Changes

sa vimuktagrahashcandro virarAja visheShataH|  

sa vimuktagrahashcandro virarAja visheShataH|  

ojasA [2] vardhito~ashvibhyAM shuddhaM sattvamavApa ca||10||  

ojasA [2] vardhito~ashvibhyAM shuddhaM sattvamavApa ca||10||  

The following story – of Chandrama (Moon)’s passionate cohabiting (with Rohini, one of his 28 celestial wives)  - was narrated by the Gods to the sages. Because of his excessive sexual indulgence with Rohini, Chandrama soon started neglecting his own health, becoming emaciated due to depletion of his bodily unctuousness (essence or vitality). Besides, his inordinate attention to just one wife in comparison to the others resulted in his not being able to satisfy the desires of his remaining wives – all of whom were the daughters of Daksha Prajapati (Lord of Progeny). This ill-treatment to his daughters made Daksha furious, and his anger came out of his mouth in the form of breath that took a physical form (Yakshma). The now lustreless, afflicted Moon sought clemency from the great Daksha, accompanied by the Gods and Sages. Daksha Prajapati , now realizing Chandrama’s pure state of mind (and therefore, admitting his folly), became cordial to him got him treated by the Ashwin, the celestial physicians. The Ashwins having enhanced his ojas (vital essence), Chandrama additionally acquired a great purity of mind. [3-10]

The following story – of Chandrama (Moon)’s passionate cohabiting (with Rohini, one of his 28 celestial wives)  - was narrated by the Gods to the sages. Because of his excessive sexual indulgence with Rohini, Chandrama soon started neglecting his own health, becoming emaciated due to depletion of his bodily unctuousness (essence or vitality). Besides, his inordinate attention to just one wife in comparison to the others resulted in his not being able to satisfy the desires of his remaining wives – all of whom were the daughters of Daksha Prajapati (Lord of Progeny). This ill-treatment to his daughters made Daksha furious, and his anger came out of his mouth in the form of breath that took a physical form (Yakshma). The now lustreless, afflicted Moon sought clemency from the great Daksha, accompanied by the Gods and Sages. Daksha Prajapati , now realizing Chandrama’s pure state of mind (and therefore, admitting his folly), became cordial to him got him treated by the Ashwin, the celestial physicians. The Ashwins having enhanced his ojas (vital essence), Chandrama additionally acquired a great purity of mind. [3-10]

Names of disease:

 

==== Names of disease ====

 

क्रोधो यक्ष्मा ज्वरो रोग एकार्थो दुःखसञ्ज्ञकः|  

क्रोधो यक्ष्मा ज्वरो रोग एकार्थो दुःखसञ्ज्ञकः|  

यस्मात् स राज्ञः प्रागासीद्राजयक्ष्मा ततो मतः||११||  

यस्मात् स राज्ञः प्रागासीद्राजयक्ष्मा ततो मतः||११||  

labdhvA caturvidhaM hetuM samAvishati mAnavAn||12||

labdhvA caturvidhaM hetuM samAvishati mAnavAn||12||

Krodha(rage), yakshma (sickness), jwara(fever) and roga (disease suffering) – these terms are synonymous, and indicate (misery, sorrow). Because it afflicted Chandrama, the king of stars, originally, it is called rajayakshma, or the king of diseases.This disease,  having been treated by the Ashwin in the celestial world, has come down to the world of mortals (i.e., human beings). Here, it afflicts human beings after being triggered by a four-fold causative factor [11-12]

Krodha(rage), yakshma (sickness), jwara(fever) and roga (disease suffering) – these terms are synonymous, and indicate (misery, sorrow). Because it afflicted Chandrama, the king of stars, originally, it is called rajayakshma, or the king of diseases.This disease,  having been treated by the Ashwin in the celestial world, has come down to the world of mortals (i.e., human beings). Here, it afflicts human beings after being triggered by a four-fold causative factor [11-12]

Four important causative factors of disease:

 

==== Four important causative factors of disease ====

 

अयथाबलमारम्भं वेगसन्धारणं क्षयम्|  

अयथाबलमारम्भं वेगसन्धारणं क्षयम्|  

यक्ष्मणः कारणं विद्याच्चतुर्थं विषमाशनम्||१३||

यक्ष्मणः कारणं विद्याच्चतुर्थं विषमाशनम्||१३||

yakShmaNaH kAraNaM vidyAccaturthaM viShamAshanam||13||

yakShmaNaH kAraNaM vidyAccaturthaM viShamAshanam||13||

Over –exertion beyond one’s capacity, suppression of natural urges, depletion of tissue elements and irregular dietary habits are the etiological factors of rajayakshma. [13]

Over –exertion beyond one’s capacity, suppression of natural urges, depletion of tissue elements and irregular dietary habits are the etiological factors of rajayakshma. [13]

1. Sahasaja rajayakshma (due to over exertion beyond one’s capacity):

 

===== 1. Sahasaja rajayakshma (due to over exertion beyond one’s capacity) =====

 

