Charaka Shosha Nidana: 6th chapter

The 6th chapter of Charaka Samhitha Nidana Sthana is called Shosha Nidana. It deals with causes, pathology, types and symptoms of Shosha – emaciation, fatigue as per Ayurveda.

अथातः शोष निदानं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātaḥ śoṣa nidānaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||
We shall explore the chapter on the “Diagnosis of Consumption”. Thus said Lord Atreya [1-2]

Nidana of Shosha (Etiology of consumption):
इह खलु चत्वारि शोषस्यायतनानि भवन्ति; तद्यथा- साहसं सन्धारणं क्षयो विषमाशनमिति||३||
iha khalu catvāri śoṣasyāyatanāni bhavanti; tadyathā- sāhasaṃ sandhāraṇaṃ kṣayo viṣamāśanamiti||3||
There are 4 causative factors of Shosha viz.
Sāhasaṃ – excessive physical activities
Sandhāraṇaṃ – Suppression of the natural urges
Kshaya – Wasting and
Vishamashana – Irregular dieting [3]

Details of Sahasa Nidana for Shosha:
तत्र साहसं शोषस्यायतनमिति यदुक्तं तदनुव्याख्यास्यामः- यदा पुरुषो दुर्बलो हि सन् बलवता सह विगृह्णाति, अतिमहता वा धनुषा व्यायच्छति, जल्पति वाऽप्यतिमात्रम्, अतिमात्रं वा भारमुद्वहति, अप्सु वा प्लवते चातिदूरम्, उत्सादनपदाघातने वाऽतिप्रगाढमासेवते, अतिप्रकृष्टं वाऽध्वानं द्रुतमभिपतति, अभिहन्यते वा, अन्यद्वा किञ्चिदेवंविधं विषममतिमात्रं वा व्यायामजातमारभते, तस्यातिमात्रेण कर्मणोरः क्षण्यते|
तस्योरः क्षतमुपप्लवते वायुः|
स तत्रावस्थितः श्लेष्माणमुरःस्थमुपसङ्गृह्य पित्तं च दूषयन् विहरत्यूर्ध्वमधस्तिर्यक् च|
तस्य योंऽशः शरीरसन्धीनाविशति तेनास्य जृम्भाऽङ्गमर्दो ज्वरश्चोपजायते, यस्त्वामाशयमभ्युपैति तेन रोगा भवन्ति उरस्या अरोचकश्च, यः कण्ठमभिप्रपद्यते कण्ठस्तेनोद्ध्वंस्यते स्वरश्चावसीदति, यः प्राणवहानि स्रोतांस्यन्वेति तेन श्वासः प्रतिश्यायश्च जायते, यः शिरस्यवतिष्ठते शिरस्तेनोपहन्यते; ततः क्षणनाच्चैवोरसो विषमगतित्वाच्च वायोः कण्ठस्य चोद्ध्वंसनात् कासः सततमस्य सञ्जायते, स कास प्रसङ्गादुरसि क्षते शोणितं ष्ठीवति, शोणितागमनाच्चास्य दौर्बल्यमुपजायते; एवमेते साहस प्रभवाः साहसिकमुपद्रवाः स्पृशन्ति|
ततः स उपशोषणैरेतैरुपद्रवैरुपद्रुतः शनैः शनैरुपशुष्यति|
तस्मात् पुरुषो मतिमान् बलमात्मनः समीक्ष्य तदनुरूपाणि कर्माण्यारभेत कर्तुं; बलसमाधानं हि शरीरं, शरीरमूलश्च पुरुष इति||४||
भवति चात्र- साहसं वर्जयेत् कर्म रक्षञ्जीवितमात्मनः|
जीवन् हि पुरुषस्त्विष्टं कर्मणः फलमश्नुते||५||
tatra sāhasaṃ śoṣasyāyatanamiti yaduktaṃ tadanuvyākhyāsyāmaḥ- yadā puruṣo durbalo hi san balavatā saha vigṛhṇāti, atimahatā vā dhanuṣā vyāyacchati, jalpati vā’pyatimātram, atimātraṃ vā bhāramudvahati, apsu vā plavate cātidūram, utsādanapadāghātane vā’tipragāḍhamāsevate, atiprakṛṣṭaṃ vā’dhvānaṃ drutamabhipatati, abhihanyate vā, anyadvā kiñcidevaṃvidhaṃ viṣamamatimātraṃ vā vyāyāmajātamārabhate, tasyātimātreṇa karmaṇoraḥ kṣaṇyate|
tasyoraḥ kṣatamupaplavate vāyuḥ|
sa tatrāvasthitaḥ śleṣmāṇamuraḥsthamupasaṅgṛhya pittaṃ ca dūṣayan viharatyūrdhvamadhastiryak ca|
tasya yoṃ’śaḥ śarīrasandhīnāviśati tenāsya jṛmbhā’ṅgamardo jvaraścopajāyate, yastvāmāśayamabhyupaiti tena rogā bhavanti urasyā arocakaśca, yaḥ kaṇṭhamabhiprapadyate kaṇṭhastenoddhvaṃsyate svaraścāvasīdati, yaḥ prāṇavahāni srotāṃsyanveti tena śvāsaḥ pratiśyāyaśca jāyate, yaḥ śirasyavatiṣṭhate śirastenopahanyate; tataḥ kṣaṇanāccaivoraso viṣamagatitvācca vāyoḥ kaṇṭhasya coddhvaṃsanāt kāsaḥ satatamasya sañjāyate, sa kāsa prasaṅgādurasi kṣate śoṇitaṃ ṣṭhīvati, śoṇitāgamanāccāsya daurbalyamupajāyate; evamete sāhasa prabhavāḥ sāhasikamupadravāḥ spṛśanti|
tataḥ sa upaśoṣaṇairetairupadravairupadrutaḥ śanaiḥ śanairupaśuṣyati|
tasmāt puruṣo matimān balamātmanaḥ samīkṣya tadanurūpāṇi karmāṇyārabheta kartuṃ; balasamādhānaṃ hi śarīraṃ, śarīramūlaśca puruṣa iti||4||
bhavati cātra- sāhasaṃ varjayet karma rakṣañjīvitamātmanaḥ|
jīvan hi puruṣastviṣṭaṃ karmaṇaḥ phalamaśnute||5||

