Changes

In Ayurveda, rather than disease, mainly the syndromes are described and kshata- kshina is also a syndrome.  Kshata means injury and kshina means depletion of tissue. The term literally means depletion of tissues due to injury. It includes various pathologies leading to depletion of tissues in the body as a result of external and internal injuries. It shows close resemblence with tuberculosis, however the cardinal cause in kshata kshina is injury. Hemoptysis (symptom of pulmonary tuberculosis), hematuria (symptom of renal tuberculosis) and diarrhea (symptom of intestinal tuberculosis) all have cardinal symptoms of tuberculosis which are described as the symptom of kshata- kshina. It refers to those dreaded complications of tuberculosis that  appear suddenly and require prompt treatment just as acute onset of chest-pain in patient of tuberculosis who suddenly develops pneumothorax due to rupture of subpleural blebs and massive painless hematuria in the patient of genitourinary tuberculosis. Similar to tuberculosis, there is impaired immunity in kshata- kshina patients also. Kshata- kshina refers to cluster of diseases like spontaneous pneumothorax and renal tuberculosis, whereas presence of hemoptysis and hematuria in a single disease suggests a pulmonary-renal syndrome (eg, Goodpasture's syndrome, Wegener's granulomatosis). The diseases due to excess exertion during work or occupational hazards can also be referred to kshata kshina.

In Ayurveda, rather than disease, mainly the syndromes are described and kshata- kshina is also a syndrome.  Kshata means injury and kshina means depletion of tissue. The term literally means depletion of tissues due to injury. It includes various pathologies leading to depletion of tissues in the body as a result of external and internal injuries. It shows close resemblence with tuberculosis, however the cardinal cause in kshata kshina is injury. Hemoptysis (symptom of pulmonary tuberculosis), hematuria (symptom of renal tuberculosis) and diarrhea (symptom of intestinal tuberculosis) all have cardinal symptoms of tuberculosis which are described as the symptom of kshata- kshina. It refers to those dreaded complications of tuberculosis that  appear suddenly and require prompt treatment just as acute onset of chest-pain in patient of tuberculosis who suddenly develops pneumothorax due to rupture of subpleural blebs and massive painless hematuria in the patient of genitourinary tuberculosis. Similar to tuberculosis, there is impaired immunity in kshata- kshina patients also. Kshata- kshina refers to cluster of diseases like spontaneous pneumothorax and renal tuberculosis, whereas presence of hemoptysis and hematuria in a single disease suggests a pulmonary-renal syndrome (eg, Goodpasture's syndrome, Wegener's granulomatosis). The diseases due to excess exertion during work or occupational hazards can also be referred to kshata kshina.

 

अथातः क्षतक्षीणचिकित्सितं व्याख्यास्यामः||१||

अथातः क्षतक्षीणचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

इति ह स्माह भगवानात्रेयः||२||

kShatakShINacikitsArthamidamAha cikitsitam||3||

kShatakShINacikitsArthamidamAha cikitsitam||3||

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

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

 

धनुषाऽऽयस्यतोऽत्यर्थं भारमुद्वहतो गुरुम्|  

धनुषाऽऽयस्यतोऽत्यर्थं भारमुद्वहतो गुरुम्|  

पततो विषमोच्चेभ्यो बलिभिः सह युध्यतः||४||  

पततो विषमोच्चेभ्यो बलिभिः सह युध्यतः||४||  

15. Who indulges in excess dry, less qualnity food or limited food  

15. Who indulges in excess dry, less qualnity food or limited food  

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

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

Pathogenesis and clinical features:

 

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

 

उरो विरुज्यते तस्य भिद्यतेऽथ  विभज्यते|  

उरो विरुज्यते तस्य भिद्यतेऽथ  विभज्यते|  

प्रपीड्येते ततः पार्श्वे शुष्यत्यङ्गं प्रवेपते||९||  

प्रपीड्येते ततः पार्श्वे शुष्यत्यङ्गं प्रवेपते||९||  

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

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

Prodromal signs and symptoms

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

 

अव्यक्तं लक्षणं तस्य पूर्वरूपमिति स्मृतम्||१२||

अव्यक्तं लक्षणं तस्य पूर्वरूपमिति स्मृतम्||१२||

उरोरुक्शोणितच्छर्दिः कासो वैशेषिकः  क्षते|  

उरोरुक्शोणितच्छर्दिः कासो वैशेषिकः  क्षते|  

Signs and symptoms in unmanifested form (less manifested) constitute the premonitory signs and symptoms of this disease. (There is no appearance of premonitory sings).

