Rajayakshma Chikitsa

Rajayakshma Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 8
Preceding Chapter	Kushtha Chikitsa
Succeeding Chapter	Unmada Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

(Chikitsa Sthana Chapter 8, Chapter on Management of Wasting Diseases)

Abstract

Rajayakshma is a syndrome consisting of diseases associated with wasting (kshaya) of various tissues including rasa and ojas causing immunodeficiency resulting in opportunistic infections, most common being tuberculosis. The term rajyakshma has been used interchangeably with tuberculosis. It is potentially fatal wasting disease that "consumes" the body. This chapter describes etio-pathogenesis, signs and symptoms and principles of management. Groups of signs viz. a group of three signs, six signs and eleven signs are enlisted to designate variety of srotasa (systems) involved with increasing severity of disease. The complications and prognosis are elaborated to categorize the disease as one of the dreadful diseases. Treatment with modern antitubercular medicines reduces mortality in patients with tuberculosis (cure rate11.42% and the death rate 40.9%) but when combined with Ayurvedic treatment there was significant improvement (cure rate 41.3% and the death rate 3.8%).

Keywords: Rajayakshma, kshaya, shosha, tuberculosis, vyadhikshamatva, dhatukshaya, immunity, depletion of tissues.

Introduction

Rajayakshma has been identified since Vedic period (2400 BC). Yakshma,the word, first appeared in the vedas (Rigveda and Atharvaveda), but a detailed description was missing. In the Ayurvedic treatises, or the Samhitas (1000 BC to 500 AD), a detailed description of rajayakshma can be found. An account of its definition, etiology, pathogenesis, general features, management, and the prognosis is found in Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya with more extensive description is in Charaka Samhita. Four etiological factors are described, sahasa (over exertion or working beyond one's capacity), samdharana (suppression of natural urges), kshaya (depletion of tissue element) and vishamashana (irregular diet).

The three chapters viz. Sosha Nidana, Rajayakshma Chikitsa and Kshatakshina Chikitsa deal with similar clinical presentation of disease and principles of management. Dhatukshaya is common feature in all. Advancement of dhatukshaya in sosha reaches a stage when immuno-suppression with resulting opportunistic infection occurs and is called rajayakshma. In kshatakshina or urakshata there is chest injury due to direct or indirect trauma along with dhatukshaya. Brimhana of dhatu (nourishment) is the principle line of management.

Thus upsarga(additional contact or exposure to) may be considered as Sannikrishta Nidana (recent cause) of rajayakshma. Sushruta was aware of this fact, and he has described its contagious nature by saying that skin diseases, fever, rajayakshma and conjunctivitis are infectious diseases which spread from one man to another man.

Symptomatology of rajayakshma has been described in three different categories viz. trirupa, shadrupa and ekadashrupa. It seems that trirupa denotes the description of early tuberculosis when the disease is of mild nature whereas shadrupa is the clinical manifestation of the moderately advanced disease. Shadrupa is the cardinal symptoms of pulmonary tuberculosis which are found in the majority of the patients. Ekadashrupa or eleven-fold manifestation may appear in the far advanced stage of tuberculosis or in those patients whose vyadhikshamatva (immunity) is hina (low). The clinical presentation of disease includes groups of signs with their specific pathogenesis. The increasing number of signs denote severity of disease and spread of disease over body organs.

As far as the treatment is concerned, mild samshodhana therapy is indicated in excess aggravation of dosha. However drastic purification leading to emaciation is strictly contraindicated especially virechana (purgation) therapy. Samshamana (pacification) therapy includes treatment of symptoms and treatment of emaciation to increase the declining dhatus (tissues) of the body by using various types of meat and wines. Meat having high protein content helps in rebuilding body tissues whereas wine acts as a tonic and appetizer, it also helps open the blocked channels thereby providing proper nutrition to all the tissues of the body. Rasayana (rejuvenatives) have a significant role in enhancing immunity and thereby preventing infectious diseases. The formulations described in Rajayakshma Chikitsa enhance immunity as well as an adjuvant therapies to anti-tubercular treatments in current practices.

This chapter underscores the importance of judicious combination of modern drug treatment of infectious diseases with Ayurvedic treatment to achieve better results.[1]

Sanskrit text, Transliteration and English Translation

अथातो राजयक्ष्मचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātō rājayakṣmacikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAto rAjayakShmacikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

Now we shall expound the chapter entitled “The management of Rajayakshma". Thus said Lord Atreya [1-2]

History of disease

दिवौकसां कथयतामृषिभिर्वै श्रुता कथा| कामव्यसनसंयुक्ता पौराणी शशिनं प्रति||३||

रोहिण्यामतिसक्तस्य शरीरं नानुरक्षतः| आजगामाल्पतामिन्दोर्देहः स्नेहपरिक्षयात्||४||

दुहितॄणामसम्भोगाच्छेषाणां च प्रजापतेः| क्रोधो निःश्वासरूपेण मूर्तिमान् निःसृतो मुखात्||५||

प्रजापतेर्हि दुहितॄरष्टाविंशतिमंशुमान्| भार्यार्थं प्रतिजग्राह न च सर्वास्ववर्तत||६||

गुरुणा तमवध्यातं भार्यास्वसमवर्तिनम्| रजःपरीतमबलं यक्ष्मा शशिनमाविशत्||७||

सोऽभिभूतोऽतिमहता गुरुक्रोधेन निष्प्रभः| देवदेवर्षिसहितो जगाम शरणं गुरुम्||८||

अथ चन्द्रमसः शुद्धां मतिं बुद्ध्वा प्रजापतिः| प्रसादं कृतवान् सोमस्ततोऽश्विभ्यां चिकित्सितः||९||

स विमुक्तग्रहश्चन्द्रो विरराज विशेषतः| ओजसा [२] वर्धितोऽश्विभ्यां शुद्धं सत्त्वमवाप च||१०||

divaukasāṁ kathayatāmr̥ṣibhirvai śrutā kathā| kāmavyasanasaṁyuktā paurāṇī śaśinaṁ prati||3||

rōhiṇyāmatisaktasya śarīraṁ nānurakṣataḥ| ājagāmālpatāmindōrdēhaḥ snēhaparikṣayāt||4||

duhitr̥̄ṇāmasambhōgācchēṣāṇāṁ ca prajāpatēḥ| krōdhō niḥśvāsarūpēṇa mūrtimān niḥsr̥tō mukhāt||5||

prajāpatērhi duhitr̥̄raṣṭāviṁśatimaṁśumān| bhāryārthaṁ pratijagrāha na ca sarvāsvavartata||6||

guruṇā tamavadhyātaṁ bhāryāsvasamavartinam| rajaḥparītamabalaṁ yakṣmā śaśinamāviśat||7||

sō'bhibhūtō'timahatā [1] gurukrōdhēna niṣprabhaḥ| dēvadēvarṣisahitō jagāma śaraṇaṁ gurum||8||

atha candramasaḥ śuddhāṁ matiṁ buddhvā prajāpatiḥ| prasādaṁ kr̥tavān sōmastatō'śvibhyāṁ cikitsitaḥ||9||

sa vimuktagrahaścandrō virarāja viśēṣataḥ| ōjasā [2] vardhitō'śvibhyāṁ śuddhaṁ sattvamavāpa ca||10||

divaukasAM kathayatAmRuShibhirvai shrutA kathA| kAmavyasanasaMyuktA paurANI shashinaM prati||3||

rohiNyAmatisaktasya sharIraM nAnurakShataH| AjagAmAlpatAmindordehaH snehaparikShayAt||4||

duhitRUNAmasambhogAccheShANAM ca prajApateH| krodho niHshvAsarUpeNa mUrtimAn niHsRuto mukhAt||5||

prajApaterhi duhitRUraShTAviMshatimaMshumAn| bhAryArthaM pratijagrAha na ca sarvAsvavartata||6||

guruNA tamavadhyAtaM bhAryAsvasamavartinam| rajaHparItamabalaM yakShmA shashinamAvishat||7||

so~abhibhUto~atimahatA [1] gurukrodhena niShprabhaH| devadevarShisahito jagAma sharaNaM gurum||8||

atha candramasaH shuddhAM matiM buddhvA prajApatiH| prasAdaM kRutavAn somastato~ashvibhyAM cikitsitaH||9||

sa vimuktagrahashcandro virarAja visheShataH| ojasA [2] vardhito~ashvibhyAM shuddhaM sattvamavApa ca||10||

The following story – of Chandrama (Moon)’s passionate cohabiting (with Rohini, one of his 28 celestial wives) - was narrated by the Gods to the sages. Because of his excessive sexual indulgence with Rohini, Chandrama soon started neglecting his own health, becoming emaciated due to depletion of his bodily unctuousness (essence or vitality). Besides, his inordinate attention to just one wife in comparison to the others resulted in his not being able to satisfy the desires of his remaining wives – all of whom were the daughters of Daksha Prajapati (Lord of Progeny). This ill-treatment to his daughters made Daksha furious, and his anger came out of his mouth in the form of breath that took a physical form (Yakshma). The now lusterless, afflicted Moon sought clemency from the great Daksha, accompanied by the Gods and Sages. Daksha Prajapati , now realizing Chandrama’s pure state of mind (and therefore, admitting his folly), became cordial to him got him treated by the Ashwin, the celestial physicians. The Ashwins having enhanced his ojas (vital essence), Chandrama additionally acquired a great purity of mind. [3-10]

Names of disease

क्रोधो यक्ष्मा ज्वरो रोग एकार्थो दुःखसञ्ज्ञकः| यस्मात् स राज्ञः प्रागासीद्राजयक्ष्मा ततो मतः||११||

स यक्ष्मा हुङ्कृतोऽश्विभ्यां मानुषं लोकमागतः| लब्ध्वा चतुर्विधं हेतुं समाविशति मानवान्||१२||

krōdhō yakṣmā jvarō rōga ēkārthō duḥkhasañjñakaḥ| yasmāt sa rājñaḥ prāgāsīdrājayakṣmā tatō mataḥ||11||

sa yakṣmā huṅkr̥tō'śvibhyāṁ mānuṣaṁ lōkamāgataḥ| labdhvā caturvidhaṁ hētuṁ samāviśati mānavān||12||

krodho yakShmA jvaro roga ekArtho duHkhasa~jj~jakaH| yasmAt sa rAj~jaH prAgAsIdrAjayakShmA tato mataH||11||

sa yakShmA hu~gkRuto~ashvibhyAM mAnuShaM lokamAgataH| labdhvA caturvidhaM hetuM samAvishati mAnavAn||12||

Krodha(rage), yakshma (sickness), jwara(fever) and roga (disease suffering) – these terms are synonymous, and indicate (misery, sorrow). Because it afflicted Chandrama, the king of stars, originally, it is called rajayakshma, or the king of diseases.This disease, having been treated by the Ashwin in the celestial world, has come down to the world of mortals (i.e., human beings). Here, it afflicts human beings after being triggered by a four-fold causative factor [11-12]

Four important causative factors of disease

अयथाबलमारम्भं वेगसन्धारणं क्षयम्| यक्ष्मणः कारणं विद्याच्चतुर्थं विषमाशनम्||१३||

ayathābalamārambhaṁ vēgasandhāraṇaṁ kṣayam| yakṣmaṇaḥ kāraṇaṁ vidyāccaturthaṁ viṣamāśanam||13||

ayathAbalamArambhaM vegasandhAraNaM kShayam| yakShmaNaH kAraNaM vidyAccaturthaM viShamAshanam||13||

Over–exertion beyond one’s capacity, suppression of natural urges, depletion of tissue elements and irregular dietary habits are the etiological factors of rajayakshma. [13]

1. Sahasaja rajayakshma (due to over exertion beyond one’s capacity)

युद्धाध्ययनभाराध्वलङ्घनप्लवनादिभिः| पतनैरभिघातैर्वा साहसैर्वा तथाऽपरैः||१४||

अयथाबलमारम्भैर्जन्तोरुरसि विक्षते| वायुः प्रकुपितो दोषावुदीर्योभौ प्रधावति||१५||

स शिरःस्थः शिरःशूलं करोति गलमाश्रितः| कण्ठोद्ध्वंसं च कासं च स्वरभेदमरोचकम्||१६||

पार्श्वशूलं च पार्श्वस्थो वर्चोभेदं गुदे स्थितः| जृम्भां ज्वरं च सन्धिस्थ उरःस्थश्चोरसो रुजम्||१७||

क्षणनादुरसः कासात् कफं ष्ठीवेत् सशोणितम्| जर्जरेणोरसा कृच्छ्रमुरःशूलातिपीडितः||१८||

इति साहसिको यक्ष्मा रूपैरेतैः प्रपद्यते| एकादशभिरात्मज्ञो भजेत्तस्मान्न साहसम्||१९||

yuddhādhyayanabhārādhvalaṅghanaplavanādibhiḥ| patanairabhighātairvā sāhasairvā tathā'paraiḥ||14||

ayathābalamārambhairjantōrurasi vikṣatē| vāyuḥ prakupitō dōṣāvudīryōbhau pradhāvati||15||

sa śiraḥsthaḥ śiraḥśūlaṁ karōti galamāśritaḥ| kaṇṭhōddhvaṁsaṁ ca kāsaṁ ca svarabhēdamarōcakam||16||

pārśvaśūlaṁ ca pārśvasthō varcōbhēdaṁ gudē sthitaḥ| jr̥mbhāṁ jvaraṁ ca sandhistha uraḥsthaścōrasō rujam||17||

kṣaṇanādurasaḥ kāsāt kaphaṁ ṣṭhīvēt saśōṇitam| jarjarēṇōrasā kr̥cchramuraḥśūlātipīḍitaḥ||18||

iti sāhasikō yakṣmā rūpairētaiḥ prapadyatē| ēkādaśabhirātmajñō bhajēttasmānna sāhasam||19||

yuddhAdhyayanabhArAdhvala~gghanaplavanAdibhiH| patanairabhighAtairvA sAhasairvA tathA~aparaiH||14||

ayathAbalamArambhairjantorurasi vikShate| vAyuH prakupito doShAvudIryobhau pradhAvati||15||

sa shiraHsthaH shiraHshUlaM karoti galamAshritaH| kaNThoddhvaMsaM ca kAsaM ca svarabhedamarocakam||16||

pArshvashUlaM ca pArshvastho varcobhedaM gude sthitaH| jRumbhAM jvaraM ca sandhistha uraHsthashcoraso rujam||17||

kShaNanAdurasaH [1] kAsAt kaphaM ShThIvet sashoNitam| jarjareNorasA kRucchramuraHshUlAtipIDitaH||18||

iti sAhasiko yakShmA rUpairetaiH prapadyate| ekAdashabhirAtmaj~jo bhajettasmAnna [2] sAhasam||19||

When beyond one’s capacity, a person indulges in excess battle, reading, weight-lifting, walking, jumping, swimming etc. or falls down - or gets injured -or exerts himself in any action that is beyond his strength or tolerance, leads to chest injury and , vitiates vata dosha. This vata dosha afflicts the other two (pitta and kapha dosha). These vitiated dosha, along with vayu, spread in all direction within body (pradhavati) and cause eleven symptoms, with each symptom directly corresponding to the particular part of the body. If the deranged dosha enters the head, it causes headache; if the throat, then irritation in throat, cough, hoarseness of voice and anorexia; if the chest, then pain in the sides of the chest; if the anus, then diarrhea; if in the joints, then fever, yawning and pain in the chest.