lady exercise

Details of Sahasa Nidana for Shosha:
We shall now discuss “excess physical activity” as an etiological factor of Shosha. When a weak person fights with a stronger one or exerts with too big a bow or speaks too much, or carries too big a load or swims in water for long distance or resorts to forceful massage and application of pressure by feet or runs fast to cover a long distance or subjects himself to assault or indulgers in such other irregular regimens and physical exercises in excess, his chest gets injured due to such excesses. The injured chest saturated with (vitiated) Vata.
The portion which affects the joints of the body causes
Jrumbha – yawning
Anga marda – malaise and
Jvara – fever
The portion which affects the Amashaya (stomach including small intestine) leads to
Arochaka – anorexia and
Urasya roga – The disease of the chest (like palpitation and cardiac pain)
The portion which affects throat causes
Kanthodhvamsa – irritation of the throat and
Svarabheda – hoarseness of voice

The portion which affects the channels carrying which affects the head causes damage to that part.
Thereafter, due to injury to the chest, irregular movement of the Vata and irritation of the throat, the patient suffers from constant coughing.
Due to continued coughing there is further injury to the chest and the patient spits blood. These are the complications arising out of rash behavior of an individual.
These emaciating complications lead to cachexia. So a wise person should perform various activities with due regard to his own strength. The body is sustained by strength and the individual (Empirical self) by the body.
Thus it is said:-
The individual enjoys the desired fruit of his action only when he is alive. Therefore, one desirous of long life should avoid rash behavior. [4-5]

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Details of Sandharana – Suppression of natural urges as Nidana(etiological factor):
सन्धारणं शोषस्यायतनमिति यदुक्तं तदनुव्याख्यास्यामः- यदा पुरुषो राजसमीपे भर्तुः समीपे वा गुरोर्वा पाद मूले द्यूतसभमन्यं वा सतां समाजं स्त्रीमध्यं वा समनुप्रविश्य यानैर्वाऽप्युच्चावचैरभियान् भयात् प्रसङ्गाद्ध्रीमत्त्वाद्धृणित्वाद्वा निरुणद्ध्यागतान् वात मूत्र पुरीष वेगान् तदा तस्य सन्धारणाद्वायुः प्रकोपमापद्यते, स प्रकुपितः पित्त श्लेष्माणौ समुदीर्योर्ध्वमधस्तिर्यक् च विहरति; ततश्चांश विशेषेण पूर्ववच्छरीरावयव विशेषं प्रविश्य शूलमुपजनयति, भिनत्ति पुरीषमुच्छोषयति वा, पार्श्वे चातिरुजति, अंसाववमृद्गाति, कण्ठमुरश्चावधमति, शिरश्चोपहन्ति, कासं श्वासं ज्वरं स्वरभेदं प्रतिश्यायं चोपजनयति; ततः स उपशोषणैरेतैरुपद्रवैरुपद्रुतः शनैः शनैरुपशुष्यति|
तस्मात् पुरुषो मतिमानात्मनः शारीरेष्वेव योगक्षेमकरेषु प्रयतेत विशेषेण; शरीरं ह्यस्य मूलं, शरीरमूलश्च पुरुषो भवति||६||
भवति चात्र- सर्वमन्यत् परित्यज्य शरीरमनुपालयेत्|
तदभावे हि भावानां सर्वाभावः शरीरिणाम्||७||
sandhāraṇaṃ śoṣasyāyatanamiti yaduktaṃ tadanuvyākhyāsyāmaḥ- yadā puruṣo rājasamīpe bhartuḥ samīpe vā gurorvā pāda mūle dyūtasabhamanyaṃ vā satāṃ samājaṃ strīmadhyaṃ vā samanupraviśya yānairvā’pyuccāvacairabhiyān bhayāt prasaṅgāddhrīmattvāddhṛṇitvādvā niruṇaddhyāgatān vāta mūtra purīṣa vegān tadā tasya sandhāraṇādvāyuḥ prakopamāpadyate, sa prakupitaḥ pitta śleṣmāṇau samudīryordhvamadhastiryak ca viharati; tataścāṃśa viśeṣeṇa pūrvavaccharīrāvayava viśeṣaṃ praviśya śūlamupajanayati, bhinatti purīṣamucchoṣayati vā, pārśve cātirujati, aṃsāvavamṛdgāti, kaṇṭhamuraścāvadhamati, śiraścopahanti, kāsaṃ śvāsaṃ jvaraṃ svarabhedaṃ pratiśyāyaṃ copajanayati; tataḥ sa upaśoṣaṇairetairupadravairupadrutaḥ śanaiḥ śanairupaśuṣyati|
tasmāt puruṣo matimānātmanaḥ śārīreṣveva yogakṣemakareṣu prayateta viśeṣeṇa; śarīraṃ hyasya mūlaṃ, śarīramūlaśca puruṣo bhavati||6||
bhavati cātra- sarvamanyat parityajya śarīramanupālayet|
tadabhāve hi bhāvānāṃ sarvābhāvaḥ śarīriṇām||7||

