Changes

=== ''Vidhi Vimarsha'' ===

=== ''Vidhi Vimarsha'' ===

Differentiation between trishna and pipasa:

==== Differentiation between ''trishna'' and ''pipasa'' ====

Trishna and pipasa are two commonly used terms. Trishna is pathological thirst while pipasa is physiological. Physiological thirst is relieved after adequate water intake, whereas, pathological thirst is not relieved even after repeated water intake. Both of them are due to vata and pitta dosha. In pipasa they are in balanced state while in trishna they are vitiated. Trishna is manifestation of decrease in saumya dhatu (body elements composed of predominantly water) in body rasa, rakta, lasika, kleda, medas, and urine. One common channel, udakavaha srotas regulates all the water content of the body. It is situated between palate, tongue and throat.

 

Udakavaha srotasa:

''Trishna'' and ''pipasa'' are two commonly used terms. ''Trishna'' is pathological thirst while ''pipasa'' is physiological. Physiological thirst is relieved after adequate water intake, whereas, pathological thirst is not relieved even after repeated water intake. Both of them are due to ''vata'' and ''pitta dosha''. In ''pipasa'' they are in balanced state while in ''trishna'' they are vitiated. ''Trishna'' is manifestation of decrease in ''saumya dhatu'' (body elements composed of predominantly water) in body ''rasa, rakta, lasika, kleda, medas,'' and urine. One common channel, ''udakavaha srotas'' regulates all the water content of the body. It is situated between palate, tongue and throat.

The root of transport channels of water are talu and kloma which have more than anatomical importance. They include the area of brain where thirst centre is located and also throughout the body where the osmoregulators are situated. They signal to higher integrative centers, where ultimately the conscious craving arises. As described in context of udara chikitsa, kloma should be understood as a physiological entity and may be compared with interstitial fluid which has definite role in pathogenesis of thirst as described in the chapter.

 

Fluid balance, normal quantity of water and other elements:

===== ''Udakavaha srotasa'' =====

The regulation of the volume and composition of body fluids (udaka), their distribution throughout the body, and balancing the pH of body fluids is crucial to maintaining overall homeostasis and health. The water and dissolved solutes throughout the body constitute the body fluids. Regulatory mechanisms involving the kidneys and other organs normally maintain homeostasis of the body fluids. Malfunction in any or all of them may seriously endanger the functioning of organs throughout the body.  

 

Body fluids are present in two main “compartments”—inside cells and outside cells. About two-thirds of body fluid is intracellular fluid (ICF) or cytosol, the fluid within cells. The other third, called extracellular fluid (ECF) includes all other body fluids. About 80% of the ECF is interstitial fluid, which occupies the microscopic spaces between tissue cells, and 20% of the ECF is plasma, the liquid portion of the blood. Other extracellular fluids that are grouped with interstitial fluid include lymph in lymphatic vessels; cerebrospinal fluid in the nervous system; synovial fluid in joints; aqueous humor and vitreous body in the eyes; endolymph and perilymph in the ears; and pleural, pericardial, and peritoneal fluids between serous membranes. The body is in fluid balance when the required amounts of water and solutes are present and are correctly proportioned among the various compartments. Water is by far the largest single component of the body, making up 45–75% of total body mass, depending on age and gender.

The root of transport channels of water are ''talu'' and ''kloma'' which have more than anatomical importance. They include the area of brain where thirst center is located and also throughout the body where the osmo-regulators are situated. They signal to higher integrative centers, where ultimately the conscious craving arises. As described in context of ''udara chikitsa, kloma'' should be understood as a physiological entity and may be compared with interstitial fluid which has definite role in pathogenesis of thirst as described in the chapter.

It may be noted that udaka has been mentioned to be present in quantity of 10 anjali and this quantity is irrespective of rasa which is 9 anjali in quantity and rakta is 8 anjali in quantity. But this udaka acts as a replacement for rakta and rasa as and when necessary. Sweda, lasika, kapha etc are also jaliya (watery) entity which are closely related with udaka.

 

Mechanisms of fluid balance:

==== Fluid balance, normal quantity of water and other elements ====

 

The regulation of the volume and composition of body fluids (''udaka''), their distribution throughout the body, and balancing the pH of body fluids is crucial to maintaining overall homeostasis and health. The water and dissolved solutes throughout the body constitute the body fluids. Regulatory mechanisms involving the kidneys and other organs normally maintain homeostasis of the body fluids. Malfunction in any or all of them may seriously endanger the functioning of organs throughout the body.  

 

Body fluids are present in two main “compartments”—inside cells and outside cells. About two-thirds of body fluid is intracellular fluid (ICF) or cytosol, the fluid within cells. The other third, called extracellular fluid (ECF) includes all other body fluids.

