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|title=Shosha Nidana

|title=Shosha Nidana

|titlemode=append

|titlemode=append

|keywords=kshaya, shosha, yakshma, sahasa, visamashana, Nidanarthakara Roga Vyadhiksamatva, Ojakshaya, chronic wasting diseases, Immune defense, Rasayana, exertion, improper dietary habits, suppression of natural urges, depletion of tissue

|keywords=kshaya, shosha, yakshma, sahasa, visamashana, Nidanarthakara Roga Vyadhiksamatva, Ojakshaya, chronic wasting diseases, Immune defense, Rasayana, exertion, improper dietary habits, suppression of natural urges, depletion of tissue, ayurveda, charak samhita

|description=Nidana Sthana Chapter 6. Diagnosis and etiopathogenesis of Progressive wasting disease

|description=Nidana Sthana Chapter 6. Diagnosis and etiopathogenesis of Progressive wasting disease

}}

}}

}}

}}

=== Introduction ===

== Introduction ==

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There are three interrelated entities mentioned by Charak in three distinct chapters within [[Charak Samhita]]: [[Shosha Nidana]] (Ni.6), ''rajayakshma'' (Chi.8) and ''kshataksheena'' (Chi. 11).  

There are three interrelated entities mentioned by Charak in three distinct chapters within [[Charak Samhita]]: [[Shosha Nidana]] (Ni.6), ''rajayakshma'' (Chi.8) and ''kshataksheena'' (Chi. 11).  

While the focus of this chapter is to delineate the views of Charak, Sushruta in his text differs in his views on the relationship between ''shosha'' and ''yakshma''. While Charak considers them as dependent entities as mentioned above, Susruta considers ''shosha'' distinctly different disease that could manifest itself in any of seven different variants caused by seven different causative factors (''vyavaya'' or excessive sexual indulgence, ''shoka'' or sorrow, ''jara'' or rapid aging process, ''vyayama'' or excessive exercise, ''adhwagaman'' or excessive travelling, ''vrana'' or wound/trauma, and ''urakshata'' or chest injury.

While the focus of this chapter is to delineate the views of Charak, Sushruta in his text differs in his views on the relationship between ''shosha'' and ''yakshma''. While Charak considers them as dependent entities as mentioned above, Susruta considers ''shosha'' distinctly different disease that could manifest itself in any of seven different variants caused by seven different causative factors (''vyavaya'' or excessive sexual indulgence, ''shoka'' or sorrow, ''jara'' or rapid aging process, ''vyayama'' or excessive exercise, ''adhwagaman'' or excessive travelling, ''vrana'' or wound/trauma, and ''urakshata'' or chest injury.

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===Sanskrit text, Transliteration and English Translation===

==Sanskrit text, Transliteration and English Translation==

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Now I shall expound upon the chapter on diagnosis of ''shosha'', said Lord Atreya. [1-2]

Now we shall expound the chapter "Shosha Nidana" (Diagnosis and etiopathogenesis of Progressive wasting disease). Thus said Lord Atreya. [1-2]

==== Four Causes of ''shosha'' ====

=== Four Causes of shosha ===

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Each of these causes will be explained here in detail:

Each of these causes will be explained here in detail:

===== 1. Overexertion as a cause =====  

==== 1. Overexertion ====  

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===== 2. Suppression of natural urges as a cause =====

==== 2. Suppression of natural urges ====

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Here is the verse: Setting all other things aside, one should protect the body, because in its absence there will be complete absence of all the bodily entities. [6-7]

Here is the verse: Setting all other things aside, one should protect the body, because in its absence there will be complete absence of all the bodily entities. [6-7]

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===== 3. Wasting as cause =====

==== 3. Depletion of tissues ====

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Now explained is wasting as the cause of ''shosha''. When a person is suffering excessively from anxiety and grief, or from emotions like envy, fear, anger, etc., and if the person is also afflicted with a wasting disorder and/or using rough food and drinks, or if a congenitally weak person is subjected to fasting or malnutrition, his ''ojas'' gets diminished leading to ''shosha''. Due to want of proper management and care, he could get afflicted with the disease having symptoms to be described later. [8]

