Decoding Respiratory Distress: A Yogatantrayukti Perspective

Introduction

The benefits that medical science brings to humanity distinguish it as greater than any other science. The optimum benefits of Ayurveda are gained by understanding its science through the study of treatises, or Samhitas. Various methodologies used to comprehend the Samhitas determine the utility of this science to humanity. Any academic, studying Samhitas through fieldwork can apply this science to understand the geographical facts. In the same way, if a skilled orator comprehends the Samhitas using the Anubandha Chatushtaya method, they can use this knowledge to raise health awareness across diverse mindsets. Thus, in order to fully utilize Ayurveda in clinical practice, one must understand the treatise by applying Tantrayukti as a study tool.

Since 2001, respiratory diseases have been the leading cause of death, and since then this trend has been evident with annual increase in incidence and prevalence rates. Several fatal disorders can present with respiratory distress as a symptom, particularly in the terminal stages.

Hikkashvaasa chikitsitam adhyaya in Charaka Samhita provides a comprehensive overview of the concept of respiratory disorder. Therefore, it becomes essential to comprehend the pathophysiology associated with respiratory distress by studying the chapter using Yogatantrayukti as a study tool. Yogatantrayukti is a study tool used to arrange the words or verses in a systematic and proper order.

The goal of this paper was to analyze the sutras from Charaka Samhita Hikkashvaasa Chikitsitam Adhyaya that deals with samprapti of Shvaasa. Further to apply Yogatantrayukti to the sutras concerning the pathophysiology of Shvaasa and arrange the corresponding sutras from the Charaka Samhita in a new and organized manner. Consequently, to comprehend the underlying reasons of respiratory distress.

Discussions

Rearranging the words in a sutra or setting up several sutras in a specific order is crucial for comprehending the manifestation of any disease. Understanding the literature on Shvaasa makes this clear.

When the sutra which deals with Shvaasa samprapti is studied without applying yogatantrayukti, it says that “when marutha enters the channels of pranavaha, srothas gets agitated and triggers the kapha dosha which is located in lungs (urah) in upward direction, thus causing  respiratory distress (shvaasa)”.¹ This kind of understanding does neither meet the Ayurvedic description of pathophysiology nor aid in the analysis of respiratory distress in patients with simple allergies, chronic renal failure, cirrhosis of the liver, anaemia, or other medical  conditions.

Ayurveda defines Samprapti as ‘the method which explains the process of vitiation  of doshas along with path in which they travel during the manifestation of diseases’.² However, the above-mentioned explanation on manifestation of shvaasa does not support this interpretation of samprapti. Moreover, the important discussion that emerges in this scenario is whether it is necessary to comprehend shvaasa as a  distinct illness or understanding shvaasa as a symptom of another disease should be the exclusive focus of this chapter and this article answers those questions.

The chapter begins with question raised by Agnivesha about diseases that are difficult to cure for which Acharya Aathreya responds, "there are many diseases that can be fatal, but none of these are as deadly as shvaasa”.¹ This means that a patient experiences respiratory difficulty at the final or terminal stages of their life.  It is evident from this that the respiratory failure that develops as a consequence to other diseases is also covered in this chapter. Additionally, this chapter clarifies the report's assertion that the "patient died of respiratory failure was suffering from End Stage Renal Disorder (ESRD) or so forth." Hence this is the chapter which deals with understanding of shvaasa as an independent disease as well as a complication of some other primary disease.

Pathophysiology of Shvaasa / Respiratory Distress

Respiratory distress due to allergens

Dust and smoke were noted to be mentioned in the beginning as causes of respiratory disorders, followed by diet and lifestyle choices.¹ The comprehension of respiratory illnesses due to allergies  was done by placing another sutra from a different chapter next to it. Replacing that sutra helps to understand the impact of the external factors like dust, smoke allergens on the body. The early signs of respiratory disorder correspond to the external factor (aagantu) entering the body.³ A person may begin to experience symptoms like  sneezing or redness, itching of eyes, if they are exposed to dust, but they may start with running  nose when exposed to pollen grains. Following this (Hetu lakshana), dosha-related symptoms (Nija vyanjana) will manifest.⁴ Therefore, while treating a patient with history of allergies leading to respiratory disorders, one must follow the method of assessing dosha dominance to get rid of allergens.

Respiratory distress due to obstructive pathology

The second category of causes responsible for shvaasa are “Vibandhaihi cha pruthagvidha” i.e., different range of blockages in various circulatory pathways.⁵ Various obstructions, such as abscesses, swelling, tumors, engorgement, or pressure in various channels from the outside, which can be  intra- or extra-abdominal affecting the liver, kidney, and other organs can lead to respiratory distress. In order to comprehend this obstructive pathology, one must put the 21st verse in the sequence next to the 16th sutra, which clears the site of obstruction. It says that channels carrying Praana, Udaka, and Anna gets obstructed, thereby vaata along with   kapha causes respiratory distress.⁶ In order to understand distribution of Praanavaha, Udakavaha and Annavaha Srotas, one has to apply yogatantrayukti. The sutras from Siddhisthana which declare that Pranavaha Srota is distributed throughout Shiras (the cranial area), Hrudaya, and Uras, must be arranged in order to comprehend the dimensions of the aforementioned Pranavaha srotas.⁷ Thus, any infections of brain leading to respiratory failure can be understood. Maha shvaasa, one of the types of shvaasa can be included under this.

