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

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

<div style="text-align:justify;">This chapter describes the basics of etiopathogenesis of progressive wasting disease termed as shosha roga and its culmination in rajayakshma vis-à-vis pulmonary tuberculosis. Shosha is characterized by severe depletion of tissues (also called phthisis) which could be a precursor of tuberculosis as known today which occurs due to tubercular infection, phthisis and immune-compromised state. Over exertion (sahasa), suppression of natural urges (vegavidharana), pre-existing emaciation (kshaya), and wrong dietary habits (vishamashana) are the four primary causes of shosha.  These four basic factors lead to progressive loss of strength (including immunity), vitiating the three doshas and culminating in rajayakshma, a major organic disease that seems to be similar to various similar progressively wasting diseases presenting characteristically with signs and symptoms of Pulmonary Tuberculosis as seen today and has been described in great clinical and therapeutic detail in [[ Rajayakshma Chikitsa ]]. </div>

<div style="text-align:justify;">This chapter describes the basics of etiopathogenesis of progressive wasting disease termed as shosha roga and its culmination in rajayakshma vis-à-vis pulmonary tuberculosis. Shosha is characterized by severe depletion of tissues (also called phthisis) which could be a precursor of tuberculosis as known today which occurs due to tubercular infection, phthisis and immune-compromised state. Over exertion (sahasa), suppression of natural urges (vegavidharana), pre-existing emaciation (kshaya), and wrong dietary habits (vishamashana) are the four primary causes of shosha.  These four basic factors lead to progressive loss of strength (including immunity), vitiating the three [[dosha]]s and culminating in rajayakshma, a major organic disease that seems to be similar to various similar progressively wasting diseases presenting characteristically with signs and symptoms of Pulmonary Tuberculosis as seen today and has been described in great clinical and therapeutic detail in [[ Rajayakshma Chikitsa ]]. </div>

'''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.

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

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

''Shosha'' is the preparatory stage of gradual, generalized emaciation due to four distinct causative factors mentioned earlier which, if untreated or ignored, may lead to ''rajayakshma''. One of the contributing factors of ''shosha'' is indicative of systemic depletion of ''dhatu'' occurring due to divergent causes. An important point to note here is that ''shosha'' is different from ''kshataksheena'', a post-treatment stage of localized or generalized emaciation needing further intensive treatment.

''Shosha'' is the preparatory stage of gradual, generalized emaciation due to four distinct causative factors mentioned earlier which, if untreated or ignored, may lead to ''rajayakshma''. One of the contributing factors of ''shosha'' is indicative of systemic depletion of ''[[dhatu]]'' occurring due to divergent causes. An important point to note here is that ''shosha'' is different from ''kshataksheena'', a post-treatment stage of localized or generalized emaciation needing further intensive treatment.

Another commonly used term for ''shosha'' is ''kshaya'' (emaciation). However, it is imperative to clarify here that while ''shosha'' and ''kshaya'' are contextually similar and synonymous to ''yakshma'' ,  the specific meaning in [[Charak Samhita]] is different for all the three stages of the disease. [[Ayurveda]] is not very stringent when it comes to discerning cause-effect. Cause and effect are largely considered a continuum. While discussing the issue of cause-effect relationship between ''kshaya-shosha-yakshma'', the concept of ''nidanarthakara roga'' has also to be kept in mind where one known disease or a morbid state can play as the ''nidana'' of another disease. That is why, ''kshaya'' is sometimes mentioned as cause of ''shosha'' too. The word ''kshaya'' in this particular context refers to pre-existing ''kshaya''. ''Kshaya'' is of two distinct types - ''anuloma kshaya'' and ''pratiloma kshaya''. ''Anulomakshaya'' is caused by the initial depletion of the ''ojas rasa'' situated in the heart, while ''pratiloma kshaya'' occurs due to an excessive indulgence in sexual activities leading to the depletion of ''shukradhatu'' which in turn leads to generalized ''vata vriddhi'' and ''vata'' induces ''shoshana'' of ''dhatus''. Both these variants contribute to ''shoshana'' (qualitative and quantitative depletion of ''sharira dhatus'' or body tissues).

