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{{Infobox

{{Infobox

|title = Shosha Nidana

|title = Shosha Nidana

|label4 = Other Sections

|label4 = Other Sections

|data4 = [[Sutra Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

|data4 = [[Sutra Sthana]], [[Vimana Sthana]],  [[Sharira Sthana]],  [[Indriya Sthana]], [[Chikitsa Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

==[[Nidana Sthana]] Chapter 6, Shosha Nidana (Chapter on progressive wasting disease)==

'''Keywords''': ''kshaya'', ''shosha'', ''yakshma'', ''sahasa'', ''visamashana'', ''Nidanarthakara Roga Vyadhiksamatva'', ''Ojakshaya'', chronic wasting diseases, Immune defense, ''[[Rasayana]]'', exertion, improper dietary habits, suppression of natural urges, depletion of tissue.

== Introduction ==

=== Introduction ===

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There are three interrelated entities mentioned by Charak in three distinct chapters within [[Charak Samhita]]: [[Shosha Nidana]] (Ni.6), ''rajayakshma'' (Chi.8) and ''kshataksheena'' (Chi. 11).  

There are three interrelated entities mentioned by Charak in three distinct chapters within [[Charak Samhita]]: [[Shosha Nidana]] [Cha.Sa.[[Nidana Sthana]].6], ''rajayakshma'' [Cha.Sa.[[Chikitsa Sthana]] 8) and ''kshataksheena'' [Cha.Sa.[[Chikitsa Sthana]] 11).  

''Shosha'' is the preparatory stage of gradual, generalized emaciation due to four distinct causative factors mentioned earlier which, if untreated or ignored, may lead to ''rajayakshma''. One of the contributing factors of ''shosha'' is indicative of systemic depletion of ''dhatu'' occurring due to divergent causes. An important point to note here is that ''shosha'' is different from ''kshataksheena'', a post-treatment stage of localized or generalized emaciation needing further intensive treatment.

''Shosha'' is the preparatory stage of gradual, generalized emaciation due to four distinct causative factors mentioned earlier which, if untreated or ignored, may lead to ''rajayakshma''. One of the contributing factors of ''shosha'' is indicative of systemic depletion of ''[[dhatu]]'' occurring due to divergent causes. An important point to note here is that ''shosha'' is different from ''kshataksheena'', a post-treatment stage of localized or generalized emaciation needing further intensive treatment.

Another commonly used term for ''shosha'' is ''kshaya'' (emaciation). However, it is imperative to clarify here that while ''shosha'' and ''kshaya'' are contextually similar and synonymous to ''yakshma'' ,  the specific meaning in [[Charak Samhita]] is different for all the three stages of the disease. Ayurveda is not very stringent when it comes to discerning cause-effect. Cause and effect are largely considered a continuum. While discussing the issue of cause-effect relationship between ''kshaya-shosha-yakshma'', the concept of ''nidanarthakara roga'' has also to be kept in mind where one known disease or a morbid state can play as the ''nidana'' of another disease. That is why, ''kshaya'' is sometimes mentioned as cause of ''shosha'' too. The word ''kshaya'' in this particular context refers to pre-existing ''kshaya''. ''Kshaya'' is of two distinct types - ''anuloma kshaya'' and ''pratiloma kshaya''. ''Anulomakshaya'' is caused by the initial depletion of the ''ojas rasa'' situated in the heart, while ''pratiloma kshaya'' occurs due to an excessive indulgence in sexual activities leading to the depletion of ''shukradhatu'' which in turn leads to generalized ''vata vriddhi'' and ''vata'' induces ''shoshana'' of ''dhatus''. Both these variants contribute to ''shoshana'' (qualitative and quantitative depletion of ''sharira dhatus'' or body tissues).

Another commonly used term for ''shosha'' is ''kshaya'' (emaciation). However, it is imperative to clarify here that while ''shosha'' and ''kshaya'' are contextually similar and synonymous to ''yakshma'' ,  the specific meaning in [[Charak Samhita]] is different for all the three stages of the disease. [[Ayurveda]] is not very stringent when it comes to discerning cause-effect. Cause and effect are largely considered a continuum. While discussing the issue of cause-effect relationship between ''kshaya-shosha-yakshma'', the concept of ''nidanarthakara roga'' has also to be kept in mind where one known disease or a morbid state can play as the ''nidana'' of another disease. That is why, ''kshaya'' is sometimes mentioned as cause of ''shosha'' too. The word ''kshaya'' in this particular context refers to pre-existing ''kshaya''. ''Kshaya'' is of two distinct types - ''anuloma kshaya'' and ''pratiloma kshaya''. ''Anulomakshaya'' is caused by the initial depletion of the ''[[ojas]] rasa'' situated in the heart, while ''pratiloma kshaya'' occurs due to an excessive indulgence in sexual activities leading to the depletion of ''[[shukra dhatu]]'' which in turn leads to generalized ''[[vata]] vriddhi'' and ''[[vata]]'' induces ''shoshana'' of ''[[dhatu]]s''. Both these variants contribute to ''shoshana'' (qualitative and quantitative depletion of ''sharira [[dhatu]]s'' or body tissues).

''Shosha'' and ''kshaya'' can be considered as independent clinical entities warranting independent strategies for diagnosis and treatment. Either of these may prove to be a ''nidanarthakara'' factor for the occurrence of ''rajayakshma'' (i.e., if ''shosha'' or ''kshaya'' are left untreated, could lead to ''rajayakshma''). ''Shosha'' is essentially a state of intractable emaciation, cachexia or consumption that could be equated to phthisis. It could be considered to be an intermediate state that may not necessarily exhibit any evidence of tubercular infection but because of persistent ''dhatukshaya''(depletion of tissues) it could be logically associated with an immunocompromised state. Some patients may catch infections that may manifest into a febrile state with probable bacteriological invasion warranting appropriate treatment on the lines of ''rajayakshma''. Because ''shosha'' and ''kshaya'' are intermediary states that are more of diagnostic significance than of significance from a core treatment perspective. Charak wrote the chapter on ''shosha'' in [[Nidana Sthana]] , while on ''rajayakshma'' in [[Chikitsa Sthana]] with the same motive.

''Shosha'' and ''kshaya'' can be considered as independent clinical entities warranting independent strategies for diagnosis and treatment. Either of these may prove to be a ''nidanarthakara'' factor for the occurrence of ''rajayakshma'' (i.e., if ''shosha'' or ''kshaya'' are left untreated, could lead to ''rajayakshma''). ''Shosha'' is essentially a state of intractable emaciation, cachexia or consumption that could be equated to phthisis. It could be considered to be an intermediate state that may not necessarily exhibit any evidence of tubercular infection but because of persistent ''[[dhatu]] kshaya''(depletion of tissues) it could be logically associated with an immunocompromised state. Some patients may catch infections that may manifest into a febrile state with probable bacteriological invasion warranting appropriate treatment on the lines of ''rajayakshma''. Because ''shosha'' and ''kshaya'' are intermediary states that are more of diagnostic significance than of significance from a core treatment perspective. Charak wrote the chapter on ''shosha'' in [[Nidana Sthana]] , while on ''rajayakshma'' in [[Chikitsa Sthana]] with the same motive.

It may appear that ''shosha'' and ''rajayakshma'' are synonymous because in this chapter there are brief descriptions of ''poorvarupa'' (preliminary signs) and ''ekadasha rupa'' (advanced stage) of ''yakshma''. However, the manifestation of ''rajayakshma'' has been described in detail only in the [[Chikitsa Sthana]].

