaches the chest and throat, fills the channels of head, causing convulsive movements of the body, pushing out the eyes, giving pain to chest, back and flanks and goes out through the mouth forcibly with the sound of broken bronze.
This is the dynamics of all sorts of cough. According to modern medicine, a cough with the ringing sound of a broken bronze bell is indicative of bronchiectasis where a part of the bronchule or the whole bronchial tree is dilated and remains dilated.This dilated area often becomes a warehouse of sputum and debris.
Cough may be dry or wet. Dry cough is unproductive whereas wet cough is followed by expectoration of large quantities of sputum. The vaata type of cough is dry. Pitta cough is characterized with inflammation of the respiratory track.There will be profuse expectoration in kapha cough.There may be running nose, vomiting and anorexia in this type of cough. Vomiting is a usual attendant in prolonged cough.
In the brain the vomiting centre is placed close to the cough centre. When the cough centre is extremely agitated, impulses will stimulate the neighbor and cause vomiting. It is like when there is domestic fight going on in next house, you are irritated and finally interfere in their domestic chores.
Cough due to trauma of chest is more severe and there will be injury to internal structures, especially the lungs.The patient gradually loses his strength and immunity. Drastic steps should be taken here to cure the patient, lest the condition may turn fatal. Fever is a usual sign of this cough as infection is likely in the injured tissue of the chest.
Cough of tuberculosis is notorious and is one among the eleven signs of the disease. Dyspnoea also is one among them.The spit sputum will be foul smelling and akin to pus in appearance. Other signs of tuberculosis also will be present. It is considered that all untreated coughs will culminate in emaciation. Untreated cough may invite breathing difficulties, emaciation, hoarseness of voice, etc.
Asthma
Difficulty of breath may occur due to the increase of cough or directly due to the vitiation of humors Diarrhea where the food is not digested, vomiting, poisoning, anemia and fever may precipitate asthma.
Exposure to dust, smoke, wind and fog, trauma to vital areas (marma), usage of chilling water etc. may cause asthma. It is interesting to note that according to Ayurveda, dyspnoea is a disease originating from the stomach (aamaasaya) and not from the lungs or bronchial tree. Though the effect of the disease is in the respiratory system, the digestive system has a say in the disease. The channels of respiration, water metabolism and food are vitiated in the disease. Aamaasaya is considered as the seat of kapha and hence the involvement of this humor is evident in asthma.
There are five types of respiratory distresses.They are: –
- Exertion dyspnoea (kshudraka- svaasajl -This is the self limiting breathlessness due to exertion. It may be grave if prompted by heart disease. If not, it needs no treatment other than rest.
- Bronchial asthma (tamaka-svaasa) – As the Sanskrit term indicates, it causes blackouts and is mostly prompted by ignorance (tamas = darkness) and the psychic factor is dominant in the production of this type of asthma. A variant of this disease is attended with fever and fainting. It is called pratamaka-svaasa. This will subside with cold treatment.
3. Cheyne stock asthma (chinna- svaasa) – This is the asthma of advanced myocardial degeneration. This is a serious condition and is usually terminal. One eye of the patient may be red.The patient will be very weak and disabled and the respiration will be intermittent.
- Great dyspnoea (mahaa-svaasa) -The patient will faint and there is blockage of urine, feces and flatus. There may be convulsions.This is a serious condition.
- The upward breath (oordhva-svaa- sa) -This is terminal and patient will not be able to inhale. His eyes roll and he dies by respiratory arrest.
Of the five types of dyspnoea the last three are incurable.The first type requires no treatment and only the second type viz. bronchial asthma could be treated and managed. According to Ayurveda this treatment is not curable, if it is chronic. It can be just managed (yaapya). Claims of permanently curing chronic bronchial asthma have no scientific support from Ayurveda. Managing a disease and curing a disease are different things.
Hiccup (hikkaa) Hiccup is also of five types.
- Food induced (annajaa hikkaa) – Caused by dry or unfamiliar food.
- Strain hiccup (kshudraa hikkaa) – This a mild hiccup due to strain.