युद्धाध्ययनभाराध्वलङ्घनप्लवनादिभिः|  

युद्धाध्ययनभाराध्वलङ्घनप्लवनादिभिः|  

पतनैरभिघातैर्वा साहसैर्वा तथाऽपरैः||१४||  

पतनैरभिघातैर्वा साहसैर्वा तथाऽपरैः||१४||  

When beyond one’s capacity, a person indulges in excess battle, reading, weight-lifting, walking, jumping, swimming etc. or falls down - or gets injured -or exerts himself in any action that is beyond his strength or tolerance, leads to chest injury and , vitiates vata dosha. This vata dosha afflicts the other two (pitta and kapha dosha). These vitiated dosha, along with vayu, spread in all direction within body (pradhavati) and cause eleven symptoms, with each symptom directly corresponding to the particular part of the body. If the deranged dosha enters the head, it causes headache; if the throat, then irritation in throat, cough, hoarseness of voice and anorexia; if the chest, then pain in the sides of the chest; if the anus, then diarrhoea; if in the joints, then fever, yawning and pain in the chest.  

When beyond one’s capacity, a person indulges in excess battle, reading, weight-lifting, walking, jumping, swimming etc. or falls down - or gets injured -or exerts himself in any action that is beyond his strength or tolerance, leads to chest injury and , vitiates vata dosha. This vata dosha afflicts the other two (pitta and kapha dosha). These vitiated dosha, along with vayu, spread in all direction within body (pradhavati) and cause eleven symptoms, with each symptom directly corresponding to the particular part of the body. If the deranged dosha enters the head, it causes headache; if the throat, then irritation in throat, cough, hoarseness of voice and anorexia; if the chest, then pain in the sides of the chest; if the anus, then diarrhoea; if in the joints, then fever, yawning and pain in the chest.  

Injury to the chest and coughing cause the patient to spit out phlegm along with blood. In this case, the patient suffers from unbearable pain in his chest due to pulmonic damage. These eleven symptoms are manifested in the patients suffering from yakshma caused by overexertion. [14-19]

Injury to the chest and coughing cause the patient to spit out phlegm along with blood. In this case, the patient suffers from unbearable pain in his chest due to pulmonic damage. These eleven symptoms are manifested in the patients suffering from yakshma caused by overexertion. [14-19]

2. Vegasandharanaja rajayakshma (due to suppression of natural urges):

 

===== 2. Vegasandharanaja rajayakshma (due to suppression of natural urges) =====

 

ह्रीमत्त्वाद्वा घृणित्वाद्वा भयाद्वा वेगमागतम्|  

ह्रीमत्त्वाद्वा घृणित्वाद्वा भयाद्वा वेगमागतम्|  

वातमूत्रपुरीषाणां निगृह्णाति यदा नरः||२०||  

वातमूत्रपुरीषाणां निगृह्णाति यदा नरः||२०||  

rUpANyekAdashaitAni yakShmA yairucyate mahAn||23||

rUpANyekAdashaitAni yakShmA yairucyate mahAn||23||

When due to bashfulness or disgust or fear one suppresses the impelling urge to pass flatus, urine and/or faeces, vayu, due to the obstruction of such urges, propels kapha and pitta upwards, obliquely and downwards within the body, causing the disorders having symptoms of all three doshas such as coryza, cough, hoarseness of voice, anorexia, pain in flank, headache, fever, pain in shoulders, bodyache, frequent vomiting and diarrhoea. These are the eleven symptoms of rajayakshma caused due to suppression of urges. [20-23]

When due to bashfulness or disgust or fear one suppresses the impelling urge to pass flatus, urine and/or faeces, vayu, due to the obstruction of such urges, propels kapha and pitta upwards, obliquely and downwards within the body, causing the disorders having symptoms of all three doshas such as coryza, cough, hoarseness of voice, anorexia, pain in flank, headache, fever, pain in shoulders, bodyache, frequent vomiting and diarrhoea. These are the eleven symptoms of rajayakshma caused due to suppression of urges. [20-23]

3. Kshayaja rajayakshma (due to depletion of tissues):

 

===== 3. Kshayaja rajayakshma (due to depletion of tissues) =====

 

ईर्ष्योत्कण्ठाभयत्रासक्रोधशोकातिकर्शनात्|  

ईर्ष्योत्कण्ठाभयत्रासक्रोधशोकातिकर्शनात्|  

अतिव्यवायानशनाच्छुक्रमोजश्च हीयते||२४||  

अतिव्यवायानशनाच्छुक्रमोजश्च हीयते||२४||  

samprAptaM rAjayakShmANaM kShayAt prANakShayapradam||27||

samprAptaM rAjayakShmANaM kShayAt prANakShayapradam||27||

Excessive envy, eagerness, fever, terror, anger, grief, excessive indulgence in sexual intercourse, and fasting leads to depletion of shukra and ojas. This, in turn, due to loss of unctuousness, provokes vata  which further aggravates the other two doshas and causes eleven symptoms such as—coryza,  fever, cough, bodyache, headache, dysponea, diarrhoea, anorexia, pain in flanks, feeble voice and feeling of warmth in shoulders. These eleven symptoms indicate the advent of the great disease rajayakshma due to wasting. [24-27]