It may appear that ''shosha'' and ''rajayakshma'' are synonymous because in this chapter there are brief descriptions of ''poorvarupa'' (preliminary signs) and ''ekadasha rupa'' (advanced stage) of ''yakshma''. However, the manifestation of ''rajayakshma'' has been described in detail only in the [[Chikitsa Sthana]].

While the focus of this chapter is to delineate the views of Charak, Sushruta in his text differs in his views on the relationship between ''shosha'' and ''yakshma''. While Charak considers them as dependent entities as mentioned above, Susruta considers ''shosha'' distinctly different disease that could manifest itself in any of seven different variants caused by seven different causative factors (''vyavaya'' or excessive sexual indulgence, ''shoka'' or sorrow, ''jara'' or rapid aging process, ''vyayama'' or excessive exercise, ''adhwagaman'' or excessive travelling, ''vrana'' or wound/trauma, and ''urakshata'' or chest injury.

While the focus of this chapter is to delineate the views of Charak, Sushruta in his text differs in his views on the relationship between ''shosha'' and ''yakshma''. While Charak considers them as dependent entities as mentioned above, Susruta considers ''shosha'' distinctly different disease that could manifest itself in any of seven different variants caused by seven different causative factors (''vyavaya'' or excessive sexual indulgence, ''shoka'' or sorrow, ''jara'' or rapid aging process, ''[[vyayama]]'' or excessive exercise, ''adhwagaman'' or excessive travelling, ''vrana'' or wound/trauma, and ''urakshata'' or chest injury.

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===Sanskrit text, Transliteration and English Translation===

 

==Sanskrit text, Transliteration and English Translation==

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अथातःशोषनिदानंव्याख्यास्यामः||१||  

अथातःशोषनिदानंव्याख्यास्यामः||१||  

इतिहस्माहभगवानात्रेयः||२||

इतिहस्माहभगवानात्रेयः||२||

AthÁtah ÐoÒanidÁnam vyÁkhyÁsyÁmah ||1||  

AthÁtah ÐoÒanidÁnam vyÁkhyÁsyÁmah ||1||  

iti ha smÁha bhagavÁnÁtreyah ||2||

iti ha smÁha bhagavÁnÁtreyah ||2||

Now I shall expound upon the chapter on diagnosis of ''shosha'', said Lord Atreya. [1-2]

=== Four Causes of shosha ===

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इहखलुचत्वारिशोषस्यायतनानिभवन्ति|

इहखलुचत्वारिशोषस्यायतनानिभवन्ति|

तद्यथा- साहसंसन्धारणंक्षयोविषमाशनमिति||३||

तद्यथा- साहसंसन्धारणंक्षयोविषमाशनमिति||३||

Ih khalu catvÁri ÐoÒasyÁyatanÁni bhavanti

Ih khalu catvÁri ÐoÒasyÁyatanÁni bhavanti

tadyathÁ- sÁhasam sa¿dhÁranam kÒayo viÒamÁÐanamiti ||3||

tadyathÁ- sÁhasam sa¿dhÁranam kÒayo viÒamÁÐanamiti ||3||

There are four causes of ''shosha'': overexertion, suppression of urges, wasting, and irregular consumption of improper food articles [3].  

There are four causes of ''shosha'': overexertion, suppression of urges, wasting, and irregular consumption of improper food articles [3].  

Each of these causes will be explained here in detail:

Each of these causes will be explained here in detail:

===== 1. Overexertion as a cause =====  

==== 1. Overexertion ====  

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तत्रसाहसंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

तत्रसाहसंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

   

   

जीवन्हिपुरुषस्त्विष्टंकर्मणःफलमश्नुते||५||

जीवन्हिपुरुषस्त्विष्टंकर्मणःफलमश्नुते||५||

Tatra sÁhasam ÐoÒasyÁyatanamiti yaduktam tadanu vyÁkhyÁsyÁmah -  

Tatra sÁhasam ÐoÒasyÁyatanamiti yaduktam tadanu vyÁkhyÁsyÁmah -  

jÍvan hi purÚÒastviÒÔam karmaÆah phalamaÐnute ||5||

jÍvan hi purÚÒastviÒÔam karmaÆah phalamaÐnute ||5||

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When a weak person fights against a strong one, or exercises with an excessively large (or weighty) bow (weapon), or speaks too much, or physically carries a lot of weight, or swims across a long distance in water, or is habitually subjected to forceful massage including kneading with feet, or sprints over a long distance, or is assaulted, or practices various complicated or excessive physical exercises, his lungs are “traumatized” due to excessive exertion. This aggravates ''vayu'' in the lung region, taking along ''kapha'' residing in the lungs while also affecting ''pitta'', causing the vitiated ''doshas'' to spread upwards, downwards and obliquely. A portion of this afflicted ''dosha'' system that gets into body joints causes yawning, body ache, and fever. That which gets into the ''amashaya'' causes diseases of lungs and anorexia. That which gets into the throat causes irritation of the throat and hoarseness of voice. That which gets into the channels carrying vital breath (bronchial channels) causes dyspnea and coryza. And that which gets into the head produces distress in the head. Thus, due to wound in lungs, irregular movement of ''vayu'' causes a variety of diseases depending upon the organs it gets into. The lungs get damaged further, triggering conditions such as hemoptysis and consequently weakening the patient. This verse, therefore, advises the reader to engage in laborious activities appropriate to his strength and not overexert himself. [4-5]

When a weak person fights against a strong one, or exercises with an excessively large (or weighty) bow (weapon), or speaks too much, or physically carries a lot of weight, or swims across a long distance in water, or is habitually subjected to forceful massage including kneading with feet, or sprints over a long distance, or is assaulted, or practices various complicated or excessive physical exercises, his lungs are “traumatized” due to excessive exertion. This aggravates ''vayu'' in the lung region, taking along ''[[kapha]]'' residing in the lungs while also affecting ''[[pitta]]'', causing the vitiated ''[[dosha]]s'' to spread upwards, downwards and obliquely. A portion of this afflicted ''[[dosha]]'' system that gets into body joints causes yawning, body ache, and fever. That which gets into the ''amashaya'' causes diseases of lungs and anorexia. That which gets into the throat causes irritation of the throat and hoarseness of voice. That which gets into the channels carrying vital breath (bronchial channels) causes dyspnea and coryza. And that which gets into the head produces distress in the head. Thus, due to wound in lungs, irregular movement of ''vayu'' causes a variety of diseases depending upon the organs it gets into. The lungs get damaged further, triggering conditions such as hemoptysis and consequently weakening the patient. This verse, therefore, advises the reader to engage in laborious activities appropriate to his strength and not overexert himself. [4-5]

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===== 2. Suppression of natural urges as a cause =====

==== 2. Suppression of natural urges ====

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सन्धारणंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

सन्धारणंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

तदभावेहिभावानांसर्वाभावःशरीरिणाम्||७||

तदभावेहिभावानांसर्वाभावःशरीरिणाम्||७||

sa¿dhÁranam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah -  

sa¿dhÁranam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah -  

tadabhÁve hi bhÁvÁnÁm sarvÁbhÁvah ÐÁrÍriÆÁm ||7||

tadabhÁve hi bhÁvÁnÁm sarvÁbhÁvah ÐÁrÍriÆÁm ||7||

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When a person suppresses the urge to pass flatulence, urination, and bowel movement due to various reasons such as attending a royalty, being in a formal setting (in the company of sages, teachers, nobles, etc), being in the midst of women, society of gambling, or while traveling on uneven vehicle, or due to fear, environment, bashfulness or disgust, ''vayu'' gets vitiated due to suppression of urges. This vitiated ''vayu'' aggravates ''pitta'' and/or ''kapha'', spreading upwards, downwards or obliquely depending upon the combination of afflicted ''doshas''. As said earlier, when a portion gets into specific body parts, it causes pain, diarrhea or drying up of feces, excessive pain in sides of the chest, pain in the shoulders, irritation in throat and lungs, headache, cough, dyspnea, fever, hoarseness of voice and coryza. Thereafter, having been afflicted with these wasting complications, the patient gradually gets afflicted with ''shosha''. Hence the wise should carefully observe the ways that promote and protect the body.

