Chapter 6. Shosha Nidana (Chapter on progressive wasting disease)
अथातःशोषनिदानंव्याख्यास्यामः||१||
इतिहस्माहभगवानात्रेयः||२||
Athatah shoshanidÁnam vyakhyasyamah ||1||iti ha smaha bhagavanÁtreyah ||2||
Now I shall expound upon the chapter on diagnosis of shosha, said Lord Atreya. [1-2]
इहखलुचत्वारिशोषस्यायतनानिभवन्ति|
तद्यथा- साहसंसन्धारणंक्षयोविषमाशनमिति||३||
Iha khalu catvari shoshasyayatanani bhavantitadyatha- sahasam sandharanam kshayo vishamashanamiti ||3||
There are four causes of shosha:
1. overexertion / sahasa,
2. suppression of urges / sandharana,
3. wasting / kshaya, and
4. irregular consumption of improper food articles / visham ashana [3].
Each of these causes will be explained here in detail:
1. Overexertion as a cause / Sahasa
तत्रसाहसंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-यदापुरुषोदुर्बलोहिसन्बलवतासहविगृह्णाति, अतिमहतावाधनुषाव्यायच्छति, जल्पतिवाऽप्यतिमात्रम्, अतिमात्रंवाभारमुद्वहति, अप्सुवाप्लवतेचातिदूरम्, उत्सादनपदाघातनेवाऽतिप्रगाढमासेवते, अतिप्रकृष्टंवाऽध्वानंद्रुतमभिपतति, अभिहन्यतेवा, अन्यद्वाकिञ्चिदेवंविधंविषममतिमात्रंवाव्यायामजातमारभते, तस्यातिमात्रेणकर्मणोरःक्षण्यते|
tatra sāhasaṁ śōṣasyāyatanamiti yaduktaṁ tadanuvyākhyāsyāmaḥ- yadā puruṣō durbalō hi san balavatā saha vigr̥hṇāti, atimahatā vā dhanuṣā vyāyacchati, jalpati vā'pyatimātram, atimātraṁ vā bhāramudvahati, apsu vā plavatē cātidūram, utsādanapadāghātanē [1] vā'tipragāḍhamāsēvatē, atiprakr̥ṣṭaṁ vā'dhvānaṁ drutamabhipatati, abhihanyatē vā, anyadvā kiñcidēvaṁvidhaṁ viṣamamatimātraṁ vā vyāyāmajātamārabhatē, tasyātimātrēṇa karmaṇōraḥ kṣaṇyatē|
- When a weak person / durbala purusha fights against a strong one / bala -यदा पुरुषो दुर्बलो हि सन् बलवता सह विगृह्णाति ,
- or exercises / vyayama with an excessively large (or weighty) bow (weapon) अतिमहता वा धनुषा व्यायच्छति,
- or speaks too much / atimatra jalpa - जल्पति वाऽप्यतिमात्रम्,
- or physically carries a lot of weight / atimatra bhara udvahanam - अतिमात्रं वा भारमुद्वहति,
- or swims across a long distance in water / atidooram plavanam in apsu -अप्सु वा प्लवते चातिदूरम् ,
- or is habitually subjected to forceful massage including kneading with feet / उत्सादनपदाघातने वाऽतिप्रगाढमासेवते ,
- or sprints over a long distance -अतिप्रकृष्टं वाऽध्वानं द्रुतमभिपतति ,
- or is assaulted - अभिहन्यते वा,
- or practices various complicated - अन्यद्वा किञ्चिदेवंविधंविषममतिमात्रं
- or excessive physical exercises - वा व्यायामजातमारभते,
- his lungs / ura are “traumatized” due to excessive exertion - तस्यातिमात्रेण कर्मणोरः क्षण्यते| .
तस्योरःक्षतमुपप्लवतेवायुः|सतत्रावस्थितःश्लेष्माणमुरःस्थमुपसङ्गृह्यपित्तंचदूषयन्विहरत्यूर्ध्वमधस्तिर्यक्च|
tasyōraḥ kṣatamupaplavatē vāyuḥ|
sa tatrāvasthitaḥ ślēṣmāṇamuraḥsthamupasaṅgr̥hya [2] pittaṁ ca dūṣayan viharatyūrdhvamadhastiryak ca|
- This aggravates vayu in the lung region,
- taking along kapha residing in the lungs
- while also affecting pitta,
- causing the vitiated doshas to spread urdhva/ upwards, adha / downwards and tiryak / obliquely.
तस्ययोंऽशःशरीरसन्धीनाविशतितेनास्यजृम्भाऽङ्गमर्दोज्वरश्चोपजायते,
tasya yōṁ'śaḥ śarīrasandhīnāviśati tēnāsya jr̥mbhā'ṅgamardō jvaraścōpajāyatē,
A portion of this afflicted dosha system that gets into body joints / शरीरसन्धीनाविशति causes
- yawning / जृम्भा,
- body ache / ऽङ्गमर्दो, and
- fever / ज्वर.
