RAJYAKSHAMA VYADHI

Dr.Navnita Sengupta
B.A.M.S , M.D (ayu)
Asst Professor (Kayachikitsa)
INTRODUCTION-
 The three chapters viz. Sosha Nidana, Rajayakshma Chikitsa and Kshatakshina Chikitsa
deal with similar clinical presentation of disease and principles of
management. Dhatukshaya is common feature in all. Advancement
of dhatukshaya in sosha reaches a stage when immuno-suppression with resulting
opportunistic infection occurs and is called rajayakshma.
 In kshatakshina or urakshata there is chest injury due to direct or indirect trauma along
with dhatukshaya. Brimhana of dhatu (nourishment) is the principle line of
management.
 Symptomatology of rajayakshma has been described in three different categories
viz. trirupa, shadrupa and ekadashrupa. It seems that trirupa denotes the description
of early tuberculosis when the disease is of mild nature whereas shadrupa is the clinical
manifestation of the moderately advanced disease. Shadrupa is the cardinal symptoms
of pulmonary tuberculosis which are found in the majority of the
patients. Ekadashrupa or eleven-fold manifestation may appear in the far advanced
stage of tuberculosis or in those patients whose vyadhikshamatva (immunity)
is hina (low). The clinical presentation of disease includes groups of signs with their
specific pathogenesis. The increasing number of signs denote severity of disease and
spread of disease over body organs.
 Mild samshodhana therapy is indicated in excess aggravation of dosha.
However drastic purification leading to emaciation is strictly contraindicated
especially virechana (purgation) therapy.

 Samshamana (pacification) therapy includes treatment of symptoms and

treatment of emaciation to increase the declining dhatus (tissues) of the body
by using various types of meat and wines.
Mythological view of the disease-

 Chandrama (Moon)’s passionate cohabiting (with Rohini, one of his 28 celestial

wives) - was narrated by the Gods to the sages. Because of his excessive sexual
indulgence with Rohini, Chandrama soon started neglecting his own health,
becoming emaciated due to depletion of his bodily unctuousness (essence or
vitality). Besides, his inordinate attention to just one wife in comparison to the
others resulted in his not being able to satisfy the desires of his remaining wives
– all of whom were the daughters of Daksha Prajapati (Lord of Progeny). This ill-
treatment to his daughters made Daksha furious, and his anger came out of his
mouth in the form of breath that took a physical form (Yakshma). The now
lusterless, afflicted Moon sought clemency from the great Daksha, accompanied
by the Gods and Sages. Daksha Prajapati , now realizing Chandrama’s pure state
of mind (and therefore, admitting his folly), became cordial to him got him
treated by the Ashwin, the celestial physicians. The Ashwins having enhanced
his ojas (vital essence), Chandrama additionally acquired a great purity of mind.
Synonyms of disease and history of yakshma

क्रोधो यक्ष्मा ज्वरो रोग एकार्थो दुःखसञ्ज्ञकः|

यस्मात् स राज्ञः प्रागासीद्राजयक्ष्मा ततो मतः||११||

स यक्ष्मा हुङ्कृ तोऽश्विभ्यां मानुषं लोकमागतः|

लब्ध्वा चतुर्विधं हेतुं समाविशति मानवान्||१२||

 Krodha(rage), yakshma (sickness), jwara(fever) and roga (disease suffering) –

these terms are synonymous, and indicate misery. Because it afflicted
Chandrama, the king of stars, originally, it is called rajayakshma, or the king
of diseases. This disease, having been treated by the Ashwin in the celestial
world, has come down to the world of mortals (i.e., human beings). Here, it
afflicts human beings after being triggered by a four-fold causative factor
Four important causative factors of disease

अयथाबलमारम्भं वेगसन्धारणं क्षयम्|

यक्ष्मणः कारणं विद्याच्चतुर्थं विषमाशनम्||१३||

Over–exertion beyond one’s capacity, suppression of natural urges, depletion of

tissue elements and irregular dietary habits are the etiological factors
of rajayakshma. [13]
Sahasaja rajayakshma (due to over exertion beyond one’s capacity)

