Introduction

The respiratory ailment that affects everyone at some point in their lives is a cough. The incidence of respiratory system-related incidents has significantly increased in recent years. The fifth most typical symptom for which a patient seeks medical attention is kasa. Kasa has been characterised by Acharya Charaka as a distinct illness. It has been noted as a symptom, complication, and sequela in certain disorders as well as a separate disease. One of the most prevalent diseases affecting pranvaha strotas is kasa. Kaphaja is one of five varieties of Kasa. The exposure has led to a rise in the prevalence of kasa. Environmental variables such pollutants, allergens, smoke, dust, smoking (both active and passive), air pollution, occupational risks, etc. are having a bigger impact on it. Overcrowding and unclean circumstances are caused by increased urbanisation. respiratory tract disorders have been the most frequently reported diseases in recent years. This needs ongoing medical care.

According to the Charaka Samhita, one should administer care based on the severity of the illness or the predominance of the doshas. Accordingly, among the doshik forms of kasa, kaphaja kasa is the most crucial to cure since, if mishandled or left untreated, it may progress to terrible illnesses like kshataja kasa, kshayaja kasa, or tamaka shwas, which are crises and are challenging to manage.1 While treating, one should concentrate on kapha nirharan or shaman and vata shaman by normalising its path because in samprapti of kaphaja kasa, kapha dosha obstructs the gati of vata and as a result, vata follows aberrant course.2 There is a relatively limited range of treatments available in modern medicine for this problem. Antihistaminic, anti-inflammatory, and steroid usage in such circumstances can have a number of negative side effects.

The main impacts of the cough suppressants that are now on the market include substantial side effects such constipation, respiratory disruption, dependency, sleepiness, etc. As a result, there is now a critical unmet need for the development of safe, efficient therapeutic solutions for the management of chronic cough. For the treatment of kaphaja kasa, Acharya Charaka gave numerous siddhanta, including vamana, katu ruksha, ushna kaphaghna Chikitsa, and yavanna sevan. This study was conducted employing one of these yogas based on the management concept.

Etymology of Kasa :

Basically, it has been derived from Ku-shabde, that means production of vikrut dhwani.

Historical view:3-7

1. Charaka Samhita - In charaka Samhita, Kasa vyadhi is described mainly in its chikitsa sthana.   

2. Sushruta Samhita - In this samhita description of Kasa vyadhi and its treatment is mentioned in uttar tantra 

3.Ashtang Hridaya - In Nidana-sthana kasa vyadhi is described along with Rakta-Pitta. It is having five types namely Vataja – Kasa, Pittaja Kasa, Kaphaja Kasa ,Khataja kasa, Kshayaja kasa and its chikitsa has been explained in chikitsasthan

4. Sharandhar Samhita - Kasa vyadhi is explained with all its types in chapter 7 of poorvakhand.      

5. According to chakradutta: Chakradutta has mentioned kaasa in chikitsasangraha.

6.According to Harita Samhita :Harita has mentioned kaasa in 12th chapter  he has stated causes, pathogenesis, types, signs and symptoms along with line of treatment.

7.According to Madhav Nidana: Madhav nidan has explained Nidan panchak, Kasa vyadhi is described in 11th chapter of this samhita.

AYURVEDIC REVIEW:

Definition 

• Sushruta 8

Sound resembling the kansya-dhatu breaking (Indian bell Metal).

• Charaka 9

The term "Kasa" refers to loud, forceful breath exhaled via the larynx. Chapter 18 of the Chikitsasthan, titled "Kasa Chikitsa Adhyaya," is where Charaka explains kasa and how it is treated. It covers the ayurvedic remedies for cough and related illnesses, as well as their causes, kinds, and treatments.

According to Acharya Charaka

Here are five types of Kasa – cough.

Types of kasa

There are five varieties of Kasa, if exacerbated they may cause cachexia.

1)         Vatika kasa

2)        Paitika kasa

3)        Kaphaja kasa

4)        Kshataja kasa

5)        Kshayaja kasa.

Premonitoring signs and symptoms of Kasa (bronchitis) 10

1)A sensation as if the throat and mouth are filled with bristles .

2)Itching sensation in the throat .

3)Obstruction to the movement of food in the gullet.

Due to the general related anorexia or due to his inability to swallow food, the patient becomes unable to eat during the premonitory period of Kasa.