Excessive envy, eagerness, fever, terror, anger, grief, excessive indulgence in sexual intercourse, and fasting leads to depletion of shukra and ojas. This, in turn, due to loss of unctuousness, provokes vata  which further aggravates the other two doshas and causes eleven symptoms such as—coryza,  fever, cough, bodyache, headache, dysponea, diarrhoea, anorexia, pain in flanks, feeble voice and feeling of warmth in shoulders. These eleven symptoms indicate the advent of the great disease rajayakshma due to wasting. [24-27]

4. Vishamashanaja rajayakshma (due to irregular dietary habits):

 

===== 4. Vishamashanaja rajayakshma (due to irregular dietary habits) =====

 

विविधान्यन्नपानानि वैषम्येण समश्नतः|  

विविधान्यन्नपानानि वैषम्येण समश्नतः|  

जनयन्त्यामयान् घोरान्विषमान्मारुतादयः||२८||  

जनयन्त्यामयान् घोरान्विषमान्मारुतादयः||२८||  

2. Due to vitiated pitta: fever, distress in shoulder and haemoptysis, and  

2. Due to vitiated pitta: fever, distress in shoulder and haemoptysis, and  

3. Due to vitiated vata: pain in flanks, headache and hoarseness of voice.[28-31]

3. Due to vitiated vata: pain in flanks, headache and hoarseness of voice.[28-31]

Premonitory signs:

 

==== Premonitory signs ====

 

पूर्वरूपं प्रतिश्यायो दौर्बल्यं दोषदर्शनम्|  

पूर्वरूपं प्रतिश्यायो दौर्बल्यं दोषदर्शनम्|  

अदोषेष्वपि भावेषु काये बीभत्सदर्शनम्||३३||  

अदोषेष्वपि भावेषु काये बीभत्सदर्शनम्||३३||  

prAgrUpaM bahurUpasya tajj~jeyaM rAjayakShmaNaH|38|

prAgrUpaM bahurUpasya tajj~jeyaM rAjayakShmaNaH|38|

The premonitory symptoms (of rajayakshma) are coryza, debility, nitpicking (or an inclination to find faults where there is no reason to), morbid appearances on the body; feeling of disgust, loss of strength and flesh (inspite of consuming adequate food), craving for women, wine and meat, desire to be always covered by something (feeling of cold), imagined feeling of one’s food being infested with insects, flies, hair,, rapid growth of hairs and fingernails, imagined feeling of being attacked by birds, wasps, and animals, seeing dreams of climbing heaps of hair, bones, and ashes, and dreaming of dried or withered ponds, mountains, and forests- these are to be known as premonitory symptoms of rajayakshma of various types.[33-38]

The premonitory symptoms (of rajayakshma) are coryza, debility, nitpicking (or an inclination to find faults where there is no reason to), morbid appearances on the body; feeling of disgust, loss of strength and flesh (inspite of consuming adequate food), craving for women, wine and meat, desire to be always covered by something (feeling of cold), imagined feeling of one’s food being infested with insects, flies, hair,, rapid growth of hairs and fingernails, imagined feeling of being attacked by birds, wasps, and animals, seeing dreams of climbing heaps of hair, bones, and ashes, and dreaming of dried or withered ponds, mountains, and forests- these are to be known as premonitory symptoms of rajayakshma of various types.[33-38]

Pathogenesis and clinical features:

 

==== Pathogenesis and clinical features ====

 

रूपं त्वस्य यथोद्देशं निर्देक्ष्यामि [१] सभेषजम्||३८||  

रूपं त्वस्य यथोद्देशं निर्देक्ष्यामि [१] सभेषजम्||३८||  

यथास्वेनोष्मणा पाकं शारीरा यान्ति धातवः|  

यथास्वेनोष्मणा पाकं शारीरा यान्ति धातवः|  

Normally, the dhatus of the body get metabolised (being acted upon) by their own ushmas or dhatwagnis (transforming enzymes in the tissue elements). From these dhatus, (nutrient tissue elements), the other dhatus ( next dhatu to it that which receive nourishment) gets nourished through their respective srotas (channels of circulation). (For example, a poshaka rasa dhatu would nourish the rakta dhatu ).  

Normally, the dhatus of the body get metabolised (being acted upon) by their own ushmas or dhatwagnis (transforming enzymes in the tissue elements). From these dhatus, (nutrient tissue elements), the other dhatus ( next dhatu to it that which receive nourishment) gets nourished through their respective srotas (channels of circulation). (For example, a poshaka rasa dhatu would nourish the rakta dhatu ).  

