अथातो राजयक्ष्मादिनिदानं व्याख्यास्यामः । इति ह स्माहुरात्रेयादयो महर्षयः ॥१॥
We will now expound the chapter named Rajayaksmadi nidana – diagnosis of pulmonary tuberculosis etc; Thus said Atreya and other great sages. (1)
अनेकरोगानुगतो बहुरोगपुरोगमः । राजयक्ष्मा क्षयः शोषो रोगराडिति च स्मृतः ॥२॥
नक्षत्राणां द्विजानां च राज्ञोऽभूद्यदयं पुरा । यच्च राजा च यक्ष्मा च राजयक्ष्मा ततो मतः ॥३॥
देहौषधक्षयकृतेः क्षयस्तत्सम्भवाच्च सः । रसादिशोषणाच्छोषो रोगराट् तेषु राजनात् ॥४॥
This disease, which follows and also followed by many diseases, known variously as Rajayaksma, Ksaya, Sosa and Rogarat, started long back as the disease of the king of stars (moon) and of the twice – born; as it is the king of diseases and also a disease complex, it is called as rajayaksma; since it causes wasting of both the body and medicines and is also caused by them, it is known as ksaya. It is called as sosa because it causes depletion ( loss) of rasa and other dhatus ( tissues), and as rogarat (king of diseases) as it governs all others (diseases). (2-4)
Rajyakshma Nidana- causes
साहसं वेगसंरोधः शुक्रौजः स्नेहसंक्षयः । अन्नपानविधित्यागश्चत्वारस्तस्य हेतवः ॥ ५ ॥
Exertion, suppression of the urges (of faeces, urine etc), decrease/ loss of semen, ojas and unctiousness (of the tissues); transgression of the regimen of foods and drinks – these four are its causes (5)
Samprapti- pathogenesis
तैरुदीर्णोऽनिलः पित्तं कफं चोदीर्य सर्वतः । शरीरसन्धीनाविश्य तान् सिराश्च प्रपीडयन् ॥६॥
मुखानि स्त्रोतसां रुध्वा तथैवातिविवृत्य वा । सर्पन्नूर्ध्वमधस्तिर्यग्यथास्वं जनयेत् गदान् ॥७॥
Vata getting aggravated (increased) by these (causes) produces increase of pitta and kapha, invades all the joints, causes abnormalities of the siras (veins and other blood vessels), makes for either obstruction or too much of dilatation of the mouths (orifices / passages) of the srotas (channels, pores), travels upwards, downwards, sidewards and gives rise to the disease. (6-7)
Purvarupa-premonitory symptoms
रूपं भविष्यतस्तस्य प्रतिश्यायो भृशं क्षवः । प्रसेको मुखमाधुर्यं सदनं वह्निदेहयोः ॥८॥
स्थाल्यमत्रानपानादौ शुचावप्यशुचीक्षणम् । मक्षिकातृणकेशादिपातः प्रयोऽन्नपानयोः ॥९॥
हलासश्छर्दिररुचिरश्वतोऽपि बलक्षयः । पाण्योरवेक्षा पादस्य शोफोऽक्ष्णोरतिशुक्लता ॥१०॥
बाह्रो : प्रमाणजिज्ञासा काये बैभत्स्यदर्शनम् । स्त्रीमद्यमांसप्रियता घृणित्वं मूर्धगुण्ठनम् ॥११॥
नखकेशातिवृद्धिश्च स्वप्ने चाभिभवो भवेत् । पतङ्गकृकलासाहिकपिश्वापदपक्षिभिः ॥ १२ ॥
केशास्थितुषभस्मादिराशौ समधिरोहणम् । शून्यानां ग्रामदेशानां दर्शनं शुष्यतोऽम्भसः ॥१३॥
ज्योतिर्गिरीणां पततां ज्वलतां च महीरुहाम् ॥१४॥
Its premonitory symptoms are running in the nose, more of sneezing, salivation, sweet taste in the mouth, weakness of digestive activity and of the body; seeing of (imagining of) dirt in the vessles, foods and drinks though they are cleen, seeing flies, grass, hairs etc, in the foods and drinks (though actually not present in them) nausea, vomiting, loss of appetite or taste ), debility even though taking food (sufficiently), observing his hands (curiously, attentively intently), swelling of the feet, too much of whiteness of the eyes, doubting the size ( thickness) of