Chapter XLI - Symptoms and Treatment of Phthisis (Shosha)

Now we shall discourse on the (symptoms and) medical treatment of Phthisis (Shosha-Pratishedha). 1.

The mythological origin of Shosha (Phthisis):—

The Moon-god married 27 daughters of Daksha of whom he was attached to Eohini in the extreme. Thereupon the personated wrath of his father-in-law, Daksha entered the Moon-god in the shape of Phthisis, whereby the body of the Moon-god began to emaciate. The Moon-god became penitent and the wrath of his father-in-law having been subdued at the intervention of the other gods, he managed to send down the personated Phthisis to earth to take possession of men indulging in any kind of excess and more particularly—sexual excess. The moon-god was then medically treated and radically cured by the celestial physicians, the twin Ashwins.

Nomenclature:—

Wasting or a general emaciation of the frame marks the sequel of and comes in as a premonitory symptom of an organic disease. Any cachectic condition of the body accompanied by a low lingering fever is called Kshaya. A correct diagnosis and a radical cure of the disease under discussion has baffled many a skilful physician. The disease is nameds Shosha from the fact of its consuming or drying up (Sosha—withering) the vital principles of the body such as Rasa—serum, etc. It is called Kshaya (wasting) since a wasting process is found to accompany all the functional activities of the body during its attack. Since the Moon-god, the king of the Brahmanas, was the first to fall a victim to its attack, it is also called Raja-yakshma (king’s disease)^[1] by some authorities. 2.

Some say that the disease is produced by the separate action of the three fundamental Doshas of the body. It being usually found to be attended with all the eleven distressing symptoms which arc manifested simultaneously with the ushering in of the disease, and being the only instance in the science of therapeutics in which the treatment does not vary according to the variation of symptoms. This disease, Sh osha, is more properly said to originate in the simultaneous aggravation of all the three Doshas, and it is the symptoms of the most predominant Dosha only that are manifested. 3.

Ætiology and general symptoms:—

The process of any wasting disease in the system, repression of any physical urging or propulsion, over-fatiguing physical exercise and irregular diet are the causes which, by aggravating the bodily Doshas and propelling them all over the organism, give rise to the disease. The aggravated Doshas with Kapha as the most predominant factor having obstructed the lymphatic channels, or the semen of a person having been exhausted by sexual excesses consequently produce a loss of the other Doshas or the principal elements of the organism, thereby producing a cachectic condition of the body, and the following symptoms, viz, aversion to food, fever, asthma, cough, emission of blood, loss of voice, numbering six in all are found in cases of Raja-yakshma. 4—6.

Specific Symptoms:—

The symptoms which mark the action of the deranged bodily Vayu in the disease are loss of voice (hoarseness), aching pain (in the chest), contraction of the sides and stoop at the shoulders (Amsha), while those which are exhibited through the action of the deranged Pitta are fever, burning sensation, Atisara and expectoration of blood, and the features which indicate the action of the deranged Kapha in the disease are a sense of fullness in the head, aversion to food, cough and a sense of the presence of a lump or plug in the throat (as if something is rising up). 7.

Prognosis:—

A physician having an eye to his professional reputation or good name should not take in hand the treatment of a case of Shosha (Phthisis) whether marked by all the preceding eleven kinds of symptoms or attended with six of them viz. cough, Atisara, pain at the sides, loss of voice, aversion to food and fever, or accompanied by only three symptoms, viz. fever, cough and blood-spitting. 8.

Other causes of Shosha and their Symptoms:—

Sexual excess, grief, old age, overfatiguing physical exercise, toils of journey, fasting, ulcers and ulceration of the Urah (lungs) are included by certain authorities within the exciting factors of this disease, Shosha. A case of Shosha due to sexual excess is attended with all the symptoms due to loss of semen and is marked by palour or yellowness of the complexion, the vital organic principles beginning with semen being wasted up in succession in their inverse order of enumeration. Constant brooding over the departed person, looseness of the limbs and all the symptoms of sexual excess other than the actual discharge of semen mark a case due to grief. A general cachectic condition of the body accompanied by imbecility of the mind, diminution of bodily strength, impaired functions of the sense-organs, laboured or difficult breathing (D. R. shivering of the limbs), aversion to food, a gong-like voice, expectorations marked by the absence of mucus (A. R. heaviness of the limbs), a general apathy to the concerns of life and (constant mucus) secretions from the ears, nose, eyes and mouth are the symptoms which indicate the origin of the disease in the natural and spontaneous waste of an extreme old age. 9–12.