Injury to the chest and coughing cause the patient to spit out phlegm along with blood. In this case, the patient suffers from unbearable pain in his chest due to pulmonic damage. These eleven symptoms are manifested in the patients suffering from yakshma caused by overexertion. [14-19]

2. Vegasandharanaja rajayakshma (due to suppression of natural urges)

ह्रीमत्त्वाद्वा घृणित्वाद्वा भयाद्वा वेगमागतम्| वातमूत्रपुरीषाणां निगृह्णाति यदा नरः||२०||

तदा वेगप्रतीघातात् कफपित्ते समीरयन्| ऊर्ध्वं तिर्यगधश्चैव विकारान् कुरुतेऽनिलः||२१||

प्रतिश्यायं च कासं च स्वरभेदमरोचकम्| पार्श्वशूलं शिरःशूलं ज्वरमंसावमर्दनम्||२२||

अङ्गमर्दं मुहुश्छर्दिं वर्चोभेदं त्रिलक्षणम्| रूपाण्येकादशैतानि यक्ष्मा यैरुच्यते महान्||२३||

hrīmattvādvā ghr̥ṇitvādvā bhayādvā vēgamāgatam| vātamūtrapurīṣāṇāṁ nigr̥hṇāti yadā naraḥ||20||

tadā vēgapratīghātāt kaphapittē samīrayan| ūrdhvaṁ tiryagadhaścaiva vikārān kurutē'nilaḥ||21||

pratiśyāyaṁ ca kāsaṁ ca svarabhēdamarōcakam| pārśvaśūlaṁ śiraḥśūlaṁ jvaramaṁsāvamardanam||22||

aṅgamardaṁ muhuśchardiṁ varcōbhēdaṁ trilakṣaṇam| rūpāṇyēkādaśaitāni yakṣmā yairucyatē mahān||23||

hrImattvAdvA ghRuNitvAdvA bhayAdvA vegamAgatam| vAtamUtrapurIShANAM nigRuhNAti yadA naraH||20||

tadA vegapratIghAtAt kaphapitte samIrayan| UrdhvaM tiryagadhashcaiva vikArAn kurute~anilaH||21||

pratishyAyaM ca kAsaM ca svarabhedamarocakam| pArshvashUlaM shiraHshUlaM jvaramaMsAvamardanam||22||

a~ggamardaM muhushchardiM varcobhedaM trilakShaNam| rUpANyekAdashaitAni yakShmA yairucyate mahAn||23||

When due to bashfulness or disgust or fear one suppresses the impelling urge to pass flatus, urine and/or feces, vayu, due to the obstruction of such urges, propels kapha and pitta upwards, obliquely and downwards within the body, causing the disorders having symptoms of all three doshas such as coryza, cough, hoarseness of voice, anorexia, pain in flank, headache, fever, pain in shoulders, bodyache, frequent vomiting and diarrhea. These are the eleven symptoms of rajayakshma caused due to suppression of urges. [20-23]

3. Kshayaja rajayakshma (due to depletion of tissues)

ईर्ष्योत्कण्ठाभयत्रासक्रोधशोकातिकर्शनात्| अतिव्यवायानशनाच्छुक्रमोजश्च हीयते||२४||

ततः स्नेहक्षयाद्वायुर्वृद्धो दोषावुदीरयन्| प्रतिश्यायं ज्वरं कासमङ्गमर्दं शिरोरुजम्||२५||

श्वासं विड्भेदमरुचिं पार्श्वशूलं स्वरक्षयम्| करोति चांससन्तापमेकादशगदानिमान् [१] ||२६||

लिङ्गान्यावेदयन्त्येतान्येकादश महागदम्| सम्प्राप्तं राजयक्ष्माणं क्षयात् प्राणक्षयप्रदम्||२७||

īrṣyōtkaṇṭhābhayatrāsakrōdhaśōkātikarśanāt| ativyavāyānaśanācchukramōjaśca hīyatē||24||

tataḥ snēhakṣayādvāyurvr̥ddhō dōṣāvudīrayan| pratiśyāyaṁ jvaraṁ kāsamaṅgamardaṁ śirōrujam||25||

śvāsaṁ viḍbhēdamaruciṁ pārśvaśūlaṁ svarakṣayam| karōti cāṁsasantāpamēkādaśagadānimān [1] ||26||

liṅgānyāvēdayantyētānyēkādaśa mahāgadam| samprāptaṁ rājayakṣmāṇaṁ kṣayāt prāṇakṣayapradam||27||

IrShyotkaNThAbhayatrAsakrodhashokAtikarshanAt| ativyavAyAnashanAcchukramojashca hIyate||24||

tataH snehakShayAdvAyurvRuddho doShAvudIrayan| pratishyAyaM jvaraM kAsama~ggamardaM shirorujam||25||

shvAsaM viDbhedamaruciM pArshvashUlaM svarakShayam| karoti cAMsasantApamekAdashagadAnimAn [1] ||26||

li~ggAnyAvedayantyetAnyekAdasha mahAgadam| samprAptaM rAjayakShmANaM kShayAt prANakShayapradam||27||

Excessive envy, eagerness, fever, terror, anger, grief, excessive indulgence in sexual intercourse, and fasting leads to depletion of shukra and ojas. This, in turn, due to loss of unctuousness, provokes vata which further aggravates the other two doshas and causes eleven symptoms such as—coryza, fever, cough, bodyache, headache, dyspnea, diarrhea, anorexia, pain in flanks, feeble voice and feeling of warmth in shoulders. These eleven symptoms indicate the advent of the great disease rajayakshma due to wasting. [24-27]

4. Vishamashanaja rajayakshma (due to irregular dietary habits)

विविधान्यन्नपानानि वैषम्येण समश्नतः| जनयन्त्यामयान् घोरान्विषमान्मारुतादयः||२८||

स्रोतांसि रुधिरादीनां वैषम्याद्विषमं गताः| रुद्ध्वा रोगाय कल्पन्ते पुष्यन्ति च न धातवः||२९||

प्रतिश्यायं प्रसेकं च कासं छर्दिमरोचकम्| ज्वरमंसाभितापं च छर्दनं रुधिरस्य च||३०||

पार्श्वशूलं शिरःशूलं स्वरभेदमथापि च| कफपित्तानिलकृतं लिङ्गं विद्याद्यथाक्रमम्||३१||

इति व्याधिसमूहस्य रोगराजस्य हेतुजम्| रूपमेकादशविधं हेतुश्चोक्तश्चतुर्विधः||३२||

vividhānyannapānāni vaiṣamyēṇa samaśnataḥ| janayantyāmayān ghōrānviṣamānmārutādayaḥ||28||

srōtāṁsi rudhirādīnāṁ vaiṣamyādviṣamaṁ gatāḥ| ruddhvā rōgāya kalpantē puṣyanti ca na dhātavaḥ||29||

pratiśyāyaṁ prasēkaṁ ca kāsaṁ chardimarōcakam| jvaramaṁsābhitāpaṁ ca chardanaṁ rudhirasya ca||30||

pārśvaśūlaṁ śiraḥśūlaṁ svarabhēdamathāpi ca| kaphapittānilakr̥taṁ liṅgaṁ vidyādyathākramam||31||

iti vyādhisamūhasya rōgarājasya [1] hētujam| rūpamēkādaśavidhaṁ hētuścōktaścaturvidhaḥ||32||

vividhAnyannapAnAni vaiShamyeNa samashnataH| janayantyAmayAn ghorAnviShamAnmArutAdayaH||28||

srotAMsi rudhirAdInAM vaiShamyAdviShamaM gatAH| ruddhvA rogAya kalpante puShyanti ca na dhAtavaH||29||

pratishyAyaM prasekaM ca kAsaM chardimarocakam| jvaramaMsAbhitApaM ca chardanaM rudhirasya ca||30||

pArshvashUlaM shiraHshUlaM svarabhedamathApi ca| kaphapittAnilakRutaM li~ggaM vidyAdyathAkramam||31||

iti vyAdhisamUhasya rogarAjasya [1] hetujam| rUpamekAdashavidhaM hetushcoktashcaturvidhaH||32||

Irregular intake of dietary articles, or irregular dietary habits lead to vitiation of doshas, causing severe amavisha disorders. These vitiated doshas obstruct the channels of blood etc. leading to weaning away of dhatus and causing the 11 symptoms of rajayakshma caused due to irregular dietary habit:

1. Due to vitiated kapha: coryza, excessive salivation, cough, vomiting and anorexia,
2. Due to vitiated pitta: fever, distress in shoulder and haemoptysis, and
3. Due to vitiated vata: pain in flanks, headache and hoarseness of voice.[28-31]

Premonitory signs

पूर्वरूपं प्रतिश्यायो दौर्बल्यं दोषदर्शनम्| अदोषेष्वपि भावेषु काये बीभत्सदर्शनम्||३३||

घृणित्वमश्नतश्चापि बलमांसपरिक्षयः| स्त्रीमद्यमांसप्रियता प्रियता चावगुण्ठने||३४||

मक्षिकाघुणकेशानां तृणानां पतनानि च| प्रायोऽन्नपाने केशानां नखानां चाभिवर्धनम्||३५||

पतत्रिभिः पतङ्गैश्च श्वापदैश्चाभिधर्षणम्| स्वप्ने केशास्थिराशीनां भस्मनश्चाधिरोहणम्||३६||

जलाशयानां शैलानां वनानां ज्योतिषामपि| शुष्यतां क्षीयमाणानां पततां यच्च दर्शनम्||३७||

प्राग्रूपं बहुरूपस्य तज्ज्ञेयं राजयक्ष्मणः|३८|

pūrvarūpaṁ pratiśyāyō daurbalyaṁ dōṣadarśanam| adōṣēṣvapi bhāvēṣu kāyē bībhatsadarśanam||33||

ghr̥ṇitvamaśnataścāpi balamāṁsaparikṣayaḥ| strīmadyamāṁsapriyatā priyatā cāvaguṇṭhanē||34||

makṣikāghuṇakēśānāṁ tr̥ṇānāṁ patanāni ca| prāyō'nnapānē kēśānāṁ nakhānāṁ cābhivardhanam||35||

patatribhiḥ pataṅgaiśca śvāpadaiścābhidharṣaṇam| svapnē kēśāsthirāśīnāṁ bhasmanaścādhirōhaṇam||36||

jalāśayānāṁ śailānāṁ vanānāṁ jyōtiṣāmapi| śuṣyatāṁ kṣīyamāṇānāṁ patatāṁ yacca darśanam||37||

prāgrūpaṁ bahurūpasya tajjñēyaṁ rājayakṣmaṇaḥ|38|

pUrvarUpaM pratishyAyo daurbalyaM doShadarshanam| adoSheShvapi bhAveShu kAye bIbhatsadarshanam||33||

ghRuNitvamashnatashcApi balamAMsaparikShayaH| strImadyamAMsapriyatA priyatA cAvaguNThane||34||

makShikAghuNakeshAnAM tRuNAnAM patanAni ca| prAyo~annapAne keshAnAM nakhAnAM cAbhivardhanam||35||

patatribhiH pata~ggaishca shvApadaishcAbhidharShaNam| svapne keshAsthirAshInAM bhasmanashcAdhirohaNam||36||

jalAshayAnAM shailAnAM vanAnAM jyotiShAmapi| shuShyatAM kShIyamANAnAM patatAM yacca darshanam||37||

prAgrUpaM bahurUpasya tajj~jeyaM rAjayakShmaNaH|38|

The premonitory symptoms (of rajayakshma) are coryza, debility, nitpicking (or an inclination to find faults where there is no reason to), morbid appearances on the body; feeling of disgust, loss of strength and flesh (inspite of consuming adequate food), craving for women, wine and meat, desire to be always covered by something (feeling of cold), imagined feeling of one’s food being infested with insects, flies, hair,, rapid growth of hairs and fingernails, imagined feeling of being attacked by birds, wasps, and animals, seeing dreams of climbing heaps of hair, bones, and ashes, and dreaming of dried or withered ponds, mountains, and forests- these are to be known as premonitory symptoms of rajayakshma of various types.[33-38]

Pathogenesis and clinical features

रूपं त्वस्य यथोद्देशं निर्देक्ष्यामि [१] सभेषजम्||३८||

यथास्वेनोष्मणा पाकं शारीरा यान्ति धातवः| स्रोतसा च यथास्वेन धातुः पुष्यति धातुतः||३९||

स्रोतसां सन्निरोधाच्च रक्तादीनां च सङ्क्षयात्| धातूष्मणां चापचयाद्राजयक्ष्मा प्रवर्तते||४०||

तस्मिन् काले पचत्यग्निर्यदन्नं कोष्ठसंश्रितम्| मलीभवति तत् प्रायः कल्पते किञ्चिदोजसे||४१||

तस्मात् पुरीषं संरक्ष्यं विशेषाद्राजयक्ष्मिणः| सर्वधातुक्षयार्तस्य बलं तस्य हि विड्बलम्||४२||

रसः स्रोतःसु रुद्धेषु स्वस्थानस्थो विदह्यते [२] | स ऊर्ध्वं कासवेगेन बहुरूपः प्रवर्तते||४३||

जायन्ते व्याधयश्चातः षडेकादश वा पुनः| येषां सङ्घातयोगेन राजयक्ष्मेति कथ्यते||४४||

कासोंऽसतापो वैस्वर्यं ज्वरः पार्श्वशिरोरुजा| छर्दनं रक्तकफयोः श्वासवर्चोगदोऽरुचिः||४५||

रूपाण्येकादशैतानि यक्ष्मणः षडिमानि वा| कासो ज्वरः पार्श्वशूलं स्वरवर्चोगदोऽरुचिः||४६||

सर्वैरर्धैस्त्रिभिर्वाऽपि लिङ्गैर्मांसबलक्षये| युक्तो वर्ज्यश्चिकित्स्यस्तु सर्वरूपोऽप्यतोऽन्यथा||४७||

rūpaṁ tvasya yathōddēśaṁ nirdēkṣyāmi [1] sabhēṣajam||38||

yathāsvēnōṣmaṇā pākaṁ śārīrā yānti dhātavaḥ| srōtasā ca yathāsvēna dhātuḥ puṣyati dhātutaḥ||39||

srōtasāṁ sannirōdhācca raktādīnāṁ ca saṅkṣayāt| dhātūṣmaṇāṁ cāpacayādrājayakṣmā pravartatē||40||

tasmin kālē pacatyagniryadannaṁ kōṣṭhasaṁśritam| malībhavati tat prāyaḥ kalpatē kiñcidōjasē||41||

tasmāt purīṣaṁ saṁrakṣyaṁ viśēṣādrājayakṣmiṇaḥ| sarvadhātukṣayārtasya balaṁ tasya hi viḍbalam||42||

rasaḥ srōtaḥsu ruddhēṣu svasthānasthō vidahyatē [2] | sa ūrdhvaṁ kāsavēgēna bahurūpaḥ pravartatē||43||

jāyantē vyādhayaścātaḥ ṣaḍēkādaśa vā punaḥ| yēṣāṁ saṅghātayōgēna rājayakṣmēti kathyatē||44||

kāsōṁ'satāpō vaisvaryaṁ jvaraḥ pārśvaśirōrujā| chardanaṁ raktakaphayōḥ śvāsavarcōgadō'ruciḥ||45||

rūpāṇyēkādaśaitāni yakṣmaṇaḥ ṣaḍimāni vā| kāsō jvaraḥ pārśvaśūlaṁ svaravarcōgadō'ruciḥ||46||

sarvairardhaistribhirvā'pi liṅgairmāṁsabalakṣayē| yuktō varjyaścikitsyastu sarvarūpō'pyatō'nyathā||47||

rUpaM tvasya yathoddeshaM nirdekShyAmi [1] sabheShajam||38||

yathAsvenoShmaNA pAkaM shArIrA yAnti dhAtavaH| srotasA ca yathAsvena dhAtuH puShyati dhAtutaH||39||

srotasAM sannirodhAcca raktAdInAM ca sa~gkShayAt| dhAtUShmaNAM cApacayAdrAjayakShmA pravartate||40||

tasmin kAle pacatyagniryadannaM koShThasaMshritam| malIbhavati tat prAyaH kalpate ki~jcidojase||41||

tasmAt purIShaM saMrakShyaM visheShAdrAjayakShmiNaH| sarvadhAtukShayArtasya balaM tasya hi viDbalam||42||

rasaH srotaHsu ruddheShu svasthAnastho vidahyate [2] | sa UrdhvaM kAsavegena bahurUpaH pravartate||43||

jAyante vyAdhayashcAtaH ShaDekAdasha vA punaH| yeShAM sa~gghAtayogena rAjayakShmeti kathyate||44||

kAsoM~asatApo vaisvaryaM jvaraH pArshvashirorujA| chardanaM raktakaphayoH shvAsavarcogado~aruciH||45||

rUpANyekAdashaitAni yakShmaNaH ShaDimAni vA| kAso jvaraH pArshvashUlaM svaravarcogado~aruciH||46||

sarvairardhaistribhirvA~api li~ggairmAMsabalakShaye| yukto varjyashcikitsyastu sarvarUpo~apyato~anyathA||47||

Now we will describe the pathogenesis, clinical features and management in brief.

Normally, the dhatus of the body get metabolised (being acted upon) by their own ushmas or dhatvagnis (transforming enzymes in the tissue elements). From these dhatus, (nutrient tissue elements), the other dhatus ( next dhatu to it that which receive nourishment) gets nourished through their respective srotas (channels of circulation). (For example, a poshaka rasa dhatu would nourish the rakta dhatu ).

