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<big>'''Nidana Sthana Chapter 6. Diagnosis and etiopathogenesis of Progressive wasting disease'''</big>

<big>'''Nidana Sthana Chapter 6. Diagnosis and etiopathogenesis of Progressive wasting disease'''</big>

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

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

अथातःशोषनिदानंव्याख्यास्यामः||१||  

अथातःशोषनिदानंव्याख्यास्यामः||१||  

इतिहस्माहभगवानात्रेयः||२||

इतिहस्माहभगवानात्रेयः||२||

AthÁtah ÐoÒanidÁnam vyÁkhyÁsyÁmah ||1||  

AthÁtah ÐoÒanidÁnam vyÁkhyÁsyÁmah ||1||  

iti ha smÁha bhagavÁnÁtreyah ||2||

iti ha smÁha bhagavÁnÁtreyah ||2||

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

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

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

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

   

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इहखलुचत्वारिशोषस्यायतनानिभवन्ति|

इहखलुचत्वारिशोषस्यायतनानिभवन्ति|

तद्यथा- साहसंसन्धारणंक्षयोविषमाशनमिति||३||

तद्यथा- साहसंसन्धारणंक्षयोविषमाशनमिति||३||

Ih khalu catvÁri ÐoÒasyÁyatanÁni bhavanti

Ih khalu catvÁri ÐoÒasyÁyatanÁni bhavanti

tadyathÁ- sÁhasam sa¿dhÁranam kÒayo viÒamÁÐanamiti ||3||

tadyathÁ- sÁhasam sa¿dhÁranam kÒayo viÒamÁÐanamiti ||3||

There are four causes of ''shosha'': overexertion, suppression of urges, wasting, and irregular consumption of improper food articles [3].  

There are four causes of ''shosha'': overexertion, suppression of urges, wasting, and irregular consumption of improper food articles [3].  

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

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

तत्रसाहसंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

तत्रसाहसंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

   

   

जीवन्हिपुरुषस्त्विष्टंकर्मणःफलमश्नुते||५||

जीवन्हिपुरुषस्त्विष्टंकर्मणःफलमश्नुते||५||

Tatra sÁhasam ÐoÒasyÁyatanamiti yaduktam tadanu vyÁkhyÁsyÁmah -  

Tatra sÁhasam ÐoÒasyÁyatanamiti yaduktam tadanu vyÁkhyÁsyÁmah -  

jÍvan hi purÚÒastviÒÔam karmaÆah phalamaÐnute ||5||

jÍvan hi purÚÒastviÒÔam karmaÆah phalamaÐnute ||5||

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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 ''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]

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

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

सन्धारणंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

सन्धारणंशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

तदभावेहिभावानांसर्वाभावःशरीरिणाम्||७||

तदभावेहिभावानांसर्वाभावःशरीरिणाम्||७||

sa¿dhÁranam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah -  

sa¿dhÁranam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah -  

tadabhÁve hi bhÁvÁnÁm sarvÁbhÁvah ÐÁrÍriÆÁm ||7||

tadabhÁve hi bhÁvÁnÁm sarvÁbhÁvah ÐÁrÍriÆÁm ||7||

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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 ''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.

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

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

क्षयःशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

क्षयःशोषस्यायतनमितियदुक्तंतदनुव्याख्यास्यामः-  

यथोपदेक्ष्यमाणरूपेण|८|

यथोपदेक्ष्यमाणरूपेण|८|

kÒayah ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

kÒayah ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

yathopadekÒyamÁÆarÚpeÆa |8|

yathopadekÒyamÁÆarÚpeÆa |8|

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

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

यदावापुरुषोऽतिहर्षादतिप्रसक्तभावःस्त्रीष्वतिप्रसङ्गमारभते, तस्यातिमात्रप्रसङ्गाद्रेतःक्षयमेति|  

यदावापुरुषोऽतिहर्षादतिप्रसक्तभावःस्त्रीष्वतिप्रसङ्गमारभते, तस्यातिमात्रप्रसङ्गाद्रेतःक्षयमेति|  

