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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.[1] Due to excessive air pollution brought on by globalisation, urbanisation, industrialization, and embrace of western culture, the prevalence of a respiratory ailment has increased. exposure to a variety of chemicals, heavy metals, organic compounds, and inorganic materials. 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, according to Ayurveda, is kasa. The Kaphaja kasa, one of the five varieties of kasa, has gained more prevalence.[2]

Environmental variables including pollutants, allergens, smoke, dust, both active and passive smoking, air pollution, occupational risks, etc. are having a growing impact on it, and these situations are inescapable in daily life. 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. Given that the severity of each form of Kasa grows in turn across the doshic categories of the most crucial condition to cure is kasa kaphaja kasa, which if neglected or ignored may result in crises such tamaka shwas, kshataja kasa, or kshayaja kasa. 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. Kasa is a rapidly degrading condition that, if untreated, can progress to shwas, kshaya, chhardi, swarsad, etc. Kasa should thus be addressed right away.[3,4]

Literary view:  [5-8]

According to:

• Rigveda - Bibhitaka is recommended for kasa roga .
• Atharva veda - Kasa roga is described as one of the upadrava of takman (jwara).
• Charaka Samhita - In Charaka Samhita, Kasa vyadhi is described mainly in its chikitsa sthana.
• Sushrut Samhita - In this Samhita description of Kasa vyadhi and its treatment is mentioned in uttar tantra.
• Ashtang Hrudaya - 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.
• Sharandhar Samhita - Kasa vyadhi is explained with all its types in chapter 7th of poorvakhand.      
• Bhavprakash - In madhyam khanda 12th chapter, Kasa vyadhi is described.

Etymology of Kasa

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

According to Acharya charaka9-10

Kasa is the word for loud, obstructed air that is ejected through the larynx. Chapter 18 of Chikitsasthan contains an explanation of Kasa and how it is treated by Charaka. It covers the ayurvedic remedies for cough and related illnesses, as well as their causes, kinds, and treatments.

Here are five types of Kasa (cough)

1)           Vatika kaasa

2)           Paitika kaasa

3)           Kaphaja kaasa

4)           Kshataja kaasa

5)           Kshayaja kaasa.

1. Premonitory signs and symptoms of Kasa (bronchitis)

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.

The patient during the premonitory stage of kasa becomes incapable of taking food because of associated anorexia or because of his inability to swallow food.

1. Purvaroopa of kasa 11,12

1) Shukapurna galasyata (a feeling of congestion in throat).

2) Kanthe kandu (Itching sensation in throat)

3)Bhojyanam Avrodh (Obstruction to the movement of food in the gut)

1. Pathogenesis (samprapti)13

The bottom region of the body is where Vatadosha becomes blocked. As it goes higher, it affects the upper body's circulatory system, takes over the respiratory system's udana vayu function, and lodges in the neck and chest. This fills up all of the channels in the brain and causes the eyes, mouth, sides of the neck (sterno-mastoid muscle), and Abhanjan and Aksipan of the body to bend. This vayu then results in the constriction and rigidity of the eyes, back, and sides of the chest, which causes coughing that may be dry or with phlegm, thus the name Kasa (cough) (the ailment is called as Kasa because it involves the movement of vayu and because it afflicts chest,etc).

Aetiology of Kaphaja kaasa 14

The causative factor of kaphaja type of kaasa are as follows :

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.          

1. Signs and symptoms

Nisthivateghanam Kapha (secretion of sticky mucous), Kanthe Kandu (itching in throat), Utklesh (Nausea), Peenasa (coryza), Murdhashoola (Headache), Kasatishushkamev (Dry cough), Pandu (anaemia), Mandagni (indigestion), Guruta (heaviness in body), Trishna (thirst) and Vaman (vomiting).