To appreciate the accessibility of Udakavaha srotas, it is necessary to apply the verse from Shareera sthana next to the above one. This sutra states that when udaka exceeds in quantity, it begins to flow through channels that carry sweat, urine, faeces and fluid tissues like rasa  and rakta.⁸ To describe it in other words, excessive amounts of fluid in the body are balanced through the excretory system, which include large intestine (into fecal matter), kidneys (into urine), skin (as sweat), liver (by merging with rasa and rakta dhatu). This manifests as profuse perspiration, frequent urination (as in diabetes mellitus), and watery faeces (as in diarrhoea). This excretion continues till there is no blockage  in these four excretory organs.

The next stage of manifestation (movement of dosha) is explained in the 45th sutra of the chapter which states that if these fluids in flow (known as kaphapurvaka marutha) are obstructed, the condition worsens (referred to as ‘udeeryate bhrushataram’) and circulates throughout the body (Vishwagvrajathi).⁹ Hence this is the sutra which needs to be arranged by yogatantrayukti. If these disorders are not managed appropriately or if there is obstruction of excretions (such as in case of renal failure due to DM, severe diarrhoea), it results in respiratory distress as the lungs are fifth in order as an excretory organ. This loop is understood only when the sutra from the 20th chapter of chikitsa sthaana is arranged in sequence by applying yogatantrayukti. It says that exacerbated dosha is manifested as shvaasa if there is blockage in the channels that convey pureesha, mootra, and sveda.¹⁰ Hence the manifestation of respiratory distress in sepsis, in renal failure cases or diarrhoea leading to acute respiratory distress can be understood.

When yogatantrayukti is applied to the words of the verses present only in Hikkashvaasa adhyaya, it helps in understanding the expression of vitiated doshas in the body and the inherited nature of disease. Hence it is important to understand any disease in terms of alterations that occur in functional and qualitative aspects of doshas in response to various causes. This can be corelated to molecular pathology. The symptoms and signs explained in the same chapter which helps to diagnose the disease are based on expressions of vitiated dhatu and mala. This can be corelated to clinical pathology.

When yogatantrayukti is applied to different verses instead of words, one must arrange many related verses from shareera sthana, chikitsa sthaana and siddhi sthana. Arranging these verses related to the concept of respiratory distress helps to understand involvement of anatomical structures that are responsible for causing respiratory distress. The different channels that carry body fluids and its relation with excretory organs and different types of vitiation of these structures are understood by this method of application of yogatantrayukti. This method of diagnosis of disease based on involvement of anatomical structures can be corelated to anatomical pathology.

Conclusion

1. Samprapti of respiratory distress is discussed in the chapter ‘Hikka-Shvaasa’, both as a primary disease and as a symptom observed secondary to other disorders.
2. In order to comprehend the pathology behind respiratory distress due to end stage renal disorder, application of yogatantrayukti to shvaasa samprapti sutra is necessary. The mechanism of fluid flow into the lungs is understood by yogatantrayukti as when there is obstruction in excretory organs like skin, liver, large intestine and kidney, the fifth excretory organ, the lungs get overloaded with fluid that is supposed to be expelled out of the body. Hence one can end up with respiratory distress due to fluid overload in lungs.
3. In diabetic patients with hypertension, frequent micturition or diarrhoea, special attention is needed for correcting fluid imbalance in the body because these associated complaints are indicative of fluid overload either in circulatory system or in kidney or large intestine. This is understood by Yogatantrayukti in verses explaining the cause of shvaasa.
4. The molecular, clinical and anatomical pathology of respiratory distress can be understood by studying the chapter using yogatantrayukti.
5. Applying yogatantrayukti to the words present in verses of Hikkashvaasa Adhyaya and understanding the signs and symptoms of vitiation of doshas, dhatu and mala, i.e., breathing sounds resembling intoxicated bull, bewildered eyes, shattered voice, oliguria, constipation, in case of mahashvaasa can be corelated to molecular and clinical pathology of the diseases.
6. Applying yogatantrayukti to verses related to shvaasa from chikitsa sthaana, shareera sthana and siddhi sthaana explains the involvement of udakava srotas, pureeshava srotas, raktavaha srotas, shiras and svedavaha srotas in the manifestation of respiratory distress. This helps to understand the anatomical pathology of the disease.

Representation of respiratory distress caused by Udakavaha Srotas

Conflict of Interest

None