Changes

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

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

Sarpi modaka (fifth recipe):

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

 

गोक्षीरार्धाढकं सर्पिः प्रस्थमिक्षुरसाढकम्| विदार्याः स्वरसात्प्रस्थं रसात्प्रस्थं च तैत्तिरात्||७०|| दद्यात्  सिध्यति तस्मिंस्तु पिष्टानिक्षुरसैरिमान्| मधूकपुष्पकुडवं  प्रियालकुडवं तथा||७१||  

गोक्षीरार्धाढकं सर्पिः प्रस्थमिक्षुरसाढकम्| विदार्याः स्वरसात्प्रस्थं रसात्प्रस्थं च तैत्तिरात्||७०|| दद्यात्  सिध्यति तस्मिंस्तु पिष्टानिक्षुरसैरिमान्| मधूकपुष्पकुडवं  प्रियालकुडवं तथा||७१||  

कुडवार्धं तुगाक्षीर्याः खर्जूराणां च  विंशतिम्| पृथग्बिभीतकानां च पिप्पल्याश्च चतुर्थिकाम्||७२|| त्रिंशत्पलानि खण्डाच्च मधुकात् कर्षमेव च| तथाऽर्धपलिकान्यत्र जीवनीयानि दापयेत्||७३|| सिद्धेऽस्मिन् कुडवं क्षौद्रं शीते क्षिप्त्वाऽथ मोदकान्| कारयेन्मरिचाजाजीपलचूर्णावचूर्णितान्||७४|| वातासृक्पित्तरोगेषु क्षतकासक्षयेषु च| शुष्यतां क्षीणशुक्राणां रक्ते चोरसि संस्थिते||७५|| कृशदुर्बलवृद्धानां पुष्टिवर्णबलार्थिनाम्| योनिदोषकृतस्रावहतानां चापि योषिताम्||७६||  

कुडवार्धं तुगाक्षीर्याः खर्जूराणां च  विंशतिम्| पृथग्बिभीतकानां च पिप्पल्याश्च चतुर्थिकाम्||७२|| त्रिंशत्पलानि खण्डाच्च मधुकात् कर्षमेव च| तथाऽर्धपलिकान्यत्र जीवनीयानि दापयेत्||७३|| सिद्धेऽस्मिन् कुडवं क्षौद्रं शीते क्षिप्त्वाऽथ मोदकान्| कारयेन्मरिचाजाजीपलचूर्णावचूर्णितान्||७४|| वातासृक्पित्तरोगेषु क्षतकासक्षयेषु च| शुष्यतां क्षीणशुक्राणां रक्ते चोरसि संस्थिते||७५|| कृशदुर्बलवृद्धानां पुष्टिवर्णबलार्थिनाम्| योनिदोषकृतस्रावहतानां चापि योषिताम्||७६||  

गर्भार्थिनीनां गर्भश्च स्रवेद्यासां म्रियेत वा| धन्या बल्या हितास्ताभ्यः शुक्रशोणितवर्धनाः||७७|| इति पञ्चमसर्पिर्मोदकाः|

गर्भार्थिनीनां गर्भश्च स्रवेद्यासां म्रियेत वा| धन्या बल्या हितास्ताभ्यः शुक्रशोणितवर्धनाः||७७||  

इति पञ्चमसर्पिर्मोदकाः|

 

gōkṣīrārdhāḍhakaṁ sarpiḥ prasthamikṣurasāḍhakam|  

gōkṣīrārdhāḍhakaṁ sarpiḥ prasthamikṣurasāḍhakam|  

vidāryāḥ svarasātprasthaṁ rasātprasthaṁ ca taittirāt||70||  

vidāryāḥ svarasātprasthaṁ rasātprasthaṁ ca taittirāt||70||  

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

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

Recipes:

==== Recipes ====

 

बस्तिदेशे विकुर्वाणे स्त्रीप्रसक्तस्य  मारुते|  

बस्तिदेशे विकुर्वाणे स्त्रीप्रसक्तस्य  मारुते|  

वातघ्नान् बृंहणान् वृष्यान् योगांस्तस्य प्रयोजयेत्||७८||  

वातघ्नान् बृंहणान् वृष्यान् योगांस्तस्य प्रयोजयेत्||७८||  

dIpte~agnau vidhireShaH syAnmande dIpanapAcanaH|  

dIpte~agnau vidhireShaH syAnmande dIpanapAcanaH|  

yakShmiNAM vihito grAhI bhinne shakRuti ceShyate||84||

yakShmiNAM vihito grAhI bhinne shakRuti ceShyate||84||

In person induging in excess sexual intercourse with women, (vitiated) vayu afflicts pelvic region. To such patients, recipes which are alleviators of vayu, promoters of nourishment and aphrodisiacs are to be administered.

