Chhardi Chikitsa: Difference between revisions

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After explaining the [[Atisara Chikitsa]] (treatment of diarrhea), there is description of [[Chhardi Chikitsa]]. The word ''chhardi'' is derived from the root ''chhard vamane''. The word ''chhad'' means gripping (''avritta'' or ''achhadana'') and ''ard'' means pain (''peedha'')<ref>Shastri Suderashan, Madhava Nidana of Madhavakara, Chardi -15 Madhukosh Tika. 4th Edition, 1975, Chaukhamba Sanskrit Series, Varanasi</ref>. The other words like ''chhardah, chhardana, chhardi, chhardika,'' etc. are considered as the synonyms of ''chhardi''.<ref>Charaka chandrika Hindi Vyakhya- Visheshs Vaktavya by Bramhanand Tripathi on Charaka Samhita Chikitsa Sthana 20/1-1</ref> The words ''chhardi'' and ''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 purification therapies of [[Panchakarma]] (five purification procedures in [[Ayurveda]]) where the physician intends to induce vomiting to expel out vitiated ''kapha'' and ''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.<ref>Shastri Ambika Dutt, Sushruta Samhita, Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi, Susruta Shareera 5/ 10</ref> The one is adhomārga (excretion through downword channel) for which the description of ''atisara'' is given in previous chapter and the other one is ''urdhvabhaga'' (excretion through upward channel) where the description of ''chhardi'' is discussed here. ''Chhardi'' comes under the category of ''koshtha rasayani shrita vyadhi'' (diseases of GI tract) whose roots are in ''mahasrotas'' (GI tract) and ''manovaha'' (mind) ''srotasa''. The ''amashaya'' and ''rasayani'' are the involved ''avayavas'' (organs) in this disease.<ref>Charaka Samhita: [[Ayurveda]] Dipika Commentry by Chakrapani Chaukhamba Sankshrit Series, Varanasi Vimanasthana 5/7-3.</ref> The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological counseling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors.<ref>Charaka Samhita: [[Ayurveda]] Dipika Commentry by Chakrapani Chaukhamba Sankshrit Series, Varanasi, Vimana sthana 5/25.</ref> The curative treatment focuses on pharmacotherapy depending upon ''dosha'' dominance and mild ''samshodhana'' (expelling out the vitiated ''dosha'').

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

== Sanskrit Text, Transliteration and English Translation ==

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</div></div>

We shall ~~now~~ expound the chapter ~~entitled “the management~~ of ~~''chhardi'' (~~vomiting)”. Thus, said Lord Atreya. [1-2]

Now we shall expound the chapter "Chhardi chikitsa" (Management of vomiting). Thus said Lord Atreya. [1-2]

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Agnivesha the disciple asked Punarvasu, the illustratious son of Atri, who was engrossed in the thinking of the well-being of humanity and who was dazzling with luster of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the well-being of all living beings [3]

==== Queries by Agnivesha ====

=== Queries by Agnivesha ===

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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]

==== Classification and premonitory symptoms ====

=== Classification and premonitory symptoms ===

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

==== ''Vataja chhardi'' ====

=== ''Vataja chhardi'' ===

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#The patient feels miserable [7-9]

==== ''Pittaja chhardi'' ====

=== ''Pittaja chhardi'' ===

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#Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation [10-11]

==== ''Kaphaja chhardi'' ====

=== ''Kaphaja chhardi'' ===

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#Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain [12-13]

==== ''Tridoshaja chhardi'' ====

=== ''Tridoshaja chhardi'' ===

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#Vomitus is salty, sour, blue, dense, hot and reddish [14-15]

==== Bad prognostic symptoms ====

=== Bad prognostic symptoms ===

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Such a patient succumbs to death quickly [16-17]

==== ''Dvishtharthasamyogaja chhardi'' ====

=== ''Dvishtharthasamyogaja chhardi'' ===

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

==== Symptoms of incurable ''chhardi'' ====

=== Symptoms of incurable ''chhardi'' ===

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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 color) is incurable. The physician should treat only curable types that are not associated with complications [19]

==== Principles of treatment ====

=== Principles of treatment ===

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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]

==== Treatment of ''vataja chhardi'' ====

=== Treatment of ''vataja chhardi'' ===

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

==== Treatment of ''pittaja chhardi'' ====

=== Treatment of ''pittaja chhardi'' ===

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##Powder of ''murva'' (Marsdenia tenacissima / sansevieria roxburghiana) along with ''tandulodaka'' (rice-water)[26-33]

