Changes

''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 ''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).

''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 ''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.

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. ''Rasayanas'' 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 ''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.

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 ====