Ayurveda Treatment Methods

A Guide Line To Ayurveda Treatments & Principles

KASA (COUGH) Treatment Protocol by Ayush

 

Brief Introduction of the disease: Kasa has been described as an independent disorder as well as a symptom of many diseases like Tamaka Swasa (Bronchial Asthma), Rajayakshma etc. Kasa (Cough) is the disease or symptom of respiratory tract occurring due to obstruction of Vata Dosha and its reverse movement. When occurring as an independent disease, it has mainly 5 different presentations as described in classical texts. The characteristic sound and pain of cough produced will be different according to causes of Dosha vitiation & nature of obstruction to the forceful movement of the Vata Dosha.

Case definition:- Prana Vayu obstructed in the respiratory tract due to various reasons, attains upward direction and comes out with force making specific sound is called as Kasa.

Various Presentation of Kasa

  • Common clinical features: Kasa Pravriti - Shushka or Sakapha. (coughing – either dry or produc­tive)

Kasa depending upon its presentation is of five types- Table 1.1: Types of Kasa with their characteristics

Features

Vataja

Pittaja

Kaphaja

Kshathaja

Kshayaja

Nature of cough

Dry cough with resonant or hollow sound

Continuous cough

Oral cavity coated with thick saliva/ phlegm

Dry cough in initial stage.

___

Character of Sputum

Scanty, dry and difficult expectoration

Yellow

Excess, slimy and thick expectoration

Dry expectoration stained with blood.

Foul smelling, greenish haemoptysis with pus.

Pain

Pain in Hrut-parshva-urah-shira

Burning sensation in chest.

Painless coughing.

Excessive pain in throat, pricking pain in chest

___

Voice

Hoarseness of voice

Change in voice

__

Change in voice with rhonchi

___

Associated features

Dryness of chest, throat, mouth

Bitterness of mouth, Burning sensation in throat, chest etc

sweetness and stickiness in mouth, Sinusitis,

___

pain in flanks, Sinusitis, feeling

 

Feeling of fullness of chest & heaviness of body

hollowness in chest,

Systemic features

Anorexia, Giddiness, Weakness, Unconsciousness

Fever, Thirst, Anorexia, Pandu Giddiness, Unconsciousness

Diminished appetite, Anorexia

Fever, Arthralgia, Dyspnoea, Thirst

Fever, sudden desire for hot & cold, glossy & clear skin, consumes excessive food; but weak and emaciated, unformed/ hard stool.

           

 

 

 

Differential Diagnosis:

  • Tamaka Swasa
  • Rajayakshma
  • Kshataksheena
  • Kapha Pittaja Jwara
  • Vata Kaphaja Jwara
  • COPD
  • Bronchitis
  • Bronchiectasis.

LEVEL 1: AT SOLO AYURVEDA PHYSICIAN’S CLINIC/PHC

Clinical Diagnosis: Kasa Pravriti (coughing), Aruchi (anorexia), Jwaranubhuti (feverish), Kaphasthivana (expectoration) and other specific Doshaja symptoms as mentioned above.

Examination:

  • Throat congestion - In almost all types and more specifically in Pittaja and Vataja Kasa.
  • Muco-purulent (greenish) sputum with foul smell – Kshayaja Kasa.
  • Raised body temperature, raised pulse or feverish feeling - Pittaja, Kshataja, Kshayaja Kasa.
  • Emaciated and debilitated general condition along with fever, muco-purulent sputum, - Kshayaja Kasa.
  • On auscultation of chest,

o Congestion, crepitation due to mucus/fluid trapped air – Kaphaja Kasa

o Wheezing in Vataja or Pittaja Kasa.

 

Investigation: No specific investigation is required to be performed in this level.

Line of treatment:

In Vataja Kasa-

  • Snehapana - Ghrita with diet of Peya, Mudagyusha or milk
  • Snigdha Swedana - Apply Sneha on chest area (Abhyanga), and then hot fomentation with warm hot water bag or hot Erand Patra1 (for 20 minutes).
  • Parisheka Snigdha Parisheka, pref­erably Ushna Jala Siddha with Erand Patra2, Tila Taila.3
  • Dhoomapana - Snaihika

In Kaphaja Kasa-

  • Dhoomapaana - with Vairechanika Dhooma using Maricha4, Pippali5, Ela6, Surasamanjari7 in conditions of Shirahshoola, Nasasrava, Urogaurav. (heaviness in chest due to congestion)

Table 1.2: Common medicines at level 1 for Kasa

Drugs

Dosage form

Dose

Time of administration

Anupana

Vasa Svarasa8

Swarasa

20 ml

two to three times

Honey

Bibhitaki Kwatha9

Decoction

20 - 40 ml

Twice a day

Luke warm water

Bibhitaki Choorna10 + PippaliChoorna11

Powder

2 gm + 1 gm

Twice a day

Luke warm water

Yastimadhu Churna12 + Sitopaladi Churna13

Powder

1 gm + 2 gm

Twice a day

Honey

 

Vataja Kasa- The treatment should be started with Snehana with ghee, Peya/Yusha/Kshira prepared with Vataghna drugs, Abhyanga, Parisheka, Snigdha Sveda.