diarrhea constipation ibs

Details of Sandharana – Suppression of natural urges as Nidana(etiological factor):
We shall now explain “Suppression of natural urges” as the etiological factor of Shosha.
When an individual suppresses the manifested urges flatus, urine and stool because of apprehension, pre-occupation, bashfulness or hatred in front of the king or master or (while sitting) at the feet of the preceptor or while gambling or attending meetings of gentlemen or in the midst of women, or while travelling in high or low vehicles, then Vata in his body gets aggravated. This aggravated Vata carrying along with it thru provoked Pitta and kapha moves upwards, downwards and sideways.
Different portions of Vata entire into different parts of the body as described before (in para 4) and cause
Shula – colic pain
Purisha bhinna – diarrhea
Parshva ati ruja – drying pain in the shoulder region
Aṃsāvavamṛdgāti – increased respiratory movement in the chest and throat
Shiraścopahanti – damage to the head
Kasa – coughing
Shvasa – dyspnoea
Jvara – fever
Svarabhedaṃ – hoarseness of voice could make special efforts not to suppress the manifested urges with a view to sustaining his body.
The body constitutes the root cause of the wellbeing of the individual and the very production of the body is dependent upon the individual self.
Thus it is said:-
Leaving everything else, one should maintain the body. For if there is no body, there is nothing that can be made available to the individual. [6-7]
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Details of Shosha (wasting) as Nidana (etiological factor):
क्षयः शोषस्यायतनमिति यदुक्तं तदनुव्याख्यास्यामः- यदा पुरुषोऽतिमात्रं शोक चिन्ता परिगत हृदयो भवति, ईर्ष्योत्कण्ठाभय क्रोधादिभिर्वा समाविश्यते, कृशो वा सन् रूक्षान्नपानसेवी भवति, दुर्बल प्रकृतिरनाहारोऽल्पाहारो वा भवति, तदा तस्य हृदय स्थायी रसः क्षयमुपैति; स तस्योपक्षयाच्छोषं प्राप्नोति, अप्रतीकाराच्चानुबध्यते यक्ष्मणा यथोपदेक्ष्यमाणरूपेण|८|
kṣayaḥ śoṣasyāyatanamiti yaduktaṃ tadanuvyākhyāsyāmaḥ- yadā puruṣo’timātraṃ śoka cintā parigata hṛdayo bhavati, īrṣyotkaṇṭhābhaya krodhādibhirvā samāviśyate, kṛśo vā san rūkṣānnapānasevī bhavati, durbala prakṛtiranāhāro’lpāhāro vā bhavati, tadā tasya hṛdaya sthāyī rasaḥ kṣayamupaiti; sa tasyopakṣayācchoṣaṃ prāpnoti, apratīkārāccānubadhyate yakṣmaṇā yathopadekṣyamāṇarūpeṇa|8|

Details of Shosha (wasting) as Nidana (etiological factor):
We shall explain wasting ‘as an etiological factors for Shosha’ Rasa residing in the heart of an individual gets diminished due to the following-
Yadā puruṣo’timātraṃ śoka cintā parigata hṛdayo bhavati – Affliction of the heart of the individual, with excessive grief and worries.
īrṣyotkaṇṭhābhaya krodhādibhirvā samāviśyate – Affliction with Irshya(jealousy), fear, anger etc. intake of ununctuous diets and drinks by emaciated individuals and
Kṛśo vā san rūkṣānnapānasevī bhavati – Intake of food in lesser quantity or fasting by persons who are weak by nature.
Due to this diminution of Rasa, the individual is afflicted with Shosha and if this condition is not neutralized, it leads to the manifestation of tuberculosis in a manner to be described later. (1)