Once, however, there is any obstruction to srotas or if there is diminution of stable tissue elements like rakta or if there is diminution of dhatu-ushmas or dhatvagnis then rajayakshma is manifested. In such a case, whatever food is digested in the gastrointestinal tract by jatharagni is mostly reduced to waste products and very little of it contributes to the formation of ojas (nourishment). The patient is depleted of all tissue elements and strength. The patient’s stool should be preserved and it is the only source of strength left with him. Because of the obstruction to the srotas, rasa dhatu becomes vidagdha (improperly metabolized) in its own location (heart) and this vitiated rasa comes out through the upper passages in different forms by way of coughing. Subsequently, six or eleven symptoms (or forms of diseases) are manifested, and their aggregation is the syndrome called rajayakshma. Cough, distress in shoulder, change of voice, fever, pain in flanks, headache, vomiting of rakta and kapha, dyspnea, diarrhea and anorexia are the eleven symptoms of rajayakshma ; or they are also six viz., cough, fever, pain in flanks, hoarseness of voice diarrhea and anorexia. With eleven, six or even three of the symptoms, a patient is incurable if he is losing mamsa (flesh tissues) and strength, but he is curable if he is behaving otherwise in spite of showing all the symptoms. [39-47]

Signs of pratishyaya

घ्राणमूले स्थितः श्लेष्मा रुधिरं पित्तमेव वा| मारुताध्मातशिरसो मारुतं श्यायते प्रति||४८||

प्रतिश्यायस्ततो घोरो जायते देहकर्शनः| तस्य रूपं शिरःशूलं गौरवं घ्राणविप्लवः||४९||

ज्वरः कासः कफोत्क्लेशः स्वरभेदोऽरुचिः क्लमः| इन्द्रियाणामसामर्थ्यं यक्ष्मा चातः [१] प्रजायते||५०||

ghrāṇamūlē sthitaḥ ślēṣmā rudhiraṁ pittamēva vā| mārutādhmātaśirasō mārutaṁ śyāyatē prati||48||

pratiśyāyastatō ghōrō jāyatē dēhakarśanaḥ| tasya rūpaṁ śiraḥśūlaṁ gauravaṁ ghrāṇaviplavaḥ||49||

jvaraḥ kāsaḥ kaphōtklēśaḥ svarabhēdō'ruciḥ klamaḥ| indriyāṇāmasāmarthyaṁ yakṣmā cātaḥ [1] prajāyatē||50||

ghrANamUle sthitaH shleShmA rudhiraM pittameva vA| mArutAdhmAtashiraso mArutaM shyAyate prati||48||

pratishyAyastato ghoro jAyate dehakarshanaH| tasya rUpaM shiraHshUlaM gauravaM ghrANaviplavaH||49||

jvaraH kAsaH kaphotkleshaH svarabhedo~aruciH klamaH| indriyANAmasAmarthyaM yakShmA cAtaH [1] prajAyate||50||

The kapha or blood or pitta located at the root of the nasal passage cause nasal catarrh in the patients whose head is afflicted with vayu. This results in severe pratishyaya (coryza) affecting entire body of the patient, This leads to emaciation of the body; its signs and symptoms are headache, heaviness in the head, loss of smell, fever, cough, increase of mucous secretion, change of voice, anorexia fatigue and asthenia of the senses and then rajayakshma manifests. [48-50]

Appearance of sputum

पिच्छिलं बहलं विस्रं हरितं श्वेतपीतकम्| कासमानो रसं यक्ष्मी निष्ठीवति [१] कफानुगम्||५१||

picchilaṁ bahalaṁ visraṁ haritaṁ śvētapītakam| kāsamānō rasaṁ yakṣmī niṣṭhīvati [1] kaphānugam||51||

picchilaM bahalaM visraM haritaM shvetapItakam| kAsamAno rasaM yakShmI niShThIvati [1] kaphAnugam||51||

Expectorates resulting from coughing (when afflicted with rajayakshma) contain slimy, thick, putrid, greenish or white-yellowish matter along with kapha. [51]

Clinical features of rajayakshma

अंसपार्श्वाभितापश्च सन्तापः करपादयोः| ज्वरः सर्वाङ्गगश्चेति लक्षणं राजयक्ष्मणः||५२||

aṁsapārśvābhitāpaśca santāpaḥ karapādayōḥ| jvaraḥ sarvāṅgagaścēti lakṣaṇaṁ rājayakṣmaṇaḥ||52||

aMsapArshvAbhitApashca santApaH [1] karapAdayoH| jvaraH sarvA~ggagashceti lakShaNaM rAjayakShmaNaH||52||

The typical characteristics of rajayakshma include a feeling of warmth (or burning sensation) in the shoulders and flanks, burning sensation in hands, and feet, and raised temperature all over the body.[52]

Swarabheda (hoarseness of voice) and characteristics as per dosha affliction

वातात्पित्तात्कफाद्रक्तात् कासवेगात् सपीनसात्| स्वरभेदो भवेद्वाताद्रूक्षः क्षामश्चलः स्वरः||५३||

तालुकण्ठपरिप्लोषः पित्ताद्वक्तुमसूयते| कफाद्भेदो विबद्धश्च स्वरः खुरखुरायते ||५४||

सन्नो रक्तविबद्धत्वात् स्वरः कृच्छ्रात् प्रवर्तते| कासातिवेगात् कषणः पीनसात्कफवातिकः||५५||

पार्श्वशूलं त्वनियतं सङ्कोचायामलक्षणम्| शिरःशूलं ससन्तापं यक्ष्मिणः स्यात्सगौरवम्||५६||

vātātpittātkaphādraktāt kāsavēgāt sapīnasāt| svarabhēdō bhavēdvātādrūkṣaḥ kṣāmaścalaḥ svaraḥ||53||

tālukaṇṭhapariplōṣaḥ pittādvaktumasūyatē| kaphādbhēdō vibaddhaśca svaraḥ khurakhurāyatē ||54||

sannō raktavibaddhatvāt svaraḥ kr̥cchrāt pravartatē| kāsātivēgāt kaṣaṇaḥ pīnasātkaphavātikaḥ||55||

pārśvaśūlaṁ tvaniyataṁ saṅkōcāyāmalakṣaṇam| śiraḥśūlaṁ sasantāpaṁ yakṣmiṇaḥ syātsagauravam||56||

vAtAtpittAtkaphAdraktAt kAsavegAt sapInasAt| svarabhedo bhavedvAtAdrUkShaH kShAmashcalaH svaraH||53||

tAlukaNThapariploShaH pittAdvaktumasUyate| kaphAdbhedo [1] vibaddhashca svaraH khurakhurAyate [2] ||54||

sanno raktavibaddhatvAt svaraH kRucchrAt pravartate| kAsAtivegAt kaShaNaH [3] pInasAtkaphavAtikaH||55||

pArshvashUlaM tvaniyataM sa~gkocAyAmalakShaNam| shiraHshUlaM sasantApaM yakShmiNaH syAtsagauravam||56||

Hoarseness of voice is engendered by morbid vata, pitta or kapha or blood or by, strain of coughing or by coryza. The voice becomes husky, feeble and unstable if caused by vata; if by pitta, there will be burning of the palate and throat and the patient will refrain from talking; and if due to kapha, the voice is low, choked and is marked with a wheezing sound; owing to the obstruction to the flow of blood, the voice becomes low and comes out with difficulty; the throat becomes injured by the strain of exorbitant coughing and in case of coryza, the characterstics of the voice resemble the condition in vata and kapha afflictions.

The rajayakshma patient is afflicted with pain in the sides of the chest (flanks) which is inconsistent and manifests during constriction and expansion of chest during breathing, with headache, burning and heaviness.[53-56]

Rakta shthivana (hemoptysis)

अभिसन्ने शरीरे तु यक्ष्मिणो विषमाशनात्| कण्ठात्प्रवर्तते रक्तं श्लेष्मा चोत्क्लिष्टसञ्चितः||५७||

abhisannē śarīrē tu yakṣmiṇō viṣamāśanāt| kaṇṭhātpravartatē raktaṁ ślēṣmā cōtkliṣṭasañcitaḥ||57||

abhisanne [1] sharIre tu yakShmiNo viShamAshanAt| kaNThAtpravartate raktaM shleShmA cotkliShTasa~jcitaH||57||

In the emaciated condition of rajayakshma patients’ indulgence in irregular diet causes expectoration of blood. The kapha too, having been vitiated, is expectorated from the throat. [57]

Causes of depletion of tissues

रक्तं विबद्धमार्गत्वान्मांसादीन्नानुपद्यते | आमाशयस्थमुत्क्लिष्टं बहुत्वात् कण्ठमेति च||५८||

वातश्लेष्मविबद्धत्वादुरसः श्वासमृच्छति| दोषैरुपहते चाग्नौ सपिच्छमतिसार्यते||५९||

raktaṁ vibaddhamārgatvānmāṁsādīnnānupadyatē | āmāśayasthamutkliṣṭaṁ bahutvāt kaṇṭhamēti ca||58||

vātaślēṣmavibaddhatvādurasaḥ śvāsamr̥cchati| dōṣairupahatē cāgnau sapicchamatisāryatē||59||

raktaM vibaddhamArgatvAnmAMsAdInnAnupadyate [2] | AmAshayasthamutkliShTaM bahutvAt kaNThameti ca||58||

vAtashleShmavibaddhatvAdurasaH shvAsamRucchati| doShairupahate cAgnau sapicchamatisAryate||59||

Owing to obstruction in the circulation, the blood does not nourish the flesh tissues and other body elements. The blood staying in the stomach, getting agitated owing to incremented quantity, passes to the throat. Due to the obstruction of vata and kapha in the chest, there occurs dyspnea and the agni, being impaired by the morbid humors, causes the patient to pass loose and slimy stools.[57-59]

Cause of anorexia

पृथग्दोषैः समस्तैर्वा जिह्वाहृदयसंश्रितैः| जायतेऽरुचिराहारे द्विष्टैरर्थैश्च मानसैः||६०||

कषायतिक्तमधुरैर्विद्यान्मुखरसैः क्रमात्| वाताद्यैररुचिं जातां मानसीं दोषदर्शनात्||६१||

pr̥thagdōṣaiḥ samastairvā jihvāhr̥dayasaṁśritaiḥ| jāyatē'rucirāhārē dviṣṭairarthaiśca mānasaiḥ||60||

kaṣāyatiktamadhurairvidyānmukharasaiḥ kramāt| vātādyairaruciṁ jātāṁ mānasīṁ dōṣadarśanāt||61||

pRuthagdoShaiH samastairvA jihvAhRudayasaMshritaiH| jAyate~arucirAhAre dviShTairarthaishca mAnasaiH||60||

kaShAyatiktamadhurairvidyAnmukharasaiH kramAt| vAtAdyairaruciM jAtAM mAnasIM doShadarshanAt||61||

Anorexia or dislike for food is caused by morbidity of one or all the three doshas in the tongue or heart or by repugnant perceptions. By knowing the astringent, bitter or sweet taste in the mouth, anorexia is to be diagnosed as caused due to dominance of vata, pitta or kapha respectively. Anorexia due to morbid perceptions is psychosomatic, caused due to visually observing disturbing or morbid visuals. [60-61]

Cause of vomiting

अरोचकात् कासवेगाद्दोषोत्क्लेशाद्भयादपि| छर्दिर्या सा विकाराणामन्येषामप्युपद्रवः||६२||

arōcakāt kāsavēgāddōṣōtklēśādbhayādapi| chardiryā sā vikārāṇāmanyēṣāmapyupadravaḥ||62||

arocakAt kAsavegAddoShotkleshAdbhayAdapi| chardiryA sA vikArANAmanyeShAmapyupadravaH||62||

Regurgitating or vomiting is caused by anorexia, bouts of coughing, and the precipitation of morbid dosha and as a result of fear; it occurs as a complication of other diseases additionally. [62]

Management of rajayakshma

सर्वस्त्रिदोषजो यक्ष्मा दोषाणां तु बलाबलम्| परीक्ष्यावस्थिकं वैद्यः शोषिणं समुपाचरेत्||६३||

प्रतिश्याये शिरःशूले कासे श्वासे स्वरक्षये| पार्श्वशूले च विविधाः क्रियाः साधारणीः शृणु||६४||

sarvastridōṣajō yakṣmā dōṣāṇāṁ tu balābalam| parīkṣyāvasthikaṁ vaidyaḥ śōṣiṇaṁ samupācarēt||63||

pratiśyāyē śiraḥśūlē kāsē śvāsē svarakṣayē| pārśvaśūlē ca vividhāḥ kriyāḥ sādhāraṇīḥ śr̥ṇu||64||

sarvastridoShajo yakShmA doShANAM tu balAbalam| parIkShyAvasthikaM vaidyaH shoShiNaM samupAcaret||63||

pratishyAye shiraHshUle kAse shvAse svarakShaye| pArshvashUle ca vividhAH kriyAH sAdhAraNIH shRuNu||64||

All types of rajayakshma are caused due to vitiated three doshas and hence the physician should treat the patient after examining the degree of intensity of the morbid dosha and the vigor of the patient. The physician should carefully observe the status (of patient) – by the symptoms such as coryza, headache, cough, dyspnea, asthenia of the voice and pain in flanks. [63-64]

Various dietary articles in treatment

पीनसे स्वेदमभ्यङ्गं धूममालेपनानि च| परिषेकावगाहांश्च यावकं [१] वाट्यमेव च||६५||

लवणाम्लकटूष्णांश्च रसान् स्नेहोपबृंहितान्| लावतित्तिरिदक्षाणां वर्तकानां च कल्पयेत्||६६||

सपिप्पलीकं सयवं सकुलत्थं सनागरम्| दाडिमामलकोपेतं स्निग्धमाजं रसं पिबेत्||६७||

तेन षड्विनिवर्तन्ते विकाराः पीनसादयः| मूलकानां कुलत्थानां यूषैर्वा सूपकल्पितैः [२] ||६८||

यवगोधूमशाल्यन्नैर्यथासात्म्यमुपाचरेत्| पिबेत्प्रसादं वारुण्या जलं वा पाञ्चमूलिकम्||६९||

धान्यनागरसिद्धं वा तामलक्याऽथवा शृतम्| पर्णिनीभिश्चतसृभिस्तेन चान्नानि कल्पयेत्||७०||

pīnasē svēdamabhyaṅgaṁ dhūmamālēpanāni ca| pariṣēkāvagāhāṁśca yāvakaṁ vāṭyamēva ca||65||

lavaṇāmlakaṭūṣṇāṁśca rasān snēhōpabr̥ṁhitān| lāvatittiridakṣāṇāṁ vartakānāṁ ca kalpayēt||66||

sapippalīkaṁ sayavaṁ sakulatthaṁ sanāgaram| dāḍimāmalakōpētaṁ snigdhamājaṁ rasaṁ pibēt||67||

tēna ṣaḍvinivartantē vikārāḥ pīnasādayaḥ| mūlakānāṁ kulatthānāṁ yūṣairvā sūpakalpitaiḥ ||68||

yavagōdhūmaśālyannairyathāsātmyamupācarēt| pibētprasādaṁ vāruṇyā jalaṁ vā pāñcamūlikam||69||

dhānyanāgarasiddhaṁ vā tāmalakyā'thavā śr̥tam| parṇinībhiścatasr̥bhistēna cānnāni kalpayēt||70||

pInase svedamabhya~ggaM dhUmamAlepanAni ca| pariShekAvagAhAMshca yAvakaM [1] vATyameva ca||65||

lavaNAmlakaTUShNAMshca rasAn snehopabRuMhitAn| lAvatittiridakShANAM vartakAnAM ca kalpayet||66||

sapippalIkaM sayavaM sakulatthaM sanAgaram| dADimAmalakopetaM snigdhamAjaM rasaM pibet||67||

tena ShaDvinivartante vikArAH pInasAdayaH| mUlakAnAM kulatthAnAM yUShairvA sUpakalpitaiH [2] ||68||

yavagodhUmashAlyannairyathAsAtmyamupAcaret| pibetprasAdaM vAruNyA jalaM vA pA~jcamUlikam||69||

dhAnyanAgarasiddhaM vA tAmalakyA~athavA shRutam| parNinIbhishcatasRubhistena cAnnAni kalpayet||70||

In coryza, sudation, inunction, smoke application, effusion, bath, cooked barley and barley gruel, meat juices of quail, partridge, chicken and vartaka quail prepared with salt, acid, pungent, sultry and unctuous articles should be given. The patient should imbibe the juice of goat-meat prepared with long pepper, barley, horse gram, dry ginger, pomegranate or emblic myrobalan and unctuous articles. By taking this, the hexad of coryza and other disorders vanishes. The patient should be treated with a suitable diet of soups made up of radish or horse gram or out of staple food composed of barley, wheat or shali rice. A potion made up of the clear supernatant part of varuni wine or water, prepared with pentaradix, or with coriander and dry ginger or with feather-foil, or with the tetrad of herbs called parnini is advised. Articles of diet may additionally be consumed with these decoctions.[65-70]

Swedana (sudation)

कृशरोत्कारिकामाषकुलत्थयवपायसैः| सङ्करस्वेदविधिना कण्ठं पार्श्वमुरः शिरः||७१||

स्वेदयेत् पत्रभङ्गेण शिरश्च परिषेचयेत्| बलागुडूचीमधुकशृतैर्वा वारिभिः सुखैः||७२||

बस्तमत्स्यशिरोभिर्वा नाडीस्वेदं प्रयोजयेत्| कण्ठे शिरसि पार्श्वे च पयोभिर्वा सवातिकैः||७३||

औदकानूपमांसानि सलिलं पाञ्चमूलिकम्| सस्नेहमारनालं वा नाडीस्वेदे प्रयोजयेत्||७४||

जीवन्त्याः शतपुष्पाया बलाया मधुकस्य च| वचाया वेशवारस्य विदार्या मूलकस्य च||७५||

औदकानूपमांसानामुपनाहाः सुसंस्कृताः| शस्यन्ते सचतुःस्नेहाः शिरःपार्श्वांसशूलिनाम्||७६||

kr̥śarōtkārikāmāṣakulatthayavapāyasaiḥ| saṅkarasvēdavidhinā kaṇṭhaṁ pārśvamuraḥ śiraḥ||71||

svēdayēt patrabhaṅgēṇa śiraśca pariṣēcayēt| balāguḍūcīmadhukaśr̥tairvā vāribhiḥ sukhaiḥ||72||

bastamatsyaśirōbhirvā nāḍīsvēdaṁ prayōjayēt| kaṇṭhē śirasi pārśvē ca payōbhirvā savātikaiḥ||73||

audakānūpamāṁsāni salilaṁ pāñcamūlikam| sasnēhamāranālaṁ vā nāḍīsvēdē prayōjayēt||74||

jīvantyāḥ śatapuṣpāyā balāyā madhukasya ca| vacāyā vēśavārasya vidāryā mūlakasya ca||75||

audakānūpamāṁsānāmupanāhāḥ susaṁskr̥tāḥ| śasyantē sacatuḥsnēhāḥ śiraḥpārśvāṁsaśūlinām||76||

kRusharotkArikAmAShakulatthayavapAyasaiH| sa~gkarasvedavidhinA kaNThaM pArshvamuraH shiraH||71||

svedayet patrabha~ggeNa shirashca pariShecayet| balAguDUcImadhukashRutairvA vAribhiH sukhaiH||72||

bastamatsyashirobhirvA nADIsvedaM prayojayet| kaNThe shirasi pArshve ca payobhirvA savAtikaiH||73||

audakAnUpamAMsAni salilaM pA~jcamUlikam| sasnehamAranAlaM vA nADIsvede prayojayet||74||

jIvantyAH shatapuShpAyA balAyA madhukasya ca| vacAyA veshavArasya vidAryA mUlakasya ca||75||

audakAnUpamAMsAnAmupanAhAH susaMskRutAH| shasyante sacatuHsnehAH shiraHpArshvAMsashUlinAm||76||

