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Trishna Chikitsa (view source)

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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.

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

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== Sanskrit Text, Transliteration and English Translation ==

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</div></div>

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Now we expound the chapter ~~entitled “The Therapeutics~~ of ~~Morbid Thirst”~~.

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Now we shall expound the chapter "Trishna Chikitsa" (Management of morbid thirst).Thus said the Lord atreya. [1-2]

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Thus said the Lord atreya. [1-2]

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The son of Atri, famed for his sagaciousness, tranquility, austerity and devoted to the wellness of the world, expounded the chapter therapeutics of morbid thirst. [3]

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==== Etio-pathogenesis ====

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=== Etio-pathogenesis ===

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As a result of shock/excess distress, fear, fatigue, grief, anger, extreme starvation, alcoholism, regular use of alkaline and sour substances, use of excessive salt, pungent, salty, dry and dehydrated food, emaciation due to excessive loss of basic body forming elements and emaciation due to disease, excessive use of purifactory procedures, excessive exposure to sunlight, ''pitta'' and ''vata'' get severely vitiated and dry up the watery contents of the body. These two ''dosha'' vigorously dehydrate the fluid carrying ducts and channels situated at the base of the tongue, throat, palate and ''kloma'' which causes morbid thirst in a man. Though the patient perpetually drinks water yet his thirst is not quenched. Such morbid thirst arises as a complication in the persons suffering from emaciation due to grave diseases. [4-8]

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==== Premonitory and cardinal symptoms and signs ====

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=== Premonitory and cardinal symptoms and signs ===

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The premonitory symptoms of morbid thirst are dryness of mouth along with constant craving for water as a cardinal symptom. All the clinical features of morbid thirst may occur in mild form or some of the features may be seen in premonitory stage of morbid thirst. [8]

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==== General clinical signs and symptoms ====

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=== General clinical signs and symptoms ===

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Dryness of mouth, hoarseness of voice, giddiness, burning sensation all over body, delirium, rigidity, dryness and roughness of palate, lip, throat and tongue, stupefaction, loss of concentration, protrusion of the tongue, anorexia, auditory impairment, burning sensation in vital organs and exhaustion are the symptoms of morbid thirst. Now listen carefully the symptoms of each of the five varieties of morbid thirst separately.[9-10]

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==== ''Vata'' dominant ''trishna'' ====

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=== ''Vata'' dominant ''trishna'' ===

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Lack of sleep, giddiness, dry mouth, distaste, and occlusion of the channels are the symptoms of the ''vataja'' morbid thirst. [12]

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==== ''Pitta'' dominant ''trishna'' ====

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=== ''Pitta'' dominant ''trishna'' ===

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Bitter taste in the mouth, burning sensation in the head, cravings for cold things, fainting and yellowish discoloration of eyes, urine and feces, are the clinical features of ''pittaja'' morbid thirst.[13-14]

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==== ''Trishna'' due to ''ama'' vitiation ====

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=== ''Trishna'' due to ''ama'' vitiation ===

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Morbid thirst, which originates from incomplete transformation or metabolism of food, is also a ''pittaja'' type as it originates from ''ama'' and ''pitta'' (''pitta'' obstructed due to vitiated ''ama''). Its clinical features are anorexia, flatulence and excessive salivation. [15]

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==== ''Trishna'' due to depletion of body elements ====

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=== ''Trishna'' due to depletion of body elements ===

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The body is composed of watery elements and the colloidal fluids of the body are in turn composed of the aqueous elements. The loss of these watery elements induces thirst, low voice (altered voice), fainting, dryness of throat and palate. [16]

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==== ''Trishna'' due to complications of other diseases ====

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=== ''Trishna'' due to complications of other diseases ===

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Morbid thirst which occurs in a person as a complication of fever, urinary disorders in which abnormal and increased quantity of urine is passed, emaciation, consumption, dyspnea and similar other disorders, cause severe dehydration and such type of ''trishna'' is very difficult to treat.[17]

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==== Serious consequence of ''trishna'' ====

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=== Serious consequence of ''trishna'' ===