क्षयोह्यस्यबहून्रोगान्मरणंवानियच्छति||९||

क्षयोह्यस्यबहून्रोगान्मरणंवानियच्छति||९||

yadÁ vÁ purÚÒoatiharÒÁdatiprasaktabhÁvah strÍÒvatiprasa¿gamÁrabhate, tasyÁtimÁtraprasa¿gÁdretah kÒayameti |  

yadÁ vÁ purÚÒoatiharÒÁdatiprasaktabhÁvah strÍÒvatiprasa¿gamÁrabhate, tasyÁtimÁtraprasa¿gÁdretah kÒayameti |  

kÒayo hyasya  bahÚn rogÁnmaraÆam vÁ niyacchati ||9||

kÒayo hyasya  bahÚn rogÁnmaraÆam vÁ niyacchati ||9||

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

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

   

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विषमाशनंशोषस्यायतनमितियदुक्तं,तदनुव्याख्यास्यामः-  

विषमाशनंशोषस्यायतनमितियदुक्तं,तदनुव्याख्यास्यामः-  

पश्यन्रोगान्बहून्कष्टान्बुद्धिमान्विषमाशनात्||११||

पश्यन्रोगान्बहून्कष्टान्बुद्धिमान्विषमाशनात्||११||

viÒamÁÐanam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

viÒamÁÐanam ÐoÒasyÁyatanamiti yaduktam tadanuvyÁkhyÁsyÁmah –  

paÐyan rogÁn bahÚn kaÒtÁn buddhimÁn viÒamÁÐanÁt ||11||

paÐyan rogÁn bahÚn kaÒtÁn buddhimÁn viÒamÁÐanÁt ||11||

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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 ''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.  

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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एतैश्चतुर्भिःशोषस्यायतनैरुपसेवितैर्वातपित्तश्लेष्माणःप्रकोपमापद्यन्ते|  

एतैश्चतुर्भिःशोषस्यायतनैरुपसेवितैर्वातपित्तश्लेष्माणःप्रकोपमापद्यन्ते|  

यस्माद्वापूर्वमासीद्भगवतःसोमस्योडुराजस्यतस्माद्राजयक्ष्मेति||१२||

यस्माद्वापूर्वमासीद्भगवतःसोमस्योडुराजस्यतस्माद्राजयक्ष्मेति||१२||

EtaiÐca caturbhi ÐoÒasyÁyatanairÚpasevitairvÁtapittaÐleÒmÁÆah prakopamÁpadyante|  

EtaiÐca caturbhi ÐoÒasyÁyatanairÚpasevitairvÁtapittaÐleÒmÁÆah prakopamÁpadyante|  

tam sarvarogÁÆÁm kaÒtatamatvÁdrÁjayakÒmÁÆamÁcakÒate bhiÒajah; yasmÁdvÁ pÚrvamÁsÍdbhagavatahsomasyo±urÁjasya tasmÁdrÁjayakÒmeti ||12||

tam sarvarogÁÆÁm kaÒtatamatvÁdrÁjayakÒmÁÆamÁcakÒate bhiÒajah; yasmÁdvÁ pÚrvamÁsÍdbhagavatahsomasyo±urÁjasya tasmÁdrÁjayakÒmeti ||12||

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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 ''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]

==== Prodromal symptoms ====

==== Prodromal symptoms ====

तस्येमानिपूर्वरूपाणिभवन्ति; तद्यथा- प्रतिश्यायः, क्षवथुरभीक्ष्णं, श्लेष्मप्रसेकः, मुखमाधुर्यम्, अनन्नाभिलाषः, अन्नकालेचायासः, दोषदर्शनमदोषेष्वल्पदोषेषुवाभावेषुपात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु, भुक्तवतश्चास्यहृल्लासः, तथोल्लेखनमप्याहारस्यान्तरान्तरा, मुखस्यपादयोश्चशोफःपाण्योश्चावेक्षणमत्यर्थम्, अक्ष्णोःश्वेतावभासताचातिमात्रं, बाह्वोश्चप्रमाणजिज्ञासा, स्त्रीकामता,निर्घृणित्वं, बीभत्सदर्शनताचास्यकाये,  