The throat, the flanks, the chest and the head regions should be made to sweat by a commixed type of lump sudation prepared using krushara (a type of gruel), utkarika (hot poultice), ebony gram, horse gram, barley and milk pudding; or the head should be effused genially with warm decoction prepared using the leaves of heart leaved sida, guduchi and liquorice; or the steam kettle sudation prepared with the decoctions of the heads of goat and fish or with vata pacifying decoctions should be utilized for sweating the throat, head and sides of the chest. The flesh of aquatic and wet land animals, the decoction of pentaradix or sour conjee with unctuous articles may be utilized in steam kettle sudation. The poultices well prepared with cork swallow wort, heart of dil seeds, leaved sida, liquorice, saccharine flag cooked meat, white yam, radish, the flesh of aquatic and wet land creatures and commixed with all the four kinds of unctuous articles should be applied to persons suffering from pain applied to persons suffering from pain in the head, side of the chest and shoulder region.[71-76]

Alepana (local applications)

शतपुष्पा समधुकं कुष्ठं तगरचन्दने| आलेपनं स्यात् सघृतं शिरःपार्श्वांसशूलनुत्||७७||

śatapuṣpā samadhukaṁ kuṣṭhaṁ tagaracandanē| ālēpanaṁ syāt saghr̥taṁ śiraḥpārśvāṁsaśūlanut||77||

shatapuShpA samadhukaM kuShThaM tagaracandane| AlepanaM syAt saghRutaM shiraHpArshvAMsashUlanut||77||

Dil, liquorice, costus, Indian valerian and sandalwood with ghee make an effective curative for pain in the head, sides of the chest and shoulder regions. [77]

बला रास्ना तिलाः सर्पिर्मधुकं नीलमुत्पलम्| पलङ्कषा देवदारु चन्दनं केशरं घृतम्||७८||

वीरा बला विदारी च कृष्णगन्धा पुनर्नवा| शतावरी पयस्या च कत्तृणं मधुकं घृतम्||७९||

चत्वार एते श्लोकार्धैः प्रदेहाः परिकीर्तिताः| शस्ताः संसृष्टदोषाणां शिरःपार्श्वांसशूलिनाम्||८०||

balā rāsnā tilāḥ sarpirmadhukaṁ nīlamutpalam| palaṅkaṣā dēvadāru candanaṁ kēśaraṁ ghr̥tam||78||

vīrā balā vidārī ca kr̥ṣṇagandhā punarnavā| śatāvarī payasyā ca kattr̥ṇaṁ madhukaṁ ghr̥tam||79||

catvāra ētē ślōkārdhaiḥ pradēhāḥ parikīrtitāḥ| śastāḥ saṁsr̥ṣṭadōṣāṇāṁ śiraḥpārśvāṁsaśūlinām||80||

balA rAsnA tilAH sarpirmadhukaM nIlamutpalam| pala~gkaShA devadAru candanaM kesharaM ghRutam||78||

vIrA balA vidArI ca kRuShNagandhA punarnavA| shatAvarI payasyA ca kattRuNaM madhukaM ghRutam||79||

catvAra ete shlokArdhaiH pradehAH parikIrtitAH| shastAH saMsRuShTadoShANAM shiraHpArshvAMsashUlinAm||80||

1. Heart leaved sida, Indian groundsel, til, ghee, liquorice and blue water-lily;
2. gum , guggulu, deodar, sandalwood, fragrant poon and ghee;
3. climbing asparagus, heart leaved sida, white yam, drumstick and hog’s weed;
4. climbing asparagus, milky yam, ginger grass, liquorice and ghee: these four groups of drugs, described one in each half verse for preparation of application are propitious in conditions of pain in the head, side of the chest and the shoulder region arising from bi-dosha discordance. [78-80]

Beneficial procedures of purification

नावनं धूमपानानि स्नेहाश्चौत्तरभक्तिकाः| तैलान्यभ्यङ्गयोगीनि [१] बस्तिकर्म तथा परम्||८१||

शृङ्गालाबुजलौकोभिः प्रदुष्टं व्यधनेन वा| शिरःपार्श्वांसशूलेषु रुधिरं तस्य निर्हरेत्||८२||

nāvanaṁ dhūmapānāni snēhāścauttarabhaktikāḥ| tailānyabhyaṅgayōgīni [1] bastikarma tathā param||81||

śr̥ṅgālābujalaukōbhiḥ praduṣṭaṁ vyadhanēna vā| śiraḥpārśvāṁsaśūlēṣu rudhiraṁ tasya nirharēt||82||

nAvanaM dhUmapAnAni snehAshcauttarabhaktikAH| tailAnyabhya~ggayogIni [1] bastikarma tathA param||81||

shRu~ggAlAbujalaukobhiH praduShTaM vyadhanena vA| shiraHpArshvAMsashUleShu rudhiraM tasya nirharet||82||

Nasal errhines, medicated smokes, post prandial unctuous potions, inunctions with medicated oils, and enemata are very useful options to help ease pain. In conditions of pain in the head, flanks and shoulder region, the vitiated blood should be depleted by betokens of the horn, bottle gourd, application of leeches or venesection.[81-82]

External applications

प्रदेहः सघृतश्चेष्टः पद्मकोशीरचन्दनैः| दूर्वामधुकमञ्जिष्ठाकेशरैर्वा घृताप्लुतैः||८३||

प्रपौण्डरीकनिर्गुण्डीपद्मकेशरमुत्पलम् [२] | कशेरुकाः पयस्या च ससर्पिष्कं प्रलेपनम्||८४||

चन्दनाद्येन तैलेन शतधौतेन सर्पिषा| अभ्यङ्गः, पयसा सेकः शस्तश्च मधुकाम्बुना||८५||

माहेन्द्रेण सुशीतेन चन्दनादिशृतेन वा| परिषेकः प्रयोक्तव्य इति संशमनी क्रिया||८६||

pradēhaḥ saghr̥taścēṣṭaḥ padmakōśīracandanaiḥ| dūrvāmadhukamañjiṣṭhākēśarairvā ghr̥tāplutaiḥ||83||

prapauṇḍarīkanirguṇḍīpadmakēśaramutpalam [2] | kaśērukāḥ payasyā ca sasarpiṣkaṁ pralēpanam||84||

candanādyēna tailēna śatadhautēna sarpiṣā| abhyaṅgaḥ, payasā sēkaḥ śastaśca madhukāmbunā||85||

māhēndrēṇa suśītēna candanādiśr̥tēna vā| pariṣēkaḥ prayōktavya iti saṁśamanī kriyā||86||

pradehaH saghRutashceShTaH padmakoshIracandanaiH| dUrvAmadhukama~jjiShThAkesharairvA ghRutAplutaiH||83||

prapauNDarIkanirguNDIpadmakesharamutpalam [2] | kasherukAH payasyA ca sasarpiShkaM pralepanam||84||

candanAdyena tailena shatadhautena sarpiShA| abhya~ggaH, payasA sekaH shastashca madhukAmbunA||85||

mAhendreNa sushItena candanAdishRutena vA| pariShekaH prayoktavya iti saMshamanI kriyA||86||

The application of Himalayan cherry, cuscus grass and sandal wood with ghee is salutary; or the application of scitch grass, liquorice, Indian madder and fragrant poon soaked in ghee; or the application composed of tubers of white lotus chaste tree, red lotus, fragrant poon, blue water lily, rushnut and milky yam with ghee. Inunction with the compound sandal oil or ghee processed for hundred times and affusion with milk or liquorice water are recommended. Effusion with cold rainwater or the sandalwood group should be given. Thus the pacification treatment has been described.. [83-86]

Indications of shodhana (purification)

दोषाधिकानां वमनं शस्यते सविरेचनम्| स्नेहस्वेदोपपन्नानां सस्नेहं यन्न कर्शनम्||८७||

शोषी मुञ्चति गात्राणि पुरीषस्रंसनादपि| अबलापेक्षिणीं मात्रां किं पुनर्यो विरिच्यते||८८||

dōṣādhikānāṁ vamanaṁ śasyatē savirēcanam| snēhasvēdōpapannānāṁ sasnēhaṁ yanna karśanam||87||

śōṣī muñcati gātrāṇi purīṣasraṁsanādapi| abalāpēkṣiṇīṁ mātrāṁ kiṁ punaryō viricyatē||88||

doShAdhikAnAM vamanaM shasyate savirecanam| snehasvedopapannAnAM sasnehaM yanna karshanam||87||

shoShI mu~jcati gAtrANi purIShasraMsanAdapi| abalApekShiNIM mAtrAM kiM punaryo viricyate||88||

In cases of excessively aggravated dosha, mild therapeutic emesis and purgation therapies after proper snehana (oleation) and swedana (sudation) which do not cause emaciation can be administered. The emaciated man (consumptive) may suffer death even on loosening of stools. Then what can be said if a strong dose of purification is given in rajayakshma patient beyond his tolerance?[87-88]

Various formulations for nasya (nasal errhines)

योगान् संशुद्धकोष्ठानां कासे श्वासे स्वरक्षये| शिरःपार्श्वांसशूलेषु सिद्धानेतान्प्रयोजयेत्||८९||

बलाविदारिगन्धाद्यैर्विदार्या [१] मधुकेन वा| सिद्धं सलवणं सर्पिर्नस्यं स्यात्स्वर्यमुत्तमम्||९०||

प्रपौण्डरीकं मधुकं पिप्पली बृहती बला| क्षीरं [२] सर्पिश्च तत्सिद्धं स्वर्यं स्यान्नावनं परम्||९१||

yōgān saṁśuddhakōṣṭhānāṁ kāsē śvāsē svarakṣayē| śiraḥpārśvāṁsaśūlēṣu siddhānētānprayōjayēt||89||

balāvidārigandhādyairvidāryā [1] madhukēna vā| siddhaṁ salavaṇaṁ sarpirnasyaṁ syātsvaryamuttamam||90||

prapauṇḍarīkaṁ madhukaṁ pippalī br̥hatī balā| kṣīraṁ [2] sarpiśca tatsiddhaṁ svaryaṁ syānnāvanaṁ param||91||

yogAn saMshuddhakoShThAnAM kAse shvAse svarakShaye| shiraHpArshvAMsashUleShu siddhAnetAnprayojayet||89||

balAvidArigandhAdyairvidAryA [1] madhukena vA| siddhaM salavaNaM sarpirnasyaM syAtsvaryamuttamam||90||

prapauNDarIkaM madhukaM pippalI bRuhatI balA| kShIraM [2] sarpishca tatsiddhaM svaryaM syAnnAvanaM param||91||

When the alimentary system is well purified, the following tested recipes should be utilized for the remedy of cough, dyspnea, loss of voice and pain in the head, sides of the chest and shoulder region:

• Ghee admixed with heart-leaved sida and tick-trefoil group of drugs or with white yam or with liquorice and salted, makes good nasal medication for the amelioration of voice.
• Ghee admixed with the tubers of white lotus, liquorice long pepper, Indian nightshade, heart leaved sida and milk is an excellent nasal medication for the amendment of the voice. [89-91]

Various unctuous formulations

शिरःपार्श्वांसशूलघ्नं कासश्वासनिबर्हणम्| प्रयुज्यमानं बहुशो घृतं चौत्तरभक्तिकम्||९२||

दशमूलेन पयसा सिद्धं मांसरसेन च| बलागर्भं घृतं सद्यो रोगानेतान् प्रबाधते||९३||

भक्तस्योपरि मध्ये वा यथाग्न्यभ्यवचारितम्| रास्नाघृतं वा सक्षीरं सक्षीरं वा बलाघृतम्||९४||

लेहान् कासापहान् स्वर्याञ् श्वासहिक्कानिबर्हणान्| शिरःपार्श्वांसशूलघ्नान् स्नेहांश्चातः परं शृणु||९५||

घृतं खर्जूरमृद्वीकाशर्कराक्षौद्रसंयुतम् [३] | सपिप्पलीकं वैस्वर्यकासश्वासज्वरापहम्||९६||

दशमूलशृतात् क्षीरात् सर्पिर्यदुदियान्नवम्| सपिप्पलीकं सक्षौद्रं तत् परं स्वरबोधनम्||९७||

शिरःपार्श्वांसशूलघ्नं कासश्वासज्वरापहम्| पञ्चभिः पञ्चमूलैर्वा शृताद्यदुदियाद्घृतम्||९८||

पञ्चानां पञ्चमूलानां रसे क्षीरचतुर्गुणे| सिद्धं सर्पिर्जयत्येतद्यक्ष्मणः सप्तकं बलम्||९९||

खर्जूरं पिप्पली द्राक्षा पथ्या शृङ्गी दुरालभा| त्रिफला पिप्पली मुस्तं शृङ्गाटगुडशर्कराः||१००||

वीरा शटी पुष्कराख्यं सुरसः शर्करा गुडः| नागरं चित्रको लाजाः पिप्पल्यामलकं गुडः||१०१||

श्लोकार्धैर्विहितानेतांल्लिह्यान्ना मधुसर्पिषा| कासश्वासापहान्स्वर्यान्पार्श्वशूलापहांस्तथा||१०२||

śiraḥpārśvāṁsaśūlaghnaṁ kāsaśvāsanibarhaṇam| prayujyamānaṁ bahuśō ghr̥taṁ cauttarabhaktikam||92||

daśamūlēna payasā siddhaṁ māṁsarasēna ca| balāgarbhaṁ ghr̥taṁ sadyō rōgānētān prabādhatē||93||

bhaktasyōpari madhyē vā yathāgnyabhyavacāritam| rāsnāghr̥taṁ vā sakṣīraṁ sakṣīraṁ vā balāghr̥tam||94||

lēhān kāsāpahān svaryāñ śvāsahikkānibarhaṇān| śiraḥpārśvāṁsaśūlaghnān snēhāṁścātaḥ paraṁ śr̥ṇu||95||

ghr̥taṁ kharjūramr̥dvīkāśarkarākṣaudrasaṁyutam [3] | sapippalīkaṁ vaisvaryakāsaśvāsajvarāpaham||96||

daśamūlaśr̥tāt kṣīrāt sarpiryadudiyānnavam| sapippalīkaṁ sakṣaudraṁ tat paraṁ svarabōdhanam||97||

śiraḥpārśvāṁsaśūlaghnaṁ kāsaśvāsajvarāpaham| pañcabhiḥ pañcamūlairvā śr̥tādyadudiyādghr̥tam||98||

pañcānāṁ pañcamūlānāṁ rasē kṣīracaturguṇē| siddhaṁ sarpirjayatyētadyakṣmaṇaḥ saptakaṁ balam||99||

kharjūraṁ pippalī drākṣā pathyā śr̥ṅgī durālabhā| triphalā pippalī mustaṁ śr̥ṅgāṭaguḍaśarkarāḥ||100||

vīrā śaṭī puṣkarākhyaṁ surasaḥ śarkarā guḍaḥ| nāgaraṁ citrakō lājāḥ pippalyāmalakaṁ guḍaḥ||101||

ślōkārdhairvihitānētāṁllihyānnā madhusarpiṣā| kāsaśvāsāpahānsvaryānpārśvaśūlāpahāṁstathā||102||

shiraHpArshvAMsashUlaghnaM kAsashvAsanibarhaNam| prayujyamAnaM bahusho ghRutaM cauttarabhaktikam||92||

dashamUlena payasA siddhaM mAMsarasena ca| balAgarbhaM ghRutaM sadyo rogAnetAn prabAdhate||93||

bhaktasyopari madhye vA yathAgnyabhyavacAritam| rAsnAghRutaM vA sakShIraM sakShIraM vA balAghRutam||94||

lehAn kAsApahAn svaryA~j shvAsahikkAnibarhaNAn| shiraHpArshvAMsashUlaghnAn snehAMshcAtaH paraM shRuNu||95||

ghRutaM kharjUramRudvIkAsharkarAkShaudrasaMyutam [3] | sapippalIkaM vaisvaryakAsashvAsajvarApaham||96||

dashamUlashRutAt kShIrAt sarpiryadudiyAnnavam| sapippalIkaM sakShaudraM tat paraM svarabodhanam||97||

shiraHpArshvAMsashUlaghnaM kAsashvAsajvarApaham| pa~jcabhiH pa~jcamUlairvA shRutAdyadudiyAdghRutam||98||

pa~jcAnAM pa~jcamUlAnAM rase kShIracaturguNe| siddhaM sarpirjayatyetadyakShmaNaH saptakaM balam||99||

kharjUraM pippalI drAkShA pathyA shRu~ggI durAlabhA| triphalA pippalI mustaM shRu~ggATaguDasharkarAH||100||

vIrA shaTI puShkarAkhyaM surasaH sharkarA guDaH| nAgaraM citrako lAjAH pippalyAmalakaM guDaH||101||

shlokArdhairvihitAnetAMllihyAnnA madhusarpiShA| kAsashvAsApahAnsvaryAnpArshvashUlApahAMstathA||102||

