1

LAKSHANA

jvar rahit rajyakshma lakshan

Kāsaḥ – Cough

śvāsaḥ – Dyspnea

Svarabhedaḥ – Hoarseness of voice

śleṣmaṇaśchardanaṃ – Voiding of phlegm

śoṇitaṣṭhīvanaṃ – Spitting of blood

Pārśvasaṃrojanam – Pain in the sides of the chest

Aṃsāvamardaḥ – Grinding pain in the shoulder

Jvaraḥ – Fever

Atīsāraḥ – Diarrhea and

Arochaka – Anorexia [14] 

2

NIDANA

We shall now discuss “excess physical activity” as an etiological factor of Shosha. When a weak person fights with a stronger one or exerts with too big a bow or speaks too much, or carries too big a load or swims in water for long distance or resorts to forceful massage and application of pressure by feet or runs fast to cover a long distance or subjects himself to assault or indulgers in such other irregular regimens and physical exercises in excess, his chest gets injured due to such excesses. The injured chest saturated with (vitiated) Vata.

The portion which affects the joints of the body causes

Jrumbha – yawning

Angamarda – malaise and

Jvara – fever

The portion which affects the Amashaya (stomach including small intestine) leads to

Arochaka – anorexia and

Urasyaroga – The disease of the chest (like palpitation and cardiac pain)

The portion which affects throat causes

Kanthodhvamsa – irritation of the throat and

Svarabheda – hoarseness of voice

The portion which affects the channels carrying which affects the head causes damage to that part.

Thereafter, due to injury to the chest, irregular movement of the Vata and irritation of the throat, the patient suffers from constant coughing.

Due to continued coughing there is further injury to the chest and the patient spits blood. These are the complications arising out of rash behavior of an individual.

These emaciating complications lead to cachexia. So a wise person should perform various activities with due regard to his own strength. The body is sustained by strength and the individual (Empirical self) by the body.

Thus it is said:-

The individual enjoys the desired fruit of his action only when he is alive. Therefore, one desirous of long life should avoid rash behavior. [4-5] 

DETAILS OF SANDHARANA – SUPPRESSION OF NATURAL URGES AS NIDANA(ETIOLOGICAL FACTOR):

We shall now explain “Suppression of natural urges” as the etiological factor of Shosha.

When an individual suppresses the manifested urges flatus, urine and stool because of apprehension, pre-occupation, bashfulness or hatred in front of the king or master or (while sitting) at the feet of the preceptor or while gambling or attending meetings of gentlemen or in the midst of women, or while travelling in high or low vehicles, then Vata in his body gets aggravated. This aggravated Vata carrying along with it thru provoked Pitta and kapha moves upwards, downwards and sideways.

Different portions of Vata entire into different parts of the body as described before (in para 4) and cause

Shula – colic pain

Purishabhinna – diarrhea

Parshvaatiruja – drying pain in the shoulder region

Aṃsāvavamṛdgāti – increased respiratory movement in the chest and throat

Shiraścopahanti – damage to the head

Kasa – coughing

Shvasa – dyspnoea

Jvara – fever

Svarabhedaṃ – hoarseness of voice could make special efforts not to suppress the manifested urges with a view to sustaining his body.

The body constitutes the root cause of the wellbeing of the individual and the very production of the body is dependent upon the individual self.

Thus it is said:-

Leaving everything else, one should maintain the body. For if there is no body, there is nothing that can be made available to the individual. [6-7]

DETAILS OF SHOSHA (WASTING) AS NIDANA (ETIOLOGICAL FACTOR):

We shall explain wasting ‘as an etiological factors for Shosha’ Rasa residing in the heart of an individual gets diminished due to the following-

Yadāpuruṣo’timātraṃśokacintāparigatahṛdayobhavati – Affliction of the heart of the individual, with excessive grief and worries.

īrṣyotkaṇṭhābhayakrodhādibhirvāsamāviśyate – Affliction with Irshya(jealousy), fear, anger etc. intake of ununctuous diets and drinks by emaciated individuals and

Kṛśovā san rūkṣānnapānasevībhavati – Intake of food in lesser quantity or fasting by persons who are weak by nature.

Due to this diminution of Rasa, the individual is afflicted with Shosha and if this condition is not neutralized, it leads to the manifestation of tuberculosis in a manner to be described later. (1)

LOSS OF SEMEN DUE TO EXCESS SEX AND ITS CONSEQUENCE:

When an individual due to excessive attachment borne out of excessive passion indulges in sexual act in excess, his detached from woman even after the diminution of semen, and he is still determined to indulge in sexual act, he will have no ejaculation of semen during cohabitation because of his semen having been already exhausted.