तस्येमानिपूर्वरूपाणिभवन्ति; तद्यथा- प्रतिश्यायः, क्षवथुरभीक्ष्णं, श्लेष्मप्रसेकः, मुखमाधुर्यम्, अनन्नाभिलाषः, अन्नकालेचायासः, दोषदर्शनमदोषेष्वल्पदोषेषुवाभावेषुपात्रोदकान्नसूपापूपोपदंशपरिवेशकेषु, भुक्तवतश्चास्यहृल्लासः, तथोल्लेखनमप्याहारस्यान्तरान्तरा, मुखस्यपादयोश्चशोफःपाण्योश्चावेक्षणमत्यर्थम्, अक्ष्णोःश्वेतावभासताचातिमात्रं, बाह्वोश्चप्रमाणजिज्ञासा, स्त्रीकामता,निर्घृणित्वं, बीभत्सदर्शनताचास्यकाये,  

स्वप्नेचाभीक्ष्णंदर्शनमनुदकानामुदकस्थानानांशून्यानांचग्रामनगरनिगमजनपदानांशुष्कदग्धभग्नानांचवनानांकृकलासमयूरवानरशुकसर्पकाकोलूकादिभिः

स्वप्नेचाभीक्ष्णंदर्शनमनुदकानामुदकस्थानानांशून्यानांचग्रामनगरनिगमजनपदानांशुष्कदग्धभग्नानांचवनानांकृकलासमयूरवानरशुकसर्पकाकोलूकादिभिः

संस्पर्शनमधिरोहणंयानंवाश्वोष्ट्रखरवराहैःकेशास्थिभस्मतुषाङ्गारराशीनांचाधिरोहणमिति (शोषपूर्वरूपाणिभवन्ति)||१३||

संस्पर्शनमधिरोहणंयानंवाश्वोष्ट्रखरवराहैःकेशास्थिभस्मतुषाङ्गारराशीनांचाधिरोहणमिति (शोषपूर्वरूपाणिभवन्ति)||१३||

tasyemÁni pÚrvarÚpÁÆi bhavanti; tadyathÁ- pratiÐyÁyah, kÒavathurabhIkÒÆam, ÐleÒmaprasekah, mukhamÁdhuryam, anannÁbhilÁÒah, annakÁle cÁyÁsah, doÒadarÐanamadoÒeÒvalpadoÒeÒu vÁ bhÁveÒu pÁtrodakÁnnasÚpÁpÚpopada¿ÐapariveÐakeÒu, bhuktavataÐcÁsya hªullÁsah, tathollekhanamapyÁhÁrasyÁntarÁntarÁ, mukhasya pÁdayoÐca Ðophah pÁÆyoÐcÁvekÒaÆamatyartham, akÒÆoh ÐvetÁvabhÁsatÁ cÁtimÁtram, bÁhvoÐca pramÁÆajijúÁsÁ, strÍkÁmatÁ, nirghªuÆitvam, bIbhatsadarÐanatÁ cÁsya kÁye, svapne cÁbhIkÒÆam darÐanamanudakÁnÁmudakasthÁnÁnÁm ÐÚnyÁnÁm ca grÁmanagaranigamajanapadÁnÁm ÐuÒkadagdhabhagnÁnÁm ca vanÁnÁm kªukalÁsamayÚravÁnaraÐukasarpakÁkolÚkÁdibhih sa¿sparÐanamadhirohaÆam yÁnam vÁ ÐvoÒtrakharavarÁhaih  keÐÁsthibhasmatuÒÁa¿gÁrarÁshÍnÁm cÁdhirohaÆamiti (ÐoÒapÚrvarÚpÁÆi bhavanti) ||13||

