Chhardi Chikitsa

Chhardi Chikitsa

Section/Chapter	Chikitsa Sthana Chapter 20
Preceding Chapter	Atisara Chikitsa
Succeeding Chapter	Visarpa Chikitsa
Other Sections	Sutra Sthana, Nidana Sthana, Vimana Sthana, Sharira Sthana, Indriya Sthana, Kalpa Sthana, Siddhi Sthana

Chikitsa Sthana Chapter 20, Chapter on the Management of Chhardi (vomiting)

Abstract

Chhardi (vomiting), is a common gastrointestinal disorder characterized by bouts of vomiting, nausea, pain and black outs. The causative factors of chhardi can be categorized under dietary, lifestyle and psychological factors. Dietary factors include excessive upavasa (starvation), over intake of vidahi or snigdha-guru dravya (drugs which are very acrid, unctuous and heavy to digest), etc. Lifestyle aspects include excessive exercise, divasvapna (day sleep), etc. whereas the psychological stressors like excess worries, grief, anger, fear can precipitate it. Amashaya (stomach) and rasayani (channels) are the sites of origin of chhardi. Vitiated doshas accumulate in amashaya and rasayani and are thrown out forcefully from the upper part of body causing pida (pain) to urdhva avayavas (organs situated above supraclavicular region). Comprehensive management includes avoidance of etiological factors with pharmacological treatment through medicament as well as non-pharmacological methods.

Keywords: Chhardi chikitsa, chhardi, vomiting, emesis

Introduction

After explaining the Atisara Chikitsa (treatment of diarrhea), there is description of Chhardi Chikitsa. The word chhardi is derived from the root chhard vamane. The word chhad means gripping (avritta or achhadana) and ard means pain (peedha). The other words like chhardah, chhardana, chhardi, chhardika, etc. are considered as the synonyms of chhardi. The words chhardi and vamana, both are used in the sense of vomiting but have basic difference. Chhardi is a pathological condition where the sufferer is exposed to particular predisposing factors for vomiting and as a result suffers from the particular condition called chhardi. On the other hand vamana is one of the purification therapies of Panchakarma (five purification procedures in Ayurveda) where the physician intends to induce vomiting to expel out vitiated kapha and pitta. In general, the vitiated doshas accumulate in stomach and are thrown out from the body through various channels. There are two major channels from which the body generally does such excretary mechanism. The one is adhomārga (excretion through downword channel) for which the description of atisara is given in previous chapter and the other one is urdhvabhaga (excretion through upward channel) where the description of chhardi is discussed here. Chhardi comes under the category of koshtha rasayani shrita vyadhi (diseases of GI tract) whose roots are in mahasrotas (GI tract) and manovaha (mind) srotasa. The amashaya and rasayani are the involved avayavas (organs) in this disease. The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological counseling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors. The curative treatment focuses on pharmacotherapy depending upon dosha dominance and mild samshodhana (expelling out the vitiated dosha).

Sanskrit Text, Transliteration and English Translation

अथातश्छर्दिचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

athātaśchardicikitsitaṁ vyākhyāsyāmaḥ||1||

iti ha smāha bhagavānātrēyaḥ||2||

athAtashchardicikitsitaM vyAkhyAsyAmaH||1||

iti ha smAha bhagavAnAtreyaH||2||

We shall now expound the chapter entitled “the management of chhardi (vomiting)”. Thus, said Lord Atreya. [1-2]

यशस्विनं ब्रह्मतपोद्युतिभ्यां ज्वलन्तमग्न्यर्कसमप्रभावम्|

पुनर्वसुं भूतहिते निविष्टं पप्रच्छ शिष्योऽत्रिजमग्निवेशः||३||

yaśasvinaṁ brahmatapōdyutibhyāṁ jvalantamagnyarkasamaprabhāvam|

punarvasuṁ bhūtahitē niviṣṭaṁ papraccha śiṣyō'trijamagnivēśaḥ||3||

yashasvinaM brahmatapodyutibhyAM jvalantamagnyarkasamaprabhAvam|

punarvasuM bhUtahite niviShTaM papraccha shiShyo~atrijamagniveshaH||3||

Agnivesha the disciple asked Punarvasu, the illustratious son of Atri, who was engrossed in the thinking of the well-being of humanity and who was dazzling with luster of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the well-being of all living beings [3]

Queries by Agnivesha

याश्छर्दयः पञ्च पुरा त्वयोक्ता रोगाधिकारे भिषजां वरिष्ठ!|

तासां चिकित्सां सनिदानलिङ्गां यथावदाचक्ष्व नृणां हितार्थम्||४||

तदग्निवेशस्य वचो निशम्य प्रीतो भिषक्श्रेष्ठ इदं जगाद|

याश्छर्दयः पञ्च पुरा मयोक्तास्ता विस्तरेण ब्रुवतो निबोध||५||

yāśchardayaḥ pañca purā tvayōktā rōgādhikārē bhiṣajāṁ variṣṭha!|

tāsāṁ cikitsāṁ sanidānaliṅgāṁ yathāvadācakṣva nr̥ṇāṁ hitārtham||4||

tadagnivēśasya vacō niśamya prītō bhiṣakśrēṣṭha idaṁ jagāda|

yāśchardayaḥ pañca purā mayōktāstā vistarēṇa bruvatō nibōdha||5||

yAshchardayaH pa~jca purA tvayoktA rogAdhikAre bhiShajAM variShTha!|

tAsAM cikitsAM sanidAnali~ggAM yathAvadAcakShva nRuNAM hitArtham||4||

tadagniveshasya vaco nishamya prIto bhiShakshreShTha idaM jagAda|

yAshchardayaH pa~jca purA mayoktAstA vistareNa bruvato nibodha||5||

Oh! Revered Physician, please describe the treatment of the five types of chhardi (vomiting) mentioned by you earlier in the context of the enumeration of diseases (in Sutra 19:3-4) along with their etiology, signs and symptoms comprehensively, for the sake of well-being of humanity.

Having heard Agnivesha and being pleased the best among physicians Punarvasu Atreya said “I shall now expound all the five types of vomiting (briefly) stated earlier, in greater details. Listen to me." [4-5]

Classification and premonitory symptoms

दोषैः पृथक्त्रिप्रभवाश्चतस्रो [१] द्बिष्टार्थयोगादपि पञ्चमी स्यात्|

तासां हृदुत्क्लेशकफप्रसेकौ द्वेषोऽशने चैव हि पूर्वरूपम्||६|

dōṣaiḥ pr̥thaktriprabhavāścatasrō dbiṣṭārthayōgādapi pañcamī syāt|

tāsāṁ hr̥dutklēśakaphaprasēkau dvēṣō'śanē caiva hi pūrvarūpam||6||

doShaiH pRuthaktriprabhavAshcatasro [1] dbiShTArthayogAdapi pa~jcamI syAt|6|

tAsAM hRudutkleshakaphaprasekau dveSho~ashane caiva hi pUrvarUpam||6||

Chhardi (vomiting) is of five types; three types of vomiting caused by a dosha each i.e. vatika, paittika, kaphaja, fourth is sannipatika and fifth is dvistartha-yogaja-chhardi (that results from contact with unpleasant sense objects). The premonitory signs and symptoms of chhardi (vomiting) are nausea, excessive salivation and aversion to food [6]

