The Compendium of Caraka 6.17: saptadaśo 'adhyāyaḥ/

Now we shall explain the treatment of hiccup and dyspnea.

Thus spoke the venerable Ātreya.

Wise Agniveśa, with folded hands, inquired about a doubt
from the supreme sage Ātreya, who knew the reality of things in the world of gods:

"These diseases of manifold nature that have been declared of two kinds, of three doṣas, and of three provocations—
among them, which is hardest to overcome?"

Hearing those words of Agniveśa, the best of the intelligent,
exceedingly pleased, spoke the ascertainment of the ultimate truth:

"To be sure, there are many life-taking diseases, but they do not do so
as dyspnea and hiccup, which sever life swiftly.

Even when a creature is beset by various other diseases,
at the end, hiccup or dyspnea with intense pain is born.

These two consist of kapha and vāta, originate from the site of pitta,
and dry up the heart and the bodily tissues beginning with chyle.

Therefore these two are considered common and exceedingly hard to overcome;
treated improperly, they become enraged and kill like venomous serpents.

These two have each been stated as fivefold in the compendium of diseases;
hear their etiology and symptoms, along with their cure."

From dust, smoke, and wind; from dwelling in cold places and using cold water;
from exercise, sexual intercourse, walking, dry food, and irregular eating;

from the disorder of āma, abdominal distension, dryness, excessive emaciation;
from debility, trauma to a vital organ, dual conflict [of seasons or regimens], and excessive cleansing;

from diarrhea, fever, vomiting, chronic catarrh, chest wound, and wasting;
from internal hemorrhage, upward movement of vāyu, visūcikā, and alasaka;

and from anemia and poison do these two diseases arise;
from the consumption of niṣpāva beans, black gram, oil cake, and sesame oil;

from pastries, lotus root, constipating, burning, and heavy foods;
from consuming meat of aquatic and marsh animals, curd, and unboiled milk;

from channel-blocking regimens and the use of kapha-increasing substances;
from obstruction of the throat and chest, and from various types of blockages,

the wind, entering the breath-bearing channels, becomes vitiated;
situated in the chest, agitating kapha, it produces hiccup and dyspnea,

terrible, obstructive of the breath of living beings, five types of each.
Hear further from me the prodromal symptoms of both.

Heaviness of the throat and chest, astringent taste in the mouth,
and rumbling in the abdomen are the prodromal symptoms of hiccups.

Abdominal distension, pain in the flanks, constriction of the heart,
and upward diversion of breath are the prodromal signs of dyspnea.

Wind combined with kapha, obstructing the channels bearing breath, water, and food,
produces hiccups; hear their signs individually:

In a person whose muscle, strength, vital breath, and vitality are depleted, wind combined with kapha,
suddenly seizing the throat, creates a loud, resoundingly noisy,

continuous hiccup, occurring singly, doubly, or triply;
obstructing the vital breath, the channels, the vital organs, and the bodily heat,

it robs consciousness, causes stiffness of the limbs,
and blocks the path of food and drink in one whose memory is stricken.

His eyes are flooded with tears, his temples stiff, his eyebrows dropped,
his speech choked and delirious, finding no relief.

Having deep roots, immense velocity, loud sound, and great strength,
that is known as the 'great hiccup' (mahāhikkā) of men, which takes life instantly.
Thus ends [the description of] mahāhikkā.
A man who hiccups incessantly, emaciated and depressed in mind,
making a deep, echoing resonance with difficulty from a worn-out chest,

yawning, contracting and stretching out his limbs,
holding both his flanks, groaning, afflicted by stiffness and pain,

his hiccup arises from the navel or from the large intestine,
violently shaking the body, as if bending him as he faints,

and blocks the passage of breath in one whose strength and mind are lost;
that hiccup, named 'deep' (gambhīrā), is considered fatal to him.
Thus ends [the description of] gambhīrā hikkā.
The hiccup known as 'interrupted' (vyapetā) arises after the fourfold food and drink,
and gains strength again at the end of digestion of food.

In one afflicted by delirium, vomiting, diarrhea, and thirst, unconscious,
yawning, with wild eyes, dry mouth, and a bent body,

and with a bloated abdomen, the hiccup that rises intermittently from the root of the collarbone
should be known as vyapetā hiccup, obstructive of life.
Thus ends [the description of] vyapetā hikkā.
When the minor vāta, agitated by exercise from the gut,
reaches the throat, it then produces the 'minor' (kṣudrā) hiccup.