Table 1.3: Medicines at level 1 for Vataja Kasa

Drugs

Dosage form

Dose

Time of administration

Anupana

Kantakaari Ghrita14

Ghee

10 ml

Empty stomach in early morning and evening

Warm water

Pippalyadi Ghrita15

Ghee

10 ml

Empty stomach in early morning and evening

Warm water

Rasna Ghrita16

Ghee

10 ml

Empty stomach in early morning and evening

Warm water

Talishadi Choorna17

Powder

3 gm

Twice a day

Ghee and honey

Dashmoola Kwatha18

Decoction

10 ml

Twice a day

Sharkara and Ghrita

Agastya Haritaki19

Avaleha

6-12 gm

Warm water/milk

               

 

Table 1.4: Medicines at level 1 for Pittaja Kasa

Drugs

Dosage form

Dose

Time of administration

Anupana

Vasa Churna20

Powder

3 gm

Twice a day

Madhu or Sharkara

Trinapanchmula + Pippali21 + Drakshakashaya22 Siddha Kshira

Medicated milk

Twice a day

Madhu or Sharkara

Gojihvadi Kwatha23

Decoction

10 ml

Twice a day

Water

Drakshadi Leha24

Avaleha

6-12 gm

Twice a day

Warm water/ milk

Kantakaryadi Kwatha25

Decoction

12 – 24 ml

Twice a day

Water

               

 

Table 1.5: Medicines at level 1 for Kaphaja Kasa

Drugs

Dosage form

Dose

Time of administration

Anupana

Trikatu + Vasa

Powder Lehana

3gm+ 2 gm

Twice a day

Madhu

Sitopaladi26 + Bharangi27

Powder Lehana

3gm + 1 gm

Twice a day

Madhu

Pippali28 roasted with Tila Taila29

Powder

Twice a day

Sharkara

Devadaaru30 + Haritaki31 + Musta32 + Pippali33 + Shunthi Churna34

Powder Lehana

1 gm each

Twice a day

Madhu

               

 

 

Referral criteria:

  • If patient not responding to above therapy.
  • In the cases where complications arise.
  • If further investigations are needed.
  • In case of Kshataja (blood stained sputum) and Kshayaja Kaasa

LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASIC FACILITIES

If patient is not responding to level-1 treatment, following investigations should be carried out.

  • Hemogram with ESR
  • Sputum
  • X-Ray Chest PA View

Treatment: Treatment given in level -1 may be continued. Following medicines may be added.

Table 1.6: Common medicines at level 2 for all type of Kasa

Drugs

Dosage form

Dose

Time of administration

Anupana

Chandramrut Rasa35

Vati

1 Tab

Twice a day

Ajadugdha in Vata, Gojihvadi Kwatha36 in Kapha, Draksharishta37 in Pitta

Bhagottara Gutika38

Two tabs

2 Tab

Thrice a day

Luke warm water

Lavangadi Vati39

Vati as lozenges

6 pills/day

Six time a day

-

Khadiradi Vati40

Vati as lozenges

6 pills/day

Six time a day

-

Samasharkara Churna41

Powder

2-4 gm

Twice a day

Honey

 

 

 

Table 1.7: Medicines at level 2 for different type of Kasa

Drug

Dosage

Dose

Time of Administration

Duration

Anupana

Vataja Kasa

Chandrmrut Rasa42

Powder

125 mg - 250 mg

Thrice daily

1-2 weeks

Sitopaladi Churna & honey

Kantakari Avaleha43

Granules

10gm

Twice daily

1-2 weeks

Sameerapannaga Rasa

Powder

60 mg

Twice daily

1-2 weeks

Sitopaladi Churna & honey

Pittaja Kasa

Shati Churna

Powder

2-3 gm

4-5 times a day

1 week

With Honey

Draksharishta44

Arishta- Liquid

10-20 ml

Twice daily

2 weeks

With equal quantity of water

Vasavaleha45

Granules

10 gm

Twice daily

2-3 weeks

Bharangyadi Avaleha46

Granules

10 gm

Twice daily

2-3 weeks

Kaphaj Kasa

Shrungyadi Churna

Powder

2-3 gm

4-5 times a day

1 week

With Honey

Vyaghriharitaki Avaleha47

Granules

10 gm

Twice daily

2-3 weeks

Agastya Haritaki Avaleha48

Granules

10 gm

Twice daily

2-3 weeks

                   

 

 

Kantakari Avaleha49

Granules

10 gm

Twice daily

2-3 weeks

Kaphaketu Rasa50

Powder

125-250 mg

Twice daily

1-2 weeks

Talisadi Churna with honey

Abhraka Bhasma51

Powder

125-250 mg

Twice daily

1-2 weeks

Sitopaladi with honey

Mrigashringa Bhasma52

Powder

125-250 mg

Twice daily

1-2 weeks

Sitopaladi with honey

Kshataja Kasa

Eladi Gutika53

Tab

2 tab

Thrice daily

2-3 weeks

Kushmand Avaleha54

Avaleha

10g

Twice daily

2-3 weeks

Warm milk

Kshayaj Kasa

Draksharishta55

Arisht- Liquid

10-20 ml

Twice daily

2-3 weeks

with same quantity of water

Shwasakuthara Rasa

Tablet

125-250 mg

3-4 times a day

2-3 weeks

with honey

Malla Sindura

Powder

30 mg

Twice daily

1 week

With Vyaghri Haritaki / honey

Shringarabhra Rasa

Powder

125-250 mg

Twice daily

2-3 weeks

Sitopaladi with honey

Shwaskaschintamani Rasa56

Powder

125-250 mg

Twice daily

2-3 weeks

Sitopaladi with honey

                 