Now explained is depletion of tissues as the cause of ''shosha''. When a person is suffering excessively from anxiety and grief, or from emotions like envy, fear, anger, etc., and if the person is also afflicted with a wasting disorder and/or using rough food and drinks, or if a congenitally weak person is subjected to fasting or malnutrition, his ''ojas'' gets diminished leading to ''shosha''. Due to want of proper management and care, he could get afflicted with the disease having symptoms to be described later. [8]

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===== 4.Excessive sexual indulgence as a cause* =====  

==== 4.Excessive sexual indulgence* ====  

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===== 5. Irregular meals/Improper meals as a cause =====

==== 5. Irregular meals/Improper meals ====

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==== Prodromal symptoms ====

=== Prodromal symptoms ===

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''Shosha''’s prodromal symptoms include coryza, frequent sneezing, excessive secretion of mucus, a sweet aftertaste in the mouth, aversion to food, exhaustion during meal time, finding fault with utensils, water, cereals, pulses flour preparations, spicy preparation and caterers who are free from fault or have a little fault. A person afflicted with ''shosha'' will experience nausea after meals, intermittent vomiting during meals, swellings in the face and feet, tendency of frequently looking at the hands, excessive whitishness in the eyes, curiosity about measurement of arms, longing for women, disgust, loathsome view of his body, frequent dreams of waterless/arid places as well as places such as deserted villages, cities, districts and regions, of forests dried, burnt and destroyed. Such a person would often be using vehicles drawn by, or coming in contact with, or riding animals like chameleon, peacock, monkey, parrot, serpent, crow, owl, dog, camel, ass and boar, and riding over heaps of hair, bones, ash, chaff and charcoal.  [13]

''Shosha''’s prodromal symptoms include coryza, frequent sneezing, excessive secretion of mucus, a sweet aftertaste in the mouth, aversion to food, exhaustion during meal time, finding fault with utensils, water, cereals, pulses flour preparations, spicy preparation and caterers who are free from fault or have a little fault. A person afflicted with ''shosha'' will experience nausea after meals, intermittent vomiting during meals, swellings in the face and feet, tendency of frequently looking at the hands, excessive whitishness in the eyes, curiosity about measurement of arms, longing for women, disgust, loathsome view of his body, frequent dreams of waterless/arid places as well as places such as deserted villages, cities, districts and regions, of forests dried, burnt and destroyed. Such a person would often be using vehicles drawn by, or coming in contact with, or riding animals like chameleon, peacock, monkey, parrot, serpent, crow, owl, dog, camel, ass and boar, and riding over heaps of hair, bones, ash, chaff and charcoal.  [13]

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==== Eleven symptoms ====

=== Eleven symptoms ===

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There are eleven typical symptoms of ''shosha'' (mentioned in this verse) such as fullness of head, cough, dyspnea, hoarseness of voice, vomiting of sputum, hemoptysis, chest-pain, pain in shoulders, fever, diarrhea, and anorexia. [14]

There are eleven typical symptoms of ''shosha'' (mentioned in this verse) such as fullness of head, cough, dyspnea, hoarseness of voice, vomiting of sputum, hemoptysis, chest-pain, pain in shoulders, fever, diarrhea, and anorexia. [14]

==== Prognosis of disease ====

=== Prognosis of disease ===

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On the contrary, the patient who is weak and has excessively diminished strength, muscles and blood should be taken as having numerous symptoms including the fatal ones, even if he has few symptoms and no fatal signs because of his intolerance to the intensity of disease and drugs. Hence he should be discarded (for treatment) because the fatal signs appear in a moment and without any apparent cause.[16]

On the contrary, the patient who is weak and has excessively diminished strength, muscles and blood should be taken as having numerous symptoms including the fatal ones, even if he has few symptoms and no fatal signs because of his intolerance to the intensity of disease and drugs. Hence he should be discarded (for treatment) because the fatal signs appear in a moment and without any apparent cause.[16]