A case due to the toils of journey or travel develops such symptoms as looseness of the limbs, flabbiness of the muscles, scorched or burntness of complexion, a haggard and cadaverous look, a gone-feeling in the limbs, the absence of natural gloss of the body and dryness of the mouth, throat and of the Kloma. These symptoms in addition to those of the ulcerated lungs (Urah-Kshata) without actual ulceration, characterise the type due to over-fatiguing physical exercise. 13–14

If a case of ulcer is attended by loss of blood, pain and difficulty in eating, it is turned to a case of Sosha and is pre-eminently the most uncurable type of the deseasc. Rupture or ulceration in the lungs (Urah-kshata) is caused by physical exercises, lifting up heavy loads, excessive and loud reading, a hurt or a b'ow, or excessive sexual congress and such other acts as require the active co-operation and entail excessive straining of the chest (Urah). They ultimately discharge blood and pusy secretions. Yellowish, black or purple coloured blood is expectorated or hawked out by coughing. A burning sensation is felt inside the region of the chest. A fetid smell is felt in the mouth and in the breath. The complexion of the body and the tone of the voice is changed and the patient becomes senseless from the excessive pain he suffers from. In certain cases the symptoms vary according to the varied natures of their exciting factors, and all the specific symptoms arc not fully exhibited. Nevertheless these diseases also go under the denomination of Kshaya (consumption) owing to the fundamental vital principles of the body being equally consumed or withered up in them, and the specific mode of their treatment has already been explained before (Chapter XV, Sutra-Sthana). 15-17.

Premonitory Symptoms:—

Laboured or difficult breathing, a gone-feeling in the limbs and a sense of physical lassitude, secretion of mucus, dryness of the palate, vomiting, dulness of appetite, vertigo or fainting fits, nasal catarrh, cough, somnolence, whiteness of the eyes, desire for meat, and increased sexual propensities are the symptoms which mark the advent of the dreadful disease—Shosha. The patient dreams that he has been borne on the wings of a crow or a parrot or a vulture or a pea-cock or has been riding a porcupine or a lizard or a monkey or sees in dreams river-beds dried up and trees dried up or fanned by gales of wind or surrounded by flames or fumes of fire. 18.

Prognosis:—

A gradual wasting of the body inspite of sufficient food, presence of Atisara (diarrhea) and swelling of the abdomen and scrotum are the symptoms of a consumptive patient who should be given up. The treatment, however, of a patient temperate in his habits and strictly conforming to the instructions of the physician and possessed of a good digestive fire and not much reduced in body may be taken in hand provided the disease be an acute one. 19–20.

Treatment:—

The patient should be made first to use the medicated clarified butter prepared from the milk of a ewe or a she-goat and duly cooked with the drugs of the Sthiradi (Vidari-gandhadi) group and then mild emetics and purgatives. Intestinal injections after the manner of an Asthapana Vasti should follow the preceding medicinal measures and head-purgative (Shiro-vireka) should be applied. The diet should then be given consisting of (cooked) wheat, barley Shali-rice together with meat-essence. Constructive tonics or tissue-builders (Vrimhana) should be given to a patient with a good digestion and relieved of all distressing symptoms or concomitants. Complications peculiar to the action of the deranged bodily Vayu generally mark a case due to sexual excess, wherein constructive tonics and remedial agents of Vayu-subduing virtue would be found to be extremely efficacious. 21—22.

Diet—moat, etc.:—

The flesh of a crow or an owl or a mungoose or a cat or a Gandupada (earthworm) or a cormorant or a beast of prey (Vyala) or of any animal of the Vileshaya or Jangala class mixed with Saindhava salt and fried in mustard oil, should be prescribed in various ways for a patient laid up with Phthisis. The diet may also consist of Mudga- soup or of Adhaki- soup or of the flesh of an ass, camel, elephant, mule or horse variously prepared and well cooked. Meat in combination with any Arishta as well as wine mixed with Madhvika may also be given. 23.

Various articles of food made of barley-grains previously soaked in the alkaline water duly prepared with Arka and Amrita may likewise be prescribed. Clarified butter skimmed off from the milk of a ewe or a she-goat, may be given with gruel at the meal-time to an extremely emaciated patient. A compound consisting of Tri-katu, Cavya and Vidanga made into a paste with honey and clarified butter should be given to be licked up by a patient suffering from Phthisis. The use of a medicated clarified butter duly cooked with the essence of the flesh of any carnivorous animal and mixed with Pippali and honey as an after-throw proves remedial in a case of Phthisis. A lambative consisting of Draksha, sugar and Magadhika pasted together with honey and oil proves efficacious as a cure for Phthisis. A case of Phthisis would yield to the use of a lambative consisting of Tila, Masha- pulse and Ashvgandha ground to a fine paste with the addition of honey and clarified butter skimmed out of the milk of a she-goat, or of sugar, Ashvagandha and Pippali pounded together and made into a fine paste with the addition of honey and clarified butter. Milk duly cooked with the admixture of Ashvagandha may be prescribed as a constructive tonic. Butter skimmed out of the preceding preparation of milk and mixed with copious quantity of sugar should be taken, as an alternative, every morning and this should be then followed by a draught of milk. 24.