It is not excessively painful, does not afflict the chest, head, or vital organs,
and does not dwell blocking the path of expiration, food, and drink.

It increases upon exertion and becomes mild as soon as food is taken;
it subsides back to that very place from which it first arose.

Residing in the heart, kloman, throat, and palate,
that mild one is proclaimed as kṣudrahikkā, curable in humans.
Thus ends [the description of] kṣudrahikkā.
Wind, compressed by sudden and excessive intake of food and drink,
or by liquors causing excessive intoxication, moves upward from the gut;

likewise, by excessive anger, talking, travel, laughter, and carrying heavy loads,
the wind residing in the gut, rushing along when compressed by food and drink,

enters the channels of the chest and produces the 'food-induced' (annajā) hiccup;
he hiccups slowly, disconnectedly, and while sneezing.

It does not produce distress in vital organs, nor does it torment the sense organs;
and that food-induced hiccup subsides after drinking and eating.
Thus ends [the description of] annajā hikkā.
In one with excessively accumulated doṣas, emaciated by abstaining from food,
in one whose body is wasted by diseases, the aged, and one given to excessive sexual intercourse,

whichever of these hiccups arises destroys life swiftly;
as does the 'double' (yamikā) hiccup when accompanied by delirium, pain, thirst, and delusion.

In one who is not depleted, not dejected, and whose tissues and sense organs are firm,
the yamikā hiccup can be cured; otherwise, it kills.

When wind preceded by kapha, obstructing the channels,
moves everywhere blocked, it then produces types of dyspnea.

A man whose vāta is violently thrown upward, distressed with a loud sound,
breathes loudly, obstructed, day and night like an intoxicated bull;

bereft of understanding and discernment, with rolling eyes,
distorted eyes and face, retention of urine and feces, broken voice,

dejected, and his expiration is discerned loudly from afar;
attacked by 'great dyspnea' (mahāśvāsa), he quickly perishes.
Thus ends [the description of] mahāśvāsa.
He who breathes deeply upward and does not draw his breath downward,
whose channel openings are coated with phlegm, tormented by enraged vāta,

staring upward, looking about with rolling eyes from side to side,
fainting, afflicted with pain, dry-mouthed, and suffering from restlessness;

when the upward breath is aggravated, the downward breath is indeed arrested;
as he faints and swoons, that upward breath (ūrdhvaśvāsa) destroys his life.
Thus ends [the description of] ūrdhvaśvāsa.
He who breathes interruptedly, tormented in all his vital breath,
or does not breathe, stricken with distress, tormented by pain as if cutting his vital organs,

afflicted with abdominal distension, sweating, and fainting, with a burning bladder,
with rolling eyes, utterly depleted, breathing with one eye reddened,

unconscious, with a parched mouth, discolored, and raving,
cut short by 'interrupted dyspnea' (chinnaśvāsa), that man swiftly abandons his life.
Thus ends [the description of] chinnaśvāsa.
When vāyu proceeds against the grain into the channels,
seizing the neck and head, and exciting the phlegm,

it causes chronic rhinitis, and blocked by it, produces a rattling sound,
and a breath of exceedingly fierce force, tormenting the life-breath.

Due to the excessive paroxysm, he faints, coughs, and is choked;
and while coughing, he falls into stupor again and again.

When the phlegm is not expelled, however, he suffers intense distress; / and once it has been cast out, he finds relief for a moment.

Then his throat becomes irritated, and he can speak only with difficulty; / nor does he get any sleep while lying down, afflicted by dyspnea.

The wind seizes his flanks when he lies down; / seated, he finds comfort, and he welcomes heat.

With rolled-up eyes, with his forehead sweating profusely, in severe pain, / his mouth parched, dyspnea recurrs constantly, and repeatedly he pants.

It is aggravated by clouds, water, cold, east winds, and phlegm-generating [factors]. / This tamakaśvāsa is manageable, or curable if newly arisen.
Thus ends [the description of] tamakaśvāsa.
One should recognize as pratamaka that which is attended by fever and fainting, / arising from upward flow of vāyu, dust, indigestion, and the suppression of a damp body;

it increases exceedingly in darkness, and is swiftly pacified by cold things; / but when he feels as if sinking into darkness, one should know that as saṃtamaka.
Thus ends [the description of] pratamaka and saṃtamaka dyspneas.
Arising from roughness and exertion, when minor vāta is stirred in the alimentary tract, / kṣudraśvāsa does not afflict the limbs with extreme suffering.