Loss of semen due to over-indulgence and its consequence:
यदा वा पुरुषोऽतिहर्षादति प्रसक्तभावः स्त्रीष्वतिप्रसङ्गमारभते, तस्यातिमात्र प्रसङ्गाद्रेतः क्षयमेति|
क्षयमपि चोपगच्छति रेतसि यदि मनः स्त्रीभ्यो नैवास्य निवर्तते, तस्य चाति प्रणीत सङ्कल्पस्य मैथुनमापद्यमानस्य न शुक्रं प्रवर्ततेऽतिमात्रोपक्षीणरेतस्त्वात्, तथाऽस्य वायुर्व्यायच्छमानशरीरस्यैव धमनीरनुप्रविश्य शोणितवाहिनीस्ताभ्यः शोणितं प्रच्यावयति, तच्छुक्रक्षयादस्य पुनः शुक्रमार्गेण शोणितं प्रवर्तते वातानुसृत लिङ्गम्|
अथास्य शुक्रक्षयाच्छोणित प्रवर्तनाच्च सन्धयः शिथिली भवन्ति, रौक्ष्यमुपजायते, भूयः शरीरं दौर्बल्यमाविशति, वायुः प्रकोपमापद्यते; स प्रकुपितो वशिकं शरीरमनुसर्पन्नुदीर्य श्लेष्मपित्ते परिशोषयति मांस शोणिते, प्रच्यावयति श्लेष्म पित्ते संरुजति पार्श्वे, अवमृद्गात्यंसौ, कण्ठमुद्ध्वंसति, शिरः श्लेष्माणमुपत्क्लेश्य प्रतिपूरयति श्लेष्मणा, सन्धींश्च प्रपीडयन् करोत्यङ्गमर्दमरोचकाविपाकौ च, पित्तश्लेष्मोत्क्लेशात् प्रतिलोमगत्वाच्च वायुर्ज्वरं कासं श्वासं स्वरभेदं प्रतिश्यायं चोपजनयति; स कास प्रसङ्गादुरसि क्षते शोणितं ष्ठीवति, शोणित गमनाच्चास्य दौर्बल्यमुपजायते, ततः स उपशोषणैरेतैरुपद्रवैरुपद्रुतः शनैः शनैरुपशुष्यति|
तस्मात् पुरुषो मतिमानात्मनः शरीरमनुरक्षञ्छुक्रमनुरक्षेत्|
परा ह्येषा फल निर्वृत्तिराहारस्येति||८||
भवति चात्र- आहारस्य परं धाम शुक्रं तद्रक्ष्यमात्मनः|
क्षयो ह्यस्य बहून् रोगान्मरणं वा नियच्छति||९||
yadā vā puruṣo’tiharṣādati prasaktabhāvaḥ strīṣvatiprasaṅgamārabhate, tasyātimātra prasaṅgādretaḥ kṣayameti|
kṣayamapi copagacchati retasi yadi manaḥ strībhyo naivāsya nivartate, tasya cāti praṇīta saṅkalpasya maithunamāpadyamānasya na śukraṃ pravartate’timātropakṣīṇaretastvāt, tathā’sya vāyurvyāyacchamānaśarīrasyaiva dhamanīranupraviśya śoṇitavāhinīstābhyaḥ śoṇitaṃ pracyāvayati, tacchukrakṣayādasya punaḥ śukramārgeṇa śoṇitaṃ pravartate vātānusṛta liṅgam|
athāsya śukrakṣayācchoṇita pravartanācca sandhayaḥ śithilībhavanti, raukṣyamupajāyate, bhūyaḥ śarīraṃ daurbalyamāviśati, vāyuḥ prakopamāpadyate; sa prakupito vaśikaṃ śarīramanusarpannudīrya śleṣmapitte pariśoṣayati māṃsa śoṇite, pracyāvayati śleṣma pitte saṃrujati pārśve, avamṛdgātyaṃsau, kaṇṭhamuddhvaṃsati, śiraḥ śleṣmāṇamupatkleśya pratipūrayati śleṣmaṇā, sandhīṃśca prapīḍayan karotyaṅgamardamarocakāvipākau ca, pittaśleṣmotkleśāt pratilomagatvācca vāyurjvaraṃ kāsaṃ śvāsaṃ svarabhedaṃ pratiśyāyaṃ copajanayati; sa kāsa prasaṅgādurasi kṣate śoṇitaṃ ṣṭhīvati, śoṇitagamanāccāsya daurbalyamupajāyate, tataḥ sa upaśoṣaṇairetairupadravairupadrutaḥ śanaiḥ śanairupaśuṣyati|
tasmāt puruṣo matimānātmanaḥ śarīramanurakṣañchukramanurakṣet|
parā hyeṣā phalanirvṛttirāhārasyeti||8||
bhavati cātra- āhārasya paraṃ dhāma śukraṃ tadrakṣyamātmanaḥ|
kṣayo hyasya bahūn rogānmaraṇaṃ vā niyacchati||9||

Loss of semen due to excess sex and its consequence:
When an individual due to excessive attachment borne out of excessive passion indulges in sexual act in excess, his detached from woman even after the diminution of semen, and he is still determined to indulge in sexual act, he will have no ejaculation of semen during cohabitation because of his semen having been already exhausted.
During the process of coitus vata would enter the blood vessels vata would enter the blood vessels of this individual leading to the ejaculation of blood; the blood being vitiated by Vata, would then enter the seminal channels because of the diminution of semen. Due to the diminution of semen, and discharge of blood, the joints would become loose, there would be dryness and further weakness in the body and aggravation of Vata.