 

 

Referral criteria:

  • If patients not responding to above therapy.
  • Koch’s lesion or pleural effusion found in chest x-ray.
  • In the cases where complications arise.
  • If further investigations are needed.

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL

LEVEL OR DISTRICT HOSPITAL/ INTEGRATED AYURVEDIC

HOSPITALS

If patient is not responding to level-2 treat­ment, following radiological investigations should be carried out.

  • CT scan- for further confirmation of diagnosis.

 

  • Sputum Culture.
  • 2D Echo

 

Treatment: Treatment given in level -2 may be continued.

Panchakarma: Panchakarma may be carried out in following conditions of Kasa.

  • Vamana: In Kaphaja or Bahukaphapittaja Kasa, only in patients with good strength.
  • Virechana: In Paitika Kasa with Tanu Kapha - Madhura Dravya Samyukta Trivrit Virechana

In Paitika Kasa with Ghana Kapha Tikta Dravya Samyukta Trivrit Virechana.

  • Shirovirechana: Kaphaja Kasa - Apamarga57, Tulsi58, Shigru Patra Swarasa59, Katphala60
  • Niruha Basti: In Vataj Kasa associated with Purisha and Adhovayu Vibandha
  • Anuvasana Basti: Snehanartha in Vataja Kasa.

REFERENCES

1 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 3 (23)

2 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 3 (23)

3 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 4 (59)

4 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 3 (53)

5 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 4 (42)

6 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.1 (64)

7 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (72)

8 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1 (76)

9 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1 (17)

10 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1 (17)

11 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 4 (42)

12 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1 (79)

13 Charaka, Charaka Samhita, Chikitsa Sthana 8/103-104, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukamba Sanskrit Sansthan; 2007.

 

14 Charaka, Charaka Samhita, Chikitsa Sthana 18/35, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukamba Sanskrit Sansthan; 2007.

15 Charaka, Charaka Samhita, Chikitsa Sthana 18/36-38, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukamba Sanskrit Sansthan; 2007.

16 Charaka, Charaka Samhita, Chikitsa Sthana 18/43-46, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukamba Sanskrit Sansthan; 2007.

17 Charaka, Charaka Samhita, Chikitsa Sthana 8/145-148, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukamba Sanskrit Sansthan; 2007.

18 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (4:10)

19 Charaka, Charaka Samhita, Chikitsa Sthana 18/57-62, In: Yadavji Trikamji Acharya, Reprint, Varanasi: Chaukamba Sanskrit Sansthan; 2007.

20 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1 (76)

21 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 4 (42)

22 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (21)

23 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 2 (4:7)

24 Sri Govinda Dasa, Bhaishajya Ratnavali Kasachikitsa 15/6, In: Ambikadutta Shastri, Chaukhamba Prakashan Varanasi, 2009

25 Sri Govinda Dasa, Bhaishajya Ratnavali Kasachikitsa 15/28, In: Ambikadutta Shastri, Chaukhamba Prakashan Varanasi, 2009

26 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (7:34)

27 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (13)

28 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 4 (42)

29 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 4 (59)

30 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 4 (12)

31 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 1 (31)

32 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (59)

33 Anonymous, The Ayurvedic Pharmacopoeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol 4 (42)

34 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol.1 (65)

35 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (20:16)

36 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 2 (4:7)

 

37 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (1:20)

38 Sri Govinda Dasa, Bhaishajya Ratnavali Kasachikitsa 15/127-129, In: Ambikadutta Shastri, Chaukhamba Prakashan Varanasi, 2009

39 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (12:26)

40 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (12:26)

41 Sri Govinda Dasa, Bhaishajya Ratnavali Kasachikitsa 15/33-34, In: Ambikadutta Shastri, Chaukhamba Prakashan Varanasi,

42 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (20:16)

43 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (3:4)

44 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (1:20)

45 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (3:2))

46 Sri Govinda Dasa, Bhaishajya Ratnavali Kasachikitsa 15/5, In: Ambikadutta Shastri, Chaukhamba Prakashan Varanasi, 2009

47 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 2 (3:6)

48 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (3:1)

49 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (3:4)

50 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (20:8)

51 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (18:1)

52 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (18:19)

53 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (12:3)

54 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (3:7)

55 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (1:20)

56 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part 2 (16:58)

57 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (7)

58 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (72)

59 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 4 (51,52,53)

60 Anonymous, The Ayurvedic Pharmaco­poeia of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 Vol. 3 (42).