In person induging in excess sexual intercourse with women, (vitiated) vayu afflicts pelvic region. To such patients, recipes which are alleviators of vayu, promoters of nourishment and aphrodisiacs are to be administered.

Boiled barley should be given to a patient suffering from kshata-kshina along with the milk of she- buffalo, mare, she-elephant and she-goat or with the meat soup or with vegetable soup or with phalamla sizzled with ghee.

Boiled barley should be given to a patient suffering from kshata-kshina along with the milk of she- buffalo, mare, she-elephant and she-goat or with the meat soup or with vegetable soup or with phalamla sizzled with ghee.

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

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

Saindhavadi churna:

 

==== Saindhavadi churna ====

 

पलिकं सैन्धवं शुण्ठी द्वे च सौवर्चलात् पले| कुडवांशानि वृक्षाम्लं दाडिमं पत्रमर्जकात्||८५||  

पलिकं सैन्धवं शुण्ठी द्वे च सौवर्चलात् पले| कुडवांशानि वृक्षाम्लं दाडिमं पत्रमर्जकात्||८५||  

एकैकं मरिचाजाज्योर्धान्यकाद्द्वे चतुर्थिके| शर्करायाः पलान्यत्र दश द्वे च प्रदापयेत्||८६||  

एकैकं मरिचाजाज्योर्धान्यकाद्द्वे चतुर्थिके| शर्करायाः पलान्यत्र दश द्वे च प्रदापयेत्||८६||  

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

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

Shadava recipe:

 

==== Shadava recipe ====

 

एका षोडशिका धान्याद्द्वे द्वेऽजाज्यजमोदयोः|  

एका षोडशिका धान्याद्द्वे द्वेऽजाज्यजमोदयोः|  

ताभ्यां दाडिमवृक्षाम्लं द्विर्द्विः सौवर्चलात्पलम्||८८||

ताभ्यां दाडिमवृक्षाम्लं द्विर्द्विः सौवर्चलात्पलम्||८८||

mandAnale shakRudbhede yakShmiNAmagnivardhanaH||90||  

mandAnale shakRudbhede yakShmiNAmagnivardhanaH||90||  

iti ShADavaH|

iti ShADavaH|

Nagabala kalpa:

 

==== Nagabala kalpa ====

 

पिबेन्नागबलामूलमर्धकर्षविवर्धितम्[ |  

पिबेन्नागबलामूलमर्धकर्षविवर्धितम्[ |  

पलं क्षीरयुतं मासं क्षीरवृत्तिरनन्नभुक्||९१||  

पलं क्षीरयुतं मासं क्षीरवृत्तिरनन्नभुक्||९१||  

eSha prayogaH puShTyAyurbalArogyakaraH paraH|  

eSha prayogaH puShTyAyurbalArogyakaraH paraH|  

maNDUkaparNyAH kalpo~ayaM shuNThImadhukayostathA||92||

maNDUkaparNyAH kalpo~ayaM shuNThImadhukayostathA||92||

Half karsha of the root (bark) of nagabala should be boiled with milk and given to the patient on the first day. Thereafter, the powder of nagabala root (bark) should be increased by half karsha every day, and given by boiling with milk. On eighth day, the quantity of nagabala- root will be one pala. Thereafter the patient should continue to take this drug in the dose of one pala for one month. While taking this drug boiled with milk, the patient should refrain from taking any cereals. Whenever he feels hungry, he should take only milk. The recipe is excellent for the promotion of nourishment, longevity, strength and immunity to diseases.