Another commonly used term for ''shosha'' is ''kshaya'' (emaciation). However, it is imperative to clarify here that while ''shosha'' and ''kshaya'' are contextually similar and synonymous to ''yakshma'' ,  the specific meaning in [[Charak Samhita]] is different for all the three stages of the disease. [[Ayurveda]] is not very stringent when it comes to discerning cause-effect. Cause and effect are largely considered a continuum. While discussing the issue of cause-effect relationship between ''kshaya-shosha-yakshma'', the concept of ''nidanarthakara roga'' has also to be kept in mind where one known disease or a morbid state can play as the ''nidana'' of another disease. That is why, ''kshaya'' is sometimes mentioned as cause of ''shosha'' too. The word ''kshaya'' in this particular context refers to pre-existing ''kshaya''. ''Kshaya'' is of two distinct types - ''anuloma kshaya'' and ''pratiloma kshaya''. ''Anulomakshaya'' is caused by the initial depletion of the ''[[ojas]] rasa'' situated in the heart, while ''pratiloma kshaya'' occurs due to an excessive indulgence in sexual activities leading to the depletion of ''[[shukra dhatu]]'' which in turn leads to generalized ''[[vata]] vriddhi'' and ''[[vata]]'' induces ''shoshana'' of ''[[dhatu]]s''. Both these variants contribute to ''shoshana'' (qualitative and quantitative depletion of ''sharira [[dhatu]]s'' or body tissues).

''Shosha'' and ''kshaya'' can be considered as independent clinical entities warranting independent strategies for diagnosis and treatment. Either of these may prove to be a ''nidanarthakara'' factor for the occurrence of ''rajayakshma'' (i.e., if ''shosha'' or ''kshaya'' are left untreated, could lead to ''rajayakshma''). ''Shosha'' is essentially a state of intractable emaciation, cachexia or consumption that could be equated to phthisis. It could be considered to be an intermediate state that may not necessarily exhibit any evidence of tubercular infection but because of persistent ''dhatukshaya''(depletion of tissues) it could be logically associated with an immunocompromised state. Some patients may catch infections that may manifest into a febrile state with probable bacteriological invasion warranting appropriate treatment on the lines of ''rajayakshma''. Because ''shosha'' and ''kshaya'' are intermediary states that are more of diagnostic significance than of significance from a core treatment perspective. Charak wrote the chapter on ''shosha'' in [[Nidana Sthana]] , while on ''rajayakshma'' in [[Chikitsa Sthana]] with the same motive.

''Shosha'' and ''kshaya'' can be considered as independent clinical entities warranting independent strategies for diagnosis and treatment. Either of these may prove to be a ''nidanarthakara'' factor for the occurrence of ''rajayakshma'' (i.e., if ''shosha'' or ''kshaya'' are left untreated, could lead to ''rajayakshma''). ''Shosha'' is essentially a state of intractable emaciation, cachexia or consumption that could be equated to phthisis. It could be considered to be an intermediate state that may not necessarily exhibit any evidence of tubercular infection but because of persistent ''[[dhatu]] kshaya''(depletion of tissues) it could be logically associated with an immunocompromised state. Some patients may catch infections that may manifest into a febrile state with probable bacteriological invasion warranting appropriate treatment on the lines of ''rajayakshma''. Because ''shosha'' and ''kshaya'' are intermediary states that are more of diagnostic significance than of significance from a core treatment perspective. Charak wrote the chapter on ''shosha'' in [[Nidana Sthana]] , while on ''rajayakshma'' in [[Chikitsa Sthana]] with the same motive.

It may appear that ''shosha'' and ''rajayakshma'' are synonymous because in this chapter there are brief descriptions of ''poorvarupa'' (preliminary signs) and ''ekadasha rupa'' (advanced stage) of ''yakshma''. However, the manifestation of ''rajayakshma'' has been described in detail only in the [[Chikitsa Sthana]].

It may appear that ''shosha'' and ''rajayakshma'' are synonymous because in this chapter there are brief descriptions of ''poorvarupa'' (preliminary signs) and ''ekadasha rupa'' (advanced stage) of ''yakshma''. However, the manifestation of ''rajayakshma'' has been described in detail only in the [[Chikitsa Sthana]].

