ISSN: 2456-6640 International Journal of of Ayurveda (A Monthly Scientific Journal of Kiban Research Publications) www.kibanresearchpublications.com REVIEW ARTICLE A Literary Review of Kshayaja Kasa Aarif Khan *1, Prashant Saini2, Archana Singh3 1Ph.D. Schlor, P.G.Dept. of Roga Evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur (Raj.), India. 2Ph.D. Schlor, P.G.Dept. of Shalya Tantra, National Institute of Ayurveda, Jaipur 3P.G. Schlor, P.G.Deptt. of Roga Evam Vikriti Vigyan, National Institute of Ayurveda, Jaipur (Raj.), India. *Corresponding Author: Aarif Khan Abstract Now a day the life style of human being is broadly changed. Due to lack of knowledge of rule and regulation or for avoidance of dinacharya and ritucharya, some disgusting habit like smoking etc. people suffer from many chronic diseases like chronic bronchitis which can be correlated with Kshayaja Kasa. Not only habit but also the environmental pollution is responsible for such diseases, mainly such habit and environmental pollution affect the pranavahasrotas and produce the diseases, Kshayaja Kasa is one of them. Here it is mentioned that due to dhatukshaya kshayaja kasa occur. Dhatuis loosely translated as tissue and represents the constituents of the body that are not eliminated. The dhatus are the basic varieties of tissues, which compose the human body. Due to lack of proper nutrition to the body, the process of formation of all these Dhatus gets decreased. These decreased Dhatus causes Vata prakopa, which is most important Samprapti ghataka in the pathogenesis of Kshayaja Kasa. In modern system of medicine, anti-biotics, anti-histamines etc. are commonly used for the management of Chronic Bronchitis .Although, they all are suppressing the symptoms, yet, none of these modalities of treatments provide a permanent cure, and have limitations owing to their effects. In other way of treatment ayurvedic drugs have no side effects and widely used in the management of Kshayaja Kasa. Keywords: Pranavahasrotas, Dhatukshaya, Samprapti, Vata, Chronic bronchitis. Introduction The illness characterized by the act of ‘Kasana’ is known as Kasa [1]. The word Kasais derived from the root ‘kasagathou’, meaning course. Pathologically speaking the morbid Vata Dosa either alone or in combination with morbid Kapha Dosa constricting the body parts like sirah, Kantha, etc. and then escapes from the mouth. This abnormal course of vayuis referred as Kasa [2]. Authors of Charaka Samhita, Sushruta Samhita, Ashtanga Sangraha and Hridaya, Bhavaprakasha, Sharngadhara Samhita, Madhava Nidana, mentioned Kasaas five types. Chronologically, they are strong one by one. They are as follows:  Vataja Kasa  Kaphaja Kasa  Kshayaja Kas PittajaKasa Kshataja Kasa Definition of Kasa Kasais a forced exptration against a closed glottis. It is usually an expression of disease in the Pranavaha Strotas. It may be either a voluntary act or a reflex response to irritation of Pranvaha Strotas. By the association of the Udanavayu, Pranavayu assumes an abnormal upward course and spontaneously escapes from the mouth generating the sound similar to the one produced by the broken bronze vessel, and this illness is known as Kasa [3-5]. Definition of Kshayaja Kasa A type of Kasa Roga in which patients expectorates offensive, greenish, sanguinous or purulent sputum and during the fit of coughing, he feels as though his heart were displaced is known as Kshayaja Kasa. Aarif Khan et. al. |October. 2017| Vol.2| Issue 10|011 Available online at:http://ija.kibanresearchpublications.com/index.php/IJA Definition of Chronic Bronchitis Presence of chronic productive cough on most days for 3 months, in each of 2 consecutive years [6]. Symptoms of Dhatu Kshaya According to Charaka [10].  he symptoms of loss of nutrient body fluid are restlessness, intolerance to loud sounds, acceleration of flow, tachycardia pain and distress even on the slightest exertion. Nidana of Kshayajakasa These are the specific causative factors responsible for the production of individual verities of Kshayaja Kasa-Visama Ahara, Asatmya Ahara, Ativyavaya, Veganigraha, Jaraa etc [7]. As Acharya Charaka says “Vayordhatukshayaat kopo maargasyaavarnenacha” means dhatu kshaya leads to Vata prakopa and prakupita vata is responsible for Kshayaj a Kasa. Hence dhatu kshaya is also the most important cause for pathogenesis of Kshayaja Kasa.  he symptoms of loss of blood are roughness, cracks, withering and dryness of skin.  he symptoms of loss of flesh are thinning in general & specially on hips, neck & belly. Dhatu Body is nothing but the combination of all dosa, dhatu and malas. If these body constituents are in the equilibrium body will be in the healthy state. (Su.su.15/3) Functions of the Seven Tissues [8]  Rasa dhatu (plasma) provides satisfaction, nutrition and supplies nourishment to raktadhatu (blood).  Rakta (blood) bestows color, nourishment to mamsa (muscle) and maintains life activities.  