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==([[Chikitsa Sthana]] Chapter 20, Chapter on the Management of vomiting) ==

==[[Chikitsa Sthana]] Chapter 20, Chapter on the Management of ''Chhardi'' (vomiting) ==

=== Abstract ===

=== Abstract ===

=== Introduction ===

=== Introduction ===

After explaining the [[Atisara Chikitsa]] (treatment of diarrhea), there is description of [[Chhardi Chikitsa]]. The word ''chhardi'' is derived from the root ''chard 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 purificatory therapies of [[Panchakarma]] (five purificatory 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) ''srotasas''. 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'').

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 ===

=== Sanskrit Text, Transliteration and English Translation ===

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]

==== ''Vatika chhardi'' ====

==== ''Vataja chhardi'' ====

व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|  

व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|  

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

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 ''vatika'' type of vomiting is characterized by the following signs and symptoms:  

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:  

#Pain in the cardiac region and flanks;   

#Pain in the cardiac region and flanks;   

#Dryness of the mouth;   

#Dryness of the mouth;   

#The patient feels miserable [7-9]

#The patient feels miserable [7-9]

==== ''Paittika chhardi'' ====

==== ''Pittaja chhardi'' ====

अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|  

अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|  

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:   

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 ''paittika'' type of ''chhardi'' (vomiting) are:  

The signs and symptoms of this ''pittaja'' type of ''chhardi'' (vomiting) are:  

#Fainting, morbid thirst and parching of mouth;   

#Fainting, morbid thirst and parching of mouth;   

#Burning (or heating) sensation in the head, palate and eyes;   

#Burning (or heating) sensation in the head, palate and eyes;   

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

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

==== ''Dvishtha chhardi'' ====

==== ''Dvishtharthasamyogaja chhardi'' ====

द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|  

द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|  

prAkkArayenmArutajAM vimucya saMshodhanaM vA kaphapittahAri||20||  

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]

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|  

चूर्णानि लिह्यान्मधुनाऽभयानां हृद्यानि वा यानि विरेचनानि|  

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 ''vatika chhardi'' ====

==== Treatment of ''vataja chhardi'' ====

सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|

सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|

snigdhAni hRudyAni ca bhojanAni rasaiH sayUShairdadhidADimAmlaiH||25||

snigdhAni hRudyAni ca bhojanAni rasaiH sayUShairdadhidADimAmlaiH||25||

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

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

#The meat juice of ''tittiri'' (partridge), ''barhi'' and ''lava'' (common quail);   

#The meat juice of ''tittiri'' (partridge), ''barhi'' and ''lava'' (common quail);   

#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);  

#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);  

#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 ''paittika chhardi'' ====

==== Treatment of ''pittaja chhardi'' ====

पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|  

पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|  

shItAmbunA gairikashAlicUrNaM mUrvAM tathA taNDuladhAvanena||33||

shItAmbunA gairikashAlicUrNaM mUrvAM tathA taNDuladhAvanena||33||

The patient of ''paittika'' 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).   

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).  

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).  

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]

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 ''dvishta (manobjghataja) chhardi'' ====

==== Treatment of ''dvishtarathasamyogaja (manobhighataja) chhardi'' ====

मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|  

मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|