Chhardi Chikitsa: Difference between revisions
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|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]] | |data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]] | ||
|label6 = Translator and commentator | |label6 = Translator and commentator | ||
|data6 = Murthy A.R.V.,Jani D. | |data6 = Murthy A.R.V., Jani D. | ||
|label7 = Reviewer | |label7 = Reviewer | ||
|data7 = Prasad B.S. | |data7 = Prasad B.S. | ||
|label8 = Editors | |label8 = Editors | ||
|data8 = Singh G., Goyal M., Deole Y.S., Basisht G. | |data8 = Singh G., Goyal M., [[Yogesh Deole|Deole Y.S.]], [[Gopal Basisht|Basisht G.]] | ||
|label9 = Year of publication | |label9 = Year of publication | ||
|data9 = 2020 | |data9 = 2020 | ||
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The premonitory signs and symptoms of ''chhardi'' (vomiting) are nausea, excessive salivation and aversion to food [6] | The premonitory signs and symptoms of ''chhardi'' (vomiting) are nausea, excessive salivation and aversion to food [6] | ||
=== [[Vata]]ja chhardi === | === [[Vata]]ja chhardi === | ||
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In a person extremely emaciated because of disease, excessive intake of | In a person extremely emaciated because of excess exercise, chronic disease, excessive intake of ''tikshna'' (sharply acting) medicines (of high potency), and indulging in grief, fear, excess fasting, etc. [[vata]] gets excessively aggravated in the ''maha-srotas'' (gastrointestinal tract), vitiates the local [[dosha]] and pushes them upwards. These [[dosha]] cause agitation in the ''amashaya'' (stomach), and after afflicting the ''marma'' (vital organs-heart) gives rise to ''chhardi'' (vomiting). This [[vata]]ja type of vomiting is characterized by the following signs and symptoms: | ||
#Pain in the cardiac region and flanks; | #Pain in the cardiac region and flanks; | ||
#Dryness of the mouth; | #Dryness of the mouth; | ||
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#The patient feels miserable [7-9] | #The patient feels miserable [7-9] | ||
=== [[Pitta]]ja chhardi === | === [[Pitta]]ja chhardi === | ||
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As a result of | As a result of indigestion, taking pungent, sour, ''vidahi'' (which cause burning sensation) and hot potency food, the [[pitta]] in the stomach gets aggravated. This aggravated [[pitta]] spreads through the ''rasayani'' (channels) and stresses the vital organs located in the upper part of the body which results in vomiting: | ||
The signs and symptoms of this [[pitta]]ja type of ''chhardi'' (vomiting) are: | The signs and symptoms of this [[pitta]]ja type of ''chhardi'' (vomiting) are: | ||
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#Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation [10-11] | #Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation [10-11] | ||
=== [[Kapha]]ja chhardi === | === [[Kapha]]ja chhardi === | ||
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As a result of the intake of unctuous, excessively heavy, ''ama'' (raw/uncooked) and ''vidahi'' (causing burning sensation) food and because of excessive sleep and similar other factors, [[kapha]] gets excessively aggravated. This [[kapha]] occludes the chest, head, vital organs and all the (concerned) channels to cause ''chhardi'' (vomiting). The signs and symptoms of this [[kapha]]ja type of ''chhardi'' are as follows: | As a result of the intake of unctuous, excessively heavy to digest, ''ama'' (raw/uncooked) and ''vidahi'' (causing burning sensation) food and because of excessive sleep and similar other factors, [[kapha]] gets excessively aggravated. This [[kapha]] occludes the chest, head, vital organs and all the (concerned) channels to cause ''chhardi'' (vomiting). The signs and symptoms of this [[kapha]]ja type of ''chhardi'' are as follows: | ||