During the process of coitus vata would enter the blood vessels vata would enter the blood vessels of this individual leading to the ejaculation of blood; the blood being vitiated by Vata, would then enter the seminal channels because of the diminution of semen. Due to the diminution of semen, and discharge of blood, the joints would become loose, there would be dryness and further weakness in the body and aggravation of Vata.

The vitiated VataDosha, while spreading all over the body from where semen is exhausted and aggravating Kapha and Pitta, would dry up(reduces) muscle tissues and blood, eliminate Kapha (Phlegm) grinding pain in the shoulders, irritate the throat, till up the head with Kapha after vitiating the latter. It would also produce malaise, anorexia and indigestion after afflicting the joints.

Due to the vitiation of Pitta and kapha and adoption of opposite course, Vata would then produce

Jvara – fever

Kasa – cough

Shvasa – dyspnoea

Svarabheda – hoarseness of voice and

Pratishyaya – Coryza

Due to the injury in the chest because of continued coughing the patient would spit blood. Due to the loss of blood he would become weak. These emaciating complications would thus lead to cachexia by and by. Therefore his own body because it (semen) is the outcome par excellence of the food taken

Thus it said : – Semen is the outcome par excellence of food. One should preserve his own semen because its diminution leads to many diseases and even death. [8-9]

VISHAMASHANA (IRREGULAR DIETING) AS ETIOLOGICAL FACTOR:

We shall explain the “irregular dieting “ as an etiological factor for drinks and diets, viz drinkables, eatables, chewable and lickables without paying proper heed towards their nature, mode of preparation, combination, quantity, locality, time dietetic rules and wholesomeness for the individual, then Vata, Pitta and Kapha in his body get imbalanced due to this irregularity.

These imbalanced dosha spreads all over the body and when they get localized in view of the obstruction to the entrances of the channels of circulation, then whatever food is taken by the individual is mostly converted into stool and urine rather than dhatus (tissue elements) of the body. The afflicted individual is sustained by the retention of the stool. Therefore, the fecal matter of individuals suffering from Shosha or others who are extremely emaciated or weak is retained. Doshas accumulated due to irregular dieting, separately produce the following in further emaciation, Vata produces

Shula – colic pain

Angamarda – malaise

Antardaham – irritation in throat

Pārśvasaṃrujanam – pain in the sides of the chest

Aṃsāvamardaṃ – grinding pain in the shoulders

SvaraBheda – hoarseness of voice and

Pratishyaya – Coryza

Pitta causes

Jvara – fever

Atisara – diarrhoea and

Antardaha – burning sensation inside the body, and

Kapha causes

Pratishyaya – coryza

Shirogaurava – heaviness of head

Arochaka – anorexia and

Kasa – coughing

Due to excessive coughing there is injury to the chest (lungs) and the patient spits blood. Because of the discharge of blood he becomes weak. Thus the 3 Doshas accumulated due to irregular dieting manifest the disease Rajayakshma (Tuberculosis).

The emaciating complications lead to cachexia by and by. Therefore, a wise person should take such diets as are not unwholesome from the point of view of mature, mode of preparation, combination, quantity, locality, time, dietic rules and the wholesomeness for the individual who takes them.

Thus it is said: – In view of the association of painful diseases with irregular dieting, a wise man with good control over his senses should take wholesome food in proper quantity and in proper time [10-11] 

The 4 causative factors of Shosha, when resorted to lead to the aggravation of Vata, Pitta and Kapha

These aggravated Doshas deplete the body due to varieties of complications. This condition is known as Rajayakshma (lit. king of diseases or disease of the king) because of its most formidable nature among all the diseases and also because according to the mythological story, it afflicted the moon who is the king of stars [12] 

3

PURVARUPA

Its premonitory symptoms are

Pratishyaya – Coryza

Kshavathu – frequent sneezing

Sleshmapraseka – excessive salivation

Mukhamadhuryam – sweet taste in the mouth

Anannābhilāṣaḥ – disinclination for food

Annakālecāyāsaḥ – feeling of tiredness during the meal time

Doṣadarśanamadoṣeṣvalpadoṣeṣuvābhāveṣupātrodakānnasūpāpūpopadaṃśapariveśakeṣu – finding fault with such things as are without any fault or with negligible fault specially that of utensils, water, food soup, cake, Upadamsa (things which are chewed before taking food), and cateres,

Bhuktavataścāsyahṛllāsaḥ – Nausea after meals

Mukhasyapādayoścaśophaḥ – swelling of the face and feet

Pāṇyoścāvekṣaṇamatyartham – frequent inspection of hands

Akṣṇoḥśvetāvabhāsatācātimātraṃ – excessive whiteness of eyes

Bāhvoścapramāṇajijñāsā – enquiry about the measurement of arms

Strīkāmatā – passionate attachment with women

Nirghṛṇitvaṃ – cruel disposition, frightful appearance (discoloration and foul smell) in his body and