==== Treatment of ''kaphaja chhardi'' ====

=== Treatment of ''kaphaja chhardi'' ===

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#''Maricha'' (black pepper/Piper nigrum) with honey [34-39]

==== Treatment of ''sannipatika chhardi'' ====

=== Treatment of ''sannipatika chhardi'' ===

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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 occurred, the stage of the disease and the power of digestion of the patient [40]

==== Treatment of ''dvishtarathasamyogaja (manobhighataja) chhardi'' ====

=== Treatment of ''dvishtarathasamyogaja (manobhighataja) chhardi'' ===

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#In general, whatever odor, 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]

==== Treatment of complications ====

=== Treatment of complications ===

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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 [[Siddhi Sthana]] (6/52-56) for excessive purgation should be carried out [45]

==== Treatment of chronic ''chhardi'' ====

=== Treatment of chronic ''chhardi'' ===

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

==== Summary ====

=== Summary ===

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== Vidhi Vimarsha (Applied Inferences ) ==

==== Pathogenesis ====

=== Pathogenesis ===

''Mahasrotus'' (gastrointestinal tract) has two parts, upper part is ''annavaha srotus'' and lower part is ''purishvaha srotus''. ''Atisara'' is related to ''purishvaha srotus'' and ''chhardi'' is to ''annavaha srotus''. Etiological factors of ''chhardi'' are irritating food and practices to ''amashaya'' (stomach). They are ''vata'' vitiating, impairing ''annavaha srotus''. Even before the digestion process starts the food comes out because of action of ''urdhvavata'' or ''udanavata'', therefore, there is no involvement of ''agni''. ''Chhardi'' is a defense mechanism to expel the toxins out of the stomach. There is vacuum created by repeated expulsion of stomach contents and ''rasayinis''(villi) instead of their normal function of absorption, they start secreting body fluids into to the stomach.

==== Types of ''chhardi'' ====

=== Types of ''chhardi'' ===

Diseases are classified according to the dominance of ''doshas''-involved and their mutual amalgamation, which are of four types. The 5th type of ''chhardi'' (''dwishtarthayoga'') is due to aversive food related to the involvement of ''panchagyanendriyas'' (five sense organs) and their ''vishaya upalabdhi'' (Cha su 1/54) (perceivance of senses). The contact through ''rupa'' (visible) or ''rasa'' (taste) or ''gandha'' (smell) or ''sparsha'' (touch) or ''shabda'' (hear) or in combination with each other, stimulates body mechanism which results in ''dwistarthayoga chhardi'' (vomiting due to aversion). One cannot exclude the role of ''manah'' (mind) as predisposing factor in causing ''dwistarthayoga chhardi''.

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''Douhruda janita'' (pregnancy induced vomitting), ''satmya prakopaja'' (vomiting due to inadequacy of substances) and ''krimija'' (vomiting due to microbial infection) type of ''chhardi'' are other causes of ''chhardi''.<ref>Shastri Ambika Dutt, Sushruta Samhita, Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi</ref>

===== ''Vataja chhardi'' =====

==== ''Vataja chhardi'' ====

There are many factors that increase ''vata'' in the ''sharira'' .<ref>Shastri Ambika Dutt, Sushruta Samhita, Sutra sthana 21/19. Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref> Particular ''ahara'' (food), ''vihara'' (lifestyle) and mental factors increase ''vata'' and its ''gunas'' (properties). This aggravation of ''vata gunas'' like ''rukshata'' (dryness), ''laghuta'' (lightness), etc. plays a role in causing ''vataja chhardi''. ([[Sutra Sthana]] 1/59) ''doshas'' conjugate (''sammurchhana'' ([[Sutra Sthana]] 18/46) with a particular organ (''mahasrotas, amashaya, marma'' (vital organ), ''urdhwabhaga'' (upper trunk, etc) as ''dushyas'' (affected ''dhatus'') to cause ''vataja chhardi'' (as ''utkshepana'' (upward movement), ''adhahkshepana'' (downward movement), etc are the ''karmas'' (actions) of ''vayu'')-(7-9).

