The Compendium of Caraka 2.6: ṣaṣṭho 'adhyāyaḥ/

Now hereafter we shall explain the etiology of wasting.

Thus indeed declared the venerable Ātreya.

Here, indeed, there are four causes of wasting; they are: rash overexertion, suppression [of natural urges], depletion, and irregular eating.

There, regarding what was said that rash overexertion is a cause of wasting, we shall explain that in detail: when a person, being weak, contends with a strong person, or struggles with an excessively large bow, or talks excessively, or carries an excessive burden, or swims too far in water, or intensely indulges in vigorous massage and stamping with feet, or runs quickly over a very long distance, or is struck, or undertakes any other such irregular or excessive form of physical exercise, his chest is injured by that excessive exertion.

Vāyu afflicts his injured chest.

Residing there, seizing the phlegm situated in the chest and vitiating pitta, it moves upward, downward, and obliquely.

That portion of it which enters the joints of the body produces in him yawning, body aches, and fever; that which enters the stomach produces diseases of the chest and anorexia; that which reaches the throat causes the throat to be irritated and the voice to sink; that which follows the channels carrying vital breath produces dyspnoea and chronic coryza; that which settles in the head afflicts his head; then, due to the injury to the chest, the irregular motion of vāyu, and the irritation of the throat, cough continuously arises in him; through the persistency of cough, the chest being injured, he spits blood; and from the discharge of blood, weakness arises in him. In this way, these complications originating from rash overexertion afflict the reckless man.

Then, overwhelmed by these emaciating complications, he slowly, slowly wastes away.

Therefore, an intelligent man, examining his own strength, should undertake to perform actions suited to it; for the body is maintained by strength, and the person has the body as his foundation.

And on this point there is [a verse]:
One should avoid rash action, preserving one's own life;

for while living, a person enjoys the desired fruit of action.

Regarding what was said that suppression [of urges] is a cause of wasting, we shall explain that in detail: when a person, being in the presence of a king, or in the presence of a master, or at the feet of a teacher, or having entered a gambling assembly or another assembly of virtuous persons, or among women, or traveling by uneven vehicles, out of fear, engagement, shame, or aversion, suppresses the oncoming urges of flatus, urine, and feces, then from that suppression vāyu undergoes provocation; being provoked, stirring up pitta and phlegm, it moves upward, downward, and obliquely; then, entering specific bodily parts in portions as described before, it produces colic, breaks or dries up the feces, causes extreme pain in the flanks, crushes the shoulders, parches the throat and chest, afflicts the head, and produces cough, dyspnoea, fever, hoarseness of voice, and coryza; then, overwhelmed by these emaciating complications, he slowly, slowly wastes away.

Therefore, an intelligent person should especially exert himself in bodily [matters] that bring security and well-being; for his body is the foundation, and the person has the body as his foundation.

And on this point there is [a verse]:

Abandoning everything else, one should protect the body;
for in its absence, there is an absence of all entities for embodied beings.

Regarding what was said that depletion is a cause of wasting, we shall explain that in detail: when a person's heart is excessively overcome by grief and worry, or he is gripped by jealousy, yearning, fear, anger, and the like, or, being lean, consumes dry food and drink, or, being of weak constitution, fasts or eats little, then the nutrient fluid residing in his heart undergoes depletion; from its depletion, he incurs wasting, and if untreated, it is followed by consumption having the symptoms that will be described;

or when a person, out of excessive passion and with an intensely attached disposition, engages in excessive sexual indulgence with women, his semen undergoes depletion from that excessive indulgence.

Even as his semen undergoes depletion, if his mind still does not turn away from women, and, having intensely directed intent, he engages in sexual intercourse, no semen is ejaculated due to excessive depletion of his semen; then, as his body strains, vāta enters the blood-carrying dhamanīs and dislodges blood from them, and because of that depletion of semen, blood is discharged instead through the seminal passage with symptoms accompanied by vāta.

Then, from the depletion of semen and the discharge of blood, his joints become loose, dryness arises, weakness overcomes the body still further, and vāta becomes aggravated. That aggravated [vāta], traversing the helpless body and stirring up kapha and pitta, dries up the flesh and blood, dislodges kapha and pitta, produces pain in the flanks, crushes the shoulders, irritates the throat, agitates kapha, fills the head with kapha, and, afflicting the joints, causes body aches, anorexia, and indigestion; and from the irritation of pitta and kapha and from its own reversed movement, vāta gives rise to fever, cough, dyspnoea, hoarseness of voice, and coryza. From persistent coughing, his chest is injured and he spits blood, and from the loss of blood, weakness arises in him; then, beset by these drying complications, he gradually wastes away.