he symptoms of loss of fat are the cracking of the joints, lassitude in the eyes, exhaustion and thinning of the abdomen.  he symptoms of the atrophy of ostio-tissue are the falling of hair, nail and teeth, fatigue and looseness of joints.  he symptoms of the atrophy of the marrow are the atrophy of bone-tissue which becomes weak and light, and the patient is afflicted with chronic vata disorders.  Mamsa (muscle) furnishes nourishments to the body and also to medas (fat).  Medas (fat) bestows lubrication, sweating, stability and nourishment to asthi (bone).  Asthi (bone) provides support to the body and nourishment to majja (bone marrow).  Majja (bone marrow) provides lubrication, strength, filling of the bones and nourishment of sukra.  Sukra (semen/reproductive tissue) bestows courage, ejaculation, lust, strength of the body, pleasure, love (affection) and the purpose of seed (formation of embryo). General Causes (Wasting) of Dhatu Kshaya Over-exercise, fasting, worries, taking dry &scanty and limited meals ,exposure to wind and sun ,fear ,grief ,dry beverages ,excessive waking excessive discharge of mucus ,blood, semen and excretion, season or age and possession by spirits are to be known as the cause of wasting [9]. Aarif Khan et. al. |October. 2017| Vol.2| Issue 10|01-04  he symptoms of wasting of semen are debility, dryness of the mouth, pallor, asthenia, fatigue, impotency and nonemission. Causes of Chronic Bronchitis The two most important etiologic factors responsible for majority of cases of chronic bronchitis are: cigarette smoking and atmospheric pollution .Other contributory factors are occupation, infection, familial and genetic factors [11]. The "Wear and Tear" Theory Dr. August Weismann, a German biologist, first introduced this theory in 1882. He believed that the body and its cells were damaged by overuse and abuse. The organs, liver, stomach, kidneys, skin and so on are worn down by toxins in our diet and in the 2 Available online at:http://ija.kibanresearchpublications.com/index.php/IJA environment; by the excessive consumption of fat, sugar, caffeine, alcohol and nicotine; by the ultra-violet rays of the sun and by the many other physical and emotional stresses to which we subject our bodies. Wear and tear is not confined to our organs, however; it also takes place on the cellular level. Of course even if you've never touched a cigarette or had a glass of wine, stayed out of the sun and eaten only natural foods, simply using the organs that nature endowed you is going to wear them out. Abuse will only wear them out more quickly. Likewise as the body ages our very cells feel the effect, no matter how healthy our life style. When we are young the body's own maintenance and repair systems keep compensating for the effects of both normal and excessive wear and tear. (That's why young people can more easily get away with a night of heavy drinking or a binge of pizza or sweets.) With age the body loses its ability to repair damage caused by diet, environmental toxins, bacteria or a virus. Thus many elderly people die of diseases that they could have resisted when they were younger [12]. Poorvaroopa of Kshayaja KASA Poorvaroopaare those signs and symptoms which appear prior to the manifestation of actual disease. They appear during Sthana Samshraya, the stage of localization at the site of Khavaigunya [13] and considered as the first indicators of future disease. There is much similarity among the Poorvaroopa of Kasa explained in the classics of Ayurveda. Those are as follows Shooka Poorna Galaasyata, Kanthe Kandu, Bhojyanaam Avarodha, Aruchi, Sashabdha Vaishamya, Agnisada, Gala Lepa & Thalu Lepa. Roopa of Kshayaja Kasa The actual signs and symptoms of fully evolved disease along with the cardinal features will be seen in Vyakta Avastha where Dosha-Dooshya Sammoorchana takes place [14]. With the help of Roopa, a disease can be diagnosed with confirmation and management can be planned accordingly. Roopa of Kshayaja Kasa explained in the classics of Ayurveda are as follows Daurgandha harit rakta puyavata kapha sthivana, Hrtchyuti anubhuti at the time of attack, Akasmat usnashitarta, Bahvasi Aarif Khan et. al. |October. 2017| Vol.2| Issue 10|01-04 durbal krsa, Snigdha mukha, varna, tvaca, Dusro ke guno me dosa nikalna, Jvara, Parsvashula, Pinasa, Aruci , Daurbalya etc. Clinical Features Chronic Bronchitis  Persistent cough with copious expectoration of long duration; initially beginning in a heavy smoker with ‘morning catarrh’ or ‘throat clearing’ which worsens in winter.  Recurrent respiratory infections are common.  Dyspnoea is generally not prominent at rest but is more on exertion.  Patients are called ‘blue bloaters’ due to cyanosis and oedema.  