Once, however, there is any obstruction to srotas or if there is diminution of stable tissue elements like rakta or if there is diminution of dhatu-ushmas or dhatwagnis then rajayakshma is manifested. In such a case, whatever food is digested in the gastrointestinal tract by jatharagni is mostly reduced to waste products and very little of it contributes to the formation of ojas (nourishment). The patient is depleted of all tissue elements and strength. The patient’s stool should be preserved and it is the only source of strength left with him. Because of the obstruction to the srotas, rasa dhatu becomes vidagdha (improperly metabolised) in its own location (heart) and this vitiated rasa comes out through the upper passages in different forms by way of coughing. Subsequently, six or eleven symptoms (or forms of diseases) are manifested, and their aggregation is the syndrome called rajayakshma. Cough, distress in shoulder, change of voice, fever, pain in flanks, headache, vomiting of rakta and kapha, dyspnoea, diarrhea and anorexia are the eleven symptoms of rajayakshma ; or they are also six viz., cough, fever, pain in flanks, hoarseness of voice diarrhea and anorexia. With eleven, six or even three of the symptoms, a patient is incurable if he is losing mamsa (flesh tissues) and strength, but he is curable if he is behaving otherwise in spite of showing all the symptoms. [39-47]

Once, however, there is any obstruction to srotas or if there is diminution of stable tissue elements like rakta or if there is diminution of dhatu-ushmas or dhatwagnis then rajayakshma is manifested. In such a case, whatever food is digested in the gastrointestinal tract by jatharagni is mostly reduced to waste products and very little of it contributes to the formation of ojas (nourishment). The patient is depleted of all tissue elements and strength. The patient’s stool should be preserved and it is the only source of strength left with him. Because of the obstruction to the srotas, rasa dhatu becomes vidagdha (improperly metabolised) in its own location (heart) and this vitiated rasa comes out through the upper passages in different forms by way of coughing. Subsequently, six or eleven symptoms (or forms of diseases) are manifested, and their aggregation is the syndrome called rajayakshma. Cough, distress in shoulder, change of voice, fever, pain in flanks, headache, vomiting of rakta and kapha, dyspnoea, diarrhea and anorexia are the eleven symptoms of rajayakshma ; or they are also six viz., cough, fever, pain in flanks, hoarseness of voice diarrhea and anorexia. With eleven, six or even three of the symptoms, a patient is incurable if he is losing mamsa (flesh tissues) and strength, but he is curable if he is behaving otherwise in spite of showing all the symptoms. [39-47]

Signs of pratishyaya:

 

==== Signs of pratishyaya ====

 

घ्राणमूले स्थितः श्लेष्मा रुधिरं पित्तमेव वा|  

घ्राणमूले स्थितः श्लेष्मा रुधिरं पित्तमेव वा|  

मारुताध्मातशिरसो मारुतं श्यायते प्रति||४८||  

मारुताध्मातशिरसो मारुतं श्यायते प्रति||४८||  

indriyANAmasAmarthyaM yakShmA cAtaH [1] prajAyate||50||

indriyANAmasAmarthyaM yakShmA cAtaH [1] prajAyate||50||

The kapha or blood or pitta located at the root of the nasal passage cause nasal catarrh in the patients whose head is afflicted with vayu. This results in severe pratishyaya (coryza) affecting entire body of the patient, This leads to emaciation of the body; its signs and symptoms are headache, heaviness in the head, loss of smell, fever, cough, increase of mucous secretion, change of voice, anorexia fatigue and asthenia of the senses and then rajayakshmais manifests.  [48-50]

The kapha or blood or pitta located at the root of the nasal passage cause nasal catarrh in the patients whose head is afflicted with vayu. This results in severe pratishyaya (coryza) affecting entire body of the patient, This leads to emaciation of the body; its signs and symptoms are headache, heaviness in the head, loss of smell, fever, cough, increase of mucous secretion, change of voice, anorexia fatigue and asthenia of the senses and then rajayakshmais manifests.  [48-50]

Appearance of sputum:

 

==== Appearance of sputum ====

 

पिच्छिलं बहलं विस्रं हरितं श्वेतपीतकम्|  

पिच्छिलं बहलं विस्रं हरितं श्वेतपीतकम्|  

कासमानो रसं यक्ष्मी निष्ठीवति [१] कफानुगम्||५१||

कासमानो रसं यक्ष्मी निष्ठीवति [१] कफानुगम्||५१||

kAsamAno rasaM yakShmI niShThIvati [1] kaphAnugam||51||

kAsamAno rasaM yakShmI niShThIvati [1] kaphAnugam||51||

Expectorates resulting from coughing (when afflicted with rajayakshma) contain slimy, thick, putrid, greenish or white-yellowish matter along with kapha. [51]

Expectorates resulting from coughing (when afflicted with rajayakshma) contain slimy, thick, putrid, greenish or white-yellowish matter along with kapha. [51]

Clinical features of rajayakshma:

 

==== Clinical features of rajayakshma ====

 

