karshya is an Aptarpanjanyavyadhi. It is a disease in which the body get emaciated, gradually. According to CharakKarshya is described under eight despicable persons (AstauNinditiyaPurush) (1). Ultimately the patients of Karshya are subjected to Balahani (loss of immunity) and proceed towards death (2). These eight physical states are described considering its unwanted clinical and social complications. These undesirable diseases are hereditary, hormonal, and nutritional in origin. In course of time following the untried exploration of ancient physician, afterward the social or community medicine is developed. An approach is made to prevent and treat the disease that is based on the study of human heredity, environmental social structure and values.

Among the eight socially undesirable persons as mentioned by Charak, Karshya has been categorised under nutritional deficiency. Aetiology aetiopathogenesis, sign and symptoms and treatment of Karshya is described in detail in CharakSamhita, Sutrasthan 21st Chapter to combat Karshya and sustain health in community therefore in nation. Altered function of Vayu and Agni leads to insufficient production of Rasa Dhatu. Upososhan of Rasa Dhatu takes place leading to Dhatukṣhaya chronologically. Hence the patient of Karshya suffers from indigestion, malabsorption and defective metabolism. Meda and Mamsadhatukṣhaya at microscopical level, ultimately express its symptoms macroscopically. These sequences are very much correlated to under nutrition. Under nutrition is defined as the outcome of insufficient food intake

Undernutrition is defined as the outcome of insufficient food intake and repeated infectious diseases. It includes being under weight and height from one’s age (stunted growth) with associated vitamin and mineral deficiency (UNICEF). According to FAO reports there are about 460 million, i.e., 15 percent of the world population excluding China who are malnourished, of which about 300 million live in South Asia constituting one third of the population. Globally priority is given to malnourished persons as kwashiorkor, marasmus, xeropthalmia, nutritional anaemia, endemic goitre, morbidity in young children, retarded physical and mental growth takes place as a squeal.

Malnutrition has defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients.

It comprises four forms:-

I.                    Undernutrition

II.                  II. Overnutrition

III.                 III. Imbalance

IV.                IV. Specific deficiency

1. UNDERNUTRITION- This is the condition which results when insufficient food is eaten over an extended period of time. In extreme cases, it is called starvation.

2. OVERNUTRITION- This is the pathological state resulting from the consumption of excessive quantity of food over an extended period of time. The high incidence of obesity, atheroma and diabetes in attributed to over nutrition.

3. IMBALANCE- It is the pathological state resulting from a disproportion among essential nutrients with or without the absolute deficiency of any nutrients.

4. SPECIFIC DEFICIENCY- It is the pathological state resulting from a relative or absolute lack of an individual nutrient.

Definition of Under Nutrition Undernutrition is defined as the outcome of insufficient food intake and repeated infectious disease. It includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin for one’s height( wasted) and deficient in vitamins and mineral(micronutrient malnutrition) [UNICEF].

On other side it is defined as deficient bodily nutrition due to inadequate food intake or faulty assimilation. Types of malnutrition (19) Malnutrition is a group of condition in children and adults generally related to poor quality or insufficient quantity of nutrient intake, absorption or utilization. There are two major types of malnutrition:- 1. Protein energy malnutrition- resulting fromdeficiencies in any or all nutrients. 2. Micro nutrient deficiency disease- resulting from a deficiency of specific micronutrients.

Under nutrition can be assessed by Anthropometric measurements like BMI (weight in kgs/Height in meter2 ) mid upper arm circumference, Waist and Hip ratio.

NIDAN OF KARSHYA 

AHARAJA NIDAN:  

·Langhana 

· Kashaya rasa atiseban 

·  Promitasan

·  Rukshaannapan

·  Vatalaahara·

Viharajan idan 

·Ati Vyayama

· Atisnanabhayas 

·  Ati Vyavaya

·  Dhyana

·  Nidra Nigraha

·  KshudaNigraha

·  Pipasa Nigraha

·  RukshaUdvartan

· ManasikNidan  Bhaya

·  Chinta

·  Krodh

·  Shok·

SAMPRAPTI GHATAK:  