• The frequent utilization of ghee as a post prandial potion remedies the pain in the head, sides of the chest and shoulder region in addition to curing cough and dyspnea.
• Ghee prepared with the decoction of dashamula (group of ten roots), milk, meat juice and the pulp of heart leaved sida is a quick remedy for all these disorders.
• The Indian groundsell ghee should be administered with milk or heart-leaved sida ghee or should be administered with milk (in the above complaints) either after or during the course of meals, in a dose considering the agni of the patient.
• Listen hereafter the description of the linctuses and unctuous preparations that are curative of cough, improving quality of voice, dyspnea, hiccup and pain in the head, flanks and shoulder region. Ghee prepared of dates and grapes and commixed with sugar, honey and long pepper is curative of hoarseness of voice, cough, dyspnea and fever.
• Fresh ghee prepared from the milk in which the dashamula ( group of ten roots) has been decocted and commixed with long pepper and honey, is an excellent tonic for the voice, is curative of pain in the head, sides of the chest and shoulder region, and remedies cough, dyspnea and fever.
• Another effective remedy is fresh ghee prepared from the milk in which have been decocted the roots of all the five varieties of panchamula. The ghee, prepared in the decoction of all the five varieties of panchamula with four times its quantity of milk, subdues the rigor of the syndrome of seven of the key symptoms of rajayakshma.
• Dates, long pepper, grapes, chebulic myrobalans, galls, and cretan prickly clover ; (2) the three myrobalans , long pepper, nut-grass, Indian water-chestnut, gur and sugar; (3) climbing asparagus, zedoary orris root, holy basils, sugar and gur; (4) dry ginger, white-flowered leadwort roasted paddy, long pepper, emblic myrobalan and gur: of any of these groups of drugs mentioned in each of the hemistichs, a lincture may be made and taken with honey and ghee. They are curative of cough, dyspnea and pain in flanks, and as voice-tonics.[92-102]

Sitopaladi formulation

सितोपलां तुगाक्षीरीं पिप्पलीं बहुलां त्वचम्| अन्त्यादूर्ध्वं द्विगुणितं लेहयेन्मधुसर्पिषा||१०३||

चूर्णितं प्राशयेद्वा तच्छ्वासकासकफातुरम् [१] | सुप्तजिह्वारोचकिनमल्पाग्निं पार्श्वशूलिनम्||१०४||

sitōpalāṁ tugākṣīrīṁ pippalīṁ bahulāṁ tvacam| antyādūrdhvaṁ dviguṇitaṁ lēhayēnmadhusarpiṣā||103||

cūrṇitaṁ prāśayēdvā tacchvāsakāsakaphāturam [1] | suptajihvārōcakinamalpāgniṁ pārśvaśūlinam||104||

sitopalAM tugAkShIrIM pippalIM bahulAM tvacam| antyAdUrdhvaM dviguNitaM lehayenmadhusarpiShA||103||

cUrNitaM prAshayedvA tacchvAsakAsakaphAturam [1] | suptajihvArocakinamalpAgniM pArshvashUlinam||104||

Sugar candy, bamboo manna, long pepper, cardamom and cinnamon - each taken in double the quantity of the preceding one (in the order mentioned here) should be ground into a powder and admixed with honey and ghee, and administered as a lincture; or the powder may be taken by itself. This remedies dyspnea, cough and excess of kapha. It can be given to the patients suffering from anesthesia of tongue, anorexia, poor digestive fire and pleurodynia.[103-104]

Vasa ghee and shatavari ghee

हस्तपादाङ्गदाहेषु ज्वरे रक्ते तथोर्ध्वगे| वासाघृतं शतावर्या सिद्धं वा परमं हितम्||१०५||

hastapādāṅgadāhēṣu jvarē raktē tathōrdhvagē| vāsāghr̥taṁ śatāvaryā siddhaṁ vā paramaṁ hitam||105||

hastapAdA~ggadAheShu jvare rakte tathordhvage| vAsAghRutaM shatAvaryA siddhaM vA paramaM hitam||105||

In cases of burning sensations in the hands, feet and limbs, fever and hemorrhage from the upper orifices of the body, vasa ghee or shatavari ghee proves very beneficial.[105]

Duralabhadi ghee

दुरालभां श्वदंष्ट्रां च चतस्रः पर्णिनीर्बलाम्| भागान्पलोन्मितान् कृत्वा पलं पर्पटकस्य च||१०६||

पचेद्दशगुणे तोये दशभागावशेषिते| रसे सुपूते द्रव्याणामेषां कल्कान् समावपेत्||१०७||

शट्याः पुष्करमूलस्य पिप्पलीत्रायमाणयोः| तामलक्याः किरातानां तिक्तस्य कुटजस्य च||१०८||

फलानां सारिवायाश्च सुपिष्टान् कर्षसम्मितान्| ततस्तेन घृतप्रस्थं क्षीरद्विगुणितं पचेत्||१०९||

ज्वरं दाहं भ्रमं कासमंसपार्श्वशिरोरुजम्| तृष्णां छर्दिमतीसारमेतत् सर्पिर्व्यपोहति||११०||

durālabhāṁ śvadaṁṣṭrāṁ ca catasraḥ parṇinīrbalām| bhāgānpalōnmitān kr̥tvā palaṁ parpaṭakasya ca||106||

pacēddaśaguṇē tōyē daśabhāgāvaśēṣitē| rasē supūtē dravyāṇāmēṣāṁ kalkān samāvapēt||107||

śaṭyāḥ puṣkaramūlasya pippalītrāyamāṇayōḥ| tāmalakyāḥ kirātānāṁ tiktasya kuṭajasya ca||108||

phalānāṁ sārivāyāśca supiṣṭān karṣasammitān| tatastēna ghr̥taprasthaṁ kṣīradviguṇitaṁ pacēt||109||

jvaraṁ dāhaṁ bhramaṁ kāsamaṁsapārśvaśirōrujam| tr̥ṣṇāṁ chardimatīsāramētat sarpirvyapōhati||110||

durAlabhAM shvadaMShTrAM ca catasraH parNinIrbalAm| bhAgAnpalonmitAn kRutvA palaM parpaTakasya ca||106||

paceddashaguNe toye dashabhAgAvasheShite| rase supUte dravyANAmeShAM kalkAn samAvapet||107||

shaTyAH puShkaramUlasya pippalItrAyamANayoH| tAmalakyAH kirAtAnAM tiktasya kuTajasya ca||108||

phalAnAM sArivAyAshca supiShTAn karShasammitAn| tatastena ghRutaprasthaM kShIradviguNitaM pacet||109||

jvaraM dAhaM bhramaM kAsamaMsapArshvashirorujam| tRuShNAM chardimatIsArametat sarpirvyapohati||110||

Decoct 48 gram each of cretan prickly clover, diminutive caltrops, and the tetrad of the drugs called parnini, sida and trailing rungia, in ten times the quantity of water. When it is reduced to one tenth of its quantity, the solution should be filtered and a medicated ghee should be prepared by mixing these into a solution along with the paste of one tola each of zedoary, orris root, long pepper, zalil, feather foil, chiretta, kurchi seeds, and Indian sarsaparilla and 64 tolas of ghee and double this quantity of milk. This ghee is effective in healing fever, burning sensations, giddiness, cough, headache, pain in flanks and shoulder region, thirst, regurgitating and diarrhea. [106-110]

Jivantyadi ghee

जीवन्तीं मधुकं द्राक्षां फलानि कुटजस्य च| शटीं पुष्करमूलं च व्याघ्रीं गोक्षुरकं बलाम्||१११||

नीलोत्पलं तामलकीं त्रायमाणां दुरालभाम्| पिप्पलीं च समं पिष्ट्वा घृतं वैद्यो विपाचयेत्||११२||

एतद्व्याधिसमूहस्य रोगेशस्य समुत्थितम्| रूपमेकादशविधं सर्पिरग्र्यं व्यपोहति||११३||

jīvantīṁ madhukaṁ drākṣāṁ phalāni kuṭajasya ca| śaṭīṁ puṣkaramūlaṁ ca vyāghrīṁ gōkṣurakaṁ balām||111||

nīlōtpalaṁ tāmalakīṁ trāyamāṇāṁ durālabhām| pippalīṁ ca samaṁ piṣṭvā ghr̥taṁ vaidyō vipācayēt||112||

ētadvyādhisamūhasya rōgēśasya samutthitam| rūpamēkādaśavidhaṁ sarpiragryaṁ vyapōhati||113||

jIvantIM madhukaM drAkShAM phalAni kuTajasya ca| shaTIM puShkaramUlaM ca vyAghrIM gokShurakaM balAm||111||

nIlotpalaM tAmalakIM trAyamANAM durAlabhAm| pippalIM ca samaM piShTvA ghRutaM vaidyo vipAcayet||112||

etadvyAdhisamUhasya rogeshasya samutthitam| rUpamekAdashavidhaM sarpiragryaM vyapohati||113||

The physician may prepare a medicated ghee by integrating pastes of equal quantities of cork swallow-wort, liquorice, grape, kurchi seeds, zedoary, orris roots, Indian night- shade, diminutive caltrops, heart leaved sida, blue water-lily, feature foil, zalil, cretan prickly clover and long pepper. This excellent medicated ghee remedies the eleven symptoms of rajayakshma.[111-113]

Baladi medicated milk

बलां स्थिरां पृश्निपर्णीं बृहतीं सनिदिग्धिकाम्| साधयित्वा रसे तस्मिन्पयो गव्यं सनागरम्||११४||

द्राक्षाखर्जूरसर्पिर्भिः पिप्पल्या च शृतं सह| सक्षौद्रं ज्वरकासघ्नं स्वर्यं चैतत् प्रयोजयेत्||११५||

आजस्य पयसश्चैवं प्रयोगो जाङ्गला रसाः| यूषार्थे चणका मुद्गा मकुष्ठाश्चोपकल्पिताः||११६||

balāṁ sthirāṁ pr̥śniparṇīṁ br̥hatīṁ sanidigdhikām| sādhayitvā rasē tasminpayō gavyaṁ sanāgaram||114||

drākṣākharjūrasarpirbhiḥ pippalyā ca śr̥taṁ saha| sakṣaudraṁ jvarakāsaghnaṁ svaryaṁ caitat prayōjayēt||115||

ājasya payasaścaivaṁ prayōgō jāṅgalā rasāḥ| yūṣārthē caṇakā mudgā makuṣṭhāścōpakalpitāḥ||116||

balAM sthirAM pRushniparNIM bRuhatIM sanidigdhikAm| sAdhayitvA rase tasminpayo gavyaM sanAgaram||114||

drAkShAkharjUrasarpirbhiH pippalyA ca shRutaM saha| sakShaudraM jvarakAsaghnaM svaryaM caitat prayojayet||115||

Ajasya payasashcaivaM prayogo jA~ggalA rasAH| yUShArthe caNakA mudgA makuShThAshcopakalpitAH||116||

Decoct in water the heart-leaved sida tick-trefoil, painted leaved uraria and yellow berried night- shade and prepare a medicated ghee by integrating to this decoction cow’s milk, the pulp of dry ginger, dates, ghee and long pepper. This milk, taken with honey, remedies fever and cough and amends the voice.

Similarly, goat’s milk along with the meat-juice of jungala animals and chick pea, green gram and math gram, prepared in the form of soup, may additionally be utilized as wholesome diet.[114-116]

Treatment of burning sensation

ज्वराणां शमनीयो यः पूर्वमुक्तः क्रियाविधिः| यक्ष्मिणां ज्वरदाहेषु ससर्पिष्कः प्रशस्यते||११७||

jvarāṇāṁ śamanīyō yaḥ pūrvamuktaḥ kriyāvidhiḥ| yakṣmiṇāṁ jvaradāhēṣu sasarpiṣkaḥ praśasyatē||117||

jvarANAM shamanIyo yaH pUrvamuktaH kriyAvidhiH| yakShmiNAM jvaradAheShu sasarpiShkaH prashasyate||117||

Medicinal pacification measures described earlier (in Jwara Chikitsa) are employed with ghee for the treatment of fever and burning sensations in the cases of patients suffering from rajayakshma. [117]

Treatment of productive cough/excessive expectoration and vomiting

कफप्रसेके बलवाञ् श्लैष्मिकश्छर्दयेन्नरः| पयसा फलयुक्तेन माधुकेन [१] रसेन वा||११८|| सर्पिष्मत्या यवाग्वा वा वमनीयोपसिद्धया| वान्तोऽन्नकाले लघ्वन्नमाददीत सदीपनम्||११९|| यवगोधूममाध्वीकसिध्वरिष्टसुरासवान्| जाङ्गलानि च शूल्यानि सेवमानः कफं जयेत्||१२०|| श्लेष्मणोऽतिप्रसेकेन वायुः श्लेष्माणमस्यति| कफप्रसेकं तं विद्वान् स्निग्धोष्णेनैव निर्जयेत्||१२१|| क्रिया कफप्रसेके या वम्यां सैव प्रशस्यते| हृद्यानि चान्नपानानि वातघ्नानि लघूनि च||१२२|| kaphaprasēkē balavāñ ślaiṣmikaśchardayēnnaraḥ| payasā phalayuktēna mādhukēna [1] rasēna vā||118|| sarpiṣmatyā yavāgvā vā vamanīyōpasiddhayā| vāntō'nnakālē laghvannamādadīta sadīpanam||119|| yavagōdhūmamādhvīkasidhvariṣṭasurāsavān| jāṅgalāni ca śūlyāni sēvamānaḥ kaphaṁ jayēt||120|| ślēṣmaṇō'tiprasēkēna vāyuḥ ślēṣmāṇamasyati| kaphaprasēkaṁ taṁ vidvān snigdhōṣṇēnaiva nirjayēt||121|| kriyā kaphaprasēkē yā vamyāṁ saiva praśasyatē| hr̥dyāni cānnapānāni vātaghnāni laghūni ca||122|| kaphapraseke balavA~j shlaiShmikashchardayennaraH| payasA phalayuktena mAdhukena [1] rasena vA||118|| sarpiShmatyA yavAgvA vA vamanIyopasiddhayA| vAnto~annakAle laghvannamAdadIta sadIpanam||119|| yavagodhUmamAdhvIkasidhvariShTasurAsavAn| jA~ggalAni ca shUlyAni sevamAnaH kaphaM jayet||120|| shleShmaNo~atiprasekena vAyuH shleShmANamasyati| kaphaprasekaM taM vidvAn snigdhoShNenaiva nirjayet||121|| kriyA kaphapraseke yA vamyAM saiva prashasyate| hRudyAni cAnnapAnAni vAtaghnAni laghUni ca||122|| In cases of excessive expectoration of phlegm in a strong patient and kapha dominant condition, he should be treated with emesis by a draught of milk mixed with emetic nut or with liquorice decoction mixed with emetic nut, or gruel prepared with emetic drugs and mixed with ghee. And after proper emesis, light diet along with digestive stimulants should be given in meals. The person who is taking the diet consisting of barley and wheat, honey wine, sidhu wine, medicated wine and the spit roasted meat of animals of arid habitat will subdue his kapha dosha. When there is excessive formation of phlegm, the vata expels this phlegm out of the body. This type of excessive phlegm expectoration should be treated with unctuous and hot medications. This line of treatment for excess expectoration is also recommended for vomiting. A diet consisting of food and beverages that are hrudya ( liked by mind), alleviate vata and light to digest are advised. [118-122]