यस्त्वामाशयमभ्युपैतितेनरोगाभवन्तिउरस्याअरोचकश्च
yastvāmāśayamabhyupaiti tēna rōgā bhavanti urasyā arōcakaśca [3] ,
- That which gets into the amashaya causes diseases of lungs / रोगा भवन्ति उरस्या and anorexia /अरोचक .
यःकण्ठमभिप्रपद्यतेकण्ठस्तेनोद्ध्वंस्यतेस्वरश्चावसीदति,
yaḥ kaṇṭhamabhiprapadyatē kaṇṭhastēnōddhvaṁsyatē svaraścāvasīdati,
- That which gets into the throat / कण्ठ causes irritation of the throat / कण्ठस्तेनोद्ध्वंस्यते and hoarseness of voice / स्वरश्चावसीदति.
यः प्राणवहानिस्रोतांस्यन्वेतितेनश्वासःप्रतिश्यायश्चजायते,
yaḥ prāṇavahāni srōtāṁsyanvēti tēna śvāsaḥ pratiśyāyaśca jāyatē,
- That which gets into the channels carrying vital breath (bronchial channels) / प्राणवहानि स्रोतां causes dyspnea / श्वासः and coryza /प्रतिश्याय .
यःशिरस्यवतिष्ठतेशिरस्तेनोपहन्यते|
yaḥ śirasyavatiṣṭhatē śirastēnōpahanyatē;
- And that which gets into the head / शिर produces distress in the head /शिरस्तेनोपहन्यते .
ततःक्षणनाच्चैवोरसोविषमगतित्वाच्चवायोःकण्ठस्यचोद्ध्वंसनात्कासःसततमस्यसञ्जायते,
tataḥ kṣaṇanāccaivōrasō viṣamagatitvācca vāyōḥ kaṇṭhasya cōddhvaṁsanāt kāsaḥ satatamasya sañjāyatē,
- Thus, due to wound in lungs, irregular movement of vayu / विषमगतित्वाच्च वायोः causes a variety of diseases depending upon the organs it gets into.
सकासप्रसङ्गादुरसिक्षतेशोणितंष्ठीवति, शोणितागमनाच्चास्यदौर्बल्यमुपजायते;
sa kāsaprasaṅgādurasi kṣatē śōṇitaṁ ṣṭhīvati, śōṇitāgamanāccāsya daurbalyamupajāyatē;
- The lungs get damaged further, triggering conditions such as hemoptysis / शोणितं ष्ठीवति and consequently weakening the patient / दौर्बल्यमुपजायते.
एवमेतेसाहसप्रभवाःसाहसिकमुपद्रवाःस्पृशन्ति|ततःसउपशोषणैरेतैरुपद्रवैरुपद्रुतःशनैःशनैरुपशुष्यति|तस्मात्पुरुषोमतिमान्बलमात्मनःसमीक्ष्यतदनुरूपाणिकर्माण्यारभेतकर्तुं|बलसमाधानंहिशरीरं, शरीरमूलश्चपुरुषइति||४||भवतिचात्र-साहसंवर्जयेत्कर्मरक्षञ्जीवितमात्मनः|
जीवन्हिपुरुषस्त्विष्टंकर्मणःफलमश्नुते||५||
ēvamētē sāhasaprabhavāḥ sāhasikamupadravāḥ spr̥śanti| tataḥ sa upaśōṣaṇairētairupadravairupadrutaḥ śanaiḥ śanairupaśuṣyati| tasmāt puruṣō matimān balamātmanaḥ samīkṣya tadanurūpāṇi karmāṇyārabhēta kartuṁ; balasamādhānaṁ hi śarīraṁ, śarīramūlaśca puruṣa iti||4||
bhavati cātra- sāhasaṁ varjayēt karma rakṣañjīvitamātmanaḥ| jīvan hi puruṣastviṣṭaṁ karmaṇaḥ phalamaśnutē||5||
- This verse, therefore, advises the reader to engage in laborious activities appropriate to his strength and not overexert himself. [4-5]
2. Suppression of natural urges as a cause / Sandharana
सन्धारणंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-यदापुरुषोराजसमीपेभर्तुःसमीपेवागुरोर्वापादमूलेद्यूतसभमन्यंवासतांसमाजंस्त्रीमध्यंवासमनुप्रविश्ययानैर्वाऽ प्युच्चावचैरभियान्भयात्प्रसङ्गाद्ध्रीमत्त्वाद्धृणित्वाद्वा
