Tissue Depletion (Shosha) Meaning, Types, Symptoms

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Shosha disease is explained by master Sushruta in the context of explaining Rajayakshma. Rajayakshma is often correlated with tuberculosis. Some doctors compare it with AIDS and other diseases with severe tissue depletion and loss of immunity.

Shosha is explained as an extended version of Rajayakshma. Master Sushruta tells that though the severe loss of tissue is common in both conditions and though they appear similar, they are different conditions due to difference in causative factors, types and symptoms. Due to their resemblance they have been explained in the same chapter.
Read – Rajayakshma – Charaka Chikitsa 8

Table of Contents

Meaning

Meaning of the word Shosha

Shosha means –

Desiccate / desiccation
Drying up / dryness / act of drying up
Absorption and removal of liquids
Destroying
Removing liquids / watery ingredients
Parching
Draining
Suction
Wither
Read – Charaka Shosha Nidana: 6th chapter

Pathogenesis

Mechanism of disease formation of shosha disease

Shosha occurs due to depletion of the tissues and drying up of tissue-fluids. Increased dryness causes desiccation of tissues. This is due to loss of unctuousness of tissues. This possible is caused due to excessive consumption of foods and activities which have dryness qualities. Dry climate and seasons are also included.
Read – Vata Increase Caused Due to Tissue Depletion: Dhatu kshaya

Causes and Types

The causes of shoshas are –

Excessive sexual indulgence
Excessive grief
Effect of old age
Excessive exercise
Excessive walking
Ulcers and wounds
Chest injury
Read – Right Time To Exercise, Benefits Of Workout As Per Ayurveda

Note: The types of shosha get their names from their causes.

Depending on the cause which causes shosha, it is of 7 types.

Vyavaya janya shosha –excessive indulgence in sexual activities
Shoka janya shosha – excessive grief
Vardhakya janya shosha – ageing process, as an effect of old age
Vyayama janya shosha – excessive physical exercise
Adhwagamana janya shosha – excessive walking
Vrana janya shosha – ulcers
Urahkshata janya shosha – chest injury
Read – Aging Gracefully – The Real Secrets To Stay Young

Sanskrit Verse

Symptoms

1. Symptoms of tissue desiccation and depletion caused by excessive indulgence in sexual activities

Cause – excessive indulgence in sex

Master Sushruta specifies that excessive indulgence in sexual activities leads to diminution in the quality and quantity of semen. In this condition the signs and symptoms of ‘depletion of semen’ are manifested. The body gets pallor and the previous tissues get depleted i.e. retrograde depletion of tissues take place. Semen is the last tissue formed in the chronology of tissue formation. The previous tissues in retrograde way are bone marrow, bones, fat, muscles, and blood and lymph tissues. Overall depletion of tissues leads to reduced immunity.
Read – Immunity In Ayurveda: Concept, Diet, Herbs, Medicines, Exercise

Symptoms of depletion of semen are –

Pain in the penis and testes
Weakness
Delayed ejaculation, in small proportions
Bleeding from genitals during ejaculation i.e. blood mixed semen

What does the modern medicine say about this?

Below mentioned are some of the observations made in the researches related to the impact of excessive sex on health –

Increased susceptibility to get urinary infections
Soreness and chafing of both partners
Pain, discomfort, low back pain
Withdrawal and resentment
Exertion and orgasmic headaches
Transient global amnesia
Postcoital Dysphoria
Post-orgasmic Illness Syndrome
Bacterial vaginosis
Higher expression of a gene associated with inflammation in brain tissues

While Ayurveda has emphasized on the local symptoms, modern researches have led to the findings which are systemic and involves many condition as far as the effects of excessive sex is related to health. But when we see through the description of semen in Ayurveda and its role in the health as a tissue, we may get more clues towards its depletion to cause gross impact on overall health rather than local effect.

2. Symptoms of tissue desiccation and depletion caused by excessive grief

Cause – excessive grief

Below mentioned are the symptoms of excessive grief –

Excessive and unnecessary thinking / worrying
Looseness of the body parts
Symptoms of desiccation of semen with the exception of the symptoms of depletion of semen i.e. pallor of the body and depletion of tissues
Read – Depression Causes, Ayurvedic Treatment, Tips And Remedies

In many people with grief the person does not eat food properly. There will be deficit nutrition to the tissues of the body and hence they are not formed in optimum quality and quantity. Gradually, with time there is destruction of tissues and severe tissue damage, most often to the quantum of non-reversal. This is dangerous for the health. The depletion of all tissues leads to lowering of immunity and susceptibility to wide array of health issues.