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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When a weak person fights against a strong one, or exercises with an excessively large (or weighty) bow (weapon), or speaks too much, or physically carries a lot of weight, or swims across a long distance in water, or is habitually subjected to forceful massage including kneading with feet, or sprints over a long distance, or is assaulted, or practices various complicated or excessive physical exercises, his lungs are “traumatized” due to excessive exertion. This aggravates ''vayu'' in the lung region, taking along ''kapha'' residing in the lungs while also affecting ''pitta'', causing the vitiated ''doshas'' to spread upwards, downwards and obliquely. A portion of this afflicted ''dosha'' system that gets into body joints causes yawning, body ache, and fever. That which gets into the ''amashaya'' causes diseases of lungs and anorexia. That which gets into the throat causes irritation of the throat and hoarseness of voice. That which gets into the channels carrying vital breath (bronchial channels) causes dyspnea and coryza. And that which gets into the head produces distress in the head. Thus, due to wound in lungs, irregular movement of ''vayu'' causes a variety of diseases depending upon the organs it gets into. The lungs get damaged further, triggering conditions such as hemoptysis and consequently weakening the patient. This verse, therefore, advises the reader to engage in laborious activities appropriate to his strength and not overexert himself. [4-5]

When a weak person fights against a strong one, or exercises with an excessively large (or weighty) bow (weapon), or speaks too much, or physically carries a lot of weight, or swims across a long distance in water, or is habitually subjected to forceful massage including kneading with feet, or sprints over a long distance, or is assaulted, or practices various complicated or excessive physical exercises, his lungs are “traumatized” due to excessive exertion. This aggravates ''vayu'' in the lung region, taking along ''[[kapha]]'' residing in the lungs while also affecting ''[[pitta]]'', causing the vitiated ''[[dosha]]s'' to spread upwards, downwards and obliquely. A portion of this afflicted ''[[dosha]]'' system that gets into body joints causes yawning, body ache, and fever. That which gets into the ''amashaya'' causes diseases of lungs and anorexia. That which gets into the throat causes irritation of the throat and hoarseness of voice. That which gets into the channels carrying vital breath (bronchial channels) causes dyspnea and coryza. And that which gets into the head produces distress in the head. Thus, due to wound in lungs, irregular movement of ''vayu'' causes a variety of diseases depending upon the organs it gets into. The lungs get damaged further, triggering conditions such as hemoptysis and consequently weakening the patient. This verse, therefore, advises the reader to engage in laborious activities appropriate to his strength and not overexert himself. [4-5]

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When a person suppresses the urge to pass flatulence, urination, and bowel movement due to various reasons such as attending a royalty, being in a formal setting (in the company of sages, teachers, nobles, etc), being in the midst of women, society of gambling, or while traveling on uneven vehicle, or due to fear, environment, bashfulness or disgust, ''vayu'' gets vitiated due to suppression of urges. This vitiated ''vayu'' aggravates ''pitta'' and/or ''kapha'', spreading upwards, downwards or obliquely depending upon the combination of afflicted ''doshas''. As said earlier, when a portion gets into specific body parts, it causes pain, diarrhea or drying up of feces, excessive pain in sides of the chest, pain in the shoulders, irritation in throat and lungs, headache, cough, dyspnea, fever, hoarseness of voice and coryza. Thereafter, having been afflicted with these wasting complications, the patient gradually gets afflicted with ''shosha''. Hence the wise should carefully observe the ways that promote and protect the body.

When a person suppresses the urge to pass flatulence, urination, and bowel movement due to various reasons such as attending a royalty, being in a formal setting (in the company of sages, teachers, nobles, etc), being in the midst of women, society of gambling, or while traveling on uneven vehicle, or due to fear, environment, bashfulness or disgust, ''vayu'' gets vitiated due to suppression of urges. This vitiated ''vayu'' aggravates ''[[pitta]]'' and/or ''[[kapha]]'', spreading upwards, downwards or obliquely depending upon the combination of afflicted ''[[dosha]]s''. As said earlier, when a portion gets into specific body parts, it causes pain, diarrhea or drying up of feces, excessive pain in sides of the chest, pain in the shoulders, irritation in throat and lungs, headache, cough, dyspnea, fever, hoarseness of voice and coryza. Thereafter, having been afflicted with these wasting complications, the patient gradually gets afflicted with ''shosha''. Hence the wise should carefully observe the ways that promote and protect the body.

