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We shall now expound the chapter on the treatment of ''Kshatakshina''.

Now we shall expound the chapter "Kshatakshina Chikitsa ( Management of emaciation due to trauma).Thus said Lord Atreya. [1-2]

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Atreya, the illustrious sage, the brahmin-seer and the knower of ultimate truth, (thereafter) expounded therapeutics for the treatment of ''kshatakshina'', as given below. [3]

Atreya, the illustrious sage, the brahmin-seer and the knower of ultimate truth, (thereafter) expounded therapeutics for the treatment of ''kshatakshina'', as given below. [3]

==== ''Nidana'' (Etiology) of ''kshatakshina'' ====

=== ''Nidana'' (Etiology) of ''kshatakshina'' ===

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''Kshatakshina'', the formidable disease, gets manifested, as a result of the injury to the chest due to the above causative factors. [4-8]

''Kshatakshina'', the formidable disease, gets manifested, as a result of the injury to the chest due to the above causative factors. [4-8]

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

=== Pathogenesis and clinical features ===

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While coughing, the patient spits out phlegm which is putrid, grayish in color, foul smelling, and yellow and knotty, in large quantities along with blood. The person suffering from ''kshatakshina'' becomes excessively emaciated due to further wastage of ''shukra'' and ''ojas''. [9-12]

While coughing, the patient spits out phlegm which is putrid, grayish in color, foul smelling, and yellow and knotty, in large quantities along with blood. The person suffering from ''kshatakshina'' becomes excessively emaciated due to further wastage of ''shukra'' and ''ojas''. [9-12]

==== Prodromal signs and symptoms ====

=== Prodromal signs and symptoms ===

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However, if there is ''kshata'' (injury), pain in the chest, blood vomiting and cough are specially manifested, and if there is ''kshaya'' (diminution of tissue elements), then hematuria and stiffness of the sides of the chest, back and lumbar region are specially manifested [121/2-13]

However, if there is ''kshata'' (injury), pain in the chest, blood vomiting and cough are specially manifested, and if there is ''kshaya'' (diminution of tissue elements), then hematuria and stiffness of the sides of the chest, back and lumbar region are specially manifested [121/2-13]

==== Prognosis ====

=== Prognosis ===

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If the signs and symptoms are mild, the power of digestion (of the patient) is strong, patient has enough strength and if the disease is new (freshly occurred), then it is curable. If the disease is chronic i.e. more than one year, then it is ''yapya'' (palliable). If however, all the signs and symptoms of the disease are simultaneously manifested, then such a patient should not be treated, because the condition is incurable.[14]

If the signs and symptoms are mild, the power of digestion (of the patient) is strong, patient has enough strength and if the disease is new (freshly occurred), then it is curable. If the disease is chronic i.e. more than one year, then it is ''yapya'' (palliable). If however, all the signs and symptoms of the disease are simultaneously manifested, then such a patient should not be treated, because the condition is incurable.[14]

==== Management ====

=== Management ===

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If the patient is suffering from cough and pain in the sides of the chest as well as bones, then he should take linctus prepared of the powder ''madhuka'' (flower), ''madhu, draksha, tvakshiri, pippali'' and ''bala'' mixed with ghee and honey. [15-20]

If the patient is suffering from cough and pain in the sides of the chest as well as bones, then he should take linctus prepared of the powder ''madhuka'' (flower), ''madhu, draksha, tvakshiri, pippali'' and ''bala'' mixed with ghee and honey. [15-20]

==== ''Eladi gutika'' ====

=== ''Eladi gutika'' ===

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Half ''aksha'' (five grams) each of ''ela, patra'' and ''tvak'', half ''pala'' (twenty grams) of ''pippali'', one ''pala'' each of ''sita''(forty grams), ''madhuka, kharjura'' and ''mridvika'' should be made to a powder. Honey should be added to this powder to make a paste. From this paste, pills of one ''aksha'' each should be prepared. One such pill should be taken every day. It cures ''kasa'' (cough), ''shvasa'' (dyspnea), ''jwara'' (fever), hiccup, vomiting, fainting, hemoptysis, morbid thirst, pain in the sides of the chest, anorexia, consumption, splenic enlargement, ''adhyavata'' (rheumatoid arthritis), hoarseness of voice, ''kshata'' (injury to the chest), ''kshaya'' (diminution of tissues elements) and ''raktapitta'' (a condition charcterised by bleeding from different parts of the body). This pill is refreshing and aphrodisiac.  [21-24]

Half ''aksha'' (five grams) each of ''ela, patra'' and ''tvak'', half ''pala'' (twenty grams) of ''pippali'', one ''pala'' each of ''sita''(forty grams), ''madhuka, kharjura'' and ''mridvika'' should be made to a powder. Honey should be added to this powder to make a paste. From this paste, pills of one ''aksha'' each should be prepared. One such pill should be taken every day. It cures ''kasa'' (cough), ''shvasa'' (dyspnea), ''jwara'' (fever), hiccup, vomiting, fainting, hemoptysis, morbid thirst, pain in the sides of the chest, anorexia, consumption, splenic enlargement, ''adhyavata'' (rheumatoid arthritis), hoarseness of voice, ''kshata'' (injury to the chest), ''kshaya'' (diminution of tissues elements) and ''raktapitta'' (a condition charcterised by bleeding from different parts of the body). This pill is refreshing and aphrodisiac.  [21-24]