What modern medicine has to say about this?

Chronic grief worsens inflammation. It leads to depletion of immunity and makes the person susceptible to infections.

Broken heart syndrome – is also an effect of grief. It refers to group of symptoms similar to a heart attack.

Constant grief can lead to chronic stress which increases adrenalin and blood pressure.
Ayurveda too has mentioned ‘too much worrying’ as one of the symptom of desiccation of tissues due to grief, which probably reflects high stress.
Read – Stress Causes, Types, Tips On How To Handle Stress

Other symptoms of grief –

Headaches
Shortness of breath
Vomiting sensation
Loss of appetite
Fatigue
Stomach pain
Chest pain / chest discomfort
Dry mouth

3. Symptoms of tissue desiccation and depletion as an effect of old age

Cause – ageing and getting old

Ayurveda has explained ageing and getting old as one of the natural diseases. All of us are bound to get old and suffer from the health issues therein with varying intensities. Immaterial of our physical constitution, vata increases in the old age. When vata increases, there is a natural tendency in the body for deterioration of quantity and quality of tissues. Kapha constitution people may bear immunity against early degeneration, but due to the age which is dominated by vata even in them, they too are bound to suffer from degeneration, destruction, desiccation and depletion of body tissues in a small proportion, while it is severe in vata people and moderate in pitta people. Old aged people will also have less appetite and less digestion capacity, therefore they eat less, hence less nutrition to the tissues and hence their desiccation. The dryness of vata naturally causes desiccation of tissues.
Read – Symptoms Of Vata Dosha Increase And Imbalance – Vata Vruddhi Lakshana

Symptoms of tissue desiccation due to old age –

The person becomes thin
Deterioration of the potency, strength, intelligence and strength of perception of the sense organs
Shaking of the body / tremors
Anorexia / loss of interest in eating food
Voice resembling the sound made by a broken brass vessel
Coughs without expectoration
Heaviness of the body
Loss of interest in doing any activities
Continuous discharge from nose, mouth and eyes
Dryness of feces
Lack of facial luster

What does the modern medicine have to say?

Old age comes with its own set of problems. Most common ones are enlisted below.

Hearing loss, osteoarthritis, diabetes, dementia etc.
Read – Role Of Ayurvedic Doctors And Hospitals In Geriatric Care

4. Symptoms of tissue desiccation and depletion caused by excessive walking

Walking is also a form of exercise and when done normally, it nourishes Vata Dosha, but when excessively, it aggravates Vata Dosha and depletes body tissues.

Symptoms of tissue desiccation caused by excessive walking –

Looseness of the body parts
Fading and wrinkling of facial complexion
Loss of sensation in the body parts
Dryness of throat and mouth

5. Symptoms of tissue desiccation and depletion caused by excessive exercising

Excessive exercise depletes tissues. Exercise increases the dryness in the body due to desiccation of tissues and this leads to increase in vata, leading to degenerative changes.
Read – How Long To Exercise? How Much Time To Workout?

Cut off point for exercising according to Ayurveda

Ayurveda has recommended undergoing walking or physical activities like walking to one third of one’s capacity. Ayurveda has kept ‘sweating of forehead’ as threshold / breakthrough point to decide the stoppage point of exercise. One should not reach this point while doing exercise. With forehead sweating one would have reached his / her maximum capacity of exercising and also might indicate over training. One may decide the time required for forehead sweating in one’s case and stop exercising / walking before it is achieved or train to 1/3 of that time.
Read – Excessive Sweating: Ayurvedic Medicines, Home Remedies, Tips

Symptoms of tissue desiccation caused by excessive exercising

Similar symptoms as those of desiccation of tissues caused due to excessive walking
Symptoms of chest injury without bleeding

Strenuous and violent exercises like excessive weightlifting, excessive indulgence in wrestling, jumping, archery, swimming, riding horses and elephants etc which are beyond one’s capacity are the causes of chest injury which will be explained later in this article. When they are done without concentrating on one’s physical efficiency and limits and without taking nutritious food will cause severe symptoms like chest pain, pain in the flanks, breathlessness, dry cough etc as explained in the chest injury, without evidence of bleeding from mouth. This happens due to increased intra-thoracic pressure. When bleeding occurs the same condition will be considered as chest injury.

What has modern medicine to say in this?