Therefore, an intelligent person, guarding his own body, should protect his semen;

for this is the ultimate resultant culmination of food.

And on this point there is [a verse]:

Semen is the supreme seat of food; that one must protect for oneself;
for its depletion brings about many diseases or death.

Regarding what was said that irregular eating is a cause of wasting, we shall explain that in detail: when a person indulges in the consumption of drinks, solid foods, snacks, and linctuses in an irregular manner with respect to innate nature, processing, combination, quantity, habitat, time, rules of consumption, and suitability, then from those [irregularities] his vāta, pitta, and kapha become deranged. Those deranged [doshas], circulating through the body, when they obstruct the openings of the channels and remain there, whatever food material that living being consumes, most of it turns only into his urine and feces, and not similarly into the other bodily tissues; he sustains himself on the support of feces; therefore, in one who is wasting away, feces should especially be preserved, as also in others who are excessively emaciated and weak. As he is not nourished, the doshas accumulated through irregular eating, afflicting him individually with complications, waste away the body still further.

There, vāta gives rise to colic, body aches, throat irritation, flank pain, shoulder pain, hoarseness of voice, and coryza; pitta [gives rise to] fever, diarrhea, and internal burning; while kapha [gives rise to] coryza, heaviness of the head, anorexia, and cough. From persistent coughing, his chest is injured and he spits blood, and from the loss of blood, weakness arises in him.

Thus these three doshas, accumulated through irregular eating, produce consumption.

Beset by those drying complications, he gradually wastes away.

Therefore, an intelligent person should consume food that is not irregular with respect to innate nature, processing, combination, quantity, habitat, time, rules of consumption, and suitability.

And on this point there is [a verse]:

One should eat wholesome food, eat moderately, eat at proper times, and have conquered the senses,
seeing the many dreadful diseases [arising] from irregular eating, if one is wise.

When these four causes of wasting are indulged in, vāta, pitta, and kapha undergo aggravation.

Aggravated, they waste away the body with various kinds of complications.

Physicians call it rājayakṣmā because it is the most dreadful of all diseases; or because it originally afflicted the divine Soma, king of the stars, therefore it is called rājayakṣmā.

Its premonitory symptoms are as follows: coryza, frequent sneezing, excessive salivation of kapha, sweetness in the mouth, lack of desire for food, fatigue at mealtime, finding fault where there is no fault or little fault in utensils, water, rice, soups, cakes, condiments, and servers; nausea in him after eating, as well as vomiting of food from time to time; swelling of the face and feet; looking excessively at one's own hands; excessive whitish appearance of the eyes; desire to measure the size of the arms; lust for women; pitilessness; repulsive appearance of his body; and in dreams, frequent seeing of waterless bodies of water, and deserted villages, cities, market towns, and regions; dried, burnt, and broken forests; being touched by, mounted by, or riding upon calotes lizards, peacocks, monkeys, parrots, snakes, crows, owls, and the like; and climbing upon mounds of dogs, camels, donkeys, boars, hair, bones, ashes, chaff, and burning coals—[these] are the premonitory symptoms of wasting.

Thereafter, its eleven symptoms arise, namely: fullness of the head, cough, dyspnoea, hoarseness of voice, vomiting of kapha, spitting of blood, flank pain, shoulder pain, fever, diarrhea, and anorexia.

Among them, one whose strength, flesh, and blood are not depleted, who is strong, in whom fatal signs have not appeared, even if beset by all the symptoms of wasting, should be known as curable.

For a strong and well-nourished person, being capable of withstanding the strength of the disease and medicine, must indeed be regarded as having only few symptoms even if he has very many symptoms.

A weak person, however, whose strength, flesh, and blood are excessively depleted, even if he has few symptoms and fatal signs have not appeared, should be known as having many symptoms and as one in whom fatal signs have appeared, because he cannot withstand the strength of the disease and medicine; one should reject him, for fatal signs manifest in an instant, and the appearance of fatal signs is without obvious cause.

There is a verse on this:

He who knows the etiology, the symptoms,
and the premonitory symptoms of wasting in truth is fit to treat a king.

Thus ends the sixth chapter, entitled "Nidāna of Wasting," in the section on Nidāna of the treatise composed by Agniveśa and redacted by Caraka. //6