Half karsha of the root (bark) of nagabala should be boiled with milk and given to the patient on the first day. Thereafter, the powder of nagabala root (bark) should be increased by half karsha every day, and given by boiling with milk. On eighth day, the quantity of nagabala- root will be one pala. Thereafter the patient should continue to take this drug in the dose of one pala for one month. While taking this drug boiled with milk, the patient should refrain from taking any cereals. Whenever he feels hungry, he should take only milk. The recipe is excellent for the promotion of nourishment, longevity, strength and immunity to diseases.

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

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

 

यद्यत् सन्तर्पणं शीतमविदाहि हितं लघु|  

यद्यत् सन्तर्पणं शीतमविदाहि हितं लघु|  

अन्नपानं निषेव्यं तत्क्षतक्षीणैः सुखार्थिभिः||९३||  

अन्नपानं निषेव्यं तत्क्षतक्षीणैः सुखार्थिभिः||९३||  

tacca kuryAdavekShyAgniM vyAdhiM sAtmyaM balaM tathA||94||

tacca kuryAdavekShyAgniM vyAdhiM sAtmyaM balaM tathA||94||

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

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

 

उपेक्षिते भवेत्तस्मिन्ननुबन्धो हि यक्ष्मणः|  

उपेक्षिते भवेत्तस्मिन्ननुबन्धो हि यक्ष्मणः|  

प्रागेवागमनात्तस्य तस्मात्तं त्वरया जयेत्||९५||

प्रागेवागमनात्तस्य तस्मात्तं त्वरया जयेत्||९५||

upekShite bhavettasminnanubandho hi yakShmaNaH|  

upekShite bhavettasminnanubandho hi yakShmaNaH|  

prAgevAgamanAttasya tasmAttaM tvarayA jayet||95||

prAgevAgamanAttasya tasmAttaM tvarayA jayet||95||

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

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

 

तत्र श्लोकौ-  

तत्र श्लोकौ-  

क्षतक्षयसमुत्थानं सामान्यपृथगाकृतिम्|  

क्षतक्षयसमुत्थानं सामान्यपृथगाकृतिम्|  

uktavāñjyēṣṭhaśiṣyāya kṣatakṣīṇacikitsitē|  

uktavāñjyēṣṭhaśiṣyāya kṣatakṣīṇacikitsitē|  

tattvārthavidvītarajastamōdōṣaḥ [7] punarvasuḥ||97||

tattvārthavidvītarajastamōdōṣaḥ [7] punarvasuḥ||97||

tatra shlokau-  

tatra shlokau-  

kShatakShayasamutthAnaM sAmAnyapRuthagAkRutim|  

kShatakShayasamutthAnaM sAmAnyapRuthagAkRutim|  

ii)  Signs and symptoms of kshata-kshina in general and of each variety;

ii)  Signs and symptoms of kshata-kshina in general and of each variety;

iii) Incurability, palliability and curability of kshata-kshina; and

iii) Incurability, palliability and curability of kshata-kshina; and

iv) Successful treatment of curable variety of kshata-kshina.                                           [96-97]

iv) Successful treatment of curable variety of kshata-kshina.   [96-97]

 

इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलपूरिते चिकित्सितस्थाने क्षतक्षीणचिकित्सितं नामैकादशोऽध्यायः||११||

इत्यग्निवेशकृते तन्त्रेऽप्राप्ते दृढबलपूरिते चिकित्सितस्थाने क्षतक्षीणचिकित्सितं नामैकादशोऽध्यायः||११||

ityagnivēśakr̥tē tantrē'prāptē dr̥ḍhabalapūritē cikitsitasthānē  

ityagnivēśakr̥tē tantrē'prāptē dr̥ḍhabalapūritē cikitsitasthānē  

Thus, ends the eleventh chapter dealing with the treatment of kshata-kshina; in the section on the therapeutics of Agnivesa’s work as redacted by Caraka and not being available, restored by Drdhabala.

Thus, ends the eleventh chapter dealing with the treatment of kshata-kshina; in the section on the therapeutics of Agnivesa’s work as redacted by Caraka and not being available, restored by Drdhabala.

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

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

• The dhatu kshaya (depletion of tissues) is major pathological event in this disease. Hence bruhana(nourishment) and replenishment of depleted tissues is principle of management.  

• The dhatu kshaya (depletion of tissues) is major pathological event in this disease. Hence bruhana(nourishment) and replenishment of depleted tissues is principle of management.  