tasyemÁni pÚrvarÚpÁÆi bhavanti; tadyathÁ- pratiÐyÁyah, kÒavathurabhIkÒÆam, ÐleÒmaprasekah, mukhamÁdhuryam, anannÁbhilÁÒah, annakÁle cÁyÁsah, doÒadarÐanamadoÒeÒvalpadoÒeÒu vÁ bhÁveÒu pÁtrodakÁnnasÚpÁpÚpopada¿ÐapariveÐakeÒu, bhuktavataÐcÁsya hªullÁsah, tathollekhanamapyÁhÁrasyÁntarÁntarÁ, mukhasya pÁdayoÐca Ðophah pÁÆyoÐcÁvekÒaÆamatyartham, akÒÆoh ÐvetÁvabhÁsatÁ cÁtimÁtram, bÁhvoÐca pramÁÆajijúÁsÁ, strÍkÁmatÁ, nirghªuÆitvam, bIbhatsadarÐanatÁ cÁsya kÁye, svapne cÁbhIkÒÆam darÐanamanudakÁnÁmudakasthÁnÁnÁm ÐÚnyÁnÁm ca grÁmanagaranigamajanapadÁnÁm ÐuÒkadagdhabhagnÁnÁm ca vanÁnÁm kªukalÁsamayÚravÁnaraÐukasarpakÁkolÚkÁdibhih sa¿sparÐanamadhirohaÆam yÁnam vÁ ÐvoÒtrakharavarÁhaih  keÐÁsthibhasmatuÒÁa¿gÁrarÁshÍnÁm cÁdhirohaÆamiti (ÐoÒapÚrvarÚpÁÆi bhavanti) ||13||

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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 ====

अतऊर्ध्वमेकादशरूपाणितस्यभवन्ति; तद्यथा- शिरसःपरिपूर्णत्वं, कासः, श्वासः, स्वरभेदः, श्लेष्मणश्छर्दनं, शोणितष्ठीवनं, पार्श्वसंरोजनम्, अंसावमर्दः, ज्वरः, अतीसारः, अरोचकश्चेति||१४||

अतऊर्ध्वमेकादशरूपाणितस्यभवन्ति; तद्यथा- शिरसःपरिपूर्णत्वं, कासः, श्वासः, स्वरभेदः, श्लेष्मणश्छर्दनं, शोणितष्ठीवनं, पार्श्वसंरोजनम्, अंसावमर्दः, ज्वरः, अतीसारः, अरोचकश्चेति||१४||

Ata ÚrdhvamekÁdaÐarÚpÁÆi tasya bhavanti; tadyathÁ- Ðirasah paripÚrÆatvam, kÁsah, ÐvÁsah, svarabhedah, ÐleÒmÁÆaÐchardanam, ÐoÆitaÒÔhÍvanam, pÁrÐvasa¿rojanam, a¿sÁvamardah, jvarah, atÍsÁrah, arocakaÐceti ||14||

Ata ÚrdhvamekÁdaÐarÚpÁÆi tasya bhavanti; tadyathÁ- Ðirasah paripÚrÆatvam, kÁsah, ÐvÁsah, svarabhedah, ÐleÒmÁÆaÐchardanam, ÐoÆitaÒÔhÍvanam, pÁrÐvasa¿rojanam, a¿sÁvamardah, jvarah, atÍsÁrah, arocakaÐceti ||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]

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 ====

तत्रापरिक्षीणबलमांसशोणितोबलवानजातारिष्टःसर्वैरपिशोषलिङ्गैरुपद्रुतःसाध्योज्ञेयः| बलवानुपचितोहिसहत्वाद्व्याध्यौषधबलस्यकामंसुबहुलिङ्गोऽप्यल्पलिङ्गएवमन्तव्यः||१५||

तत्रापरिक्षीणबलमांसशोणितोबलवानजातारिष्टःसर्वैरपिशोषलिङ्गैरुपद्रुतःसाध्योज्ञेयः| बलवानुपचितोहिसहत्वाद्व्याध्यौषधबलस्यकामंसुबहुलिङ्गोऽप्यल्पलिङ्गएवमन्तव्यः||१५||