When a person suppresses the urge to pass flatulence, urination, and bowel movement due to various reasons such as attending a royalty, being in a formal setting (in the company of sages, teachers, nobles, etc), being in the midst of women, society of gambling, or while traveling on uneven vehicle, or due to fear, environment, bashfulness or disgust, ''vayu'' gets vitiated due to suppression of urges. This vitiated ''vayu'' aggravates ''[[pitta]]'' and/or ''[[kapha]]'', spreading upwards, downwards or obliquely depending upon the combination of afflicted ''[[dosha]]s''. As said earlier, when a portion gets into specific body parts, it causes pain, diarrhea or drying up of feces, excessive pain in sides of the chest, pain in the shoulders, irritation in throat and lungs, headache, cough, dyspnea, fever, hoarseness of voice and coryza. Thereafter, having been afflicted with these wasting complications, the patient gradually gets afflicted with ''shosha''. Hence the wise should carefully observe the ways that promote and protect the body.

Here is the verse: Setting all other things aside, one should protect the body, because in its absence there will be complete absence of all the bodily entities. [6-7]

Here is the verse: Setting all other things aside, one should protect the body, because in its absence there will be complete absence of all the bodily entities. [6-7]

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===== 3. Wasting as cause =====

==== 3. Depletion of tissues ====

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क्षयःशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

क्षयःशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

यथोपदेक्ष्यमाणरूपेण|८|

यथोपदेक्ष्यमाणरूपेण|८|

kÒayah ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

kÒayah ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

yathopadekÒyamÁÆarÚpeÆa |8|

yathopadekÒyamÁÆarÚpeÆa |8|

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Now explained is wasting as the cause of ''shosha''. When a person is suffering excessively from anxiety and grief, or from emotions like envy, fear, anger, etc., and if the person is also afflicted with a wasting disorder and/or using rough food and drinks, or if a congenitally weak person is subjected to fasting or malnutrition, his ''ojas'' gets diminished leading to ''shosha''. Due to want of proper management and care, he could get afflicted with the disease having symptoms to be described later. [8]

Now explained is depletion of tissues as the cause of ''shosha''. When a person is suffering excessively from anxiety and grief, or from emotions like envy, fear, anger, etc., and if the person is also afflicted with a wasting disorder and/or using rough food and drinks, or if a congenitally weak person is subjected to fasting or malnutrition, his ''[[ojas]]'' gets diminished leading to ''shosha''. Due to want of proper management and care, he could get afflicted with the disease having symptoms to be described later. [8]

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===== 4.Excessive sexual indulgence as a cause* =====  

==== 3a.Excessive sexual indulgence* ====  

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यदावापुरुषोऽतिहर्षादतिप्रसक्तभावःस्त्रीष्वतिप्रसङ्गमारभते, तस्यातिमात्रप्रसङ्गाद्रेतःक्षयमेति|  

यदावापुरुषोऽतिहर्षादतिप्रसक्तभावःस्त्रीष्वतिप्रसङ्गमारभते, तस्यातिमात्रप्रसङ्गाद्रेतःक्षयमेति|  

क्षयोह्यस्यबहून्रोगान्मरणंवानियच्छति||९||

क्षयोह्यस्यबहून्रोगान्मरणंवानियच्छति||९||

yadÁ vÁ purÚÒoatiharÒÁdatiprasaktabhÁvah strÍÒvatiprasa¿gamÁrabhate, tasyÁtimÁtraprasa¿gÁdretah kÒayameti |  

yadÁ vÁ purÚÒoatiharÒÁdatiprasaktabhÁvah strÍÒvatiprasa¿gamÁrabhate, tasyÁtimÁtraprasa¿gÁdretah kÒayameti |  

kÒayo hyasya  bahÚn rogÁnmaraÆam vÁ niyacchati ||9||

kÒayo hyasya  bahÚn rogÁnmaraÆam vÁ niyacchati ||9||

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When a person indulges in excessive sexual intercourse habitually, his semen gets diminished. In spite of diminished semen, if he obsesses about sex mentally as well as physically and continues to engage in sexual acts with excessively determined passion, his semen is not discharged because of its already diminished state causing ''vayu'' to enter his blood vessels and blood getting discharged from the seminal passage. Now, due to loss of semen and hemorrhage, his joints loosen, the skin loses its suppleness and becomes rough or scaly, body weakens further and ''vayu'' gets vitiated. The vitiated ''vayu''spreads in the body deficient of semen and blood, aggravating ''kapha'' and ''pitta'' and drying up the muscles and blood. Further, the vitiated vayu expels kapha and pitta, causing pain in the sides of the chest and shoulders, irritation of throat, aggravating ''kapha'' of the head and replacing it with the vitiated ''kapha'' expelled from their natural locations, causing pain in joints, body ache, anorexia and indigestion. Due to frequent cough the lungs get damaged and hemoptysis ensues, debilitating the patient further and afflicting him with wasting complications. If untreated, the patient gradually is afflicted with phthisis.  

When a person indulges in excessive sexual intercourse habitually, his semen gets diminished. In spite of diminished semen, if he obsesses about sex mentally as well as physically and continues to engage in sexual acts with excessively determined passion, his semen is not discharged because of its already diminished state causing ''vayu'' to enter his blood vessels and blood getting discharged from the seminal passage. Now, due to loss of semen and hemorrhage, his joints loosen, the skin loses its suppleness and becomes rough or scaly, body weakens further and ''vayu'' gets vitiated. The vitiated ''vayu''spreads in the body deficient of semen and blood, aggravating ''[[kapha]]'' and ''[[pitta]]'' and drying up the muscles and blood. Further, the vitiated vayu expels [[kapha]] and [[pitta]], causing pain in the sides of the chest and shoulders, irritation of throat, aggravating ''[[kapha]]'' of the head and replacing it with the vitiated ''[[kapha]]'' expelled from their natural locations, causing pain in joints, body ache, anorexia and indigestion. Due to frequent cough the lungs get damaged and hemoptysis ensues, debilitating the patient further and afflicting him with wasting complications. If untreated, the patient gradually is afflicted with phthisis.  