• With due regard to the agni (power of digestion), nature of disease, wholesomeness of diet, and regimens prescribed for rajayakshma, kasa and raktapitta.   

• With due regard to the agni (power of digestion), nature of disease, wholesomeness of diet, and regimens prescribed for rajayakshma, kasa and raktapitta.   

• Kshata- kshina , if untreated, results in rajayakshma. Therefore, treatment at appropriate time is necessary to prevent rajayakshma.  

• Kshata- kshina , if untreated, results in rajayakshma. Therefore, treatment at appropriate time is necessary to prevent rajayakshma.  

Vidhi vimarsha:

 

Derivation of term:

=== Vidhi Vimarsha ===

 

==== Derivation of term ====

 

Another reading of this term ‘kshata kshina’ is ‘kshina kshata’. This term implies that the injury to the chest (kshata) is caused by diminution of vital elements, like semen and ojas (kshina).

Another reading of this term ‘kshata kshina’ is ‘kshina kshata’. This term implies that the injury to the chest (kshata) is caused by diminution of vital elements, like semen and ojas (kshina).

Some other scholar read ‘kshata kshina’ as ‘kshata kshaya’. According to them, description of this chapter refers to two diseases, viz. ‘kshata’ and ‘kshaya’. In this context, vide the description in the verse no.13, the cardinal sign of both ‘kshata’ and ‘kshina’ are described. This view is not tenable, because this disease is described in the singular form, while describing the premonitory signs and symptoms (vide verse 12) and prognostic signs and symptoms (vide verse 14).

Some other scholar read ‘kshata kshina’ as ‘kshata kshaya’. According to them, description of this chapter refers to two diseases, viz. ‘kshata’ and ‘kshaya’. In this context, vide the description in the verse no.13, the cardinal sign of both ‘kshata’ and ‘kshina’ are described. This view is not tenable, because this disease is described in the singular form, while describing the premonitory signs and symptoms (vide verse 12) and prognostic signs and symptoms (vide verse 14).

From the above it appears that the ‘kshata kshina’ is a singular entity as a disease, and as a result of causative factors, its signs and symptoms are manifested in two different ways.  

From the above it appears that the ‘kshata kshina’ is a singular entity as a disease, and as a result of causative factors, its signs and symptoms are manifested in two different ways.  

Nirghata:

==== Nirghata ====

 

“Nirghata” is a type of weapon.  Alternattively, the term ‘nirghata’ implies throwing a substance with the impact of excessive strength.

“Nirghata” is a type of weapon.  Alternattively, the term ‘nirghata’ implies throwing a substance with the impact of excessive strength.

Difference between kshata kshina and rajayakshma:  

Difference between kshata kshina and rajayakshma:  

The term kshina, meaning diminution of tissue elements, implies diminution of semen and ojas (vital essence).

The term kshina, meaning diminution of tissue elements, implies diminution of semen and ojas (vital essence).

According to some other scholars, the description in verse 13, pertains to the two groups of signs and symptoms, which are manifested in two different stages (type of this disease).

According to some other scholars, the description in verse 13, pertains to the two groups of signs and symptoms, which are manifested in two different stages (type of this disease).

Etiological factors:

 

==== Etiological factors ====

 

All the mentioned etiological factors can be divided into two categories viz. (1) exogenous factors related to over-exertion/ strenuous malpractice of physical activity that causes trauma to the lung tissues, (2) endogenous factors related to malnutrition that causes depletion of body tissues. The etiological factors described for kshata are related to those that causes spontaneous lung injury and the clinical feature suggest that it is a condition of pneumothorax. Studies showed that strenuous athletic activites like vigorous swimming, heavy weight lifting, jolting, etc. can cause pneumothorax (PTX) and pneumomediastinum (PTM).  

All the mentioned etiological factors can be divided into two categories viz. (1) exogenous factors related to over-exertion/ strenuous malpractice of physical activity that causes trauma to the lung tissues, (2) endogenous factors related to malnutrition that causes depletion of body tissues. The etiological factors described for kshata are related to those that causes spontaneous lung injury and the clinical feature suggest that it is a condition of pneumothorax. Studies showed that strenuous athletic activites like vigorous swimming, heavy weight lifting, jolting, etc. can cause pneumothorax (PTX) and pneumomediastinum (PTM).  

