Chapter CL - The Nidanam dyspaksea

Dhanvantari said:—Now I shall discourse on the Nidanam of Dyspnœa (Shvasa). A case of chronic or aggravated cough may run into one of Dyspnœa, or the enraged morbific principles of the body may likewise give rise to this diseased condition. Difficult breathing may also mark the sequel of amatisara (mucous dysentery), vomiting, chlorosis, fever, or poisoning, or may be produced as the effect of an exposure to dust storm, smoke, cold wind, or of a blow on any of the vulnerable amestomoses of nerves, arteries, etc., (Marmas). Dyspnoea may be divided into five different kinds such as Kshudraka, Tamaka, Chhinna, Mahan, and Urdha-Shvasa. The Vayu (nerve-force), that courses all through the organism, affects the channels of food-carrying, watercarrying and breath-carrying ducts in the event of its own vessels being obstructed by the deranged Kapham (mucous deposits), and remains incarcerated in the cardiac region, producing dyspnœa from the lower end of the stomach. An aching pain about the heart and the sides, contrary direction of the breath-wind, long drawn breaths, pain at the temporal bones, and tympanites are the premonitory symptoms of this disease. The Vayu, enraged and aggravated by the toils of overeating, and over fatiguing physical labour, obstructs the vessels by enraging and aggravating the deranged Kapham, coursing through them in a contrary direction, and produces the form of difficult breathing known as Kshudra-Shvasa. The enraged Vayu, by exciting the deranged Kapham, lies catching at the head, neck and cardiac region, and produces an aching pain at the sides. A wheezing sound is heard in the throat, and catarrh with fits of fainting and a non-relish for food supervene. The aggravated Vayu increases the difficulty of breathing, and the patient is seized with a violent fit of cough, feeling a little relief when a little mucous is coughed, or belched out. He is obliged to sit up, as a lying or reaumbent(?) posture tends to aggravate the pain and difficulty of breath. The eyes are turned upward and beads of perspiration break out on the forehead of the patient, testifying to the intense agony he suffers from in this form of disease. The lining membrane of the cavity of the mouth gets dry and parched up by constant drawing in of the breath-wind, and the patient evinces a strong desire for hot drinks or food. Winter, rain, east-wind, and partaking of phlegm-generating food, are set down as the aggravating factors of Asthma.

The type known as Tamaka Shvasa is curable only in a strong patient, but the paroxysm does not speedily abate in the event of there being fever, epiliptic fits, rigour, etc., in its company. In this type both cough and dyspnœa are marked by their virulence. The patient becomes emaciated, and complains of a cutting pain at the chest and the Marinas. Perspiration, fainting fits, and tympanites with a burning sensation in the bladder are its further characteristics. The eyes become red, swollen, and glossy, and are turned downward. The patient complains of a dryness in the throat, and drops down unconscious, moaning in a low, piteous voice.

In the type known as Maha-Shvasa (cerebral dyspnœa) the patient breathes very bard and upward (with upturned nose) like an infuriated bull. The breathing is hard, rapid and hurried, and the patient lies senseless and almost speechless with eyes turned upward, and stool and urine are entirely suppressed. The throat is dry and parched, respiration becomes hard and rapid, drops of perspiration appear on the forehead, and the patient complains of an excruciating pain at the head and the temples. All chance of recovery should be given up if the patient is found to continue in this state for a while. In this type the mouth and ears of the patient are found to be stuffed with mucous, and the eyes under the influence of the aggravated Vayu, are found to roll about in their sockets or are fixed in an upward stare. The heart seems as if being torn asunder, and the patient moans for a while and then lies speechless in death. Medical treatment may be useful in this tye(type?) of dyspnœa until the preceding symptoms appear, in which case the physician should think it prudent to retire.