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All varieties of diseases which are chronic in nature, which occur in the patients emaciated by diseases and afflicted with perpetual vomiting which occurs along with grave complications to be known as being indicative of approaching death. [18]

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==== Role of ''vata'' and ''pitta'' in ''trishna'' ====

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=== Role of ''vata'' and ''pitta'' in ''trishna'' ===

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The body heat of the person is obstructed in the peripheral region by a cold bath and it passes to the internal organs and produces thirst. Therefore, the person who is fatigued by excessive heat should not take cold water immediately. [23]

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==== Management of ''trishna'' ====

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=== Management of ''trishna'' ===

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In all these types of the morbid thirst, symptoms arising from the vitiation of ''vata, pitta'' and loss of watery elements of the body are manifested. Now, I shall describe the treatment of morbid thirst of various types one by one according to the authoritative tradition. [24]

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==== Properties of pure rain water and its benefits ====

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=== Properties of pure rain water and its benefits ===

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The water, that has slight astringent, secondary taste, which is light to digest, cool, possess good smell and taste and devoid of channel blocking quality, should be considered equal to rain water in effect though it may be terrestrial.[25-26]

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==== Various diet recipes in management of ''trishna'' ====

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=== Various diet recipes in management of ''trishna'' ===

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Or, the ghee prepared out of this medicated milk is propitious as potion and inunction as well as nasal medication. Breast milk or camel’s milk with sugar or sugarcane juice is good as nasal medication. [27-33]

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==== Various therapeutics modalities ====

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=== Various therapeutics modalities ===

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The thinking of or listening to the description of Himalayan caves, woods, streams, lakes, lotuses, breezes, moonlight, and other cool things as well as of lovely cool waters- these have an allaying effect on morbid thirst.[34-39]

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==== Guidelines for management of ''vata'' dominant ''trishna'' ====

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=== Guidelines for management of ''vata'' dominant ''trishna'' ===

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If the morbid thirst is due to ''vata'' dominance, then soft, light to digest food and drink with cooling property, curative of ''vata'' are recommended. Also ghee which is churned directly from milk is indicated which has been mentioned for the treatment of ''kshayaja kasa'' (cough due to wasting) and is curative of thirst and dyspnea. [40]

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==== Guidelines for management of ''pitta'' dominant ''trishna'' ====

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=== Guidelines for management of ''pitta'' dominant ''trishna'' ===

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The cold infusions prepared from ''kshiri'' and ''madhur, shita'' group of plants should be given after adding sugar and honey quenching of baked clay should be done as described earlier. It is useful in ''pittaja trishna''. [41-46]

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==== Guidelines for management of ''amaja trishna'' ====

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=== Guidelines for management of ''amaja trishna'' ===

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The physician may also give pomegranate or other sour fruits or the linctus mixed with astringent substances or he may give a potion containing turmeric and sugar.[47-49]

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==== Guidelines for management of ''kshayaja trishna'' ====

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=== Guidelines for management of ''kshayaja trishna'' ===

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The thirst resulting from eating unctuous food should be quenched with jaggery water; and the thirst in a person who has fainted should be remedied by medication mentioned in ''murchha'' (fainting).[50-56]

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==== Indications of cold and hot water ====

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=== Indications of cold and hot water ===

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If the thirst is remedied, it is facile to subdue the complication arising from it; therefore thirst should be treated first in all diseases. [57-62]

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==== Summary ====

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=== Summary ===

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== Vidhi Vimarsha (Applied Inferences ) ==

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

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=== 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.

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

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

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.

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

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=== 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.

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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''.

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

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=== 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 anayati iti samanam'' is the definition of ''samana vayu''. ''Samana'' has a seat in ''sweda, dosha'' and ''ambhuvaha srotas''. As discussed above maintaining the pH (''sami karoti'') is brought about by specific ionic movement and this particular force is provided by ''samana vayu''. 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 e.g. 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 osmo-receptors 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.

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The above mechanisms are disturbed in ''trishna''.