Bībhatsadarśanatācāsyakāye – appearance of the following in dreams:

Svapnecābhīkṣṇaṃdarśanamanudakānāmudakasthānānāṃ – Empty water reservoirs

Janapadānāṃśuṣkabhagnānāṃ – villages, towns, cities and countries

Dagdhavanānāṃ – Dried, burnt and denuded forests

Kṛkalāsamayūravānaraśukasarpakākolūkādibhiḥsaṃsparśanamadhirohaṇaṃ – Coming into physical contact with chameleon, peacocks, monkey, parrots, serpents, crows, owls etc

Yānaṃvāśvoṣṭrakharavarāhaiḥ – Riding over dogs, camels, donkeys and pigs or vehicles drawn by them

Keśāsthibhasmatuṣāṅgārarāśīnāṃcādhirohaṇamiti – Climbing over heaps of hair, bones, ash chaff and fire brands [13] 

4

SAMPRAPTI

Nidana sevana-> dhatu kshaya -> vayu dusthi->shosha

5

SAMPRAPTI GHATAKA

DOSHA- vata

DUSHYA- rasadi datu

ADHISTHANA- fuffush,sarvasarira

SHROTAS- rasa,prana & raktvaha

SVABHAVA- daruna

AGINDUSTI- agnimandya

SADHYAASADHYATA- sadhya

A patient even having a few symptoms of the disease and without bad prognostic signs is incurable (like the one having all symptoms and manifested bad prognostic signs). If he is weak and there is diminution of strength, muscle tissue and blood, because he will be unable to resist the effect of the diseases as well as the medicines. He should not be treated. Bad prognostic signs may appear in such patients in time and even without any causative factor. [16]

6

SHOSHA – RAJAYAKSHMA – DIFFERENCE 

Raja Yakshma means the ‘king of diseases’. This condition has been often compared to tuberculosis, chronic pulmonary diseases or consumption. Some experts have also compared it to some autoimmune disorders and also with AIDS.

1. BY NAME AND DEFINITION

In the pathogenesis of rajayakshma it is said that ‘all the body tissues will get depleted and consequently the person undergoes desiccation or dried up’. Therefore in rajayakshma initially the tissues will get depleted and then the person as a whole gets desiccated.

In shosha the tissues get depleted of their fluidity and get desiccated. As a result the tissues dry up. Later they may undergo depletion.

2. BY ETIOLOGICAL FACTORS

Below mentioned four etiological factors are mandatory in the causation of rajayakshma. Indulgence in one or more of these factors is compulsory if tissue depletion has to happen, leading to rajayakshma. They are –

• Forcibly withholding to the natural urges of the body like those of feces, urine, thirst, hunger, tears etc

• Tissue depletion as caused by etiologies like indulgence in excessive sex, starvation, excessive bleeding etc and also due to mental causes like excessive grief, jealousy etc.

• Indulgence in excessive exercises like running, wrestling, riding etc

• Irregular eating / eating without following the eating etiquettes or by breaking the rules and regulations of dieting

The etiological factors for shosha are specific to the types of shosha. Reading it the other way, a particular etiological factor will cause particular type of shosha. They are –

• Excessive indulgence in sex

• Excessive grief

• Ageing and getting old

• Excessive indulgence in exercise

• Excessive walking

• Ulcers and wounds

• Chest injury

The above said causes will lead to manifestation of tissue desiccation of the same names.

3. BY PATHOGENESIS

Rajayakshma has a pathogenesis of its own. It happens in one of the below mentioned ways –

Antero-grade deterioration and depletion of tissues – Here the doshas, mainly kapha predominant doshas will block the channels carrying rasa tissue i.e. lymph. As a result the successive tissues which should be formed in chronology i.e. blood, muscle, fat, bones, bone marrow and semen in that order, are not formed properly. There is quantitative depletion of all tissues and the person gets dried out.

Retrograde depletion of tissues – In this case, in a person who is excessively indulged in sexual activities, the semen tissue gets depleted. It is depleted in such great pace that the predecessor tissues get depleted in order to compensate for the loss of semen. As a result, all tissues undergo retrograde depletion in reverse order i.e. bone marrow, bones, fat, muscles, blood and lymph in that order. Following this the person gets dried out.

The types of shosha do not undergo such type of pathogenesis. The tissues are desiccated and wasted out due to their related etiological factors as mentioned above.

4. BY TYPES

Rajayakshma is of one type. It is also said to be of four types as caused by individual causative factor mentioned above.

Shosha is of 7 types. They carry the name of the etiological factor specifically related to them. The etiological factors have been mentioned above.

5. BY PREMONITORY SYMPTOMS

Rajayakshma has premonitory symptoms which occur before the manifestation of the actual disease. Important premonitory symptoms include short of breath, body pains, excessive salivation, dryness of mouth, loss of appetite, vomiting, intoxication, cough, excessive sleep, rhinitis etc.