==== Treatment of excessive bleeding ====

=== Treatment of excessive bleeding ===

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The patient having hemoptysis should take the powder of ''punarnava,'' red variety of shali rice and sugar cooked along with grape juice, milk and ghee. [25-26]

The patient having hemoptysis should take the powder of ''punarnava,'' red variety of shali rice and sugar cooked along with grape juice, milk and ghee. [25-26]

==== Various formulations ====

=== Various formulations ===

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The  patient having injury to the chest and diminution of semen, should take ''sali'' rice mixed with ghee which latter is prepared of the milk boiled with ''nyagrodha, udumbara, ashvattha, plaksha, sala, priyangu,'' tuft of ''tala'', bark of ''jambu, priyala, padmaka'' and ''asvakarna''.

The  patient having injury to the chest and diminution of semen, should take ''sali'' rice mixed with ghee which latter is prepared of the milk boiled with ''nyagrodha, udumbara, ashvattha, plaksha, sala, priyangu,'' tuft of ''tala'', bark of ''jambu, priyala, padmaka'' and ''asvakarna''.

===== ''Yashtyavahadi ghrita'' =====

==== ''Yashtyavahadi ghrita'' ====

Ghee should be cooked with equal quantity of milk, the decoction of ''madhuyashti'' and ''nagabala'' (four times of ghee in total), and the paste of ''payasya, pippali'' and ''vamshi'' (one fourth in total of ghee). The medicated ghee is useful in the treatment of ''kshata'' (injury to chest).

Ghee should be cooked with equal quantity of milk, the decoction of ''madhuyashti'' and ''nagabala'' (four times of ghee in total), and the paste of ''payasya, pippali'' and ''vamshi'' (one fourth in total of ghee). The medicated ghee is useful in the treatment of ''kshata'' (injury to chest).

===== ''Koladi ghrita'' =====

==== ''Koladi ghrita'' ====

Similarly, ghee should be cooked with the decoction of ''kola'' and ''laksha'' (four times in total of ghee), eight times of milk, and the paste of the bark of ''kaivanga'', bark of ''darvi'', bark of ''kutaja'' and fruit of ''kutaja'' (one fourth in total of ghee). This medicated ghee is useful in the treatment of ''kshata''.[27-34]

Similarly, ghee should be cooked with the decoction of ''kola'' and ''laksha'' (four times in total of ghee), eight times of milk, and the paste of the bark of ''kaivanga'', bark of ''darvi'', bark of ''kutaja'' and fruit of ''kutaja'' (one fourth in total of ghee). This medicated ghee is useful in the treatment of ''kshata''.[27-34]

==== ''Amritaprasha ghee'' ====

=== ''Amritaprasha ghee'' ===

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Two ''prasthas'' of ghee should be cooked with the juice ''dhatri'' (two ''prasthas''), juice of ''vidari'' (two ''prasthas''), sugarcane juice (two ''prasthas''), soup of the meat of goat (two ''prasthas''), milk (two ''prasthas''), and the paste (one ''karsha'' each) of ''jivaka, rsabhaka, vira, jivanti, nagara, shati, shalaparni, prushniparni, mashaparni, mudgaparni,meda, mahameda, kakoli, kshirakakoli, kantakari, bruhati, shveta punarnava, rakta punarnava,madhuka, atmagupta, shatavari, riddhi,parushaka, bharangi, mridvika, brihati, shringataka,tamalaki, payasya'' (''kshiravidari''), ''pippali, badara, akshota, kharjura, vatama, abhishuka'' (''pista'') and such other fruits  which alleviate ''vayu'' and ''pitta''. After cooking when the the recipe is cooled, one ''prastha'' of honey, half ''tula'' of sugar, and the powder (two ''karshas'' each) of ''patra, ela, hema, tvak'' and ''maricha'' should be added to it. This medicated ghee should be taken by a person in appropriate dose regularly. This is called ''amrita prasa ghrita'' and it is like ''amrita'' (ambrosia) for human beings.  This linctus is like ''sudha'' (ambrosia worth the consumption of worldly creatures) and the ''amrita'' (ambrosia worth the consumption of the gods). It should be taken along with milk and meat soup. It promotes nourishment of persons who had depleted ''shukra'' ( as in azoospermia or oligospermia), who are suffering from ''kshatakshina'', who are weak, who are emaciated because of chronic diseases, who are cachectic and who have lost their complexion and voice. It cures cough, hiccup, fever, asthma, burning sensation, morbid thirst, ''rakta-pitta'', vomiting, fainting and diseases of the heart, female genital tract and urinary tract. It helps in the treatment of infertility. [35-43]