The vitiated Vata Dosha, while spreading all over the body from where semen is exhausted and aggravating Kapha and Pitta, would dry up(reduces) muscle tissues and blood, eliminate Kapha (Phlegm) grinding pain in the shoulders, irritate the throat, till up the head with Kapha after vitiating the latter. It would also produce malaise, anorexia and indigestion after afflicting the joints.
Due to the vitiation of Pitta and kapha and adoption of opposite course, Vata would then produce
Jvara – fever
Kasa – cough
Shvasa – dyspnoea
Svara bheda – hoarseness of voice and
Pratishyaya – Coryza
Due to the injury in the chest because of continued coughing the patient would spit blood. Due to the loss of blood he would become weak. These emaciating complications would thus lead to cachexia by and by. Therefore his own body because it (semen) is the outcome par excellence of the food taken
Thus it said : – Semen is the outcome par excellence of food. One should preserve his own semen because its diminution leads to many diseases and even death. [8-9]

Vishamashana (irregular dieting) as etiological factor:
विषमाशनं शोषस्यायतनमिति यदुक्तं, तदनुव्याख्यास्यामः- यदा पुरुषः पानाशन भक्ष्यलेह्योपयोगान् प्रकृतिकरणसंयोगराशिदेशकालोपयोगसंस्थोपशयविषमानासेवते, तदा तस्य तेभ्यो वात पित्त श्लेष्माणो वैषम्यमापद्यन्ते; ते विषमाः शरीरमनुसृत्य यदा स्रोतसामयनमुखानि प्रतिवार्यावतिष्ठन्ते तदा जन्तुर्यद्यदाहारजातमाहरति तत्तदस्य मूत्रपुरीषमेवोपजायते भूयिष्ठं नान्यस्तथा शरीरधातुः; स पुरीषोपष्टम्भाद्वर्तयति, तस्माच्छुष्यतो विशेषेण पुरीषमनुरक्ष्यं तथाऽन्येषामतिकृशदुर्बलानां; तस्यानाप्यायमानस्य विषमाशनोपचिता दोषाः पृथक् पृथगुपद्रवैर्युञ्जन्तो भूयः शरीरमुपशोषयन्ति|
तत्र वातः शूलमङ्गमर्दं कण्ठोद्ध्वंसनं पार्श्व संरुजनमंसावमर्दं स्वरभेदं प्रतिश्यायं चोपजनयति; पित्तं ज्वरमतीसारमन्तर्दाहं च; श्लेष्मा तु प्रतिश्यायं शिरसो गुरुत्वमरोचकं कासं च, स कास प्रसङ्गादुरसि क्षते शोणितं निष्ठीवति, शोणितगमनाच्चास्य दौर्बल्यमुपजायते|
एवमेते विषमाशनोपचितास्त्रयो दोषा राजयक्ष्याणमभिनिर्वर्तयन्ति|
स तैरुपशोषणैरुपद्रवैरुपद्रुतः शनैः शनैः शुष्यति|
तस्मात् पुरुषो मतिमान् प्रकृतिकरण संयोगराशिदेशकालोपयोग संस्थोपशयादविषममाहारमाहरेत्||१०||
भवति चात्र- हिताशी स्यान्मिताशी स्यात्कालभोजी जितेन्द्रियः|
पश्यन् रोगान् बहून् कष्टान् बुद्धिमान् विषमाशनात्||११||
viṣamāśanaṃ śoṣasyāyatanamiti yaduktaṃ, tadanuvyākhyāsyāmaḥ- yadā puruṣaḥ pānāśanabhakṣyalehyopayogān prakṛtikaraṇasaṃyogarāśideśakālopayogasaṃsthopaśayaviṣamānāsevate, tadā tasya tebhyo vātapittaśleṣmāṇo vaiṣamyamāpadyante; te viṣamāḥ śarīramanusṛtya yadā srotasāmayanamukhāni prativāryāvatiṣṭhante tadā janturyadyadāhārajātamāharati tattadasya mūtrapurīṣamevopajāyate bhūyiṣṭhaṃ nānyastathā śarīradhātuḥ; sa purīṣopaṣṭambhādvartayati, tasmācchuṣyato viśeṣeṇa purīṣamanurakṣyaṃ tathā’nyeṣāmatikṛśadurbalānāṃ; tasyānāpyāyamānasya viṣamāśanopacitā doṣāḥ pṛthak pṛthagupadravairyuñjanto bhūyaḥ śarīramupaśoṣayanti|
tatra vātaḥ śūlamaṅgamardaṃ kaṇṭhoddhvaṃsanaṃ pārśva saṃrujanamaṃsāvamardaṃ svarabhedaṃ pratiśyāyaṃ copajanayati; pittaṃ jvaramatīsāramantardāhaṃ ca; śleṣmā tu pratiśyāyaṃ śiraso gurutvamarocakaṃ kāsaṃ ca, sa kāsa prasaṅgādurasi kṣate śoṇitaṃ niṣṭhīvati, śoṇitagamanāccāsya daurbalyamupajāyate|
evamete viṣamāśanopacitāstrayo doṣā rājayakṣyāṇamabhinirvartayanti|
sa tairupaśoṣaṇairupadravairupadrutaḥ śanaiḥ śanaiḥ śuṣyati|
tasmāt puruṣo matimān prakṛtikaraṇa saṃyogarāśideśakālopayoga saṃsthopaśayādaviṣamamāhāramāharet||10||
bhavati cātra- hitāśī syānmitāśī syātkālabhojī jitendriyaḥ|
paśyan rogān bahūn kaṣṭān buddhimān viṣamāśanāt||11||