- Twin hiccup (yamalaa hikkaa) – Two hiccups as a single unit.This is mainly due to diseases of the pancreas and is serious. It usually occurs during active digestion of food.
- The great hiccup (mahatee hikkaa) – Hiccup with convulsions.
- Deep hiccup (gambheeraa hikkaa) -With deep resonance and yawning.
The first two among them are curable.The last two are not curable. Sometimes the twin type also may turn incurable.
Pulmonary tuberculosis (raaja- yakshmaa)
According to Ayurveda there are four etiological factors for the disease. Classical Ayurveda does not entertain bacterium as the causative agent.Today we know that in spite of the presence of the bacteria, all are not contracting the disease. Other factors are more relevant.The four causes are:-
1. Over strain of the body (saahasa) 2. Suppression of natural urges (vega-rodha)
3. Depletion of reproductive tissue due to over indulgence in sex and reduction of the immunity factor and unctuousness of the body (sukla-oja- sneha-samkshaya) and (anna-paana-vidhi-tyaaga).
There are eleven cardinal signs for the disease (ekaadasa-roopa).
They are listed below: –
- Running nose
- Dyspnoea
- Cough
- Pain of shoulder
- Headache
- Hoarseness of voice
- Anorexia
- Diarrhea or Constipation
- Vomiting
- Pain on flanks
- Fever.
Of these 1 to 6 occur when the filth is located in the upper body. When it is stationed in the lower part of the body diarrhea or constipation may occur. Vomiting occurs when the filth is in the G.l.tract. When the filth is positioned transversely, there will be pain of flanks and when it is
in joints there will be fever.The sign and symptoms of the disease vary with the predominance of humors involved.The disease is primarily trihumoral in nature.
One salient feature of emaciation is that the body is turning more and more into filth and in the later stage the patient survives on the strength of this filth. Hence attempt to eliminate the filth to effect cure may turn fatal.
Ashtaangga-hrdaya details many of the diseases enlisted as signs of the disease in the same chapter. Thus anorexia, vomiting, hoarseness of voice are detailed in this chapter. Epigastric pain (hrdroga),and pathogenic thirst (trshnaa) also find slot in the same chapter even though they are not mentioned among the eleven signs. Hrdroga is interpreted by many as heart disease. Such a correlation may not be always true. Epigastric pain or even pre-cordial pain need not be always prompted by a sick heart. As a morphologic land mark hrt means the epigatrium, the upper most part of the abdomen which lies centrally just below the chest bone (sternum).
It is practically impossible to include all the diseases of the respiratory system in one article. Hence detailing of many of these diseases is not attempted.
Treatment of respiratory diseases.
Dyspnoea and cough are of the same etiology and pathology and hence both are treated in the same lines. (A.H.Ci.4.1). In cough, the treatment varies with the humor involved. In Principle, the treatment of vaata cough is nutritive. Inhalation of medicinal fumes is also suggested. Pitta cough is of two types – with thick sputum and with thin sputum. In case of cough with thick sputum, vomiting is indicated. In the case of cough with thin mucous, purgation is the choice.Turpeth with sweets is prescribed for it.
In Kapha cough, oil extracted from deodar is given orally first, with three acrids (black pepper, long pepper and dry ginger) and the barley ash. Many of the classical prescriptions are not readily available in the market. Some important formulations available in the market are listed below.
- Taaleesa-patraadi coornam
- Vyoshaadi vatakam
- Asvagandhaadi coornam
- Agastya rasaayanam
- Vasishtha rasaayanam
- Kooshmaanda rasaayanam
- Dasamoola rasaayanam
- Dasamoola hareetakee
- Dasamoola-katutrayam kvaatham
- Maatala rasaayanam
- Vidaaryaafdi kvaatham
- Elaakanaadi kvaadham
- Indukaantam ghrtam
- Kantakaaree ghrtam
- Vaasaarishtam
- . Dasamoolaarishtam
- Kanakaasavam
These formulations may be used in all respiratory diseases.