Vataja chhardi

व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|

वायुर्महास्रोतसि सम्प्रवृद्ध उत्क्लेश्य दोषांस्तत ऊर्ध्वमस्यन्||७||

आमाशयोत्क्लेशकृतां च मर्म प्रपीडयंश्छर्दिमुदीरयेत्तु|

हृत्पार्श्वपीडामुखशोषमूर्धनाभ्यर्तिकासस्वरभेदतोदैः||८||

उद्गारशब्दप्रबलं सफेनं विच्छिन्नकृष्णं तनुकं कषायम्|

कृच्छ्रेण चाल्पं महता च वेगेनार्तोऽनिलाच्छर्दयतीह दुःखम्||९||

vyāyāmatīkṣṇauṣadhaśōkarōgabhayōpavāsādyatikarśitasya|

vāyurmahāsrōtasi sampravr̥ddha utklēśya dōṣāṁstata ūrdhvamasyan||7||

āmāśayōtklēśakr̥tāṁ ca marma prapīḍayaṁśchardimudīrayēttu|

hr̥tpārśvapīḍāmukhaśōṣamūrdhanābhyartikāsasvarabhēdatōdaiḥ||8||

udgāraśabdaprabalaṁ saphēnaṁ vicchinnakr̥ṣṇaṁ tanukaṁ kaṣāyam|

kr̥cchrēṇa cālpaṁ mahatā ca vēgēnārtō'nilācchardayatīha duḥkham||9||

vyAyAmatIkShNauShadhashokarogabhayopavAsAdyatikarshitasya|

vAyurmahAsrotasi [1] sampravRuddha utkleshya doShAMstata Urdhvamasyan||7||

AmAshayotkleshakRutAM ca marma prapIDayaMshchardimudIrayettu|

hRutpArshvapIDAmukhashoShamUrdhanAbhyartikAsasvarabhedatodaiH||8||

udgArashabdaprabalaM saphenaM vicchinnakRuShNaM tanukaM kaShAyam|

kRucchreNa cAlpaM mahatA ca vegenArto~anilAcchardayatIha duHkham||9||

In a person extremely emaciated because of disease, excessive intake of medicines having tikshna (sharply acting) attributes and indulging in grief, fear, fasting, etc. vata gets excessively aggravated in the maha-srotas (gastrointestinal tract), vitiates the local doshas and pushes them upwards. These doshas cause agitation in the amashaya (stomach), and after afflicting the marma (vital organs-heart) gives rise to chhardi (vomiting). This vataja type of vomiting is characterized by the following signs and symptoms:

1. Pain in the cardiac region and flanks;
2. Dryness of the mouth;
3. Pain in the head and umbilical region;
4. Cough, hoarseness of voice and pricking pain;
5. Eructation with loud noise;
6. Vomiting of material which is frothy, scattered, black in color, thin and astringent;
7. The urge for vomiting is forceful, but patient vomits only in small quantities with pain;
8. The patient feels miserable [7-9]

Pittaja chhardi

अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|

रसायनीभिर्विसृतं प्रपीड्य मर्मोर्ध्वमागम्य वमिं करोति||१०||

मूर्च्छापिपासामुखशोषमूर्धताल्वक्षिसन्तापतमोभ्रमार्तः|

पीतं भृशोष्णं हरितं सतिक्तं धूम्रं च पित्तेन वमेत् सदाहम्||११||

ajīrṇakaṭvamlavidāhyaśītairāmāśayē pittamudīrṇavēgam|

rasāyanībhirvisr̥taṁ prapīḍya marmōrdhvamāgamya vamiṁ karōti||10||

mūrcchāpipāsāmukhaśōṣamūrdhatālvakṣisantāpatamōbhramārtaḥ|

pītaṁ bhr̥śōṣṇaṁ haritaṁ satiktaṁ dhūmraṁ ca pittēna vamēt sadāham||11||

ajIrNakaTvamlavidAhyashItairAmAshaye pittamudIrNavegam|

rasAyanIbhirvisRutaM prapIDya marmordhvamAgamya vamiM karoti||10||

mUrcchApipAsAmukhashoShamUrdhatAlvakShisantApatamobhramArtaH|

pItaM bhRushoShNaM haritaM satiktaM dhUmraM ca pittena vamet sadAham||11||

As a result of intake of food before the previous meal is digested, or taking pungent, sour, vidahi (which cause burning sensation) and cold diet, 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 pittaja type of chhardi (vomiting) are:

1. Fainting, morbid thirst and parching of mouth;
2. Burning (or heating) sensation in the head, palate and eyes;
3. A feeling as if the patient is entering into darkness:
4. Giddiness;
5. Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation [10-11]

Kaphaja chhardi

स्निग्धातिगुर्वामविदाहिभोज्यैः स्वप्नादिभिश्चैव कफोऽतिवृद्धः|

उरः शिरो मर्म रसायनीश्च सर्वाः समावृत्य वमिं करोति||१२||

तन्द्रास्यमाधुर्यकफप्रसेकसन्तोषनिद्रारुचिगौरवार्तः|

स्निग्धं घनं स्वादु कफाद्विशुद्धं सलोमहर्षोऽल्परुजं वमेत्तु||१३||

snigdhātigurvāmavidāhibhōjyaiḥ svapnādibhiścaiva kaphō'tivr̥ddhaḥ|

uraḥ śirō marma rasāyanīśca sarvāḥ samāvr̥tya vamiṁ karōti||12||

tandrāsyamādhuryakaphaprasēkasantōṣanidrārucigauravārtaḥ|

snigdhaṁ ghanaṁ svādu kaphādviśuddhaṁ salōmaharṣō'lparujaṁ vamēttu||13||

snigdhAtigurvAmavidAhibhojyaiH svapnAdibhishcaiva kapho~ativRuddhaH|

uraH shiro marma rasAyanIshca sarvAH samAvRutya vamiM karoti||12||

tandrAsyamAdhuryakaphaprasekasantoShanidrArucigauravArtaH|

snigdhaM ghanaM svAdu kaphAdvishuddhaM salomaharSho~alparujaM vamettu||13||

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 kaphaja type of chhardi are as follows:

1. Drowsiness, sweetness in the mouth and salivation;
2. Sense of satiety, sleep, anorexia and heaviness;
3. Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain [12-13]

Tridoshaja chhardi

समश्नतः सर्वरसान् प्रसक्तमामप्रदोषर्तुविपर्ययैश्च|

सर्वे प्रकोपं युगपत् प्रपन्नाश्छर्दिं त्रिदोषां जनयन्ति दोषाः||१४||

शूलाविपाकारुचिदाहतृष्णाश्वासप्रमोहप्रबला प्रसक्तम्|

छर्दिस्त्रिदोषाल्लवणाम्लनीलसान्द्रोष्णरक्तं वमतां नृणां स्यात्||१५||

samaśnataḥ sarvarasān prasaktamāmapradōṣartuviparyayaiśca|

sarvē prakōpaṁ yugapat prapannāśchardiṁ tridōṣāṁ janayanti dōṣāḥ||14||

śūlāvipākārucidāhatr̥ṣṇāśvāsapramōhaprabalā prasaktam|

chardistridōṣāllavaṇāmlanīlasāndrōṣṇaraktaṁ vamatāṁ nr̥ṇāṁ syāt||15||

samashnataH sarvarasAn prasaktamAmapradoShartuviparyayaishca|

sarve prakopaM yugapat prapannAshchardiM tridoShAM janayanti doShAH||14||

shUlAvipAkArucidAhatRuShNAshvAsapramohaprabalA prasaktam|

chardistridoShAllavaNAmlanIlasAndroShNaraktaM vamatAM nRuNAM syAt||15||

Because of constant indulgence in diet consisting of wholesome and unwholesome diet together, having all categories of taste together because of ama-dosha (ailments caused by improper digestion) and because of seasonal perversions, all the three doshas get simultaneously aggravated and cause sannipatika chhardi.

The signs and symptoms of this type of vomiting are as follows:

1. Colic pain, indigestion, anorexia, burning sensation, morbid thirst, dyspnea and fainting spells that are severe and persistent;
2. Vomitus is salty, sour, blue, dense, hot and reddish [14-15]

Bad prognostic symptoms

विट्स्वेदमूत्राम्बुवहानि वायुः स्रोतांसि संरुध्य यदोर्ध्वमेति|

उत्सन्नदोषस्य समाचितं तं दोषं समुद्धूय नरस्य कोष्ठात्||१६||

विण्मूत्रयोस्तत् समवर्णगन्धं तृट्श्वासहिक्कार्तियुतं प्रसक्तम्|

प्रच्छर्दयेद्दुष्टमिहातिवेगात्तयाऽर्दितश्चाशु विनाशमेति||१७||

viṭsvēdamūtrāmbuvahāni vāyuḥ srōtāṁsi saṁrudhya yadōrdhvamēti|

utsannadōṣasya samācitaṁ taṁ dōṣaṁ samuddhūya narasya kōṣṭhāt||16||

viṇmūtrayōstat samavarṇagandhaṁ tr̥ṭśvāsahikkārtiyutaṁ prasaktam|

pracchardayēdduṣṭamihātivēgāttayā'rditaścāśu vināśamēti||17||

viTsvedamUtrAmbuvahAni vAyuH srotAMsi saMrudhya yadordhvameti|

utsannadoShasya samAcitaM taM doShaM samuddhUya narasya koShThAt||16||

viNmUtrayostat samavarNagandhaM tRuTshvAsahikkArtiyutaM prasaktam|

pracchardayedduShTamihAtivegAttayA~arditashcAshu vinAshameti||17||

When the morbid vata occludes the channels carrying faeces, 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:

1. Vomitus having color and odor of the feces and urine;
2. Persistent thirst, dyspnea hiccup and pain
3. Vomiting of foul smelling or dusta (putrid material); and
4. Bouts of vomiting ejected with great force.