sedentary lifestyle

Vishamashana (irregular dieting) as etiological factor:
We shall explain the “irregular dieting “ as an etiological factor for drinks and diets, viz drinkables, eatables, chewable and lickables without paying proper heed towards their nature, mode of preparation, combination, quantity, locality, time dietetic rules and wholesomeness for the individual, then Vata, Pitta and Kapha in his body get imbalanced due to this irregularity.
These imbalanced dosha spreads all over the body and when they get localized in view of the obstruction to the entrances of the channels of circulation, then whatever food is taken by the individual is mostly converted into stool and urine rather than dhatus (tissue elements) of the body. The afflicted individual is sustained by the retention of the stool. Therefore, the fecal matter of individuals suffering from Shosha or others who are extremely emaciated or weak is retained. Doshas accumulated due to irregular dieting, separately produce the following in further emaciation, Vata produces
Shula – colic pain
Anga marda – malaise
Antar daham – irritation in throat
Pārśva saṃrujanam – pain in the sides of the chest
Aṃsāvamardaṃ – grinding pain in the shoulders
Svara Bheda – hoarseness of voice and
Pratishyaya – Coryza
Pitta causes
Jvara – fever
Atisara – diarrhoea and
Antar daha – burning sensation inside the body, and
Kapha causes
Pratishyaya – coryza
Shiro gaurava – heaviness of head
Arochaka – anorexia and
Kasa – coughing
Due to excessive coughing there is injury to the chest (lungs) and the patient spits blood. Because of the discharge of blood he becomes weak. Thus the 3 Doshas accumulated due to irregular dieting manifest the disease Rajayakshma (Tuberculosis).
The emaciating complications lead to cachexia by and by. Therefore, a wise person should take such diets as are not unwholesome from the point of view of mature, mode of preparation, combination, quantity, locality, time, dietic rules and the wholesomeness for the individual who takes them.
Thus it is said: – In view of the association of painful diseases with irregular dieting, a wise man with good control over his senses should take wholesome food in proper quantity and in proper time [10-11]

Nomenclature of disease:
एतैश्चतुर्भिः शोषस्यायतनैरुपसेवितैर्वात पित्त श्लेष्माणः प्रकोपमापद्यन्ते|
ते प्रकुपिता नानाविधैरुपद्रवैः शरीरमुपशोषयन्ति|
तं सर्वरोगाणां कष्टतमत्वाद्राजयक्ष्माणमाचक्षते भिषजः; यस्माद्वा पूर्वमासीद्भगवतः सोमस्योडुराजस्य तस्माद्राजयक्ष्मेति||१२||
etaiścaturbhiḥ śoṣasyāyatanairupasevitairvāta pitta śleṣmāṇaḥ prakopamāpadyante|
te prakupitā nānāvidhairupadravaiḥ śarīramupaśoṣayanti|
taṃ sarvarogāṇāṃ kaṣṭatamatvādrājayakṣmāṇamācakṣate bhiṣajaḥ; yasmādvā pūrvamāsīdbhagavataḥ somasyoḍurājasya tasmādrājayakṣmeti||12||
The 4 causative factors of Shosha, when resorted to lead to the aggravation of Vata, Pitta and Kapha
These aggravated Doshas deplete the body due to varieties of complications. This condition is known as Rajayakshma (lit. king of diseases or disease of the king) because of its most formidable nature among all the diseases and also because according to the mythological story, it afflicted the moon who is the king of stars [12]