sandhāraṇaṁ śōṣasyāyatanamiti yaduktaṁ tadanuvyākhyāsyāmaḥ- yadā puruṣō rājasamīpē bhartuḥ samīpē vā gurōrvā pādamūlē dyūtasabhamanyaṁ vā satāṁ samājaṁ strīmadhyaṁ vā samanupraviśya yānairvā'pyuccāvacairabhiyān [5] bhayāt prasaṅgāddhrīmattvāddhr̥ṇitvādvā
When a person suppresses the urge to pass flatulence, urination, and bowel movement due to various reasons
- such as attending a royalty / यदा पुरुषो राजसमीपे भर्तुः,
- being in a formal setting (in the company of sages, teachers, nobles, etc) /समीपे वा गुरोर्वा पादमूले द्यूतसभमन्यं वा सतां समाजं ,
- being in the midst of women, society of gambling, / or स्त्रीमध्यं वा समनुप्रविश्य
- while traveling on uneven vehicle / यानैर्वाऽप्युच्चावचैरभियान्,
- or due to fear, environment, bashfulness / भयात् प्रसङ्गाद्ध्रीमत्त्वाद्
- or disgust / र्घृणित्वं ,
निरुणद्ध्यागतान्वातमूत्रपुरीषवेगान्तदातस्यसन्धारणाद्वायुःप्रकोपमापद्यते, सप्रकुपितःपित्तश्लेष्माणौसमुदीर्योर्ध्वमधस्तिर्यक्चविहरति;
niruṇaddhyāgatān vātamūtrapurīṣavēgān tadā [6] tasya sandhāraṇādvāyuḥ prakōpamāpadyatē, sa prakupitaḥ pittaślēṣmāṇau samudīryōrdhvamadhastiryak ca viharati;
- vayu gets vitiated due to suppression of urges.
- This vitiated vayu aggravates pitta and/or kapha, spreading upwards / urdhva, downwards / adha or obliquely / tiryak depending upon the combination of afflicted doshas.
ततश्चांशविशेषेणपूर्ववच्छरीरावयवविशेषंप्रविश्यशूलमुपजनयति, भिनत्तिपुरीषमुच्छोषयतिवा, पार्श्वेचातिरुजति, अंसाववमृद्गाति, कण्ठमुरश्चावधमति, शिरश्चोपहन्ति, कासंश्वासंज्वरंस्वरभेदंप्रतिश्यायंचोपजनयति|
tataścāṁśaviśēṣēṇa pūrvavaccharīrāvayavaviśēṣaṁ praviśya śūlamupajanayati, bhinatti purīṣamucchōṣayati vā, pārśvē cātirujati, aṁsāvavamr̥dgāti, kaṇṭhamuraścāvadhamati, śiraścōpahanti, kāsaṁ śvāsaṁ jvaraṁ svarabhēdaṁ pratiśyāyaṁ cōpajanayati;
As said earlier, when a portion gets into specific body parts, it causes
- pain / शूल,
- diarrhea / भिनत्ति पुरीष or
- drying up of feces / पुरीषमुच्छोषयति,
- pain in sides of the chest / पार्श्वे चातिरुजति,
- pain in the shoulders / अंसाववमृद्गाति,
- irritation in throat and lungs / कण्ठमुरश्चावधमति,
- headache / शिरश्चोपहन्ति,
- cough / कासं,
- dyspnea / श्वासं,
- fever /ज्वरं ,
- hoarseness of voice / स्वरभेदं, and
- coryza / प्रतिश्यायं.
ततःसउपशोषणैरेतैरुपद्रवैरुपद्रुतःशनैःशनैरुपशुष्यति|
tataḥ sa upaśōṣaṇairētairupadravairupadrutaḥ śanaiḥ śanairupaśuṣyati|
- Thereafter, having been afflicted with these wasting complications, the patient gradually gets afflicted with shosha.
तस्मात्पुरुषोमतिमानात्मनःशारीरेष्वेवयोगक्षेमकरेषुप्रयतेतविशेषेण; शरीरंह्यस्यमूलं, शरीरमूलश्चपुरुषोभवति||६||
tasmāt puruṣō matimānātmanaḥ śārīrēṣvēva yōgakṣēmakarēṣu prayatēta viśēṣēṇa; śarīraṁ hyasya mūlaṁ, śarīramūlaśca puruṣō bhavati||6||
- Hence the wise should carefully observe the ways that promote and protect the body.
