Changes

=== 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.

The other meaning of ''trishna'' is greed or insatiable desire for something. It can be referred that word ''trishna'' not only denotes physical craving but includes psychological desires also. In morbid thirst both body and mind crave and there are conditions like psychogenic polydypsia in which thirst is only due to mental involvement. As mind plays an important role in thirst as a disease this chapter has been named as ''trishna chikitsitam'' (or [[Trishna Chikitsa]]) not ''pipasa chikitsitam''.  

The other meaning of ''trishna'' is greed or insatiable desire for something. It can be referred that word ''trishna'' not only denotes physical craving but includes psychological desires also. In morbid thirst both body and mind crave and there are conditions like psychogenic polydypsia in which thirst is only due to mental involvement. As mind plays an important role in thirst as a disease this chapter has been named as ''trishna chikitsitam'' (or [[Trishna Chikitsa]]) not ''pipasa chikitsitam''.  

''Trishna'' word in Ayurveda is interchangeably used for physiological as well as pathological thirst. Normally, ''vata'' and ''pitta'' are the two ''dosha'' inseparably involved in causing ''trishna'' as they have ''shoshana guna'' (property to absorb the water element) but the difference is ''vata'' absorbs the moisture by its dry property, whereas ''pitta'' does it by its hot property. Thirst is function of unvitiated ''pitta'' and clinically presents as ''mukha shosha'' (dry mouth) which occurs due to ''vata''. So, it can be said that both ''dosha'' are inseparably involved in thirst production. When they are ‘unvitiated’, physiological thirst is produced and when ‘vitiated’ they can cause ''trishna''. Based on etiological factor and pathogenesis involved, ''trishna'' is classified into five types – ''vataja, pittaja, amaja, kshayaja'' and ''upasargaja''. These ''dosha'' absorb water from the ''saumya dhatu'' like ''rasa, udaka'' and ''kapha'' (tissues in which water content is more). Three more types – ''kaphaja, bhaktodhabhavaja'' (after excess eating) and ''kshataja'' (thirst produced due to external injury).  

''Trishna'' word in [[Ayurveda]] is interchangeably used for physiological as well as pathological thirst. Normally, ''vata'' and ''pitta'' are the two ''dosha'' inseparably involved in causing ''trishna'' as they have ''shoshana guna'' (property to absorb the water element) but the difference is ''vata'' absorbs the moisture by its dry property, whereas ''pitta'' does it by its hot property. Thirst is function of unvitiated ''pitta'' and clinically presents as ''mukha shosha'' (dry mouth) which occurs due to ''vata''. So, it can be said that both ''dosha'' are inseparably involved in thirst production. When they are ‘unvitiated’, physiological thirst is produced and when ‘vitiated’ they can cause ''trishna''. Based on etiological factor and pathogenesis involved, ''trishna'' is classified into five types – ''vataja, pittaja, amaja, kshayaja'' and ''upasargaja''. These ''dosha'' absorb water from the ''saumya dhatu'' like ''rasa, udaka'' and ''kapha'' (tissues in which water content is more). Three more types – ''kaphaja, bhaktodhabhavaja'' (after excess eating) and ''kshataja'' (thirst produced due to external injury).  

Presently we rely only on fluid and electrolyte supplementation to treat thirst. Treatment of ''trishna'' by ayurvedic principles may open newer vistas in the cases where thirst is difficult to treat. Increased mortality due to dehydration, especially in vulnerable populations, it is commonly observed during periods of abnormally warm weather.<ref> Maughan RJ.,Nutr Rev. 2012 Nov;70 Suppl 2:S152-5, Hydration, morbidity, and mortality in vulnerable populations.</ref> Mortality rate is high in remote areas where health care facilities are not good enough. Ayurvedic preparations mentioned in this chapter are easy to make, can be life saving where sophisticated medical care is not available. Based on Ayurvedic principles, rules regarding use of water in various diseases have been also given in this chapter.

Presently we rely only on fluid and electrolyte supplementation to treat thirst. Treatment of ''trishna'' by ayurvedic principles may open newer vistas in the cases where thirst is difficult to treat. Increased mortality due to dehydration, especially in vulnerable populations, it is commonly observed during periods of abnormally warm weather.<ref> Maughan RJ.,Nutr Rev. 2012 Nov;70 Suppl 2:S152-5, Hydration, morbidity, and mortality in vulnerable populations.</ref> Mortality rate is high in remote areas where health care facilities are not good enough. Ayurvedic preparations mentioned in this chapter are easy to make, can be life saving where sophisticated medical care is not available. Based on Ayurvedic principles, rules regarding use of water in various diseases have been also given in this chapter.