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<big>'''Abstract </big>'''

<big>'''Abstract </big>'''

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''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 ''rajayakshma'' 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 rate 11.42% 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%).  

''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 ''rajayakshma'' 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 rate 11.42% 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, wasting diseases. </div>

'''Keywords''': ''Rajayakshma, kshaya, shosha,'' tuberculosis, ''vyadhikshamatva, dhatukshaya,'' immunity, depletion of tissues, wasting diseases. </div>

''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 [[Charak Samhita]], ''Sushruta Samhita'', and ''Ashtanga Hridaya'' with more extensive description is in [[Charak 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).  

''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 [[Charak Samhita]], ''Sushruta Samhita'', and ''Ashtanga Hridaya'' with more extensive description is in [[Charak 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.  

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.

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.  

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.   

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 ''[[dhatu]]s'' (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]

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

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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]

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]

=== Synonyms of disease and history of ''yakshma''===

=== Synonyms of disease and history of ''yakshma''===

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''Krodha''(rage), ''yakshma'' (sickness), ''jwara''(fever) and ''roga'' (disease suffering) – these terms are synonymous, and indicate misery. 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]

''Krodha''(rage), ''yakshma'' (sickness), ''jwara''(fever) and ''roga'' (disease suffering) – these terms are synonymous, and indicate misery. 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 ===

=== Four important causative factors of disease ===

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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.  

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]

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]

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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]

When due to bashfulness or disgust or fear one suppresses the impelling urge to pass flatus, urine and/or feces, ''[[vata]]'', 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 ''[[dosha]]s'' 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) ====

==== 3. ''Kshayaja rajayakshma'' (due to depletion of tissues) ====

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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]

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 ''[[dosha]]s'' 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) ====

==== 4. ''Vishamashanaja rajayakshma'' (due to irregular dietary habits) ====

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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:

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

#Due to vitiated ''kapha'': coryza, excessive salivation, cough, vomiting and anorexia,  

#Due to vitiated ''[[kapha]]'': coryza, excessive salivation, cough, vomiting and anorexia,  

#Due to vitiated ''pitta'': fever, distress in shoulder and haemoptysis, and  

#Due to vitiated ''[[pitta]]'': fever, distress in shoulder and haemoptysis, and  

#Due to vitiated ''vata'': pain in flanks, headache and hoarseness of voice.[28-31]

#Due to vitiated ''[[vata]]'': pain in flanks, headache and hoarseness of voice.[28-31]

=== Premonitory signs ===

=== Premonitory signs ===

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

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'' ).  

Normally, the ''[[dhatu]]s'' of the body get metabolised (being acted upon) by their own ''ushmas'' or ''dhatvagnis'' (transforming enzymes in the tissue elements). From these ''[[dhatu]]s'', (nutrient tissue elements), the other ''[[dhatu]]s'' ( 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]

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'' ===

=== Signs of ''pratishyaya'' ===

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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]

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 ===

=== Appearance of sputum ===

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

=== Clinical features of ''rajayakshma'' ===

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]

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 ===

=== ''Swarabheda'' (hoarseness of voice) and characteristics as per ''[[dosha]]'' affliction ===

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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.  

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]

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]

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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]

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 ===

=== Causes of depletion of tissues ===

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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]

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 ===

=== Cause of anorexia ===

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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]

Anorexia or dislike for food is caused by morbidity of one or all the three ''[[dosha]]s'' 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 ===

=== Cause of vomiting ===

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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]

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'' ===

=== Management of ''rajayakshma'' ===

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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]

All types of ''rajayakshma'' are caused due to vitiated three ''[[dosha]]s'' 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 ===

=== Various dietary articles in treatment ===

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]

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) ===

=== ''[[Swedana]]'' (sudation) ===

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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]

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) ===

=== ''Alepana'' (local applications) ===

#gum , ''guggulu,'' ''deodar,'' sandalwood, fragrant poon and ghee;  

#gum , ''guggulu,'' ''deodar,'' sandalwood, fragrant poon and ghee;  

#climbing asparagus, heart leaved ''sida,'' white yam, drumstick and hog’s weed;  

#climbing asparagus, heart leaved ''sida,'' white yam, drumstick and hog’s weed;  

#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]

#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 ===

=== Beneficial procedures of purification ===

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]

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) ===

=== Indications of ''[[shodhana]]'' (purification) ===

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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]

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) ===

=== Various formulations for ''[[nasya]]'' (nasal errhines) ===

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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]

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'' ===

=== ''Vasa ghee'' and ''shatavari ghee'' ===

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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.  