Even the modern medicine is against one’s indulgence in excessive exercises and physical activities. One should not exercise beyond one’s strength and capacity.

Signs of excessive exercising

Muscle and body fatigue
Injuries and exhaustion
Restless legs
Increased stress
Increased heart rate
Dehydration
Decreased appetite
Amenorrhea
Hormone imbalance
Read – Excessive Thirst – Ayurvedic Understanding And Treatment

6. Symptoms of tissue desiccation and depletion caused by ulcers and wounds

Desiccation leading to depletion of tissues takes place in a person suffering from wounds and ulcers wherein there is severe loss of blood. Severe loss of blood, pain caused due to the ulcers and wounds and due to deficit consumption of food due to pain are the three main causes which cause desiccation of tissues in those suffering from ulcers and wounds.

Severe loss of blood causes vata vitiation. If the bleeding is continuous and if clotting doesn’t occur, severe vata aggravation takes place which in turn causes desiccation of other tissues too. Excessive pain too has similar impact. It causes vata vitiation which in turn causes desiccation of tissues. When proper food is not given to those suffering from ulcers and wounds, there is less nutrition to the tissues. This leads to depletion of tissues which leads to vata vitiation. This vitiated vata causes desiccation and destruction of tissues.

Excessive blood loss is the major cause for anemia. Anemia leads to less blood supply to the body tissues and organs, loss of oxygenation and nutrition to the tissues and tissue damage. This also makes the body susceptible to wide array of disorders and infections and also lowering of immunity.

ulcers in the stomach or small intestine,
diverticulosis,
polyps in large intestine, or
cancers in the large intestine
kidney and bladder tumors and
heavy menstrual bleeding
Read – Heavy Periods, Menstrual Bleeding: Ayurvedic Treatment

7. Symptoms of tissue desiccation and depletion caused by chest injuries

Causes of chest injury are as follows –

practice of pulling the strings of bow regularly
lifting heavy weights beyond one’s capacity
fighting with a person who is immensely strong
falling down from heights
forcibly trying to stop the running bulls and horses, camels and elephants
throwing heavy and huge stones, boulders, wood, weapons etc
wrestling with a person who is more stronger
reading loudly
walking briskly for long distances
swimming across large streams of water like river, sea etc
running alongside horses
high and long jumps
dancing for long durations and dancing fast for long time
severe injury
having excessive sex without having food or after consumption of dry foods and foods in small quantities or just getting indulged in excessive sexual acts
Read – Different Causes For Vata Dosha Imbalance, Increase

Pathogenesis – due to the one or more of the above said etiological factors, injury occurs in the chest and chest organs.

Shosha – Rajayakshma – Difference

Raja Yakshma means the ‘king of diseases’. This condition has been often compared to tuberculosis, chronic pulmonary diseases or consumption. Some experts have also compared it to some autoimmune disorders and also with AIDS.

Are rajayakshma and shosha identical conditions?

Rajayakshma and shosha appear identical because in both these conditions there is depletion of tissues of the body. But they are not similar conditions.

1. By name and definition

In the pathogenesis of rajayakshma it is said that ‘all the body tissues will get depleted and consequently the person undergoes desiccation or dried up’. Therefore in rajayakshma initially the tissues will get depleted and then the person as a whole gets desiccated.

In shosha the tissues get depleted of their fluidity and get desiccated. As a result the tissues dry up. Later they may undergo depletion.

2. By etiological factors

Below mentioned four etiological factors are mandatory in the causation of rajayakshma. Indulgence in one or more of these factors is compulsory if tissue depletion has to happen, leading to rajayakshma. They are –

Forcibly withholding to the natural urges of the body like those of feces, urine, thirst, hunger, tears etc
Tissue depletion as caused by etiologies like indulgence in excessive sex, starvation, excessive bleeding etc and also due to mental causes like excessive grief, jealousy etc.
Indulgence in excessive exercises like running, wrestling, riding etc
Irregular eating / eating without following the eating etiquettes or by breaking the rules and regulations of dieting

The etiological factors for shosha are specific to the types of shosha. Reading it the other way, a particular etiological factor will cause particular type of shosha. They are –

Excessive indulgence in sex
Excessive grief
Ageing and getting old
Excessive indulgence in exercise
Excessive walking
Ulcers and wounds
Chest injury

The above said causes will lead to manifestation of tissue desiccation of the same names.