Treatment of diarrhea

प्रायेणोपहताग्नित्वात् सपिच्छमतिसार्यते| प्राप्नोति चास्यवैरस्यं न चान्नमभिनन्दति||१२३|| तस्याग्निदीपनान् योगानतीसारनिबर्हणान्| वक्त्रशुद्धिकरान् कुर्यादरुचिप्रतिबाधकान्||१२४|| सनागरानिन्द्रयवान् पाययेत्तण्डुलाम्बुना| सिद्धां यवागूं जीर्णे च चाङ्गेरीतक्रदाडिमैः||१२५|| पाठा बिल्वं यमानी च पातव्यं तक्रसंयुतम्| दुरालभा शृङ्गवेरं पाठा च सुरया सह||१२६|| जम्ब्वाम्रमध्यं बिल्वं च सकपित्थं सनागरम्| पेयामण्डेन पातव्यमतीसारनिवृत्तये||१२७|| एतानेव च योगांस्त्रीन् पाठादीन् कारयेत् खडान्| ससूप्यधान्यान्सस्नेहान् [२] साम्लान्सङ्ग्रहणान् परम्||१२८|| वेतसार्जुनजम्बूनां मृणालीकृष्णगन्धयोः| श्रीपर्ण्या मदयन्त्याश्च यूथिकायाश्च पल्लवान्||१२९|| मातुलुङ्गस्य धातक्या दाडिमस्य च कारयेत्| स्नेहाम्ललवणोपेतान् खडान् साङ्ग्राहिकान् परम्||१३०|| चाङ्गेर्याश्चुक्रिकायाश्च दुग्धिकायाश्च कारयेत्| खडान्दधिसरोपेतान् ससर्पिष्कान्सदाडिमान्||१३१|| मांसानां लघुपाकानां रसाः साङ्ग्राहिकैर्युताः| व्यञ्जनार्थं प्रशस्यन्ते भोज्यार्थं रक्तशालयः||१३२|| स्थिरादिपञ्चमूलेन पाने शस्तं शृतं जलम्| तक्रं सुरा सचुक्रीका दाडिमस्याथवा रसः||१३३|| इत्युक्तं भिन्नशकृतां दीपनं ग्राहि भेषजम्|१३४| prāyēṇōpahatāgnitvāt sapicchamatisāryatē| prāpnōti cāsyavairasyaṁ na cānnamabhinandati||123|| tasyāgnidīpanān yōgānatīsāranibarhaṇān| vaktraśuddhikarān kuryādarucipratibādhakān||124|| sanāgarānindrayavān pāyayēttaṇḍulāmbunā| siddhāṁ yavāgūṁ jīrṇē ca cāṅgērītakradāḍimaiḥ||125|| pāṭhā bilvaṁ yamānī ca pātavyaṁ takrasaṁyutam| durālabhā śr̥ṅgavēraṁ pāṭhā ca surayā saha||126|| jambvāmramadhyaṁ bilvaṁ ca sakapitthaṁ sanāgaram| pēyāmaṇḍēna pātavyamatīsāranivr̥ttayē||127|| ētānēva ca yōgāṁstrīn pāṭhādīn kārayēt khaḍān| sasūpyadhānyānsasnēhān sāmlānsaṅgrahaṇān param||128|| vētasārjunajambūnāṁ mr̥ṇālīkr̥ṣṇagandhayōḥ| śrīparṇyā madayantyāśca yūthikāyāśca pallavān||129|| mātuluṅgasya dhātakyā dāḍimasya ca kārayēt| snēhāmlalavaṇōpētān khaḍān sāṅgrāhikān param||130|| cāṅgēryāścukrikāyāśca dugdhikāyāśca kārayēt| khaḍāndadhisarōpētān sasarpiṣkānsadāḍimān||131|| māṁsānāṁ laghupākānāṁ rasāḥ sāṅgrāhikairyutāḥ| vyañjanārthaṁ praśasyantē bhōjyārthaṁ raktaśālayaḥ||132|| sthirādipañcamūlēna pānē śastaṁ śr̥taṁ jalam| takraṁ surā sacukrīkā dāḍimasyāthavā rasaḥ||133|| ityuktaṁ bhinnaśakr̥tāṁ dīpanaṁ grāhi bhēṣajam|134| prAyeNopahatAgnitvAt sapicchamatisAryate| prApnoti cAsyavairasyaM na cAnnamabhinandati||123|| tasyAgnidIpanAn yogAnatIsAranibarhaNAn| vaktrashuddhikarAn kuryAdarucipratibAdhakAn||124|| sanAgarAnindrayavAn pAyayettaNDulAmbunA| siddhAM yavAgUM jIrNe ca cA~ggerItakradADimaiH||125|| pAThA bilvaM yamAnI ca pAtavyaM takrasaMyutam| durAlabhA shRu~ggaveraM pAThA ca surayA saha||126|| jambvAmramadhyaM bilvaM ca sakapitthaM sanAgaram| peyAmaNDena pAtavyamatIsAranivRuttaye||127|| etAneva ca yogAMstrIn pAThAdIn kArayet khaDAn| sasUpyadhAnyAnsasnehAn [2] sAmlAnsa~ggrahaNAn param||128|| vetasArjunajambUnAM mRuNAlIkRuShNagandhayoH| shrIparNyA madayantyAshca yUthikAyAshca pallavAn||129|| mAtulu~ggasya dhAtakyA dADimasya ca kArayet| snehAmlalavaNopetAn khaDAn sA~ggrAhikAn param||130|| cA~ggeryAshcukrikAyAshca dugdhikAyAshca kArayet| khaDAndadhisaropetAn sasarpiShkAnsadADimAn||131|| mAMsAnAM laghupAkAnAM rasAH sA~ggrAhikairyutAH| vya~jjanArthaM prashasyante bhojyArthaM raktashAlayaH||132|| sthirAdipa~jcamUlena pAne shastaM shRutaM jalam| takraM surA sacukrIkA dADimasyAthavA rasaH||133|| ityuktaM bhinnashakRutAM dIpanaM grAhi bheShajam|134| • Due to the impairement of agni, diarrhea accompanied with mucus occurs in patients of rajayakshma. Further distaste in the mouth (asyavairasya) and aversion towards food occurs. The following recipes to stimulate digestion, treat diarrhea, cleanse up mouth to enhance taste and counteract anorexia are described. Indrayava (Wrightia tinctoria) with nagara (zingiber officinale) admixed with tandulambu (rice water), and yavagu (thick gruel) cooked along with Cchangeri (Oxalis corniculata), butter-milk, and pomegranate (punica granatum) • Potion made up of patha (Cyclea peltata), bilva (Agele Marmelos), and yavani (Carum copticum) mixed with buttermilk. • Duralabha (Fagonia cretica), sringavera (Zingiber officinale), and patha (Cyclea peltata) taken along with sura (wine). • Pulp of the seeds of jambu (Syzygium cumini) and amra (Mangifera Indica), bilva (Aegle marmelos), kapittha (limonia acidissima) and nagara (zingiber officinale) mixed with manda of peya (i.e. cream of a thin gruel) • The last two recipes could also be prepared in the form of khada (a type of sour drink) by adding fats, sour ingredients, and pulses. These are also very effective recipes to cure diarhoea. Some of the recipes for preparing khada include: • Mixing the leaves of vetasa (Garcinia pedunculata), arjuna (Terminalia arjuna), jambu (Syzygium cumini), mrinali, krishnagandha, sriparni (Gmelina arborea), madayanti (Lawsonia inermis), and yuthika (Jasminum auriculatum) mixed with matulunga (Citrus medica), dhataki (Woodfordia fruticosa), dadima (Punica granatum), fats, sour ingredients, and salt. • Changeri (Oxalis corniculata), chukrika (Rumex vesicarius), and dugdhika (Euphorbia thymifolia) mixed with cream of curd, ghee, and dadima (Punica granatum) • Soups of different types of meat (light to digest), mixed with astringent ingredients, consumed with shali rice - are effective remedies for counteracting diarhoea. • Water boiled with laghupanchamula (shalaparni, prishnaparni (Uraria picta), brihati (Solanum indicum), kantakari (Solanum xanthocarpum) and goksura (Tribulus terrestris), butter, sura, chukrika (Rumex vesicarius) and the juice of dadima (Punica granatum) makes for an excellent digestive stimulant and grahi (constipative) for patients of tuberculosis suffering from bouts of diarhoea [123-134]

Formulations for treatment of anorexia

परं मुखस्य वैरस्यनाशनं रोचनं शृणु [३] ||१३४|| द्वौ कालौ दन्तपवनं भक्षयेन्मुखधावनम्| तद्वत् प्रक्षालयेदास्यं धारयेत् कवलग्रहान्||१३५|| पिबेद्धूमं ततो मृष्टमद्याद्दीपनपाचनम्| भेषजं पानमन्नं च हितमिष्टोपकल्पितम्||१३६|| त्वङ्मुस्तमेला धान्यानि मुस्तमामलकं त्वचम्| दार्वीत्वचो यवानी च तेजोह्वा पिप्पली तथा||१३७|| यवानी तिन्तिडीकं च पञ्चैते मुखधावनाः| श्लोकपादेष्वभिहिता रोचना मुखशोधनाः||१३८|| गुटिकां धारयेदास्ये चूर्णैर्वा शोधयेन्मुखम्| एषामालोडितानां वा धारयेत् कवलग्रहान्||१३९|| सुरामाध्वीकसीधूनां तैलस्य मधुसर्पिषोः| कवलान् धारयेदिष्टान् क्षीरस्येक्षुरसस्य च||१४०|| paraṁ mukhasya vairasyanāśanaṁ rōcanaṁ śr̥ṇu [3] ||134|| dvau kālau dantapavanaṁ bhakṣayēnmukhadhāvanam| tadvat prakṣālayēdāsyaṁ dhārayēt kavalagrahān||135|| pibēddhūmaṁ tatō mr̥ṣṭamadyāddīpanapācanam| bhēṣajaṁ pānamannaṁ ca hitamiṣṭōpakalpitam||136|| tvaṅmustamēlā dhānyāni mustamāmalakaṁ tvacam| dārvītvacō yavānī ca tējōhvā pippalī tathā||137|| yavānī tintiḍīkaṁ ca pañcaitē mukhadhāvanāḥ| ślōkapādēṣvabhihitā rōcanā mukhaśōdhanāḥ||138|| guṭikāṁ dhārayēdāsyē cūrṇairvā śōdhayēnmukham| ēṣāmālōḍitānāṁ vā dhārayēt kavalagrahān||139|| surāmādhvīkasīdhūnāṁ tailasya madhusarpiṣōḥ| kavalān dhārayēdiṣṭān kṣīrasyēkṣurasasya ca||140|| paraM mukhasya vairasyanAshanaM rocanaM shRuNu [3] ||134|| dvau kAlau dantapavanaM bhakShayenmukhadhAvanam| tadvat prakShAlayedAsyaM dhArayet kavalagrahAn||135|| pibeddhUmaM tato mRuShTamadyAddIpanapAcanam| bheShajaM pAnamannaM ca hitamiShTopakalpitam||136|| tva~gmustamelA dhAnyAni mustamAmalakaM tvacam| dArvItvaco yavAnI ca tejohvA pippalI tathA||137|| yavAnI tintiDIkaM ca pa~jcaite mukhadhAvanAH| shlokapAdeShvabhihitA rocanA mukhashodhanAH||138|| guTikAM dhArayedAsye cUrNairvA shodhayenmukham| eShAmAloDitAnAM vA dhArayet kavalagrahAn||139|| surAmAdhvIkasIdhUnAM tailasya madhusarpiShoH| kavalAn dhArayediShTAn kShIrasyekShurasasya ca||140|| Now, hear this description of remedies for the removal of distaste in the mouth and for enhancing appetite. These are as follows: • Tooth-twigs should be used twice a day for brushing one’s teeth and then use mukhadhavana (drugs chewed for alleviating vitiated doshas in the mouth). • Wash the mouth and use kavala graha (keeping mouthful of medicinal preparations in a thin paste form in the oral cavity), and • Smoke medicated cigars and, thereafter, take digestive stimulant drugs, and wholesome food, and drinks. The recipe for mukhadhavana are: • Cinnamon, nut-grass, cardamom and coriander; (2) nut- grass, emblic myrobalan and cinnamon; (3) Indian berberry and cinnamon; (4) Indian tooth-ache tree and long pepper; (5) bishop’s weed and tamarind- these five groups of mouth washes mentioned one in each quarter verse, act as taste stimulant and relish-givers and mouth- cleansers. • Pills prepared of these may be kept in the mouth; or the mouth may be cleansed with these powders; or a mouthful of water commixed with these powders may be kept for a time in the mouth. • Mouthfuls of sura, madhvika or sidhu wines, oil, honey ghee, milk or sugar-cane juice may be utilized as found beneficial. [134-140]

Yavani shadava formulation

यवानीं तिन्तिडीकं च नागरं साम्लवेतसम्| दाडिमं बदरं चाम्लं कार्षिकं चोपकल्पयेत्||१४१|| धान्यसौवर्चलाजाजीवराङ्गं चार्धकार्षिकम्| पिप्पलीनां शतं चैकं द्वे शते मरिचस्य च||१४२|| शर्करायाश्च चत्वारि पलान्येकत्र चूर्णयेत्| जिह्वाविशोधनं हृद्यं तच्चूर्णं भक्तरोचनम्||१४३|| हृत्प्लीहपार्श्वशूलघ्नं विबन्धानाहनाशनम्| कासश्वासहरं ग्राहि ग्रहण्यर्शोविकारनुत्||१४४|| इति यवानीषाडवम् yavānīṁ tintiḍīkaṁ ca nāgaraṁ sāmlavētasam| dāḍimaṁ badaraṁ cāmlaṁ kārṣikaṁ cōpakalpayēt||141|| dhānyasauvarcalājājīvarāṅgaṁ cārdhakārṣikam| pippalīnāṁ śataṁ caikaṁ dvē śatē maricasya ca||142|| śarkarāyāśca catvāri palānyēkatra cūrṇayēt| jihvāviśōdhanaṁ hr̥dyaṁ taccūrṇaṁ bhaktarōcanam||143|| hr̥tplīhapārśvaśūlaghnaṁ vibandhānāhanāśanam| kāsaśvāsaharaṁ grāhi grahaṇyarśōvikāranut||144|| iti yavānīṣāḍavam yavAnIM tintiDIkaM ca nAgaraM sAmlavetasam| dADimaM badaraM cAmlaM kArShikaM copakalpayet||141|| dhAnyasauvarcalAjAjIvarA~ggaM cArdhakArShikam| pippalInAM shataM caikaM dve shate maricasya ca||142|| sharkarAyAshca catvAri palAnyekatra cUrNayet| jihvAvishodhanaM hRudyaM taccUrNaM bhaktarocanam||143|| hRutplIhapArshvashUlaghnaM vibandhAnAhanAshanam| kAsashvAsaharaM grAhi grahaNyarshovikAranut||144|| iti yavAnIShADavam Bishop’s weed, tamarind, dry ginger, country sorrel, pomegranate, sour jujube - take one tola each of these and half tolas of coriander, rock-salt, cumin seeds, cinnamon, one hundred pieces of long pepper, 200 ebony pepper grains and 16 tolas of sugar: all these should be powdered and commixed together. This powder is tongue-detergent, cordial, and refreshing, curative of pain in the stomach, splenic region and flanks, and remedies constipation, tympanitis, cough and dyspnoea. It is an astringent and is curative of assimilative disorders and hemorhoids. Thus has been described the shadava preparation of bishop’s weed. [141-144]

Talisadi formulation

तालीशपत्रं मरिचं नागरं पिप्पली शुभा| यथोत्तरं भागवृद्ध्या त्वगेले चार्धभागिके||१४५|| पिप्पल्यष्टगुणा चात्र प्रदेया सितशर्करा| कासश्वासारुचिहरं तच्चूर्णं दीपनं परम्||१४६|| हृत्पाण्डुग्रहणीदोषशोषप्लीहज्वरापहम्| वम्यतीसारशूलघ्नं मूढवातानुलोमनम्||१४७|| कल्पयेद्गुटिकां चैतच्चूर्णं पक्त्वा सितोपलाम्| गुटिका ह्यग्निसंयोगाच्चूर्णाल्लघुतराः स्मृताः||१४८|| इति तालीशाद्यं चूर्णं गुटिकाश्च tālīśapatraṁ maricaṁ nāgaraṁ pippalī śubhā| yathōttaraṁ bhāgavr̥ddhyā tvagēlē cārdhabhāgikē||145|| pippalyaṣṭaguṇā cātra pradēyā sitaśarkarā| kāsaśvāsāruciharaṁ taccūrṇaṁ dīpanaṁ param||146|| hr̥tpāṇḍugrahaṇīdōṣaśōṣaplīhajvarāpaham| vamyatīsāraśūlaghnaṁ mūḍhavātānulōmanam||147|| kalpayēdguṭikāṁ caitaccūrṇaṁ paktvā sitōpalām| guṭikā hyagnisaṁyōgāccūrṇāllaghutarāḥ smr̥tāḥ||148|| iti tālīśādyaṁ cūrṇaṁ guṭikāśca tAlIshapatraM maricaM nAgaraM pippalI shubhA| yathottaraM bhAgavRuddhyA tvagele cArdhabhAgike||145|| pippalyaShTaguNA cAtra pradeyA sitasharkarA| kAsashvAsAruciharaM taccUrNaM dIpanaM param||146|| hRutpANDugrahaNIdoShashoShaplIhajvarApaham| vamyatIsArashUlaghnaM mUDhavAtAnulomanam||147|| kalpayedguTikAM caitaccUrNaM paktvA sitopalAm| guTikA hyagnisaMyogAccUrNAllaghutarAH smRutAH||148|| iti tAlIshAdyaM cUrNaM guTikAshca Take Himalayan silver fir, ebony pepper, dry ginger and long pepper and in proportions of 1,2,3 and 4 chunks/pieces respectively; cinnamon and cardamom in the proportion of ½ part each and white sugar eight times the quantity of long pepper (32 components). This powder is curative of cough, dyspnoea and anorexia and is an excellent digestive stimulant, alleviative of stomach disorders anaemia, assimilation disorders, rajayakshma, splenic disorders, fever, regurgitating, diarrhea, colic and alleviate aggravated vata. Pills can also be prepared from this formulation after processing it with sugar water on fire. The pills are light to digest because of they are processed on fire. [145-148]

Importance of meat in emaciation

शुष्यतां क्षीणमांसानां कल्पितानि विधानवित्| दद्यान्मांसादमांसानि बृंहणानि विशेषतः||१४९|| शोषिणे बार्हिणं दद्याद्बर्हिशब्देन चापरान्| गृध्रानुलूकांश्चाषांश्च विधिवत् सूपकल्पितान्||१५०|| काकांस्तित्तिरिशब्देन वर्मिशब्देन चोरगान्| भृष्टान् मत्स्यान्त्रशब्देन दद्याद्गण्डूपदानपि||१५१|| लोपाकान् स्थूलनकुलान् बिडालांश्चोपकल्पितान्| शृगालशावांश्च भिषक् शशशब्देन दापयेत्||१५२|| सिंहानृक्षांस्तरक्षूंश्च व्याघ्रानेवंविधांस्तथा| मांसादान् मृगशब्देन दद्यान्मांसाभिवृद्धये||१५३|| गजखड्गितुरङ्गाणां वेशवारीकृतं भिषक्| दद्यान्महिषशब्देन मांसं मांसाभिवृद्धये||१५४|| मांसेनोपचिताङ्गानां मांसं मांसकरं परम्| तीक्ष्णोष्णलाघवाच्छस्तं विशेषान्मृगपक्षिणाम्||१५५||