Differential diagnosis:

 

==== Differential diagnosis ====

Clinical Features of Sahasajanya Rajayaksma Clinical Features of Kshata-Kshina Clinical Features of Kshataja Kasa

Clinical Features of Sahasajanya Rajayaksma Clinical Features of Kshata-Kshina Clinical Features of Kshataja Kasa

Examing the etiological factors, pathogenesis and clinical features it is clear all the three disease have same etiopathogenesis as well as clinical manifestation.  Now the question arise that if all these three disease are same then what is the reason for their separate description? To answer this question it is necessary to explore the similarity and distinction between these three diseases. The main difference between these three appears in their management as follows:

Examing the etiological factors, pathogenesis and clinical features it is clear all the three disease have same etiopathogenesis as well as clinical manifestation.  Now the question arise that if all these three disease are same then what is the reason for their separate description? To answer this question it is necessary to explore the similarity and distinction between these three diseases. The main difference between these three appears in their management as follows:

Table 1: Difference in the treatment of Sahasajanya Rajayakshma and Kshata-Kshina

Table 1: Difference in the treatment of Sahasajanya Rajayakshma and Kshata-Kshina

4. Use of Sandhaniya drugs like laksha, madhuyasti is not mentioned.

4. Use of Sandhaniya drugs like laksha, madhuyasti is not mentioned.

5. Pancakarma is not indicated.

5. Pancakarma is not indicated.

Kshaya is described as one among the four causes of rajayakshma and at some place it is used as synonym of rajayakshma like kshayaja kasa, kshayaja grahani etc.  

Kshaya is described as one among the four causes of rajayakshma and at some place it is used as synonym of rajayakshma like kshayaja kasa, kshayaja grahani etc.  

From the above discussion it is very clear that ksayaja kasa refers to kasa in rajayakshma i.e. ksaya is used as a synonym of rajayakshma and it denotes a state where the disease causes so much debility and immunity is compromised to such extent that secondary infection becomes more severe.  While describing the management of ksayaja kasa, Acharya Caraka describes the treatment of discoloration of urine and dysuria as:

From the above discussion it is very clear that ksayaja kasa refers to kasa in rajayakshma i.e. ksaya is used as a synonym of rajayakshma and it denotes a state where the disease causes so much debility and immunity is compromised to such extent that secondary infection becomes more severe.  While describing the management of ksayaja kasa, Acharya Caraka describes the treatment of discoloration of urine and dysuria as:

Acarya Caraka says that if the patient of ksayaja kasa suffers from discoloration of urine or dysuria then he should be given ghrit processed with the decoction of kadamba, vidarikanda and tala.

Charaka says that if the patient of ksayaja kasa suffers from discoloration of urine or dysuria then he should be given ghrit processed with the decoction of kadamba, vidarikanda and tala.

This shows that discoloration of urine (hematuria) is associated with Ksaya or rajayakshma. Genitourinary tuberculosis is the most common cause of painless hematuria.With one-third of the world's population currently harboring latent mycobacterium tuberculosis infection, many modern day texts on nephrology do not discuss genitourinary TB as a serious cause of urological infections and advanced renal disease. Classic TB symptoms are rarely observed in these patients, compounding the difficulty of a diagnosis. Many times treatment of renal TB is delayed due to the vagueness of chronic, intermittent, and nonspecific urinary symptoms. Thus it is clear that the clinical features described for kshina are the features of renal tuberculosis that may appear abruptly (like sudden onset of hematuria in a patient of renal tuberculosis requiring prompt management).

This shows that discoloration of urine (hematuria) is associated with Ksaya or rajayakshma. Genitourinary tuberculosis is the most common cause of painless hematuria.With one-third of the world's population currently harboring latent mycobacterium tuberculosis infection, many modern day texts on nephrology do not discuss genitourinary TB as a serious cause of urological infections and advanced renal disease. Classic TB symptoms are rarely observed in these patients, compounding the difficulty of a diagnosis. Many times treatment of renal TB is delayed due to the vagueness of chronic, intermittent, and nonspecific urinary symptoms. Thus it is clear that the clinical features described for kshina are the features of renal tuberculosis that may appear abruptly (like sudden onset of hematuria in a patient of renal tuberculosis requiring prompt management).