Two ''prasthas'' of ghee should be cooked with the juice ''dhatri'' (two ''prasthas''), juice of ''vidari'' (two ''prasthas''), sugarcane juice (two ''prasthas''), soup of the meat of goat (two ''prasthas''), milk (two ''prasthas''), and the paste (one ''karsha'' each) of ''jivaka, rsabhaka, vira, jivanti, nagara, shati, shalaparni, prushniparni, mashaparni, mudgaparni,meda, mahameda, kakoli, kshirakakoli, kantakari, bruhati, shveta punarnava, rakta punarnava,madhuka, atmagupta, shatavari, riddhi,parushaka, bharangi, mridvika, brihati, shringataka,tamalaki, payasya'' (''kshiravidari''), ''pippali, badara, akshota, kharjura, vatama, abhishuka'' (''pista'') and such other fruits  which alleviate ''vayu'' and ''pitta''. After cooking when the the recipe is cooled, one ''prastha'' of honey, half ''tula'' of sugar, and the powder (two ''karshas'' each) of ''patra, ela, hema, tvak'' and ''maricha'' should be added to it. This medicated ghee should be taken by a person in appropriate dose regularly. This is called ''amrita prasa ghrita'' and it is like ''amrita'' (ambrosia) for human beings.  This linctus is like ''sudha'' (ambrosia worth the consumption of worldly creatures) and the ''amrita'' (ambrosia worth the consumption of the gods). It should be taken along with milk and meat soup. It promotes nourishment of persons who had depleted ''shukra'' ( as in azoospermia or oligospermia), who are suffering from ''kshatakshina'', who are weak, who are emaciated because of chronic diseases, who are cachectic and who have lost their complexion and voice. It cures cough, hiccup, fever, asthma, burning sensation, morbid thirst, ''rakta-pitta'', vomiting, fainting and diseases of the heart, female genital tract and urinary tract. It helps in the treatment of infertility. [35-43]

==== ''Shvadamshtradi ghee'' ====

=== ''Shvadamshtradi ghee'' ===

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One ''pala'' of each of ''shvadamshtra, ushira, manjishtha, bala, kashmarya, katrna'', the root of  ''darbha, prithak parni, palasha, rishabhaka,'' and ''sthira'' should be made to decoction. Two ''prasthas'' of ghee should be mixed with the above mentioned decoction, eight prasthas of milk, and the paste of ''svagupta, jivanti, meda, rishabhaka, jivaka, shatavari, riddhi, mridvika, sharkara, shravani'' and bias (lotus stalk), (half prastha in total) and cooked. This medicated ghee cures ''hridaya shula'' caused by ''vayu'' and ''pitta, mutrakrucchra'' (dysuria), ''prameha'' (diabetes mellitus), piles, bronchitis, and consumption and ''kshatakshina''. It promotes strength of muscles tissues of persons emaciated because of indulgence in archery, women, alcohol, carrying heavy weight and walking a long distance. [44-47]

One ''pala'' of each of ''shvadamshtra, ushira, manjishtha, bala, kashmarya, katrna'', the root of  ''darbha, prithak parni, palasha, rishabhaka,'' and ''sthira'' should be made to decoction. Two ''prasthas'' of ghee should be mixed with the above mentioned decoction, eight prasthas of milk, and the paste of ''svagupta, jivanti, meda, rishabhaka, jivaka, shatavari, riddhi, mridvika, sharkara, shravani'' and bias (lotus stalk), (half prastha in total) and cooked. This medicated ghee cures ''hridaya shula'' caused by ''vayu'' and ''pitta, mutrakrucchra'' (dysuria), ''prameha'' (diabetes mellitus), piles, bronchitis, and consumption and ''kshatakshina''. It promotes strength of muscles tissues of persons emaciated because of indulgence in archery, women, alcohol, carrying heavy weight and walking a long distance. [44-47]

==== ''Samasaktu ghee'' ====

=== ''Samasaktu ghee'' ===

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Two ''prasthas'' of ghee should be cooked by adding the decoction of ''madhuka'' (eight ''palas'') and ''draksha'' (one ''prastha''), and the paste of ''pippali'' (eight ''palas''). After it is cooked and cooled, eight ''palas'' of each of honey and sugar should be added and mixed well. This medicated ghee should be administered by adding ''saktu'' (roasted barley flour) in equal quantity. It is useful in the treatment of ''kshatakshina'' and ''rakta gulma''. [48-49]

Two ''prasthas'' of ghee should be cooked by adding the decoction of ''madhuka'' (eight ''palas'') and ''draksha'' (one ''prastha''), and the paste of ''pippali'' (eight ''palas''). After it is cooked and cooled, eight ''palas'' of each of honey and sugar should be added and mixed well. This medicated ghee should be administered by adding ''saktu'' (roasted barley flour) in equal quantity. It is useful in the treatment of ''kshatakshina'' and ''rakta gulma''. [48-49]

==== ''Sarpi-gud'' ====

=== ''Sarpi-gud'' ===

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This and such other recipes of ''sarpigud'' [recipes of medicated ghee in which sugar, honey etc. are added] should be added with honey (which should be equal in quantity with the powder of ''tvak-kshiri'', etc.) and taken. Thereafter, the patient should drink milk. This instantaneously promotes semen, potency, strength and nourishment.  [50-55]