1. Treatment of Kaphaja Kasa 14,15

• If the patient is suffering from kaphaja kasa is strong then he should be given Vaman, barley and such other kapha alleviating ingriedient as are pungent,unctuous and hot in potencty to eat.
• The patient should take light food with the soup of kulatha mixed  with the powder of pippali and alkalies.
• Pushkarmool root of Aragwadh and patol should be kept in water for the whole night next morning the water should be stained out and added with honey they should be taken before during and after meals.
• Devdaru Shati Rasna,Karkatshringi,Duralabha( should be made to powders ) mixed with honey and oil. Intake of this linctus cures Kaphaja Kasa associated wih aggrevated Vata.

Pippali ,Nagara, Musta ,Pathya ,Dhatri, And Sitopala ( should be made to powders ) mixed with honey and oil. Intake of this linctus cures Kaphaja Kasa associated wih aggrevated Vata.

• Kulathadi Ghrita - Ghee cooked with the kulatha qwath and the paste of Panchakol is useful in, hiccups, asthma and, Kaphaja Kasa.
• He should then be administered upward purgation (Emesis therapy), downward purgatives (Purgation therapy) and for the head Nasya (Nasal medication) appropriately. A strong person may be administered strong purgatives.
• Warm decoction of Dashamoola, warm water, vines or honey water processed with roots of Pushkara, Shamyak, Patol kept overnight and mixed with honey should be used the next for drinking during all the three times of meals.

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 Vyaghri, Bhringa, Vartaka, Kasaghna, Horse dung and asita Surasa (Krishna Tulsi)

Gudadi yog

Gudakshara (Yavakshar), ushna, kana and dadim in the proportion of two pala, half aksha(karsha), one karsha, half karsha  and one pala irrespectively licked with honey cures dyspnoea and cough.

Dadimadi Yog

Two pala of dadima, eight pala of Guda(jaggery) and three pala of Vyosha licked with honey improves taste, kindles digestion, improves voice and cures nasal catarrh, dyspnoea and cough.

Other treatment :

Patha, Shunthi, Shati, murva, gavakshi, pippali and Ghana are all masserated in hot water mixed with hingu and saindhava and taken as a drink. Similarly, musta, shati, shunthi, nagar, ativisha, abhaya can also be used or the drugs coming with pathya described in the treatment of fever may be used along with bhringa acts as a digestive or dipyaka, trivrit, vishala, Ghana, pushkar, kana are boiled in cow’s urine or water and taken as a drink by the patient of kaphaj kasa.Kaas Nashak ghrita KantaKari Ghrita, Kantakari Avleha and Smoking therapy has also been told.

According to Sushrut Samhita16-18

Kasa refers to a sound that sounds like kansya-dhatu cracking (Indian bell Metal ). According to where it originated, this illness is split into five categories. As it was brought on by the body's dysfunctional Vayu, Pitta, or Kapha, or because the organism had an ulcer (Kshata), or it was through a wasting process (Kshayaj). Physicians who practise recognise these five forms of kasa, which, when fully established (i.e., if neglected), tend to cause yakshma (Phthisis).

1. Etiology with Samprapti

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). This causes it to be quickly forced upward and released through the mouth, where it joins with the disorganised Udana vayu (located in the trachea) and produces an odd sound that sounds like a broken Indian bell.

1. Pre-monitoring Symptoms

Itching in the throat, a sense of obstruction while eating (Difficulty in deglutination), a sticky feeling in throat and in the palate, changed voice, aversion and dullness of the digestive fire are the symptoms which usher in attack of all the five kasa.

1. Specific Symptoms

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.

1. Treatment of Kaphaja kasa:  19,20

• A case of cough due to the deranged bodily kapha is relieved by the use of trikatu or the clarified butter duly cooked with expressed juice of krimighna (vidanga )or with the expressed juice of the leaves of Nirgundi .
• A clarified butter duly cooked in combination with twice as much as juice of nidigdhika (kantakari) and with the kalka of patha vit-salt, vyosha, vidanga, saindhava, trikantaka (gokshur)  Rasna ,Chitraka, Vata, shringi, vacha, musta and sunthi, process curative in asthama ,dullness of digestion, hoarseness in voice as well as the violent attacks of the different types of cough.
• 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.
• Similarly a patient suffering from an attack  of cough due to vaat and kapha should inhale the smoke of a varti prepared with musta bark of ingudi, yashtimadhu and mansi, manashila amd Hartaal pasted together with goats urine and then take a draught of milk.
• Milk duly boiled and cooked with the admixture of draksha ,Ambu (valka,manjishtha and pura (guggulu)should be taken with honey.
• Well boiled mudga should be taken with powdered kantakari ,Nagara ,and pippali mixed with honey.
• Utkarika prepared with clarified butter mula and truti (ela) leaves of vadara  and a copious quantity of powdered nagara should be used.
• A thin peya prepared with preceeding drugs may be taken cold in combination with honey.