Such a patient succumbs to death quickly [16-17]

Dvishtharthasamyogaja chhardi

द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|

यच्छर्दयेत्तप्तमना मनोध्नैर्द्विष्टार्थसंयोगभवा मता सा||१८||

dviṣṭapratīpāśucipūtyamēdhyabībhatsagandhāśanadarśanaiśca|

yacchardayēttaptamanā manōdhnairdviṣṭārthasaṁyōgabhavā matā sā||18||

dviShTapratIpAshucipUtyamedhyabIbhatsagandhAshanadarshanaishca|

yacchardayettaptamanA manodhnairdviShTArthasaMyogabhavA matA sA||18||

As a result of mental disgust occasioned by senses contact with despicable, antagonistic, unclean, putrid, unholy and loathsome odors, diet or sights, the chhardi(vomiting) is known as vomiting induced by contact with hateful things [18]

Symptoms of incurable chhardi

क्षीणस्य या छर्दिरतिप्रवृद्धा सोपद्रवा शोणितपूययुक्ता|

सचन्द्रिकां तां प्रवदन्त्यसाध्यां साध्यां चिकित्सेदनुपद्रवां च||१९||

kṣīṇasya yā chardiratipravr̥ddhā sōpadravā śōṇitapūyayuktā|

sacandrikāṁ tāṁ pravadantyasādhyāṁ sādhyāṁ cikitsēdanupadravāṁ ca||19||

kShINasya yA chardiratipravRuddhA sopadravA shoNitapUyayuktA|

sacandrikAM tAM pravadantyasAdhyAM sAdhyAM cikitsedanupadravAM ca||19||

Vomiting that occurs in an emaciated person, that continues incessantly, that is associated with complications, and vomitus that contains blood, pus and chandrika (circular shiny patches with variegated color) is incurable. The physician should treat only curable types that are not associated with complications [19]

Principles of treatment

आमाशयोत्क्लेशभवा हि सर्वाश्छर्द्यो मता लङ्घनमेव तस्मात्|

प्राक्कारयेन्मारुतजां विमुच्य संशोधनं वा कफपित्तहारि||२०||

āmāśayōtklēśabhavā hi sarvāśchardyō matā laṅghanamēva tasmāt|

prākkārayēnmārutajāṁ vimucya saṁśōdhanaṁ vā kaphapittahāri||20||

AmAshayotkleshabhavA hi sarvAshchardyo matA la~gghanameva tasmAt|

prAkkArayenmArutajAM vimucya saMshodhanaM vA kaphapittahAri||20||

As all the types of vomiting are considered originating from the agitations of the doshas in the stomach, fasting therapy should first be prescribed or purificatory procedure curative of kapha and pitta should be administered except in cases of vata dominance. [20]

चूर्णानि लिह्यान्मधुनाऽभयानां हृद्यानि वा यानि विरेचनानि|

मद्यैः पयोभिश्च युतानि युक्त्या नयन्त्यधो दोषमुदीर्णमूर्ध्वम्||२१||

वल्लीफलाद्यैर्वमनं पिबेद्वा यो दुर्बलस्तं शमनैश्चिकित्सेत्|

रसैर्मनोज्ञैर्लघुभिर्विशुष्कैर्भक्ष्यैः सभोज्यैर्विविधैश्च पानैः||२२||

cūrṇāni lihyānmadhunā'bhayānāṁ hr̥dyāni vā yāni virēcanāni|

madyaiḥ payōbhiśca yutāni yuktyā nayantyadhō dōṣamudīrṇamūrdhvam||21||

vallīphalādyairvamanaṁ pibēdvā yō durbalastaṁ śamanaiścikitsēt|

rasairmanōjñairlaghubhirviśuṣkairbhakṣyaiḥ sabhōjyairvividhaiśca pānaiḥ||22||

cUrNAni lihyAnmadhunA~abhayAnAM hRudyAni vA yAni virecanAni|

madyaiH payobhishca yutAni yuktyA nayantyadho doShamudIrNamUrdhvam||21||

vallIphalAdyairvamanaM pibedvA yo durbalastaM shamanaishcikitset|

rasairmanoj~jairlaghubhirvishuShkairbhakShyaiH sabhojyairvividhaishca pAnaiH||22||

The patient shall take powder of abhaya (chebulic myrobalans) with honey or such other palatable purgatives skillfully combined with madya (alcohol) or dugdha (milk). These recipes cause downward movement of the aggravated doshas that are impelled to move upwards.

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 vataja chhardi

सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|

छर्दिं तथा कोलकुलत्थधान्यबिल्वादिमूलाम्लयवैश्च यूषः||२३||

वातात्मिकायां हृदयद्रवार्तो नरः पिबेत् सैन्धववद्धृतं तु|

सिद्धं तथा धान्यकनागराभ्यां दध्ना च तोयेन च दाडिमस्य||२४||

व्योषेण युक्तां लवणैस्त्रिभिश्च घृतस्य मात्रामथवा विदध्यात्|

स्निग्धानि हृद्यानि च भोजनानि रसैः सयूषैर्दधिदाडिमाम्लैः||२५||

susaṁskr̥tāstittiribarhilāvarasā vyapōhantyanilapravr̥ttām|

chardiṁ tathā kōlakulatthadhānyabilvādimūlāmlayavaiśca yūṣaḥ||23||

vātātmikāyāṁ [1] hr̥dayadravārtō naraḥ pibēt saindhavavaddhr̥taṁ tu|

siddhaṁ tathā dhānyakanāgarābhyāṁ dadhnā ca tōyēna ca dāḍimasya||24||

vyōṣēṇa yuktāṁ lavaṇaistribhiśca ghr̥tasya mātrāmathavā vidadhyāt|

snigdhāni hr̥dyāni ca bhōjanāni rasaiḥ sayūṣairdadhidāḍimāmlaiḥ||25||

SusamskrutAstittiribrhilAvrasA vyapohantyanilapravRuttAm|

chardiM tathA kolakulatthadhAnyabilvAdimUlAmlayavaishca yUShaH||23||

vAtAtmikAyAM hRudayadravArto naraH pibet saindhavavaddhRutaM tu|

siddhaM tathA dhAnyakanAgarAbhyAM dadhnA ca toyena ca dADimasya||24||

vyoSheNa yuktAM lavaNaistribhishca ghRutasya mAtrAmathavA vidadhyAt|

snigdhAni hRudyAni ca bhojanAni rasaiH sayUShairdadhidADimAmlaiH||25||

The following recipes are useful in vataja type of vomiting (chhardi):

1. The meat juice of tittiri (partridge), barhi and lava (common quail);
2. Vegetable soup prepared out of kola (Zyziphus jujuba), kulattha (horse gram/Dolichos biflorus), dhanya (coriander fruit/coriandrum sativum ), group of roots of bilva (Bilva-Bengal quince/bael fruit/Aegle marmelos), etc. (syonaka (Oroxylem indicum) , gambhari (Gmelina arborea), patala (Trumpet/Stereospermum chelonoides), ganikarika (Premna integrifolia)), amla (sour substances) and yava (barley/Hordeum vulgare);
3. If the patient is suffering from vomiting of vata type of chhardi that is associated with hriddrava (palpitation), then may take ghee with rock salt.
4. Ghee cooked with dhanyaka (coriander), nagara (dry zingiber/ginger/Zingiber officinale), dadhi(curd) and the juice of dadima (pomegranate/Punica granatum);
5. Ghee mixed with the powder of trikatu (shunthi, pippali and maricha) and three salts viz. saindhava (rock salt), sauvarchala (black salt) and vida (pakyam));
6. The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour dadima (pomegranate/Punica granatum) [23-25]