==== Summary ====

=== Summary ===

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Thus, ends the sixth chapter on diagnosis of ''shosha'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [16-17]

Thus, ends the sixth chapter on diagnosis of ''shosha'' in [[Nidana Sthana]] in the treatise composed by Agnivesha and redacted by Charak. [16-17]

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

== Tattva Vimarsha (Fundamental Principles) ==

* Wasting or emaciating conditions like ''shosha'' occur because of four factors: ''Sahasa'' (overexertion), ''Sandhaarana'' (suppression of natural urges), ''Kshaya'' (emaciation), and ''Vishamasana'' (Dietary error).

* Wasting or emaciating conditions like ''shosha'' occur because of four factors: ''Sahasa'' (overexertion), ''Sandhaarana'' (suppression of natural urges), ''Kshaya'' (emaciation), and ''Vishamasana'' (Dietary error).

* Etiological factors, ''dosha'' vitiation and clinical features help in understanding the pathophysiology of the disease.

* Etiological factors, ''dosha'' vitiation and clinical features help in understanding the pathophysiology of the disease.

=== ''Vidhi Vimarsha'' / Applied Inferences===

== Vidhi Vimarsha (Applied Inferences) ==

The point of significance in this chapter is the identification of the intermediary clinical state called ''shosha'' which is the precursor to ''rajayakshma'', a pathological state warranting early diagnosis and treatment as a promotive health care strategy. Sushruta acknowledges the specific role of microbial infection through direct physical contacts as the real cause, while Charak emphasizes upon the role of pre-existing progressive weakness and emaciation accompanied with lowered ''vyadhikshamatva'' (poor immune strength) as some of the key causative factors responsible for the entire spectrum of the disease complex that includes ''shosha, kshaya,'' and ''rajayakshma''. This fundamental idea for which Charak devotes one full chapter in [[Nidana Sthana]] is an original contribution of Charak, drawing specific attention to the fact that the host factor and host resistance against disease is more important than the causative microbial organism in case of contagious diseases like tuberculosis. It also endorses the Ayurvedic stand that the solution lies in enhancing or strengthening the immunity of the host and not merely in tackling the microorganisms afflicting the person. Use of antibiotics, as is prevalent in western medicine, is now dwindling because of their adverse side effects and rapidly emerging problems associated with drug resistance. In fact, there is now a growing consensus that an idea of an antibiotic war in medicine is anti-life and anti-health.

The point of significance in this chapter is the identification of the intermediary clinical state called ''shosha'' which is the precursor to ''rajayakshma'', a pathological state warranting early diagnosis and treatment as a promotive health care strategy. Sushruta acknowledges the specific role of microbial infection through direct physical contacts as the real cause, while Charak emphasizes upon the role of pre-existing progressive weakness and emaciation accompanied with lowered ''vyadhikshamatva'' (poor immune strength) as some of the key causative factors responsible for the entire spectrum of the disease complex that includes ''shosha, kshaya,'' and ''rajayakshma''. This fundamental idea for which Charak devotes one full chapter in [[Nidana Sthana]] is an original contribution of Charak, drawing specific attention to the fact that the host factor and host resistance against disease is more important than the causative microbial organism in case of contagious diseases like tuberculosis. It also endorses the Ayurvedic stand that the solution lies in enhancing or strengthening the immunity of the host and not merely in tackling the microorganisms afflicting the person. Use of antibiotics, as is prevalent in western medicine, is now dwindling because of their adverse side effects and rapidly emerging problems associated with drug resistance. In fact, there is now a growing consensus that an idea of an antibiotic war in medicine is anti-life and anti-health.

As mentioned earlier, Ayurvedic texts propound the doctrine of an immunocompromised state as the precursor of chronic wasting diseases like ''shosha, kshaya'' and ''yakshma''. Sushruta, while describing the ''samkramaka'' (contagious diseases) specially, observes that ''jwara'', ''shosha, rajayakshma, abhisyanda'' or conjunctivitis, and ''kushtha'' (or dermatoses such as leprosy) spread from person to person by contact. The spread of such diseases may be prevented by avoiding personal contacts and by promoting ''vyadhiksamatva'' or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of ''rasayana'' therapy.