===== ''Pittaja chhardi'' =====

==== ''Pittaja chhardi'' ====

''Nidanas'' of ''pittaprakopaka'' increase ''pitta'' in nature <ref>Shastri Ambika Dutt, Sushruta Samhita, Sutra sthana 21/21 Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref>and cause provocation of ''gunas'' like ''ushna'' (hot), ''tikshna'' (sharp), ''snigdha'' (unctous), etc. ([[Sutra Sthana]] 1/60) in the body. This aggravated ''pitta'' joins (''sammurchhana'') with a particular organ (''rasayani, amashaya, marma, urdhwabhaga,'' etc) as ''dushyas''. The conjugation of ''dosha'' and ''dushya'' has affinity towards ''urdhwabhaga'' which results in ''pittaja chhardi'' (10-11).

===== ''Kaphaja chhardi'' =====

==== ''Kaphaja chhardi'' ====

''Nidanas'' of ''kaphaprakopaka'' increase ''kapha'' in nature which causes provocation of ''gunas'' like ''guru'' (heavyness), ''sheeta'' (coldness), ''manda'' (slowness), etc. ([[Sutra Sthana]] 1/60) in the body. This aggravated ''kapha'' joins (''sammurchhana'') with a particular organ (''urah'' (chest), ''shirah'' (head), ''rasayani marma, urdhwabhaga,'' etc.) as ''dushyas''. This amalgamation of ''dosha'' and ''dushya'' has affinity towards ''urdhwabhaga'' which results in ''kaphaja chhardi'' (12-13).

===== ''Sannipataja chhardi'' =====

==== ''Sannipataja chhardi'' ====

Intake of diet containing all ''rasas'' or tastes ideal but the intake of food with imbalances in ''rasas'' leads to the vitiation of ''tridoshas''(Ch.Su.26/90-101)and causes ''sannipataja chhardi'' which has varied manifestations covering broad signs of ''tridosha'' involvement ( verses 14-15).

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Excessive loss of any ''dhatu'' (''rasa-rakta-vasa'', etc) due to physical exercise or ''vamana vega'' (bouts) or arising out of any complications in the form of diseases like ''kasa'' (cough), ''shwasa'' (asthama), ''jwara'' (fever)<ref>Shastri Suderashan, Madhava Nidana of Madhavakara, 4th Edition, 1975, Chaukhamba Sanskrit Series, Varanasi, Ma. Ni 15</ref>, etc. are considered to be life threatening.

==== Treatment ====

=== Treatment ===

*''Langhana'' becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where ''doshas'' are in ''utklishtha'' stage and ready to be expelled out. ''Vamana'' is recommended when ''doshas'' are accumulated in ''amashaya'' or ''amashayottha'' (originating from stomach or upper gastro-intestinal tract). Whereas ''virechana'' is recommended in case of post-''amashayottha'' (in lower gastro-intestinal tract) accumulated ''doshas'', considering nearest route of ''samshodhana''. The choice of drugs should be done as per the ''doshanashakatva'' (capacity to subside the vitiated ''doshas'') ( verse 20).

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The selection of drugs plays very important role here. Most of the ''dravyas'' mentioned here are ''vichitrapratyarabhadha'' (extraordinary) in nature which achieve ''stambhana'' but would not increase ''vata''. The description about ''sarpiguda'' (a formulation), ''kalyanaka ghrita'' (a formulation), ''vrishya yoga'' (a formulation), ''avalehas'' (a formulation) etc. are the desired formulations for the management may have synergistic action.

==== Current clinical practice for management of chhardi (referred from Chikitsa Pradeep page 25) ====

=== Current clinical practice for management of chhardi (referred from Chikitsa Pradeep page 25) ===

{|class="wikitable"

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==== Further researches ====

=== Further researches ===

Many parenteral and oral medicines are available in conventional medical systems for management of dehydration and emergency conditions. The ayurveada drugs listed in this chaper need to be researched further for evaluating their efficacy specifically in conditions where the parenteral administration is contra-indicated and in case of drug intorerance.