भवतिचात्र-सर्वमन्यत्परित्यज्यशरीरमनुपालयेत्|तदभावेहिभावानांसर्वाभावःशरीरिणाम्||७||
bhavati cātra- sarvamanyat parityajya śarīramanupālayēt|
tadabhāvē hi bhāvānāṁ sarvābhāvaḥ śarīriṇām||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]3. Kshaya / Wasting as cause
क्षयःशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-यदापुरुषोऽतिमात्रंशोकचिन्तापरिगतहृदयोभवति, ईर्ष्योत्कण्ठाभयक्रोधादिभिर्वासमाविश्यते, कृशोवासन्रूक्षान्नपानसेवीभवति, दुर्बलप्रकृतिरनाहारोऽल्पाहारोवाभवति,
kṣayaḥ śōṣasyāyatanamiti yaduktaṁ tadanuvyākhyāsyāmaḥ- yadā puruṣō'timātraṁ śōkacintāparigatahr̥dayō bhavati, īrṣyōtkaṇṭhābhayakrōdhādibhirvā samāviśyatē, kr̥śō vā san rūkṣānnapānasēvī bhavati, durbalaprakr̥tiranāhārō'lpāhārō vā bhavati,
Now explained is wasting as the cause of shosha.
- When a person is suffering excessively from anxiety and grief, ऽतिमात्रं शोकचिन्तापरिगतहृदयो
- or from emotions like envy, fear, anger, etc., ईर्ष्योत्कण्ठाभयक्रोधादिभिर्वा समाविश्यते and
- if the person is also afflicted with a wasting disorder कृशो and/
- or using rough food and drinks / रूक्षान्नपानसेवी,
- or if a congenitally weak person is subjected to fasting or malnutrition / दुर्बलप्रकृतिरनाहारोऽल्पाहारो,
तदातस्यहृदयस्थायीरसःक्षयमुपैति;
tadā tasya hr̥dayasthāyī rasaḥ kṣayamupaiti;
- his ojas gets diminished leading to shosha.
सतस्योपक्षयाच्छोषंप्राप्नोति, अप्रतीकाराच्चानुबध्यतेयक्ष्मणा |यथोपदेक्ष्यमाणरूपेण|८|
sa tasyōpakṣayācchōṣaṁ prāpnōti, apratīkārāccānubadhyatē yakṣmaṇā yathōpadēkṣyamāṇarūpēṇa|8|
- Due to want of proper management and care, he could get afflicted with the disease having symptoms to be described later. [8]
4.अतिहर्षादतिप्रसक्तभावः / Excessive sexual indulgence as a cause* /
यदावापुरुषोऽतिहर्षादतिप्रसक्तभावःस्त्रीष्वतिप्रसङ्गमारभते, तस्यातिमात्रप्रसङ्गाद्रेतःक्षयमेति|क्षयमपिचोपगच्छतिरेतसियदिमनःस्त्रीभ्योनैवास्यनिवर्तते, तस्यचातिप्रणीतसङ्कल्पस्यमैथुनमापद्यमानस्यनशुक्रंप्रवर्ततेऽतिमात्रोपक्षीणरेतस्त्वात्, तथाऽस्यवायुर्व्यायच्छमानशरीरस्यैवधमनीरनुप्रविश्यशोणितवाहिनीस्ताभ्यःशोणितंप्रच्यावयति, तच्छुक्रक्षयादस्यपुनःशुक्रमार्गेणशोणितंप्रवर्ततेवातानुसृतलिङ्गम्|
yadā vā puruṣō'tiharṣādatiprasaktabhāvaḥ strīṣvatiprasaṅgamārabhatē, tasyātimātraprasaṅgādrētaḥ kṣayamēti|
kṣayamapi cōpagacchati rētasi yadi manaḥ strībhyō naivāsya nivartatē, tasya cātipraṇītasaṅkalpasya maithunamāpadyamānasya na śukraṁ pravartatē'timātrōpakṣīṇarētastvāt, tathā'sya vāyurvyāyacchamānaśarīrasyaiva dhamanīranupraviśya śōṇitavāhinīstābhyaḥ śōṇitaṁ pracyāvayati, tacchukrakṣayādasya punaḥ śukramārgēṇa śōṇitaṁ pravartatē vātānusr̥taliṅgam|
When a person indulges in excessive sexual intercourse habitually,
- his semen gets diminished / kshaya.
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.