Shosha doesn’t have premonitory symptoms. This means to tell that these conditions develop almost immediately or quickly after exposure to their related etiological factors while Rajayakshma goes through the chain of events constituting the pathogenesis of the disease.

6. BY SYMPTOMS

Rajayakshma symptoms present in a strange way. The disease has generalized symptoms which comprises of three symptoms complex. At the same time it also has variants of presentation of symptoms in the form of a collection of 6 and 11 symptoms.

Generalized symptoms of Rajayakshma – the three symptom complex

• Raised heat / burning sensation in the region of shoulder blades and flanks

• Burning sensation in the hands and feet

• Fever with rise in temperature in the entire body

Six symptoms of Rajayakshma

• Aversion towards food

• Fever

• Shortness of breath / dyspnea / breathlessness

• Cough

• Expectoration of blood / hemoptysis

• Hoarseness of voice 

7

PRICIPAL OF CHIKITSA 

Sandhaniya dravya- rakta roknae ke liye

- Brahman dravya- dhatu pusti hetu

- Deepaniya/pachan- agni vriddhi hetu

- Sansodhan karma nisheda hai(contraindicate) 

8

SODHANA CHIKITSA 

Contrainducated

Contrainducated

Pathya(DO):

Wheat, java, mugda, arhar, masoor, chana, mayur, murga, aja milk, godugdha, butter, goghrita, angoor, seb, papita, mausami, banana, pindkhajur, munakka, anjeera, kaju, akhroth, badam, chironji

Apathya(DON’T):

Ruksha annapana, karela, amla, tikta, kasaya,katu dravya, taila, hingu, kshara

Krodha, diwaswapna, ati maithuna,vega dharana, ativyayama  

A. PUNARNAVADI KASHAYAM

Ingredients - Punarnava , Bala , Chavya , Shalaparni , Pippali , Gokshura , Jivanti 

Method of using - The decoction prepared with these ingredients should be served fresh 

Indications

1. Cures tuberculosis and destruction of tissues

2. Nourishes the body tissues

B. AMRUTADI KASHAYAM

Ingredients - Guduchi , Dashamoola , Devadaru , Bharangi , Vasa , Vrischira , Musta , Dhanvayasa , Bala ,  Chirubilwa, Panchakola 

Method of using -  The decoction prepared with these ingredients should be served fresh by mixing it with the milk 

Indications

1. Tuberculosis

C. ELAKANADI KASHAYAM

D. BILWAMRUTADI KASHAYAM

Ingredients - Bilwa , Guduchi , Patola , Bharangi , Kachora , Ponnavaram , Brihati , Mustaka, Devadaru, Ginger , Vasa , Gokshura 

Method of using - The decoction prepared with these ingredients should be served fresh 

Indications

1. Tuberculosis

2. Disorders caused due to wasting of tissues

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Sheelajatyadi curna-(sheelajit)

- Rajmrigank rasa-(parad,gandhak,manshila,svarn,tambhasma,varatika)

- Mukta panchmrit-(praval,mukta)

- Praval panchamrit-(praval)

- Shringa bhasma-(shringa)

VATI-(250-500MG WITH USHNA JALA)

- Eladi vati-(ela,dalcheeni,tejpatra,mulethi,kharjura)

- Chandraprabha vati-(triphala,trimada,sadushak,sheelajatu,guggalu,loha)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Sitopaladi curna-(sita,vanshlochana,pippali,trigashiri)

- Talisadicurna-(talisa,maricha,sunthi,pippali,vanshlochana,mishri)

- Sandavadi curna-(sandhav,sunthi,sauvarchal,vrikshamla,anardana,tulasipatra)

KAVATH/ASAV/ARISHTA-(20-40ML WITH SAMABHAG WATER)

- Usheerasava-(usheer,chandan,nagkesar)

- Chandanasava-(svetachandan,raktachandan,madhuk,dhataki,guda)

- Balarista-(bala,punarnava,draksha,majistha,jeevanti)

- Draksharista

- kharjurasava

GHRITA(20-30ML WITH USHNODAKA)

- Pippali ghrita-(pippali,ghrita,sunthi,amlaki)

- Rashna ghrita-(rasna,panchmula,trikatu,katkari,ghrita,pippali mula)

- Amritprashghrita

AVLEHA/PAKA(20GM WITH DUGHDHA)

- Drakshavaleh-(draksha,kharjura,haritaki)

- Kharjuravaleha-(kharjura,draksha,pippali)

- Sarpi guda-(amlaki,vidarikanda,ikshu,goghrita,godugdha,mishri,madhu)

RASAYANA-(20GM DUGDHA)

Chywanprasha Rasayana-(Dashmula,Amlaki,Kuth,Pushkarmula)