Purvaroopa of Kasa: 11

1: Shukapurna galasyata - a sense of the throat and mouth being choked with bristles.

2) Kanthe kandu - which causes throat itching

3) Bhojyanam Avrodh - Impediment to food flow in the intestines.

Pathogenesis (samprapti): 12

In the bottom region of the body, Vatadosha becomes blocked. It causes problems with the upper body's circulation channel as it goes higher, takes over the respiratory system's udana vayu function, and lodges in the neck and chest. This vata affects and fills up all of the channels in the head, which leads to bending, stretching (Aksipan), and pain in the jaws, sides of the neck (sterno-mastoid muscle), and eyes as well as Abhanjan and Abhanjanjan. Following the tightness and stiffness generated by this vayu in the eyes, back, and sides of the chest, coughing may result, which may be dry or with phlegm, thus the name Kasa-cough. (The condition is referred to as Kasa because it affects the chest and involves vayu movement.

Causes of pain variation: 

Different varieties of Kasa (cold cough) generate various variations in the discomfort and sound, which are brought on by the nature of the barrier to the vigorously moving vayu (caused, for example, by kapha).

• Etiology of Vataja kasa nidana:13,14

1) Intake of unctuous ,cold and astringent food;

2) Pramita (intake of food in less quantity) or Anasana (not taking food at all.

3) Excessive indulgence in sex .

4) Suppression of natural urges; and

5) Excessive physical strain.

• Signs and symptoms of Vataja kasa: 15

1) Excruciating pain in the cardiac region, chest and head.

2) Excessive hoarseness of voice

3) Dryness in the chest, throat and mouth;

4) The coughing gets alleviated by food and drinks that are unctuous, sour, saline and warm

5) Resonant sound during coughing, hollow sound during coughing;

6)Weakness, agitation and unconsciousness

7) Dry cough;

8) The phlegm that comes out with pain is sem-solid (dry);

• Aetiology of Paittika Kasa16

1) Excessive intake of pungent, hot, vidahi (which causes burning sensation), sour and alkaline food ;

2) Anger

3) Exposure to the heat of the fire and sun.

• Signs and Symptoms of Paittika Kasa17

1)Yellowness of the sputum and eyes;

2)Bitterness in the mouth;

3)Impairment of voice;

4)The patient splits out phlegm mixed with pitta

5)Morbid thirst, burning sensation, unconsciousness, anorexia, and giddiness .

• Etiology of Kaphaja kasa18 

1) Intake of heavy, abhishyandi which causes obstruction to the channels of circulation sweet and unctuous ingreidients (inexcess) and

 2) Excessive sleep and indolence.

The Kapha gets aggravated because of the the above mentioned symptoms and obstructs the movement of vayu which gives rise to kaphaja type of kaasa.

• Signs and symptoms:19

1) Suppression of the power of digestion

2)Anorexia, Vomiting, Chronic bronchitis, Nausea and feeling of heaviness in the body.

3)Horripilation, sweetness and sticking in the mouth and asthenia.

4)Spitting of thick phlegm in large quantity which is sweet in taste and unctuous .

5)No feeling of pain in the chest while coughing.

Line of treatment20

The patient should be given Vaman, barley and other kapha-alleviating foods that are pungent, unctuous, and hot in potency to eat if their kaphaja kaasa is severe. The patient should have light fare such as kulatha soup combined with alkalies and pippali powder, juice of mulaka made by adding pungent medications, sesame or mustard oil, or bilva. He may also drink honey, sour drinks, warm water, buttermilk, or risk-free alcoholic beverages. They should be consumed before, during, and after meals. Pushkarmool root of Aragwadh and patol should be kept in water for the entire night. The next morning, the water should be dyed out and combined with honey. Katphala, Katruna, Bharangi, Musta, Dhanyak, Vacha, AbhayaSunthi, Shati, Murva ,Gavakshi, Musta and Pippali in paste form along with warm water mixed with Hingu and Saindhava  in the above-mentioned manner the patient should take Nagar, Ativisha, Musta ,Karkatshringi, Haritaki and Shati.

• Kantakari Ghrita:21

One Adhaka of decoction of Kantakari along with its root, fruit, leaf and one Prastha of ghee should be cooked by adding the paste of Sauvarchal, Yavakshar, Pippalimoola, Pushkarmoola, Chavya,  Bala, Sunthi, Pippali, Marich, Vidanga, Shati, Chitraka, Bharangi, Rasna Duralabha, Amlabvetas, Shringi, amalaki, and Gokshur.