अथास्यशुक्रक्षयाच्छोणितप्रवर्तनाच्चसन्धयःशिथिलीभवन्ति, रौक्ष्यमुपजायते, भूयःशरीरंदौर्बल्यमाविशति वायुःप्रकोपमापद्यते;
athāsya śukrakṣayācchōṇitapravartanācca sandhayaḥ śithilībhavanti, raukṣyamupajāyatē, bhūyaḥ śarīraṁ daurbalyamāviśati [8] , vāyuḥ prakōpamāpadyatē;
Now, due to loss of semen and hemorrhage,
- his joints loosen / सन्धयः शिथिलीभवन्ति,
- the skin loses its suppleness / and
- becomes rough or scaly / रौक्ष्यमुपजायते,
- body weakens further / शरीरंदौर्बल्यमाविशति and
- vayu gets vitiated. / वायुः प्रकोपमापद्यते
सप्रकुपितोवशिकंशरीरमनुसर्पन्नुदीर्यश्लेष्मपित्तेपरिशोषयतिमांसशोणिते,
sa prakupitō vaśikaṁ [9] śarīramanusarpannudīrya ślēṣmapittē pariśōṣayati māṁsaśōṇitē,
- The vitiated vayu spreads in the body deficient of semen and blood,
- aggravating kapha and pitta and
- drying up the muscles and blood. परिशोषयति मांसशोणिते
प्रच्यावयतिश्लेष्मपित्तेसंरुजतिपार्श्वे, अवमृद्गात्यंसौकण्ठमुद्ध्वंसति, शिरःश्लेष्माणमुपत्क्लेश्यप्रतिपूरयतिश्लेष्मणा, सन्धींश्चप्रपीडयन्करोत्यङ्गमर्दमरोचकाविपाकौच, पित्तश्लेष्मोत्क्लेशात्प्रतिलोमगत्वाच्चवायुर्ज्वरंकासंश्वासंस्वरभेदंप्रतिश्यायंचोपजनयति;
pracyāvayati ślēṣmapittē saṁrujati pārśvē, avamr̥dgātyaṁsau [10] , kaṇṭhamuddhvaṁsati, śiraḥ ślēṣmāṇamupatklēśya pratipūrayati ślēṣmaṇā, sandhīṁśca prapīḍayan karōtyaṅgamardamarōcakāvipākau ca, pittaślēṣmōtklēśāt pratilōmagatvācca vāyurjvaraṁ kāsaṁ śvāsaṁ svarabhēdaṁ pratiśyāyaṁ cōpajanayati;
- Further, the vitiated vayu expels kapha and pitta / प्रच्यावयति श्लेष्मपित्ते,
- causing pain in the sides of the chest and shoulders/ संरुजति पार्श्वे ,
- irritation of throat / कण्ठमुद्ध्वंसति,
- aggravating kapha of the head / शिरः श्लेष्माणमुपत्क्लेश्य and
- replacing it with the vitiated kapha / प्रतिपूरयति श्लेष्मणा expelled from their natural locations,
- causing pain in joints /सन्धींश्च प्रपीडयन् ,
- body ache / angamarda,
- anorexia / arochaka and
- indigestion / avipaka.
सकासप्रसङ्गादुरसिक्षतेशोणितंष्ठीवति,शोणितगमनाच्चास्यदौर्बल्यमुपजायते, ततःसउपशोषणैरेतैरुपद्रवैरुपद्रुतःशनैःशनैरुपशुष्यति|
sa kāsaprasaṅgādurasi kṣatē śōṇitaṁ ṣṭhīvati, śōṇitagamanāccāsya daurbalyamupajāyatē, tataḥ sa upaśōṣaṇairētairupadravairupadrutaḥ śanaiḥ śanairupaśuṣyati|
- 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.
तस्मात्पुरुषोमतिमानात्मनः|शरीरमनुरक्षञ्छुक्रमनुरक्षेत्|
पराह्येषाफलनिर्वृत्तिराहारस्येति||८||भवतिचात्र-आहारस्यपरंधामशुक्रंतद्रक्ष्यमात्मनः|क्षयोह्यस्यबहून्रोगान्मरणंवानियच्छति||९||
tasmāt puruṣō matimānātmanaḥ śarīramanurakṣañchukramanurakṣēt|
parā hyēṣā phalanirvr̥ttirāhārasyēti||8||
bhavati cātra- āhārasya paraṁ dhāma śukraṁ tadrakṣyamātmanaḥ|
kṣayō [11] hyasya bahūn rōgānmaraṇaṁ vā niyacchati||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]- * This is not mentioned as a main cause of shosha in verse 3, but is a derivation of verses 8-9.
5. Irregular meals/Improper meals as a cause - Vishama ashana
विषमाशनंशोषस्यायतनमितियदुक्तं,तदनुव्याख्यास्यामः-यदापुरुषःपानाशनभक्ष्यलेह्योपयोगान्प्रकृतिकरणसंयोगराशिदेशकालोपयोगसंस्थोपशयविषमानासेवते, तदातस्यतेभ्योवातपित्तश्लेष्माणोवैषम्यमापद्यन्ते;
viṣamāśanaṁ śōṣasyāyatanamiti yaduktaṁ, tadanuvyākhyāsyāmaḥ- yadā puruṣaḥ pānāśanabhakṣyalēhyōpayōgān prakr̥tikaraṇasaṁyōgarāśidēśakālōpayōgasaṁsthōpaśayaviṣamānāsēvatē, tadā tasya tēbhyō vātapittaślēṣmāṇō vaiṣamyamāpadyantē;
This verse talks of irregular diet as a cause of shosha.