It does not injure the limbs, nor is it painful like the others; / nor does it obstruct the proper passage of food and drinks.

It produces neither distress to the sense organs nor any pain. / It is declared curable in the strong, as are all [types] when their symptoms are not fully manifest.

Thus the dyspneas and hiccups have been fully explained with their specific characteristics. / Among these, those that destroy life must be avoided, for they are dreadful and act swiftly.

The physician should quickly treat those that are curable and manageable with medicines; / for if neglected, they burn like fire in dry brushwood.

Because of the identity of their cause, site, and source, their treatment is one and the same; / learn that which was perceived by the sages for both.

One afflicted with hiccup and dyspnea should first be treated with unctuous sudations, / anointed with salt-oil, using tube, stone-slab, and mixed fomentations.

By these, his clotted phlegm in the channels dissolves completely; / the apertures attain softness, and therefrom comes the downward movement of vāta.

Just as snow heated by sunbeams in mountain clefts melts away, / so firm phlegm in the body, heated by sudations, melts away.

Knowing that he has perspired, one should promptly feed him unctuous boiled rice / with broths of fish or pork, or topped with curd.

Then, when the phlegm has increased, one should administer to him an emetic / combined with pippalī, rock salt, and honey, which does not conflict with vāta.

When the phlegm of corrupt form has been expelled, he attains ease; / and when the channels are purified, the wind circulates unobstructed.

If a residue of the humor remains clinging, the wise physician should remove it with smokes: / turmeric, patra, castor root, lac, realgar,

along with devadāru, realgar, and māṃsī, ground to make a wick; / smeared with ghee, he should inhale its smoke, or [smoke of] barley combined with ghee;

or having placed beeswax, resin of sarja, and ghee in an earthen bowl enclosure, / he should inhale the smoke; or the horn, hair, or sinew of cows;

or a dry reed of syonāka, castor, or kuśa grass; / or padmaka, guggulu, loha, or śallakī soaked with ghee.

Hiccup and dyspnea arising with voice-loss, diarrhea, bleeding pitta, and burning sensation / should be treated with sweet, unctuous, and cold substances.

Those afflicted with pitta and burning sensation, those with excessive flow of blood or sweat, / those whose tissues and strength are depleted, the dry, pregnant women, and pitta-constitutions should not be sweated.

One may gently sweat the chest and throat at will for a moment with lukewarm, / sugar-containing sprinklings of unctuous substances and poultice applications.

A poultice prepared with powders of sesame, linseed, black gram, and wheat, together with vāta-alleviating / unctuous substances and sours, or with milk, is beneficial.

In fresh fever and disorders of āma, one should employ dry sudation and fasting; / or having examined [the condition], one should cause emesis with salt water.

Observing vāta aggravated by excessive administration, the physician should bring it to peace / with vāta-alleviating meat broths and the like, not too cold nor hot, and with massages.

In upward flow of vāyu and abdominal distension, food combined with mātuluṅga, amlavetasa, / asafoetida, pīlu, and biḍa salt promotes downward movement.

One patient with hiccup and dyspnea is strong, while another is weak; / likewise, one has an excess of phlegm, while another is dry with an excess of vāta.

In one whose phlegm is excessive and who is strong, one should perform emesis together with purgation; / thereafter, for one taking wholesome food, pacification with smokes, electuaries, and the like.

Those with vāta disorders, the weak, the young, and the elderly / one should simply nourish with vāta-destroying pacifying agents: unctuous substances, vegetable broths, meat broths, and the like.

Because of purification in those whose phlegm is unexcited, who are unfomented and weak, / vāyu, having found a seat, dries up the vital spots and quickly takes away life.

Therefore, having satiated the robust who have much phlegm with broths of wetland and aquatic animals, / and having fomented them, the physician should purify them; the others he should nourish.

Peacocks, partridges, cocks, and wild animals and birds / cooked in a decoction of the ten roots or horse gram broth are beneficial.

Nidigdhikā, pulp of bilva, karkaṭākhyā, durālabhā, / trikaṇṭaka, guḍūcī, horse gram, and citraka—

cooking these in water, the strained liquid, fried with pippalī and ghee, / with dry ginger and salt, yields a soup beneficial with meals.