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==== Etiopathogenesis of ''trishna'' ====

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=== Etiopathogenesis of ''trishna'' ===

In morbid thirst, ''vata'' and ''pitta dosha'' are predominately involved. Etiological factors aggravate either ''vata, pitta'' or both and manifest ''trishna''. Both ''dosha'' have absorbent (''soshaka'') property, ''vata dosha'' by its drying property and ''pitta'' by its heating property. Therefore excess exposure to various factors in diet and lifestyles leading to dryness and heat inside the body are considered as causative factors for ''trishna''. Some of the commonly observed factors are enlisted below:

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*Complication (''upasarga'') of diseases like ''jwara, meha, kshaya, shosha, shwasa'' (Cha.22/17)

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==== General pathogenesis ====

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=== General pathogenesis ===

Due to above mentioned factors, ''vata'' and ''pitta dosha'' are vitiated and further affect channels carrying fluids like ''rasavaha'' and ''udakavaha srotasa''.

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==== Etio-pathological factors in thirst ====

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=== Etio-pathological factors in thirst ===

Acute fall in blood pressure and/or blood volume will also stimulate thirst. 15% or more reduction in circulating blood volume is required for this effect. However, the effects are short-lived and the effect of osmolality changes on thirst is more significant.

Thus classification may be done as follows:

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===== A. Causes of excessive thirst without excessive urination =====

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==== A. Causes of excessive thirst without excessive urination ====

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====== 1. Dehydration due to: ======

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==== 1. Dehydration due to: ====

*Excessive sweating (diaphoresis)

*Diarrhea

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*Hyperventilation due to anxiousness, certain diseases, such as pneumonia, or at high altitudes.

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====== 2. ~~Dry~~ mouth ~~by causes other than dehydration: ==~~====

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==== 2. Other causes of dry mouth ====

'''Acute (sudden) causes of dry mouth''':

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*Amphetamine

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===== B. Causes of excessive thirst with excessive urination =====

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==== B. Causes of excessive thirst with excessive urination ====

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====== Psychogenic Polydipsia ======

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==== Psychogenic Polydipsia ====

In most cases of polydipsia, people drink water to replace water they have lost due to excessive urination caused by certain organic disorders. Individuals with primary or psychogenic polydipsia (often associated with schizophrenia) have no organic disorder, but they believe or feel they should drink a lot of fluid. This can lead to water intoxication (hyponatremia), which can be life threatening.

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====== Brain Disorders Resulting in Central Diabetes Insipidus ======

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==== Brain Disorders Resulting in Central Diabetes Insipidus ====

*Head injury, tumor, stroke

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====== Impaired Kidney Function Resulting in Nephrogenic Diabetes Insipidus ======

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==== Impaired Kidney Function Resulting in Nephrogenic Diabetes Insipidus ====

*Salt-wasting nephropathy (in a polycystic kidney disease) , post-obstructive diuresis (after resolution of urinary tract blockage), medullary kidney cystic disease, proximal renal tubular acidosis

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====== Heart Disorders ======

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==== Heart Disorders ====

*Supraventricular tachycardia (a type of heart arrhythmia), postural hypotension, systemic capillary leak syndrome

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====== Hormonal Disorders ======

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==== Hormonal Disorders ====

*Gestational diabetes insipidus; in the 3rd trimester of pregnancy

*Adrenal hyperactivity

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**Hyperparathyroidism

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====== Metabolic Disorders ======

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==== Metabolic Disorders ====

*Hypokalemia

*Hypercalcemia

*Hypernatremia

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====== Genetic and Congenital Disorders ======

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==== Genetic and Congenital Disorders ====

*Aceruloplasminemia

*Alsing syndrome

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*Apparent Mineralocorticoid Excess Syndrome

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====== Other Disorders ======

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==== Other Disorders ====

*Adiposogenital dystrophy

*Langerhans cell histiocytosis

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**Pheochromocytoma

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====== Drugs ======

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==== Drugs ====

*Amphotericin B

*Antiobesity drugs: lorcaserin, orlistat, phentermine, sibutramine

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*Vitamin D overdose (hypervitaminosis D)