#Drowsiness, sweetness in the mouth and salivation; | #Drowsiness, sweetness in the mouth and salivation; | ||
#Sense of satiety, sleep, anorexia and heaviness; | #Sense of satiety, sleep, anorexia and heaviness; | ||
#Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain [12-13] | #Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain [12-13] | ||
=== Tri[[dosha]]ja chhardi === | === Tri[[dosha]]ja chhardi === | ||
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When the morbid [[vata]] occludes the channels carrying | When the morbid [[vata]] occludes the channels carrying feces, sweat, urine and body fluids and moves upwards, then the morbid matter from the [[koshtha]] (gastrointestinal tract), gets incited to cause vomiting, that has the following characteristics: | ||
#Vomitus having color and odor of the feces and urine; | #Vomitus having color and odor of the feces and urine; | ||
#Persistent thirst, dyspnea hiccup and pain | #Persistent thirst, dyspnea hiccup and pain | ||
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Patient may also be given emetic therapy prepared of the drugs of the ''valliphala'' (group of cucurbitaceous fruits), etc. or if the patient is weak, then he should be treated with pacification therapy through delicious soups and light as well as dry food articles for diet along with various kinds of drinks [21-22] | Patient may also be given emetic therapy prepared of the drugs of the ''valliphala'' (group of cucurbitaceous fruits), etc. or if the patient is weak, then he should be treated with pacification therapy through delicious soups and light as well as dry food articles for diet along with various kinds of drinks [21-22] | ||
=== Treatment of [[vata]]ja chhardi === | === Treatment of [[vata]]ja chhardi === | ||
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#The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour ''dadima'' (pomegranate/Punica granatum) [23-25] | #The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour ''dadima'' (pomegranate/Punica granatum) [23-25] | ||
=== Treatment of [[pitta]]ja chhardi === | === Treatment of [[pitta]]ja chhardi === | ||
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##Powder of ''murva'' (Marsdenia tenacissima / sansevieria roxburghiana) along with ''tandulodaka'' (rice-water)[26-33] | ##Powder of ''murva'' (Marsdenia tenacissima / sansevieria roxburghiana) along with ''tandulodaka'' (rice-water)[26-33] | ||
=== Treatment of [[kapha]]ja chhardi === | === Treatment of [[kapha]]ja chhardi === | ||
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''Douhruda janita'' (pregnancy induced vomitting), ''satmya prakopaja'' (vomiting due to inadequacy of substances) and ''krimija'' (vomiting due to microbial infection) type of ''chhardi'' are other causes of ''chhardi''.<ref>Sushruta. Sushruta Samhita . In: Kaviraj Shastri Ambika Dutt, Editors. 5th ed. Varanasi: Chaukhambha Sanskrit Series;1982. p.?.</ref> | ''Douhruda janita'' (pregnancy induced vomitting), ''satmya prakopaja'' (vomiting due to inadequacy of substances) and ''krimija'' (vomiting due to microbial infection) type of ''chhardi'' are other causes of ''chhardi''.<ref>Sushruta. Sushruta Samhita . In: Kaviraj Shastri Ambika Dutt, Editors. 5th ed. Varanasi: Chaukhambha Sanskrit Series;1982. p.?.</ref> | ||
==== [[Vata]]ja chhardi ==== | ==== [[Vata]]ja chhardi ==== | ||
