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==8. Name of the chapter:  Rajayakshma Chikitsitam ==

==([[Chikitsa Sthana Chapter 8, Chapter on Management of Wasting Diseases) ==

 

Abstract

=== Abstract ===

 

"Rajayakshma" is a syndrome consisting of diseases associated with wasting (kshaya) of various tissues including rasa and ojas causing immunedeficiency resulting in opportunistic infections, most common being tuberculosis. The term rajyakshma has been used interchangeably with tuberculosis. It is potentially fatal wasting disease that "consumes" the body.  This chapter describes etio-pathogenesis, signs and symptoms and principles of management. Groups of signs viz. a group of three signs, six signs and eleven signs are enlisted to designate variety of srotasa (systems) involved with increasing severity of disease. The complications and prognosis are elaboarated to categorize the disease as one of the dreadful diseases. Treatment with modern antitubercular medicines reduces mortality in patients with tuberculosis (cure rate11.42% and the death rate 40.9%)  but when combined with Ayurvedic treatment there was significant improvement (cure rate 41.3% and the death rate 3.8%).  

"Rajayakshma" is a syndrome consisting of diseases associated with wasting (kshaya) of various tissues including rasa and ojas causing immunedeficiency resulting in opportunistic infections, most common being tuberculosis. The term rajyakshma has been used interchangeably with tuberculosis. It is potentially fatal wasting disease that "consumes" the body.  This chapter describes etio-pathogenesis, signs and symptoms and principles of management. Groups of signs viz. a group of three signs, six signs and eleven signs are enlisted to designate variety of srotasa (systems) involved with increasing severity of disease. The complications and prognosis are elaboarated to categorize the disease as one of the dreadful diseases. Treatment with modern antitubercular medicines reduces mortality in patients with tuberculosis (cure rate11.42% and the death rate 40.9%)  but when combined with Ayurvedic treatment there was significant improvement (cure rate 41.3% and the death rate 3.8%).  

Keywords: Rajayakshma, kshaya, shosha, tuberculosis, vyadhikshamatva, dhatukshaya, immunity, depletion of tissues.

 

Introduction

'''Keywords''': Rajayakshma, kshaya, shosha, tuberculosis, vyadhikshamatva, dhatukshaya, immunity, depletion of tissues.

 

=== Introduction ===

Rajayakshma has been identified since Vedic period (2400 BC). 'Yakshma' word appeared in Rigveda and Atharvaveda, but a detailed description was missing. In Ayurvedic Samhitas (1000 BC to 500 AD) a detailed description of rajayakshma is found. An account of its definition, etiology, pathogenesis, general features, management, and the prognosis is found in Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya with more extensive description is in Charak Samhita. Four etiological factors are described, sahasa (over exertion or working beyond one's capacity), samdharana (suppression of natural urges), kshaya (depletion of tissue element) and vishamashana (irregular diet).  

Rajayakshma has been identified since Vedic period (2400 BC). 'Yakshma' word appeared in Rigveda and Atharvaveda, but a detailed description was missing. In Ayurvedic Samhitas (1000 BC to 500 AD) a detailed description of rajayakshma is found. An account of its definition, etiology, pathogenesis, general features, management, and the prognosis is found in Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya with more extensive description is in Charak Samhita. Four etiological factors are described, sahasa (over exertion or working beyond one's capacity), samdharana (suppression of natural urges), kshaya (depletion of tissue element) and vishamashana (irregular diet).  

The three chapters viz. shosha nidana, rajayakshma chikitsa and kshatshin chikitsa deal with similar clinical presentation of disease and priniciples of management. Dhatukshaya is common feature in all. Advancement of dhatukshaya in shosha reaches a stage when immunosuppression with resulting opportunistic infection occurs and is called rajyakshma.  In kshatshina or urakshata there is chest injury due to direct or indirect trauma along with dhatukshaya. Brumhana of dhatu (nourishment) is the priniciple line of management.  

The three chapters viz. shosha nidana, rajayakshma chikitsa and kshatshin chikitsa deal with similar clinical presentation of disease and priniciples of management. Dhatukshaya is common feature in all. Advancement of dhatukshaya in shosha reaches a stage when immunosuppression with resulting opportunistic infection occurs and is called rajyakshma.  In kshatshina or urakshata there is chest injury due to direct or indirect trauma along with dhatukshaya. Brumhana of dhatu (nourishment) is the priniciple line of management.  