Treatment of pittaja chhardi

पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|

कफाशयस्थं त्वतिमात्रवृद्धं पित्तं हरेत् स्वादुभिरूर्ध्वमेव||२६||

शुद्धाय काले मधुशर्कराभ्यां लाजैश्च मन्थं यदि वाऽपि पेयाम्|

प्रदापयेन्मुद्गरसेन वाऽपि शाल्योदनं जाङ्गलजै रसैर्वा||२७||

सितोपलामाक्षिकपिप्पलीभिः कुल्माषलाजायवसक्तुगृञ्जान्|

खर्जूरमांसान्यथ नारिकेलं द्राक्षामथो वा बदराणि लिह्यात्||२८||

स्रोतोजलाजोत्पलकोलमज्जचूर्णानि लिह्यान्मधुनाऽभयां च|

कोलास्थिमज्जाञ्जनमक्षिकाविड्लाजासितामागधिकाकणान् वा||२९||

द्राक्षारसं वाऽपि पिबेत् सुशीतं मृद्भृष्टलोष्टप्रभवं जलं वा|

जम्ब्वाम्रयोः पल्लवजं कषायं पिबेत् सुशीतं मधुसंयुतं वा||३०||

निशि स्थितं वारि समुद्गकृष्णं सोशीरधान्यं चणकोदकं वा|

गवेधुकामूलजलं गुडूच्या जलं पिबेदिक्षुरसं पयो वा||३१||

सेव्यं पिबेत् काञ्चनगैरिकं वा सबालकं तण्डुलधावनेन|

धात्रीरसेनोत्तमचन्दनं वा तृष्णावमिघ्नानि समाक्षिकाणि||३२||

कल्कं तथा चन्दनचव्यमांसीद्राक्षोत्तमाबालकगैरिकाणाम्|

शीताम्बुना गैरिकशालिचूर्णं मूर्वां तथा तण्डुलधावनेन||३३||

pittātmikāyāmanulōmanārthaṁ drākṣāvidārīkṣurasaistrivr̥t syāt|

kaphāśayasthaṁ tvatimātravr̥ddhaṁ pittaṁ harēt svādubhirūrdhvamēva||26||

śuddhāya kālē madhuśarkarābhyāṁ lājaiśca manthaṁ yadi vā'pi pēyām|

pradāpayēnmudgarasēna vā'pi śālyōdanaṁ jāṅgalajai rasairvā||27||

sitōpalāmākṣikapippalībhiḥ kulmāṣalājāyavasaktugr̥ñjān|

kharjūramāṁsānyatha nārikēlaṁ drākṣāmathō vā badarāṇi lihyāt||28||

srōtōjalājōtpalakōlamajjacūrṇāni lihyānmadhunā'bhayāṁ ca|

kōlāsthimajjāñjanamakṣikāviḍlājāsitāmāgadhikākaṇān vā||29||

drākṣārasaṁ vā'pi pibēt suśītaṁ mr̥dbhr̥ṣṭalōṣṭaprabhavaṁ jalaṁ vā|

jambvāmrayōḥ pallavajaṁ kaṣāyaṁ pibēt suśītaṁ madhusaṁyutaṁ vā||30||

niśi sthitaṁ vāri samudgakr̥ṣṇaṁ sōśīradhānyaṁ caṇakōdakaṁ vā|

gavēdhukāmūlajalaṁ guḍūcyā jalaṁ pibēdikṣurasaṁ payō vā||31||

sēvyaṁ pibēt kāñcanagairikaṁ vā sabālakaṁ taṇḍuladhāvanēna|

dhātrīrasēnōttamacandanaṁ vā tr̥ṣṇāvamighnāni samākṣikāṇi||32||

kalkaṁ tathā candanacavyamāṁsīdrākṣōttamābālakagairikāṇām|

śītāmbunā gairikaśālicūrṇaṁ mūrvāṁ tathā taṇḍuladhāvanēna||33||

pittAtmikAyAmanulomanArthaM drAkShAvidArIkShurasaistrivRut syAt|

kaphAshayasthaM tvatimAtravRuddhaM pittaM haret svAdubhirUrdhvameva||26||

shuddhAya kAle madhusharkarAbhyAM lAjaishca manthaM yadi vA~api peyAm|

pradApayenmudgarasena vA~api shAlyodanaM jA~ggalajai rasairvA||27||

sitopalAmAkShikapippalIbhiH kulmAShalAjAyavasaktugRu~jjAn|

kharjUramAMsAnyatha nArikelaM drAkShAmatho vA badarANi lihyAt||28||

srotojalAjotpalakolamajjacUrNAni lihyAnmadhunA~abhayAM ca|

kolAsthimajjA~jjanamakShikAviDlAjAsitAmAgadhikAkaNAn vA||29||

drAkShArasaM vA~api pibet sushItaM mRudbhRuShTaloShTaprabhavaM jalaM vA|

jambvAmrayoH pallavajaM kaShAyaM pibet sushItaM madhusaMyutaM vA||30||

nishi sthitaM vAri samudgakRuShNaM soshIradhAnyaM caNakodakaM vA|

gavedhukAmUlajalaM guDUcyA jalaM pibedikShurasaM payo vA||31||

sevyaM pibet kA~jcanagairikaM vA sabAlakaM taNDuladhAvanena|

dhAtrIrasenottamacandanaM vA tRuShNAvamighnAni samAkShikANi||32||

kalkaM tathA candanacavyamAMsIdrAkShottamAbAlakagairikANAm|

shItAmbunA gairikashAlicUrNaM mUrvAM tathA taNDuladhAvanena||33||

The patient of pittaja type of chhardi should be given trivrit (Operculina turpethum) along with the juice of draksha (grapes/Vitis vinifera), vidari (Purera tuberosa) and ikshu (sugar-cane/Saccharaum officinarum) for causing downward movement of the morbid matter (laxation). When aggravated pitta is located in site of kapha (chest/stomach), then drugs having sweet taste should be administered for elimination of pitta (through emetic therapy).

After this purificatory therapy patient should be given at proper time laja-mantha (flour of popped-rice diluted in water) or laja-peya (thin gruel made of popped-rice) along with honey and sugar. The patient may also be given boiled shāli type of rice along with the soup of mudga (green gram/Phaseolus aureus) or the meat juice of jangala creatures (animals inhabiting in arid zone).

The following recipes are also advocated in this context:

1. Kulmasha, the paste of boiled mudga (green gram/Phaseolus aureus), masura (lentil/ Ervum lens), etc., laja (popped paddy), yava-saktu (flour of roasted barley), grunja (boiled barley along with its supernatant segment), or the pulp of kharjura (date/Phoenix sylvestris), narikela (coconut/Cocos nucifera), draksha (grapes/Vitis vinifera) or badara (Zyziphus jujuba) should be made to a linctus by adding sitopala (sugar having big crystals), honey and pippali (long pepper/Piper longum).
2. The water of fountain, laja (popped paddy), utpala (Nymphaea stellata) and the pulp of kola (Zyziphus jujuba) be made into linctus by adding honey, and given.
3. Abhaya (chebulic myrobalan) with honey may also be taken.
4. The seed-pulp of kola (Zyziphus jujuba), anjana (srotonjana), makshika vit (excreta of house- fly), laja (popped paddy), sugar and grains of pippali mixed with honey.
5. The patient may drink cooled grape juice or cooled water prepared with baked clay or earth.
6. The patient may be given the cooled decoction of the tender leaves of jambu (Syzygium cumini) and amra (mango/Mangifera indica) by adding honey.
7. The following things kept overnight should be taken:
   1. Water with mudga (green gram/Phaseolus aureus) and pippali (long pepper/ Piper longum),
   2. Water with usheera (cuscus grass/Viteveria zizanioides) and dhanyaka (coriander/Coriandrum sativum),
   3. Water with chanaka (bengal gram/gram/chick pea/Cicer arietinum),
   4. Water with root of gavedhuka (Adlay/Jobs tears/Coix lachryma),
   5. Water with guduchi (Tinospora cordifolia),
      1. The patient may be given sugar-cane-juice or milk to drink.
8. The following recipes are useful in morbid thirst and vomiting:
   1. The powder of sevya (Cuscus grass/Viteveria zizanioides) and kanchana-gairika (Hematite, Fe2O3) along with tandulodaka (rice-water);
   2. The powder of sevya and balaka (Coleus vettiveroides) along with tandulodaka (rice-water);
   3. The paste of white variety of chandana (sandal wood) mixed with the juice of amalaki (emblic myrobalan/Emblica officinale) along with honey.
9. The following recipes also useful in paittika type of vomiting:
   1. The paste of chandana (sandal wood/Santalum album), chavya (Piper chaba/Piper officinarum), mamsi (Indian nard/nardus root/Nardostachys jatamansi), draksha (grapes/Vitis vinifera) of good quality, balaka (Coleus vettiveroides) and gairika (Hematite, Fe2O3);
   2. Powder of gairika (Hematite, Fe2O3) and shali rice along with cold water;
   3. Powder of murva (Marsdenia tenacissima / sansevieria roxburghiana) along with tandulodaka (rice-water)[26-33]