There are many factors that increase [[vata]] in the ''sharira'' .<ref> Sushruta. Sutra sthana cha 21 Vranaprashna Adhyaya verse 19. In: Kaviraj Shastri Ambika Dutt, editors, 5th Edition, Varanasi : Chaukhamba Sanskrit Series,1982.</ref> Particular ''ahara'' (food), ''vihara'' (lifestyle) and mental factors increase [[vata]] and its ''gunas'' (properties). This aggravation of [[vata]] gunas like ''rukshata'' (dryness), ''laghuta'' (lightness), etc. plays a role in causing [[vata]]ja chhardi. [ Cha. Sa. [[Sutra Sthana]] 1/59] [[dosha]] conjugate (''sammurchhana'' [ Cha. Sa.[[Sutra Sthana]] 18/46] with a particular organ (''mahasrotas, amashaya, marma'' (vital organ), ''urdhwabhaga'' (upper trunk, etc) as ''dushyas'' (affected [[dhatu]]) to cause [[vata]]ja chhardi (as ''utkshepana'' (upward movement), ''adhahkshepana'' (downward movement), etc are the ''karmas'' (actions) of [[vayu]])-(7-9). | There are many factors that increase [[vata]] in the ''sharira'' .<ref> Sushruta. Sutra sthana cha 21 Vranaprashna Adhyaya verse 19. In: Kaviraj Shastri Ambika Dutt, editors, 5th Edition, Varanasi : Chaukhamba Sanskrit Series,1982.</ref> Particular ''ahara'' (food), ''vihara'' (lifestyle) and mental factors increase [[vata]] and its ''gunas'' (properties). This aggravation of [[vata]] gunas like ''rukshata'' (dryness), ''laghuta'' (lightness), etc. plays a role in causing [[vata]]ja chhardi. [ Cha. Sa. [[Sutra Sthana]] 1/59] [[dosha]] conjugate (''sammurchhana'' [ Cha. Sa.[[Sutra Sthana]] 18/46] with a particular organ (''mahasrotas, amashaya, marma'' (vital organ), ''urdhwabhaga'' (upper trunk, etc) as ''dushyas'' (affected [[dhatu]]) to cause [[vata]]ja chhardi (as ''utkshepana'' (upward movement), ''adhahkshepana'' (downward movement), etc are the ''karmas'' (actions) of [[vayu]])-(7-9). | ||
==== [[Pitta]]ja chhardi ==== | ==== [[Pitta]]ja chhardi ==== | ||
''Nidanas'' of [[pitta]]prakopaka increase [[pitta]] in nature <ref> Sushruta, Sutra sthana c21/21 Hindi commentary by Kaviraj, Shastri Ambika Dutt, 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref>and cause provocation of ''gunas'' like ''ushna'' (hot), ''tikshna'' (sharp), ''snigdha'' (unctous), etc. [ Cha. Sa. [[Sutra Sthana]] 1/60] in the body. This aggravated ''pitta'' joins (''sammurchhana'') with a particular organ (''rasayani, amashaya, marma, urdhwabhaga,'' etc) as ''dushyas''. The conjugation of [[dosha]] and ''dushya'' has affinity towards ''urdhwabhaga'' which results in [[pitta]]ja chhardi (10-11). | ''Nidanas'' of [[pitta]]prakopaka increase [[pitta]] in nature <ref> Sushruta, Sutra sthana c21/21 Hindi commentary by Kaviraj, Shastri Ambika Dutt, 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref>and cause provocation of ''gunas'' like ''ushna'' (hot), ''tikshna'' (sharp), ''snigdha'' (unctous), etc. [ Cha. Sa. [[Sutra Sthana]] 1/60] in the body. This aggravated ''pitta'' joins (''sammurchhana'') with a particular organ (''rasayani, amashaya, marma, urdhwabhaga,'' etc) as ''dushyas''. The conjugation of [[dosha]] and ''dushya'' has affinity towards ''urdhwabhaga'' which results in [[pitta]]ja chhardi (10-11). | ||
==== [[Kapha]]ja chhardi ==== | ==== [[Kapha]]ja chhardi ==== | ||