Cooking rāsnā, balā, the lesser five roots, and mung beans with citraka / in water, a soup should be prepared in that liquid as before.

Cooking tender shoots of mātuluṅga, neem, and patola, / and mung beans with the three pungents, one should prepare an alkali-soup.

Having added salt, alkali, drumstick seeds, and black pepper, / the soup properly prepared removes disorders of hiccup and dyspnea.

A soup of kāsamarda leaves and śobhāñjana, / and a soup of dried radish, wards off hiccup and dyspnea.

An eggplant soup with curd, the three pungents, and ghee is beneficial; / as well as food made from aged śāli rice, ṣaṣṭika rice, wheat, and barley.

Prepared with asafoetida, sauvarcala salt, cumin, biḍa salt, pauṣkara, citraka, / and karkaṭaśṛṅgī, a gruel is for those with dyspnea and hiccup.

With the ten roots, śaṭī, rāsnā, pippalī root, pauṣkara, / śṛṅgī, āmalakī, bhārgī, guḍūcī, dry ginger, and water,

a person should drink a gruel properly prepared, or a decoction, / for the pacification of cough, cardiac arrest, flank pain, hiccup, and dyspnea.

With puṣkara root, śaṭī, the three pungents, mātuluṅga, and amlavetasa, / one should prepare foods and drinks, together with ghee, biḍa salt, and asafoetida.

A person suffering from hiccup and dyspnea, when thirsty, should drink / a decoction of the ten roots or of devadāru, or wine.

Having washed and crushed pāṭhā, madhurasā, rāsnā, / sarala, and devadāru, one should place them in the scum of surā.

Having added a little salt to it, the physician / should administer a prasṛta measure to drink; thereby hiccup and dyspnea are alleviated.

One should drink asafoetida, sauvarcala salt, kola, samaṅgā, long pepper, and balā, / ground in mātuluṅga juice or with sour gruel.

Sauvarcala salt, dry ginger, and bhārgī with two parts of sugar / one should drink with warm water; this removes the disorders of hiccup and dyspnea.

One should drink with water a paste of bhārgī and dry ginger, / and likewise black pepper and alkali, / together with pītadru, citraka, āsphotā, and mūrvā.

Madhūlikā, tugākṣīrī, dry ginger, and long pepper / cooked with ghee into an utkārikā porridge are beneficial in dyspnea associated with pitta.

Meat of porcupine and hare, and the blood of pangolin, / prepared with long pepper and ghee, are beneficial in dyspnea associated with vāta.

Juice of suvarcalā, milk, and ghee combined with the three pungents, / taken as an after-drink with boiled śāli rice, is beneficial in [dyspnea] following vāta and pitta.

Fresh juice of śirīṣa flowers, or of saptaparṇa, / combined with long pepper and honey, is considered suitable in [dyspnea] following kapha and pitta.

Madhuka, root of long pepper, jaggery, fresh dung juice of a cow or horse, / ghee, and honey are beneficial for those suffering from cough, dyspnea, hiccup, and conjunctivitis.

When kapha is abundant, one should drink the fresh dung juice of donkeys, horses, camels, boars, / sheep, or elephants, individually with honey.

A man should lick the alkali of aśvagandhā with honey and ghee, / or the leg-quill of a peacock, or a scale of a pangolin,

or the hair of a porcupine, a hedgehog, or an Indian roller, or of an osprey; / or the skins, bones, and hooves of horned, single-hoofed, or cloven-hoofed animals—

having burnt all of these together or individually, / by licking the powder combined with honey and ghee, one overcomes severe cough, hiccup, and dyspnea.

For these [diseases] arise from the provocation of the vital breath whose passage is blocked by kapha; / therefore, these linctuses should be given to clear its channels, not when kapha is absent.

The wise physician should administer emesis to one coughing and when there is hoarseness, / with drugs that remove vāta and kapha; but in tamakaśvāsa, purgation [should be given].

Just as flowing water surges all the more forcefully / from an obstruction of its channel, so does wind; one should constantly clear its channel.

Śaṭī, coraka, jīvantī, vantī, cinnamon bark, musta, puṣkara root, / surasā, tāmalakī, cardamom, long pepper, aguru, dry ginger,

and vālaka in equal parts made into a powder with eight times as much sugar: / one should employ this in every way in tamaka dyspnea and in hiccup.