• Dashmooladi Ghrita22

One Adhaka of the Dashmoola decoction should be added to one PRASTHA of ghee, along with one Aksha of the paste made from Pushkarmool, Shati, Bilva, Sursa, Sunthi, Pippali, Maricha, and Hingu. The patient should be offered Peya (thin gruel) as a post-meal beverage after consuming this medicinal ghee. It treats all forms of asthama brought on by Vayu and Kapha as well as Kaasa (induced by both).

Aetiology of Kshataj kasa:

 The causative fctor of kshataja kaasa are as follows

1) Excessive indulgence in shake .

2) Carrying excessively heavy load

3) Walking excessively long distance

4) Indulgence in fighting

5) Excessive indulgence in restraining the movement of horses and elephants,

Signs and symptoms of Kshataj kasa 23

1) In the beginning the patient cough without any phlegm output but thereafter, he spits out phlegm along with blood ;

2) He experiences excessive pain in the throat and feels as if the chest is cracking

3) He feels pricking pain as if pricked by sharp needles.

4)He gets excruciating pain and discomfort by touch

5)He feels miserable because of piercing type of pain

6)He feels miserable due to piercing type of pain.

Aetiology of Kshayaja kasa 24

1)Intake of vishama or irregular type of meals and unwholesome food

2) Excessive indulgence in sex

3) Suppression of natural urges;

4) Immensely hateful disposition and

The agni (gastric fire) is adversely affected by the aforementioned conditions; as a result, all three doshas are inflamed, leading to kshayaja kaasa, which results in the body being emaciated.

Signs and symptoms and prognosis of kshayaja kasa 25

1) Patient spits phlegm which is foul smelling, green or red in colour and which is like pus;

2) While coughing, feels as if the heart is displaced (falling down from its normal location)

3) He suffers from fever where signs and symptoms of all aggravated doshas

4) He consumes food in excess quantity

5) Voice becomes hoarse

6) His face, complexion, skin, become clean and unctuous

7) Suffers from pain in the sides of the chest, chronic rhinitis, anorexia.

Prognosis: 26

If the patient is strong, the Kshayaja form of Kasa might be felt. However, if the patient is elderly and these two illnesses (kshataja and kshayaj kasa) are in their early stages, they may be treatable. In general, kshayaja kasa is palpable. Old age results in two different sorts of kasa: one is brought on by the kshaya of tissue components, and the other is brought on by the aggravation of doshas.

Premonitory signs with Purvaroopa: 27

Their pre-monitoring symptoms include throat irritation, appetite loss, a sense that their throats are choked with thorns, and discomfort around their hearts.

Samprapti (Pathogenesis): 28

By overindulging in foods that are astringent, highly moist, sour, salty, dry, cold, difficult to digest, and fatty that cause nausea, as well as by suppressing the body's natural urges, exertion, and other factors that either deplete or hinder the dhatus from performing their functions, the apanvata, which is growing or becoming obstructed, moves upward to the site of rasa (the heart), where it causes discomfort in the chest

When combined with Udana, it clogs the throat passages, causes jerky movements of the eyes, back, chest, and flanks that hurt and sound like a broken bronze bell when they come out of the open mouth, and causes a loss of color—that is, of complexion, brilliance, vigour, and physique—as well as depletion of colour throughout the body.

Kaphaja kasa symptoms: 29

When a person has kaphaj kasa, they have slight chest discomfort, lack of mobility, a sense of weight in the head and around the heart, a coating of sputum in the throat, weakness, runny nose, vomiting, loss of appetite, horripilation, and expectoration of thick, slimy, and white sputum.

Kaphaj Kasa Chikitsa:

In addition to the powders of Vyosha and Yavakshar, the patient with kaphaj kasa (cough brought on by severe kaphaj dasha) should first consume oil exuded from Surakashtha that has been lit on fire. He should next get the necessary head Nasya (nasal medicine), downward purgatives, and upward purgation (emesis treatment). Strong purgatives may be given to a strong individual. Leha (Linctuses) prepared from drugs enumerated in the following seven half verses, used along with honey cures Kaphaj kasa.