''Nidanas'' of [[kapha]]prakopaka increase [[kapha]] in nature which causes provocation of [[guna]] like ''guru'' (heavyness), ''sheeta'' (coldness), ''manda'' (slowness), etc. [ Cha. Sa.[[Sutra Sthana]] 1/60] in the body. This aggravated [[kapha]] joins (''sammurchhana'') with a particular organ (''urah'' (chest), ''shirah'' (head), ''rasayani marma, urdhwabhaga,'' etc.) as ''dushyas''. This amalgamation of [[dosha]] and ''dushya'' has affinity towards ''urdhwabhaga'' which results in [[kapha]]ja chhardi(12-13). | ''Nidanas'' of [[kapha]]prakopaka increase [[kapha]] in nature which causes provocation of [[guna]] like ''guru'' (heavyness), ''sheeta'' (coldness), ''manda'' (slowness), etc. [ Cha. Sa.[[Sutra Sthana]] 1/60] in the body. This aggravated [[kapha]] joins (''sammurchhana'') with a particular organ (''urah'' (chest), ''shirah'' (head), ''rasayani marma, urdhwabhaga,'' etc.) as ''dushyas''. This amalgamation of [[dosha]] and ''dushya'' has affinity towards ''urdhwabhaga'' which results in [[kapha]]ja chhardi(12-13). | ||
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=== Treatment === | === Treatment === | ||
*[[Langhana]] becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where [[dosha]] are in ''utklishtha'' stage and ready to be expelled out. [[Vamana]] is recommended when [[dosha]] are accumulated in ''amashaya'' or ''amashayottha'' (originating from stomach or upper gastro-intestinal tract). Whereas [[virechana]] is recommended in case of post-''amashayottha'' (in lower gastro-intestinal tract) accumulated [[dosha]], considering nearest route of ''samshodhana''. The choice of drugs should be done as per the [[dosha]]nashakatva(capacity to subside the vitiated [[dosha]]) ( verse 20). | *[[Langhana]] becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where [[dosha]] are in ''utklishtha'' stage and ready to be expelled out. [[Vamana]] is recommended when [[dosha]] are accumulated in ''amashaya'' or ''amashayottha'' (originating from stomach or upper gastro-intestinal tract). Whereas [[virechana]] is recommended in case of post-''amashayottha'' (in lower gastro-intestinal tract) accumulated [[dosha]], considering nearest route of ''samshodhana''. The choice of drugs should be done as per the [[dosha]]nashakatva(capacity to subside the vitiated [[dosha]]) ( verse 20). | ||
*''Haritaki'' is known for its laxative action (''anulomaneeya''). It not only ''tridoshahara'' but also possesses many more qualities [Cha. Sa. [[Chikitsa Sthana]] 1/1/29-34] which can be helpful for ''samprapti vighanatana'' (breaking pathogenesis) in ''chhardi''. The choice of ''hridaya dravya'' (liking to mind) is recommended in ''chhardi'' which should be given with ''madya'' (alcohol) and ''dugdha'' (cow milk) as an ''anupana''. ''Madya'' due to its specific [[guna]][Cha.Sa. [[Sutra Sthana]] 27/ 193-195] results in quick absorption of the ''dravya'' and hastens the mode of action. ''Dugdha'' (cow milk) along with many other qualities [ Cha. Sa.[[Sutra Sthana]] 27/217-18] is naturally ''saraka'' (purgative) in nature which makes ''anulomana gati'' (natural movements) of [[vayu]]. | *''Haritaki'' is known for its laxative action (''anulomaneeya''). It not only ''tridoshahara'' but also possesses many more qualities [Cha. Sa. [[Chikitsa Sthana]] 1/1/29-34] which can be helpful for ''samprapti vighanatana'' (breaking pathogenesis) in ''chhardi''. The choice of ''hridaya dravya'' (liking to mind) is recommended in ''chhardi'' which should be given with ''madya'' (alcohol) and ''dugdha'' (cow milk) as an ''anupana''. ''Madya'' due to its specific [[guna]][Cha.Sa. [[Sutra Sthana]] 27/ 193-195] results in quick absorption of the ''dravya'' and hastens the mode of action. ''Dugdha'' (cow milk) along with many other qualities [ Cha. Sa.[[Sutra Sthana]] 27/217-18] is naturally ''saraka'' (purgative) in nature which makes ''anulomana gati'' (natural movements) of [[vayu]]. | ||