When a person takes food – drinkable / पाना, eatable /अशन, chewable / भक्ष्य and लेह्य / lickable – irregularly in terms of
- nature / प्रकृति
- preparation / करण
- combination / संयोग
- quantity / राशि
- place / देश
- time, काल and
- various dietary rules (do’s and don’ts) appropriate for his constitution / उपयोगसंस्थोपशयविषमानासेवते
- - his doshas get imbalanced / वातपित्तश्लेष्माणो वैषम्यमापद्यन्ते
तेविषमाःशरीरमनुसृत्ययदास्रोतसामयनमुखानिप्रतिवार्यावतिष्ठन्तेतदाजन्तुर्यद्यदाहारजातमाहरतितत्तदस्यमूत्रपुरीषमेवोपजायतेभूयिष्ठंनान्यस्तथाशरीरधातुः;
tē viṣamāḥ śarīramanusr̥tya yadā srōtasāmayanamukhāni [12] prativāryāvatiṣṭhantē tadā janturyadyadāhārajātamāharati tattadasya mūtrapurīṣamēvōpajāyatē bhūyiṣṭhaṁ nānyastathā śarīradhātuḥ;
- These imbalanced doshas spread in the body,
- obstructing the स्रोतसामयनमुखानि / openings of various channels and the flow of dhatus.
सपुरीषोपष्टम्भाद्वर्तयति, तस्माच्छुष्यतोविशेषेणपुरीषमनुरक्ष्यंतथाऽन्येषामतिकृशदुर्बलानां; तस्यानाप्यायमानस्यविषमाशनोपचितादोषाःपृथक्पृथगुपद्रवैर्युञ्जन्तोभूयःशरीरमुपशोषयन्ति|
sa purīṣōpaṣṭambhādvartayati, tasmācchuṣyatō viśēṣēṇa purīṣamanurakṣyaṁ tathā'nyēṣāmatikr̥śadurbalānāṁ; tasyānāpyāyamānasya viṣamāśanōpacitā dōṣāḥ pr̥thak pr̥thagupadravairyuñjantō bhūyaḥ śarīramupaśōṣayanti|
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 / shosha and
- in cases where the individual is emaciated or very weak.
तत्रवातःशूलमङ्गमर्दंकण्ठोद्ध्वंसनंपार्श्वसंरुजनमंसावमर्दंस्वरभेदंप्रतिश्यायंचोपजनयति;
tatra vātaḥ śūlamaṅgamardaṁ kaṇṭhōddhvaṁsanaṁ pārśvasaṁrujanamaṁsāvamardaṁ svarabhēdaṁ pratiśyāyaṁ cōpajanayati;
The vitiated vata causes
- pain / शूल ,
- body ache / अङ्गमर्दं ,
- irritation of throat / कण्ठोद्ध्वंसनं,
- chest pain / पार्श्वसंरुज,
- pain in shoulders / असंIवमर्दं,
- hoarseness of voice / स्वरभेदं and
- coryza / प्रतिश्यायं
पित्तंज्वरमतीसारमन्तर्दाहंच;
pittaṁ jvaramatīsāramantardāhaṁ ca;
Vitiated pitta causes
- fever / ज्वर
- diarrhea / अतीसार,
- internal heat / अन्तर्दाहं,and
श्लेष्मातुप्रतिश्यायंशिरसोगुरुत्वमरोचकंकासंच,
ślēṣmā tu pratiśyāyaṁ śirasō gurutvamarōcakaṁ kāsaṁ ca,
vitiated kapha causes
- coryza / प्रतिश्यायं ,
- heaviness of head / शिरसो गुरुत्व,
- anorexia / अरोचकं and
- cough / कासं.
सकासप्रसङ्गादुरसिक्षतेशोणितंनिष्ठीवति,शोणितगमनाच्चास्यदौर्बल्यमुपजायते|एवमेतेविषमाशनोपचितास्त्रयोदोषाराजयक्ष्याणमभिनिर्वर्तयन्ति|सतैरुपशोषणैरुपद्रवैरुपद्रुतःशनैःशनैःशुष्यति|
sa kāsaprasaṅgādurasi kṣatē śōṇitaṁ niṣṭhīvati, śōṇitagamanāccāsya daurbalyamupajāyatē|
ēvamētē viṣamāśanōpacitāstrayō dōṣā rājayakṣyāṇamabhinirvartayanti|
sa tairupaśōṣaṇairupadravairupadrutaḥ śanaiḥ śanaiḥ śuṣyati|
Due to frequent bouts of cough,
- lungs get damaged / उरसि क्षतेand
- hemoptysis ensues / शोणितं निष्ठीवति,
- consequently debilitating the patient /दौर्बल्यमुपजायते further and
- causing shosha.
Having been afflicted with these wasting complications,
- the patient gradually becomes very weak and gaunt.