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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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]

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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When a person indulges in excessive sexual intercourse habitually, his semen gets diminished. In spite of diminished semen, if he obsesses about sex mentally as well as physically and continues to engage in sexual acts with excessively determined passion, his semen is not discharged because of its already diminished state causing ''vayu'' to enter his blood vessels and blood getting discharged from the seminal passage. Now, due to loss of semen and hemorrhage, his joints loosen, the skin loses its suppleness and becomes rough or scaly, body weakens further and ''vayu'' gets vitiated. The vitiated ''vayu''spreads in the body deficient of semen and blood, aggravating ''kapha'' and ''pitta'' and drying up the muscles and blood. Further, the vitiated vayu expels kapha and pitta, causing pain in the sides of the chest and shoulders, irritation of throat, aggravating ''kapha'' of the head and replacing it with the vitiated ''kapha'' expelled from their natural locations, causing pain in joints, body ache, anorexia and indigestion. Due to frequent cough the lungs get damaged and hemoptysis ensues, debilitating the patient further and afflicting him with wasting complications. If untreated, the patient gradually is afflicted with phthisis.  

When a person indulges in excessive sexual intercourse habitually, his semen gets diminished. In spite of diminished semen, if he obsesses about sex mentally as well as physically and continues to engage in sexual acts with excessively determined passion, his semen is not discharged because of its already diminished state causing ''vayu'' to enter his blood vessels and blood getting discharged from the seminal passage. Now, due to loss of semen and hemorrhage, his joints loosen, the skin loses its suppleness and becomes rough or scaly, body weakens further and ''vayu'' gets vitiated. The vitiated ''vayu''spreads in the body deficient of semen and blood, aggravating ''[[kapha]]'' and ''[[pitta]]'' and drying up the muscles and blood. Further, the vitiated vayu expels [[kapha]] and [[pitta]], causing pain in the sides of the chest and shoulders, irritation of throat, aggravating ''[[kapha]]'' of the head and replacing it with the vitiated ''[[kapha]]'' expelled from their natural locations, causing pain in joints, body ache, anorexia and indigestion. Due to frequent cough the lungs get damaged and hemoptysis ensues, debilitating the patient further and afflicting him with wasting complications. If untreated, the patient gradually is afflicted with phthisis.  

Here is the verse: Semen is the final essence of one’s food hence it should be protected because its depletion leads to many diseases or even death. [8-9]

Here is the verse: Semen is the final essence of one’s food hence it should be protected because its depletion leads to many diseases or even death. [8-9]

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This verse talks of irregular diet as a cause of ''shosha''. When a person takes food – drinkable, eatable, chewable and lickable – irregularly in terms of nature, preparation, combination, quantity, place, time, and various dietary rules (do’s and don’ts) appropriate for his constitution, his ''doshas'' get imbalanced. These imbalanced ''doshas'' spread in the body, obstructing the openings of various channels and the flow of ''dhatus''. In such cases, the body survives on the support of ''malas''. Hence ''mala'' should be protected, particularly in case where the patient has already been afflicted with phthisis and in cases where the individual is emaciated or very weak. The vitiated ''vata'' causes pain, body ache, irritation of throat, chest pain, pain in shoulders, hoarseness of voice and coryza. Vitiated ''pitta'' causes fever, diarrhea, internal heat and vitiated ''kapha'' causes coryza, heaviness of head, anorexia and cough. Due to frequent bouts of cough, lungs get damaged and hemoptysis ensues, consequently debilitating the patient further and causing ''shosha''. Having been afflicted with these wasting complications, the patient gradually becomes very weak and gaunt.  

