Chapter CXLIX - The Nidanam of Cough

Dhanvantari said:—I shall first deal with the aetiology of cough, inasmuch as this disease fast affects the entire organism, and speedily runs its course The disease admits of being grouped under five sub-heads according as it is brought about through the deranged action of Vayu, Pittam, or Kapham, or as the outcome of consumption, or ulcerative Endocarditis. Any of these five types of cough, being neglected at the outset, may run into a case of Pthisis, and each of them is successively more virulent than the one immediately preceding it in the order of enumeration. An itching, tickling sensation in the throat, and a non-relish for food are the symptoms which mark the premonitory stage of every type of cough. Parchedness of the throat and mouth, and a sensation of dryness in the cavity of the ear are the symptoms which characterise the type due to the action of the deranged Vayu. The wind, which courses through the lower parts of the body, violently rushes upward and presses upon the larynx and the bronchi. The agitated wind fills the vessels causing the sides to heave up in spasms, and the eyes seem as if starting out of their sockets. The voice becomes weak and a sound resembling that of a broken belmetal gong is perceived in the mouth and larynx. The patient complains of a bruised pain at the sides, attended with a violent headache, and an aching pain about the region of the heart. Aphonia, hurried breathing and swooning may be also present, and a sort of dry spasmodic cough constantly harrasses the patient who finds a little relief only by hawking a kind of dry mucous out of the throat, which often causes horripilation. These are the symptoms which mark the type due to the action of the disordered Vayu (Nervous, spasmodic cough).

A bitter taste in the mouth accompanied with fever, vertigo, billious vomitting, and yellowness of the conjunctiva, as well as blood-spitting, thirst, aphonia, darkness of vision, etc., mark the billious type, and the patient sees bright rings of fire floating before his eyes during a fit of cough. In the type due to the action of the deranged Kapham, the patient complains of a slight dull pain in the chest, and a heavy numbness in the head and cardiac region, and feels as if the throat has been plastered with a coat of sticky mucous, which cannot be scraped out with efforts. Vomiting, and horrifibation, attended with a fluent coryza secreting a thick glossy mucous, a nd a non-relish for food are the symptoms, Which further characterise this type of cough.

The local Vayu enraged through such factors as inordinate and overfatiguing physical exercise, lifting of heavy loads, etc., which give rise to ulcers in the chest, becomes United With the aggravated Pittam, and produces a type of cough in which the patient coughs out bloody or blood-streaked mucous, or spits out a sort of brown, yellowish, dry, knotty, or angry-looking mucous. The patient feels pain in the throat at the time of coughing, and complains" of heat and an aching, piercing pain in the heart while spitting; Or hawking out the phlegm. Fever with thirst, shivering, and dyspnœa, and hoarseness with a breaking pain in the joints, Supervene; the voice becomes small, weak and resembles the cooing of a dove; the sides ache; the digestion is impaired; and palour and weakness go on increasing every day. In this stage all the specific symptoms of Pthisis are developed. There is extreme prostration with bloody micturition, dyspnœa and a catching pain at the bade and sacrum. A pthisis patient generally coughs out a greenish, bloody, or blood-streaked, fetid, pus-like, mucous; and complains of diverse kind of pain even in bed. The heart seems as if it is being boiled; and the patient, without any ostensible reason, complains of heat; and evinces a desire for cool things and heavy meals. Prostration goes on increasing; the eyes, teeth, and face of the patient assume a glossy peaceful look; and all the specific Symptoms of wasting supervene.

A case of consumption (Raja Yakshma) or Ulcerative Endocarditis (Urah-kshata) may be arrested, if not radically cured, under a judicious medical treatment resorted to at the very commencement of the disease. Both these diseases in a strong and young patient, may be expected to be cured, if well-cared for from the outset. All those forms of ailment which admit only of a palliative treatment, as well as the maladies of old age may bring on dyspnœa, cough, consumption, vomiting, Aphonia and a host of other distempers, if not well-cared for, at the outset. Thus ends the Ætiology of Cough.