§ Dosa - Vata 

§Dusya - Rasa dhatu

§  Ama- formation of ama due to agnimandya§ Agni- Mandagni 

§  Udvadhathan -Amasaya

§  Srotas affected -Rasa vaha, raktavaha,

§  Type of Srotodusti -Sanga§medavaha, mamsavaha,   Rogmarga - Abhyantarrogamarga

§  Vyaktasthan -Sphiga, Udar, Uriba, Twak,

§  Sadhyasadhyatwa - Kricchasadhya

§ Vyadhiprakar - Chirakari. §Asthi  

UPADRAVA OF KARSHYA

The Karshya patients are prone to develop the following diseases like Pleeha, Kas, Kshaya, Swas, Gulma, Arsha, Udar, Grahani.

CHIKITSA SUTRA (PRINCIPLE OF MANAGEMENT):

1. Laghu Dravya Santarpan Chikitsa that means light and nourishing diet should be administered in KarshyaRogi.

2. In chronic state of Karshya the refreshing therapy should be administered slowly depending upon the physical constitution, power of digestion, Doshas vitiated, nature of therapy, dose, season and time of administration. For such patients, meat soup, milk and ghee of different animals, different types of bath, enema, massage and nourishing drinks are useful.

MANAGEMENT OF UNDER NOURISHED CHILDREN THROUGH AYURVEDA

Ayurveda, the age old science of longevity has its own unique approach in dealing with childhood nutritional disorders. The signs and symptoms of karshya mentioned in Ayurveda (wasted muscles over buttocks, abdomen and neck, prominent veins, bony prominences, loose skin folds, etc.) has close proximity with the signs and symptoms of undernourished children. The cause of karshya is explained as the excess intake of dry food items (biscuits, rusks, namkeen, bread etc.), less intake of food, fasting, psychological causes like anger, fear, grief etc. Here due to the regular faulty dietary habits, agnimandya (diminished digestion) occurs. The ahara rasa formed will not be of good quality and will be inadequate to nourish the dhatus (tissues), gradually resulting in wasting of tissues leading to underweight. The ahara rasa formed from mandagni (diminished digestive power) will result in the formation of ama (toxic substance) which circulates throughout the body and obstructs the channels in the body meant for nourishment, further hampering dhatu poshana. In such circumstances, if the child is given heavy nourishing diet, it will lead to indigestion. Taking the agni into consideration, Ayurveda advocates the use of laghusantarpana (light to digest and nourishing) diet and medicines in karshya. Medicines which are having deepana (appetizing) amapachana and brimhana (nourishing) properties are the drugs of choice. Introducing nourishing diet like khichdi, banana mashed with ghee and jaggery, ragi porridge, curd rice etc., after the agni is ignited, channels being free from obstructions will give promising results in under nutrition.

ADARSH CHIKITSA PATRA

1.       Satavari curna 2gm + Praval panchamrut 250mg (twice with madhu or dugdha)

2.       Yavani sadav curna 3gm + Chitrakadi vati 500mg (teice with water)

3.       Draksharista 20ml + Balarista 20ml (twice with 40ml water)

4.       Chyawanprasha 20gm/ Bramha rasayan 20gm (twice with milk)

5.       Sarvang Abhyanga with Chandanadi taila

PATHYA PATHYA:

Pathya Ahar:

Intake of freshly harvested rice, fresh wine, meat soup of domestic marshy aquatic animals, curd, ghee, milk, sugarcane, Sali rice, masa, wheat sugar candy preparations etc.

Vihar: 

Sleep, joy, comfortable bed, contentment, tranquility of mind, abstinence from anxiety, sexual act and physical exercise, pleasant sight, regular oil massage, unctuous unction bath, use of scents and garlands, use of white apparel etc.

Ousadh:

1. Enema consisting of unctuous and sweet drugs, elimination of Dosas in time and administration of rejuvenating and aphrodisiac drugs.

2. Payashya, Aswagandha, Salparni, Shatavari, Bala, Atibala, Nagbala, etc. Madhuradrugs should be administered. Apathya: Intake of pungent, bitter and astringent substances, oilcake of mustard and til, honey, sexual indulgence, night awakening, excessive physical and mental exercise etc should be avoided in Karshya.