~~=== Glossary ===~~

== References ==

~~#Āmāśayōtklēśabhavā (आमाशयोत्क्लेशभवा): originated from agitatied Doshas in stomach~~

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

#Āśuchipūtyamēdhyabībhatsagandhāśanadarśanaiśca (अशुचिपूत्यमेध्यबीभत्सगन्धाशन- दर्शनैश्च): contact with diet or sights having despicable, antagonistic unclean, putried, unholy and loathsome odor

~~#Brahmatapōdyutibhyāṁ (ब्रह्मतपोद्युतिभ्यां): lustre of divine knowledge and penance~~

~~#Chhardi (छर्दि): vomitting~~

~~#Chhardīnāṁ Praśamārthaṁ (छर्दीनां प्रशमार्थं ): management for the relief of vomiting~~

~~#Chhardiratipravr̥ddhā (छर्दिरतिप्रवृद्धा): incessantly vomiting~~

~~#Chhardyutthitānāṁ (छर्द्युत्थितानां): treatment of complications arising from vomiting~~

#Chikitsitāt Svachchikitsitaṁ (चिकित्सितात् स्वाच्चिकित्सितं): treatment should be done according to the lines suggested in respect of each of those ailments

~~#Chirapravr̥ttāsvanilāpahāni (चिरप्रवृत्तास्वनिलापहानि ): chronic vomiting~~

~~#Chūrṇāni Lihyān (चूर्णानि लिह्यान): powder with honey~~

~~#Dhātukṣayāddhr̥ddhimupaiti (धातुक्षयाद्धृद्धिमुपैति): loss of tiussue elements~~

#Dōṣarturōgāgnibalānyavēkṣya (दोषर्तुरोगाग्निबलान्यवेक्ष्य ): considering of preponderance of Dosas, season of occurring of the disease, digestive power and strength of patient

~~#Durbalastaṁ Śamanaiścikitsēt (दुर्बलस्तं शमनैश्चिकित्सेत्): weak patient should be treated with pacification therapy~~

~~#Dviṣṭapratīp (द्विष्टप्रतीप): mental disgust occasioned by sense~~

~~#Hitā Vihārāḥ (हिता विहाराः): healthy life style~~

~~#Hr̥tpārśvapīḍā (हृत्पार्श्वपीडा): pain in the cardiac region and sides of the chest~~

~~#Jvalantamagnyarkasamaprabhāvam (ज्वलन्तमग्न्यर्कसमप्रभावम्): brilliance like that of fire and the sun~~

~~#Kaphāmāśayaśōdhanārtham (कफामाशयशोधनार्थम्): to clean the seat of Kapha and Āmāshaya (stomach)~~

~~#Kaphāśayasthaṁ Tvatimātravr̥Ddhaṁ (कफाशयस्थं त्वतिमात्रवृद्धं): aggravated Pitta is located in Kapahasthana (chest/stomach)~~

#Kaphātmikāyāṁ Vamanaṁ Praśastaṁ (कफात्मिकायां वमनं प्रशस्तं):- Vamana (therapeutic emesis) is supposed to be the most suitable therapy in Kaphaja type

#Kāryāṇyupastambhanabr̥ṁhaṇāni (कार्याण्युपस्तम्भनबृंहणानि): medications that are bulk promoting, anti-Vāta Upastambhana (anti-diarrhoeal) and Brimhana (nutritive)

~~#Kāsasvarabhēdatōdaiḥ (कासस्वरभेदतोदैः): cough, hoarseness of voice and pricking pain~~

~~#Kr̥cchrēṇa Cālpaṁ Mahatā (कृच्छ्रेण चाल्पं महता): vomiting urge is forceful, but the patient vomits only small quantity with pain~~

~~#Kṣīṇasya (क्षीणस्य ): emaciated~~

~~#Laṅghanamēva (लङ्घनमेव): fasting therapy~~

~~#Lōkaprasiddhāḥ Śrutayō Vayasyāḥ (लोकप्रसिद्धाः श्रुतयो वयस्याः): Popular legends and stories and congenial companions~~

~~#Manōbhighātē (मनोभिघाते): mental disgust~~

~~#Manōnukūlā (मनोनुकूला): pleasing and conforting~~

~~#Marma Prapīḍayaṁ (मर्म प्रपीडयं): afflicting the Marma (vital organs),~~

~~#Mukhaśōṣa (मुखशोष): dryness of mouth~~

~~#Mukhaśōṣa (मुखशोष): dryness of the mouth~~

~~#Mūrcchā (मूर्च्छा): unconsciousness~~

~~#Mūrdhanābhyarti (मूर्धनाभ्यर्ति): Pain in the head and umbilical region~~

~~#Mūrdhatālvakṣisantāpa (मूर्धताल्वक्षिसन्ताप):- burning sensation in head, palates and eyes~~