तस्मात्पुरुषोमतिमान्प्रकृतिकरणसंयोगराशिदेशकालोपयोगसंस्थोपशयादविषममाहारमाहरेत्||१०||भवतिचात्र-हिताशीस्यान्मिताशीस्यात्कालभोजीजितेन्द्रियः|पश्यन्रोगान्बहून्कष्टान्बुद्धिमान्विषमाशनात्||११||
tasmāt puruṣō matimān prakr̥tikaraṇasaṁyōgarāśidēśakālōpayōgasaṁsthōpaśayādaviṣamamāhāramāharēt||10||
bhavati cātra- hitāśī syānmitāśī syātkālabhōjī jitēndriyaḥ|
paśyan rōgān bahūn kaṣṭān buddhimān viṣamāśanāt||11||
The final verse advises thus: Observing many troublesome diseases caused by विषमाशनो /irregular dieting, the wise should eat wholesome / हिताशी, measured and timely food with self-restraint. [10-11]
एतैश्चतुर्भिःशोषस्यायतनैरुपसेवितैर्वातपित्तश्लेष्माणःप्रकोपमापद्यन्ते|तेप्रकुपितानानाविधैरुपद्रवैःशरीरमुपशोषयन्ति|
ētaiścaturbhiḥ śōṣasyāyatanairupasēvitairvātapittaślēṣmāṇaḥ prakōpamāpadyantē|
tē prakupitā nānāvidhairupadravaiḥ śarīramupaśōṣayanti|
- 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.
why the name rajayakshma?
तंसर्वरोगाणांकष्टतमत्वाद्राजयक्ष्माणमाचक्षतेभिषजः;यस्माद्वापूर्वमासीद्भगवतःसोमस्योडुराजस्यतस्माद्राजयक्ष्मेति||१२||
taṁ sarvarōgāṇāṁ kaṣṭatamatvādrājayakṣmāṇamācakṣatē bhiṣajaḥ; yasmādvā pūrvamāsīdbhagavataḥ sōmasyōḍurājasya tasmādrājayakṣmēti||12||
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]
Prodromal symptoms/ purvaroopa
तस्येमानिपूर्वरूपाणिभवन्ति; तद्यथा- प्रतिश्यायः, क्षवथुरभीक्ष्णं, श्लेष्मप्रसेकः, मुखमाधुर्यम्, अनन्नाभिलाषः, अन्नकालेचायासः, दोषदर्शनमदोषेष्वल्पदोषेषुवाभावेषुपात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु,
tasyēmāni pūrvarūpāṇi bhavanti; tadyathā- pratiśyāyaḥ, kṣavathurabhīkṣṇaṁ, ślēṣmaprasēkaḥ, mukhamādhuryam, anannābhilāṣaḥ, annakālē cāyāsaḥ, dōṣadarśanamadōṣēṣvalpadōṣēṣu vā bhāvēṣu pātrōdakānnasūpāpūpōpadaṁśaparivēśakēṣu,
Shosha’s prodromal symptoms include
- coryza / प्रतिश्यायः, , , , , ,
- frequent sneezing / क्षवथुरभीक्ष्णं,
- excessive secretion of mucus / श्लेष्मप्रसेकः,
- a sweet aftertaste in the mouth / मुखमाधुर्यम्,
- aversion to food / अनन्नाभिलाषः,
- exhaustion during meal time अन्नकाले चायासः,
- finding fault with utensils / patra, water / udaka, cereals / anna, pulses / soopa, flour preparations /apoopa, spicy preparation / upadamsa and caterers / परिवेशकेषु who are free from fault or have a little fault / दोषदर्शनमदोषेष्वल्पदोषेषु वा भावेषुपात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु,
भुक्तवतश्चास्यहृल्लासः, तथोल्लेखनमप्याहारस्यान्तरान्तरा, मुखस्यपादयोश्चशोफःपाण्योश्चावेक्षणमत्यर्थम्, अक्ष्णोःश्वेतावभासताचातिमात्रं, बाह्वोश्चप्रमाणजिज्ञासा, स्त्रीकामता,निर्घृणित्वं, बीभत्सदर्शनताचास्यकाये, स्वप्नेचाभीक्ष्णंदर्शनमनुदकानामुदकस्थानानांशून्यानांचग्रामनगरनिगमजनपदानांशुष्कदग्धभग्नानांचवनानां
bhuktavataścāsya hr̥llāsaḥ, tathōllēkhanamapyāhārasyāntarāntarā, mukhasya pādayōśca śōphaḥ [15] , pāṇyōścāvēkṣaṇamatyartham, akṣṇōḥ śvētāvabhāsatā cātimātraṁ, bāhvōśca pramāṇajijñāsā, strīkāmatā, nirghr̥ṇitvaṁ, bībhatsadarśanatā cāsya kāyē, svapnē cābhīkṣṇaṁ darśanamanudakānāmudakasthānānāṁ śūnyānāṁ ca grāmanagaranigamajanapadānāṁ śuṣkadagdhabhagnānāṁ ca vanānāṁ