This and such other recipes of ''sarpigud'' [recipes of medicated ghee in which sugar, honey etc. are added] should be added with honey (which should be equal in quantity with the powder of ''tvak-kshiri'', etc.) and taken. Thereafter, the patient should drink milk. This instantaneously promotes semen, potency, strength and nourishment.  [50-55]

==== ''Sarpi gud'' (second recipe) ====

=== ''Sarpi gud'' (second recipe) ===

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''Bala, vidari, hrasva panchamula'' (''shalaparni, prsniparni, brihati, kantakari'' and ''gokshura''), ''punarnava'', and the ''sungas'' (terminal buds) of five ''kshirivrikshas'' (''nyagrodha, udumbara, asvattha, madhuka'' and ''plaksha'')- one ''pala'' of each of these drugs should be made to a decoction. To this, milk (two parts, i.e., double the quantity of the decoction), juice of ''vidari'' (one part), soup of goat meat (one part), ghee (two ''adhakas'') (in the text, actually one ''adhaka'' is mentioned. But in practice, it is to be taken double the quantity according to the general rule), and the paste of drugs belonging to the ''jivaniya'' group (one ''aksa'' each) should be added and cooked. When it is well cooked and cooled, thirty two ''palas'' of sugar should be added. Thereafter, one ''kudava'' of each of the powder of ''godhuma, pippali, vamsha lochana, shringataka'' and honey should be added. All of them should be stirred with the help of a stirrer. When it becomes dense, cakes (''sarpigud'') should be prepared and each of them should be wrapped with thin bark of ''bhurja'' tree. Having taken this cake one ''pala'' in weight, the patient should take milk or alcohol as post-prandial drink. These are useful in the treatment of disease caused by ''kapha, sosha, kasa'' and ''kshatakshina''. These are also helpful for persons who are emaciated because of excessive exertion, overindulgence in sex and exhaustion by lifting excessive weight. These cakes are efficacious in the treatment of ''rakta-nishthivana'' (hemoptysis), burning sensation, chronic rhinitis (''pinasa''), having residual infection in the chest, pain in the sides of the chest, headache, hoarseness of voice and loss of complexion. [56-61]

''Bala, vidari, hrasva panchamula'' (''shalaparni, prsniparni, brihati, kantakari'' and ''gokshura''), ''punarnava'', and the ''sungas'' (terminal buds) of five ''kshirivrikshas'' (''nyagrodha, udumbara, asvattha, madhuka'' and ''plaksha'')- one ''pala'' of each of these drugs should be made to a decoction. To this, milk (two parts, i.e., double the quantity of the decoction), juice of ''vidari'' (one part), soup of goat meat (one part), ghee (two ''adhakas'') (in the text, actually one ''adhaka'' is mentioned. But in practice, it is to be taken double the quantity according to the general rule), and the paste of drugs belonging to the ''jivaniya'' group (one ''aksa'' each) should be added and cooked. When it is well cooked and cooled, thirty two ''palas'' of sugar should be added. Thereafter, one ''kudava'' of each of the powder of ''godhuma, pippali, vamsha lochana, shringataka'' and honey should be added. All of them should be stirred with the help of a stirrer. When it becomes dense, cakes (''sarpigud'') should be prepared and each of them should be wrapped with thin bark of ''bhurja'' tree. Having taken this cake one ''pala'' in weight, the patient should take milk or alcohol as post-prandial drink. These are useful in the treatment of disease caused by ''kapha, sosha, kasa'' and ''kshatakshina''. These are also helpful for persons who are emaciated because of excessive exertion, overindulgence in sex and exhaustion by lifting excessive weight. These cakes are efficacious in the treatment of ''rakta-nishthivana'' (hemoptysis), burning sensation, chronic rhinitis (''pinasa''), having residual infection in the chest, pain in the sides of the chest, headache, hoarseness of voice and loss of complexion. [56-61]

==== ''Sarpi gud''(third recipe) ====

=== ''Sarpi gud''(third recipe) ===

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One ''pala'' of each of ''tvak-kshiri, shravani'' (''munditika''), ''draksha, murva, rushabhaka, jivaka, vira'' (''vidarikanda''), ''riddhi, kshirakakoli, brihati, kapikacchu,'' fruit of ''kharjura'' and ''meda'' should be made into paste by triturating with milk. This paste, juice of ''dhatri'' (two ''prasthas''), juice of ''vidari'' (two ''prasthas''), sugarcane juice (two ''prasthas''), and ghee (two ''prasthas'') should be cooked together. After the ghee is well cooked and cooled, half ''tulas'' of sugar and one ''prastha'' of honey should be added, out of which cakes (''sarpi gud'') should be prepared. These cakes cures cough, hiccup, fever, ''rajayakshma, tamaka svasa, rakta-pitta, halimaka'' ( a serious type of jaundice), ''shukra kshaya'' (diminution of ''shukra''), insomnia, ''trishna'' (morbid thirst), ''karshya'' (emaciation) and ''kamala'' (jaundice). (In transalation liquids, ghee and honey are taken double the prescribed quantity according to the rule) [ 62-65]