Ashvagandha, Punarnava and Yava should be used in rubbing (Utsadana) the body of the patient. Clarified butter duly cooked with (the decoction of) the whole of a Vasaka tree (viz., its roots, leaves, branches and barks) and with its flower (as Kalka) and mixed with an adequate quantity of honey^[2] should be taken by a consumptive patient strictly conforming to the regimen of diet. Thus a virulent attack of Phthisis accompanied with cough, asthma and chlorosis would be speedily conquered. 25–26.

A wise physician should take equal parts of clarified butter, milk, decoctions of Murva, Haridra and of Khadira and the expressed liquid of the dungs of a cow, a horse, an elephant, a she-goat and a ewe. Ten equal parts of the above ten articles should be duly boiled and cooked together with the Kalka of powdered Tri-katu, Tri-phala, Devadaru and the drugs of the sweet (Kakolyadi) group. This medicated clarified butter would be found highly beneficial in the cure of Phthisis (Yakshma). 27.

Six Patra measures of the duly prepared decoction of Dasha-mula, Vanina, Karanja, Bhallataka, Vilva, the two kinds of Punarnava, Yava, Kulattha, Badara, Bhargi, Patha, Citraka and Mahi-Kadamba should be cooked with a Patra measure of clarified butter and with (the Kalka of) Vyosha (Tri-katu), the milk of Maha-vriksha (Snuhi), Abhaya, Cavya, Devadaru and Saindhava salt (D. R. Pippali). The medicated clarified butter thus prepared proves efficacious in cases of Phthisis, Ascites and Vataja-Prameha. Clarified butter duly cooked with the milk, blood, meat-essence and the expressed liquid of the dungs of a cow, a mare, a ewe, a she-goat, a cow-elephant, a hind, a she-ass and a she-camel and with the Kalka of Draksha, Ashvagandha, Magadha and sugar proves extremely beneficial in cases of Phthisis. 28–29.

Eladi-mantha:—

A Prastha measure of clarified butter should be duly cooked with the decoction of Ela, Ajamoda, Amalaka, Abhaya, Aksha, Gayatri, Arishta, Asana, Shalasara, Vidanga, Bhallataka, Citraka, Ugra^[3], Tri-katu, Ambhoda and Surashtraja -earth. When duly cooked it should be taken down from the oven and thirty Pala weight of candied sugar, six-Pala-weight of Tuga-kshira (Vamsha-locana) and two-Prastha-measure of honey should be added to it and stirred with a laddie. A Pala weight of this preparation followed by a draught of milk should be given to be licked every morning to a Phthisical patient. The present elixir is possessed of ambrosial sanctity. The extent of its therapeutic application embraces such diseases of the body as Phthisis, chlorosis, fistula-in-ano, asthma, loss of voice, cough, troubles of the heart, enlarged spleen, Gulma and chronic diarrhea or indigestion. It imparts longevity to a person using it, leads to the expansion of his intellectual faculties and tends to invigorate his eye-sight. It is the best of all rejuvenating preparations of our pharmacopea and no strict regimen of diet and conduct is required to be followed while it is used. 30.

The medicated clarified butter mentioned under the treatment of Plihodara (dropsy of the abdomen owing to the enlargement of spleen—Chapter XIII, Chikitsita-sthana) as well as the three others mentioned in that connection may be also used with advantage in the disease under discussion. The accompanying symptoms or complications such as hoarseness of voice, etc. should be remedied with appropriate medicines presented for those diseases in the Shastras. The patient should be made to use regularly the milk, butter, urine, blood, meat and the (expressed liquid of the) dung of a goat as his bath or in any other way possible (e.g., in drinking) and to live in a goat-shed (in the company of goats) whereby he would be cured of his Phthisis in a month. A Phthisical patient should likewise be made to take Rasona (garlic) or Naga-vala or Magadhika or Shilajatu with milk, in the prescribed manner (laid down in connection with the medical treatment of Maha-vata-Vyadhi). 31–34.

Rules of conduct:—

He should not allow any grief, anger or jealousy to disturb the equilibrium of his mind, should lead a life of strict continence, deal in the discussion of sublime subjects and conform to the injunctions of his medical advisers or physicians. He should pay respects to the gods, superiors and Brahmanas and listen to the discussions of the spiritual truths from the lips of Brahmans. 35.

 

Thus ends the forty-first chapter of the Uttara Tantra in the Sushruta Samhita which deals with the (symptoms and) treatment of Phthisis.

Footnotes and references:

[1]:

Cf. Scrofula which is now know n as the “King’s disease.”

[2]:

This preparation is also found in the Charaka Samhitā though in different language under the treatment of Rakta-pitta.

[3]:

Chakradatta does not read Ugrā in the list.