śuṣyatāṁ kṣīṇamāṁsānāṁ kalpitāni vidhānavit| dadyānmāṁsādamāṁsāni br̥ṁhaṇāni viśēṣataḥ||149|| śōṣiṇē bārhiṇaṁ dadyādbarhiśabdēna cāparān| gr̥dhrānulūkāṁścāṣāṁśca vidhivat sūpakalpitān||150|| kākāṁstittiriśabdēna varmiśabdēna cōragān| bhr̥ṣṭān matsyāntraśabdēna dadyādgaṇḍūpadānapi||151|| lōpākān sthūlanakulān biḍālāṁścōpakalpitān| śr̥gālaśāvāṁśca bhiṣak śaśaśabdēna dāpayēt||152|| siṁhānr̥kṣāṁstarakṣūṁśca vyāghrānēvaṁvidhāṁstathā| māṁsādān mr̥gaśabdēna dadyānmāṁsābhivr̥ddhayē||153|| gajakhaḍgituraṅgāṇāṁ vēśavārīkr̥taṁ bhiṣak| dadyānmahiṣaśabdēna māṁsaṁ māṁsābhivr̥ddhayē||154|| māṁsēnōpacitāṅgānāṁ māṁsaṁ māṁsakaraṁ param| tīkṣṇōṣṇalāghavācchastaṁ viśēṣānmr̥gapakṣiṇām||155|| shuShyatAM kShINamAMsAnAM kalpitAni vidhAnavit| dadyAnmAMsAdamAMsAni bRuMhaNAni visheShataH||149|| shoShiNe bArhiNaM dadyAdbarhishabdena cAparAn| gRudhrAnulUkAMshcAShAMshca vidhivat sUpakalpitAn||150|| kAkAMstittirishabdena varmishabdena coragAn| bhRuShTAn matsyAntrashabdena dadyAdgaNDUpadAnapi||151|| lopAkAn sthUlanakulAn biDAlAMshcopakalpitAn| shRugAlashAvAMshca bhiShak shashashabdena dApayet||152|| siMhAnRukShAMstarakShUMshca vyAghrAnevaMvidhAMstathA| mAMsAdAn mRugashabdena dadyAnmAMsAbhivRuddhaye||153|| gajakhaDgitura~ggANAM veshavArIkRutaM bhiShak| dadyAnmahiShashabdena mAMsaM mAMsAbhivRuddhaye||154|| mAMsenopacitA~ggAnAM mAMsaM mAMsakaraM param| tIkShNoShNalAghavAcchastaM visheShAnmRugapakShiNAm||155|| The patient who are emaciated and depleted with mamsa dhatu (flesh), should be prescribed with dishes of the meats of carnivorous animals intended for special nourishment therapy. The flesh of peacock should be given to the patient, and that of vultures, owls and blue jays, well prepared in the prescribed manner, should be given in the denomination of peacock’s flesh. In the denomination of partridge, give the flesh of crows; in the denomination of the snake fish, give the flesh of snakes, and in the designation of the intestines of fish, give fried earth-worms. The physician may give dressed meats of the fox, astronomically immense mongoose, feline and jackal-cubs in the designation of rabbit-flesh. The flesh of lion, bear, hyena, tiger, and such other carnivorous animals may be given in the denomination of the flesh of deer for strengthening the patient. The meats of elephant, rhinoceros and horse well-seasoned with spices should be given in the denomination of buffalo-flesh, for promoting the flesh of the patient. The flesh of birds and animals that have grown plump on flesh diet is an excellent flesh-enhancing food. because of its quick action, hot potency and light to digest nature. [149-155]

Jugupsa treatment (administration of medicine without telling the patient)

मांसानि यान्यनभ्यासादनिष्टानि प्रयोजयेत्| तेषूपधा, सुखं भोक्तुं तथा शक्यानि तानि हि||१५६|| जानञ्जुगुप्सन्नैवाद्याज्जग्धं वा पुनरुल्लिखेत्| तस्माच्छद्मोपसिद्धानि मांसान्येतानि दापयेत्||१५७|| māṁsāni yānyanabhyāsādaniṣṭāni prayōjayēt| tēṣūpadhā, sukhaṁ bhōktuṁ tathā śakyāni tāni hi||156|| jānañjugupsannaivādyājjagdhaṁ vā punarullikhēt| tasmācchadmōpasiddhāni māṁsānyētāni dāpayēt||157|| mAMsAni yAnyanabhyAsAdaniShTAni prayojayet| teShUpadhA, sukhaM bhoktuM tathA shakyAni tAni hi||156|| jAna~jjugupsannaivAdyAjjagdhaM vA punarullikhet| tasmAcchadmopasiddhAni mAMsAnyetAni dApayet||157|| When the patient is not used to consume meats and that are not relished, it may cause harm to patient. Then considering the benefit towards patient’s health, meat should be given in other forms or under dissimulated designations without telling the patient. If the patient comes to know that meat is being given to him, then he would not eat the meat or if eaten, would vomit it. (Hence, in these patients, the recepi should not be shared with patients). [156-157]

Best animal meats in rajayakshma

बर्हितित्तिरिदक्षाणां हंसानां शूकरोष्ट्रयोः| खरगोमहिषाणां च मांसं मांसकरं परम्||१५८|| योनिरष्टविधा चोक्ता मांसानामन्नपानिके| तां परीक्ष्य भिषग्विद्वान् दद्यान्मांसानि शोषिणे||१५९|| barhitittiridakṣāṇāṁ haṁsānāṁ śūkarōṣṭrayōḥ| kharagōmahiṣāṇāṁ ca māṁsaṁ māṁsakaraṁ param||158|| yōniraṣṭavidhā cōktā māṁsānāmannapānikē| tāṁ parīkṣya bhiṣagvidvān dadyānmāṁsāni śōṣiṇē||159|| barhitittiridakShANAM haMsAnAM shUkaroShTrayoH| kharagomahiShANAM ca mAMsaM mAMsakaraM param||158|| yoniraShTavidhA coktA mAMsAnAmannapAnike| tAM parIkShya bhiShagvidvAn dadyAnmAMsAni shoShiNe||159||

The fleshes of peacock, partridge, cock, swan, hog, camel, ass, bull, and buffalo are best to enhance flesh tissues in the patient. A wise physician should take meticulous note of the eight groups of creatures, described in the chapter on ‘eats and drinks’, and then cull the opportune flesh for the patient. [158-159]

Types of meats for alleviation of specific dosha

प्रसहा भूशयानूपवारिजा वारिचारिणः| आहारार्थं प्रदातव्या मात्रया वातशोषिणे||१६०|| प्रतुदा विष्किराश्चैव धन्वजाश्च मृगद्विजाः| कफपित्तपरीतानां प्रयोज्याः शोषरोगिणाम्||१६१|| विधिवत्सूपसिद्धानि मनोज्ञानि मृदूनि च| रसवन्ति सुगन्धीनि मांसान्येतानि भक्षयेत्||१६२|| prasahā bhūśayānūpavārijā vāricāriṇaḥ| āhārārthaṁ pradātavyā mātrayā vātaśōṣiṇē||160|| pratudā viṣkirāścaiva dhanvajāśca mr̥gadvijāḥ| kaphapittaparītānāṁ prayōjyāḥ śōṣarōgiṇām||161|| vidhivatsūpasiddhāni manōjñāni mr̥dūni ca| rasavanti sugandhīni māṁsānyētāni bhakṣayēt||162|| prasahA bhUshayAnUpavArijA vAricAriNaH| AhArArthaM pradAtavyA mAtrayA vAtashoShiNe||160|| pratudA viShkirAshcaiva dhanvajAshca mRugadvijAH| kaphapittaparItAnAM prayojyAH shoSharogiNAm||161|| vidhivatsUpasiddhAni manoj~jAni mRudUni ca| rasavanti sugandhIni mAMsAnyetAni bhakShayet||162||

The flesh of the tearer group of creatures , wet land and aquatic animals and wading birds should be given in large measures as food to one suffering from the vata dominance in rajayakshma. The flesh of peckers, gallinaceous birds and jangala beasts and birds should be given to those consumptives who are predominantly affected with kapha and pitta. After preparing these fleshes well in the prescribed manner and having rendered them soft, palatable, ambrosial and fragrant, they should be given to the rajayakshma patient. [160-162]

Prescription of wines in rajayakshma

मांसमेवाश्नतः शोषो माध्वीकं पिबतोऽपि च| नियतानल्पचित्तस्य चिरं काये न तिष्ठति||१६३|| वारुणीमण्डनित्यस्य बहिर्मार्जनसेविनः| अविधारितवेगस्य यक्ष्मा न लभतेऽन्तरम्||१६४|| प्रसन्नां वारुणीं सीधुमरिष्टानासवान्मधु| यथार्हमनुपानार्थं पिबेन्मांसानि भक्षयन्||१६५|| मद्यं तैक्ष्ण्यौष्ण्यवैशद्यसूक्ष्मत्वात् स्रोतसां मुखम्| प्रमथ्य विवृणोत्याशु तन्मोक्षात् सप्त धातवः||१६६|| पुष्यन्ति धातुपोषाच्च शीघ्रं शोषः प्रशाम्यति| māṁsamēvāśnataḥ śōṣō mādhvīkaṁ pibatō'pi ca| niyatānalpacittasya ciraṁ kāyē na tiṣṭhati||163|| vāruṇīmaṇḍanityasya bahirmārjanasēvinaḥ| avidhāritavēgasya yakṣmā na labhatē'ntaram||164|| prasannāṁ vāruṇīṁ sīdhumariṣṭānāsavānmadhu| yathārhamanupānārthaṁ pibēnmāṁsāni bhakṣayan||165|| madyaṁ taikṣṇyauṣṇyavaiśadyasūkṣmatvāt srōtasāṁ mukham| pramathya vivr̥ṇōtyāśu tanmōkṣāt sapta dhātavaḥ||166|| puṣyanti dhātupōṣācca śīghraṁ śōṣaḥ praśāmyati| mAMsamevAshnataH shoSho mAdhvIkaM pibato~api ca| niyatAnalpacittasya ciraM kAye na tiShThati||163|| vAruNImaNDanityasya bahirmArjanasevinaH| avidhAritavegasya yakShmA na labhate~antaram||164|| prasannAM vAruNIM sIdhumariShTAnAsavAnmadhu| yathArhamanupAnArthaM pibenmAMsAni bhakShayan||165|| madyaM taikShNyauShNyavaishadyasUkShmatvAt srotasAM mukham| pramathya vivRuNotyAshu tanmokShAt sapta dhAtavaH||166|| puShyanti dhAtupoShAcca shIghraM shoShaH prashAmyati|

Only meat shall be consumed in rajayakshma with madhvika (wine prepared from honey). The disease does not persist long in one who is well disciplined and with good mental strength (control over mind), who daily drinks varuni wine, regularly follows the external cleansing of the body and who does not suppress the natural urges. The rajayakshma patient shall take prasanna, varuni or sidhu wine or simple medicated wines as per suitability after taking a meat-diet. Wine owing to its qualities of quickly acting, hot potency, cleasning effect, and subtle action, churns up obstructions in the orifices of the body channels and soon dilates them. As a result of this re-establishment of the liberation of circulation in the vessels, all the seven body- elements get nourished, and the wasting due to rajayakshma soon gets cured. [163-167]

Various ghee formulations

मांसादमांसस्वरसे सिद्धं सर्पिः प्रयोजयेत्||१६७|| सक्षौद्रं, पयसा सिद्धं सर्पिर्दशगुणेन वा| सिद्धं मधुरकैर्द्रव्यैर्दशमूलकषायकैः||१६८|| क्षीरमांसरसोपेतैर्घृतं शोषहरं परम्| पिप्पलीपिप्पलीमूलचव्यचित्रकनागरैः||१६९|| सयावशूकैः सक्षीरैः स्रोतसां शोधनं घृतम्| रास्नाबलागोक्षुरकस्थिरावर्षाभुसाधितम्||१७०|| जीवन्तीपिप्पलीगर्भं सक्षीरं शोषनुद्घृतम्| यवाग्वा वा पिबेन्मात्रां लिह्याद्वा मधुना सह||१७१|| सिद्धानां सर्पिषामेषामद्यादन्नेन वा सह| शुष्यतामेष निर्दिष्टो विधिराभ्यवहारिकः||१७२|| māṁsādamāṁsasvarasē siddhaṁ sarpiḥ prayōjayēt||167|| sakṣaudraṁ, payasā siddhaṁ sarpirdaśaguṇēna vā| siddhaṁ madhurakairdravyairdaśamūlakaṣāyakaiḥ||168|| kṣīramāṁsarasōpētairghr̥taṁ śōṣaharaṁ param| pippalīpippalīmūlacavyacitrakanāgaraiḥ||169|| sayāvaśūkaiḥ sakṣīraiḥ srōtasāṁ śōdhanaṁ ghr̥tam| rāsnābalāgōkṣurakasthirāvarṣābhusādhitam||170|| jīvantīpippalīgarbhaṁ sakṣīraṁ śōṣanudghr̥tam| yavāgvā vā pibēnmātrāṁ lihyādvā madhunā saha||171|| siddhānāṁ sarpiṣāmēṣāmadyādannēna vā saha| śuṣyatāmēṣa nirdiṣṭō vidhirābhyavahārikaḥ||172|| mAMsAdamAMsasvarase siddhaM sarpiH prayojayet||167|| sakShaudraM, payasA siddhaM sarpirdashaguNena vA| siddhaM madhurakairdravyairdashamUlakaShAyakaiH||168|| kShIramAMsarasopetairghRutaM shoShaharaM param| pippalIpippalImUlacavyacitrakanAgaraiH||169|| sayAvashUkaiH sakShIraiH srotasAM shodhanaM ghRutam| rAsnAbalAgokShurakasthirAvarShAbhusAdhitam||170|| jIvantIpippalIgarbhaM sakShIraM shoShanudghRutam| yavAgvA vA pibenmAtrAM lihyAdvA madhunA saha||171|| siddhAnAM sarpiShAmeShAmadyAdannena vA saha| shuShyatAmeSha nirdiShTo vidhirAbhyavahArikaH||172|| The ghee prepared with the meat-juice of carnivorous animals may be administered with honey to the rajayakshma patient or the ghee prepared in ten times the quantity of milk may be given to the patient. The medicated ghee prepared in the decoction of dashamula, milk and meat-juice with the paste of drugs of the madhura (sweet) group is an excellent remedy for rajayakshma. The medicated ghee prepared with the paste of long pepper, roots of long pepper, chaba pepper, white flowered leadwort, dry ginger, barley, alkali and milk is a cleanser of body channels. The medicated ghee prepared in the decoction of Indian ground sel, heart-leaved sida, small caltrop, tick trefoil, fog weed and milk along with the paste of cork swallow wort and long pepper, is curative of rajayakshma . These medicated ghees may be taken with gruel or licked with honey or eaten commixed with the food in the suitable dose. Thus has been described the dietetic regimen for the rajayakshma.[167-172]

External treatments

बहिःस्पर्शनमाश्रित्य वक्ष्यतेऽतः परं विधिः| स्नेहक्षीराम्बुकोष्ठेषु स्वभ्यक्तमवगाहयेत्||१७३|| स्रोतोविबन्धमोक्षार्थं बलपुष्ट्यर्थमेव च| उत्तीर्णं मिश्रकैःस्नेहैः पुनराक्तैः सुखैः करैः||१७४|| मृद्नीयात् सुखमासीनं सुखं चोत्सादयेन्नरम्| जीवन्तीं शतवीर्यां च विकसां सपुनर्नवाम्||१७५|| अश्वगन्धामपामार्गं तर्कारीं मधुकं बलाम्| विदारीं सर्षपं कुष्ठं तण्डुलानतसीफलम्||१७६|| माषांस्तिलांश्च किण्वं च सर्वमेकत्र चूर्णयेत्| यवचूर्णत्रिगुणितं दध्ना युक्तं समाक्षिकम्||१७७|| एतदुत्सादनं कार्यं पुष्टिवर्णबलप्रदम्| गौरसर्षपकल्केन कल्कैश्चापि सुगन्धिभिः||१७८|| स्नायादृतुसुखैस्तोयैर्जीवनीयौषधैः शृतैः|१७९| bahiḥsparśanamāśritya vakṣyatē'taḥ paraṁ vidhiḥ| snēhakṣīrāmbukōṣṭhēṣu svabhyaktamavagāhayēt||173|| srōtōvibandhamōkṣārthaṁ balapuṣṭyarthamēva ca| uttīrṇaṁ miśrakaiḥsnēhaiḥ punarāktaiḥ sukhaiḥ karaiḥ||174|| mr̥dnīyāt sukhamāsīnaṁ sukhaṁ cōtsādayēnnaram| jīvantīṁ śatavīryāṁ ca vikasāṁ sapunarnavām||175|| aśvagandhāmapāmārgaṁ tarkārīṁ madhukaṁ balām| vidārīṁ sarṣapaṁ kuṣṭhaṁ taṇḍulānatasīphalam||176|| māṣāṁstilāṁśca kiṇvaṁ ca sarvamēkatra cūrṇayēt| yavacūrṇatriguṇitaṁ dadhnā yuktaṁ samākṣikam||177|| ētadutsādanaṁ kāryaṁ puṣṭivarṇabalapradam| gaurasarṣapakalkēna kalkaiścāpi sugandhibhiḥ||178|| snāyādr̥tusukhaistōyairjīvanīyauṣadhaiḥ śr̥taiḥ|179| bahiHsparshanamAshritya vakShyate~ataH paraM vidhiH| snehakShIrAmbukoShTheShu svabhyaktamavagAhayet||173|| srotovibandhamokShArthaM balapuShTyarthameva ca| uttIrNaM mishrakaiHsnehaiH punarAktaiH sukhaiH karaiH||174|| mRudnIyAt sukhamAsInaM sukhaM cotsAdayennaram| jIvantIM shatavIryAM ca vikasAM sapunarnavAm||175|| ashvagandhAmapAmArgaM tarkArIM madhukaM balAm| vidArIM sarShapaM kuShThaM taNDulAnatasIphalam||176|| mAShAMstilAMshca kiNvaM ca sarvamekatra cUrNayet| yavacUrNatriguNitaM dadhnA yuktaM samAkShikam||177|| etadutsAdanaM kAryaM puShTivarNabalapradam| gaurasarShapakalkena kalkaishcApi sugandhibhiH||178|| snAyAdRutusukhaistoyairjIvanIyauShadhaiH shRutaiH|179| The patient, after being proper therapeutic massage, should be given a tub- bath with unctuous liquid, milk and water in order to mitigate the constriction of the channels and to enhance vigor and plumpness. After tub-bath, the patient should be made to sit at his ease and once again be treated with a gentle massage lightly with hands utilizing mishraka sneha( mixed forms of sneha), and then with a massage mixed with powder and unctuous matter as described below. Take cork swallow wort,scotch grass, mudar, hog-weed, winter cherry, rough chaff, wind killer, liquorice, heart-leaved sida, white yam, rape seed, costus, rice, linseed, ebony gram, til and yeast, and powder the mixture . Co-mix this with thrice its quantity of barley powder and integrate curds and honey; this should be utilized for massage for promoting plumpness, complexion and vitality. Then the patient should take a bath in water in which have been boiled vitality-enhancing herbs, the paste of white mustard and the paste of fragrant substances, cooling the water to the degree of temperature found congenial in the particular season. [173-179]