Here is the verse: Semen is the final essence of one’s food hence it should be protected because its depletion leads to many diseases or even death. [8-9]

Here is the verse: Semen is the final essence of one’s food hence it should be protected because its depletion leads to many diseases or even death. [8-9]

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===== 5. Irregular meals/Improper meals as a cause =====

==== 4. Irregular meals/Improper meals ====

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विषमाशनंशोषस्यायतनमितियदुक्तं,तदनुव्याख्यास्यामः-  

विषमाशनंशोषस्यायतनमितियदुक्तं,तदनुव्याख्यास्यामः-  

पश्यन्रोगान्बहून्कष्टान्बुद्धिमान्विषमाशनात्||११||

पश्यन्रोगान्बहून्कष्टान्बुद्धिमान्विषमाशनात्||११||

viÒamÁÐanam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

viÒamÁÐanam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

paÐyan rogÁn bahÚn kaÒtÁn buddhimÁn viÒamÁÐanÁt ||11||

paÐyan rogÁn bahÚn kaÒtÁn buddhimÁn viÒamÁÐanÁt ||11||

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This verse talks of irregular diet as a cause of ''shosha''. When a person takes food – drinkable, eatable, chewable and lickable – irregularly in terms of nature, preparation, combination, quantity, place, time, and various dietary rules (do’s and don’ts) appropriate for his constitution, his ''doshas'' get imbalanced. These imbalanced ''doshas'' spread in the body, obstructing the openings of various channels and the flow of ''dhatus''. In such cases, the body survives on the support of ''malas''. Hence ''mala'' should be protected, particularly in case where the patient has already been afflicted with phthisis and in cases where the individual is emaciated or very weak. The vitiated ''vata'' causes pain, body ache, irritation of throat, chest pain, pain in shoulders, hoarseness of voice and coryza. Vitiated ''pitta'' causes fever, diarrhea, internal heat and vitiated ''kapha'' causes coryza, heaviness of head, anorexia and cough. Due to frequent bouts of cough, lungs get damaged and hemoptysis ensues, consequently debilitating the patient further and causing ''shosha''. Having been afflicted with these wasting complications, the patient gradually becomes very weak and gaunt.  

This verse talks of irregular diet as a cause of ''shosha''. When a person takes food – drinkable, eatable, chewable and lickable – irregularly in terms of nature, preparation, combination, quantity, place, time, and various dietary rules (do’s and don’ts) appropriate for his constitution, his ''[[dosha]]s'' get imbalanced. These imbalanced ''[[dosha]]s'' spread in the body, obstructing the openings of various channels and the flow of ''[[dhatu]]s''. In such cases, the body survives on the support of ''[[mala]]s''. Hence ''[[mala]]'' should be protected, particularly in case where the patient has already been afflicted with phthisis and in cases where the individual is emaciated or very weak. The vitiated '[[vata]]'' causes pain, body ache, irritation of throat, chest pain, pain in shoulders, hoarseness of voice and coryza. Vitiated ''[[pitta]]'' causes fever, diarrhea, internal heat and vitiated ''[[kapha]]'' causes coryza, heaviness of head, anorexia and cough. Due to frequent bouts of cough, lungs get damaged and hemoptysis ensues, consequently debilitating the patient further and causing ''shosha''. Having been afflicted with these wasting complications, the patient gradually becomes very weak and gaunt.  

The final verse advises thus: Observing many troublesome diseases caused by irregular dieting, the wise should eat wholesome, measured and timely food with self-restraint. [10-11]

The final verse advises thus: Observing many troublesome diseases caused by irregular dieting, the wise should eat wholesome, measured and timely food with self-restraint. [10-11]

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एतैश्चतुर्भिःशोषस्यायतनैरुपसेवितैर्वातपित्तश्लेष्माणःप्रकोपमापद्यन्ते|  

एतैश्चतुर्भिःशोषस्यायतनैरुपसेवितैर्वातपित्तश्लेष्माणःप्रकोपमापद्यन्ते|  

यस्माद्वापूर्वमासीद्भगवतःसोमस्योडुराजस्यतस्माद्राजयक्ष्मेति||१२||

यस्माद्वापूर्वमासीद्भगवतःसोमस्योडुराजस्यतस्माद्राजयक्ष्मेति||१२||

EtaiÐca caturbhi ÐoÒasyÁyatanairÚpasevitairvÁtapittaÐleÒmÁÆah prakopamÁpadyante|  

EtaiÐca caturbhi ÐoÒasyÁyatanairÚpasevitairvÁtapittaÐleÒmÁÆah prakopamÁpadyante|  

tam sarvarogÁÆÁm kaÒtatamatvÁdrÁjayakÒmÁÆamÁcakÒate bhiÒajah; yasmÁdvÁ pÚrvamÁsÍdbhagavatahsomasyo±urÁjasya tasmÁdrÁjayakÒmeti ||12||

tam sarvarogÁÆÁm kaÒtatamatvÁdrÁjayakÒmÁÆamÁcakÒate bhiÒajah; yasmÁdvÁ pÚrvamÁsÍdbhagavatahsomasyo±urÁjasya tasmÁdrÁjayakÒmeti ||12||

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Regular use of the four etiological factors of ''shosha'' vitiates the ''doshas''. These vitiated ''doshas'' dry up the body while afflicting it with various complications. Physicians call it ''rajayakshma'' because it is most troublesome among all the diseases (''rajayakshma'' would literally translate to the “king of ''yakshmas''”) or because in ''vedic'' mythologies, it afflicted Lord Moon, the king of stars. [12]

Regular use of the four etiological factors of ''shosha'' vitiates the ''[[dosha]]s''. These vitiated ''[[dosha]]s'' dry up the body while afflicting it with various complications. Physicians call it ''rajayakshma'' because it is most troublesome among all the diseases (''rajayakshma'' would literally translate to the “king of ''yakshmas''”) or because in ''vedic'' mythologies, it afflicted Lord Moon, the king of stars. [12]

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==== Prodromal symptoms ====

=== Prodromal symptoms ===

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तस्येमानिपूर्वरूपाणिभवन्ति; तद्यथा- प्रतिश्यायः, क्षवथुरभीक्ष्णं, श्लेष्मप्रसेकः, मुखमाधुर्यम्, अनन्नाभिलाषः, अन्नकालेचायासः, दोषदर्शनमदोषेष्वल्पदोषेषुवाभावेषुपात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु, भुक्तवतश्चास्यहृल्लासः, तथोल्लेखनमप्याहारस्यान्तरान्तरा, मुखस्यपादयोश्चशोफःपाण्योश्चावेक्षणमत्यर्थम्, अक्ष्णोःश्वेतावभासताचातिमात्रं, बाह्वोश्चप्रमाणजिज्ञासा, स्त्रीकामता,निर्घृणित्वं, बीभत्सदर्शनताचास्यकाये,  

तस्येमानिपूर्वरूपाणिभवन्ति; तद्यथा- प्रतिश्यायः, क्षवथुरभीक्ष्णं, श्लेष्मप्रसेकः, मुखमाधुर्यम्, अनन्नाभिलाषः, अन्नकालेचायासः, दोषदर्शनमदोषेष्वल्पदोषेषुवाभावेषुपात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु, भुक्तवतश्चास्यहृल्लासः, तथोल्लेखनमप्याहारस्यान्तरान्तरा, मुखस्यपादयोश्चशोफःपाण्योश्चावेक्षणमत्यर्थम्, अक्ष्णोःश्वेतावभासताचातिमात्रं, बाह्वोश्चप्रमाणजिज्ञासा, स्त्रीकामता,निर्घृणित्वं, बीभत्सदर्शनताचास्यकाये,  

स्वप्नेचाभीक्ष्णंदर्शनमनुदकानामुदकस्थानानांशून्यानांचग्रामनगरनिगमजनपदानांशुष्कदग्धभग्नानांचवनानांकृकलासमयूरवानरशुकसर्पकाकोलूकादिभिः

स्वप्नेचाभीक्ष्णंदर्शनमनुदकानामुदकस्थानानांशून्यानांचग्रामनगरनिगमजनपदानांशुष्कदग्धभग्नानांचवनानांकृकलासमयूरवानरशुकसर्पकाकोलूकादिभिः

संस्पर्शनमधिरोहणंयानंवाश्वोष्ट्रखरवराहैःकेशास्थिभस्मतुषाङ्गारराशीनांचाधिरोहणमिति (शोषपूर्वरूपाणिभवन्ति)||१३||