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====== Poisons ======

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==== Poisons ====

*Acid ingestion

*Amanita muscaria (fly agaric) and other toxic mushrooms

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*Snake bites

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===== Table 1: Condition with morbid thirst and diagnostic tests =====

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==== Table 1: Condition with morbid thirst and diagnostic tests ====

{|class="wikitable"

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|}

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==== Laboratory Tests ====

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=== Laboratory Tests ===

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===== Blood Tests =====

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==== Blood Tests ====

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====== Glucose Elevated ======

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==== Glucose Elevated ====

*Diabetes mellitus

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*Pheochromocytoma

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====== Sodium ======

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==== Sodium ====

*Normal levels (135-145 meq/L):

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**Diabetes insipidus

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====== Potassium ======

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==== Potassium ====

*Hypokalemia:

**Hyperaldosteronism

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**Diabetic ketoacidosis (usually)

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====== Calcium ======

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==== Calcium ====

*Hypercalcemia:

**Hyperparathyroidism

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**Diabetic ketoacidosis (usually)

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====== CBC ======

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==== CBC ====

*White blood cells increased or decreased in sepsis

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====== Hematocrit (HCT) ======

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==== Hematocrit (HCT) ====

*Decreased in water intoxication

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====== Blood Urea Nitrogen (BUN) ======

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==== Blood Urea Nitrogen (BUN) ====

*Increased in kidney failure

*Decreased in water intoxication

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====== pH ======

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==== pH ====

*<7.3 (diabetic ketoacidosis)

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====== Proteins ======

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==== Proteins ====

*Hypoalbuminemia in liver cirrhosis, nephrotic syndrome, severe malnutrition

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====== Hormone levels ======

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==== Hormone levels ====

*ADH

*Decreased in central diabetes insipidus

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*Aldosterone may be increased in adrenal adenoma or primary hyperaldosteronism

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====== Urine Tests ======

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==== Urine Tests ====

*Osmolality

*<200 mOsm/kg in psychogenic polydipsia, diabetes insipidus

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*Sodium >20 meq/L: cerebral salt wasting

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====== Principles of management ======

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==== Principles of management ====

The treatment modalities intended to pacify ''vata'' and ''pitta dosha'' are applied for management of ''trishna''. Specifically rain water, water processed with drugs having ''manda'' (mild) and ''sheeta'' (cool) properties, various medicated ghee mentioned in the text are used to manage ''trishna''.

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===== Various preparations used in management =====

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==== Various preparations used in management ====

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====== Food and beverages ======

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==== Food and beverages ====

*''Trina panchamula'' medicated water

''Trina Panchamula'' contains five drugs namely ''kusha, kasha, nala, darbha'' and ''kandekshu''. It pacifies ''pitta'' and it is indicated in ''trishna'' (Su. Su. 38/77). In ''Bhaisajya Ratnavali, Shara'' is given in place of ''Nala''. (''Bhaisajya Ratnavali, Mutrakricharogadhikar'' 10)

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*''Trina panchamula, munjataka, priyala'' drugs should be mixed with ''mamsa rasa'' or ''kshira paka'' prepared from these should be given after mixing honey and sugar to it. All above drugs pacify ''pitta'' hence quench the thirst.

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====== External applications ======

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==== External applications ====

External application of ''shatadhauta ghrita'' is ''pitta shamaka'' so it should be used. ''Yusha'' is a soup prepared from pulses. Drugs which are ''madhura, tikta, sheeta'' and having ''jeevaniya'' properties, pacify ''pitta''. They should be given to the patient for drinking as well as for external application.

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====== Medicated ghee ======

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==== Medicated ghee ====

''Ghrita'' processed with drugs of ''madhuradi gana'' mentioned in [[Vimana Sthana]] 8th chapter should be used for drinking, massage and sprinkling purpose. ''Ghrita'' is best for pacifying ''pitta'' and ''vata''.(Ca.Su.25/40) When processed with ''madhura gana'' drugs its property increases as it is ''yogavahi'' in nature (the one that accelerates the properties of others).