Lifestyle treatments

गन्धैः समाल्यैर्वासोभिर्भूषणैश्च विभूषितः||१७९|| स्पृश्यान् संस्पृश्य सम्पूज्य देवताः सभिषग्द्विजाः| इष्टवर्णरसस्पर्शगन्धवत् पानभोजनम्||१८०|| इष्टमिष्टैरुपहितं सुखमद्यात् [१] सुखप्रदम्| समातीतानि धान्यानि कल्पनीयानि शुष्यताम्||१८१|| लघून्यहीनवीर्याणि स्वादूनि गन्धवन्ति च| यानि प्रहर्षकारीणि तानि पथ्यतमानि हि||१८२|| यच्चोपदेक्ष्यते पथ्यं [२] क्षतक्षीणचिकित्सिते| यक्ष्मिणस्तत् प्रयोक्तव्यं बलमांसाभिवृद्धये||१८३|| अभ्यङ्गोत्सादनैश्चैव वासोभिरहतैः प्रियैः| यथर्तुविहितैः स्नानैरवगाहैर्विमार्जनैः||१८४|| बस्तिभिः क्षीरसर्पिर्भिर्मांसैर्मांसरसौदनैः| इष्टैर्मद्यैर्मनोज्ञानां गन्धानामुपसेवनैः||१८५|| सुहृदां रमणीयानां प्रमदानां च दर्शनैः| गीतवादित्रशब्दैश्च प्रियश्रुतिभिरेव च||१८६|| हर्षणाश्वासनैर्नित्यं गुरूणां समुपासनैः| ब्रह्मचर्येण दानेन तपसा देवतार्चनैः||१८७|| सत्येनाचारयोगेन मङ्गल्यैरप्यहिंसया| वैद्यविप्रार्चनाच्चैव रोगराजो निवर्तते||१८८|| यया प्रयुक्तया चेष्ट्या राजयक्ष्मा पुरा जितः| तां वेदविहितामिष्टिमारोग्यार्थी प्रयोजयेत्||१८९|| gandhaiḥ samālyairvāsōbhirbhūṣaṇaiśca vibhūṣitaḥ||179|| spr̥śyān saṁspr̥śya sampūjya dēvatāḥ sabhiṣagdvijāḥ| iṣṭavarṇarasasparśagandhavat pānabhōjanam||180|| iṣṭamiṣṭairupahitaṁ sukhamadyāt [1] sukhapradam| samātītāni dhānyāni kalpanīyāni śuṣyatām||181|| laghūnyahīnavīryāṇi svādūni gandhavanti ca| yāni praharṣakārīṇi tāni pathyatamāni hi||182|| yaccōpadēkṣyatē pathyaṁ [2] kṣatakṣīṇacikitsitē| yakṣmiṇastat prayōktavyaṁ balamāṁsābhivr̥ddhayē||183|| abhyaṅgōtsādanaiścaiva vāsōbhirahataiḥ priyaiḥ| yathartuvihitaiḥ snānairavagāhairvimārjanaiḥ||184|| bastibhiḥ kṣīrasarpirbhirmāṁsairmāṁsarasaudanaiḥ| iṣṭairmadyairmanōjñānāṁ gandhānāmupasēvanaiḥ||185|| suhr̥dāṁ ramaṇīyānāṁ pramadānāṁ ca darśanaiḥ| gītavāditraśabdaiśca priyaśrutibhirēva ca||186|| harṣaṇāśvāsanairnityaṁ gurūṇāṁ samupāsanaiḥ| brahmacaryēṇa dānēna tapasā dēvatārcanaiḥ||187|| satyēnācārayōgēna maṅgalyairapyahiṁsayā| vaidyaviprārcanāccaiva rōgarājō nivartatē||188|| yayā prayuktayā cēṣṭyā rājayakṣmā purā jitaḥ| tāṁ vēdavihitāmiṣṭimārōgyārthī [3] prayōjayēt||189|| gandhaiH samAlyairvAsobhirbhUShaNaishca vibhUShitaH||179|| spRushyAn saMspRushya sampUjya devatAH sabhiShagdvijAH| iShTavarNarasasparshagandhavat pAnabhojanam||180|| iShTamiShTairupahitaM sukhamadyAt [1] sukhapradam| samAtItAni dhAnyAni kalpanIyAni shuShyatAm||181|| laghUnyahInavIryANi svAdUni gandhavanti ca| yAni praharShakArINi tAni pathyatamAni hi||182|| yaccopadekShyate pathyaM [2] kShatakShINacikitsite| yakShmiNastat prayoktavyaM balamAMsAbhivRuddhaye||183|| abhya~ggotsAdanaishcaiva vAsobhirahataiH priyaiH| yathartuvihitaiH snAnairavagAhairvimArjanaiH||184|| bastibhiH kShIrasarpirbhirmAMsairmAMsarasaudanaiH| iShTairmadyairmanoj~jAnAM gandhAnAmupasevanaiH||185|| suhRudAM ramaNIyAnAM pramadAnAM ca darshanaiH| gItavAditrashabdaishca priyashrutibhireva ca||186|| harShaNAshvAsanairnityaM gurUNAM samupAsanaiH| brahmacaryeNa dAnena tapasA devatArcanaiH||187|| satyenAcArayogena ma~ggalyairapyahiMsayA| vaidyaviprArcanAccaiva rogarAjo nivartate||188|| yayA prayuktayA ceShTyA rAjayakShmA purA jitaH| tAM vedavihitAmiShTimArogyArthI [3] prayojayet||189|| The consumptive patient should then adorn himself with perfumes, flower garlands, habiliments and ornaments, touch auspicious articles, worship the gods, the Brahmins and the Vaidya. He should eat suitable food and drink with favourate color, taste, feel and odour, prepared by agreeable persons and leading to comfort. Those grains, which are a year old, are to be utilized in the preparation of food for the patients of rajayakshma. Those which are light to digest , which have not lost their nutritive quality and which are dainty, fragrant and virilific, are the most wholesome. The rajayakshma patients, in order to amend their vigor and flesh must utilize those articles that are prescribed as wholesome in the treatment of ‘kshata-ksheena’(chapter 11). It is a recourse to inunction (applying oil), massage, congenial and untorn garments, affusions, baths immersion baths, internal and external cleansing which are congruous to the prevailing season, enemata, milk ghee, meat-foods cooked rice commixed with meat juices, suitable wines, delectable perfumes, optical discernment of friends, comely things and adolescent women, the congenial sound of musical compositions and the musical instruments , cheering and comforting words, constant accommodation to preceptors and elders, practice of Brahmacharya, charity, austerity, worship of the gods, truth, rectitudinous, conduct, auspicious rites, nonviolence and deference to the physician and Brahmins, that one gets liberate from rajayakshma , the king of disease.The patient desirous of regaining his health should perform the same spiritual therapies enjoined by the vedas as those by the performance of which this king of diseases was subdued in the first instance. [179-189]

Summary

तत्र श्लोकौ- प्रागुत्पत्तिर्निमित्तानि प्राग्रूपं रूपसङ्ग्रहः| समासाद् व्यासतश्चोक्तं भेषजं राजयक्ष्मणः||१९०|| नामहेतुरसाध्यत्वं साध्यत्वं कृच्छ्रसाध्यता| इत्युक्तः सङ्ग्रहः कृत्स्नो राजयक्ष्मचिकित्सिते||१९१|| tatra ślōkau- prāgutpattirnimittāni prāgrūpaṁ rūpasaṅgrahaḥ| samāsād vyāsataścōktaṁ bhēṣajaṁ rājayakṣmaṇaḥ||190|| nāmahēturasādhyatvaṁ sādhyatvaṁ kr̥cchrasādhyatā| ityuktaḥ saṅgrahaḥ kr̥tsnō rājayakṣmacikitsitē||191|| tatra shlokau- prAgutpattirnimittAni prAgrUpaM rUpasa~ggrahaH| samAsAd vyAsatashcoktaM bheShajaM rAjayakShmaNaH||190|| nAmaheturasAdhyatvaM sAdhyatvaM kRucchrasAdhyatA| ityuktaH sa~ggrahaH kRutsno rAjayakShmacikitsite||191||

Concerning rajayakshma, the protogenesis, etiological factors, premonitory symptoms band syndromes of designations and symptoms have been described in brief and methods of treatment extensively.Explanations of the designation of rajayakshma, incurable, curable, and formidable conditions: these have been addressed in this chapter on the ‘ Therapeutics of rajayakshma ’. [190-191]

Tattva Vimarsha

• Over –exertion beyond one’s capacity, suppression of natural urges, depletion of tissue elements and irregular dietary habits are the etiological factors of rajayakshma. • The symptoms are manifested where the vitiated dosha are lodged and interact with the dhatu. • One shall know his own capacity or tolerance before starting any kind of activity. Otherwise the activities done beyond one’s capacity leads to depletion of dhatu, vitiation of vata and rajayakshma. • One shall not suppress the natural urge to prevent vitiation of vata dosha and rajayakshma. • The samprapti (pathogenesis) of rajayakshma includes obstruction in channels and depletion of dhatus. • Normally, the dhatus of the body get metabolised (being acted upon) by their own ushmas or dhatwagnis (transforming enzymes in the tissue elements). From these dhatus, (nutrient tissue elements), the other dhatus (next dhatu to it that which receive nourishment) gets nourished through their respective srotas (channels of circulation). (For example, a poshaka rasa dhatu would nourish the rakta dhatu). • Rajayakshma is manifested if there is any obstruction to a srotas or if there is diminution of stable tissue elements like rakta or if there is diminution of dhatu-ushmas or dhatwagnis then. • In coryza, sudation, inunctions, medicated smoke application, affusion, bath are the modes of treatment. • Nasal errhines, medicated smokes, post prandial unctuous potions, inunctions with medicated oils, enemata and blood letting are indicated to release pain in head and shoulder region. • In cases of excessively aggravated dosha, mild therapeutic emesis and purgation therapies after proper snehana (oleation) and swedana (sudation) which do not cause emaciation can be administered. • The signs like diarrhea, anorexia manifest due to impairment of the agni. Treatment shall be planned to improve functioning of agni, stopping diarrhea and promoting taste in mouth. • The nourishment therapies with ghee, linctus, milk processed with the herbs having properties of sweet, bitter taste and cold potency are used in treatment of rajayakshma. • Meat and madhvika (wine prepared from honey) are considered the best diet in rajayakshma. • The disease does not persist long in one who is well disciplined and with good mental strength (control over mind), who daily drinks varuni wine, regularly follows external cleansing of the body (maintains cleanliness) and who does not suppress the natural urges. • Lifestyle treatments intended to enhance mental strength and comfort for patient are administered in rajayakshma.

Vidhi Vimarsha

Pathogenesis of various types of rajayakshma: I. Sahasaja rajayakshma: Due to physical exertion like— Battle Reading Weight lifting This increases the inspiration & expiration. Travelling on foot Leaping Such abnormal breathing injures the tissues of lung (Kshat) Jumping Injured tissues of lung gets filled with vayu

This vitiated vayu deranged the kapha & pitta.

This deranged dosha along with vayu spread in all direction within the body.

And produce eleven symptoms of rajayakshma due to the over exertion.

     II. Vegasandharanaja rajayakshma:                    
                                                            Suppression of natural urges

Vitiation of vata Disruption of agni Vitiation of all three doshas Obstruction of the channels of circulation. These vitiated humours produce the disorder having symptoms of all three doshas. III. Kshayaja rajayakshma: Excessive sexual indulgence Loss of unctuousness Fasting Vitiation of vata Excessive bleeding & aggrevated two other doshas Envy obstruction of channels circulation Eagerness Degradation of dhatus Fever & produce 11 symptoms. Terror Anger IV. Vishamashanaja rajayakshma: A person who taks food against the ashta-vidhi visheshayatan and ten vidhi vidhan. This leads to vitiation of vata vata aggravates other two doshas Obstruction of channels of rasa and other dhatus dhatu not nourished properly And produce 11 symptoms of rajayakshma due to the irregular diet.

General pathogenesis:

Nidana

Sannikrishta Viprikrishta Nidana Nidana

Sahasa Dhatu Samdha- Visham- Kshaya rana ashana

Shukrakshaya Kapha Pradhan Tridosha

Vataprakopa Srotovarodha

Dhatukshaya in Dhatukshaya in Pratiloma krama Anuloma krama

Sarvadhatu Kshaya

Shosha (Emaciation)

Rajayakshma

A Contemporary Treatments: Priniciples of treatments: Deepana, Srotoshodhana, Balya and Brumhana Main drugs: Bala, Abhraka, Suvarna, Kushmanda Medicine formulations used: I. Sahasaja rajayakshma /urakshata: 1. Laksha mixture 10 to 20 grams frequently with vasavaleha 2. Amrutaprasha 10 to 20 grams after meals with milk II. Vishamashanaja : 1. Swarna vasanta 250 to 500 mg between two meals with milk 2. Drakshasava 10 to 20 ml after meals with water III. Vegarodhaja: 1. Chaturbhuja kalpa 125 to 250 mg before meals with milk and chyavana prasha 2. Chaturmukha rasa 60 to 120 mg after meals with brahmi prasha IV. Kshayaja rajayakshma : 1. Laksmivilasa rasa 250 to 500 mg between two meals with milk 2. Vanga mixture 500 to 1000mg between two meals with milk

Cautions for purification treatments

Panchakarma( therapeutic purification) treatments are indicated only in strong patients with excess aggravation of doshas in rajayakshma. In a patient with low strength, purification is not done. If at all, it needs to be done due to excess dosha, then mild purification is prescribed after taking every care of strength of the patient. Role of rasayana in enhancing the immunity: Rasayana drugs have got an important role in the management of rajayakshma. Mandagni (at the level of jatharagni and dhatwagni both) and srotovarodha play an important role in the pathogenesis of this disease. Rasayana drugs act at various levels to promote nutrition. Some of them work at the level of rasa (enriching nutrient plasma) while others work at the level of agni (improve digestion and metabolism). Some other work at the level of srotas by promoting the competence of microcirculatory channels in the body leading to better bio-availability of nutrients to the tissues and improved tissue perfusion.[2] Hence, rasayana acting at all three levels may prove beneficial in the management of rajayakshma. Rasayana drugs also improve the status of ojas in the body by their immunomodulatory action. Thus these drugs are used as an adjuvant to anti-tubercular drugs and they enhance efficacy of treatment at various levels. Details about rasayana drugs have already been described in first chapter of chikitsa section. Nidana parivarjan (removal of the causes) is yet another aspect of treatment.

Research on ayurveda treatment in tuberculosis patients

As we look back to the history of tuberculosis treatment, the immune-boost up was the main treatment. Ayurvedic treatment of tuberculosis was initiated in 1933 by the establishment of Patipukur TB Hospital, Kolkata. Later on, a full-fledged research unit was commissioned with exclusive budget. Treatment guidelines were adopted on Ayurvedic principles for therapeutic management which was a unique effort of its kind in pre-independence India. This regimen was discontinued from 1st November 1947 on the introduction of synthetic ATDs. Drugs containing mercury, gold, calcium was prepared at the in-house pharmacy and was administered to the patients with fresh juice of herbs cultivated in the hospital garden. Formulations like vasantamalati, kanchanabhra rasa, rajamriganka rasa were under use including bhallataka (Semicarpus anacardium) rasayan, mallasindura, vasa (Adatoda vasica) etc. The statistics on the treatment of pulmonary tuberculosis using Ayurvedic medicine for over a period of 13 years is of immense value.[1] Research outcome relevant for public health from the Indian systems of medicine on tuberculosis at The Patipukur TB Hospital: Modern TB-drugs were administered to about 2766 patients and the cure rate turned out to be 11.42% and the death rate 40.9%. When a group of patients on modern anti-TB drugs received supplementary Ayurvedic drugs, the cure rate was 41.3% and the death rate was 3.8%. Studies have also been conducted to assess the role of Ayurvedic treatment in resistant cases. [1]

References

1. Shailaja C. Journal of Health & Population in Developing Countries. Vol. 3. WHO publication; 2000.A few research outcomes relevant for Public Health from Indian System of Medicine; p. 109. 2. Singh, RH and Rastogi, S. Rasayana Therapy and Rejuvenation. In Evidence based practice of CAM, PP 177-190. Springer, Germany. 2012