A person afflicted with shosha will experience
- nausea after meals / भुक्तवतश्चास्य हृल्लासः,. ,
- intermittent vomiting during meals तथोल्लेखनमप्याहारस्यान्तरान्तरा,
- swellings in the face and feet / मुखस्य पादयोश्च शोफः,
- tendency of frequently looking at the hands / पाण्योश्चावेक्षणमत्यर्थम्,
- excessive whitishness in the eyes / श्वेतावभासता चातिमात्रं अक्ष्णोः,
- curiosity about measurement of arms / बाह्वोश्चप्रमाणजिज्ञासा,
- longing for women / स्त्रीकामता,
- disgust / निर्घृणित्वं,
- loathsome view of his body / बीभत्सदर्शनता चास्य काये, ,
- स्वप्ने चाभीक्ष्णं दर्शनमनुदकानामुदकस्थानानां / frequent dreams of waterless/arid places as well as places such as deserted / शून्यानां च villages / ग्राम, cities नगर, districts निगम and regions जनपदानां, of forests dried, burnt and destroyed - शुष्कदग्धभग्नानां च वनानां
कृकलासमयूरवानरशुकसर्पकाकोलूकादिभिः संस्पर्शनमधिरोहणंयानंवाश्वोष्ट्रखरवराहैःकेशास्थिभस्मतुषाङ्गारराशीनांचाधिरोहणमिति (शोषपूर्वरूपाणिभवन्ति)||१३||
kr̥kalāsamayūravānaraśukasarpakākōlūkādibhiḥ saṁsparśanamadhirōhaṇaṁ yānaṁ vā śvōṣṭrakharavarāhaiḥ [16] kēśāsthibhasmatuṣāṅgārarāśīnāṁ cādhirōhaṇamiti (śōṣapūrvarūpāṇi [17] bhavanti)||13||
Such a person would
- often be using vehicles drawn by / संस्पर्शनमधिरोहणं यानं,
- or coming in contact with,
- or riding animals like chameleon कृकलास, peacock मयूर, monkey वानर, parrot शुक, serpent सर्प, काक crow, उलूकादिभिःowl, श्व dog, उष्ट्र camel, खर ass and वराहैः boar, and
- riding over heaps of hair केशा, bones अस्थि, ash भस्म, chaff तुषा and charcoal / अङ्गारराशीनां. [13]
Eleven symptoms / Ekadesha roopa
अतऊर्ध्वमेकादशरूपाणितस्यभवन्ति; तद्यथा- शिरसःपरिपूर्णत्वं, कासः, श्वासः, स्वरभेदः, श्लेष्मणश्छर्दनं, शोणितष्ठीवनं, पार्श्वसंरोजनम्, अंसावमर्दः, ज्वरः, अतीसारः, अरोचकश्चेति||१४||
ata ūrdhvamēkādaśarūpāṇi tasya bhavanti; tadyathā- śirasaḥ paripūrṇatvaṁ, kāsaḥ, śvāsaḥ, svarabhēdaḥ, ślēṣmaṇaśchardanaṁ, śōṇitaṣṭhīvanaṁ, pārśvasaṁrōjanam, aṁsāvamardaḥ, jvaraḥ, atīsāraḥ, arōcakaścēti||14||
There are eleven typical symptoms of shosha (mentioned in this verse) such as
1. fullness of head / शिरसः परिपूर्णत्वं
2. cough / कासः,
3. dyspnea / श्वासः,
4. hoarseness of voice / स्वरभेदः,
5. vomiting of sputum / श्लेष्मणश्छर्दनं,
6. hemoptysis / शोणितष्ठीवनं,
7. chest-pain / पार्श्वसंरोजनम्,
8. pain in shoulders / अंसावमर्दः,
9. fever / ज्वरः
10. diarrhea / अतीसारः, and
11. anorexia / अरोचक. [14]
Prognosis / Sadhya Asadhyatha
तत्रापरिक्षीणबलमांसशोणितोबलवानजातारिष्टःसर्वैरपिशोषलिङ्गैरुपद्रुतःसाध्योज्ञेयः| बलवानुपचितोहिसहत्वाद्व्याध्यौषधबलस्यकामंसुबहुलिङ्गोऽप्यल्पलिङ्गएवमन्तव्यः||१५||
tatrāparikṣīṇabalamāṁsaśōṇitō [18] balavānajātāriṣṭaḥ sarvairapi śōṣaliṅgairupadrutaḥ sādhyō jñēyaḥ|
balavānupacitō hi sahatvādvyādhyauṣadhabalasya kāmaṁ subahuliṅgō'pyalpaliṅga ēva mantavyaḥ||15||
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