Treatment of kaphaja chhardi

कफात्मिकायां वमनं प्रशस्तं सपिप्पलीसर्षपनिम्बतोयैः|

पिण्डीतकैः सैन्धवसम्प्रयुक्तैर्वम्यां कफामाशयशोधनार्थम्||३४||

गोधूमशालीन् सयवान् पुराणान् यूषैः पटोलामृतचित्रकाणाम्|

व्योषस्य निम्बस्य च तक्रसिद्धैर्यूषैः फलाम्लैः कटुभिस्तथाऽद्यात्||३५||

रसांश्च शूल्यानि च जाङ्गलानां मांसानि जीर्णान्मधुसीध्वरिष्टान्|

रागांस्तथा षाडवपानकानि द्राक्षाकपित्थैः फलपूरकैश्च||३६||

मुद्गान्मसूरांश्चणकान् कलायान् भृष्टान् युतान्नागरमाक्षिकाभ्याम्|

लिह्यात्तथैव त्रिफलाविडङ्गचूर्णं विडङ्गप्लवयोरथो [१] वा||३७||

सजाम्बवं वा बदराम्लचूर्णं [२] मुस्तायुतां कर्कटकस्य शृङ्गीम्|

दुरालभां वा मधुसम्प्रयुक्तां लिह्यात् कफच्छर्दिविनिग्रहार्थम्||३८||

मनःशिलायाः फलपूरकस्य रसैः कपित्थस्य च पिप्पलीनाम्|

क्षौद्रेण चूर्णं मरिचैश्च युक्तं लिहञ्जयेच्छर्दिमुदीर्णवेगाम्||३९||

kaphātmikāyāṁ vamanaṁ praśastaṁ sapippalīsarṣapanimbatōyaiḥ|

piṇḍītakaiḥ saindhavasamprayuktairvamyāṁ kaphāmāśayaśōdhanārtham||34||

gōdhūmaśālīn sayavān purāṇān yūṣaiḥ paṭōlāmr̥tacitrakāṇām|

vyōṣasya nimbasya ca takrasiddhairyūṣaiḥ phalāmlaiḥ kaṭubhistathā'dyāt||35||

rasāṁśca śūlyāni ca jāṅgalānāṁ māṁsāni jīrṇānmadhusīdhvariṣṭān|

rāgāṁstathā ṣāḍavapānakāni drākṣākapitthaiḥ phalapūrakaiśca||36||

mudgānmasūrāṁścaṇakān kalāyān bhr̥ṣṭān yutānnāgaramākṣikābhyām|

lihyāttathaiva triphalāviḍaṅgacūrṇaṁ viḍaṅgaplavayōrathō vā||37||

sajāmbavaṁ vā badarāmlacūrṇaṁ mustāyutāṁ karkaṭakasya śr̥ṅgīm|

durālabhāṁ vā madhusamprayuktāṁ lihyāt kaphacchardivinigrahārtham||38||

manaḥśilāyāḥ phalapūrakasya rasaiḥ kapitthasya ca pippalīnām|

kṣaudrēṇa cūrṇaṁ maricaiśca yuktaṁ lihañjayēcchardimudīrṇavēgām||39||

kaphAtmikAyAM vamanaM prashastaM sapippalIsarShapanimbatoyaiH|

piNDItakaiH saindhavasamprayuktairvamyAM kaphAmAshayashodhanArtham||34||

godhUmashAlIn sayavAn purANAn yUShaiH paTolAmRutacitrakANAm|

vyoShasya nimbasya ca takrasiddhairyUShaiH phalAmlaiH kaTubhistathA~adyAt||35||

rasAMshca shUlyAni ca jA~ggalAnAM mAMsAni jIrNAnmadhusIdhvariShTAn|

rAgAMstathA ShADavapAnakAni drAkShAkapitthaiH phalapUrakaishca||36||

mudgAnmasUrAMshcaNakAn kalAyAn bhRuShTAn yutAnnAgaramAkShikAbhyAm|

lihyAttathaiva triphalAviDa~ggacUrNaM viDa~ggaplavayoratho [1] vA||37||

sajAmbavaM vA badarAmlacUrNaM [2] mustAyutAM karkaTakasya shRu~ggIm|

durAlabhAM vA madhusamprayuktAM lihyAt kaphacchardivinigrahArtham||38||

manaHshilAyAH phalapUrakasya rasaiH kapitthasya ca pippalInAm|

kShaudreNa cUrNaM maricaishca yuktaM liha~jjayecchardimudIrNavegAm||39||

Vamana (therapeutic emesis) is supposed to be the most suitable therapy in kaphaja type of chhardi (vomiting). In order to clean the seat of kapha and amashaya, the patient should be given the decoction of pippali, sarsapa (yellow sarson/Indian colza/Brassica campestris) and nimba (neem tree/Margosa/Indian lilac/Azadirachta indica) added with powder of pinditaka (madanaphala/emetic nut/bushy gardenia/Randia dumetorum) and saindhava (rock-salt).

The patient should be given old wheat, rice and barley along with

1. Vegetable soup of patola (Trichosanthes dioica),
2. Amrita (Tinospora cordifolia) and
3. Chitraka (Ceylon leadwort/ white leadwort/Plumbago zeylanica) or
4. with the soup of trikatu (three spices) and neem prepared with butter milk, or
5. Soup of sour fruits along with pungent drugs.

The patient should also take the meat juices and roasted flesh of jangala creature (animals inhabiting arid zone), old honey, sidhu (alcohol prepared of sugar-cane-juice) and arishta (a type of alcoholic drink); and raga (condiments), shādava (pickles) and panaka (syrup) prepared of draksha (grapes) and phala-puraka (citrion/Citrus medica).

The patient should take following three recipes mixed with shunthi (dry zingiber) and honey:

1. Roasted mudga (green gram), masura (lentil/Ervum lens), chanaka (bengal gram/Gram/ chick pea/Cicer arietinum) and kalaya (peas/Pisum sativum)
2. Triphala (haritaki, bibhitaka and amalaka), and vidanga (babreng fruits/embelia ribes)
3. Vidanga (babreng fruits/embelia ribes) and plava (nut grass/Cyperys rotundus)

The following recipes should be taken mixed with the honey

1. Jambu (Syzygium cumini) and sour fruits of badara (Zizyphus jujuba)
2. Musta (nut grass/Cyperus rotundus)and karkata-shringi (Pistacia integerrima)
3. Duralabha (Fegonia cretica).

The forcefully generated urge of vomiting can be controlled with the following regims

1. Purified manahsila (red arsenic) with the juice of bijapuraka (citrion/Citrus medica),
2. Pippali (long piper/Piper longum) mixed with the juice of kapittha (Feronia limonia)
3. Maricha (black pepper/Piper nigrum) with honey [34-39]

Treatment of sannipatika chhardi

यैषा पृथक्त्वेन मया क्रियोक्ता तां सन्निपातेऽपि समस्य [१] बुद्ध्या|

दोषर्तुरोगाग्निबलान्यवेक्ष्य प्रयोजयेच्छास्त्रविदप्रमत्तः||४०||

yaiṣā pr̥thaktvēna mayā kriyōktā tāṁ sannipātē'pi samasya buddhyā|

dōṣarturōgāgnibalānyavēkṣya prayōjayēcchāstravidapramattaḥ||40||

yaiShA pRuthaktvena mayA kriyoktA tAM sannipAte~api samasya [1] buddhyA|

doSharturogAgnibalAnyavekShya prayojayecchAstravidapramattaH||40||

Judicious synthesis of the separate lines of treatment indicated by me for the derangement of individual humors should be employed by the learned physician for the patient suffering from sannipatika chhardi after carefully examining the relative preponderance of the doshas involved, the season when the disease has occurred, the stage of the disease and the power of digestion of the patient [40]

