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.
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