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''.

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.  

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 ''hridya'' ( liked by mind), alleviate ''vata'' and light to digest are advised. [118-122]

This line of treatment for excess expectoration is also recommended for vomiting. A diet consisting of food and beverages that are ''hridya'' ( liked by mind), alleviate ''[[vata]]'' and light to digest are advised. [118-122]

=== Treatment of diarrhea ===

=== Treatment of diarrhea ===

Now, hear this description of remedies for the removal of distaste in the mouth and for enhancing appetite. These are as follows:

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).

*Tooth-twigs should be used twice a day for brushing one’s teeth and then use ''mukhadhavana'' (drugs chewed for alleviating vitiated ''[[dosha]]s'' 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  

*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:

*Smoke medicated cigars and, thereafter, take digestive stimulant drugs, and wholesome food, and drinks. The recipe for ''mukhadhavana'' are:

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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, dyspnea and anorexia and is an excellent digestive stimulant, alleviative of stomach disorders anemia, 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]

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, dyspnea and anorexia and is an excellent digestive stimulant, alleviative of stomach disorders anemia, 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 ===

=== Importance of meat in emaciation ===

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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 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.  

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.  

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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]

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 recipe should not be shared with patients). [156-157]

=== Best animal meats in ''rajayakshma'' ===

=== Best animal meats in ''rajayakshma'' ===

The fleshes of peacock, partridge, chicken, 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]

The fleshes of peacock, partridge, chicken, 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'' ===

=== Types of meats for alleviation of specific ''[[dosha]]'' ===

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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]

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'' ===

=== Prescription of wines in ''rajayakshma'' ===

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

*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''.

*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 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''.  

*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''.  

*The ''samprapti'' (pathogenesis) of ''rajayakshma'' includes obstruction in channels and depletion of ''[[dhatu]]s''.  

*Normally, the ''dhatus'' of the body get metabolized (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'').  

*Normally, the ''[[dhatu]]s'' of the body get metabolized (being acted upon) by their own ''ushmas'' or ''dhatvagnis'' (transforming enzymes in the tissue elements). From these ''[[dhatu]]s'', (nutrient tissue elements), the other ''[[dhatu]]s'' (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 ''dhatvagnis'' then.

*''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 ''dhatvagnis'' then.

*In coryza, sudation, inunctions, medicated smoke application, effusion, bath are the modes of treatment.  

*In coryza, sudation, inunctions, medicated smoke application, effusion, 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.  

*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.

*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 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''.  

*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''.  

=== Contemporary Treatments ===

=== Contemporary Treatments ===

'''Priniciples of treatments:'''  ''Deepana, Srotoshodhana, Balya'' and ''Brimhana''

'''Priniciples of treatments:'''  ''[[Deepana]], Srotoshodhana, Balya'' and ''[[Brimhana]]''

   

   

'''Main drugs''': ''Bala, Abhraka, Suvarna, Kushmanda''

'''Main drugs''': ''Bala, Abhraka, Suvarna, Kushmanda''

=== Cautions for purification treatments ===

=== 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.  

[[Panchakarma]]( therapeutic purification) treatments are indicated only in strong patients with excess aggravation of ''[[dosha]]s'' 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 ===

=== 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 ''dhatvagni'' 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 Sthana]].  ''Nidana parivarjana'' (removal of the causes) is yet another aspect of treatment.

''[[Rasayana]]'' drugs have got an important role in the management of ''rajayakshma''. ''Mandagni'' (at the level of ''jatharagni'' and ''dhatvagni'' 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 Sthana]].  ''Nidana parivarjana'' (removal of the causes) is yet another aspect of treatment.

=== Research on [[Ayurveda]] treatment in tuberculosis patients ===

=== Research on [[Ayurveda]] treatment in tuberculosis patients ===