अंसपार्श्वाभितापश्च सन्तापः  करपादयोः|  

अंसपार्श्वाभितापश्च सन्तापः  करपादयोः|  

ज्वरः सर्वाङ्गगश्चेति लक्षणं राजयक्ष्मणः||५२||

ज्वरः सर्वाङ्गगश्चेति लक्षणं राजयक्ष्मणः||५२||

jvaraH sarvA~ggagashceti lakShaNaM rAjayakShmaNaH||52||

jvaraH sarvA~ggagashceti lakShaNaM rAjayakShmaNaH||52||

The typical characteristics of rajayakshma include a feeling of warmth (or burning sensation) in the shoulders and flanks, burning sensation in hands, and feet, and raised temperature all over the body.[52]

The typical characteristics of rajayakshma include a feeling of warmth (or burning sensation) in the shoulders and flanks, burning sensation in hands, and feet, and raised temperature all over the body.[52]

Swarabheda (hoarseness of voice) and characteristics as per dosha affliction:

 

==== Swarabheda (hoarseness of voice) and characteristics as per dosha affliction ====

 

वातात्पित्तात्कफाद्रक्तात् कासवेगात् सपीनसात्|  

वातात्पित्तात्कफाद्रक्तात् कासवेगात् सपीनसात्|  

स्वरभेदो भवेद्वाताद्रूक्षः क्षामश्चलः स्वरः||५३||  

स्वरभेदो भवेद्वाताद्रूक्षः क्षामश्चलः स्वरः||५३||  

Hoarseness of voice is engendered by morbid vata, pitta or kapha or blood or by, strain of coughing or by coryza. The voice becomes husky, feeble and unstable if caused by vata; if by pitta, there will be burning of the palate and throat and the patient will refrain from talking; and if due to kapha, the voice is low, choked and is marked with a wheezing sound; owing to the obstruction to the flow of blood, the voice becomes low and comes out with difficulty; the throat becomes injured by the strain of exorbitant coughing and in case of coryza, the characterstics of the voice resemble the condition in vata and kapha afflictions.  

Hoarseness of voice is engendered by morbid vata, pitta or kapha or blood or by, strain of coughing or by coryza. The voice becomes husky, feeble and unstable if caused by vata; if by pitta, there will be burning of the palate and throat and the patient will refrain from talking; and if due to kapha, the voice is low, choked and is marked with a wheezing sound; owing to the obstruction to the flow of blood, the voice becomes low and comes out with difficulty; the throat becomes injured by the strain of exorbitant coughing and in case of coryza, the characterstics of the voice resemble the condition in vata and kapha afflictions.  

The rajayakshma patient is afflicted with pain in the sides of the chest (flanks) which is inconsistent and manifests during constriction and expansion of chest during breathing, with headache, burning and heaviness.[53-56]

The rajayakshma patient is afflicted with pain in the sides of the chest (flanks) which is inconsistent and manifests during constriction and expansion of chest during breathing, with headache, burning and heaviness.[53-56]

Rakta shthivana (hemoptysis):

 

==== Rakta shthivana (hemoptysis) ====

 

अभिसन्ने  शरीरे तु यक्ष्मिणो विषमाशनात्|  

अभिसन्ने  शरीरे तु यक्ष्मिणो विषमाशनात्|  

कण्ठात्प्रवर्तते रक्तं श्लेष्मा चोत्क्लिष्टसञ्चितः||५७||

कण्ठात्प्रवर्तते रक्तं श्लेष्मा चोत्क्लिष्टसञ्चितः||५७||

kaNThAtpravartate raktaM shleShmA cotkliShTasa~jcitaH||57||

kaNThAtpravartate raktaM shleShmA cotkliShTasa~jcitaH||57||

In the emaciated condition of rajayakshma patients’ indulgence in irregular diet causes expectoration of blood. The kapha too, having been vitiated, is expectorated from the throat. [57]

In the emaciated condition of rajayakshma patients’ indulgence in irregular diet causes expectoration of blood. The kapha too, having been vitiated, is expectorated from the throat. [57]

Causes of depletion of tissues:

 

==== Causes of depletion of tissues ====

 

रक्तं विबद्धमार्गत्वान्मांसादीन्नानुपद्यते  |  

रक्तं विबद्धमार्गत्वान्मांसादीन्नानुपद्यते  |  

आमाशयस्थमुत्क्लिष्टं बहुत्वात् कण्ठमेति च||५८||  

आमाशयस्थमुत्क्लिष्टं बहुत्वात् कण्ठमेति च||५८||  

doShairupahate cAgnau sapicchamatisAryate||59||

doShairupahate cAgnau sapicchamatisAryate||59||

Owing to obstruction in the circulation, the blood does not nourish the flesh tissues and other body elements. The blood staying in the stomach, getting agitated owing to incremented quantity, passes to the throat. Due to the obstruction of vata and kapha in the chest, there occurs dyspnoea and the agni, being impaired by the morbid humors, causes the patient to pass loose and slimy stools.[57-59]

Owing to obstruction in the circulation, the blood does not nourish the flesh tissues and other body elements. The blood staying in the stomach, getting agitated owing to incremented quantity, passes to the throat. Due to the obstruction of vata and kapha in the chest, there occurs dyspnoea and the agni, being impaired by the morbid humors, causes the patient to pass loose and slimy stools.[57-59]