This verse talks of irregular diet as a cause of ''shosha''. When a person takes food – drinkable, eatable, chewable and lickable – irregularly in terms of nature, preparation, combination, quantity, place, time, and various dietary rules (do’s and don’ts) appropriate for his constitution, his ''[[dosha]]s'' get imbalanced. These imbalanced ''[[dosha]]s'' spread in the body, obstructing the openings of various channels and the flow of ''[[dhatu]]s''. In such cases, the body survives on the support of ''[[mala]]s''. Hence ''[[mala]]'' should be protected, particularly in case where the patient has already been afflicted with phthisis and in cases where the individual is emaciated or very weak. The vitiated '[[vata]]'' causes pain, body ache, irritation of throat, chest pain, pain in shoulders, hoarseness of voice and coryza. Vitiated ''[[pitta]]'' causes fever, diarrhea, internal heat and vitiated ''[[kapha]]'' causes coryza, heaviness of head, anorexia and cough. Due to frequent bouts of cough, lungs get damaged and hemoptysis ensues, consequently debilitating the patient further and causing ''shosha''. Having been afflicted with these wasting complications, the patient gradually becomes very weak and gaunt.  

The final verse advises thus: Observing many troublesome diseases caused by irregular dieting, the wise should eat wholesome, measured and timely food with self-restraint. [10-11]

The final verse advises thus: Observing many troublesome diseases caused by irregular dieting, the wise should eat wholesome, measured and timely food with self-restraint. [10-11]

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Regular use of the four etiological factors of ''shosha'' vitiates the ''doshas''. These vitiated ''doshas'' dry up the body while afflicting it with various complications. Physicians call it ''rajayakshma'' because it is most troublesome among all the diseases (''rajayakshma'' would literally translate to the “king of ''yakshmas''”) or because in ''vedic'' mythologies, it afflicted Lord Moon, the king of stars. [12]

Regular use of the four etiological factors of ''shosha'' vitiates the ''[[dosha]]s''. These vitiated ''[[dosha]]s'' dry up the body while afflicting it with various complications. Physicians call it ''rajayakshma'' because it is most troublesome among all the diseases (''rajayakshma'' would literally translate to the “king of ''yakshmas''”) or because in ''vedic'' mythologies, it afflicted Lord Moon, the king of stars. [12]

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* 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).

* The common effect of the four factors is ''dhatukshaya'' (loss of body tissue), especially rasa which is responsible for maintaining ''vyadhikshamatya'' (Immunity).

* The common effect of the four factors is ''[[dhatu]] kshaya'' (loss of body tissue), especially rasa which is responsible for maintaining ''vyadhikshamatya'' (Immunity).

* ''Sahajabala'' (Innate immunity) is fundamental to prognosis of the disease. If ''sahajabala'' is intact, the outcome of treatment is favorable, even if the symptoms are full blown.

* ''Sahajabala'' (Innate immunity) is fundamental to prognosis of the disease. If ''sahajabala'' is intact, the outcome of treatment is favorable, even if the symptoms are full blown.

* 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.

The recent advances in biomedical sciences unfolding the shape and role of genome, epigenome and microbiome in human health have partly proven the generic fact that our genes, our environment and “friendly” microbes are our collective friends and are an integral part of our being. They are protective tool for the immune-enhancing through positive life style, healthy dietetics and regulated use of ''rasayana'' remedies. ''Rasayanas'' are described in [[Ayurveda]] for promotive and preventive health care as well as for promotion of longevity.

The recent advances in biomedical sciences unfolding the shape and role of genome, epigenome and microbiome in human health have partly proven the generic fact that our genes, our environment and “friendly” microbes are our collective friends and are an integral part of our being. They are protective tool for the immune-enhancing through positive life style, healthy dietetics and regulated use of ''[[rasayana]]'' remedies. ''[[Rasayana]]s'' are described in [[Ayurveda]] for promotive and preventive health care as well as for promotion of longevity.