One ''pala'' of each of ''tvak-kshiri, shravani'' (''munditika''), ''draksha, murva, rushabhaka, jivaka, vira'' (''vidarikanda''), ''riddhi, kshirakakoli, brihati, kapikacchu,'' fruit of ''kharjura'' and ''meda'' should be made into paste by triturating with milk. This paste, juice of ''dhatri'' (two ''prasthas''), juice of ''vidari'' (two ''prasthas''), sugarcane juice (two ''prasthas''), and ghee (two ''prasthas'') should be cooked together. After the ghee is well cooked and cooled, half ''tulas'' of sugar and one ''prastha'' of honey should be added, out of which cakes (''sarpi gud'') should be prepared. These cakes cures cough, hiccup, fever, ''rajayakshma, tamaka svasa, rakta-pitta, halimaka'' ( a serious type of jaundice), ''shukra kshaya'' (diminution of ''shukra''), insomnia, ''trishna'' (morbid thirst), ''karshya'' (emaciation) and ''kamala'' (jaundice). (In transalation liquids, ghee and honey are taken double the prescribed quantity according to the rule) [ 62-65]

==== ''Sarpi gud'' (fourth recipe) ====

=== ''Sarpi gud'' (fourth recipe) ===

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Freshly collected and dried ''amalaki'' (ten ''palas''), ''draksha'' (ten ''palas''), ''atmagupta'' (ten ''palas''), ''punarnava'' (ten ''palas''), ''shatavari'' (ten ''palas''), ''vidari'' (ten ''palas''), ''samanga'' (ten ''palas''), ''pippali'' (ten ''palas''), ''nagara'' (eight ''palas''), ''madhuyashti'' (one ''palas''), ''saurvachala'' (one ''pala'') and ''maricha'' (two ''palas'') – all these drugs should be made to powders. Milk (two ''adhakas''), ''tila taila'' (two ''adhakas''), ghee (two ''adhakas'') and sugar (one hundred ''palas'') should be cooked together. Thereafter, the above mentioned powder should be added to it. Out of this, cakes of one ''bilva'' or ''pala'' each should be prepared. These cakes should be taken by the person suffering from ''kshatakshina'' and consumption. Intake of these cakes instantaneously promote tissues elements like ''rasa'' etc. as a result of which the individual gets nourished.  [66-69]

Freshly collected and dried ''amalaki'' (ten ''palas''), ''draksha'' (ten ''palas''), ''atmagupta'' (ten ''palas''), ''punarnava'' (ten ''palas''), ''shatavari'' (ten ''palas''), ''vidari'' (ten ''palas''), ''samanga'' (ten ''palas''), ''pippali'' (ten ''palas''), ''nagara'' (eight ''palas''), ''madhuyashti'' (one ''palas''), ''saurvachala'' (one ''pala'') and ''maricha'' (two ''palas'') – all these drugs should be made to powders. Milk (two ''adhakas''), ''tila taila'' (two ''adhakas''), ghee (two ''adhakas'') and sugar (one hundred ''palas'') should be cooked together. Thereafter, the above mentioned powder should be added to it. Out of this, cakes of one ''bilva'' or ''pala'' each should be prepared. These cakes should be taken by the person suffering from ''kshatakshina'' and consumption. Intake of these cakes instantaneously promote tissues elements like ''rasa'' etc. as a result of which the individual gets nourished.  [66-69]

==== ''Sarpi modaka'' (fifth recipe) ====

=== ''Sarpi modaka'' (fifth recipe) ===

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Cow’s milk (one ''adhaka''), ghee (two ''prasthas''), sugar cane juice (two ''adhakas''), juice of ''vidari'' (two ''prasthas'') and soup of meat of ''tittira'' (two ''prasthas'') should be cooked together. During the final stage of cooking, the paste of ''madhuka pushpa'' (one ''kudava''), ''priyala'' (one ''kudava''), ''tugakshiri'' (half ''kudava''), ''kharjura'' (twenty fruits), ''bibhitaki'' (twenty fruits), ''pippali'' (one ''pala''), sugar (thirty ''palas''), ''madhuka'' (one ''karsa'') and drugs belonging to ''jivaniya'' group (half ''pala'' each) should be added. The above mentioned drugs should be made to a paste by triturating with sugarcane juice before adding to the recipe. After the recipe is fully cooked and cooled, honey (two ''kudavas'') should be added and from it, ''modaka'' (large size pills) should be prepared. Over these ''modakas'', one pala of the powder of ''maricha'' and ''ajaji'' should be sprinkled. These ''modakas'' cure ''vatasruka'', diseases caused by ''pitta, kshatakshina, kasa'' and ''kshaya''. These are useful for persons suffering from emaciation, who have reduced semen, whose blood is blocked in the chest, who are thin, weak and old, and also for those desirous of having nourishment, complexion and strength. These ''modakas'' are also helpful for ladies suffering from exudations through the vitiated genital tract, who desire conception and who suffer from miscarriages and death of the fetus in the womb. By the use of these pills, ladies are endowed with auspiciousness strength and wholesomeness. These are promoters of ''shukra'' (sperm) and ''shonita'' (ovum). [70-77]