#Nayantyadhō Dōṣamudīrṇamūrdhvam (नयन्त्यधो दोषमुदीर्णमूर्ध्वम् ): downward movement of the aggravated Doshas that are impelled to move upwards

~~#Pavanō'pyavaśyaṁ (पवनोऽप्यवश्यं): Vāta invariably gets agrevated~~

~~#Pipāsā (पिपासा): thirst~~

~~#Pittamudīrṇavēgam (पित्तमुदीर्णवेगम् ): the aggravated Pitta spreads rapidly~~

#Pittātmikāyāmanulōmanārthaṁ (पित्तात्मिकायामनुलोमनार्थं): patient of Paittika Chhardi should be given laxatives to cause downward movement of the morbid matter

~~#Prapīḍya Marmōrdhva (प्रपीड्य मर्मोर्ध्व): stresses vital organs of upper parts of the body~~

~~#Pravadantyasādhyāṁ (प्रवदन्त्यसाध्यां): only curable types~~

~~#Pr̥thaktriprabhavāścatasrō (पृथक्त्रिप्रभवाश्चतस्रो): kinds each of which is caused by a single morbid humor~~

#Rasairmanōjñairlaghubhirviśuṣkairbhakṣyaiḥ (रसैर्मनोज्ञैर्लघुभिर्विशुष्कैर्भक्ष्यैः): delicious soups and light as well as dry food articles for diet

~~#Rasāyanībhirvisr̥taṁ (रसायनीभिर्विसृतं ): spreads through the Rasāyani (channels)~~

~~#Sabhōjyairvividhaiśca Pānaiḥ (सभोज्यैर्विविधैश्च पानैः): along with various kinds of drinks~~

~~#Sacandrikāṁ (सचन्द्रिकां): vomitus that contains Chandrika (circular patches with variegated colour like that at the top of pea-cock feather)~~

~~#Samaśnataḥ (समश्नतः): constant indulgence in diet/eating nixture of wholesome and unwholesome food~~

~~#Samāśvāsanaharṣaṇāni (समाश्वासनहर्षणानि ): counseling and encouraging~~

~~#Samavarṇagandhaṁ (समवर्णगन्धं): having similar colour and odour~~

~~#Samāvr̥tya (समावृत्य): collectively~~

#Saphēna Vicchinnakr̥ṣṇaṁ Tanukaṁ Kaṣāyam (सफेनं विच्छिन्नकृष्णं तनुकं कषायम् ): frothy, scattered, black, thin and astringent vomitus

~~#Sarvāśchardyō (सर्वाश्छर्द्यो): all the varieties of vomiting~~

~~#Sarvē Prakōpaṁ Yugapat (सर्वे प्रकोपं युगपत्): all the three Dosas get simultaneously aggravated~~

~~#Śōka (शोक): grief~~

~~#Śōṇitapūyayuktā (शोणितपूययुक्ता): vomitus that contains blood and pus~~

~~#Sōpadravā (सोपद्रवा): associated with complications~~

~~#Svapnādibhiścaiva (स्वप्नादिभिश्चैव ): sense of sleep~~

#Tāṁ Sannipāta'pi Samasya Buddhyā (तां सन्निपातेऽपि समस्य बुद्ध्या): Sannipatika Chhardi patient should carefully be examined for the relative preponderance of involved Dosas

~~#Tamōbhramārtaḥ (तमोभ्रमार्तः): feeling as entering into darkness~~

~~#Tīkṣṇauṣadha (तीक्ष्णौषध): sharp medicine~~

~~#Udgāraśabdaprabalaṁ (उद्गारशब्दप्रबलं): eructation with loud sound~~

~~#Utklēśya (उत्क्लेश्य ): the morbid Doshas which are about to come out~~

~~#Utsannadōṣasya Samācitaṁ (उत्सन्नदोषस्य समाचितं): morbid matter from the Kostha (gastro-intestinal tract) gets provoked~~

#Vallīphalādyairvamanaṁ Pibēdvā (वल्लीफलाद्यैर्वमनं पिबेद्वा): emetic therapy prepared of the drugs of the Valliphala (group of cucurbitaceous fruits)

~~#Vamiprasaṅgāt (वमिप्रसङ्गात्): persistant vomiting~~

~~#Vāyuḥ Srōtāṁsi Saṁrudhya (वायुः स्रोतांसि संरुध्य): occlusion of channels by morbid Vāta~~