 

About 80% of the ECF is interstitial fluid, which occupies the microscopic spaces between tissue cells, and 20% of the ECF is plasma, the liquid portion of the blood. Other extracellular fluids that are grouped with interstitial fluid include lymph in lymphatic vessels; cerebrospinal fluid in the nervous system; synovial fluid in joints; aqueous humor and vitreous body in the eyes; endolymph and perilymph in the ears; and pleural, pericardial, and peritoneal fluids between serous membranes. The body is in fluid balance when the required amounts of water and solutes are present and are correctly proportioned among the various compartments. Water is by far the largest single component of the body, making up 45–75% of total body mass, depending on age and gender.

 

It may be noted that ''udaka'' has been mentioned to be present in quantity of ten ''anjali'' and this quantity is irrespective of ''rasa'' which is nine ''anjali'' in quantity and ''rakta'' is eight ''anjali'' in quantity. But this ''udaka'' acts as a replacement for ''rakta'' and ''rasa'' as and when necessary. ''Sweda, lasika, kapha'', etc. are also ''jaliya'' (watery) entity which are closely related with ''udaka''.

 

==== Mechanisms of fluid balance ====

 

• Osmosis is the primary means of water movement between intracellular fluid and interstitial fluid, the concentration of solutes in these fluids determines the direction of water movement. Because most solutes in body fluids are electrolytes, inorganic compounds that dissociate into ions, fluid balance is closely related to electrolyte balance. Because intake of water and electrolytes rarely occurs in exactly the same proportions as their presence in body fluids, the ability of the kidneys to excrete excess water by producing dilute urine, or to excrete excess electrolytes by producing concentrated urine, is of utmost importance in the maintenance of homeostasis. “sama ānayati iti samānam” is the definition of samāna vāyu. Samāna has a seat in sweda, dōsa and ambhuvaha srōtas. As discussed above maintaining the pH (sami karōti) is brought about by specific ionic movement and this particular force is provided by samāna vāyu. It maintains the pH by maintaining a specific ratio of solutes and solvents and if this specific ratio is disturbed it leads to various diseases for eg. A decrease in blood volume causes blood pressure to fall. This change stimulates the kidneys to release renin, which promotes the formation of angiotensin II. Increased nerve impulses from osmoreceptors in the hypothalamus, triggered by increased blood osmolarity, and increased angiotensin II in the blood both stimulate the thirst center in the hypothalamus. Other signals that stimulate thirst come from (1) neurons in the mouth that detect dryness due to a decreased flow of saliva and (2) baroreceptors that detect lowered blood pressure in the heart and blood vessels. As a result, the sensation of thirst increases, which usually leads to increased fluid intake (if fluids are available) and restoration of normal fluid volume. Overall, fluid gain balances fluid loss. Sometimes, however, the sensation of thirst does not occur quickly enough or access to fluids is restricted, and significant dehydration ensues. This happens most often in elderly people, in infants, and in those who are in a confused mental state. Even though the loss of water and solutes through sweating and exhalation increases during exercise, elimination of excess body water or solutes occurs mainly by control of their loss in urine.

• Osmosis is the primary means of water movement between intracellular fluid and interstitial fluid, the concentration of solutes in these fluids determines the direction of water movement. Because most solutes in body fluids are electrolytes, inorganic compounds that dissociate into ions, fluid balance is closely related to electrolyte balance. Because intake of water and electrolytes rarely occurs in exactly the same proportions as their presence in body fluids, the ability of the kidneys to excrete excess water by producing dilute urine, or to excrete excess electrolytes by producing concentrated urine, is of utmost importance in the maintenance of homeostasis. “sama ānayati iti samānam” is the definition of samāna vāyu. Samāna has a seat in sweda, dōsa and ambhuvaha srōtas. As discussed above maintaining the pH (sami karōti) is brought about by specific ionic movement and this particular force is provided by samāna vāyu. It maintains the pH by maintaining a specific ratio of solutes and solvents and if this specific ratio is disturbed it leads to various diseases for eg. A decrease in blood volume causes blood pressure to fall. This change stimulates the kidneys to release renin, which promotes the formation of angiotensin II. Increased nerve impulses from osmoreceptors in the hypothalamus, triggered by increased blood osmolarity, and increased angiotensin II in the blood both stimulate the thirst center in the hypothalamus. Other signals that stimulate thirst come from (1) neurons in the mouth that detect dryness due to a decreased flow of saliva and (2) baroreceptors that detect lowered blood pressure in the heart and blood vessels. As a result, the sensation of thirst increases, which usually leads to increased fluid intake (if fluids are available) and restoration of normal fluid volume. Overall, fluid gain balances fluid loss. Sometimes, however, the sensation of thirst does not occur quickly enough or access to fluids is restricted, and significant dehydration ensues. This happens most often in elderly people, in infants, and in those who are in a confused mental state. Even though the loss of water and solutes through sweating and exhalation increases during exercise, elimination of excess body water or solutes occurs mainly by control of their loss in urine.