Cause of anorexia:

 

==== Cause of anorexia ====

 

पृथग्दोषैः समस्तैर्वा जिह्वाहृदयसंश्रितैः|  

पृथग्दोषैः समस्तैर्वा जिह्वाहृदयसंश्रितैः|  

जायतेऽरुचिराहारे द्विष्टैरर्थैश्च मानसैः||६०||  

जायतेऽरुचिराहारे द्विष्टैरर्थैश्च मानसैः||६०||  

vAtAdyairaruciM jAtAM mAnasIM doShadarshanAt||61||

vAtAdyairaruciM jAtAM mAnasIM doShadarshanAt||61||

Anorexia or dislike for food is caused by morbidity of one or all the three doshas in the tongue or heart or by repugnant perceptions. By knowing the astringent, bitter or sweet taste in the mouth, anorexia is to be diagnosed as caused due to dominance of vata, pitta or kapha respectively. Anorexia due to morbid perceptions is psychosomatic, caused due to visually observing disturbing or morbid visuals. [60-61]  

Anorexia or dislike for food is caused by morbidity of one or all the three doshas in the tongue or heart or by repugnant perceptions. By knowing the astringent, bitter or sweet taste in the mouth, anorexia is to be diagnosed as caused due to dominance of vata, pitta or kapha respectively. Anorexia due to morbid perceptions is psychosomatic, caused due to visually observing disturbing or morbid visuals. [60-61]

Cause of vomiting:

==== Cause of vomiting ====

 

अरोचकात् कासवेगाद्दोषोत्क्लेशाद्भयादपि|  

अरोचकात् कासवेगाद्दोषोत्क्लेशाद्भयादपि|  

छर्दिर्या सा विकाराणामन्येषामप्युपद्रवः||६२||

छर्दिर्या सा विकाराणामन्येषामप्युपद्रवः||६२||

chardiryA sA vikArANAmanyeShAmapyupadravaH||62||

chardiryA sA vikArANAmanyeShAmapyupadravaH||62||

Regurgitating or vomitting is caused by anorexia, bouts of coughing, and the precipitation of morbid dosha and as a result of fear; it occurs as a complication of other diseases additionally. [62]

Regurgitating or vomitting is caused by anorexia, bouts of coughing, and the precipitation of morbid dosha and as a result of fear; it occurs as a complication of other diseases additionally. [62]

Management of rajayakshma:

 

==== Management of rajayakshma ====

 

सर्वस्त्रिदोषजो यक्ष्मा दोषाणां तु बलाबलम्|  

सर्वस्त्रिदोषजो यक्ष्मा दोषाणां तु बलाबलम्|  

परीक्ष्यावस्थिकं वैद्यः शोषिणं समुपाचरेत्||६३||  

परीक्ष्यावस्थिकं वैद्यः शोषिणं समुपाचरेत्||६३||  

pArshvashUle ca vividhAH kriyAH sAdhAraNIH shRuNu||64||

pArshvashUle ca vividhAH kriyAH sAdhAraNIH shRuNu||64||

All types of rajayakshma are caused due to vitiated three doshas and hence the physician should treat the patient after examining the degree of intensity of the morbid dosha and the vigor of the patient. The physician should carefully observe the status (of patient) – by the symptoms such as coryza, headache, cough, dyspnoea, asthenia of the voice and pain in flanks. [63-64]

All types of rajayakshma are caused due to vitiated three doshas and hence the physician should treat the patient after examining the degree of intensity of the morbid dosha and the vigor of the patient. The physician should carefully observe the status (of patient) – by the symptoms such as coryza, headache, cough, dyspnoea, asthenia of the voice and pain in flanks. [63-64]

Various dietary articles in treatment:

 

==== Various dietary articles in treatment ====

 

पीनसे स्वेदमभ्यङ्गं धूममालेपनानि च|  

पीनसे स्वेदमभ्यङ्गं धूममालेपनानि च|  

परिषेकावगाहांश्च यावकं [१] वाट्यमेव च||६५||  

परिषेकावगाहांश्च यावकं [१] वाट्यमेव च||६५||  

parNinIbhishcatasRubhistena cAnnAni kalpayet||70||

parNinIbhishcatasRubhistena cAnnAni kalpayet||70||

In coryza, sudation, inunction, smoke application, affusion, bath, cooked barley and barley gruel, meat juices of quail, partridge, cock and vartaka quail prepared with salt, acid, pungent, sultry and unctuous articles should be given. The patient should imbibe the juice of goat-meat prepared with long pepper, barley, horse gram, dry ginger, pomegranate or emblic myrobalan and unctuous articles. By taking this, the hexad of coryza and other disorders vanishes.The patient should be treated with a suitable diet of soups made up of radish or horse gram or out of staple food composed of barley, wheat or shali rice. A potion made up of the clear supernatant part of ‘varuni’ wine or water, prepared with pentaradix, or with coriander and dry ginger or with featherfoil, or with the tetrad of herbs called ‘parnini’ is advised. Articles of diet may additionally be consumed with these decoctions.[65-70]