*As the [[dosha]] are already in ''utklishta avastha''(stage of aggravation or ready to come out), the choice of ''valliphala'' for [[vamana]] is considered as a ''mridu'' (mild). On the other hand if the patient is weak and cannot tolerate the [[vamana]] effort, ''shamana chikitsa'' should be considered. The treatment planning should be done keeping ''manah'' as center point. The diet or ''pathya'' should be a ''manah prasannakara'' (mind pleasing) [ Cha. Sa.[[Chikitsa Sthana]] 20/ 41-42] . It should be preferably ''mamsarasa'', dry food or liquid diet which is easily digestible ( verses 21-22). | *As the [[dosha]] are already in ''utklishta avastha''(stage of aggravation or ready to come out), the choice of ''valliphala'' for [[vamana]] is considered as a ''mridu'' (mild). On the other hand if the patient is weak and cannot tolerate the [[vamana]] effort, ''shamana chikitsa'' should be considered. The treatment planning should be done keeping ''manah'' as center point. The diet or ''pathya'' should be a ''manah prasannakara'' (mind pleasing) [ Cha. Sa.[[Chikitsa Sthana]] 20/ 41-42] . It should be preferably ''mamsarasa'', dry food or liquid diet which is easily digestible ( verses 21-22). | ||
*In [[vata]]ja chhardi, ''laghu susanskrita mamsarasa'' (processed meat soup) is helpful in easy digestion and gives strength due to [[vata]] pacifying property. The ''yusha'' prepared from ''amlarasatmaka'' (sour taste) is not only [[vata]] pacifying but also stimulates the heart and leads to ''anulomana gati'' of [[vayu]]. ''Ghrita'' as ''sanskaranuvartana'' (synergistically increases the properties of associated drugs) [ Cha. Sa.[[Sutra Sthana]] 27/231-32] and [ Cha. Sa. [[Sutra Sthana]] 13/13] can be beneficial in [[vata]]ja hridroga. | *In [[vata]]ja chhardi, ''laghu susanskrita mamsarasa'' (processed meat soup) is helpful in easy digestion and gives strength due to [[vata]] pacifying property. The ''yusha'' prepared from ''amlarasatmaka'' (sour taste) is not only [[vata]] pacifying but also stimulates the heart and leads to ''anulomana gati'' of [[vayu]]. ''Ghrita'' as ''sanskaranuvartana'' (synergistically increases the properties of associated drugs) [ Cha. Sa.[[Sutra Sthana]] 27/231-32] and [ Cha. Sa. [[Sutra Sthana]] 13/13] can be beneficial in [[vata]]ja hridroga. | ||
*If the aggravated [[dosha]] are in distal part of ''amashaya'' (post- ''amashaya'') the nearest route to remove [[pitta]] is through [[virechana]] procedure. If the aggravated [[pitta]] is in ''amashaya'' then the nearest route to remove [[pitta]] is through [[vamana]]. Both these procedures should be adopted in ''balavana rogi'' (physically strong patient) judiciously clubbing with proper ''samsarjana krama'' (protocol after purification procedure) to prevent aggravation of [[vata]] [[dosha]]. | *If the aggravated [[dosha]] are in distal part of ''amashaya'' (post- ''amashaya'') the nearest route to remove [[pitta]] is through [[virechana]] procedure. If the aggravated [[pitta]] is in ''amashaya'' then the nearest route to remove [[pitta]] is through [[vamana]]. Both these procedures should be adopted in ''balavana rogi'' (physically strong patient) judiciously clubbing with proper ''samsarjana krama'' (protocol after purification procedure) to prevent aggravation of [[vata]] [[dosha]]. | ||
*For ''shamana'' treatment the selection of drugs should be [[pitta]] pacifying, ''manapralhadakara'' (mind pleasing) and ''balya'' (strength of patient) criteria. The mechanism of action of these drugs can be through ''hetu viparita'' (anti-etiology), ''vyadhi viparita'' (anti-disease) or ''hetu-vyadhi veeparita chikitsa'' (anti-cause & disease treatment). | *For ''shamana'' treatment the selection of drugs should be [[pitta]] pacifying, ''manapralhadakara'' (mind pleasing) and ''balya'' (strength of patient) criteria. The mechanism of action of these drugs can be through ''hetu viparita'' (anti-etiology), ''vyadhi viparita'' (anti-disease) or ''hetu-vyadhi veeparita chikitsa'' (anti-cause & disease treatment). | ||