Purva rupa of Shosha – Premonitory symptoms:
तस्येमानि पूर्वरूपाणि भवन्ति; तद्यथा- प्रतिश्यायः, क्षवथुरभीक्ष्णं, श्लेष्मप्रसेकः, मुख माधुर्यम्, अनन्नाभिलाषः, अन्नकाले चायासः, दोष दर्शनमदोषेष्वल्पदोषेषु वा भावेषु पात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु, भुक्तवतश्चास्य हृल्लासः, तथोल्लेखनमप्याहारस्यान्तरान्तरा, मुखस्य पादयोश्च शोफः, पाण्योश्चावेक्षणमत्यर्थम्, अक्ष्णोः श्वेतावभासता चातिमात्रं, बाह्वोश्च प्रमाणजिज्ञासा, स्त्रीकामता, निर्घृणित्वं, बीभत्स दर्शनता चास्य काये, स्वप्ने चाभीक्ष्णं दर्शनमनुदकानामुदकस्थानानां शून्यानां च ग्राम नगर निगम जनपदानां शुष्क दग्ध भग्नानां च वनानां कृकलास मयूर वानर शुक सर्पकाकोलूकादिभिः संस्पर्शनमधिरोहणं यानं वा श्वोष्ट्रखरवराहैः केशास्थिभस्मतुषाङ्गारराशीनां चाधिरोहणमिति (शोषपूर्वरूपाणि भवन्ति)||१३||
tasyemāni pūrvarūpāṇi bhavanti; tadyathā- pratiśyāyaḥ, kṣavathurabhīkṣṇaṃ, śleṣmaprasekaḥ, mukha mādhuryam, anannābhilāṣaḥ, annakāle cāyāsaḥ, doṣa darśanamadoṣeṣvalpadoṣeṣu vā bhāveṣu pātrodakānnasūpāpūpopadaṃśapariveśakeṣu, bhuktavataścāsya hṛllāsaḥ, tathollekhanamapyāhārasyāntarāntarā, mukhasya pādayośca śophaḥ, pāṇyoścāvekṣaṇamatyartham, akṣṇoḥ śvetāvabhāsatā cātimātraṃ, bāhvośca pramāṇajijñāsā, strīkāmatā, nirghṛṇitvaṃ, bībhatsa darśanatā cāsya kāye, svapne cābhīkṣṇaṃ darśanamanudakānāmudakasthānānāṃ śūnyānāṃ ca grāma nagara nigama janapadānāṃ śuṣka dagdha bhagnānāṃ ca vanānāṃ kṛkalāsa mayūra vānara śuka sarpakākolūkādibhiḥ saṃsparśanamadhirohaṇaṃ yānaṃ vā śvoṣṭrakharavarāhaiḥ keśāsthibhasmatuṣāṅgārarāśīnāṃ cādhirohaṇamiti (śoṣapūrvarūpāṇi bhavanti)||13||

Shosha Purvaroopa: 
Its premonitory symptoms are
Pratishyaya – Coryza
Kshavathu – frequent sneezing
Sleshma praseka – excessive salivation
Mukha madhuryam – sweet taste in the mouth
Anannābhilāṣaḥ – disinclination for food
Annakāle cāyāsaḥ – feeling of tiredness during the meal time
Doṣa darśanamadoṣeṣvalpadoṣeṣu vā bhāveṣu pātrodakānnasūpāpūpopadaṃśapariveśakeṣu – finding fault with such things as are without any fault or with negligible fault specially that of utensils, water, food soup, cake, Upadamsa (things which are chewed before taking food), and cateres,
Bhuktavataścāsya hṛllāsaḥ – Nausea after meals
Mukhasya pādayośca śophaḥ – swelling of the face and feet
Pāṇyoścāvekṣaṇamatyartham – frequent inspection of hands
Akṣṇoḥ śvetāvabhāsatā cātimātraṃ – excessive whiteness of eyes
Bāhvośca pramāṇajijñāsā – enquiry about the measurement of arms
Strīkāmatā – passionate attachment with women
Nirghṛṇitvaṃ – cruel disposition, freightful appearance (discoloration and foul smell) in his body and
Bībhatsa darśanatā cāsya kāye – appearance of the following in dreams:
Svapne cābhīkṣṇaṃ darśanamanudakānāmudakasthānānāṃ – Empty water reservoirs
Janapadānāṃ śuṣka bhagnānāṃ – villages, towns, cities and countries
Dagdha vanānāṃ – Dried, burnt and denuded forests
Kṛkalāsa mayūra vānara śuka sarpakākolūkādibhiḥ saṃsparśanamadhirohaṇaṃ – Coming into physical contact with chameleon, peacocks, monkey, parrots, serpents, crows, owls etc
Yānaṃ vā śvoṣṭrakharavarāhaiḥ – Riding over dogs, camels, donkeys and pigs or vehicles drawn by them
Keśāsthibhasmatuṣāṅgārarāśīnāṃ cādhirohaṇamiti – Climbing over heaps of hair, bones, ash chaff and fire brands [13]