• The extent of urinary salt (NaCl) loss is the main factor that determines body fluid volume. The reason for this is that “water follows solutes” in osmosis, and the two main solutes in extracellular fluid (and in urine) are sodium ions (Na) and chloride ions (Cl). In a similar way, the main factor that determines body fluid osmolarity is the extent of urinary water loss. Because our daily diet contains a highly variable amount of NaCl, urinary excretion of Na and Cl must also vary to maintain homeostasis. Hormonal changes regulate the urinary loss of these ions, which in turn affects blood volume. The increased intake of NaCl produces an increase in plasma levels of Na and Cl (the major contributors to osmolarity of extracellular fluid). As a result, the osmolarity of interstitial fluid increases, which causes movement of water from intracellularfluid into interstitial fluid and then into plasma. Such water movement increases blood volume.  

• The extent of urinary salt (NaCl) loss is the main factor that determines body fluid volume. The reason for this is that “water follows solutes” in osmosis, and the two main solutes in extracellular fluid (and in urine) are sodium ions (Na) and chloride ions (Cl). In a similar way, the main factor that determines body fluid osmolarity is the extent of urinary water loss. Because our daily diet contains a highly variable amount of NaCl, urinary excretion of Na and Cl must also vary to maintain homeostasis. Hormonal changes regulate the urinary loss of these ions, which in turn affects blood volume. The increased intake of NaCl produces an increase in plasma levels of Na and Cl (the major contributors to osmolarity of extracellular fluid). As a result, the osmolarity of interstitial fluid increases, which causes movement of water from intracellularfluid into interstitial fluid and then into plasma. Such water movement increases blood volume.  

In pandu there is presence of haemodilution and edema so water intake should be restricted to minimal. In gulma, mandagni is main causative factor. (Ca. Ci. 5/112)

In pandu there is presence of haemodilution and edema so water intake should be restricted to minimal. In gulma, mandagni is main causative factor. (Ca. Ci. 5/112)

Excessive intake of water causes mandagni and if, water is taken in mandagni stage excessively, strength of agni decreases further (Ma.Ni.6/7). So, water is contraindicated in mandagni stage. If needed, water can be given in less quantity.

Excessive intake of water causes mandagni and if, water is taken in mandagni stage excessively, strength of agni decreases further (Ma.Ni.6/7). So, water is contraindicated in mandagni stage. If needed, water can be given in less quantity.

Now-a-days we are using bottled water frequently. So, it is necessary that we analyze properties of bottled water also. Studies have shown that chemicals called phthalates, which are known to disrupt testosterone and other hormones, can leach into bottled water over time. One study found that water that had been stored for 10 weeks in plastic and in glass bottles contained phthalates, suggesting that the chemicals could be coming from the plastic cap or liner.[ ] The bacterial count in bottled water increased dramatically, from less than 1 colony per milliliter (col/mL) to 38,000 col/mL over 48 hours of storage at 37 degrees C. Bacterial growth was markedly reduced at cold temperatures (refrigeration) compared with room temperature, with 50% fewer bacterial colonies in 24 hours and 84% fewer colonies in 48 hours. Interestingly, tap water resulted in only minimal growth, especially at cold temperatures (< 100 col/mL at 48 hours). These findings may be useful to increase public awareness and development of guidelines on storage temperature and expiration time for bottled water once it is opened and used.[ ] In a study it was suggested that various types of unfinished beverages have microorganism growth and can include food borne pathogens and bacterial toxins.[ ] This suggests that proper and judicious use of water should be done in healthy as well as diseases condition.  

Now-a-days we are using bottled water frequently. So, it is necessary that we analyze properties of bottled water also. Studies have shown that chemicals called phthalates, which are known to disrupt testosterone and other hormones, can leach into bottled water over time. One study found that water that had been stored for 10 weeks in plastic and in glass bottles contained phthalates, suggesting that the chemicals could be coming from the plastic cap or liner.[ ] The bacterial count in bottled water increased dramatically, from less than 1 colony per milliliter (col/mL) to 38,000 col/mL over 48 hours of storage at 37 degrees C. Bacterial growth was markedly reduced at cold temperatures (refrigeration) compared with room temperature, with 50% fewer bacterial colonies in 24 hours and 84% fewer colonies in 48 hours. Interestingly, tap water resulted in only minimal growth, especially at cold temperatures (< 100 col/mL at 48 hours). These findings may be useful to increase public awareness and development of guidelines on storage temperature and expiration time for bottled water once it is opened and used.[ ] In a study it was suggested that various types of unfinished beverages have microorganism growth and can include food borne pathogens and bacterial toxins.[ ] This suggests that proper and judicious use of water should be done in healthy as well as diseases condition.

=== References ===

=== References ===