~~#Viṭsvēdamūtrāmbuvahāni (विट्स्वेदमूत्राम्बुवहानि ): channels carrying faeces, sweat, urine and body fluids~~

~~#Vyākhyā (व्याख्या): explanation~~

~~#Vyāyāma (व्यायाम): physical excercise~~

~~#Yaiṣā Pr̥thaktvēna Mayā Kriyōktā (यैषा पृथक्त्वेन मया क्रियोक्ता ): judicious synthesis of the separate lines of treatment~~

=== References ===

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 After explaining the [[Atisara Chikitsa]] (treatment of diarrhea), there is description of [[Chhardi Chikitsa]]. The word ''chhardi'' is derived from the root ''chhard vamane''. The word ''chhad'' means gripping (''avritta'' or ''achhadana'') and ''ard'' means pain (''peedha'')<ref>Shastri Suderashan, Madhava Nidana of Madhavakara, Chardi -15 Madhukosh Tika. 4th Edition, 1975, Chaukhamba Sanskrit Series, Varanasi</ref>.  The other words like ''chhardah, chhardana, chhardi, chhardika,'' etc. are considered as the synonyms of ''chhardi''.<ref>Charaka chandrika Hindi Vyakhya- Visheshs Vaktavya by Bramhanand Tripathi on Charaka Samhita Chikitsa Sthana 20/1-1</ref>  The words ''chhardi'' and ''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 purification therapies of [[Panchakarma]] (five purification procedures in [[Ayurveda]]) where the physician intends to induce vomiting to expel out vitiated ''kapha'' and ''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.<ref>Shastri Ambika Dutt, Sushruta Samhita, Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi, Susruta Shareera 5/ 10</ref>  The one is adhomārga (excretion through downword channel) for which the description of ''atisara'' is given in previous chapter and the other one is ''urdhvabhaga'' (excretion through upward channel) where the description of ''chhardi'' is discussed here.  ''Chhardi'' comes under the category of ''koshtha rasayani shrita vyadhi'' (diseases of GI tract)  whose roots are in ''mahasrotas'' (GI tract) and ''manovaha'' (mind) ''srotasa''. The ''amashaya'' and ''rasayani'' are the involved ''avayavas'' (organs) in this disease.<ref>Charaka Samhita:  [[Ayurveda]] Dipika Commentry by Chakrapani Chaukhamba Sankshrit Series, Varanasi Vimanasthana 5/7-3.</ref>  The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological counseling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors.<ref>Charaka Samhita:  [[Ayurveda]] Dipika Commentry by Chakrapani Chaukhamba Sankshrit Series, Varanasi, Vimana sthana 5/25.</ref>  The curative treatment focuses on pharmacotherapy depending upon ''dosha'' dominance and mild ''samshodhana'' (expelling out the vitiated ''dosha'').
-=== Sanskrit Text, Transliteration and English Translation ===
+== Sanskrit Text, Transliteration and English Translation ==
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-We shall now expound the chapter entitled “the management of ''chhardi'' (vomiting)”. Thus, said Lord Atreya. [1-2]
+Now we shall expound the chapter "Chhardi chikitsa" (Management of vomiting). Thus said Lord Atreya. [1-2]
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 Agnivesha the disciple asked Punarvasu, the illustratious son of Atri, who was engrossed in  the thinking of the well-being of humanity and who was dazzling with luster of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the well-being of all living beings [3]
-==== Queries by Agnivesha ====
+=== Queries by Agnivesha ===
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 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]
-==== Classification and premonitory symptoms ====
+=== Classification and premonitory symptoms ===
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 The premonitory signs and symptoms of ''chhardi'' (vomiting) are nausea, excessive salivation and aversion to food [6]
-==== ''Vataja chhardi'' ====
+=== ''Vataja chhardi'' ===
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 #The patient feels miserable [7-9]
-==== ''Pittaja chhardi'' ====
+=== ''Pittaja chhardi'' ===
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 #Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation [10-11]
-==== ''Kaphaja chhardi'' ====
+=== ''Kaphaja chhardi'' ===
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 #Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain [12-13]
-==== ''Tridoshaja chhardi'' ====
+=== ''Tridoshaja chhardi'' ===
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 #Vomitus is salty, sour, blue, dense, hot and reddish [14-15]
-==== Bad prognostic symptoms ====
+=== Bad prognostic symptoms ===
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 Such a patient succumbs to death quickly [16-17]
-==== ''Dvishtharthasamyogaja chhardi'' ====