Rupa – Eleven symptoms of Shosha:
अत ऊर्ध्वमेकादशरूपाणि तस्य भवन्ति; तद्यथा- शिरसः परिपूर्णत्वं, कासः, श्वासः, स्वरभेदः, श्लेष्मणश्छर्दनं, शोणितष्ठीवनं, पार्श्वसंरोजनम्, अंसावमर्दः, ज्वरः, अतीसारः, अरोचकश्चेति||१४||
ata ūrdhvamekādaśarūpāṇi tasya bhavanti; tadyathā- śirasaḥ paripūrṇatvaṃ, kāsaḥ, śvāsaḥ, svarabhedaḥ, śleṣmaṇaśchardanaṃ, śoṇitaṣṭhīvanaṃ, pārśvasaṃrojanam, aṃsāvamardaḥ, jvaraḥ, atīsāraḥ, arocakaśceti||14||
Thereafter 11 symptoms of this disease are manifested they are
Shirasaḥ paripūrṇatvaṃ – Heaviness of head
Kāsaḥ – Cough
śvāsaḥ – Dyspnea
Svarabhedaḥ – Hoarseness of voice
śleṣmaṇaśchardanaṃ – Voiding of phlegm
śoṇitaṣṭhīvanaṃ – Spitting of blood
Pārśvasaṃrojanam – Pain in the sides of the chest
Aṃsāvamardaḥ – Grinding pain in the shoulder
Jvaraḥ – Fever
Atīsāraḥ – Diarrhea and
Arochaka – Anorexia [14]

Shosham Sadhya Asadhyata – Prognosis:
तत्रापरिक्षीण बल मांस शोणितो बलवानजातारिष्टः सर्वैरपि शोष लिङ्गैरुपद्रुतः साध्यो ज्ञेयः|
बलवानुपचितो हि सहत्वाद्व्याध्यौषधबलस्य कामं सुबहुलिङ्गोऽप्यल्पलिङ्ग एव मन्तव्यः||१५||
tatrāparikṣīṇabalamāṃsaśoṇito balavānajātāriṣṭaḥ sarvairapi śoṣaliṅgairupadrutaḥ sādhyo jñeyaḥ|
balavānupacito hi sahatvādvyādhyauṣadhabalasya kāmaṃ subahuliṅgo’pyalpaliṅga eva mantavyaḥ||15||
A patient whose strength, muscle tissues and blood have not undergone diminution, who is strong and in whose body bad prognostic symptoms have not appeared is curable even if all symptoms of the disease- Shosha- are manifested in his body. A strong and well-nourished patient can resist both the disease and medicines; hence even if all symptoms of the disease are manifested in his body, still he may be considered as having a few symptoms only i. e easily curable. [15]

Asadhya Lakshana – Signs of incurable of Sosha:
दुर्बलं त्वतिक्षीण बल मांस शोणितमल्पलिङ्गमजातारिष्टमपि बहुलिङ्गं जातारिष्टं च विद्यात्, असहत्वाद्व्याध्यौषधबलस्य; तं परिवर्जयेत्, क्षणेनैव हि प्रादुर्भवन्त्यरिष्टानि, अनिमित्तश्चारिष्टप्रादुर्भाव इति||१६||
तत्र श्लोकः- समुत्थानं च लिङ्गं च यः शोषस्यावबुध्यते|
पूर्वरूपं च तत्त्वेन स राज्ञः कर्तुमर्हति||१७||
durbalaṃ tvatikṣīṇabalamāṃsaśoṇitamalpaliṅgamajātāriṣṭamapi bahuliṅgaṃ jātāriṣṭaṃ ca vidyāt, asahatvādvyādhyauṣadhabalasya; taṃ parivarjayet, kṣaṇenaiva hi prādurbhavantyariṣṭāni, animittaścāriṣṭaprādurbhāva iti||16||
tatra ślokaḥ- samutthānaṃ ca liṅgaṃ ca yaḥ śoṣasyāvabudhyate|
pūrvarūpaṃ ca tattvena sa rājñaḥ kartumarhati||17||
A patient even having a few symptoms of the disease and without bad prognostic signs is incurable (like the one having all symptoms and manifested bad prognostic signs). If he is weak and there is diminution of strength, muscle tissue and blood, because he will be unable to resist the effect of the diseases as well as the medicines. He should not be treated. Bad prognostic signs may appear in such patients in time and even without any causative factor. [16]

Merits of royal physician:
तत्र श्लोकः- समुत्थानं च लिङ्गं च यः शोषस्यावबुध्यते|
पूर्वरूपं च तत्त्वेन स राज्ञः कर्तुमर्हति||१७||
tatra ślokaḥ- samutthānaṃ ca liṅgaṃ ca yaḥ śoṣasyāvabudhyate|
pūrvarūpaṃ ca tattvena sa rājñaḥ kartumarhati||17||
To sum up :- the physician who is well versed in the etiology, symptomatology and premonitory symptoms of Shoshais verily competent to be a “ Royal Physician”. [17]

इत्यग्निवेशकृते तन्त्रे चरक प्रतिसंस्कृते निदान स्थाने शोष निदानं नाम षष्ठोऽध्यायः||६||
ityagniveśakṛte tantre carakapratisaṃskṛte nidāna sthāne śoṣa nidānaṃ nāma ṣaṣṭho’dhyāyaḥ||6||
Thus ends the 6th chapter on “Shosha Nidana” of the section on the Diagnosis of Diseases (Nidana sthana) of Agniveshas work as redacted by Charaka.


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