Treatment of dvishtarathasamyogaja (manobhighataja) chhardi

मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|

लोकप्रसिद्धाः श्रुतयो वयस्याः शृङ्गारिकाश्चैव हिता विहाराः||४१||

गन्धा विचित्रा मनसोऽनुकूला मृत्पुष्पशुक्ताम्लफलादिकानाम्|

शाकानि भोज्यान्यथ पानकानि सुसंस्कृताः षाडवरागलेहाः||४२||

यूषा रसाः काम्बलिका खडाश्च मांसानि धाना विविधाश्च भक्ष्याः|

फलानि मूलानि च गन्धवर्णरसैरुपेतानि वमिं जयन्ति||४३||

गन्धं रसं स्पर्शमथापि शब्दं रूपं च यद्यत् प्रियमप्यसात्म्यम्|

तदेव दद्यात् प्रशमाय तस्यास्तज्जो हि रोगः सुख एव जेतुम्||४४||

manōbhighātē tu manōnukūlā vācaḥ samāśvāsanaharṣaṇāni|

lōkaprasiddhāḥ śrutayō vayasyāḥ śr̥ṅgārikāścaiva hitā vihārāḥ||41||

gandhā vicitrā manasō'nukūlā mr̥tpuṣpaśuktāmlaphalādikānām|

śākāni bhōjyānyatha pānakāni susaṁskr̥tāḥ ṣāḍavarāgalēhāḥ||42||

yūṣā rasāḥ kāmbalikā khaḍāśca māṁsāni dhānā vividhāśca bhakṣyāḥ|

phalāni mūlāni ca gandhavarṇarasairupētāni vamiṁ jayanti||43||

gandhaṁ rasaṁ sparśamathāpi śabdaṁ rūpaṁ ca yadyat priyamapyasātmyam|

tadēva dadyāt praśamāya tasyāstajjō hi rōgaḥ sukha ēva jētum||44||

manobhighAte tu manonukUlA vAcaH samAshvAsanaharShaNAni|

lokaprasiddhAH shrutayo vayasyAH shRu~ggArikAshcaiva hitA vihArAH||41||

gandhA vicitrA manaso~anukUlA mRutpuShpashuktAmlaphalAdikAnAm|

shAkAni bhojyAnyatha pAnakAni susaMskRutAH ShADavarAgalehAH||42||

yUShA rasAH kAmbalikA khaDAshca mAMsAni dhAnA vividhAshca bhakShyAH|

phalAni mUlAni ca gandhavarNarasairupetAni vamiM jayanti||43||

gandhaM rasaM sparshamathApi shabdaM rUpaM ca yadyat priyamapyasAtmyam|

tadeva dadyAt prashamAya tasyAstajjo hi rogaH sukha eva jetum||44||

In case of vomiting caused by mental disgust the following measures should be resorted to:

1. Words which are pleasing and comforting, counseling and encouraging
2. Popular legends and stories, congenial companions and pleasant wholesome diversions, amorous and wholesome regimens (games);
3. Odor of various types of pleasing perfumes emanating from the earth, flowers, vinegar (sukta) and sour fruits
4. Well prepared vegetables, articles of food drinks, sadavas (pickles), raga (condiments) and lehas (preparations in the form of linctus or jam), yusha (Vegetable-soups), rasa (meat-soups), kambalika (sour curry of fish and meat), khada (sour drinks prepared of fruits), mamsa dhana (meat preparations), bhakshya (popped cereals), different eatables, fruits and roots having pleasant odor, color and taste will win over the vomiting caused by mental disgust.
5. In general, whatever odor, taste, contact, sound or sights those are pleasing to such patients should be given though otherwise unsuitable and unwholesome because in this way disease can be treated easily [41-44]

Treatment of complications

छर्द्युत्थितानां च चिकित्सितात् स्वाच्चिकित्सितं कार्यमुपद्रवाणाम्|

अतिप्रवृत्तासु विरेचनस्य कर्मातियोगे विहितं विधेयम्||४५||

chardyutthitānāṁ ca cikitsitāt svāccikitsitaṁ kāryamupadravāṇām|

atipravr̥ttāsu virēcanasya karmātiyōgē vihitaṁ vidhēyam||45||

chardyutthitAnAM ca cikitsitAt svAccikitsitaM kAryamupadravANAm|

atipravRuttAsu virecanasya karmAtiyoge vihitaM vidheyam||45||

The treatment of complications arising from vomiting should be done according to the lines suggested in respect of each of those ailments. In case of excessive vomiting; treatment that is suggested in Siddhi Sthana (6/52-56) for excessive purgation should be carried out [45]

Treatment of chronic chhardi

वमिप्रसङ्गात् पवनोऽप्यवश्यं धातुक्षयाद्धृद्धिमुपैति तस्मात्|

चिरप्रवृत्तास्वनिलापहानि कार्याण्युपस्तम्भनबृंहणानि||४६||

सर्पिर्गुडाः क्षीरविधिर्घृतानि कल्याणकत्र्यूषणजीवनानि|

वृष्यास्तथा मांसरसाः सलेहाश्चिरप्रसक्तां च वमिं जयन्ति||४७||

vamiprasaṅgāt pavanō'pyavaśyaṁ dhātukṣayāddhr̥ddhimupaiti tasmāt|

cirapravr̥ttāsvanilāpahāni kāryāṇyupastambhanabr̥ṁhaṇāni||46||

sarpirguḍāḥ kṣīravidhirghr̥tāni kalyāṇakatryūṣaṇajīvanāni|

vr̥ṣyāstathā māṁsarasāḥ salēhāściraprasaktāṁ ca vamiṁ jayanti||47||

vamiprasa~ggAt pavano~apyavashyaM dhAtukShayAddhRuddhimupaiti tasmAt|

cirapravRuttAsvanilApahAni kAryANyupastambhanabRuMhaNAni||46||

sarpirguDAH kShIravidhirghRutAni kalyANakatryUShaNajIvanAni|

vRuShyAstathA mAMsarasAH salehAshciraprasaktAM ca vamiM jayanti||47||

In persistent vomiting vāta invariably gets aggravated because of loss of tissue elements. Therefore, in case of chronic vomiting medications that are bulk promoting, vata pacifying, upastambhana (astringents) and brimhana (nutritive) should be administered.

The following recipes are useful in chronic type of vomiting.

Sarpirguda (Chikitsa 11:50-77), kshira-vidhi (milk boiled by adding vata-alleviating drugs), kalyanaka-ghrita (Chikitsa 9:33-42), tryushana-ghrita (Chikitsa 18:39-42), jivaniya-ghrita (Chikitsa 29:55-57), vrishya (virilific) recipes, mamsarasa (meat soup) and lehya like chyavanprasha (linctuses) [46-47]

Summary

तत्र श्लोकः-

हेतुं सङ्ख्यां लक्षणमुपद्रवान् साध्यतां न योगांश्च|

छर्दीनां प्रशमार्थं प्राह चिकित्सितं मुनिवर्यः||४८||

tatra ślōkaḥ-

hētuṁ saṅkhyāṁ lakṣaṇamupadravān sādhyatāṁ na yōgāṁśca|

chardīnāṁ praśamārthaṁ prāha cikitsitaṁ munivaryaḥ||48||

tatra shlokaH-

hetuM sa~gkhyAM lakShaNamupadravAn sAdhyatAM na yogAMshca|

chardInAM prashamArthaM prAha cikitsitaM munivaryaH||48||

To sum up, in this chapter the predisposing factors, numerals of the vomiting, symptoms, complications, prognosis, formulations and other measures of management for the relief of vomiting are described by the foremost of the sages [48]

Thus the section on therapeutics in the treatise compiled by Agnivesha redacted by Charaka and reconstructed by Dridhabala as it was not available.

Tattva Vimarsha

• Chhardi (vomiting) can be either caused by vitiation of endogenous dosha or by exogenous factors like in dvistartha-yogaja-chhardi (that results from contact with unpleasant sense objects).
• The dosha vitiation due to their own specific causative factors lead to irritation of stomach, spread through rasayani (channels carrying rasa) resulting in chhardi. Different types of chhardi shall be diagnosed based on the specific etio-pathogenesis and clinical presentation.
• Mind and sense objects play significant role in pathogenesis of chhardi due to exposure to unwholesome objects.
• The prognosis of chhardi depends upon strength of patient, bouts, presence of associated disorders and complications, contents of vomitus.
• All the types of vomiting are considered originating from the agitations of the doshas in the stomach. Therefore, fasting therapy is first principle of treatment. Purification therapies of kapha and pitta are administered to expel out vitiated doshas. These therapies are contraindicated in cases of vata dominance. The choice of therapy depends upon strength of patient and type of vitiated dosha.
• The drugs having nutritive properties, carminative, dosha pacifying actions are prescribed in the treatment of chhardi.
• Sublingual, pleasant tasting linctus, mild purgative to open the channel to lower G I tract.
• During initial stage of chhardi, because of irritated stomach, anti-emetic treatment is not advised. Soothing, taste enhancing and nutritive liquid substances should be given. Mind diverting and entertaining activities are also advised.
• The treatment of complications arising from vomiting should be done according to the lines suggested in respect of each of those ailments.
• In persistent vomiting vāta invariably gets aggravated because of loss of tissue elements. Therefore, in case of chronic vomiting medications that are bulk promoting, vata pacifying, upastambhana (astringents) and brimhana (nutritive) should be administered.