the arms; body (configuration) causing fear, anxiety; desire for women (sexual activity), alcoholic driaks and meat, anger (irritability); covering the head with cloth ( while sleeping), increased (rate of) growth of nails and hairs, seeing dreams as though being overpowered by butterfly, chemeleon, snake, monkey and bird, climbing on (standing upon) heaps of hairs, bones, husk, ash etc, empty villages, lands and reservoirs of water, falling of bright objects (meteors, comets, lightning) and mountains, trees catching fire and burning etc. (8-14)
Rajyakshma Lakshana – clinical features
पीनसश्वासकासांसमूर्धस्वररुजोऽरुचिः । ऊर्ध्वं विट्ांससंशोषावधश्छर्दिस्तु कोष्ठगे ॥१५॥
तिर्यक्स्थे पार्श्वरुक्दोषे सन्धिगे भवतिज्वरः । रूपाण्येकादशैतानि जायन्ते राजयक्ष्मणः ॥१६॥
Running in the nose, dyspnoea, pain in the shoulders and head cough, pain during talking, loss of voice and loss of taste (loss of appetite) are the symptoms manifesting when the doshas are found in the upper parts (of the body); elimination of facces and it being dry are found when the doshas are in the lower parts; vomiting when doshas are in the alimentary tract; pain in the flanks when they are in sideward parts (in the dhatus); fever when in joints- these eleven are the symptoms of Rajayaksma. (15-16)
Rajyakshma Upadrava – complications
तेषामुपद्रवा विद्यात् कण्ठोद्ध्वंसमुरोरुजम् । जृम्भाङ्गमर्दनिष्ठीववह्रिसादास्यपूतिताः ॥१७॥
Its complications (secondary diseases) are pain in the throat (loss of voice); pain in the chest, excess of yawning, aches in the body, expectoration of sputum, weakness of digestion and bad smell from the mouth. (17)
तत्र वाताच्छिर: पार्श्वशूलमंसाङ्गमर्दनम् । कण्ठोद्ध्वंसः स्वरभ्रंशः पित्तात् पादास्यपाणिषु ॥१८॥
दाहोतिसारोऽसृक्छर्दिर्मुखगन्धो ज्वरो मदः । कफादरोचकश्छर्दिः कासो मूर्धाङ्गगौरवम् ॥१९॥
प्रसेकः पीनसः श्वासः स्वरसादोऽल्पवह्निता ॥२०॥
Among these, pain in the head and flanks, aches ( discomfort) in the shoulders and other parts, pain in the throat and loss of voice are due to vata; burning sensation in the feet (soles), mouth and hands (palms), diarrhoea, vomiting of blood, bad smell from the mouth, fever and toxicity are due to pitta; loss of appetite, vomiting cough, heaviness of the head and body, excess of salivation, running in the nose, dyspnoea, feeble voice and weakness of digestive activity are due to kapha. (18-20)
दोषैर्मन्दानलत्वेन सोपलेपैः कफोल्बणैः । स्त्रोतोमुखेषु रुद्धेषु धातूष्णस्वल्पकेषु च ॥ २१ ॥
विदामान: स्वस्थाने रसस्तांस्तानुपद्रवान् । कुर्यादगच्छन् मांसादीनस्क चोर्ध्वं प्रधावति ॥ २२ ॥
पच्यते कोष्ठ एवान्नमन्त्रपकत्रैव चास्य यत् । प्रायोऽस्मान्मलतां यातं नैवालं धातुपुष्टये ॥२३॥
‘रसोऽप्यस्य न रक्ताय मांसाय कुत एव तु । अवष्टब्धः स शकृता केवलं वर्तते क्षयी ॥२४॥