Pearl, coral, cat's eye, conch shell, crystal, black antimony, / heartwood, sulfur, mica, calotropis, small cardamom, the two salts,

powders of copper and iron, silver, ruby, lead, / nutmeg, seed of sunn hemp, and seeds of apāmārga—

a handful of powder of these equal parts, licked with honey and ghee, / quickly checks hiccup, dyspnea, and cough.

Used as a collyrium, it destroys timira, kāca, nīlikā, puṣpaka, tamaḥ, / malya, itching, ophthalmia, and pterygium.
Thus ends the Muktādya powder.
Powder of śaṭī, puṣkara root, and āmalaka / combined with honey should be licked, or powder prepared from black iron.

One should administer as food and as nasal drops tāmalakī with sugar, grapes, / fresh dung juice of a cow or horse, equal parts of jaggery, and dry ginger.

One should administer as nasal drops the root of garlic, of onion, or of carrot, / or sandalwood combined with human breast milk.

Or comfortably warm scum of ghee dusted with rock salt / one should administer as nasal drops, or fly feces with the juice of red lac.

Or ghee cooked with human breast milk and with the madhura drugs, / drunk or instilled into the nose, immediately arrests hiccup.

For those with hiccup, milk alternately once warm and once cold, / combined with sugar and honey, in drinks or in nasal treatment [is beneficial].

Ghee prepared with purgative drugs immediately arrests hiccup; / or the juices of dhātrī and kapittha combined with long pepper and honey.

One should lick puffed paddy, lac, honey, grapes, long pepper, and fresh horse-dung juice; / or jujube, honey, grapes, long pepper, and dry ginger.

Sudden sprinkling of cold water, terror, astonishment, fear, / anger, joy, and sorrowful anxiety are considered dislodgers of hiccup.

The etiology that has been stated for the disorders of hiccup and dyspnea / should be avoided by those suffering from hiccup and dyspnea who desire health.

Those with hiccup and dyspnea whose chest, throat, and palate are dry, / and whose bodies are dry by constitution, should be treated with ghees.

One should cook ghee in decoction of the ten roots and in curds scum, / with long pepper, sauvarcala salt, alkali, vayaḥsthā, asafoetida, coraka,

and kāyasthā; from drinking it, one destroys hiccup and dyspnea. / Tejovatī, abhayā, kuṣṭha, long pepper, kaṭurohiṇī,

bhūtīka, puṣkara root, palāśa, citraka, śaṭī, / sauvarcala salt, tāmalakī, rock salt, dried pulp of bael,

tālīsapatra, jīvantī, and vacā: with one akṣa measure of each of these, / and a quarter part of asafoetida, one should cook a prastha of ghee in four times as much water.

Having drunk this according to one's strength, a person overcomes hiccup and dyspnea, / and also swelling, wind-piles, grahaṇī disorder, and pain in the heart and flanks.
Thus ends the Tejovatyādighṛta.
A prastha of ghee cooked with realgar, resin of sarja, lac, turmeric, padmaka, / mañjiṣṭhā, and cardamom, one karṣa each, is beneficial.

Or one should lick ghee prepared with the vitalizing drugs, together with honey; / or one should drink tryūṣaṇa ghee, curd-ghee, or likewise vāsā ghee.
Thus ends the Manaḥśilādighṛta.
Whatever is pacifying to kapha and vāta, hot, and promoting downward movement of vāta, / whether medicament, drink, or food, is wholesome for the patient with dyspnea and hiccup.

Treatment that increases vāta while removing kapha, or increases kapha while removing wind, / should not be used exclusively; between the two, what removes wind is generally preferable.

For in all of them, the risk in nourishment is slight and generally manageable; / in pacification the danger is not extreme, but in emaciation it is great and unmanageable.

Therefore, whether cleansed or uncleansed, beings afflicted with hiccup and dyspnea / should generally be treated with pacifying and nourishing measures.

Here is a summary verse:

The cause of the difficulty to conquer, of the origin, and of the single line of treatment, / the symptoms, and the wholesome regimen for hiccups and dyspneas have been shown here.

Thus ends the seventeenth chapter, named the Treatment of Hiccup and Dyspnea, in the Cikitsāsthāna of the compendium composed by Agniveśa, redacted by Caraka, and, being unavailable, completed by Dṛḍhabala.