   

   

Recent researches on ''rasayana'' drugs such as ''amalaki'' and ''ashwagandha'' have appeared in certain high impact journals. Lakhotia et al, in their 2012 study on drosophilia model, have recorded marked DNA repairing effects besides better maturation rate and healthier and longer life span in fruit flies treated with ''amalaki rasayana''. Similarly, Kuboyama et al (2005) have reported that withanolide-A, isolated from the ''ashwagandha rasayana'', has significant regenerative effect on neurons. Singh et al (2008) reported neuro-nutrient impact of Ayurvedic ''rasayana'' therapy while Jayprakash et al (2013) reported the neuroprotective role of ''ashwagandha'' in experimentally induced Parkinsonism. In view of the conceptual strength and the recent scientific studies now it could be suggested that ''rasayanas'' like ''amalaki, chyavanprasha'' and ''ashwagandha'' should be used in the management of ''shosha, kshaya'' and ''yakshma'' with great advantage, besides administration of other therapeutics described in Ayurvedic texts.

Recent researches on ''[[rasayana]]'' drugs such as ''amalaki'' and ''ashwagandha'' have appeared in certain high impact journals. Lakhotia et al, in their 2012 study on drosophilia model, have recorded marked DNA repairing effects besides better maturation rate and healthier and longer life span in fruit flies treated with ''amalaki rasayana''. Similarly, Kuboyama et al (2005) have reported that withanolide-A, isolated from the ''ashwagandha rasayana'', has significant regenerative effect on neurons. Singh et al (2008) reported neuro-nutrient impact of Ayurvedic ''rasayana'' therapy while Jayprakash et al (2013) reported the neuroprotective role of ''ashwagandha'' in experimentally induced Parkinsonism. In view of the conceptual strength and the recent scientific studies now it could be suggested that ''[[rasayana]]s'' like ''amalaki, chyavanprasha'' and ''ashwagandha'' should be used in the management of ''shosha, kshaya'' and ''yakshma'' with great advantage, besides administration of other therapeutics described in Ayurvedic texts.

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 ''[[dhatu]]s'' namely ''[[rasa]], [[rakta]], [[mamsa]], [[meda]], [[asthi]], [[majja]],'' and ''[[shukra]]''. Sushruta describes ''[[ojas]]'' as the ''param teja'' of the ''sapta [[dhatu]]s'' 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 ''oja-bala'' (''ojas'' strength) derived from ''ojas'' has been categorized to be of three kinds: ''sahaja bala'' or primary natural immunity, ''kalaja bala'' or acquired immunity through environmental factors such as climate etc., and ''yuktikrit bala'' or artificially-induced acquired immunity. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic wasting diseases and contagious diseases, such as ''shosha, kshaya'' and ''yakshma''.  

The ''oja-bala'' (''[[ojas]]'' strength) derived from ''[[ojas]]'' has been categorized to be of three kinds: ''sahaja bala'' or primary natural immunity, ''kalaja bala'' or acquired immunity through environmental factors such as climate etc., and ''yuktikrit bala'' or artificially-induced acquired immunity. The classics prompt to utilize these three resources to enhance the bala/immunity in order to prevent all ailments especially chronic wasting diseases and contagious diseases, such as ''shosha, kshaya'' and ''yakshma''.  

The texts describe three categories of ''bala-dosha'' or disorders of ''bala'' which are comparable to three categories of immune disorders such as :

The texts describe three categories of ''bala-dosha'' or disorders of ''bala'' which are comparable to three categories of immune disorders such as :

=== 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.

#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.

#Clinical and experimental studies on different ''rasayana'' remedies for their immunoenhancing effect in cases of ''kshaya,shosha'' and ''yakshma''.

#Clinical and experimental studies on different ''[[rasayana]]'' remedies for their immunoenhancing effect in cases of ''kshaya,shosha'' and ''yakshma''.

#To develop precise diagnostic criteria for the three disease states described by Charak namely ''kshaya, shosha'' and ''yakshma'' including attempts to identify biomarkers, indicators and clinical rating scales to develop good diagnostic methodology to be used by Ayurvedic practitioners.

#To develop precise diagnostic criteria for the three disease states described by Charak namely ''kshaya, shosha'' and ''yakshma'' including attempts to identify biomarkers, indicators and clinical rating scales to develop good diagnostic methodology to be used by Ayurvedic practitioners.