The doshas of which kapha is predominant, associated with the weakness of fire (digestive activity) and also of the fire in the dhatus (metobolic activity in the tissues) bring about the closure of the srotas (passages, pores) forming of coating inside them, thus getting obstructed and undergoing excessive cooking (process by heat) in its own place, the rasa dhatu produces the aforesaid complications (secondary diseases); then it moves upwards (to the head chest etc) without reaching the blood, musices, and others dhatus (tissues) leading to lack of nourishment and wasting of the tissues; the food gets cooked only by the fire which digests the food (kostagni and not by other agnis such as bhutagni; because of this, it (food) becomes more of waste material, the little amount of nutrient is not sufficient to nourish the dhatus (tissues); when there is no rasa for (nourishing) the rakta itself, where will it be for mansa ( muscle and other ). Thus the patient of ksaya (consumption), sustains only by the strength of the faeces. (21-24)
लिङ्गेष्वल्पेष्वपि क्षीणं व्याध्यौषधबलाक्षमम् । वर्जयेत् साधयेदेव सर्वेष्वपि ततोऽन्यथा ॥ २५ ॥
Though the symptoms are few, if the patient is emaciated and unable to withstand the strength of the disease and drugs (or therapies) he should be refused; whereas he who can with stand these, should be treated, though all the symptoms are present. (25)
Svarasada nidanam – diagnosis of hoarseness
दोषैर्व्यस्तैः समस्तैश्च क्षयात् पष्ठश्च मेदसा । स्वरसादो भवेत्तत्र क्षामो रूक्षश्चलः स्वरः ॥२६॥
शूकपूर्णाभकण्ठत्वं स्त्रिग्धोष्णोपशयोऽनिलात् । पित्तात्तालुगले दाहः शोष उक्तावसूयनम् ॥२७॥
लिम्पन्निव कफात् कण्ठं मन्दः खुरखुरायते । स्वरो विबद्धः सर्वैस्तु सर्वलिङ्गः क्षयात् कषेत् ॥२८॥
धूमायतीव चात्यर्थं मेदसा लेष्मलक्षणः । कृच्छ्रलक्ष्याक्षरश्चात्र सर्वैरन्त्यं च वर्जयेत् ॥२९॥
Svarasada (weakness of voice, hoarseness) arises from each of the doshas and their combinations, from wasting (of the dhatus) and sixth, by (accumilation of) medas (fat). Among these, that produced by vata makes the voice low (diminished), harsh and unsteady, the throat feels as though filled with thorns and the patient finds comfort by unctous and warm procedures; that produced by pitta causes burning sensation and dryness of the palate and throat, the voice is non-continuous and lame (slowed); that produced by kapha causes throat to be slow (in producing the voice), the voice is husky and mixed up (slurreci, overlap); that produced by all the doshas combined together, creates all the above symptoms simultaneously; that caused by wasting of tissues, makes for irritation (of the throat), and feeling of hot smoke coming out; that produced by fat has the symptoms/similar to that of kapha and the words which come out recognisable with difficulty. (out of these kinds) that which is produced by the combination of all the doshas and the last one (produced by fat) are to be rejected. (26-29)
Arochaka nidanam – diagnosis of anorexia
अरोचको भवेद्दोषैर्जिह्वाहृदयसंश्रयैः । सन्निपातेन मनसः सन्तापेन च पञ्चमः ॥३०॥
Arocaka (anorexia, loss of taste or appetite) arises from each one of the doshas which are localised in the tongue and the heart (mind) by the combination of all of them, and the fifth by the disorders of the mind. ( 30 )
कषायतिक्तमंधुरं वातादिषु मुखं क्रमात् । सर्वोत्थे विरसं शोकक्रोधादिषु यथामलम् ॥३१॥
The taste in the mouth is astringent, bitter and sweet respectively from vata and others (pitta and kapha); the taste is abnormal (unusual, opposite of the natural) in that caused by all the doshas together, and in that produced by grief, anger etc (mental) the taste is related to the dosha (which gets increased). (31)