Signs and symptoms in unmanifested form (less manifested) constitute the premonitory signs and symptoms of this disease. (There is no appearance of premonitory sings).

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

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

Prognosis:

 

==== Prognosis ====

 

अल्पलिङ्गस्य दीप्ताग्नेः साध्यो बलवतो नवः|  

अल्पलिङ्गस्य दीप्ताग्नेः साध्यो बलवतो नवः|  

परिसंवत्सरो याप्यः सर्वलिङ्गं तु वर्जयेत्||१४||

परिसंवत्सरो याप्यः सर्वलिङ्गं तु वर्जयेत्||१४||

parisaMvatsaro yApyaH sarvali~ggaM tu varjayet||14||

parisaMvatsaro yApyaH sarvali~ggaM tu varjayet||14||

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

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

Management:

 

==== Management ====

 

उरो मत्वा क्षतं लाक्षां पयसा मधुसंयुताम्|

उरो मत्वा क्षतं लाक्षां पयसा मधुसंयुताम्|

सद्य एव पिबेज्जीर्णे पयसाऽद्यात् सशर्करम्||१५||  

सद्य एव पिबेज्जीर्णे पयसाऽद्यात् सशर्करम्||१५||  

For healing of the injury, the patient should take milk boiled with ikshuvalika, bisagranthi, padma kesara and chandana with added honey.

For healing of the injury, the patient should take milk boiled with ikshuvalika, bisagranthi, padma kesara and chandana with added honey.

If there is fever and burning sensation in the body, then the patient should take barley powder cooked with milk and added ghee. Alternatively, such a patient should take sugar, honey and saktu (roasted corn- flour) mixed with milk.

If there is fever and burning sensation in the body, then the patient should take barley powder cooked with milk and added ghee. Alternatively, such a patient should take sugar, honey and saktu (roasted corn- flour) mixed with milk.

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

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

 

एलापत्रत्वचोऽर्धाक्षाः पिप्पल्यर्धपलं तथा|  

एलापत्रत्वचोऽर्धाक्षाः पिप्पल्यर्धपलं तथा|  

सितामधुकखर्जूरमृद्वीकाश्च पलोन्मिताः||२१||  

सितामधुकखर्जूरमृद्वीकाश्च पलोन्मिताः||२१||  

guTikA tarpaNI vRuShyA raktapittaM ca nAshayet||24|| ityelAdiguTikA|

guTikA tarpaNI vRuShyA raktapittaM ca nAshayet||24|| ityelAdiguTikA|

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

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

 

Treatment of excessive bleeding:

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

 

रक्तेऽतिवृत्ते दक्षाण्डं यूषैस्तोयेन वा पिबेत्|  

रक्तेऽतिवृत्ते दक्षाण्डं यूषैस्तोयेन वा पिबेत्|  

चटकाण्डरसं वाऽपि रक्तं वा छागजाङ्गलम्||२५||  

चटकाण्डरसं वाऽपि रक्तं वा छागजाङ्गलम्||२५||  

cūrṇaṁ paunarnavaṁ raktaśālitaṇḍulaśarkaram|  

cūrṇaṁ paunarnavaṁ raktaśālitaṇḍulaśarkaram|  

raktaṣṭhīvī pibēt siddhaṁ drākṣārasapayōghr̥taiḥ||26||

raktaṣṭhīvī pibēt siddhaṁ drākṣārasapayōghr̥taiḥ||26||

rakte~ativRutte dakShANDaM yUShaistoyena vA pibet|  

rakte~ativRutte dakShANDaM yUShaistoyena vA pibet|  

raktaShThIvI pibet siddhaM drAkShArasapayoghRutaiH||26||

raktaShThIvI pibet siddhaM drAkShArasapayoghRutaiH||26||

If there is excessive bleeding, then the patient should take eggs of daksha (wild hen) along with green gram soup or water. He may also take the soup of eggs of sparrow or (preparations) of the blood of goat or wild animals (like deer, etc).

If there is excessive bleeding, then the patient should take eggs of daksha (wild hen) along with green gram soup or water. He may also take the soup of eggs of sparrow or (preparations) of the blood of goat or wild animals (like deer, etc).

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

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

Various formulations:

Various formulations:

मधूकमधुकक्षीरसिद्धं वा तण्डुलीयकम्|  

मधूकमधुकक्षीरसिद्धं वा तण्डुलीयकम्|