Introduction

Ayurveda science of life, emphasized to maintain the health and prevent the diseases. The basic is Swasthyashya Swasthya Rakshanam, which means to maintain the health of the healthy, rather than Aturashya Vikara Prashamanancha, means to cure the diseases of the diseased. In Ayurveda there is mention of Trayopasthambha (three pillars of life), i.e., Ahara (diet), Nidra (sleep), and Brahmacharya (celibacy), an important role in maintaining the health.1 Karshya can be understood as a separate disease entity and as an important feature of many diseases as well. It is considered as a Kuposhanajanya vyadhi. Karshya being a vata pradhana vyadhi causing dhatukshaya, vatahara chikitsa which is bruhmana and laghu is the main line of treatment.2 In children, the mild or moderate form of nutritional deficiency disorder is considered as karshya. In children, as palatability of drugs is a challenge, alternate methods were sought for the treatment of Karshya malnourished (underweight) children. According to the World Health Organisation (WHO), malnutrition affects health outcomes, survival rates and even the development of population groups worldwide.3 India accounts for 40% of world's malnourished kids and 35% of developing world's low birth-weight babies.Every year, 2.5 million kids die in India, making it one of the top five causes of death in the world.4 How is malnutrition measured in young children? The most common way to measure malnutrition in young children is by measuring height and weight, measuring mid-arm circumference, and measuring skinfold thickness (skin fat) in relation to age.

Ayurveda gives prime importance to the nutrition at every stage of life for preserving health of an individual. Proper nutrition is essential for rapid growth and development which obtains through baby’s first year of life. Malnutrition in India, as in other developing countries, results from a series of interrelated factors rooted in poverty, including lack of access to food, health care, safe water, sanitation services, and appropriate child feeding and caring practices. Under nutrition is a state of poor nutritional status as a result of inadequate intake, mal absorption or excessive loss of nutrients. As these children is future of community and if such conditioned is not overcome within a stipulated timeframe, then it may result further in growth and ultimately it directly affects the economy of a country also. In Ayurveda, there are some home remedies like Shatawari, Rajgira ladu, Shengdana chikki having   energy value with protein rich content and also it is cost effective treatment for Karshyata. Under nutrition is a condition in which there is inadequate consumption, poor absorption or excessive loss of nutrients. Term Mal nutrition refers to both under nutrition and overnutrition. However, sometimes the terms Mal nutrition and PEM are used interchangeably with undernutrition. Karshya being a vatapradhana vyadhi causing dhatukshaya, vatahara chikitsa which is bruhmana and laghu is the main line of treatment.5 According to Acharya Charaka, required food is prime factor producing Karshya.6 Dalhana comments Karshya as “Karshyam Mamsakshayam”. Means person having lean and thin body personality but doesn’t have any other complaints is Karshya.7 Karshya is equal to underweight or undernourished to some extent. Karshya and Atikarshya shows to forms of Malnutrition that is mild moderate and severe form. In India Malnutrition is as disorders, results from a series of interrelated factors rooted in poverty, health care, clean water, including lack of access to food, sanitation services, and appropriate child feeding and caring practices.

Causes of Karshya:8

Dietary cause: Kashaya rasa atisevan, Langhana, Pramitasan, Rukshaannapan Vatalaahara etc. Viharaja cause: Atisnanabhayas, AtiVyayama, AtiVyavaya, Dhyana, Nidra Nigraha, Kshudha Nigraha, Pipasa Nigraha, RukshaUdvartan.

Manasik Nidan: Bhaya, Chinta. Krodh, Shok

Samprapti:

The disease of Karshya is an independent disease or it may manifest along with the other diseases. Karshya is a disease caused by Vata Dosha, where Vata Dosha plays a vital role in pathogenesis. In addition, Vata Dosha is vitiated by the Pitta. The Pitta vitiates Vata Dushti, which in turn vitiates Pachaka Dushti.9 The Dhatus are not properly nourished resulting in the disease of Anuloma kshaya. The altered function of the Vata Dosha and the Agni results in the lack of production of Ras dhatu. The lack of the production of Ras Dhatu results in the development of Dhatu chronologically.10

Samprapti Ghatak:11

1. Dosa - Vata
2. Dusya - Rasa dhatu
3. Agni- Jatha-ragni (Mandagni)
4. Ama- formation of Ama due to Agnimandya
5. Vyadhi-Sthan -Amasaya
6. Srotas affected -Rasa vaha, Raktavaha, Medavaha and Mamsavaha,
7. Type of Srotodusti -Sanga
8. Rogamarga – Abhyantar-rogamarga
9. Vyaktasthan -Sphiga, Udar, Uriba, Twak, Asthi
10. Vyadhiprakar - Chirakari.
11. Sadhyasadhyata – Kricchasadhy

Rupa (Clinical features of Karshya):12

Aacharya Charaka, Sushruta and Vagbhatta have described almost identical symptoms of Karshya as Shushk Sphiga Udar Griva (Emaciated buttock, abdomen, neck region), DhamanijalaSantatah (Prominent venous network), Twak-Asthi Shesh (Skin bone appearance) Sthula Parva (Prominent joint), Patient can’t tolerate-AtiVyayama (excessive exercise), Kshut Pipasha Oushadha (Hunger, Thirst, Medicines), AtiShita Ushnamaithuna (excessive cold- hot, sexual intercourse).

Discussion

CHIKITSA SUTRA (PRINCIPLE OF MANAGEMENT):

Karshya is a type of treatment that has two properties: laghu-santarpana, which has both properties, and Mudga, which also has both properties. It's also known as brumhana yoga, and it has two properties: kapichchu, which has two properties, and shatavari, which is one of the properties of brumhana. Both of these properties make Karshya a better treatment for those with moderate, mild, or severe malnutrition. For these patients, there are some pharmacotherapeutic options like brinhana and rasayana, which have been used in the classics to help manage Karshya.

For chronic patients, it's important to administer the refreshing therapy slowly, depending on their physical condition, digestion, vitiated Doshas, the nature of the therapy, the dose, the season, and the time of day. Mansa rasa, ksheer, and ghee from different animals, as well as different types of brinhana and abhyanga, as well as nourishing drinks can all help.

Conclusion

Undernutrition is a condition characterised by insufficient nutrient consumption, poor absorption, or excessive nutrient loss. In Ayurveda, there are some home remedies for Karshyata such as Shatawari, Rajgira ladu, and Shengdana chikki that have energy value with protein rich content and are also cost effective.