In coryza, sudation, inunction, smoke application, affusion, bath, cooked barley and barley gruel, meat juices of quail, partridge, cock and vartaka quail prepared with salt, acid, pungent, sultry and unctuous articles should be given. The patient should imbibe the juice of goat-meat prepared with long pepper, barley, horse gram, dry ginger, pomegranate or emblic myrobalan and unctuous articles. By taking this, the hexad of coryza and other disorders vanishes.The patient should be treated with a suitable diet of soups made up of radish or horse gram or out of staple food composed of barley, wheat or shali rice. A potion made up of the clear supernatant part of ‘varuni’ wine or water, prepared with pentaradix, or with coriander and dry ginger or with featherfoil, or with the tetrad of herbs called ‘parnini’ is advised. Articles of diet may additionally be consumed with these decoctions.[65-70]

Swedana (sudation):

 

==== Swedana (sudation) ====

 

कृशरोत्कारिकामाषकुलत्थयवपायसैः|  

कृशरोत्कारिकामाषकुलत्थयवपायसैः|  

सङ्करस्वेदविधिना कण्ठं पार्श्वमुरः शिरः||७१||  

सङ्करस्वेदविधिना कण्ठं पार्श्वमुरः शिरः||७१||  

shasyante sacatuHsnehAH shiraHpArshvAMsashUlinAm||76||

shasyante sacatuHsnehAH shiraHpArshvAMsashUlinAm||76||

The throat, the flanks, the chest and the head regions should be made to sweat by a commixed type of lump sudation prepared using krushara (a type of gruel), utkarika (hot poultice), ebony gram, horse gram, barley and milk pudding; or the head should be affused genially with warm decoction prepared using the leaves of heart leaved sida, guduchi and liquorice; or the steam kettle sudation prepared with the decoctions of  the heads of goat and fish or with vata pacifying decoctions should be utilized for sweating the throat, head and sides of the chest. The flesh of aquatic and wet land animals, the decoction of pentaradix or sour conjee with unctuous articles may be utilized in steam kettle sudation. The poultices well prepared with cork swallow wort, dil seeds heart, leaved sida, liquorice, saccharine flag cooked meat, white yam, radish, the flesh of aquatic and wet land creatures and commixed with all the four kinds of unctuous articles should be applied to persons suffering from pain applied to persons suffering from pain in the head, side of the chest and shoulder region.[71-76]

The throat, the flanks, the chest and the head regions should be made to sweat by a commixed type of lump sudation prepared using krushara (a type of gruel), utkarika (hot poultice), ebony gram, horse gram, barley and milk pudding; or the head should be affused genially with warm decoction prepared using the leaves of heart leaved sida, guduchi and liquorice; or the steam kettle sudation prepared with the decoctions of  the heads of goat and fish or with vata pacifying decoctions should be utilized for sweating the throat, head and sides of the chest. The flesh of aquatic and wet land animals, the decoction of pentaradix or sour conjee with unctuous articles may be utilized in steam kettle sudation. The poultices well prepared with cork swallow wort, dil seeds heart, leaved sida, liquorice, saccharine flag cooked meat, white yam, radish, the flesh of aquatic and wet land creatures and commixed with all the four kinds of unctuous articles should be applied to persons suffering from pain applied to persons suffering from pain in the head, side of the chest and shoulder region.[71-76]

Alepana (local applications):

 

==== Alepana (local applications) ====

 

शतपुष्पा समधुकं कुष्ठं तगरचन्दने|  

शतपुष्पा समधुकं कुष्ठं तगरचन्दने|  

आलेपनं स्यात् सघृतं शिरःपार्श्वांसशूलनुत्||७७||  

आलेपनं स्यात् सघृतं शिरःपार्श्वांसशूलनुत्||७७||  

Dil, liquorice, costus, Indian valerian and sandalwood with ghee make an effective curative for pain in the head, sides of the chest and shoulder regions. [77]

Dil, liquorice, costus, Indian valerian and sandalwood with ghee make an effective curative for pain in the head, sides of the chest and shoulder regions. [77]

बला रास्ना तिलाः सर्पिर्मधुकं नीलमुत्पलम्|  

बला रास्ना तिलाः सर्पिर्मधुकं नीलमुत्पलम्|  

पलङ्कषा देवदारु चन्दनं केशरं घृतम्||७८||  

पलङ्कषा देवदारु चन्दनं केशरं घृतम्||७८||  

shastAH saMsRuShTadoShANAM shiraHpArshvAMsashUlinAm||80||  

shastAH saMsRuShTadoShANAM shiraHpArshvAMsashUlinAm||80||  

(1) Heart leaved sida, Indian groundsel, til, ghee, liquorice and blue waterlily; (2) gum gugglu, deodar, sandal wood, fragrant poon and ghee; (3) climbing asparagus, heart leaved sida, white yam, drumstick and hog’s weed; (4) climbing asparagus, milky yam, ginger grass, liquorice and ghee: these four groups of drugs, described one in each half verse for preparation of application are propitious in conditions of pain in the head, side of the chest and the shoulder region arising from bi-dosha discordance. [78-80]

