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<big>''' Abstract </big>'''  

<big>''' Abstract </big>'''  

 

''Trishna'' and ''pipasa'' are two commonly used words denoting desire for water, the difference between the two is, ''trishna'' is pathological and ''pipasa'' is physiological. Generally, desire for water is physiological process to maintain fluid balance but if ''dosha'' are vitiated then they can lead to excessive thirst and can produce ''trishna'', a disease in which person constantly craves for the water. Beside independent disease, ''trishna'' or thirst is also seen as prodromal symptom, clinical feature, complication, poor prognostic sign etc. in various clinical conditions. In this chapter, etiological factors, premonitory symptoms, pathogenesis, clinical features and complications of trishna as a disease are discussed.

''Trishna'' and ''pipasa'' are two commonly used words denoting desire for water, the difference between the two is, ''trishna'' is pathological and ''pipasa'' is physiological. Generally, desire for water is physiological process to maintain fluid balance but if ''dosha'' are vitiated then they can lead to excessive thirst and can produce ''trishna'', a disease in which person constantly craves for the water. Beside independent disease, ''trishna'' or thirst is also seen as prodromal symptom, clinical feature, complication, poor prognostic sign etc. in various clinical conditions. In this chapter, etiological factors, premonitory symptoms, pathogenesis, clinical features and complications of trishna as a disease are discussed.

 

'''Keywords''': ''trishna, vata, pitta, mukha shosha, jala,'' thirst, polydipsia, water and fluid balance, osmosis, ion balance.

'''Keywords''': ''trishna, vata, pitta, mukha shosha, jala,'' thirst, polydipsia, water and fluid balance, osmosis, ion balance.

== Introduction ==

== Introduction ==

 

‘Water is not necessary to life but rather life itself’ – This quotation describes importance of water in our life. Water is the most abundant constituent in the body, comprising approximately 50% of body weight in women and 60% in men.<ref> Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine.,  Chapter 46, Fluid and Electrolyte Disturbances, Sodium and Water, 16th ed. New York: McGraw Hill; 2005.</ref> It is crucial for survival as it performs various functions. It transports nutrients to the tissues, removes metabolic waste products, detoxifies body elements, regulates body temperature, maintains pH, electrolyte balance etc. and homeostasis of body. In normal physiological process, certain amount of fluid is lost continuously. If this fluid balance is not maintained then, both acute and chronic fluid deficits may lead to number of adverse health outcomes. Even modest fluid deficits may precipitate adverse events, especially in young children, in the frail elderly and in those with poor health.<ref>Maughan RJ., Hydration, morbidity, and mortality in vulnerable populations, Nutr Rev. 2012 Nov;70 Suppl 2:S152-5.</ref> Fluid balance in body is maintained via thirst, a feedback-controlled variable, regulated acutely by central and peripheral mechanisms.<ref>Millard-Stafford M, Wendland DM, O'Dea NK, Norman TL, Thirst and hydration status in everyday life. Nutr Rev. 2012 Nov;70 Suppl 2:S147-51</ref> Thirst is physiological but when it exceeds its threshold it becomes pathological and is common in many diseases. Modern science accepts it as symptom only and have not given it as an entity of ‘disease’. [[Ayurveda]] is more comprehensive and broader in its approach. Fluid imbalance is a major cause of morbidity and mortality and considering this fact ‘thirst’ which is an indicator of fluid imbalance has been described as separate disease and not merely a symptom.

‘Water is not necessary to life but rather life itself’ – This quotation describes importance of water in our life. Water is the most abundant constituent in the body, comprising approximately 50% of body weight in women and 60% in men.<ref> Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine.,  Chapter 46, Fluid and Electrolyte Disturbances, Sodium and Water, 16th ed. New York: McGraw Hill; 2005.</ref> It is crucial for survival as it performs various functions. It transports nutrients to the tissues, removes metabolic waste products, detoxifies body elements, regulates body temperature, maintains pH, electrolyte balance etc. and homeostasis of body. In normal physiological process, certain amount of fluid is lost continuously. If this fluid balance is not maintained then, both acute and chronic fluid deficits may lead to number of adverse health outcomes. Even modest fluid deficits may precipitate adverse events, especially in young children, in the frail elderly and in those with poor health.<ref>Maughan RJ., Hydration, morbidity, and mortality in vulnerable populations, Nutr Rev. 2012 Nov;70 Suppl 2:S152-5.</ref> Fluid balance in body is maintained via thirst, a feedback-controlled variable, regulated acutely by central and peripheral mechanisms.<ref>Millard-Stafford M, Wendland DM, O'Dea NK, Norman TL, Thirst and hydration status in everyday life. Nutr Rev. 2012 Nov;70 Suppl 2:S147-51</ref> Thirst is physiological but when it exceeds its threshold it becomes pathological and is common in many diseases. Modern science accepts it as symptom only and have not given it as an entity of ‘disease’. [[Ayurveda]] is more comprehensive and broader in its approach. Fluid imbalance is a major cause of morbidity and mortality and considering this fact ‘thirst’ which is an indicator of fluid imbalance has been described as separate disease and not merely a symptom.

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.

Nowadays 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.<ref>Available from: http://www.nrdc.org/about </ref> 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.<ref>Raj SD., Bottled water: how safe is it? Water Environ Res. 2005 Nov-Dec;77(7):3013-8.</ref> In a study it was suggested that various types of unfinished beverages have microorganism growth and can include food borne pathogens and bacterial toxins.<ref>Watanabe M, Ohnishi T, Araki E, Kanda T, Tomita A, Ozawa K, Goto K, Sugiyama K, Konuma H, Hara-Kudo Y., Characteristics of bacterial and fungal growth in plastic bottled beverages under a consuming condition model, J Environ Sci Health A Tox Hazard Subst Environ Eng. 2014;49(7):819-26.</ref> This suggests that proper and judicious use of water should be done in healthy as well as diseases condition.

Nowadays 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.<ref>Available from: http://www.nrdc.org/about </ref> 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.<ref>Raj SD., Bottled water: how safe is it? Water Environ Res. 2005 Nov-Dec;77(7):3013-8.</ref> In a study it was suggested that various types of unfinished beverages have microorganism growth and can include food borne pathogens and bacterial toxins.<ref>Watanabe M, Ohnishi T, Araki E, Kanda T, Tomita A, Ozawa K, Goto K, Sugiyama K, Konuma H, Hara-Kudo Y., Characteristics of bacterial and fungal growth in plastic bottled beverages under a consuming condition model, J Environ Sci Health A Tox Hazard Subst Environ Eng. 2014;49(7):819-26.</ref> This suggests that proper and judicious use of water should be done in healthy as well as diseases condition.

 

== References ==

== References ==