As mentioned earlier, Ayurvedic texts propound the doctrine of an immunocompromised state as the precursor of chronic wasting diseases like ''shosha, kshaya'' and ''yakshma''. Sushruta, while describing the ''samkramaka'' (contagious diseases) specially, observes that ''jwara'', ''shosha, rajayakshma, abhisyanda'' or conjunctivitis, and ''kushtha'' (or dermatoses such as leprosy) spread from person to person by contact. The spread of such diseases may be prevented by avoiding personal contacts and by promoting ''vyadhiksamatva'' or immunity with the help of leading a healthy lifestyle, following good nutrition and through administration of ''rasayana'' therapy.

==== ''Ojas'' (vital essence of the body) ====

=== ''Ojas'' (vital essence of the body) ===

The Ayurvedic classics describe a unique hitherto-less-known concept of ''ojas'' (vital essence of the body) that is responsible for biological strength (including immunity). ''Ojas'' is the final product of tissue nourishment and is quintessential to all the seven ''dhatus'' namely ''rasa, rakta, mamsa, meda, asthi, majja,'' and ''shukra''. Sushruta describes ''ojas'' as the ''param teja'' of the ''saptadhatus'' and as the ''bala'' or biological strength of an individual. ''Ojas'' is of two kinds, namely, ''para ojas'' and ''apara ojas''. ''Para ojas'' is subtle and present in very minute quantities in the heart while ''apara ojas'' is gross and as much as half an ''anjali'' (handful) in quantity spread all over the body. ''Para ojas'' is vital to life and any damage or vitiation of it may lead to instant death. ''Apara ojas'' is responsible for gross immune strength.  

The Ayurvedic classics describe a unique hitherto-less-known concept of ''ojas'' (vital essence of the body) that is responsible for biological strength (including immunity). ''Ojas'' is the final product of tissue nourishment and is quintessential to all the seven ''dhatus'' namely ''rasa, rakta, mamsa, meda, asthi, majja,'' and ''shukra''. Sushruta describes ''ojas'' as the ''param teja'' of the ''saptadhatus'' and as the ''bala'' or biological strength of an individual. ''Ojas'' is of two kinds, namely, ''para ojas'' and ''apara ojas''. ''Para ojas'' is subtle and present in very minute quantities in the heart while ''apara ojas'' is gross and as much as half an ''anjali'' (handful) in quantity spread all over the body. ''Para ojas'' is vital to life and any damage or vitiation of it may lead to instant death. ''Apara ojas'' is responsible for gross immune strength.  

It cannot be overemphasized that while looking at the above mentioned ancient classical descriptions on ''ojabala'' and ''bala-dosha'' it seems immunology was already highly advanced in the ''Samhita'' period of [[Ayurveda]] and the knowledge in this field was almost comparable with the latest basic knowledge of immunology as known today.

It cannot be overemphasized that while looking at the above mentioned ancient classical descriptions on ''ojabala'' and ''bala-dosha'' it seems immunology was already highly advanced in the ''Samhita'' period of [[Ayurveda]] and the knowledge in this field was almost comparable with the latest basic knowledge of immunology as known today.

==== Ancient Ayurvedic leads in Microbiology ====

=== Ancient Ayurvedic leads in Microbiology ===

It will be pertinent to review the concept of microbiology and parasitology in Ayurvedic classics in the context of immunity and body resistance. ''Ojas, bala'' and ''vyadhikshamatva'' need to be adequate within the body for it to possess immunity. Though the role of microbes in pathology was not known in modern medicine 200 years ago, [[Ayurveda]] had a good knowledge of their role, albeit of a primitive nature. [[Ayurveda]] describes two kinds of organisms, namely ''prakrita'' (non-pathogenic) and ''vaikrita'' (pathogenic). Also described are two categories of pathogens/parasites, namely, external and internal. The internal organisms are mainly of three categories in terms of their natural environments: those that thrive on mucus (''shleshma''), those thriving in fecal matter, and those thriving in blood. Some of these, particularly the ones thriving in fecal matter seem to be intestinal parasites while others simulate microbes. The texts repeatedly advocate protecting surgical wounds from these organisms. There is also a clear description of vector borne diseases and that diseases such as leprosy, tuberculosis, conjunctivitis and fever as contagious diseases spread by contact with other patients or vectors.