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*For ''chhardinigrahana'' (anti-emetic group), the drugs should be ''kashaya rasatmaka'' (astringent taste), ''sheetaveerya'' (cool potency) and [[kapha]]ghna ([[kapha]] alleviators) in nature. The ''manahshiladi yoga'' (a formulation) is considered to be ''vyadhiviparitarthakari'' (anti-disease) measures. | *For ''chhardinigrahana'' (anti-emetic group), the drugs should be ''kashaya rasatmaka'' (astringent taste), ''sheetaveerya'' (cool potency) and [[kapha]]ghna ([[kapha]] alleviators) in nature. The ''manahshiladi yoga'' (a formulation) is considered to be ''vyadhiviparitarthakari'' (anti-disease) measures. | ||
*In case of ''dwistarthayoga chhardi'' (vomiting due to hate/ aversion), the treatment includes ''ashvasana'' (assurance), ''vartalapa'' (conversation), ''mitramandali'' (friend circle), ''mananusarena ahara-vihara'' (preferable food & lifestyle). By doing so one can easily overcome the disease for the time being and once the ''vegavastha'' (vomiting bouts) is overcome, actual conceptual treatment can be adopted. | *In case of ''dwistarthayoga chhardi'' (vomiting due to hate/ aversion), the treatment includes ''ashvasana'' (assurance), ''vartalapa'' (conversation), ''mitramandali'' (friend circle), ''mananusarena ahara-vihara'' (preferable food & lifestyle). By doing so one can easily overcome the disease for the time being and once the ''vegavastha'' (vomiting bouts) is overcome, actual conceptual treatment can be adopted. | ||
*The ''vegakalina'' or chronic ''chhardi'', whether mild or severe, involves constant irritation of involved body parts/systems which leads to poor nourishment of [[dhatu]] resulting in [[dhatu]]ksheenata. Such a long term [[dhatu]]kshaya (loss of [[dhatu]]) increases [[vata]] in the body. The management should be purely [[vata]]shamaka treatment especially [[stambhana]] (which restricts the [[vamana]] vega) in combination with [[brimhana]] (nourishment to [[dhatu]]). | *The ''vegakalina'' or chronic ''chhardi'', whether mild or severe, involves constant irritation of involved body parts/systems which leads to poor nourishment of [[dhatu]] resulting in [[dhatu]]ksheenata. Such a long term [[dhatu]]kshaya (loss of [[dhatu]]) increases [[vata]] in the body. The management should be purely [[vata]]shamaka treatment especially [[stambhana]] (which restricts the [[vamana]] vega) in combination with [[brimhana]] (nourishment to [[dhatu]]). | ||
The selection of drugs plays very important role here. Most of the dravyas mentioned here are ''vichitrapratyarabhadha'' (extraordinary) in nature which achieve [[stambhana]] but would not increase [[vata]]. The description about ''sarpiguda'' (a formulation), ''kalyanaka ghrita'' (a formulation), ''vrishya yoga'' (a formulation), ''avalehas'' (a formulation) etc. are the desired formulations for the management may have synergistic action. | The selection of drugs plays very important role here. Most of the dravyas mentioned here are ''vichitrapratyarabhadha'' (extraordinary) in nature which achieve [[stambhana]] but would not increase [[vata]]. The description about ''sarpiguda'' (a formulation), ''kalyanaka ghrita'' (a formulation), ''vrishya yoga'' (a formulation), ''avalehas'' (a formulation) etc. are the desired formulations for the management may have synergistic action. | ||