Tatra parikÒÍÆabalama¿saÐoÆito balavÁnajÁtÁriÒtah sarvairapi ÐoÒali¿gairÚpadrutah sÁdhyo jÆayah | balavÁnupacito hi sahatvÁdvyÁdhyauÒadhabalasya kÁmam subahuli¿goapyalpali¿ga eva mantavyah ||15||

Tatra parikÒÍÆabalama¿saÐoÆito balavÁnajÁtÁriÒtah sarvairapi ÐoÒali¿gairÚpadrutah sÁdhyo jÆayah | balavÁnupacito hi sahatvÁdvyÁdhyauÒadhabalasya kÁmam subahuli¿goapyalpali¿ga eva mantavyah ||15||

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One having all the above symptoms of ''shosha'' should be considered curable in case his strength, muscles and blood are not wasted, he is strong and the fatal signs have not appeared. The strong and well-nourished, because of tolerance to intensity of disease and drugs, should be assumed to have fewer symptoms even if they have many, and treated accordingly. [15]

One having all the above symptoms of ''shosha'' should be considered curable in case his strength, muscles and blood are not wasted, he is strong and the fatal signs have not appeared. The strong and well-nourished, because of tolerance to intensity of disease and drugs, should be assumed to have fewer symptoms even if they have many, and treated accordingly. [15]

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दुर्बलंत्वतिक्षीणबलमांसशोणितमल्पलिङ्गमजातारिष्टमपिबहुलिङ्गंजातारिष्टंचविद्यात्, असहत्वाद्व्याध्यौषधबलस्य; तंपरिवर्जयेत्, क्षणेनैवहिप्रादुर्भवन्त्यरिष्टानि, अनिमित्तश्चारिष्टप्रादुर्भावइति||१६||  

दुर्बलंत्वतिक्षीणबलमांसशोणितमल्पलिङ्गमजातारिष्टमपिबहुलिङ्गंजातारिष्टंचविद्यात्, असहत्वाद्व्याध्यौषधबलस्य; तंपरिवर्जयेत्, क्षणेनैवहिप्रादुर्भवन्त्यरिष्टानि, अनिमित्तश्चारिष्टप्रादुर्भावइति||१६||  

Durbalam tvatikÒÍÆabalama¿saÐoÆitamalpali¿gamajÁtÁriÒtamapi bahuli¿gam jÁtÁriÒtam ca

Durbalam tvatikÒÍÆabalama¿saÐoÆitamalpali¿gamajÁtÁriÒtamapi bahuli¿gam jÁtÁriÒtam ca

vidyÁt, asahatvÁdvyÁdhyauÒadhabalasya; tam parivarjayet, kÒaÆenaiva hi prÁdurbhavantyariÒtÁni, animittaÐcÁriÒtaprÁdurbhÁva iti ||16||

vidyÁt, asahatvÁdvyÁdhyauÒadhabalasya; tam parivarjayet, kÒaÆenaiva hi prÁdurbhavantyariÒtÁni, animittaÐcÁriÒtaprÁdurbhÁva iti ||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]

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 ====

तत्रश्लोकः-  

तत्रश्लोकः-  

समुत्थानंचलिङ्गंचयःशोषस्यावबुध्यते|  

समुत्थानंचलिङ्गंचयःशोषस्यावबुध्यते|  

पूर्वरूपंचतत्त्वेनसराज्ञःकर्तुमर्हति||१७||

पूर्वरूपंचतत्त्वेनसराज्ञःकर्तुमर्हति||१७||

tatra Ðlokah-

tatra Ðlokah-

samutthÁnam ca li¿gam ca yah ÐoÒasyÁvabudhyate|

samutthÁnam ca li¿gam ca yah ÐoÒasyÁvabudhyate|

pÚrvarÚpam ca tattvena sa rÁjÆah kartumarhati ||17||

pÚrvarÚpam ca tattvena sa rÁjÆah kartumarhati ||17||

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