Chardi nidanam – diagnosis of vomiting
छर्दिर्दोषैः पृथक् सर्वैर्द्विष्टैरर्थैश्च पञ्चमी । उदानो विकृतो दोषान् सर्वास्वप्यूर्ध्वमस्यति ॥ ३२ ॥
तासूत्क्लेशास्यलावण्यप्रसेकारुचयोऽग्रगाः ।
Chardi (vomiting) is caused by each one of the doshas seperately; by all of them together and the fifth by disaggreable objects of sense organs (such as sight, smell, taste, sound and touch) udana vata becoming abnormal brings the other doshas upwards (and causes vomiting). Nausea, salty taste in the mouth, excess salivation and loss of taste are its premonitary symptoms. (32)
नाभिं पृष्ठं रुजन् वायुः पार्श्वेचाहारमुत्क्षिपेत् ॥३३॥
ततो विच्छिन्नमल्पाल्पं कषायं फेनिलं वमेत् । शब्दोद्गारयुतं कृष्णमच्छं कृच्छ्रेण वेगवत् ॥३४॥
कासास्यशोषहृन्मूर्धस्वरपीडाक्लमान्वितः । पित्तात् क्षारोदकनिभं धूम्रं हरितपीतकम् ॥३५॥
सासृगम्लं कटूष्णं च तृणमूर्छादाहतापवान् । कफात् स्निग्धं घनं श्वेतं श्लेष्मतन्तुगवाक्षितम् ॥३६॥
मधुरं लवणं भूरिप्रसक्तं लोमहर्षणम् । मुखश्वयथुमाधुर्यतन्द्राहल्लासकासवान् ॥३७॥
सर्वलिङ्गा मलैः सर्वै रिष्टोक्ता याच तां त्यजेत् । पूत्यमेध्याशुचिद्विष्टदर्शनश्रवणादिभिः ॥३८॥
तप्ते चित्ते हृदि क्लिष्टे छर्दिर्द्विष्टार्थयोगजा ॥३९॥
वातादीनेव विमृशेत् कृमितृष्णामदौहृदे । शूलवेपथुहल्लासैर्विशेषात् कृमिजां वदेत् ॥ ४० ॥ कृमिहृदोगलिङ्गैश्च
Vomiting associated with pain in the umbilicus, back and flanks, bouts not continuous, vomittus less in quantity, astringent and forthy, accompanied with noise and belchings, black, thin material coming out with difficulty and with great force, cough, dryness of the mouth, pain in the region of heart and head and during speech (throat) and exhaustion also being associated; these are the symptoms of vomiting caused by vata.
In vomiting caused by pitta, the vomitted material resembles solution of alkalies, is smoky, green or yellow, mixed with blood, sour, pungent, hot and associated with thirst, fainting, burning sensation and increased heat (fever).
In vomiting caused by kapha, the material is unctuous, thick and white, contains threads of kapha, sweet or salty, large in quantity and is of frequent bouts associated with horripilations, swelling of the face, sweetness of the mouth, stupor, nausea and cough.
The vomiting caused by all the three doshas has the symptoms of all the doshas and also those enumerated under fatal signs, this should be rejected.
Sight, smell etc of things which are putrifying, unpleasant, dirty, hated and such others bring about abnormalities in the mind and discomfort in the heart and produce vomiting known as ‘that arising from bad contact of the senses with their objects.’
In vomiting due to krimi (worms, internal parasites ), (suppression of ), thirst ama (improperly processed food), and dauhrda (longings of pregnancy ), the symptoms corresponding to vata and others should be recognised; specially in krimija (caused by internal parasites) there is pain in the abdomen, rigors, nausea and symptoms of krimija hrdroga ( disease of the heart due to worms). (33-41-a.)
