Changes

==== Treatment ====

==== Treatment ====

*''Langhana'' becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where ''doshas'' are in ''utklishtha'' stage and ready to be expelled out. ''Vamana'' is recommended when ''doshas'' 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 ''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).   

*''Langhana'' becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where ''doshas'' are in ''utklishtha'' stage and ready to be expelled out. ''Vamana'' is recommended when ''doshas'' 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 ''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 possesses many more qualities ([[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. 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 ([[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 ([[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. 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 ([[Sutra Sthana]] 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).   

*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) ([[Chikitsa Sthana]] 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.  

*In ''vataja 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) ([[Sutra Sthana]] 27/231-32 and 13/13) can be beneficial in ''vataja 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.  

*If the aggravated ''doshas'' 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).  

*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.  

*For ''kaphaja chhardi chikitsa'', as the ''doshas'' are situated in ''kaphashaya'' (''amashaya / 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.  

*Various types of ''yusha, ragashadava, panaka'' ([[Sutra Sthana]] 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.

*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.   

*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.