Cow’s milk (one ''adhaka''), ghee (two ''prasthas''), sugar cane juice (two ''adhakas''), juice of ''vidari'' (two ''prasthas'') and soup of meat of ''tittira'' (two ''prasthas'') should be cooked together. During the final stage of cooking, the paste of ''madhuka pushpa'' (one ''kudava''), ''priyala'' (one ''kudava''), ''tugakshiri'' (half ''kudava''), ''kharjura'' (twenty fruits), ''bibhitaki'' (twenty fruits), ''pippali'' (one ''pala''), sugar (thirty ''palas''), ''madhuka'' (one ''karsa'') and drugs belonging to ''jivaniya'' group (half ''pala'' each) should be added. The above mentioned drugs should be made to a paste by triturating with sugarcane juice before adding to the recipe. After the recipe is fully cooked and cooled, honey (two ''kudavas'') should be added and from it, ''modaka'' (large size pills) should be prepared. Over these ''modakas'', one pala of the powder of ''maricha'' and ''ajaji'' should be sprinkled. These ''modakas'' cure ''vatasruka'', diseases caused by ''pitta, kshatakshina, kasa'' and ''kshaya''. These are useful for persons suffering from emaciation, who have reduced semen, whose blood is blocked in the chest, who are thin, weak and old, and also for those desirous of having nourishment, complexion and strength. These ''modakas'' are also helpful for ladies suffering from exudations through the vitiated genital tract, who desire conception and who suffer from miscarriages and death of the fetus in the womb. By the use of these pills, ladies are endowed with auspiciousness strength and wholesomeness. These are promoters of ''shukra'' (sperm) and ''shonita'' (ovum). [70-77]

==== Recipes ====

=== Recipes ===

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The above mentioned recipes should be given to a patient having strong power of digestion. If the power of digestion is suppressed, then the patient should be given recipes which are stimulants of digestion and carminative. If there is diarrhea in a patient suffering from ''kshatakshina'', then the bowel – binding recipes prescribed for the treatment of ''rajayakshma'' (chapter-8) should be used. [78-84]

The above mentioned recipes should be given to a patient having strong power of digestion. If the power of digestion is suppressed, then the patient should be given recipes which are stimulants of digestion and carminative. If there is diarrhea in a patient suffering from ''kshatakshina'', then the bowel – binding recipes prescribed for the treatment of ''rajayakshma'' (chapter-8) should be used. [78-84]

==== ''Saindhavadi churna'' ====

=== ''Saindhavadi churna'' ===

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''Saindhava'' (one ''pala''), ''shunthi'' (one ''pala''), ''sauvarchala'' (two ''palas''), ''vrikshamla'' (one ''kudava''), ''dadima'' (one ''kudava''), leaf of ''arjaka'' (one ''kudava''), ''maricha'' (one ''pala''), ''ajaji'' (one ''pala''), ''dhanyaka'' (two ''palas'') and sugar (twelve ''palas'') should be made in to powder and mixed together. In appropriate quantity, this powder should be added to food and drinks. It is appetizer, stimulant of digestion and promoter of strength. It cures ''parshvashula'' (pain in the sides of the chest), ''shvasa'' (respiratory disorders including asthma) and ''kasa'' (cough).  [85-87]

''Saindhava'' (one ''pala''), ''shunthi'' (one ''pala''), ''sauvarchala'' (two ''palas''), ''vrikshamla'' (one ''kudava''), ''dadima'' (one ''kudava''), leaf of ''arjaka'' (one ''kudava''), ''maricha'' (one ''pala''), ''ajaji'' (one ''pala''), ''dhanyaka'' (two ''palas'') and sugar (twelve ''palas'') should be made in to powder and mixed together. In appropriate quantity, this powder should be added to food and drinks. It is appetizer, stimulant of digestion and promoter of strength. It cures ''parshvashula'' (pain in the sides of the chest), ''shvasa'' (respiratory disorders including asthma) and ''kasa'' (cough).  [85-87]

==== ''Shadava'' recipe ====

=== ''Shadava'' recipe ===

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Powders of ''dhanyaka'' (one ''pala''), ''ajaji'' (two ''palas''), ''ajamoda'' (two ''palas''), ''dadima'' (four ''palas''), ''vrikshamla'' (four ''palas''), ''sauvarchala'' (one ''pala''), ''shunthi'' (one ''karsa''), pulp of ''kapittha'' (five ''palas'') and sugar (sixteen ''palas'') should be mixed together. Like the other recipe, the present ''shadava'' (delicious recipe having sweet and sour tastes) should be administered along with food and drinks for the treatment of ''mandanala'' (suppression of the power of digestion) and diarrhea. It promotes the digestive power of patients suffering from ''rajayakshma''. [88-90]