संस्पर्शनमधिरोहणंयानंवाश्वोष्ट्रखरवराहैःकेशास्थिभस्मतुषाङ्गारराशीनांचाधिरोहणमिति (शोषपूर्वरूपाणिभवन्ति)||१३||

tasyemÁni pÚrvarÚpÁÆi bhavanti; tadyathÁ- pratiÐyÁyah, kÒavathurabhIkÒÆam, ÐleÒmaprasekah, mukhamÁdhuryam, anannÁbhilÁÒah, annakÁle cÁyÁsah, doÒadarÐanamadoÒeÒvalpadoÒeÒu vÁ bhÁveÒu pÁtrodakÁnnasÚpÁpÚpopada¿ÐapariveÐakeÒu, bhuktavataÐcÁsya hªullÁsah, tathollekhanamapyÁhÁrasyÁntarÁntarÁ, mukhasya pÁdayoÐca Ðophah pÁÆyoÐcÁvekÒaÆamatyartham, akÒÆoh ÐvetÁvabhÁsatÁ cÁtimÁtram, bÁhvoÐca pramÁÆajijúÁsÁ, strÍkÁmatÁ, nirghªuÆitvam, bIbhatsadarÐanatÁ cÁsya kÁye, svapne cÁbhIkÒÆam darÐanamanudakÁnÁmudakasthÁnÁnÁm ÐÚnyÁnÁm ca grÁmanagaranigamajanapadÁnÁm ÐuÒkadagdhabhagnÁnÁm ca vanÁnÁm kªukalÁsamayÚravÁnaraÐukasarpakÁkolÚkÁdibhih sa¿sparÐanamadhirohaÆam yÁnam vÁ ÐvoÒtrakharavarÁhaih  keÐÁsthibhasmatuÒÁa¿gÁrarÁshÍnÁm cÁdhirohaÆamiti (ÐoÒapÚrvarÚpÁÆi bhavanti) ||13||

tasyemÁni pÚrvarÚpÁÆi bhavanti; tadyathÁ- pratiÐyÁyah, kÒavathurabhIkÒÆam, ÐleÒmaprasekah, mukhamÁdhuryam, anannÁbhilÁÒah, annakÁle cÁyÁsah, doÒadarÐanamadoÒeÒvalpadoÒeÒu vÁ bhÁveÒu pÁtrodakÁnnasÚpÁpÚpopada¿ÐapariveÐakeÒu, bhuktavataÐcÁsya hªullÁsah, tathollekhanamapyÁhÁrasyÁntarÁntarÁ, mukhasya pÁdayoÐca Ðophah pÁÆyoÐcÁvekÒaÆamatyartham, akÒÆoh ÐvetÁvabhÁsatÁ cÁtimÁtram, bÁhvoÐca pramÁÆajijúÁsÁ, strÍkÁmatÁ, nirghªuÆitvam, bIbhatsadarÐanatÁ cÁsya kÁye, svapne cÁbhIkÒÆam darÐanamanudakÁnÁmudakasthÁnÁnÁm ÐÚnyÁnÁm ca grÁmanagaranigamajanapadÁnÁm ÐuÒkadagdhabhagnÁnÁm ca vanÁnÁm kªukalÁsamayÚravÁnaraÐukasarpakÁkolÚkÁdibhih sa¿sparÐanamadhirohaÆam yÁnam vÁ ÐvoÒtrakharavarÁhaih  keÐÁsthibhasmatuÒÁa¿gÁrarÁshÍnÁm cÁdhirohaÆamiti (ÐoÒapÚrvarÚpÁÆi bhavanti) ||13||

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''Shosha''’s prodromal symptoms include coryza, frequent sneezing, excessive secretion of mucus, a sweet aftertaste in the mouth, aversion to food, exhaustion during meal time, finding fault with utensils, water, cereals, pulses flour preparations, spicy preparation and caterers who are free from fault or have a little fault. A person afflicted with ''shosha'' will experience nausea after meals, intermittent vomiting during meals, swellings in the face and feet, tendency of frequently looking at the hands, excessive whitishness in the eyes, curiosity about measurement of arms, longing for women, disgust, loathsome view of his body, frequent dreams of waterless/arid places as well as places such as deserted villages, cities, districts and regions, of forests dried, burnt and destroyed. Such a person would often be using vehicles drawn by, or coming in contact with, or riding animals like chameleon, peacock, monkey, parrot, serpent, crow, owl, dog, camel, ass and boar, and riding over heaps of hair, bones, ash, chaff and charcoal.  [13]

''Shosha''’s prodromal symptoms include coryza, frequent sneezing, excessive secretion of mucus, a sweet aftertaste in the mouth, aversion to food, exhaustion during meal time, finding fault with utensils, water, cereals, pulses flour preparations, spicy preparation and caterers who are free from fault or have a little fault. A person afflicted with ''shosha'' will experience nausea after meals, intermittent vomiting during meals, swellings in the face and feet, tendency of frequently looking at the hands, excessive whitishness in the eyes, curiosity about measurement of arms, longing for women, disgust, loathsome view of his body, frequent dreams of waterless/arid places as well as places such as deserted villages, cities, districts and regions, of forests dried, burnt and destroyed. Such a person would often be using vehicles drawn by, or coming in contact with, or riding animals like chameleon, peacock, monkey, parrot, serpent, crow, owl, dog, camel, ass and boar, and riding over heaps of hair, bones, ash, chaff and charcoal.  [13]

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==== Eleven symptoms ====

=== Eleven symptoms ===

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अतऊर्ध्वमेकादशरूपाणितस्यभवन्ति; तद्यथा- शिरसःपरिपूर्णत्वं, कासः, श्वासः, स्वरभेदः, श्लेष्मणश्छर्दनं, शोणितष्ठीवनं, पार्श्वसंरोजनम्, अंसावमर्दः, ज्वरः, अतीसारः, अरोचकश्चेति||१४||

अतऊर्ध्वमेकादशरूपाणितस्यभवन्ति; तद्यथा- शिरसःपरिपूर्णत्वं, कासः, श्वासः, स्वरभेदः, श्लेष्मणश्छर्दनं, शोणितष्ठीवनं, पार्श्वसंरोजनम्, अंसावमर्दः, ज्वरः, अतीसारः, अरोचकश्चेति||१४||

Ata ÚrdhvamekÁdaÐarÚpÁÆi tasya bhavanti; tadyathÁ- Ðirasah paripÚrÆatvam, kÁsah, ÐvÁsah, svarabhedah, ÐleÒmÁÆaÐchardanam, ÐoÆitaÒÔhÍvanam, pÁrÐvasa¿rojanam, a¿sÁvamardah, jvarah, atÍsÁrah, arocakaÐceti ||14||

Ata ÚrdhvamekÁdaÐarÚpÁÆi tasya bhavanti; tadyathÁ- Ðirasah paripÚrÆatvam, kÁsah, ÐvÁsah, svarabhedah, ÐleÒmÁÆaÐchardanam, ÐoÆitaÒÔhÍvanam, pÁrÐvasa¿rojanam, a¿sÁvamardah, jvarah, atÍsÁrah, arocakaÐceti ||14||

There are eleven typical symptoms of ''shosha'' (mentioned in this verse) such as fullness of head, cough, dyspnea, hoarseness of voice, vomiting of sputum, hemoptysis, chest-pain, pain in shoulders, fever, diarrhea, and anorexia. [14]

