Kashyap samhita is one of the important ancient documents of kaumarbhritya. Kaumarbhritya is one among the eight branch of ayurveda. Kaumarbhritya consist from birth of baby up to he becomes capable of independent existence. During this phase physical and mental development takes place. It consists of various descriptions of diseases and their treatment. Phakka roga one of the most important diseases happens in childhood period and has been described only in kashyap samhita elaborately.

Bala: samvatsara (panna:) padaabhyam: yo na Gacchati |
Sa Pakka iti Vidneya: || - Kashypa.Sa.Chi 17/3

Phakka has been defined as inability of a child to walk even by the age of one year. The word Phakka denotes sluggish movement due to poor physical development associated with psychomotor changes. Phakka roga mainly classify into three groups on the basis of their causes as follows.

1. Kshiraja Phakka
2. Garbhaja Phakka and
3. Vyadhija Phakka.

Kshiraja Phakka:

Dhatri shlaishmikdugdha tu Pakkadugdhetisadnyeta |
tatkhirpo bahuvyadhi: karshyat Pakkatvamapnuyat || - Kashyapa.Sa. chi 17/4

Stanya vitiated with kapha dosha is called Phakka-dugdha. This Phakka-dugdha causes obstruction in rasa vaha strotasa and cause nutritional deficiency in a child resulting in to Kshiraja Phakka roga.

Garbhaja Phakka:

Garbhinimatruka: kshripra stanyasya vinivartanat |
Kshiyate mriyate va-api sa Pakko garbhapidit: || - Kashyapa.Sa. chi 17/4

When a nourishing Dhatri conceives during breast feeding period, deficient milk secretion results. There by the Balak gets emaciated due to malnourishment and even dies. This condition is called a Garbhaja Phakka.

Vyadhija Phakka:

Nijragantubhischev………..Jwaradhibhi: |
Itetaiya: karanaer vidyat Vyadhija Pakkata shisho: || - Kashyapa.Sa. chi 17/4

In some diseases if proper care and treatment is not provided it leads to emaciation with improper formation of metabolites (Rasa, mamsa, meda and asthidhatu), leading to severe malnourishment associated with weak limbs as well as mobilization of subcutaneous fat from gluteal, chest and extremities with increase in frequency to stool and urine, irritability untrimmed nails and uncleanness to skin indicates the children of poor socio-economic condition is also known as vyadhija Phakka. It shows growth and developmental deficiency. which stimulates with protein energy malnutrition, marasmus, rickets, chronic malabsorption states like celiac diseases. Most of the characters are correlating with marasmic child. Kshiraja and Garbhaja Phakka comes in to acute malnutrition where as Vyadhija Phakka is a state chronic malnutrition with general debility and reversible motor disability owning to malnourish state.

Principles of management of Phakka roga:

In Balyavastha , there is more vitiated condition of Kapha dosha. Due to these Balaka more prone to kaphaj vikara. There are references for the treatment of Phakka roga available in Phakka chikitsa adhyaaya for normalization of kapha and-vata dosa.(Ka.chi 17/4).

Bastay: snehapanani swedaacch uadwartanani cha |
Vaat rogeshu balana sanshrutheshu visheshat: | - Kashyapa.Sa. chi 17/4
……………………karayet kriya ||
Klyanak pibet Pakka:Khatpal Wa yatha amrtam |
saptratrat par chaina Trivvrut kshiren shodhayet ||
shudrakoshtata: Pakka: | - Kashyapa.Sa. chi 17/4

Kshiraja Phakka:

The whole treatment can be broadly classified in to two parts.

1. For Dhatri,
2. For Balaka

• For Dhatri:

In Dhatri stanya vitiated with kapha dosha , acharya kashyapa explains the severity of vitiation of stanya and stated that samprapti due to sannipataja dushti , results in Balaka with the symptoms jadatva , mukatva, and pangutva.

In the etiopathogenesis of phakka , agnimandya due to dusta stanya, stanyabhava as well as vyadhi leads to improper dhatu-nirman especially rasa, mamsa, meda and asthi dhatu, so treatment should be aimed at prakruta rasa nirmana with the augmentation of agni by mrudu shodhan followed by deepana, pachana, balya and bruhana therapy.

This etiopathogenesis can be controled by two upakrama. In Kshiraja Phakka, shodhan upakrama done to the dhatri having kaphaj stanya. According to vagbhatacharya tikshna shodhan vamana dravya we use vacha, sarshapa, pippali dravya . After vamana sansarjana karma should be followed, and for shaman internally dipana and pachana dravya like vacha, ativisha, panchmula ghana kwatha should be given. Then nasya, dhum , gandush, pradeha, parisheka, and kapha shamak aahara indicated.

• For Balaka:

According to acharya kashyapa Balaka snehana can be accomplished with Raja taila and Abhyantar snehana with amruta ghrita , kalyanaka ghrita, shatpala ghrita, bramhi ghrita for seven days given internally after followed by virechana carried out with trivrutksheeram basti Basti best during this period with the predominance of vata dosha and mamsa as well as vataharaka dravyas .

In Shaman chikitsa internally we should give dipana dravya like raasna, madhuka siddha ghrita then pachana for stroto shodhana (udavartanam) milk mixed with gomutra for pana then bruhana dravya includes mamsa-rasa and kshira siddha with raasna madhu, shatpushpa, ekparnni indicated.

Garbhaj Phakka:

In this type it closely resembles with balshosha, Parigarbhik described by Vagbhatt. This relationship should be explained on the basis of stages. In initial stages shosha leads to kshiraj Phakka, parigarbhik then garbhaj Phakka. For graham Phakka we should treat parigarbhik in which agnidipan chikitsa is ideal. In which we use dipan and pachan dravya includes. Nutritious food siddha with vidari, yava , godhum, pippali with sufficient ghrita should be given in such cases then anupana rich in milk mixed with honey and sugar, this all nutritious food covers vitamin deficiency disorders.

Vyadhija Phakka:

In vyadhij Phakka a main cause is dosh dushya samprapti due to the nija roga and agantuj roga. Due to mandagni and dushta grahani the nutrition of food cannot nourish the tissue .Due to this, disordered grahani, sara sanhanan of body get deteriorated. These all symptoms seen in accordance with related disease. For vyadhiaja Phakka the treatment should be classified on hetu‘s in treatment swalp-aahara proper quantity of nutritious food including kshirapeya indicated. For the strength of agni various lehya dravya and kalpas described by acharya kashyapa of highly nutritious value of both animal and vegetable origin should be internally given to the balak.

Bahya chikitsa: oil for massage (abhyanga) raj-taila made of earanda , shaliparnni , bilva this may be given internally too. Oil siddha with mamsa, yusa.are also useful. As per the experience of vaidyas, Sudhavarga ausadhi dravyas like Sudhasatak is very much helpful for nourishment of Asthidhatu.Samvardhan Ghrita described in Lehadhyaya is successfully practised in developmental disorders is of high therapeutic value.
Physiotherapy: For disabled child, Phakka ratha has been advocated which is specifcally made by skilled and technical person should be manufactured in order to support disable balaka keeps resemblance with modern physiotherapy.

References:

• Kashyap samhita (Hemraj Sharma)
• Ashtang Hridaya (Bramhanand Tripathi)
• Kaumarbhritya (Prof. Dr. Premvati Tewari)
• Kaumarbhritya ( Dr. Dinesh K. S.)
• Nelson Textbook of Pediatrics(Behrman, kliegman & Jenson)
• Essential Peaditric (O.P. Ghai)