Now let us try to understand the meaning of second word- kshata and its significance as a disease.  Kshata means trauma or injury. Sahasajanya rajayakshma cause kshata in the urah(chest) similarly in kshataja kasa also there is urahkshata. Thus there are three places where urahkshata is encountered in Ayurvedic texts namely- sahasajanya rajayakshma, kshataja kasa and kshatakshina. Let us discuss the similarity between these three conditions to draw a conclusion.

Now let us try to understand the meaning of second word- kshata and its significance as a disease.  Kshata means trauma or injury. Sahasajanya rajayakshma cause kshata in the urah(chest) similarly in kshataja kasa also there is urahkshata. Thus there are three places where urahkshata is encountered in Ayurvedic texts namely- sahasajanya rajayakshma, kshataja kasa and kshatakshina. Let us discuss the similarity between these three conditions to draw a conclusion.

5. Fighting with strong animal or try to restrain them,

5. Fighting with strong animal or try to restrain them,

6. Excessive sexual indulgence.

6. Excessive sexual indulgence.

Table 5: Similarity between the samprapti (pathogenesis) of sahasajanya rajayaksma, kshata-kshina and kshataja kasa:

Table 5: Similarity between the samprapti (pathogenesis) of sahasajanya rajayaksma, kshata-kshina and kshataja kasa:

| Kshata kshina gets manifested as a result of the injury to the chest due to the excessive strenuous physical activity. Indulgence in strenuous physical activity causes injury to the chest.

| Kshata kshina gets manifested as a result of the injury to the chest due to the excessive strenuous physical activity. Indulgence in strenuous physical activity causes injury to the chest.

 

==== Kshata –Kshina as complication of Rajayakshma ====

Kshata –Kshina as complication of Rajayakshma:

यच्चोपदेक्ष्यते पथ्यं क्षतक्षीणचिकित्सिते| यक्ष्मिणस्तत् प्रयोक्तव्यं बलमांसाभिवृद्धये| (Ca.Ci.8/183)

यच्चोपदेक्ष्यते पथ्यं क्षतक्षीणचिकित्सिते| यक्ष्मिणस्तत् प्रयोक्तव्यं बलमांसाभिवृद्धये| (Ca.Ci.8/183)

Here, Acharya Caraka says that the regimens as described in next chapter of Kshata – Kshina should also use for the management of Rajayaksma for enhancing strength and muscle mass.

Here, Acharya Caraka says that the regimens as described in next chapter of Kshata – Kshina should also use for the management of Rajayaksma for enhancing strength and muscle mass.

If the patient suffering from kshata- kshina is not given appropriate treatment on time, then this may lead to rajayakshma. Therefore well before the arrival of this ailment (attack of rajayakshma), the kshata- kshina should be treated, subdued (cured).     

If the patient suffering from kshata- kshina is not given appropriate treatment on time, then this may lead to rajayakshma. Therefore well before the arrival of this ailment (attack of rajayakshma), the kshata- kshina should be treated, subdued (cured).     

In the above discussion, we see that there is conflict between the statements given in chapter originally written by Acharya Caraka (Ca.Ci. 8/183) and that restored by Acharya Dalhana (Ca. Ci.11/94). In chapter 8th, Acharya says that the treatment given in next chapter is also applicable for Rajayaksma whereas in chapter 11th, Acharya says that the regimens given in the chapter of Rajayaksma should be given to the patient of Kshata- Kshina. Thus it is clear that the management of both the diseases is interrelated but the controversy appears in accepting the sequence of protocol to be followed for the management of diseases. Therefore it can be concluded that Kshata- Kshina is the specific state of Rajayaksma that appears acutely and required prompt treatment. Accepting Kshata- Kshina as a singular disease refers to a cascade of autoimmune reactions that results in a complex syndrome known as Pulmonary- Renal Syndrome. Indulgence in the specific etiological factors provokes the activity of specific autoantibodies pervading the specific loci and destructing the body tissues that ultimately results in dreaded consequences.

