Chhardi Chikitsa: Difference between revisions

After explaining the atisāra chikitsā (treatment of diarrhoea), there is description of chhardi chikitsā. The word ‘chhardi’ is derived from the root ‘chard vamane’. The word ‘chhad’ means gripping (avrutta or achchhadana) and ‘ard’ means pain (peeda).  The other words like chhardah, chhardana, chhardi, chhardika, etc. are considered as the synonyms of chhardi.  The words chhardi & vamana, both are used in the sense of vomiting but have basic difference. Chhardi is a pathological condition where the sufferer is exposed to particular predisposing factors for vomiting and as a result suffers from the particular condition called chhardi. On the other hand vamana is one of the purificatory therapies of panchakarma (five purificatory procedures in Ayurveda) where the physician intends to induce vomiting to expel out vitiated kapha & pitta. In general, the vitiated doshas accumulate in stomach and are thrown out from the body through various channels. There are two major channels from which the body generally does such excretary mechanism.  The one is adhomārga (excretion through downword channel) for which the description of atisāra is given in previous chapter and the other one is urdhvabhāga (excretion through upword channel) where the description of chhardi is discussed here.  Chhardi comes under the category of koshtha rasāyani shrita vyādhi (diseases of GI tract)  whose roots are in mahasrotas (GI tract) and manovaha (mind) srotasas. The amāshaya and rasāyani are the involved avayavas (organs) in this disease.  The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological conselling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors.  The curative treatment focuses on pharmacotherapy depending upon dosha dominance and mild samshodhana (expelling out the vitiated dosha).

अथातश्छर्दिचिकित्सितं व्याख्यास्यामः||१||  

punarvasuM bhUtahite niviShTaM papraccha shiShyo~atrijamagniveshaH||3||

Agnivesha the disciple enquired Punarvasu, the illustratious son of Atri, who was engrossed in  the thinking of the wellbeing of humanity and who was dazzling with lustre of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the wellbeing of all living beings (3).

याश्छर्दयः पञ्च पुरा त्वयोक्ता रोगाधिकारे भिषजां वरिष्ठ!|  

तासां चिकित्सां सनिदानलिङ्गां यथावदाचक्ष्व नृणां हितार्थम्||४||  

yAshchardayaH pa~jca purA mayoktAstA vistareNa bruvato nibodha||5||  

Oh! Revered Physician, please describe the treatment of the five types of chhardi (vomiting) mentioned by you earlier in the context of the enumeration of diseases (in Sutra 19:3-4) along with their etiology, signs and symptoms comprehensively, for the sake of wellbeing of humanity.

Having heard Agnivesha and being pleased the best among physicians Punarvasu Atreya said “I shall now expound all the five types of vomiting (briefly) stated earlier, in greater details. Listen to me." (4-5)

tāsāṁ hr̥dutklēśakaphaprasēkau dvēṣō'śanē caiva hi pūrvarūpam||6||

doShaiH pRuthaktriprabhavAshcatasro [1] dbiShTArthayogAdapi pa~jcamI syAt|6|  

tAsAM hRudutkleshakaphaprasekau dveSho~ashane caiva hi pUrvarUpam||6||  

Chhardi (vomiting) is of five types; three types of vomitings caused by a dosha each i.e. vātika, paittika, kaphaja, fourth is sannipātika and fifth is dvistartha-yogaja-chhardi (that results from contact with unpleasant sense objects).

The premonitory signs and symptoms of chhardi (vomiting) are nausea, excessive salivation and aversion to food (6).  

व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|  

वायुर्महास्रोतसि  सम्प्रवृद्ध उत्क्लेश्य दोषांस्तत ऊर्ध्वमस्यन्||७||  

8. The patient feels miserable (7-9).

अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|  

रसायनीभिर्विसृतं प्रपीड्य मर्मोर्ध्वमागम्य वमिं करोति||१०||  

5. Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation (10-11).  

स्निग्धातिगुर्वामविदाहिभोज्यैः स्वप्नादिभिश्चैव कफोऽतिवृद्धः|  

उरः शिरो मर्म रसायनीश्च सर्वाः समावृत्य वमिं करोति||१२||  

3. Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain (12-13).

समश्नतः सर्वरसान् प्रसक्तमामप्रदोषर्तुविपर्ययैश्च|  

सर्वे प्रकोपं युगपत् प्रपन्नाश्छर्दिं त्रिदोषां जनयन्ति दोषाः||१४||  

2. Vomitus is salty, sour, blue, dense, hot and reddish (14-15).

विट्स्वेदमूत्राम्बुवहानि वायुः स्रोतांसि संरुध्य यदोर्ध्वमेति|  

उत्सन्नदोषस्य समाचितं तं दोषं समुद्धूय नरस्य कोष्ठात्||१६||  

   Such a patient succumbs to death quickly (16-17).

द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|  

यच्छर्दयेत्तप्तमना मनोध्नैर्द्विष्टार्थसंयोगभवा मता सा||१८||  

As a result of mental disgust occasioned by senses contact with despicable, antagonistic, unclean, putried, unholy and loathsome odors, diet or sights, the chhardi(vomiting) is known as vomiting induced by contact with hateful things (18).