Hridroga nidanam – diagnosis of heart diseases
स्मृताः पञ्च तु हृद्गदाः । तेषां गुल्मनिदानोक्तैः समुत्थानैश्च सम्भवः ॥४१॥
Hrdroga (disease of the heart) are five; they arise by the same causes which are enumerated for Gulma (abdominal tumor), (vide chapter – 11). (41-b.)
वातेन शूल्यतेऽत्यर्थं तुद्येते स्फुटतीव च । भिद्यते शुष्यति स्तब्धं हृदयं शून्यता द्रवः ॥४२॥
अकस्माद्दीनता शोको भयं शब्दासहिष्णुता । वेपथुर्वेष्टनं मोहः श्वासरोधोऽल्पनिद्रता ॥४३॥
पित्तात्तृष्णा भ्रमो मूर्च्छा स्वेदो दाहोऽम्लक: क्लमः । छर्दनं चाम्लपित्तस्य धूमकः पीतता ज्वरः ॥४४॥
लेष्मणा हृदयं स्तब्धं भारि कंसाश्मगर्भवत् । कासाग्निसादनिष्ठीवनिद्रालस्यारुचिञ्चराः ॥४५॥
In that caused by vata, the heart has very severe pain such as pricking, bursting and tearing (cutting); feeling of dryness, stillness ( decreased rate ) feeling of emptiness, increased rate, peevishness without any other cause grief, fear ( anxiety), inability to torerate noise, rigors, twisting of the body, delusion (confusion) obstruction, to respiration and very little sleep ( are also seen).
In that caused by pitta, there is thirst, giddiness, fainting perspiration, burning sensation, sourness inside the stomach (acidity) exhaustion without effort, vomiting of sour bile, feeling of hot fumes coming out, yellow discolouration (of the skin) and fever.
In that caused by kapha, the patient feels his heart as static ( inactive), heavy as though having a stone within it; is associated with cough, weakness of digestive activity, expectoration, sleepiness lassitude, loss of taste (or appetite) and fever (42-45). That caused by combination of the three doshas will have symptoms of all of them. ( 451 2 )
सर्वलिङ्गस्त्रिभिर्दोषैः कृमिभिः श्यावनेत्रता । तमः प्रवेशो हल्लासः शोषः कण्डूः कफस्रुतिः ॥४६॥
हृदयं प्रततञ्चात्र क्रकचेनेव दार्यते । चिकित्सेदामयं घोरं तं शीघ्रं शीघ्रकारिणम् ॥४७॥
In that caused by krimi (internal parasites) there is blackish discolouration of the eyes, feeling of entering into dark (unconsciousness) nausea, dryness, itching, discharge of kapha, the patient feels as though his heart is constantly being cut by a saw, this disease should be treated urgently as it is dreadful and of quick activity (progessive). (46-47)
Trishna nidanam – diagnosis of thirst
वातात् पित्तात् कफात् तृष्णा सन्निपाताद्रसक्षयात् । षष्ठी स्यादुपसर्गाच्च वातपित्ते तु कारणम् ॥४८॥
सर्वासु तत्प्रकोपो हि सौम्यधातुप्रशोषणात् । सर्वदेहभ्रमोत्कम्पतापतृद्दाहमोहकृत् ॥४९॥
Trishna ( thirst ) is caused by vata, pitta kapha combination of all of them, loss / depletion of rasa (dhatu) and sixth by upasarga (secondary to other diseases). In all these, vata and pitta are the (chief) causes because it is they which get aggravated (increased) by the dryning of all watery tissues, and produce giddiness, tremors, heat, thirst, burning sensation and delusion. (48-49)
जिह्वामूलगलक्लोमतालुतोयवहाः सिराः । संशोष्य तृष्णा जायन्ते तासां सामान्यलक्षणम् ॥५०॥
मुखशोषो जलातृप्तिरन्नद्वेषः स्वरक्षयः । कण्ठौष्ठजिह्वाकार्कश्यं जिह्वानिष्क्रमणं क्लमः ॥५१॥ प्रलापश्चित्तविभ्रंशस्तृड्ङ्ग्रहोक्तास्तथामयाः ॥५२॥