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====== Nasal administration ======

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==== Nasal administration ====

Various milk or juice of sugarcane when administered through nasal route decreases thirst. (Cha.Su.27/224)

Following table enlists various diet recipes and medicinal formulations used in the management of ''trishna'' referred at various places.

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===== Table 2: Diet and formulations for management of ''trishna'' =====

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==== Table 2: Diet and formulations for management of ''trishna'' ====

{| class = "wikitable"

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''Gandusha'' (filling the mouth to its full capacity with liquid without allowing its movement in oral cavity) with various sweet and sour drugs is useful in thirst. ''Madhura rasa'' pacify ''pitta'' whereas ''amla rasa'' is cold on external application and increases salivation so both have soothing effect in dry mouth.(Su.Su.42/10) Use of ''amla'' drugs in the form of external application has also been advocated as they have cooling effect on touch. Thinking about cold things and environment is a part of psychotherapy which helps patient to combat desire of water.

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===== Management of ''vata'' dominant ''trishna'' =====

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==== Management of ''vata'' dominant ''trishna'' ====

All dietary formulations and drugs used in ''vataja trishna'' must have property to pacify ''vata''. Milk and ''ghrita'' mentioned in ''kshayaja kasa'' (like ''dwipanchamuladi ghrita, guduchyadi ghrita, kasmardadi ghrita'' etc.) pacify ''vata dosha'' effectively and thus these preparations can also be used in ''vataja trishna''.

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===== Management of ''pitta'' dominant ''trishna'' =====

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==== Management of ''pitta'' dominant ''trishna'' ====

Various ''pitta'' pacifying drugs mixed with water are mentioned in treatment of ''pittaja trishna''. These drugs pacify ''pitta'' as well as they are useful in maintaining water homeostasis.

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Water obtained after quenching of baked earth is said to be best for pacifying excessive thirst in ''agrya prakarana''. This simple method can be clinically evaluated in patients of morbid thirst. (Cha.Su.25/40).

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===== Management of ''amaja trishna'' =====

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==== Management of ''amaja trishna'' ====

To treat ''amaja trishna'', it is necessary that first ''ama'' is removed. For ''ama pachana'' drugs which increase ''agni'' can be used as well. Treatment of ''kaphaja chhardi'' can be followed as ''kapha nasaka'' treatment helps to remove ''ama''. If symptoms pertaining to ''ama'' are seen than ''ama'' should be removed by inducing emesis and warm water should be used to increase ''agni'' to remove ''ama''. As discussed earlier ''kshaya'' refers to emaciation of tissues. So, treatment which helps in revitalizing the tissue can be used as mentioned in ''kshatakshina, shosha'' can also be used.

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===== Management of ''trishna'' due to ''madatyaya'' =====

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==== Management of ''trishna'' due to ''madatyaya'' ====

Use of alcohol for treating thirst induced due to alcohol is example of ''Hetu Vipritarthakari'' (treatment with a substance similar to the cause).

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===== Effect of cold water and hot water on body fluid balance =====

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==== Effect of cold water and hot water on body fluid balance ====

In conditions of dehydration and where ''pitta'' is dominant (''Dhaha, bhrama, madatyaya'' etc) cold water should be given as it restores water content in body as well as pacify ''pitta'' by its ''sheeta guna''. After boiling, water becomes free from various micro-organisms. Boiled water should be used in ''sannipatika'' diseases after cooling, such diseases are difficult to treat. In a study it was found that temperature range from 55 to 65 degree C is critical for effective elimination of enteric/pathogenic bacterial components.<ref> Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine, Chapter 11. Palliative and End-of-Life Care,16th ed. New York: McGraw Hill; 2005</ref> As all three ''dosha'' are involved we can’t use hot or cold water as they will aggravate at least one of the ''dosha'' (hot will increase ''pitta'', cold water will increase ''vata/kapha'') so normal water should be used.

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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.