3. By pathogenesis

Rajayakshma has a pathogenesis of its own. It happens in one of the below mentioned ways –

Antero-grade deterioration and depletion of tissues – Here the doshas, mainly kapha predominant doshas will block the channels carrying rasa tissue i.e. lymph. As a result the successive tissues which should be formed in chronology i.e. blood, muscle, fat, bones, bone marrow and semen in that order, are not formed properly. There is quantitative depletion of all tissues and the person gets dried out.

Retrograde depletion of tissues – In this case, in a person who is excessively indulged in sexual activities, the semen tissue gets depleted. It is depleted in such great pace that the predecessor tissues get depleted in order to compensate for the loss of semen. As a result, all tissues undergo retrograde depletion in reverse order i.e. bone marrow, bones, fat, muscles, blood and lymph in that order. Following this the person gets dried out.

The types of shosha do not undergo such type of pathogenesis. The tissues are desiccated and wasted out due to their related etiological factors as mentioned above.

4. By types

Rajayakshma is of one type. It is also said to be of four types as caused by individual causative factor mentioned above.

Shosha is of 7 types. They carry the name of the etiological factor specifically related to them. The etiological factors have been mentioned above.

5. By premonitory symptoms

Rajayakshma has premonitory symptoms which occur before the manifestation of the actual disease. Important premonitory symptoms include short of breath, body pains, excessive salivation, dryness of mouth, loss of appetite, vomiting, intoxication, cough, excessive sleep, rhinitis etc.

Shosha doesn’t have premonitory symptoms. This means to tell that these conditions develop almost immediately or quickly after exposure to their related etiological factors while Rajayakshma goes through the chain of events constituting the pathogenesis of the disease.

6. By symptoms

Rajayakshma symptoms present in a strange way. The disease has generalized symptoms which comprises of three symptoms complex. At the same time it also has variants of presentation of symptoms in the form of a collection of 6 and 11 symptoms.

Generalized symptoms of Rajayakshma – the three symptom complex

Raised heat / burning sensation in the region of shoulder blades and flanks
Burning sensation in the hands and feet
Fever with rise in temperature in the entire body

Six symptoms of Rajayakshma

Aversion towards food
Fever
Shortness of breath / dyspnea / breathlessness
Cough
Expectoration of blood / hemoptysis
Hoarseness of voice

Eleven symptoms of Rajayakshma

Due to vata

1. Hoarseness of voice,

2. Pain and

3. Constriction in the region of shoulder blades and flanks

Due to pitta

4. Fever

5. Burning sensation

6. Loose motions / diarrhea

7. Expectoration of blood

Due to kapha

8. Heaviness or feeling of fullness in the head

9. Aversion towards food

10. Cough

11. Pain in the throat

Shosha doesn’t present symptoms of these kinds and variants. The symptoms are specific to the cause and type of shosha. The symptoms of individual type of shosha are –

Sl No	Type of Shosha	Symptoms
1	Caused due to excessive indulgence in sexual activities	Pallor of the body Pain in the penis and testes Weakness in performing sex Delayed ejaculation Ejaculation in small proportions Bleeding from genitals during ejaculation
2	Caused due to excessive grief	Excessive worrying Looseness of the body parts Pallor of the body
3	Caused due to an effect of old age	Thinness Deterioration of potency, strength, intelligence and sensory perception Tremors Anorexia Broken and brassy voice Cough without expectoration Body heaviness Lack of enthusiasm in activities Discharge from nose, mouth and eyes Dryness of feces Loss of facial luster
4	Caused by excessive walking	Looseness of body parts Fading of facial complexion Loss of sensation Dryness of throat and mouth
5	Caused due to excessive exercising	Similar symptoms as those caused due to excessive walking Symptoms of chest injury without bleeding
6	Caused by ulcers and wounds	Desiccation and depletion of tissues due to blood loss
7	Caused due to chest injuries	Severe pain in the chest & flanks Gradual dryness and desiccation of the body Tremors in the body parts Deterioration of strength, muscle bulk, color, taste and digestion capacity Fever Discomfort and pain in various body parts Grief Diarrhea Expectoration of blood mixed phlegm while coughing. The color of phlegm is blackish, yellow or red; the phlegm is clotted and has foul smell.

7. By quality and quantity, in terms of cause and effect

In Rajayakshma initially there is quantitative depletion of tissues and then there is desiccation of the body parts and body as a whole, which indicates qualitative changes in the body. Depletion is cause and desiccation is effect.