1. Samprapti ghataka`s of Kaphaja kasa

• Dosha - Kapha, Vata
• Dushya - Rasa
• Agni - Jatharagnimandya
• Ama - Jatharagnimandyajanyaama
• Strotas – Pranavaha and Rasavaha
• Srotodusti - Sanga
• Udbhavasthana - Amashya
• Sancharasthana - Rasayani (Srotas)

Adhishtana Urahpradesha

Discussion

Kasa (cough) can manifest as either Pradhan Vyadhi or Updravya of any ailment, making its diagnosis difficult. The comprehensive understanding of the Nidana (aetiology), Purvaroopa (prodromal symptoms), Roopa (symptoms), Samprapti (pathogenesis), and Samprapti is crucial for the diagnosis of any disease. Kaphaprakopa is caused by the etiological element’s guru, snigdha, utkedi, vijjalaahara, and diwaswapna. These Nidhana exacerbate Kapha in the uras, which prevents Vata from moving lower in the pranavashastrotas. As a result, vata experiences pratilomagati, which emerges as Kasa with Kapha Shteevana. Avasthika samprati and veg kalensamprathi are two categories of Kaphaja Kasa's samprati. Both vata and kapha have a tendency to become vitiated by the causes. The early stages of samprati are udanavatadusti and kaphadusti. Kapha will interfere with udanavata's ability to execute its job, and these doshas will take up residence in Uraha, Kantha, and Shiras. The Samprapti leading to Aadraj Kaphaja Kasa Vega, where Kasa is related with Nishtivana, would be precipitated at Vegakala Vyajakahetu by characters like Raja, Dhuma, and Shithambu.

At various phases of the therapy for kaphajakasa, several modes of approaches are required. The majority of the time, a multi-treatment strategy must be used, says Nidana Parivarjana. It is the most crucial component of therapy. A person with Kaphaja Kasa must avoid things that might provoke it, such as smoking and breathing in dust. To prevent these Nidana, a person occasionally has to change his line of work. Examples include using a mask and avoiding air conditioning. When travelling to cold climates and throughout the winter, patients should exercise greater caution.

Kastoushadhi and Rashushadhi are two single medications that are recommended for Kaphaja Kasa. These have Kasagnaguna, Katu, Ushna, Tikshna, Sukshma, Chedana, and Kaphanissaraka. In Kaphaja Kasa, Trikatu, Pippali, Kantakari Avaleha, and Agastya Haritaki Avaleha are all useful. Rasayana in kaphajakasa can be utilised with Pippali and AgasthyaHaritaki Yoga. Vamana is the first line of Shodhana in the KaphajaKasa. Vamana will drive out Dushita Kapha and relieve Aavarana to Vata, producing a more significant and productive outcome in Kaphaja Kasa.

Conclusion

Cough is seen as a disease in ayurveda, despite the fact that modern science only views it as a symptom. The nature of the cough and the production of sputum can be used to understand the different types of Kasa. Based on the Nidana, Samprati, and Lakshana, chronic bronchitis and kaphajakasa may be connected. First and foremost, according to our acharyas, raja and dhuma are to blame for the manifestation of Kasa since they start the pathological process in pranavahasamprati, and chronic bronchitis can also appear in those who smoke regularly or are constantly exposed to dust at work. In order to cure the Kaphajakasa, Nidana Parivarjana, various Shamnoushdhis, and other Shodhana techniques would be helpful. These Shamana medications most likely include expectorant, mucolytic, and cough suppressant properties.