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~~=== Glossary ===~~

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#ādhmāna (AdhmAna, आध्मान) The term signifies distention or inflation of a body part caused due to stagnation of the substances inside it; but generally is taken for distention of the abdomen associated with pain due to various reasons like obstruction to the urine and faeces, accumulation of blood in abdomen etc.

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~~#āmaja trishna (Amaja tRuṣṇa,आमज तृष्णा) Polydypsia due to indigestion~~

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~~#bādhiryaṁ (bAdhiryaM, बाधिर्यं) Impaired hearing, deafness, a disease condition where in the patient has impaired hearing or complete loss of sound perception.~~

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~~#bhrama (bhrama, भ्रम) Giddiness, dizziness or tremor.~~

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~~#gulma (gulma,गुल्म) - Lump in abdomen. A lump like formation occurring in the abdomen either mobile or static in nature, circular in shape and constantly increasing and decreasing in size.~~

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~~#hikkā (hikkA,हिक्का) – Hiccoughs. A disease characterized by production of peculiar sound like hic-hic by mouth.~~

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~~#lājā (lAjA, लाजा) Obtained by roasting undried and unhusked paddy. Is light and easily digestible. Cures thirst, vomiting, diarrhoea, diabetes, obesity, cough and pitta.~~

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~~#māṁsarasa (māṁsarasa ,मांसरस) soup prepared with meat by adding 8 times of water & reducing it to 1/4th and seasoned with trikatu, ghee & jaggery~~

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~~#mūrcchā (mUrcchA,मूर्च्छा) - Syncope A fatal condition characterized by loss of consciousness and postural tone due to vitiation of blood.~~

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#nasya(nasya, नस्य) Administration of drugs by nasal route, all drugs and measures introduced through nose spread throughout the head and its constituent drugs may influence all the dosha, poisons and disease situated in these parts.

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#pāṇḍuroga (pANDuroga ,पाण्डुरोग) - Pallor of body, Anemia The term literally means paleness of the skin and mucosa along with yellowish discoloration of urine and faeces; marked by lack of blood, strength complexion, body fat and essence of the body tissues.

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#pēyā (pēyā ,पेया) Thin gruel of rice along with its solid portion (Siktha). To prepare Pēyā, 14 parts of water and 1 part of broken rice are taken and boiled well till all the rice particles become soft. It increases digestive fire.

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~~#pittaja trishna (pittaja tRuṣṇa,पित्तज तृष्णा )Polydypsia due to severe emaciation, Polydypsia associated with fainting, delirium and burning sensation.~~

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~~#Śaktu (-Śaktu, शक्तु)- Is a diet preparation. Prepared by frying and powdering husked grains like barley, wheat, rice, parched rice etc.~~

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#santāpa(santApa ,सन्ताप) Abnormal Psychosomatic feeling, the term denotes feeling of distress with or without rise in body temperature. And it may reflect in the externally body as hotness in somatic level.

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#śvāsa (shvAsa,श्वास) - Dyspnoea due to respiratory disease. It is a respiratory disease marked by recurrent paroxysmal attacks of Shortness of breath, a subjective difficulty or distress in breathing, with or without wheezing due to obstruction in the respiratory airways.

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~~#trishna(tRuṣṇa,तृष्णा) - Polydypsia The condition resembles to morbid thirst in which the person even after continuous water intake fails to quench his thirst.~~

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~~#udara (udara, उदर) - Generalized abdominal enlargement.~~

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#upadrava (upadrava, उपद्रव) Secondary diseases- The diseases that develop subsequent to a disease or during, the course of the main disease that is being treated, and is dependent upon the main disease for its origination, nature and the strength. It is called secondary in the sense that its onset follows the presence of the primary disease.

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~~#ōpasarga trishna, (opasarga tRuṣṇa, उपसर्ग तृष्णा) Polydypsia caused as a complication to some other disease.~~

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~~#vātaja trishna (vātaja tRuṣṇa(वातज तृष्णा) - Polydypsia due to dehydration, Polydypsia associated with excessive dryness in the throat and giddiness.~~

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~~#vāṭya (vATya, वाट्य) Porridge- prepared with fried barley~~

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=== References ===

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== References ==

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