Vidhi Vimarsha

Pathogenesis

Mahasrotus (gastrointestinal tract) has two parts, upper part is annavaha srotus and lower part is purishvaha srotus. Atisara is related to purishvaha srotus and chhardi is to annavaha srotus. Etiological factors of chhardi are irritating food and practices to amashaya (stomach). They are vata vitiating, impairing annavaha srotus. Even before the digestion process starts the food comes out because of action of urdhvavata or udanavata, therefore, there is no involvement of agni. Chhardi is a defense mechanism to expel the toxins out of the stomach. There is vacuum created by repeated expulsion of stomach contents and rasayinis(villi) instead of their normal function of absorption, they start secreting body fluids into to the stomach.

Types of chhardi

Diseases are classified according to the dominance of doshas-involved and their mutual amalgamation, which are of four types. The 5th type of chhardi (dwishtarthayoga) is due to aversive food related to the involvement of panchagyanendriyas (five sense organs) and their vishaya upalabdhi (Cha su 1/54) (perceivance of senses). The contact through rupa (visible) or rasa (taste) or gandha (smell) or sparsha (touch) or shabda (hear) or in combination with each other, stimulates body mechanism which results in dwistarthayoga chhardi (vomiting due to aversion). One cannot exclude the role of manah (mind) as predisposing factor in causing dwistarthayoga chhardi.

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.

Vataja chhardi

There are many factors that increase vata in the sharira . 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 vataja chhardi. (Sutra Sthana 1/59) doshas conjugate (sammurchhana (Sutra Sthana 18/46) with a particular organ (mahasrotas, amashaya, marma (vital organ), urdhwabhaga (upper trunk, etc) as dushyas (affected dhatus) to cause vataja chhardi (as utkshepana (upward movement), adhahkshepana (downward movement), etc are the karmas (actions) of vayu)-(7-9).

Pittaja chhardi

Nidanas of pittaprakopaka increase pitta in nature and cause provocation of gunas like ushna (hot), tikshna (sharp), snigdha (unctous), etc. (Charaka sutra sthana 1/60) in the body. This aggravated pitta joins (Sammurchhana) with a particular organ (rasāyani, amāshaya, marma, urdhwabhaga, etc) as dushyas. The conjugation of dosha and dushya has affinity towards urdhwabhaga which results in pittaja chhardi (10-11).

Kaphaja chhardi

Nidānas of kaphaprakopaka increase kapha in nature which causes provocation of gunas like guru (heavyness), sheeta (coldness), manda (slowness), etc. (Charaka Sutra sthana 1/60) in the body. This aggravated Kapha joins (sammurchhana) with a particular organ (urah (chest), shirah (head), rasāyani marma, urdhwabhaga, etc.) as dushyas. This amalgamation of dosha and dushya has affinity towards urdhwabhaga which results in kaphaja chhardi (12-13).

Sannipataja chhardi

Intake of diet containing all rasas or tastes ideal but the intake of food with imbalances in rasas leads to the vitiation of tridoshas(Ch.Su.26/90-101)and causes sannipataja chhardi which has varied manifestations covering broad signs of tridosha involvement ( verses 14-15).

The sama-varna-gandha (color & smell similar to) of vomitus is due to conjugation with purisha (stool) and mutra (urine). This conjugation indicates involvement of multiple srotasas and have tendency towards asadhyata (incurable)(Charaka Vimana 5/3) ( verses 16-17).

Excessive loss of any dhatu (rasa-rakta-vasa, etc) due to physical exercise or vamana vega (bouts) or arising out of any complications in the form of diseases like kasa (cough), shwasa (asthama), jwara (fever), etc. are considered to be life threatening.

Treatment

• Langhana becomes the first line of treatment in chhardi as shamana chikitsa (pacificatory treatment). Samshodha can be preferred where doshas are in utklisht stage and ready to be expelled out. Vamana is recommended when doshas are accumulated in amashya 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 doshas, considering nearest route of samshodhana. The choice of drugs should be done as per the doshanashakatva (capacity to subside the vitiated doshas) ( verse 20). • Haritaki is known for its laxative action (anulomaneeya). It not only tridoshahara but also posseses many more qualities (Charaka Chikitsa 1/1/29-34) which can be helpful for samprapti vighanatana (breaking pathogenesis) in chhardi. The choice of hridya 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. Su. 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 su 27/217-18) is naturally saraka (purgative) in nature which makes anulomana gati (natural movements) of vayu. • As the doshas 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. Chi. 20/ 41-42) . It should be preferably mamsarasa, dry food or liquid diet which is easily digestible ( verses 21-22). • In vataja chhardi, laghu susanskrita mamsarasa (processed meat soup) is helpful in easy digestion and gives strength due to vatapacifying 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. Su. 27/231-32, Cha. Su. 13/13) can be benifitial in vātaja hridroga. • If the aggravated doshas are in distal part of amāshaya (post- amāshaya) the nearest route to remove pitta is through virechana procedure. If the aggravated pitta is in amāshaya then the nearest route to remove pitta is through vamana. Both these procedures should be adopted in balavan rogi (physically strong) 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 kaphaja chhardi chikitsa, as the doshas are situated in kaphashaya (amāshaya / ura) the nearest and ideal route is vamana. The choice of dravyas for vamana should be kaphahara like pippali, sarshapa, nimbatoya, madanaphala, etc. The choice of treatment is based on aggravated dosha, sanchayasthana (place of accumulation), sannikrishtha marga (nearest route), dosha-shamaka guna of dravyas, etc. • Various types of Yusha, Ragashadava, Panaka (Cha.Su.27/279-281) are kaphahara, madhura-amlarasatmaka (sweet & sour), deepaneeya-pachaneeya (appetizer & digestant) in nature. • For chhardinigrahana (anti-emetic group), the drugs should be kashaya rasatmaka (astringent taste), sheetaveerya (cool potency) and kaphaghna (kapha alleviators) in nature. The manahshiladi yoga (a formulation) is considered to be vyadhiviparitarthakari (anti-disease) measures. • In case of dvistarthayoga chhardi (vomiting due to hate/ aversion) The treatment includes ashvāshana (assurance), vārtālāpa (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 dhatus resulting in dhatuksheenata. Such a long term dhatukshaya (loss of dhatus) increases vata in the body. The management should be purely vatashamaka treatment especially stambhana (which restricts the vamana vega) in combination with brimhana (nourishment to dhatus). The selection of drugs plays very important role here. Most of the dravyas mentioned here are vichitrapratyarabhadha (extraordinary) in nature which achieve stambhana but won’t 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.

Current clinical practice for management of chhardi (referred from Chikitsa Pradeep page 25)

Type	Medicine	Dosage	Time	Anupana
Vata dominant and vata-pitta dominant	Shankha bhasma	60-120 mg	Frequently	Nimbu Panaka (lemon water)
Pitta dominant	Sutashekhara kalpa	500-1000 mg	Frequently	Dadimavaleha
Kapha dominant	Mayu piccha mashi	1 - 3 gms	Frequently	Ardrakavaleha
Tridoshaja	Brihad vata chintamani	50 - 100 mg	Frequently	Ardraka swarasa + sugar + honey
Dauhridaja (in pregnancy)	Swarnashekhara mixture	250-500 mg	After meals	Ardraka swarasa + Nimbu swarasa + rock salt
Krimija	Vidanga-yavani phanta	20-40 ml	Empty stomach, two times	-

Further researches

Many parenteral and oral medicines are available in conventional medical systems for management of dehydration and emergency conditions. The ayurveada drugs listed in this chaper need to be researched further for evaluating their efficacy specifically in conditions where the parenteral administration is contra-indicated and in case of drug intorerance.