Thirst is caused due to the dryness of the siras (veins and other blood vessels) and toyavaha srotas (channels maintaining water balance) located at the root (base) of the tongue, throat, kloma (pancreas) and palate. General symptoms are; dryness of the mouth, lack of contentment for water (craving for more water), aversion to food, loss of voice (feeble voice), roughness of the throat, lips, and tongue, protrusion of the tongue, exhaustion (without effort), delerium, disorders of the mind and other diseases mentioned as arising from suppression of thirst. (50-52)
मारुतात् क्षामता दैन्यं शङ्खतोदः शिरोभ्रमः । गन्धाज्ञानास्यवैरस्य श्रुतिनिद्राबलक्षयाः ॥ ५३॥
शीताम्बुपानावृद्धिश्च पित्तान्मूर्छास्यतिक्तता । रक्तेक्षणत्वं प्रततं शोषो दाहोऽतिधूमकः ॥५४॥
In thirst caused by vata, the patient is wasted, timid (helplessness) has pricking pain in the temples, giddiness, loss of sense of smell, bad taste in the mouth, decrease of voice, sleep and strength and increase of thirst by drinking cold water; in that caused by pitta, there is faining, bitter taste in the mouth, redness of the eyes, constant dryness, burning sensation and severe feeling of hot smoke coming out. (53-54)
कफो रुणद्धि कुपितस्तोयवाहिषु मारुतम् । स्रोतस्तु सकफस्तेन पङ्कवच्छोष्यते ततः ॥५५॥
शूकैरिवाचितः कण्ठो निद्रा मधुरवाता । आध्मानं शिरसो जाड्यं स्तैमित्यच्छर्घरोचकाः ॥
आलस्यमविपाकश्च सर्वैः स्यात् सर्वलक्षणा ॥५६॥
Kapha undergoing increase obstructs/blocks the vata inside the channels of water, this (vata) in combinations with kapha causes dryness like the (drying of) slush, produces the feeling as though throat is full of thorns, sleep, sweet taste in the mouth, flatulance, headache, inactivity, vomiting, loss of appetite (or taste ), lazyness and indigestion. In thirst caused by all the doshas symptoms of all the doshas will be present. (55-56)
आमोद्भवा च भक्तस्य संरोधाद्वातपित्तजा । उष्णक्लान्तस्य सहसा शीताम्भो भजतस्तृषम् ॥५७॥
ऊष्मा रुद्धो गतः कोष्ठं यां कुर्यात् पित्तजैव सा । या च पानातिपानोत्था तीक्ष्णाग्नेः स्नेहजा चया ॥५८ ॥
स्त्रिग्धगुर्वम्ललवणभोजनेन कफोद्भवा । तृष्णा रसक्षयोक्तेन लक्षणेन क्षयात्मिका ॥ ५९॥
शोषमेहज्वराद्यन्यदीर्घरोगोपसर्गतः । या तृष्णा जायते तीव्रा सोपसर्गात्मिका स्मृता ॥६०॥
That due to ama, is caused by obstruction to food and is vatapittaja in origin.
By taking bath in cold water immediately after getting exhausted from long exposure to sun, the heat of the body getting obstructed goes into the alimentary tract and causes thirst; this is by (increased) pitta only; similarly also those caused by excess intake of alcoholic drinks and by oleation therapy (drinking of oil) in persons having tiksnagni (powerful digestive activity).
Thirst caused by ingestion of fatty, heavy (hard to digest) sour and salty foods is due to (increase of) kapha, that manifesting with symptoms of Rasaksaya (loss deficincy of Rasa dhatu) is Ksayaja kind of thirst.
That severe form of thirst which accompanies Sosa (consumption tuberculosis), meha (polyurea/diabetes), jvara (fevers) and such other diseases of long duration is known as Aupasargika trishna (thirst as secondary disease).
॥ इति पञ्चमोऽध्यायः ॥ Thus ends the Fifth chapter.