Powders of ''dhanyaka'' (one ''pala''), ''ajaji'' (two ''palas''), ''ajamoda'' (two ''palas''), ''dadima'' (four ''palas''), ''vrikshamla'' (four ''palas''), ''sauvarchala'' (one ''pala''), ''shunthi'' (one ''karsa''), pulp of ''kapittha'' (five ''palas'') and sugar (sixteen ''palas'') should be mixed together. Like the other recipe, the present ''shadava'' (delicious recipe having sweet and sour tastes) should be administered along with food and drinks for the treatment of ''mandanala'' (suppression of the power of digestion) and diarrhea. It promotes the digestive power of patients suffering from ''rajayakshma''. [88-90]

==== ''Nagabala kalpa'' ====

=== ''Nagabala kalpa'' ===

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In the above mentioned manner, ''mandukaparni, sunthi'' and ''madhuka'' should be administered for therapeutic effects described above.[91-92]

In the above mentioned manner, ''mandukaparni, sunthi'' and ''madhuka'' should be administered for therapeutic effects described above.[91-92]

==== Diet and Drinks ====

=== Diet and Drinks ===

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Food and drinks which are nourishing, cooling, ''avidahi'' (which do not cause burning sensation), wholesome and light to digest, should be used by the patient suffering from ''kshatakshina'' and who is desirous of regaining health. With due regard to the ''agni'' (power of digestion), nature of disease, wholesomeness of diet, and regimens prescribed for ''rajayakshma, kasa'' and ''raktapitta''.[93-94]

Food and drinks which are nourishing, cooling, ''avidahi'' (which do not cause burning sensation), wholesome and light to digest, should be used by the patient suffering from ''kshatakshina'' and who is desirous of regaining health. With due regard to the ''agni'' (power of digestion), nature of disease, wholesomeness of diet, and regimens prescribed for ''rajayakshma, kasa'' and ''raktapitta''.[93-94]

==== Need for prompt attention ====

=== Need for prompt attention ===

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If the patient suffering from ''kshatakshina'' is not given appropriate treatment on time, then this may lead to ''rajayakshma''. Therefore well before the appearance of ''rajayakshma'', the ''kshatakhsina'' should be treated, subdued (cured). [95]

If the patient suffering from ''kshatakshina'' is not given appropriate treatment on time, then this may lead to ''rajayakshma''. Therefore well before the appearance of ''rajayakshma'', the ''kshatakhsina'' should be treated, subdued (cured). [95]

==== Summary ====

=== Summary ===

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Thus, ends the eleventh chapter (on the treatment of ''Kshatakshina'') of the [[Chikitsa Sthana]]; in the section on the therapeutics of Agnivesha’s work as redacted by Charak and not being available, restored by Dridhabala.

Thus, ends the eleventh chapter (on the treatment of ''Kshatakshina'') of the [[Chikitsa Sthana]]; in the section on the therapeutics of Agnivesha’s work as redacted by Charak and not being available, restored by Dridhabala.

===''Tattva Vimarsha'' / Fundamental Principles===

== Tattva Vimarsha (Fundamental Principles) ==

*In ''Kshatakshina, kshata'' (injury) is caused due to indulgence in various physical activities beyond one’s capacity. ''Kshina'' is a consequence of that injury with improper dietary habit and excess sexual intercourse.  

*In ''Kshatakshina, kshata'' (injury) is caused due to indulgence in various physical activities beyond one’s capacity. ''Kshina'' is a consequence of that injury with improper dietary habit and excess sexual intercourse.  

*''Kshatakshina'' , if untreated, results in ''rajayakshma''. Therefore, treatment at appropriate time is necessary to prevent ''rajayakshma''.

*''Kshatakshina'' , if untreated, results in ''rajayakshma''. Therefore, treatment at appropriate time is necessary to prevent ''rajayakshma''.

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences) ==

''Kshatakshina'' is a disease characterized by depletion of body tissues due to chest injury. In present era, the condition occurs due to over exertion, strenuous work  beyond one’s capacity, direct or indirect injury to the chest. The conditions like pneumothorax, pleural effusion and related respiratory conditions need to be addressed simultaneously by the surgical team to prevent progression of emaciation and complications of injury to vital lung tissues.  

''Kshatakshina'' is a disease characterized by depletion of body tissues due to chest injury. In present era, the condition occurs due to over exertion, strenuous work  beyond one’s capacity, direct or indirect injury to the chest. The conditions like pneumothorax, pleural effusion and related respiratory conditions need to be addressed simultaneously by the surgical team to prevent progression of emaciation and complications of injury to vital lung tissues.  

==== Etiopathology ====

=== Etiopathology ===

The etiological factors can be divided into two categories viz. (1) Exogenous factors related to over-exertion/ strenuous physical activity that causes trauma to the lung tissues, excess weight lifting and excess sexual intercourse. Studies showed that strenuous athletic activities like vigorous swimming, heavy weight lifting, jolting, etc. can cause pneumothorax (PTX), pleural effusion and pneumomediastinum (PTM) etc.  (2) Endogenous factors related to malnutrition that cause depletion of body tissues and excess intake of food having dry properties (less intake of unctuous dietary substances like ghee, oil, fats. Lipids leading to dryness in body)

The etiological factors can be divided into two categories viz. (1) Exogenous factors related to over-exertion/ strenuous physical activity that causes trauma to the lung tissues, excess weight lifting and excess sexual intercourse. Studies showed that strenuous athletic activities like vigorous swimming, heavy weight lifting, jolting, etc. can cause pneumothorax (PTX), pleural effusion and pneumomediastinum (PTM) etc.  (2) Endogenous factors related to malnutrition that cause depletion of body tissues and excess intake of food having dry properties (less intake of unctuous dietary substances like ghee, oil, fats. Lipids leading to dryness in body)

The etiological factors described for ''kshata'' are related to those that cause spontaneous lung injury.  