Glossary

1. Āmāśayōtklēśabhavā (आमाशयोत्क्लेशभवा): originated from agitatied Doshas in stomach
2. Āmāśayōtklēśakr̥tāṁ (आमाशयोत्क्लेशकृतां ): morbid humor which are agitating Amasaya (stomach) and likely to come out
3. Āśuchipūtyamēdhyabībhatsagandhāśanadarśanaiśca (अशुचिपूत्यमेध्यबीभत्सगन्धाशन- दर्शनैश्च): contact with diet or sights having despicable, antagonistic unclean, putried, unholy and loathsome odor
4. Brahmatapōdyutibhyāṁ (ब्रह्मतपोद्युतिभ्यां): lustre of divine knowledge and penance
5. Chhardi (छर्दि): vomitting
6. Chhardīnāṁ Praśamārthaṁ (छर्दीनां प्रशमार्थं ): management for the relief of vomiting
7. Chhardiratipravr̥ddhā (छर्दिरतिप्रवृद्धा): incessantly vomiting
8. Chhardyutthitānāṁ (छर्द्युत्थितानां): treatment of complications arising from vomiting
9. Chikitsitāt Svachchikitsitaṁ (चिकित्सितात् स्वाच्चिकित्सितं): treatment should be done according to the lines suggested in respect of each of those ailments
10. Chirapravr̥ttāsvanilāpahāni (चिरप्रवृत्तास्वनिलापहानि ): chronic vomiting
11. Chūrṇāni Lihyān (चूर्णानि लिह्यान): powder with honey
12. Dhātukṣayāddhr̥ddhimupaiti (धातुक्षयाद्धृद्धिमुपैति): loss of tiussue elements
13. Dōṣarturōgāgnibalānyavēkṣya (दोषर्तुरोगाग्निबलान्यवेक्ष्य ): considering of preponderance of Dosas, season of occurring of the disease, digestive power and strength of patient
14. Durbalastaṁ Śamanaiścikitsēt (दुर्बलस्तं शमनैश्चिकित्सेत्): weak patient should be treated with pacification therapy
15. Dviṣṭapratīp (द्विष्टप्रतीप): mental disgust occasioned by sense
16. Hitā Vihārāḥ (हिता विहाराः): healthy life style
17. Hr̥tpārśvapīḍā (हृत्पार्श्वपीडा): pain in the cardiac region and sides of the chest
18. Jvalantamagnyarkasamaprabhāvam (ज्वलन्तमग्न्यर्कसमप्रभावम्): brilliance like that of fire and the sun
19. Kaphāmāśayaśōdhanārtham (कफामाशयशोधनार्थम्): to clean the seat of Kapha and Āmāshaya (stomach)
20. Kaphāśayasthaṁ Tvatimātravr̥Ddhaṁ (कफाशयस्थं त्वतिमात्रवृद्धं): aggravated Pitta is located in Kapahasthana (chest/stomach)
21. Kaphātmikāyāṁ Vamanaṁ Praśastaṁ (कफात्मिकायां वमनं प्रशस्तं):- Vamana (therapeutic emesis) is supposed to be the most suitable therapy in Kaphaja type
22. Kāryāṇyupastambhanabr̥ṁhaṇāni (कार्याण्युपस्तम्भनबृंहणानि): medications that are bulk promoting, anti-Vāta Upastambhana (anti-diarrhoeal) and Brimhana (nutritive)
23. Kāsasvarabhēdatōdaiḥ (कासस्वरभेदतोदैः): cough, hoarseness of voice and pricking pain
24. Kr̥cchrēṇa Cālpaṁ Mahatā (कृच्छ्रेण चाल्पं महता): vomiting urge is forceful, but the patient vomits only small quantity with pain
25. Kṣīṇasya (क्षीणस्य ): emaciated
26. Laṅghanamēva (लङ्घनमेव): fasting therapy
27. Lōkaprasiddhāḥ Śrutayō Vayasyāḥ (लोकप्रसिद्धाः श्रुतयो वयस्याः): Popular legends and stories and congenial companions
28. Manōbhighātē (मनोभिघाते): mental disgust
29. Manōnukūlā (मनोनुकूला): pleasing and conforting
30. Marma Prapīḍayaṁ (मर्म प्रपीडयं): afflicting the Marma (vital organs),
31. Mukhaśōṣa (मुखशोष): dryness of mouth
32. Mukhaśōṣa (मुखशोष): dryness of the mouth
33. Mūrcchā (मूर्च्छा): unconsciousness
34. Mūrdhanābhyarti (मूर्धनाभ्यर्ति): Pain in the head and umbilical region
35. Mūrdhatālvakṣisantāpa (मूर्धताल्वक्षिसन्ताप):- burning sensation in head, palates and eyes
36. Nayantyadhō Dōṣamudīrṇamūrdhvam (नयन्त्यधो दोषमुदीर्णमूर्ध्वम् ): downward movement of the aggravated Doshas that are impelled to move upwards
37. Pavanō'pyavaśyaṁ (पवनोऽप्यवश्यं): Vāta invariably gets agrevated
38. Pipāsā (पिपासा): thirst
39. Pittamudīrṇavēgam (पित्तमुदीर्णवेगम् ): the aggravated Pitta spreads rapidly
40. Pittātmikāyāmanulōmanārthaṁ (पित्तात्मिकायामनुलोमनार्थं): patient of Paittika Chhardi should be given laxatives to cause downward movement of the morbid matter
41. Prapīḍya Marmōrdhva (प्रपीड्य मर्मोर्ध्व): stresses vital organs of upper parts of the body
42. Pravadantyasādhyāṁ (प्रवदन्त्यसाध्यां): only curable types
43. Pr̥thaktriprabhavāścatasrō (पृथक्त्रिप्रभवाश्चतस्रो): kinds each of which is caused by a single morbid humor
44. Rasairmanōjñairlaghubhirviśuṣkairbhakṣyaiḥ (रसैर्मनोज्ञैर्लघुभिर्विशुष्कैर्भक्ष्यैः): delicious soups and light as well as dry food articles for diet
45. Rasāyanībhirvisr̥taṁ (रसायनीभिर्विसृतं ): spreads through the Rasāyani (channels)
46. Sabhōjyairvividhaiśca Pānaiḥ (सभोज्यैर्विविधैश्च पानैः): along with various kinds of drinks
47. Sacandrikāṁ (सचन्द्रिकां): vomitus that contains Chandrika (circular patches with variegated colour like that at the top of pea-cock feather)
48. Samaśnataḥ (समश्नतः): constant indulgence in diet/eating nixture of wholesome and unwholesome food
49. Samāśvāsanaharṣaṇāni (समाश्वासनहर्षणानि ): counseling and encouraging
50. Samavarṇagandhaṁ (समवर्णगन्धं): having similar colour and odour
51. Samāvr̥tya (समावृत्य): collectively
52. Saphēna Vicchinnakr̥ṣṇaṁ Tanukaṁ Kaṣāyam (सफेनं विच्छिन्नकृष्णं तनुकं कषायम् ): frothy, scattered, black, thin and astringent vomitus
53. Sarvāśchardyō (सर्वाश्छर्द्यो): all the varieties of vomiting
54. Sarvē Prakōpaṁ Yugapat (सर्वे प्रकोपं युगपत्): all the three Dosas get simultaneously aggravated
55. Śōka (शोक): grief
56. Śōṇitapūyayuktā (शोणितपूययुक्ता): vomitus that contains blood and pus
57. Sōpadravā (सोपद्रवा): associated with complications
58. Svapnādibhiścaiva (स्वप्नादिभिश्चैव ): sense of sleep
59. Tāṁ Sannipāta'pi Samasya Buddhyā (तां सन्निपातेऽपि समस्य बुद्ध्या): Sannipatika Chhardi patient should carefully be examined for the relative preponderance of involved Dosas
60. Tamōbhramārtaḥ (तमोभ्रमार्तः): feeling as entering into darkness
61. Tīkṣṇauṣadha (तीक्ष्णौषध): sharp medicine
62. Udgāraśabdaprabalaṁ (उद्गारशब्दप्रबलं): eructation with loud sound
63. Utklēśya (उत्क्लेश्य ): the morbid Doshas which are about to come out
64. Utsannadōṣasya Samācitaṁ (उत्सन्नदोषस्य समाचितं): morbid matter from the Kostha (gastro-intestinal tract) gets provoked
65. Vallīphalādyairvamanaṁ Pibēdvā (वल्लीफलाद्यैर्वमनं पिबेद्वा): emetic therapy prepared of the drugs of the Valliphala (group of cucurbitaceous fruits)
66. Vamiprasaṅgāt (वमिप्रसङ्गात्): persistant vomiting
67. Vāyuḥ Srōtāṁsi Saṁrudhya (वायुः स्रोतांसि संरुध्य): occlusion of channels by morbid Vāta
68. Viṭsvēdamūtrāmbuvahāni (विट्स्वेदमूत्राम्बुवहानि ): channels carrying faeces, sweat, urine and body fluids
69. Vyākhyā (व्याख्या): explanation
70. Vyāyāma (व्यायाम): physical excercise
71. Yaiṣā Pr̥thaktvēna Mayā Kriyōktā (यैषा पृथक्त्वेन मया क्रियोक्ता ): judicious synthesis of the separate lines of treatment