In the above discussion, we see that there is conflict between the statements given in chapter originally written by Acharya Caraka (Ca.Ci. 8/183) and that restored by Acharya Dalhana (Ca. Ci.11/94). In chapter 8th, Acharya says that the treatment given in next chapter is also applicable for Rajayaksma whereas in chapter 11th, Acharya says that the regimens given in the chapter of Rajayaksma should be given to the patient of Kshata- Kshina. Thus it is clear that the management of both the diseases is interrelated but the controversy appears in accepting the sequence of protocol to be followed for the management of diseases. Therefore it can be concluded that Kshata- Kshina is the specific state of Rajayaksma that appears acutely and required prompt treatment. Accepting Kshata- Kshina as a singular disease refers to a cascade of autoimmune reactions that results in a complex syndrome known as Pulmonary- Renal Syndrome. Indulgence in the specific etiological factors provokes the activity of specific autoantibodies pervading the specific loci and destructing the body tissues that ultimately results in dreaded consequences.

Management of kshata-kshina:

 

==== Management of kshata-kshina ====

 

Herbs used for the management of Kshata-kshina can be classified in two category viz. (1) having antioxidant properties and (2) having hemostatic and bone healing properties.

Herbs used for the management of Kshata-kshina can be classified in two category viz. (1) having antioxidant properties and (2) having hemostatic and bone healing properties.

Different views on formulations:  

Different views on formulations:  

For the preparation of the decoction, the eleven drugs mentioned above should be added with eight times of water and reduced to one forth. Thus the quantity of the decoction will be twenty two palas. [This is in accordance with the commentary of Gangadhara. Cakrapani’s commentary in Nirnayasagara edition is different from C.K. Sen & Co. edition. Both of them perhaps, full of textual incongruities]. The quantity of milk should be four times of ghee. According to some scholars, milk should be four times of the quantity of the decoction.

For the preparation of the decoction, the eleven drugs mentioned above should be added with eight times of water and reduced to one forth. Thus the quantity of the decoction will be twenty two palas. [This is in accordance with the commentary of Gangadhara. Cakrapani’s commentary in Nirnayasagara edition is different from C.K. Sen & Co. edition. Both of them perhaps, full of textual incongruities]. The quantity of milk should be four times of ghee. According to some scholars, milk should be four times of the quantity of the decoction.

For the preparation of decoction, eight palas of madhuka and one prastha of draksha should be added with four times of water and reduced to one fourth. Thus in total, the quantity of decoction will be one and half prastha. [According to general rule (paribhasha), the total quantity of liquid should be four times of ghee. But if the quantity of decoction is taken according to the above mentioned commentary of Cakrapani, then it will be less than the quantity of ghee. This may, however be treated as an exception to the general rule.]

For the preparation of decoction, eight palas of madhuka and one prastha of draksha should be added with four times of water and reduced to one fourth. Thus in total, the quantity of decoction will be one and half prastha. [According to general rule (paribhasha), the total quantity of liquid should be four times of ghee. But if the quantity of decoction is taken according to the above mentioned commentary of Cakrapani, then it will be less than the quantity of ghee. This may, however be treated as an exception to the general rule.]

Sarpi guda:

 

==== Sarpi guda ====

 

This medicated ghee is prescribed to be prepared by adding sugar and honey. This will reduce the ghee to the form of a paste and it is suitable only to be used as linctus. This should be given to the patient having aggravated pitta. If sugar and honey are not added to the medicated ghee, then it remains in the liquid form (in warm condition). This liquid form of medicated ghee should be given to the patient having aggravated vayu, to drink. Alternatively, the medicated ghee mixed with the powders, prescribed in verse 54, and made to a paste form, should be used by the patient having aggravated pitta. When it is in a melted state, it should be given to the patient having aggravated vayu.

This medicated ghee is prescribed to be prepared by adding sugar and honey. This will reduce the ghee to the form of a paste and it is suitable only to be used as linctus. This should be given to the patient having aggravated pitta. If sugar and honey are not added to the medicated ghee, then it remains in the liquid form (in warm condition). This liquid form of medicated ghee should be given to the patient having aggravated vayu, to drink. Alternatively, the medicated ghee mixed with the powders, prescribed in verse 54, and made to a paste form, should be used by the patient having aggravated pitta. When it is in a melted state, it should be given to the patient having aggravated vayu.

The medicated ghee is generally given in a small dose, i.e. one karsha (12ml). This quantity is enough to alleviate pitta, but it does not suppress the agni (the power of digestion).