There are eleven typical symptoms of ''shosha'' (mentioned in this verse) such as fullness of head, cough, dyspnea, hoarseness of voice, vomiting of sputum, hemoptysis, chest-pain, pain in shoulders, fever, diarrhea, and anorexia. [14]

==== Prognosis of disease ====

=== Prognosis of disease ===

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तत्रापरिक्षीणबलमांसशोणितोबलवानजातारिष्टःसर्वैरपिशोषलिङ्गैरुपद्रुतःसाध्योज्ञेयः| बलवानुपचितोहिसहत्वाद्व्याध्यौषधबलस्यकामंसुबहुलिङ्गोऽप्यल्पलिङ्गएवमन्तव्यः||१५||

तत्रापरिक्षीणबलमांसशोणितोबलवानजातारिष्टःसर्वैरपिशोषलिङ्गैरुपद्रुतःसाध्योज्ञेयः| बलवानुपचितोहिसहत्वाद्व्याध्यौषधबलस्यकामंसुबहुलिङ्गोऽप्यल्पलिङ्गएवमन्तव्यः||१५||

Tatra parikÒÍÆabalama¿saÐoÆito balavÁnajÁtÁriÒtah sarvairapi ÐoÒali¿gairÚpadrutah sÁdhyo jÆayah | balavÁnupacito hi sahatvÁdvyÁdhyauÒadhabalasya kÁmam subahuli¿goapyalpali¿ga eva mantavyah ||15||

Tatra parikÒÍÆabalama¿saÐoÆito balavÁnajÁtÁriÒtah sarvairapi ÐoÒali¿gairÚpadrutah sÁdhyo jÆayah | balavÁnupacito hi sahatvÁdvyÁdhyauÒadhabalasya kÁmam subahuli¿goapyalpali¿ga eva mantavyah ||15||

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One having all the above symptoms of ''shosha'' should be considered curable in case his strength, muscles and blood are not wasted, he is strong and the fatal signs have not appeared. The strong and well-nourished, because of tolerance to intensity of disease and drugs, should be assumed to have fewer symptoms even if they have many, and treated accordingly. [15]

One having all the above symptoms of ''shosha'' should be considered curable in case his strength, muscles and blood are not wasted, he is strong and the fatal signs have not appeared. The strong and well-nourished, because of tolerance to intensity of disease and drugs, should be assumed to have fewer symptoms even if they have many, and treated accordingly. [15]

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दुर्बलंत्वतिक्षीणबलमांसशोणितमल्पलिङ्गमजातारिष्टमपिबहुलिङ्गंजातारिष्टंचविद्यात्, असहत्वाद्व्याध्यौषधबलस्य; तंपरिवर्जयेत्, क्षणेनैवहिप्रादुर्भवन्त्यरिष्टानि, अनिमित्तश्चारिष्टप्रादुर्भावइति||१६||  

दुर्बलंत्वतिक्षीणबलमांसशोणितमल्पलिङ्गमजातारिष्टमपिबहुलिङ्गंजातारिष्टंचविद्यात्, असहत्वाद्व्याध्यौषधबलस्य; तंपरिवर्जयेत्, क्षणेनैवहिप्रादुर्भवन्त्यरिष्टानि, अनिमित्तश्चारिष्टप्रादुर्भावइति||१६||  

Durbalam tvatikÒÍÆabalama¿saÐoÆitamalpali¿gamajÁtÁriÒtamapi bahuli¿gam jÁtÁriÒtam ca

Durbalam tvatikÒÍÆabalama¿saÐoÆitamalpali¿gamajÁtÁriÒtamapi bahuli¿gam jÁtÁriÒtam ca

vidyÁt, asahatvÁdvyÁdhyauÒadhabalasya; tam parivarjayet, kÒaÆenaiva hi prÁdurbhavantyariÒtÁni, animittaÐcÁriÒtaprÁdurbhÁva iti ||16||

vidyÁt, asahatvÁdvyÁdhyauÒadhabalasya; tam parivarjayet, kÒaÆenaiva hi prÁdurbhavantyariÒtÁni, animittaÐcÁriÒtaprÁdurbhÁva iti ||16||

On the contrary, the patient who is weak and has excessively diminished strength, muscles and blood should be taken as having numerous symptoms including the fatal ones, even if he has few symptoms and no fatal signs because of his intolerance to the intensity of disease and drugs. Hence he should be discarded (for treatment) because the fatal signs appear in a moment and without any apparent cause.[16]

On the contrary, the patient who is weak and has excessively diminished strength, muscles and blood should be taken as having numerous symptoms including the fatal ones, even if he has few symptoms and no fatal signs because of his intolerance to the intensity of disease and drugs. Hence he should be discarded (for treatment) because the fatal signs appear in a moment and without any apparent cause.[16]

==== Summary ====

=== Summary ===

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तत्रश्लोकः-  

तत्रश्लोकः-  

समुत्थानंचलिङ्गंचयःशोषस्यावबुध्यते|  

समुत्थानंचलिङ्गंचयःशोषस्यावबुध्यते|  

पूर्वरूपंचतत्त्वेनसराज्ञःकर्तुमर्हति||१७||

पूर्वरूपंचतत्त्वेनसराज्ञःकर्तुमर्हति||१७||

tatra Ðlokah-

tatra Ðlokah-

samutthÁnam ca li¿gam ca yah ÐoÒasyÁvabudhyate|

samutthÁnam ca li¿gam ca yah ÐoÒasyÁvabudhyate|

pÚrvarÚpam ca tattvena sa rÁjÆah kartumarhati ||17||

pÚrvarÚpam ca tattvena sa rÁjÆah kartumarhati ||17||

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Thus, ends the sixth chapter on diagnosis of ''shosha'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [16-17]

Thus, ends the sixth chapter on diagnosis of ''shosha'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [16-17]

=== ''Tattva Vimarsha'' ===

== Tattva Vimarsha (Fundamental Principles) ==

* Wasting or emaciating conditions like ''shosha'' occur because of four factors: ''Sahasa'' (overexertion), ''Sandhaarana'' (suppression of natural urges), ''Kshaya'' (emaciation), and ''Vishamasana'' (Dietary error).

* Wasting or emaciating conditions like ''shosha'' occur because of four factors: ''Sahasa'' (overexertion), ''Sandhaarana'' (suppression of natural urges), ''Kshaya'' (emaciation), and ''Vishamasana'' (Dietary error).

* The common effect of the four factors is ''dhatukshaya'' (loss of body tissue), especially rasa which is responsible for maintaining ''vyadhikshamatya'' (Immunity).

* The common effect of the four factors is ''[[dhatu]] kshaya'' (loss of body tissue), especially rasa which is responsible for maintaining ''vyadhikshamatya'' (Immunity).

* ''Sahajabala'' (Innate immunity) is fundamental to prognosis of the disease. If ''sahajabala'' is intact, the outcome of treatment is favorable, even if the symptoms are full blown.

* ''Sahajabala'' (Innate immunity) is fundamental to prognosis of the disease. If ''sahajabala'' is intact, the outcome of treatment is favorable, even if the symptoms are full blown.

* Etiological factors, ''dosha'' vitiation and clinical features help in understanding the pathophysiology of the disease.

* Etiological factors, ''[[dosha]]'' vitiation and clinical features help in understanding the pathophysiology of the disease.