The etiological factors described for ''kshata'' are related to those that cause spontaneous lung injury.  

==== Pathogenesis ====

=== Pathogenesis ===

The disease has acute onset without any premonitory signs. This shows sudden appearance of clinical features due to traumatic etiology.  As disease progresses, it leads to depletion of body tissues causing emaciation.  

The disease has acute onset without any premonitory signs. This shows sudden appearance of clinical features due to traumatic etiology.  As disease progresses, it leads to depletion of body tissues causing emaciation.  

*Prognosis: Curable if newly developed, and mildly emaciated, palliable in chronic stage, incurable in advanced stage and severely emaciated with multiple system involvement   

*Prognosis: Curable if newly developed, and mildly emaciated, palliable in chronic stage, incurable in advanced stage and severely emaciated with multiple system involvement   

===== Management of disease =====

==== Management of disease ====

*Experience based clinical practices:  

*Experience based clinical practices:  

**Rejuvenation therapies  

**Rejuvenation therapies  

====== ''Shodhana chikitsa'' (body purification treatments) and procedures ======

==== ''Shodhana chikitsa'' (body purification treatments) and procedures ====

Purification treatments are not indicated in this disease.  

Purification treatments are not indicated in this disease.  

Chest physiotherapy for improving lung functions is advised.  

Chest physiotherapy for improving lung functions is advised.  

====== ''Shamana chikitsa'' (pacification treatments) with list of formulations and medicines ======

==== ''Shamana chikitsa'' (pacification treatments) with list of formulations and medicines ====

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*''Apathya'' or contraindicated activity: Over exertion, strenuous exercise, weight lifting etc.

*''Apathya'' or contraindicated activity: Over exertion, strenuous exercise, weight lifting etc.

===== Parallel management of chest injury =====

==== Parallel management of chest injury ====

Use of ''sandhaniya'' drugs like ''laksha'' (mainly indicated for the healing of fracture of bone) and ''madhuyashti'' clearly indicates that in ''kshatakshina'' there is external trauma (ribs fracture leading to pneumothorax) that should be managed with quick remedies. As only conservative management for the ''kshatakshina'' is described, it excludes the possibility of surgical interventions in ''kshatakshina'' in that era. However nowadays the surgical procedures like tube drainage with or without medical pleurodesis, vacuum-assisted thoracostomy (VATS) with pleurodesis and/or closure of leaks and bullectomy, and open surgical procedures such as thoracotomy for pleurectomy or pleurodesis) are conducted to decrease the chances of incurability of ''kshatakshina''. At the present time, it is necessary to elaborate the management of acute dreaded complications like pneumothorax and hematuria in separate chapter.   

Use of ''sandhaniya'' drugs like ''laksha'' (mainly indicated for the healing of fracture of bone) and ''madhuyashti'' clearly indicates that in ''kshatakshina'' there is external trauma (ribs fracture leading to pneumothorax) that should be managed with quick remedies. As only conservative management for the ''kshatakshina'' is described, it excludes the possibility of surgical interventions in ''kshatakshina'' in that era. However nowadays the surgical procedures like tube drainage with or without medical pleurodesis, vacuum-assisted thoracostomy (VATS) with pleurodesis and/or closure of leaks and bullectomy, and open surgical procedures such as thoracotomy for pleurectomy or pleurodesis) are conducted to decrease the chances of incurability of ''kshatakshina''. At the present time, it is necessary to elaborate the management of acute dreaded complications like pneumothorax and hematuria in separate chapter.   

==== Future Scope for Research ====

=== Future Scope for Research ===

*Exploring the clinical evidences for the immunomodulator and hemostatic properties of Sida Veronicaefolia Lam. (''Nagabala'').

*Exploring the clinical evidences for the immunomodulator and hemostatic properties of Sida Veronicaefolia Lam. (''Nagabala'').

*Evaluating role of anti-oxidant drugs [like amalaki (Emblica officinalis)] and vitamin C in the management of chronic inflammatory as well as infectious pulmonary diseases.  

*Evaluating role of anti-oxidant drugs [like amalaki (Emblica officinalis)] and vitamin C in the management of chronic inflammatory as well as infectious pulmonary diseases.  

=== Further reading ===

== Further reading ==

   

   

#Curtin SM, Tucker AM, Gens DR. Pneumothorax in sports: issues in recognition and follow-up care. Phys Sportsmed 2000;28:23 – 32.

#Curtin SM, Tucker AM, Gens DR. Pneumothorax in sports: issues in recognition and follow-up care. Phys Sportsmed 2000;28:23 – 32.