• Pippali, Pippali mool, Shrungavera, and Bibhitak
• Ash of feathers of peacock and cock and Kshar prepared from Yava.
• Vishala, Pippali mool and Trivrit.

Powder of marich should be licked with honey or jongala with honey or juice of any one out of Kasaghna, Vyaghri, Bhringa, Vartaka,  Horse dung and asita Surasa (Krishna Tulsi).

According to Acharya Sushruta

• Aetiology with Samprapti 30

The reasons of high cough and asthma attacks are the same ones that induce coughing, and they are outlined below. The entry of smoke or dust particles (into the nostrils and larynx), over exhaustion, physical exercise, excessive use of any dry or parched food, any food going the wrong way, voluntary suppression of sneezing or of any natural propulsion of the body are just a few of the factors that can derange the vital Vayu of the body, also known as Pranavayu, along with other doshas (pitta and kapha). As a result, it is abruptly forced upward and released through the mouth. It then joins with the disorganised Udana vayu (located in the trachea), creating an odd sound that sounds like a broken Indian bell metal. This is known as kasa.

• Specific Symptoms:31

A person affected with the Kasa of the Kaphaja type complains of the sticky sense in the mouth, a sense of physical lassitude, headache, aversion of food, a sense heaviness in the body, itching, frequent bouts of cough and thick mucous expectoration are the features with which distinguishes it.

• General Treatment32

Long-lasting coughs might be quickly cured by taking a mixture of Shrungi, vacha, Abhaya, Bharangi, Devadaru, Vishwa, katphala, Katrina, Musta, Dhanyaka, and Hingu in hot water.

A patient with a cough should take Krishna and Saindhava salt with warm water, or use sugar, amalaki, fried paddy, magadhi, and sunthi mashed together and combined with honey and clarified butter.33

He had to use nagara, pippali along with teakle or lambative made from draksha paste combined with honey and clarified butter.34

When dealing with a coughing fit, one should combine equal amounts of harenuka and magadhika with curd as a pounding agent. It is recommended to take the two types of haridra, devdaru, shunthi, and pith of a gayatri tree, crushed and combined in equal portions.

Treatment of Kaphaja kasa:35

Inhalation of dhuma :The patient is made to inhale the smoke of a varti (medicinal stick) composed of bharangi, vacha and hinga ,pounded together and mixed with clarified butter or with the scrapings of bamboo, ela and lavana mixed with clarified butter. In the alternative sidhu (a kind of wine) should be taken in combination with maricha whereby a bout of cough would be instantaneously subdued. Milk duly boiled and cooked with the admixture of draksha, Ambu (valka, manjishtha and pura (guggulu )should be taken with honey.

Discussion

The Prana and Udana Vayu are responsible for normal functioning of Praanvahasrotas. The vitiation of these can lead to manifestation of Kasa (cough). Kasa is one the troublesome disorders and it may turn into chronic if not treated well in time and also lead to some serious problem like bronchitis, chronic, prostatic pulmonary disorders, pulmonary  eosinophilia etc. Acharya Charaka gave numerous formulations in Ayurveda  including Snehapana, vamana, virechana, vairechanika nasya (nasal catarrhal), dhumapana (medicated cigaretes) are indicated as treatment modalities in different types of kasa. Intake of the powder prepared out of vidanga, nagara, rasna, pippali, hingu, saindhava lavana, bharangi and kshara along with appropriate quantity of ghrita is beneficial in vataja kasa, kaphaja kasa, shwasa, hikka and suppression of digestion power. Basic principle of treating kasa is, if kaphaja kasa is associated with tamaka(a type of shwasa) then at this stage of kasa, therapies prescribed for pittaja kasa should be administered. If there is association kapha in vataja kasa the kaphahara measures should be administered. If pitta is associated with vataja and kaphaja kasa then pittahara measures should be followed. If vataja and kaphaja kasa are associated with expectoration of phlegm, then rukshana therapy should be followed, whereas if not associated with phlegm then snigdha therapy should be administered.

Conclusion

In ayurveda there are several medicines available with least side effects to treat Kasa like Katphala, Katruna, Bharangi, Musta, Abhaya Sunthi, Shati as single drug and Dashamuladi ghritam, Kantakari ghritam, to prevent from various side effects and to get cure early Ayurveda medicine is best effective and soothing effect in kasa, it can be administered for the treating kasa adult as well as child patients.