Choorna is powder. Vataka is a confection. Rasaayana mentioned here are semisolid jams.Ghrta is medicated ghee. Kvaatham is decoction. Arishta is a fermented liquid containing self generated alcohol. Aasava is a similar preparation.The base of arishta is decoction. In case of aasava it is not decoction. Many of these formula¬tions are converted into proprietary preparations with minor changes by Ayurvedic companies.Taleesa- patraadi is available in tablet form. Vyoshaadi vatakam is available as granules. It is found effective in curing and preventing asthma.
Indukaanta ghrtam and Elaakanaadi kvaatham are more spe¬cific for pulmonary tuberculosis.Ta- aleesapatraadi powder is useful also in hoarseness of voice and anorexia. Karpooraadi powder is more useful in respiratory diseases prompted by the problems of heart. Kanakaasa- vam is specific for asthma. It should be used with medical advice as it contains thorn apple (Datura metel Linn.), a poisonous plant.
This author will prefer to refer patients of tuberculosis to allopathic doctors as they should be put under the national treatment scheme for the disease. Ayurvedic medicines may be provided simultaneously. Ayurvedic treatment of the disease is based on improving immunity.
Indukaanta ghrtam is noted for its immuno-modulating effects.
Vaasaa is considered as a good single remedy for respiratory diseases.Vaasaa is Malabar nut, also known as adhatoda = Justicia beddomei (Clarke) Bennet = Adhatoda beddomei C.B.CIarke ACANTHACEAE. Note: In India, generally Adhatoda vasica Nees is used as vaasaa. But in Kerala A. beddomei is preferred. A teaspoonful of the juice of its leaves with honey three times a day usually combats cough and difficult breathing. It is also specific for cough with blood stained sputum.
Long pepper is another wonder drug useful in respiratory diseases and liver diseases. Many of the cough syrups available in market contain long pepper (Piper longum Linn.). Long pepper should not be used for long periods without observing the norms of rasaayana therapy. Note that among the three acrids, long pepper is not permitted in kitchen.The other two members ginger and black pepper are permitted.This means that long pepper is not a food.
Nowadays many cough syrups are available in the market. People consume them without any prescription as part of self medication. Self medication is not a good practice. Treatment of respiratory disorders according to Ayurveda should be modulated according to the stage of the disease, cause of the disease and predominance of humor involved.
Hence to use the apt procedure or drug, it is better to consult an ayurvedic doctor. You may try tit bits for a week or so. If the cough or dyspnoea is persistent, do not hesitate for a consultation.
Many classical formulations and proprietary products for respiratory diseases contain camphor or camphor containing herbs such as betel leaves. Camphor is good for respiratory diseases. But it is a cardiac stimulant. Moreover, used in excess camphor may cause epileptiform seizures due to its effect on brain. Maatala-rasaayanam and Dasamoola- rasaayanam are notorious for this effect.
In south Kerala Dasamoola hareetaki is also termed as Dasamoo- la-rasaayanam. Hence when you are buying Dasamoola-rasaayanam from north Kerala with a prescription from south Kerala, be sure that you are getting the medicine intended by the doctor.The adult dose of Dasamoola-hareetaki is one table spoon (15 g) whereas that of Dasamoola-rasaayanam is about 250 – 500 mg.The ten roots (dasamoola) are very good for respiratory diseases as they will reduce inflammation and in all respiratory diseases there will be some inflammation, even in that of allergy.
suggested daily dose of medicine for respiratory diseases should be divided into small quantities and use only a fraction of the dose at a time. Bulk consumption of medicine will not be beneficial. Frequent dose is the key in respiratory diseases.
In case of repeated attacks of respiratory diseases, allergy and lack of immunity is to be suspected. In such cases intense treatments, by way of hospitalization, in the disease free intervals are useful. Many of the procedures like rice pouch fomentation (navara-kizhi) and oil irrigation (pizhiccil), buttermilk irrigation (takra-dhaara) etc. have the ability to improve immunity.
Primary complex (tuberculosis of the childhood) can be well addressed by immune-modulation by Ayurveda.This requires long term therapy. But it is child friendly. Remember! It is the immunity that cures neither the physician nor the medicine.