Features of right heart (corpulmonale) are common. failure  Chest X-ray shows enlarged heart with prominent vessels. Upashaya and Kshayajakasa Anupashaya of Upashayafor a disease is considered to be Satmya for that disease and should be practiced by the patient. Anupashayais Asatmya (harmful) for the disease and patient has to avoid those. The causative factors which leads to irritation of bronchial tree, like that of dust, smoke, pollens, cold breeze, fog, polluting gases, etc. leads to aggravation of the illness. The Dosa producing products as stated in Nidana as well as the behaviors inducing Vat and Kaphapra kopa because of divasvapna, ratrijagarana, etc. prolongs the Kasa. Living in an environment which is free of dust and pollution, are considered as upasaya. [15,16]. Samprapti of Kshayajakasa The gastric fire being vitiated in squeamish or mournful persons as the result of unbalanced or unwholesome diet, excessive sexual indulgence and suppression of natural urges, the three humors become provoked and produce the cough, born of wasting ,which in turn leads to the consumption of the body [17]. Pathogenesis [18]  Chronic bronchitis and emphysema occur as a result of an inflammatory process involving the airways and distal airspaces.  Increased activity of oxidants combined with reduced activity of antioxidants has 3 Available online at:http://ija.kibanresearchpublications.com/index.php/IJA been implicated in the development of inflammation and COPD. treatment, it can lead to Upadra vas like Jwara, Arochaka, Swasa, Swarabheda and Kshaya.  Cigarette smoke, produce high concentration of oxygen free radicals (reactive oxygen species-ROS) including Complications superoxide, hydrogen peroxide and hypochlorous acid. These are responsible for tissue damage and activation of eosinophils and neutrophils. Mucopurulent relapses, Respiratory failure, pulmonary hypertension and right ventricular failure (corpulmonale). Chikitsa of Kshayaja Kasa  Inflammatory response is initiated through the activation of transcription factors (nuclear factor-kB {NF-kB} and activator protein-1(AP-1), and gene expression of pro-inflammatory mediators. Chikitsa Sidhanta of Kshayaja Kasa The measures that are promotive of the gastric fire and roborant, as well as the measures predicative of the channels are administered alternately, they will become strength giving and beneficial [22].  Further, cigarette smoke, various oxidants and activated neutrophils damage alpha-antitrypsin that is required to prevent degradation of elastin. All these result in various changes seen in patients with chronic bronchitis and emphysema. A general principle of management of any disorder in Ayurveda is divided into three parts [23].  Nidana Parivarjana    Various inflammatory mediators involved in COPD include leucotriene B4 (which amplify inflammatory response and may be responsible for systemic effects) and transforming growth factor-beta (which may induce fibrosis in small airways). Samshodhana Samshamana Management Regular exercise, nutritional management, Reduction of bronchial irritation likesmoking, dusty and smoke-laden atmospheres, antibiotics, bronchodilator and steroid therapy.  Pulmonary hypertension develops due to vascular remodelling in COPD, which results from combined effects of hypoxia, inflammation, and in severe emphysema, loss of capillaries. Pathyapathya Acharya Charaka has considered the word “Pathya” as a synonym of Chikitsa. Treatment procedure for any disease without Pathya diet will not be complete. It playsa very important role in combating the disease as well as in keeping Doshas under control. In some instances, following only Pathya pathyas in its primary stage the disease can be treated or arrested or weakened. Upadrava Charaka in the context of Nidanarthakara Roga tells, untreated or partially treated Kasawill land up in Kshaya [19]. In Astanga Hridaya [20] and as well as in Yogaratnakara, it is mentioned that if Kasais neglected then it leads to Swasa, Kshaya, Chardi and Swarabheda. In Bhavaprakasha [21], it is explained that, if the Kasa is neglected without proper References 1 Ch.Chi.18/8 10 Ch.su.17/64-69 11 Harsh Mohan (ed’s) Textbook of pathology, sixth edition, Published by Jaypee brothers medical publishers(P)LT 12 http://www.anti-aging-today.org 13 Ibidem (8) Madhava Nidana, Panchanidana Lakshanam, (1/56).p.32 14 Ibidem (7), Ashtanga Hridaya, Nidana Sthana, Sarvaroganidana Adhyaya (1/5).p.441 2 Ch.Chi.18/6-8 3 Su.U.52/20 Dalhanatika 4 Ch.chi.18/8 5 M.N.11/2 6 Graham Devereux. ABC of chronic obstructive Published by pulmonary disease, 7 Ch.Chi.18/24 15 Ch.Chi.18/108 8 Su.su.15/5[1] 16 Ch.Chi.18/133 9 Ch.su.17/76-77 17 Ch.chi.18/24 Aarif Khan et. al. |October. 2017| Vol.2| Issue 10|01-04 4 Available online at:http://ija.kibanresearchpublications.com/index.php/IJA 18 K.George Mathew & Praveen Aggarwal (ed’s) Medicine, pre manual for undergraduates, fourth edition, Published by Elsevier,163. 19 Ibidem (3), Charaka Samhita, Nidana Sthana, ApasmaraNidana Adhyaya (8/19).227 20 Ibidem (7), Ashtanga Hridaya, Nidana Sthana, Raktapitta Kasa Nidana (3/37).471 21 Ibidem (14) Bhavaprakasha Kasarogadhikara (12/18). 22 Ch.Chi.18/187 23 Ch.V.7/30 Samhita, Madhyama Aarif Khan et. al. |October. 2017| Vol.2| Issue 10|01-04 Khanda, 2