=== ''Vidhi Vimarsha'' ===

== Vidhi Vimarsha (Applied Inferences) ==

The point of significance in this chapter is the identification of the intermediary clinical state called ''shosha'' which is the precursor to ''rajayakshma'', a pathological state warranting early diagnosis and treatment as a promotive health care strategy. Sushruta acknowledges the specific role of microbial infection through direct physical contacts as the real cause, while Charak emphasizes upon the role of pre-existing progressive weakness and emaciation accompanied with lowered ''vyadhikshamatva'' (poor immune strength) as some of the key causative factors responsible for the entire spectrum of the disease complex that includes ''shosha, kshaya,'' and ''rajayakshma''. This fundamental idea for which Charak devotes one full chapter in [[Nidana Sthana]] is an original contribution of Charak, drawing specific attention to the fact that the host factor and host resistance against disease is more important than the causative microbial organism in case of contagious diseases like tuberculosis. It also endorses the Ayurvedic stand that the solution lies in enhancing or strengthening the immunity of the host and not merely in tackling the microorganisms afflicting the person. Use of antibiotics, as is prevalent in western medicine, is now dwindling because of their adverse side effects and rapidly emerging problems associated with drug resistance. In fact, there is now a growing consensus that an idea of an antibiotic war in medicine is anti-life and anti-health.

The point of significance in this chapter is the identification of the intermediary clinical state called ''shosha'' which is the precursor to ''rajayakshma'', a pathological state warranting early diagnosis and treatment as a promotive health care strategy. Sushruta acknowledges the specific role of microbial infection through direct physical contacts as the real cause, while Charak emphasizes upon the role of pre-existing progressive weakness and emaciation accompanied with lowered ''vyadhikshamatva'' (poor immune strength) as some of the key causative factors responsible for the entire spectrum of the disease complex that includes ''shosha, kshaya,'' and ''rajayakshma''. This fundamental idea for which Charak devotes one full chapter in [[Nidana Sthana]] is an original contribution of Charak, drawing specific attention to the fact that the host factor and host resistance against disease is more important than the causative microbial organism in case of contagious diseases like tuberculosis. It also endorses the Ayurvedic stand that the solution lies in enhancing or strengthening the immunity of the host and not merely in tackling the microorganisms afflicting the person. Use of antibiotics, as is prevalent in western medicine, is now dwindling because of their adverse side effects and rapidly emerging problems associated with drug resistance. In fact, there is now a growing consensus that an idea of an antibiotic war in medicine is anti-life and anti-health.

The recent advances in biomedical sciences unfolding the shape and role of genome, epigenome and microbiome in human health have partly proven the generic fact that our genes, our environment and “friendly” microbes are our collective friends and are an integral part of our being. They are protective tool for the immune-enhancing through positive life style, healthy dietetics and regulated use of ''rasayana'' remedies. ''Rasayanas'' are described in Ayurveda for promotive and preventive health care as well as for promotion of longevity.

The recent advances in biomedical sciences unfolding the shape and role of genome, epigenome and microbiome in human health have partly proven the generic fact that our genes, our environment and “friendly” microbes are our collective friends and are an integral part of our being. They are protective tool for the immune-enhancing through positive life style, healthy dietetics and regulated use of ''[[rasayana]]'' remedies. ''[[Rasayana]]s'' are described in [[Ayurveda]] for promotive and preventive health care as well as for promotion of longevity.

   

   

Recent researches on ''rasayana'' drugs such as ''amalaki'' and ''ashwagandha'' have appeared in certain high impact journals. Lakhotia et al, in their 2012 study on drosophilia model, have recorded marked DNA repairing effects besides better maturation rate and healthier and longer life span in fruit flies treated with ''amalaki rasayana''. Similarly, Kuboyama et al (2005) have reported that withanolide-A, isolated from the ''ashwagandha rasayana'', has significant regenerative effect on neurons. Singh et al (2008) reported neuro-nutrient impact of Ayurvedic ''rasayana'' therapy while Jayprakash et al (2013) reported the neuroprotective role of ''ashwagandha'' in experimentally induced Parkinsonism. In view of the conceptual strength and the recent scientific studies now it could be suggested that ''rasayanas'' like ''amalaki, chyavanprasha'' and ''ashwagandha'' should be used in the management of ''shosha, kshaya'' and ''yakshma'' with great advantage, besides administration of other therapeutics described in Ayurvedic texts.

Recent researches on ''[[rasayana]]'' drugs such as ''amalaki'' and ''ashwagandha'' have appeared in certain high impact journals. Lakhotia et al, in their 2012 study on drosophilia model, have recorded marked DNA repairing effects besides better maturation rate and healthier and longer life span in fruit flies treated with ''amalaki rasayana''. Similarly, Kuboyama et al (2005) have reported that withanolide-A, isolated from the ''ashwagandha rasayana'', has significant regenerative effect on neurons. Singh et al (2008) reported neuro-nutrient impact of Ayurvedic ''rasayana'' therapy while Jayprakash et al (2013) reported the neuroprotective role of ''ashwagandha'' in experimentally induced Parkinsonism. In view of the conceptual strength and the recent scientific studies now it could be suggested that ''[[rasayana]]s'' like ''amalaki, chyavanprasha'' and ''ashwagandha'' should be used in the management of ''shosha, kshaya'' and ''yakshma'' with great advantage, besides administration of other therapeutics described in Ayurvedic texts.

As mentioned earlier, Ayurvedic texts propound the doctrine of an immunocompromised state as the precursor of chronic wasting diseases like ''shosha, kshaya'' and ''yakshma''. Sushruta, while describing the ''samkramaka'' (contagious diseases) specially, observes that ''jwara'', ''shosha, rajayakshma, abhisyanda'' or conjunctivitis, and ''kushtha'' (or dermatoses such as leprosy) spread from person to person by contact. The spread of such diseases may be prevented by avoiding personal contacts and by promoting ''vyadhiksamatva'' or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of ''rasayana'' therapy.

As mentioned earlier, Ayurvedic texts propound the doctrine of an immunocompromised state as the precursor of chronic wasting diseases like ''shosha, kshaya'' and ''yakshma''. Sushruta, while describing the ''samkramaka'' (contagious diseases) specially, observes that ''[[jwara]]'', ''shosha, rajayakshma, abhisyanda'' or conjunctivitis, and ''kushtha'' (or dermatoses such as leprosy) spread from person to person by contact. The spread of such diseases may be prevented by avoiding personal contacts and by promoting ''vyadhiksamatva'' or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of ''[[rasayana]]'' therapy.

==== ''Ojas'' (vital essence of the body) ====

=== ''[[Ojas]]'' (vital essence of the body) ===

The Ayurvedic classics describe a unique hitherto-less-known concept of ''ojas'' (vital essence of the body) that is responsible for biological strength (including immunity). ''Ojas'' is the final product of tissue nourishment and is quintessential to all the seven ''dhatus'' namely ''rasa, rakta, mamsa, meda, asthi, majja,'' and ''shukra''. Sushruta describes ''ojas'' as the ''param teja'' of the ''saptadhatus'' and as the ''bala'' or biological strength of an individual. ''Ojas'' is of two kinds, namely, ''para ojas'' and ''apara ojas''. ''Para ojas'' is subtle and present in very minute quantities in the heart while ''apara ojas'' is gross and as much as half an ''anjali'' (handful) in quantity spread all over the body. ''Para ojas'' is vital to life and any damage or vitiation of it may lead to instant death. ''Apara ojas'' is responsible for gross immune strength.  