 When beyond one’s capacity, a person indulges in excess battle, reading, weight-lifting,
walking, jumping, swimming etc. or falls down - or gets injured -or exerts himself in any
action that is beyond his strength or tolerance, leads to chest injury and , vitiates vata
dosha. This vata dosha afflicts the other two (pitta and kapha dosha). These
vitiated dosha, along with vayu, spread in all direction within body (pradhavati) and
cause eleven symptoms, with each symptom directly corresponding to the particular part
of the body. If the deranged dosha enters the head, it causes headache; if the throat,
then irritation in throat, cough, hoarseness of voice and anorexia; if the chest, then pain
in the sides of the chest; if the anus, then diarrhea; if in the joints, then fever, yawning
and pain in the chest.
 Injury to the chest and coughing cause the patient to spit out phlegm along with blood. In
this case, the patient suffers from unbearable pain in his chest due to pulmonic damage.
These eleven symptoms are manifested in the patients suffering from yakshma caused by
overexertion. [14-19]
Vegasandharanaja rajayakshma (due to suppression of
natural urges)
 When due to bashfulness or disgust or fear one suppresses the impelling urge
to pass flatus, urine and/or feces, vayu, due to the obstruction of such urges,
propels kapha and pitta upwards, obliquely and downwards within the body,
causing the disorders having symptoms of all three doshas such as coryza,
cough, hoarseness of voice, anorexia, pain in flank, headache, fever, pain in
shoulders, bodyache, frequent vomiting and diarrhea. These are the eleven
symptoms of rajayakshma caused due to suppression of urges. [20-23]
Kshayaja rajayakshma (due to depletion of tissues)

 Excessive envy, eagerness, fever, terror, anger, grief, excessive indulgence in

sexual intercourse, and fasting leads to depletion of shukra and ojas. This, in
turn, due to loss of unctuousness, provokes vata which further aggravates the
other two doshas and causes eleven symptoms such as—coryza, fever, cough,
bodyache, headache, dyspnea, diarrhea, anorexia, pain in flanks, feeble
voice and feeling of warmth in shoulders. These eleven symptoms indicate the
advent of the great disease rajayakshma due to wasting. [24-27]
Vishamashanaja rajayakshma (due to irregular dietary habits)

 Irregular intake of dietary articles, or irregular dietary habits lead to vitiation

of doshas, causing severe amavisha disorders. These vitiated doshas obstruct
the channels of blood etc. leading to weaning away of dhatus and causing the
11 symptoms of rajayakshma caused due to irregular dietary habit:
1. Due to vitiated kapha: coryza, excessive salivation, cough, vomiting and
anorexia,
2. Due to vitiated pitta: fever, distress in shoulder and haemoptysis, and
3. Due to vitiated vata: pain in flanks, headache and hoarseness of voice.[28-31]
Premonitory signs

 The premonitory symptoms (of rajayakshma) are coryza, debility, nitpicking

(or an inclination to find faults where there is no reason to), morbid
appearances on the body; feeling of disgust, loss of strength and flesh (inspite
of consuming adequate food), craving for women, wine and meat, desire to
be always covered by something (feeling of cold), imagined feeling of one’s
food being infested with insects, flies, hair,, rapid growth of hairs and
fingernails, imagined feeling of being attacked by birds, wasps, and animals,
seeing dreams of climbing heaps of hair, bones, and ashes, and dreaming of
dried or withered ponds, mountains, and forests- these are to be known as
premonitory symptoms of rajayakshma of various types.[33-38]
Pathogenesis and clinical features

 Normally, the dhatus of the body get metabolised (being acted upon) by their
own ushmas or dhatvagnis (transforming enzymes in the tissue elements). From these dhatus,
(nutrient tissue elements), the other dhatus ( next dhatu to it that which receive nourishment)
gets nourished through their respective srotas (channels of circulation). (For example, a poshaka
rasa dhatu would nourish the rakta dhatu ).
 Once, however, there is any obstruction to srotas or if there is diminution of stable tissue
elements like rakta or if there is diminution of dhatu-ushmas or dhatvagnis then rajayakshma is
manifested. In such a case, whatever food is digested in the gastrointestinal tract
by jatharagni is mostly reduced to waste products and very little of it contributes to the
formation of ojas (nourishment). The patient is depleted of all tissue elements and strength. The
patient’s stool should be preserved and it is the only source of strength left with him. Because of
the obstruction to the srotas, rasa dhatu becomes vidagdha (improperly metabolized) in its own
location (heart) and this vitiated rasa comes out through the upper passages in different forms
by way of coughing. Subsequently, six or eleven symptoms (or forms of diseases) are manifested,
and their aggregation is the syndrome called rajayakshma. Cough, distress in shoulder, change of
voice, fever, pain in flanks, headache, vomiting of rakta and kapha, dyspnea, diarrhea and
anorexia are the eleven symptoms of rajayakshma ; or they are also six viz., cough, fever, pain in
flanks, hoarseness of voice diarrhea and anorexia. With eleven, six or even three of the
symptoms, a patient is incurable if he is losing mamsa (flesh tissues) and strength, but he is
curable if he is behaving otherwise in spite of showing all the symptoms. [39-47]
Pathogenesis of Rajyakshma
Signs of pratishyaya