It will be pertinent to review the concept of microbiology and parasitology in Ayurvedic classics in the context of immunity and body resistance. ''Ojas, bala'' and ''vyadhikshamatva'' need to be adequate within the body for it to possess immunity. Though the role of microbes in pathology was not known in modern medicine 200 years ago, [[Ayurveda]] had a good knowledge of their role, albeit of a primitive nature. [[Ayurveda]] describes two kinds of organisms, namely ''prakrita'' (non-pathogenic) and ''vaikrita'' (pathogenic). Also described are two categories of pathogens/parasites, namely, external and internal. The internal organisms are mainly of three categories in terms of their natural environments: those that thrive on mucus (''shleshma''), those thriving in fecal matter, and those thriving in blood. Some of these, particularly the ones thriving in fecal matter seem to be intestinal parasites while others simulate microbes. The texts repeatedly advocate protecting surgical wounds from these organisms. There is also a clear description of vector borne diseases and that diseases such as leprosy, tuberculosis, conjunctivitis and fever as contagious diseases spread by contact with other patients or vectors.

It is interesting to note that these ancient texts recognized the existence of “friendly” non-pathogenic organisms and their functions - something that is only now being considered the greatest discovery in microbiology .It is claimed by modern scientists that our living body is made up of 10 trillion somatic cells and is home to some 100 trillion friendly microbes. This “empire” of microbes is called Microbiome. Understanding the relationship between the microbiome and the human being, the animal and the environment - is as important as unravelling human genome. The microbiome is like a well structured organ with unique functions and hence needs to be protected in the same way as we protect our other vital organs like liver, heart or kidney. This recognition of the existence of these friendly ''prakrita'' (non-pathogenic organisms) by [[Ayurveda]] thousands of years ago is of great historical significance.

It is interesting to note that these ancient texts recognized the existence of “friendly” non-pathogenic organisms and their functions - something that is only now being considered the greatest discovery in microbiology .It is claimed by modern scientists that our living body is made up of 10 trillion somatic cells and is home to some 100 trillion friendly microbes. This “empire” of microbes is called Microbiome. Understanding the relationship between the microbiome and the human being, the animal and the environment - is as important as unravelling human genome. The microbiome is like a well structured organ with unique functions and hence needs to be protected in the same way as we protect our other vital organs like liver, heart or kidney. This recognition of the existence of these friendly ''prakrita'' (non-pathogenic organisms) by [[Ayurveda]] thousands of years ago is of great historical significance.

==== Research Topics on this Subject ====

=== Research Topics on this Subject ===

#A literary and conceptual study to identify the nature and strength of Bala or immune strength of human body and its scope in prevention and treatment of various diseases and to evaluate its contemporary application.

#A literary and conceptual study to identify the nature and strength of Bala or immune strength of human body and its scope in prevention and treatment of various diseases and to evaluate its contemporary application.

=== Glossary ===

== Further reading ==

 

 

 

=== References ===

#Charak Samhita Vimana 7.9 on natural non-pathogenic organisms.

#Charak Samhita Vimana 7.9 on natural non-pathogenic organisms.

#Jay Prakash et al 2013 Neuroprotective role of Withania somnifera root extract in Moneb-paraquat induced mouse model of Parkinsonism. Neurochem Res. Feb. 2013

#Jay Prakash et al 2013 Neuroprotective role of Withania somnifera root extract in Moneb-paraquat induced mouse model of Parkinsonism. Neurochem Res. Feb. 2013

=== Related Chapters ===

== Related Chapters ==

* [[Rajayakshma Chikitsa]]  

* [[Rajayakshma Chikitsa]]