The Ayurvedic classics describe a unique hitherto-less-known concept of ''[[ojas]]'' (vital essence of the body) that is responsible for biological strength (including immunity). ''[[Ojas]]'' is the final product of tissue nourishment and is quintessential to all the seven ''[[dhatu]]s'' namely ''[[rasa]], [[rakta]], [[mamsa]], [[meda]], [[asthi]], [[majja]],'' and ''[[shukra]]''. Sushruta describes ''[[ojas]]'' as the ''param teja'' of the ''sapta [[dhatu]]s'' and as the ''bala'' or biological strength of an individual. ''[[Ojas]]'' is of two kinds, namely, ''para ojas'' and ''apara ojas''. ''Para ojas'' is subtle and present in very minute quantities in the heart while ''apara ojas'' is gross and as much as half an ''anjali'' (handful) in quantity spread all over the body. ''Para ojas'' is vital to life and any damage or vitiation of it may lead to instant death. ''Apara ojas'' is responsible for gross immune strength.  

The ''oja-bala'' (''ojas'' strength) derived from ''ojas'' has been categorized to be of three kinds: ''sahaja bala'' or primary natural immunity, ''kalaja bala'' or acquired immunity through environmental factors such as climate etc., and ''yuktikrit bala'' or artificially-induced acquired immunity. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic wasting diseases and contagious diseases, such as ''shosha, kshaya'' and ''yakshma''.  

The ''oja-bala'' (''[[ojas]]'' strength) derived from ''[[ojas]]'' has been categorized to be of three kinds: ''sahaja bala'' or primary natural immunity, ''kalaja bala'' or acquired immunity through environmental factors such as climate etc., and ''yuktikrit bala'' or artificially-induced acquired immunity. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic wasting diseases and contagious diseases, such as ''shosha, kshaya'' and ''yakshma''.  

The texts describe three categories of ''bala-dosha'' or disorders of ''bala'' which are comparable to three categories of immune disorders such as :

The texts describe three categories of ''bala-dosha'' or disorders of ''bala'' which are comparable to three categories of immune disorders such as :

There are specific methods and approaches to tackle the three categories of immune disorders.

There are specific methods and approaches to tackle the three categories of immune disorders.

It cannot be overemphasized that while looking at the above mentioned ancient classical descriptions on ''ojabala'' and ''bala-dosha'' it seems immunology was already highly advanced in the ''Samhita'' period of Ayurveda and the knowledge in this field was almost comparable with the latest basic knowledge of immunology as known today.

It cannot be overemphasized that while looking at the above mentioned ancient classical descriptions on ''ojabala'' and ''bala-dosha'' it seems immunology was already highly advanced in the ''Samhita'' period of [[Ayurveda]] and the knowledge in this field was almost comparable with the latest basic knowledge of immunology as known today.

==== Ancient Ayurvedic leads in Microbiology ====

=== Ancient Ayurvedic leads in Microbiology ===

It will be pertinent to review the concept of microbiology and parasitology in Ayurvedic classics in the context of immunity and body resistance. ''Ojas, bala'' and ''vyadhikshamatva'' need to be adequate within the body for it to possess immunity. Though the role of microbes in pathology was not known in modern medicine 200 years ago, Ayurveda had a good knowledge of their role, albeit of a primitive nature. Ayurveda describes two kinds of organisms, namely ''prakrita'' (non-pathogenic) and ''vaikrita'' (pathogenic). Also described are two categories of pathogens/parasites, namely, external and internal. The internal organisms are mainly of three categories in terms of their natural environments: those that thrive on mucus (''shleshma''), those thriving in fecal matter, and those thriving in blood. Some of these, particularly the ones thriving in fecal matter seem to be intestinal parasites while others simulate microbes. The texts repeatedly advocate protecting surgical wounds from these organisms. There is also a clear description of vector borne diseases and that diseases such as leprosy, tuberculosis, conjunctivitis and fever as contagious diseases spread by contact with other patients or vectors.

It will be pertinent to review the concept of microbiology and parasitology in Ayurvedic classics in the context of immunity and body resistance. ''[[Ojas]], bala'' and ''vyadhikshamatva'' need to be adequate within the body for it to possess immunity. Though the role of microbes in pathology was not known in modern medicine 200 years ago, [[Ayurveda]] had a good knowledge of their role, albeit of a primitive nature. [[Ayurveda]] describes two kinds of organisms, namely ''prakrita'' (non-pathogenic) and ''vaikrita'' (pathogenic). Also described are two categories of pathogens/parasites, namely, external and internal. The internal organisms are mainly of three categories in terms of their natural environments: those that thrive on mucus (''shleshma''), those thriving in fecal matter, and those thriving in blood. Some of these, particularly the ones thriving in fecal matter seem to be intestinal parasites while others simulate microbes. The texts repeatedly advocate protecting surgical wounds from these organisms. There is also a clear description of vector borne diseases and that diseases such as leprosy, tuberculosis, conjunctivitis and fever as contagious diseases spread by contact with other patients or vectors.

It is interesting to note that these ancient texts recognized the existence of “friendly” non-pathogenic organisms and their functions - something that is only now being considered the greatest discovery in microbiology .It is claimed by modern scientists that our living body is made up of 10 trillion somatic cells and is home to some 100 trillion friendly microbes. This “empire” of microbes is called Microbiome. Understanding the relationship between the microbiome and the human being, the animal and the environment - is as important as unravelling human genome. The microbiome is like a well structured organ with unique functions and hence needs to be protected in the same way as we protect our other vital organs like liver, heart or kidney. This recognition of the existence of these friendly ''prakrita'' (non-pathogenic organisms) by Ayurveda thousands of years ago is of great historical significance.

It is interesting to note that these ancient texts recognized the existence of “friendly” non-pathogenic organisms and their functions - something that is only now being considered the greatest discovery in microbiology .It is claimed by modern scientists that our living body is made up of 10 trillion somatic cells and is home to some 100 trillion friendly microbes. This “empire” of microbes is called Microbiome. Understanding the relationship between the microbiome and the human being, the animal and the environment - is as important as unravelling human genome. The microbiome is like a well structured organ with unique functions and hence needs to be protected in the same way as we protect our other vital organs like liver, heart or kidney. This recognition of the existence of these friendly ''prakrita'' (non-pathogenic organisms) by [[Ayurveda]] thousands of years ago is of great historical significance.

==== Research Topics on this Subject ====

=== Research Topics on this Subject ===

#A literary and conceptual study to identify the nature and strength of Bala or immune strength of human body and its scope in prevention and treatment of various diseases and to evaluate its contemporary application.

#A literary and conceptual study to identify the nature and strength of Bala or immune strength of human body and its scope in prevention and treatment of various diseases and to evaluate its contemporary application.

#Clinical and experimental studies on different ''rasayana'' remedies for their immunoenhancing effect in cases of ''kshaya,shosha'' and ''yakshma''.

#Clinical and experimental studies on different ''[[rasayana]]'' remedies for their immunoenhancing effect in cases of ''kshaya,shosha'' and ''yakshma''.

#To develop precise diagnostic criteria for the three disease states described by Charak namely ''kshaya, shosha'' and ''yakshma'' including attempts to identify biomarkers, indicators and clinical rating scales to develop good diagnostic methodology to be used by Ayurvedic practitioners.

#To develop precise diagnostic criteria for the three disease states described by Charak namely ''kshaya, shosha'' and ''yakshma'' including attempts to identify biomarkers, indicators and clinical rating scales to develop good diagnostic methodology to be used by Ayurvedic practitioners.

=== Glossary ===

== Further reading ==

 

 

 

=== References ===

#Charak Samhita Vimana 7.9 on natural non-pathogenic organisms.

#Charak Samhita Vimana 7.9 on natural non-pathogenic organisms.

* [[Rajayakshma Chikitsa]]  

* [[Rajayakshma Chikitsa]]  

* [[Kshatakshina Chikitsa]]

* [[Kshatakshina Chikitsa]]

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