Thus 'upsarga'(addional contact or exposure to) may be considered as "Sannikrishta Nidana" (recent cause) of rajayakshma. Sushruta was aware of this fact, and he has described its contagious nature by saying that skin diseases, fever, rajayakshma and conjunctivitis are infectious diseases which spread from one man to another man.

Thus 'upsarga'(addional contact or exposure to) may be considered as "Sannikrishta Nidana" (recent cause) of rajayakshma. Sushruta was aware of this fact, and he has described its contagious nature by saying that skin diseases, fever, rajayakshma and conjunctivitis are infectious diseases which spread from one man to another man.

Symptomatology of rajayakshma has been described in three different categories viz. trirupa, shadrupa and ekadashrupa. It seems that trirupa denotes the description of early tuberculosis when the disease is of mild nature whereas shadrupa is the clinical manifestation of the moderately advanced disease. Shadrupa is the cardinal symptoms of pulmonary tuberculosis which are found in the majority of the patients. Ekadashrupa or elevenfold manifestation may appear in the far advanced stage of tuberculosis or in those patients whose 'vyadhikshamatva' (immunity) is hina (low). The clinical presentation of disease includes groups of signs with their specific pathogenesis. The increasing number of signs denote severity of disease and spread of disease over body organs.  

 

Symptomatology of rajayakshma has been described in three different categories viz. trirupa, shadrupa and ekadashrupa. It seems that trirupa denotes the description of early tuberculosis when the disease is of mild nature whereas shadrupa is the clinical manifestation of the moderately advanced disease. Shadrupa is the cardinal symptoms of pulmonary tuberculosis which are found in the majority of the patients. Ekadashrupa or elevenfold manifestation may appear in the far advanced stage of tuberculosis or in those patients whose 'vyadhikshamatva' (immunity) is hina (low). The clinical presentation of disease includes groups of signs with their specific pathogenesis. The increasing number of signs denote severity of disease and spread of disease over body organs.  

As far as the treatment is concerned, mild samshodhan therapy is indicated in excess aggravation of dosha. However drastic purification leading to emaciation is strictly contraindicated especially virechana (purgation) therapy. Samshaman (pacification) therapy includes treatment of symptoms and treatment of emaciation to increase the declining dhatus (tissues) of the body by using various types of meat and wines. Meat having high protein content helps in rebuilding body tissues whereas wine acts as a tonic and appetizer, it also helps open the blocked channels thereby providing proper nutrition to all the tissues of the body. Rasayana (rejuvenation therapy) has significant role in enhancing immunity and thereby preventing infectious diseases. The formulations described in rajayakshma chapter are used to enhance immunity as well as an adjuvant therapies to anti-tubercular treatments in current practices.   

As far as the treatment is concerned, mild samshodhan therapy is indicated in excess aggravation of dosha. However drastic purification leading to emaciation is strictly contraindicated especially virechana (purgation) therapy. Samshaman (pacification) therapy includes treatment of symptoms and treatment of emaciation to increase the declining dhatus (tissues) of the body by using various types of meat and wines. Meat having high protein content helps in rebuilding body tissues whereas wine acts as a tonic and appetizer, it also helps open the blocked channels thereby providing proper nutrition to all the tissues of the body. Rasayana (rejuvenation therapy) has significant role in enhancing immunity and thereby preventing infectious diseases. The formulations described in rajayakshma chapter are used to enhance immunity as well as an adjuvant therapies to anti-tubercular treatments in current practices.   

This chapter underscores the importance of judicious combination of modern drug treatment of infectious diseases with Ayurvedic treatment to achieve better results.[1]  

This chapter underscores the importance of judicious combination of modern drug treatment of infectious diseases with Ayurvedic treatment to achieve better results.[1]  

 

The chapter:

The chapter:

अथातो राजयक्ष्मचिकित्सितं व्याख्यास्यामः||१||  

अथातो राजयक्ष्मचिकित्सितं व्याख्यास्यामः||१||