क्षीणस्य या छर्दिरतिप्रवृद्धा सोपद्रवा शोणितपूययुक्ता|  

सचन्द्रिकां तां प्रवदन्त्यसाध्यां साध्यां चिकित्सेदनुपद्रवां च||१९||

sacandrikAM tAM pravadantyasAdhyAM sAdhyAM cikitsedanupadravAM ca||19||  

Vomiting that occurs in an emaciated person, that continues incessantly, that is associated with complications, and vomitus that contains blood, pus and chandrika (circular shiny patches with variegated colour) is incurable. The physician should treat only curable types that are not associated with complications (19).

आमाशयोत्क्लेशभवा हि सर्वाश्छर्द्यो मता लङ्घनमेव तस्मात्|  

प्राक्कारयेन्मारुतजां विमुच्य संशोधनं वा कफपित्तहारि||२०||  

vallIphalAdyairvamanaM pibedvA yo durbalastaM shamanaishcikitset|  

rasairmanoj~jairlaghubhirvishuShkairbhakShyaiH sabhojyairvividhaishca pAnaiH||22||

Patient may also be given emetic therapy prepared of the drugs of the valliphala (group of cucurbitaceous fruits), etc. or if the patient is weak, then he should be treated with pacification therapy through delicious soups and light as well as dry food articles for diet along with various kinds of drinks (21-22).

सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|

छर्दिं तथा कोलकुलत्थधान्यबिल्वादिमूलाम्लयवैश्च यूषः||२३||

6. The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour dadima (pomegranate/Punica granatum)- (23-25).

पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|  

कफाशयस्थं त्वतिमात्रवृद्धं पित्तं हरेत् स्वादुभिरूर्ध्वमेव||२६||  

• Powder of murva (Marsdenia tenacissima / sansevieria roxburghiana) along with tandulodaka (rice-water)-(26-33).

कफात्मिकायां वमनं प्रशस्तं सपिप्पलीसर्षपनिम्बतोयैः|  

पिण्डीतकैः सैन्धवसम्प्रयुक्तैर्वम्यां कफामाशयशोधनार्थम्||३४||  

3. Maricha (black pepper/Piper nigrum) with honey (34-39).

यैषा पृथक्त्वेन मया क्रियोक्ता तां सन्निपातेऽपि समस्य [१] बुद्ध्या|  

दोषर्तुरोगाग्निबलान्यवेक्ष्य प्रयोजयेच्छास्त्रविदप्रमत्तः||४०||

Judicious synthesis of the separate lines of treatment indicated by me for the derangement of individual humors should be employed by the learned physician for the patient suffering from sannipatika chhardi after carefully examining the relative preponderance of the doshas involved, the season when the disease has occured, the stage of the disease and the power of digestion of the patient (40).  

मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|  

लोकप्रसिद्धाः श्रुतयो वयस्याः शृङ्गारिकाश्चैव हिता विहाराः||४१||  

5. In general, whatever odour, taste, contact, sound or sights those are pleasing to such patients should be given though otherwise unsuitable and unwholesome because in this way disease can be treated easily (41-44).  

छर्द्युत्थितानां च चिकित्सितात् स्वाच्चिकित्सितं कार्यमुपद्रवाणाम्|  

अतिप्रवृत्तासु विरेचनस्य कर्मातियोगे विहितं विधेयम्||४५||  

The treatment of complications arising from vomiting should be done according to the lines suggested in respect of each of those ailments. In case of excessive vomiting; treatment that is suggested in Siddhisthana (6/ 52-56) for excessive purgation should be carried out (45).

वमिप्रसङ्गात् पवनोऽप्यवश्यं धातुक्षयाद्धृद्धिमुपैति तस्मात्|  

चिरप्रवृत्तास्वनिलापहानि कार्याण्युपस्तम्भनबृंहणानि||४६||  

Sarpirguda (Chikitsa 11:50-77), kshira-vidhi (milk boiled by adding vāta-alleviating drugs), Kalyanaka-ghrita (Chikitsa 9:33-42), tryushana-ghrita (Chikitsa 18:39-42), jivaniya-ghrita (Cikitsa 29:55-57), vrishya (virilific) recipes, mamsarasa (meat soup) and lehya like chyavanprasha (linctuses) –(46-47).

तत्र श्लोकः-  

हेतुं सङ्ख्यां लक्षणमुपद्रवान् साध्यतां न योगांश्च|  

Thus the section on therapeutics in the treatise compiled by Agnivesha redacted by Charaka and reconstructed by Dridhabala as it was not available.

• Chhardi (vomiting) can be either caused by vitiation of endogenous dosha or by exogenous factors like in dvistartha-yogaja-chhardi (that results from contact with unpleasant sense objects).

• The dosha vitiation due to their own specific causative factors lead to irritation of stomach, spread through rasayani (channels carrying rasa) resulting in chhardi.  Different types of chhardi shall be diagnosed based on the specific etio-pathogenesis and clinical presentation.  

• The treatment of complications arising from vomiting should be done according to the lines suggested in respect of each of those ailments.

• In persistent vomiting vāta invariably gets aggravated because of loss of tissue elements. Therefore, in case of chronic vomiting medications that are bulk promoting, vāta pacifying, upastambhana (astringents) and brimhana (nutritive) should be administered.

 Āmāśayōtklēśabhavā  (आमाशयोत्क्लेशभवा): originated from agitatied Doshas in stomach

 Āmāśayōtklēśakr̥tāṁ (आमाशयोत्क्लेशकृतां ): morbid humor which are agitating Amasaya (stomach) and likely to come out