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Introduction

Person who is skinny, with only bones and skin and is underweight and weak can be called as having karshya disease.(1) According to the report of Global Hunger index 2019, India is ranked 102 out of a total of 119 countries [2]. Prevalence of undernutrition among under five children according to the National family health survey 4 (NFHS 4) in India shows that 35.7% under five children were underweight, 38.4% were stunted and 21% were wasted [3]. Karshya patients are referred as Balahani(loss of immunity) and proceed towards death [4]. According to Acharya Charak Karshya is described under eight despicable persons (Astau Ninditiya Purush) [5]. Glob-ally priority is given to malnourished persons as kwashiorkor, marasmus, xerophthalmia, nutritional anaemia, endemic goitre, morbidity in young children, retarded physical and mental growth. Karshya literally means reduction in Upachaya,Rupa and Bala.

Causes of Karshya [7]

Intake of insufficient diet, which is dry and light, too cold and too rough qualities. Excessive fasting, constant worry and fear, excess strain and stress, staying awake at night, insomnia, remaining in bed for a long time due to some chronic disease, old age and hereditary factors can produce karshya. It can be due to irregular eating habits, eating too much junk foods, malnourishment, or chronic diseases like cancer. Vata constitution people are usually underweight. In new-born babies it can be a serious problem if the weight at the birth is below average. This is because during pregnancy the mother has not taken a proper nutritious diet sufficient enough for herself and the baby.

Aharaja (Dietary)

Ruksha annapana sevan, indulgence in rough food and drinks, ruksha guna causes kharatva (roughness), vaishadya (non slimminess) and roukshya (dryness). The substances which consist of roukshya, laghu, khara, tikshna, ushna, sthira, apichila are causing rukshana karma. Ruksha annapana is constituted of intake of katu, tikta, kashaya substances, honey, etc.

Viharaja (Behavioral)

Vega, nidra, trusha, kshudha nigraha i.e suppression of natural urges such as sleep, thirst, hunger. Vegdharan and vega udiran of all 13 urges.

• Manasika (psychological)

• Krodha, shoka, chinta, bhaya.

These all causes aggravate vayu that is vitiation of rasa dhatu, insufficient production of rasa dhatu along with other dhatus, chronologically ultimately forms karshya.

Symptoms:

Extremely emaciated people have only bones and skin. His muscle tissue gets depleted, there are prominent veins on his skin. He cannot tolerate the changes in the weather. The skin becomes very dry and rough; the joints are exposed and prominent. He loses his strength and capacity to work. Since he has low immunity, he suffers from frequent coughs and colds, fever, piles, low agni, enlargement of liver and spleen. There is always vitiation of Vata hence various diseases of Vata may occur. Joint pains, weakness in muscles, insomnia; various types of neuralgic pains, fatigue after manual work, are common symptoms.

Samprapti [8]

Pramitashanam karshaniyam.

Atilanghan leads to the rasa kshaya which causes chronologically sufficient production of the next dhatus leading to produce karshya. Intake of ruksha ahar leads to vata prakopa causing increase in ruksha, khara, laghu gunas. This indirectly cause karshan in the mamsa, medadi dhatus and produces karshya. Vegadharan causes vitiation of vata and pitta which leads to insufficient production of mamsa, medadi dhatus and causes karshya.

Principal of management: Chikitsa sutra [9]

detoxification therapy is ideal for this condition. First, herbs should be given to improve his digestive fire and then should be given a light but nutritive diet. Proper rest, relaxing oily massage, light exercise, plenty of enjoyment without any stress and strain is very important. The herbs of choice are shatavari, ashwagandha, black musli, and herbs in jeevaniya group as well as bruhaniya group. Any one of these Two main causes aggravate vata i.e loss of tissues from the body and obstruction in channels by kapha, ama or any other substance. When aggravation is due to tissue loss, tonification of bruhan treatment should be used, while for removing obstruction, purification and langhana should be carried out.

Pathya apathya

Diet: Diet should be anti-vata and nutritious. It should be warm and slightly oily containing preparations of wheat, brown rice, basmati rice, oats, root vegetables, cooked vegetables, meat with mild spices like ginger, cardamom, all dairy products are good. Sweet and sour fruits and sugars like jaggery as well as nuts are advisable.

Pathya

1. Ahara: Intake of milk, curd, ghruta, shastishali, yava, godhum, intake of freshly harvested rice.

2. Vihara:Divaswapa, brahmacharya, no exercise, snehan bbasti, abhyanga by ashwagandha or til oil.

3. Aushadh: Payasa, ashwagandha, vidarigandha, shatavari, bala, atibala, nagbala,etc madhura drugs should be given.

Apathya

Night awakening, katu tikta kashaya ahara, honey, sexual indulgence, excessive physical and mental exercise, etc should be avoided in karshya.

Relaxing oil Massage:

Massage with sesame oil is excellent. One can also use almond oil or apricot oil. Massage with medicated oils containing ashwagandha, shatavari, ginger, dashamula also gives good results.

Internal oleation:

This should be done with sesame oil or medicated sesame oil with ghee or some herbs like ashwagandha, shatavari, etc

Tonic herbs:

Ashwagandha, shatavari, bala, at I bala

Mild exercises and yoga:

Mild exercises like sun salute(surya namaskar), walking, running and yoga postures like padmasana, vajrasana and meditation are indicated.

Purificatory procedures:

Decoction enema with dashamoola or rasna, nasya with sesame oil or ghee (brihana therapy), matra basti is indicated.

Physical health and mental relaxation: Proper rest is essential. Vata persons should avoid excessive traveling, speech, stress and strain.

Discussion

Laghu dravya santarpan chikitsa means light and nourishing diet should be administered in karshya roga. Laghu, ushna, ruksha dravyas increase the power of digestion which is very useful to treat agnimandya. Newly harvested food is guru and santarpak so it should be used after some sanskar. Use of bruhan, vrushya, vajikaran and truptighna aushad. Use of ashwagandha kalka, kwatha or medicated oil or til taila for abhyanga. Abhyanga with medicated sesame oil is useful for gaining weight, since sesame oil is vatanashak and has bruhan effect. Intake of ashwagandha. Medicated ghee with milk or oil. The description of karshya as a disease along with its diagnosis and treatment are available in classical samhitas in Ayurveda.

Conclusion

Karshya is a disease caused by nutritional deficiencies in which the body gets emaciated gradually mainly the gluteal region, abdomen and neck shows gross bulk muscle loss and subcutaneous fat depletion. A systematic study of these conditions represents different aspects of karshya and proper understanding of pathogenesis of conditions provide a valuable key for effective management.