(1) Heart leaved sida, Indian groundsel, til, ghee, liquorice and blue waterlily; (2) gum gugglu, deodar, sandal wood, fragrant poon and ghee; (3) climbing asparagus, heart leaved sida, white yam, drumstick and hog’s weed; (4) climbing asparagus, milky yam, ginger grass, liquorice and ghee: these four groups of drugs, described one in each half verse for preparation of application are propitious in conditions of pain in the head, side of the chest and the shoulder region arising from bi-dosha discordance. [78-80]

Beneficial procedures of purification:

 

==== Beneficial procedures of purification ====

 

नावनं धूमपानानि स्नेहाश्चौत्तरभक्तिकाः|  

नावनं धूमपानानि स्नेहाश्चौत्तरभक्तिकाः|  

तैलान्यभ्यङ्गयोगीनि [१] बस्तिकर्म तथा परम्||८१||

तैलान्यभ्यङ्गयोगीनि [१] बस्तिकर्म तथा परम्||८१||

shiraHpArshvAMsashUleShu rudhiraM tasya nirharet||82||  

shiraHpArshvAMsashUleShu rudhiraM tasya nirharet||82||  

Nasal errhines, medicated smokes, post prandial unctuous potions, inunctions with medicated oils, and enemata are very useful options to help ease pain. In conditions of pain in the head, flanks and shoulder region, the vitiated blood should be depleted by betokens of the horn, bottle gourd, application of leeches or venesection.[81-82]  

Nasal errhines, medicated smokes, post prandial unctuous potions, inunctions with medicated oils, and enemata are very useful options to help ease pain. In conditions of pain in the head, flanks and shoulder region, the vitiated blood should be depleted by betokens of the horn, bottle gourd, application of leeches or venesection.[81-82]  

External applications:

 

==== External applications ====

 

प्रदेहः सघृतश्चेष्टः पद्मकोशीरचन्दनैः|  

प्रदेहः सघृतश्चेष्टः पद्मकोशीरचन्दनैः|  

दूर्वामधुकमञ्जिष्ठाकेशरैर्वा घृताप्लुतैः||८३||  

दूर्वामधुकमञ्जिष्ठाकेशरैर्वा घृताप्लुतैः||८३||  

pariShekaH prayoktavya iti saMshamanI kriyA||86||

pariShekaH prayoktavya iti saMshamanI kriyA||86||

The application of Himalayan cherry, cuscus grass and sandal wood with ghee is salutary; or the application of scitch grass, liquorice, Indian madder and fragrant poon soaked in ghee; or the application composed of tubers of white lotus chaste tree, red lotus, fragrant poon, blue water lily, rushnut and milky yam with ghee. Inunction with the compound sandal oil or ghee processed for hundred times and affusion with milk or liquorice water are recommended. Affusion with cold rain water or the sandal wood group should be given. Thus the pacification treatment has been described.. [83-86]

The application of Himalayan cherry, cuscus grass and sandal wood with ghee is salutary; or the application of scitch grass, liquorice, Indian madder and fragrant poon soaked in ghee; or the application composed of tubers of white lotus chaste tree, red lotus, fragrant poon, blue water lily, rushnut and milky yam with ghee. Inunction with the compound sandal oil or ghee processed for hundred times and affusion with milk or liquorice water are recommended. Affusion with cold rain water or the sandal wood group should be given. Thus the pacification treatment has been described.. [83-86]

Indications of shodhana (purification):

 

==== Indications of shodhana (purification) ====

 

दोषाधिकानां वमनं शस्यते सविरेचनम्|  

दोषाधिकानां वमनं शस्यते सविरेचनम्|  

स्नेहस्वेदोपपन्नानां सस्नेहं यन्न कर्शनम्||८७||  

स्नेहस्वेदोपपन्नानां सस्नेहं यन्न कर्शनम्||८७||  

abalApekShiNIM mAtrAM kiM punaryo viricyate||88||

abalApekShiNIM mAtrAM kiM punaryo viricyate||88||

In cases of excessively aggravated dosha, mild therapeutic emesis and purgation therapies after proper snehana (oleation) and svedana (sudation) which do not cause emaciation can be administered. The emaciated man (consumptive) may suffer death even on loosening of stools. Then what can be said if a strong dose of purification is given in rajayakshma patient beyond his tolerance?[87-88]

In cases of excessively aggravated dosha, mild therapeutic emesis and purgation therapies after proper snehana (oleation) and svedana (sudation) which do not cause emaciation can be administered. The emaciated man (consumptive) may suffer death even on loosening of stools. Then what can be said if a strong dose of purification is given in rajayakshma patient beyond his tolerance?[87-88]

Various formulations for nasya (nasal errhines):

Various formulations for nasya (nasal errhines):

योगान् संशुद्धकोष्ठानां कासे श्वासे स्वरक्षये|  

योगान् संशुद्धकोष्ठानां कासे श्वासे स्वरक्षये|