The medicated ghee is generally given in a small dose, i.e. one karsha (12ml). This quantity is enough to alleviate pitta, but it does not suppress the agni (the power of digestion).

5.Vanga mishrana 250 to 500 mg In between two meals Milk

5.Vanga mishrana 250 to 500 mg In between two meals Milk

Future Scope for Research:

=== Future Scope for Research ===

 

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

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

• In vitro and in-vivo evaluation of hemostatic property of Boerhavia diffusa and clinical demonstration of its use in hemoptysis.

• In vitro and in-vivo evaluation of hemostatic property of Boerhavia diffusa and clinical demonstration of its use in hemoptysis.

Further reading:  

Further reading:  

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

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

[2] Miles JW, Barrett GR. Rib fractures in athletes. Sports Med 1991;12:66 – 9.

[2] Miles JW, Barrett GR. Rib fractures in athletes. Sports Med 1991;12:66 – 9.

[3] Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma 1990;30:695 – 700.

[3] Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma 1990;30:695 – 700.

[4] Armstrong CP, Vanderspuy J. The fractured scapula: importance in management based on series of 62 patients. Injury 1984;15:324 – 9.

[4] Armstrong CP, Vanderspuy J. The fractured scapula: importance in management based on series of 62 patients. Injury 1984;15:324 – 9.

[5] Ferro RT, McKeag DB. Neck pain and dyspnea in a swimmer. Phys Sports Med 1999;27.

[5] Ferro RT, McKeag DB. Neck pain and dyspnea in a swimmer. Phys Sports Med 1999;27.

[6] Neer II CS. Fractures about the shoulder. In: Rockwood Jr CA, Green DP, editors. Fractures. Philadelphia: JD Lippincott; 1984. p. 713 – 21.

[6] Neer II CS. Fractures about the shoulder. In: Rockwood Jr CA, Green DP, editors. Fractures. Philadelphia: JD Lippincott; 1984. p. 713 – 21.

[7] Pfeiffer RP, Young TR. Case report: spontaneous pneumothorax in a jogger. Phys Sportsmed 1980;8:65 – 7.

[7] Pfeiffer RP, Young TR. Case report: spontaneous pneumothorax in a jogger. Phys Sportsmed 1980;8:65 – 7.

[8] Marnejon T, Sarac S, Cropp AJ. Spontaneous pneumothorax in weightlifters. J Sports Med

[8] Marnejon T, Sarac S, Cropp AJ. Spontaneous pneumothorax in weightlifters. J Sports Med

Phys Fitness 1995;35:124 – 6.

Phys Fitness 1995;35:124 – 6.

[9] Simoneaux SF, Murphy BJ, Tehranzadeh J. Spontaneous pneumothorax in a weightlifter. Am J Sports Med 1990;18:647 – 8.

[9] Simoneaux SF, Murphy BJ, Tehranzadeh J. Spontaneous pneumothorax in a weightlifter. Am J Sports Med 1990;18:647 – 8.

[18] Harmer PA, Moriarty J, Walsh M, Bean M, Cramer J. Distant entry pneumothorax in a competitive fencer. Br J Sports Med 1996;30:265–6.

[18] Harmer PA, Moriarty J, Walsh M, Bean M, Cramer J. Distant entry pneumothorax in a competitive fencer. Br J Sports Med 1996;30:265–6.

[20] Fischer RP, Flynn TC, Miller PW, Thompson DA. Scapular fractures and major ipsilateral upper torso injuries. Curr Concepts Trauma Care 1985;1:14– 6.

[20] Fischer RP, Flynn TC, Miller PW, Thompson DA. Scapular fractures and major ipsilateral upper torso injuries. Curr Concepts Trauma Care 1985;1:14– 6.

[21] Morgan EJ, Henderson DA. Pneumomediastinum as a complication of athletic competition.

[21] Morgan EJ, Henderson DA. Pneumomediastinum as a complication of athletic competition.

Thorax 1981;36:155–6.

Thorax 1981;36:155–6.

[22] O’Kane J, O’Kane E, Marquet J. Delayed complication of a rib fracture. Phys Sportsmed

[22] O’Kane J, O’Kane E, Marquet J. Delayed complication of a rib fracture. Phys Sportsmed