In Shosha initially there is desiccation of tissue / tissues as caused by increased dryness prevailing in the body due to exposure to related etiological factor i.e. initially there is qualitative changes in the tissues. Later there may be depletion of tissues if desiccation is not controlled and normalcy not restored. Desiccation is cause and depletion is effect.

Other important points about Rajayakshma and Shosha

Are all conditions of tissue depletion considered as Rajayakshma?

If there is depletion of one or two tissues, it is not called as Rajayakshma. Tissue depletion, destruction and damage will be there in all disorders to different extent. If we consider all these conditions as rajayakshma then all diseases should be called as rajayakshma.

The rules for tissue depletion to be called as rajayakshma are –

There should be loss of / depletion of all tissues.
The tissue loss should have occurred due to one or more of the mentioned etiological factors.
The loss of tissues should follow the antero-grade or retrograde pathway of pathogenesis.
The tissue depletion should give raise to the 3 fold, 6 fold or 11 fold symptom complex.

When can a shosha be called as rajayakshma?

Any type of shosha which effects destruction of all tissues and follows one of the pathogenic routes of rajayakshma and presents with signs and symptoms of rajayakshma, it can be called as rajayakshma.

Effective decoctions for tuberculosis and wasting disorders from Sahasrayogam

Ref – Sahasrayogam, Kashaya Prakaranam, 27

a. Punarnavadi Kashayam

Ingredients	Botanical Name	Method of using	Indications
Punarnava	Boerhavia diffusa	The decoction prepared with these ingredients should be served fresh	1. Cures tuberculosis and destruction of tissues 2. Nourishes the body tissues
Bala	Sida cordifolia
Chavya	Piper retrofractum
Shalaparni	Desmodium gangeticum
Pippali	Piper longum
Gokshura	Tribulus terrestris
Jivanti	Leptadenia reticulata

b. Amrutadi Kashayam

Ingredients	Botanical Name	Method of using	Indications
Guduchi	Tinospora cordifolia	The decoction prepared with these ingredients should be served fresh by mixing it with the milk	1. Tuberculosis
Dashamoola	Ten roots
Devadaru	Cedrus deodara
Bharangi	Clerodendron serratum
Vasa	Adhatoda vasica
Vrischira	Trianthema portulacastrum
Musta	Cyperus rotundus
Dhanvayasa	Alhagi camelorum
Bala	Sida cordifolia
Chirubilwa	Holoptelea integrifolia
Panchakola	Piper longum Piper nigrum Piper retrofractum Plumbago zeylanica Zingiber officinalis

c. Elakanadi Kashayam

2. Bilwamrutadi Kashayam

Ref – Sahasrayogam, Parishishta Prakaranam, 32

Ingredients	Botanical Name	Method of using	Indications
Bilwa	Aegle marmelos	The decoction prepared with these ingredients should be served fresh	1. Tuberculosis 2. Disorders caused due to wasting of tissues
Guduchi	Tinospora cordifolia
Patola	Trichosanthes dioica
Bharangi	Clerodendron serratum
Kachora	Curcuma zedoaria
Ponnavaram	Cassia occidentalis
Brihati	Solanum indicum
Mustaka	Cyperus rotundus
Devadaru	Cedrus deodara
Ginger	Zingiber officinale
Vasa	Adhatoda vasica
Gokshura	Tribulus terrestris

Yogas for Rajayakshma from Sahasra Yoga Text Book
Kshyarogahara Kashaya
Panchatiktaka Guggulu Ghrita
Indukanta Ghrita
Dasanga Ghrita
Sasa Vasadi Ghrita
Dhanvantari Ghrita
Kushmanda Ghrita
Mahakushmanda Ghrita
Balashwagandhadi Taila
Lakshadi Taila
Maha Lakshadi Taila
Choornamruta Yoga
Sitopaladi Choorna
Tugadi Choorna
Ashvagandhadi Choorna
Kapittashtaka Choorna
Agnimukha Choorna
Narasimha Choorna
Draksharishta
Dasamoolarishta
Kumaryasava
Kushmanda Rasayana
Madhusnuhi Rasayana
Agasthya Rasayana
Chyavanaprasavaleha
Brihadvasavaleha
Bharngyadi Lehya
Jeerakadi Lehya (Muttu Kulambu)
Sarvarogakulantaka Rasa
Neelakanta Rasa
Jatilingadi Gutika
Dhanvantari Gutika
Bilwamrutadi kashaya
Amrutaprasa Ghrita