 घ्राणमूले स्थितः श्लेष्मा रुधिरं पित्तमेव वा|

मारुताध्मातशिरसो मारुतं श्यायते प्रति||४८||

 प्रतिश्यायस्ततो घोरो जायते देहकर्शनः|

तस्य रूपं शिरःशूलं गौरवं घ्राणविप्लवः||४९||

 ज्वरः कासः कफोत्क्ले शः स्वरभेदोऽरुचिः क्लमः|

इन्द्रियाणामसामर्थ्यं यक्ष्मा चातः [१] प्रजायते||५०||

 The kapha or blood or pitta located at the root of the nasal passage cause
nasal catarrh in the patients whose head is afflicted with vayu. This results in
severe pratishyaya (coryza) affecting entire body of the patient, This leads to
emaciation of the body; its signs and symptoms are headache, heaviness in
the head, loss of smell, fever, cough, increase of mucous secretion, change of
voice, anorexia fatigue and asthenia of the senses and
then rajayakshma manifests. [48-50]
 Appearance of sputum

 पिच्छिलं बहलं विस्रं हरितं श्वेतपीतकम्|

कासमानो रसं यक्ष्मी निष्ठीवति [१] कफानुगम्||५१||

Expectorates resulting from coughing (when afflicted with rajayakshma) contain

slimy, thick, putrid, greenish or white-yellowish matter along with kapha. [51]
Clinical features of rajayakshma

 अंसपार्श्वाभितापश्च सन्तापः करपादयोः|

ज्वरः सर्वाङ्गगश्चेति लक्षणं राजयक्ष्मणः||५२||

The typical characteristics of rajayakshma include a feeling of warmth (or

burning sensation) in the shoulders and flanks, burning sensation in hands, and
feet, and raised temperature all over the body.[52]
Swarabheda (hoarseness of voice) and
characteristics as per dosha affliction
 Hoarseness of voice is engendered by morbid vata, pitta or kapha or blood or
by, strain of coughing or by coryza. The voice becomes husky, feeble and
unstable if caused by vata; if by pitta, there will be burning of the palate and
throat and the patient will refrain from talking; and if due to kapha, the
voice is low, choked and is marked with a wheezing sound; owing to the
obstruction to the flow of blood, the voice becomes low and comes out with
difficulty; the throat becomes injured by the strain of exorbitant coughing
and in case of coryza, the characterstics of the voice resemble the condition
in vata and kapha afflictions.
 The rajayakshma patient is afflicted with pain in the sides of the chest
(flanks) which is inconsistent and manifests during constriction and expansion
of chest during breathing, with headache, burning and heaviness.[53-56]
Rakhta Sthivana ( Hemoptysis)

अभिसन्ने शरीरे तु यक्ष्मिणो विषमाशनात्|

कण्ठात्प्रवर्तते रक्तं श्लेष्मा चोत्क्लिष्टसञ्चितः||५७||

In the emaciated condition of rajayakshma patients’ indulgence in irregular diet

causes expectoration of blood. The kapha too, having been vitiated, is
expectorated from the throat. [57]
Causes of depletion of tissues

 रक्तं विबद्धमार्गत्वान्मांसादीन्नानुपद्यते |
आमाशयस्थमुत्क्लिष्टं बहुत्वात् कण्ठमेति च||५८||

 वातश्लेष्मविबद्धत्वादुरसः श्वासमृच्छति|
दोषैरुपहते चाग्नौ सपिच्छमतिसार्यते||५९||

Owing to obstruction in the circulation, the blood does not nourish the flesh
tissues and other body elements. The blood staying in the stomach, getting
agitated owing to incremented quantity, passes to the throat. Due to the
obstruction of vata and kapha in the chest, there occurs dyspnea and the agni,
being impaired by the morbid humors, causes the patient to pass loose and slimy
stools.[57-59]
Cause of anorexia

 पृथग्दोषैः समस्तैर्वा जिह्वाहृदयसंश्रितैः|

जायतेऽरुचिराहारे द्विष्टैरर्थैश्च मानसैः||६०||

 कषायतिक्तमधुरैर्विद्यान्मुखरसैः क्रमात्|
वाताद्यैररुचिं जातां मानसीं दोषदर्शनात्||६१||

Anorexia or dislike for food is caused by morbidity of one or all the

three doshas in the tongue or heart or by repugnant perceptions. By knowing the
astringent, bitter or sweet taste in the mouth, anorexia is to be diagnosed as
caused due to dominance of vata, pitta or kapha respectively. Anorexia due to
morbid perceptions is psychosomatic, caused due to visually observing disturbing
or morbid visuals. [60-61]
Cause of vomiting

अरोचकात् कासवेगाद्दोषोत्क्ले शाद्भयादपि|

छर्दिर्या सा विकाराणामन्येषामप्युपद्रवः||६२||

Regurgitating or vomiting is caused by anorexia, bouts of coughing, and the

precipitation of morbid dosha and as a result of fear; it occurs as a complication
of other diseases additionally. [62]