+=== ''Dvishtharthasamyogaja chhardi'' ===
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 As a result of mental disgust occasioned by senses contact with despicable, antagonistic, unclean, putrid, unholy and loathsome odors, diet or sights, the ''chhardi''(vomiting) is known as vomiting induced by contact with hateful things [18]
-==== Symptoms of incurable ''chhardi'' ====
+=== Symptoms of incurable ''chhardi'' ===
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 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 color) is incurable. The physician should treat only curable types that are not associated with complications [19]
-==== Principles of treatment ====
+=== Principles of treatment ===
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 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]
-==== Treatment of ''vataja chhardi'' ====
+=== Treatment of ''vataja chhardi'' ===
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 #The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour ''dadima'' (pomegranate/Punica granatum) [23-25]
-==== Treatment of ''pittaja chhardi'' ====
+=== Treatment of ''pittaja chhardi'' ===
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 ##Powder of ''murva'' (Marsdenia tenacissima / sansevieria roxburghiana) along with ''tandulodaka'' (rice-water)[26-33]
-==== Treatment of ''kaphaja chhardi'' ====
+=== Treatment of ''kaphaja chhardi'' ===
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 #''Maricha'' (black pepper/Piper nigrum) with honey [34-39]
-==== Treatment of ''sannipatika chhardi'' ====
+=== Treatment of ''sannipatika chhardi'' ===
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 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 occurred, the stage of the disease and the power of digestion of the patient [40]
-==== Treatment of ''dvishtarathasamyogaja (manobhighataja) chhardi'' ====
+=== Treatment of ''dvishtarathasamyogaja (manobhighataja) chhardi'' ===
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 #In general, whatever odor, 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]
-==== Treatment of complications ====
+=== Treatment of complications ===
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 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 [[Siddhi Sthana]] (6/52-56) for excessive purgation should be carried out [45]
-==== Treatment of chronic ''chhardi'' ====
+=== Treatment of chronic ''chhardi'' ===
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 ''Sarpirguda'' (Chikitsa 11:50-77), ''kshira-vidhi'' (milk boiled by adding ''vata''-alleviating drugs), ''kalyanaka-ghrita'' (Chikitsa 9:33-42), ''tryushana-ghrita'' (Chikitsa 18:39-42), ''jivaniya-ghrita'' (Chikitsa 29:55-57), ''vrishya'' (virilific) recipes, ''mamsarasa'' (meat soup) and ''lehya'' like ''chyavanprasha'' (linctuses) [46-47]
-==== Summary ====
+=== Summary ===
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 == Vidhi Vimarsha (Applied Inferences ) ==
-==== Pathogenesis ====
+=== Pathogenesis ===
 ''Mahasrotus'' (gastrointestinal tract) has two parts, upper part is ''annavaha srotus'' and lower part is ''purishvaha srotus''. ''Atisara'' is related to ''purishvaha srotus'' and ''chhardi'' is to ''annavaha srotus''. Etiological factors of ''chhardi'' are irritating food and practices to ''amashaya'' (stomach). They are ''vata'' vitiating, impairing ''annavaha srotus''. Even before the digestion process starts the food comes out because of action of ''urdhvavata'' or ''udanavata'', therefore, there is no involvement of ''agni''. ''Chhardi'' is a defense mechanism to expel the toxins out of the stomach. There is vacuum created by repeated expulsion of stomach contents and ''rasayinis''(villi) instead of their normal function of absorption, they start secreting body fluids into to the stomach.
-==== Types of ''chhardi'' ====
+=== Types of ''chhardi'' ===
 Diseases are classified according to the dominance of ''doshas''-involved and their mutual amalgamation, which are of four types. The 5th type of ''chhardi'' (''dwishtarthayoga'') is due to aversive food related to the involvement of ''panchagyanendriyas'' (five sense organs) and their ''vishaya upalabdhi'' (Cha su 1/54) (perceivance of senses). The contact through ''rupa'' (visible) or ''rasa'' (taste) or ''gandha'' (smell) or ''sparsha'' (touch) or ''shabda'' (hear) or in combination with each other, stimulates body mechanism which results in ''dwistarthayoga chhardi'' (vomiting due to aversion). One cannot exclude the role of ''manah'' (mind) as predisposing factor in causing ''dwistarthayoga chhardi''.
@@ Line 871: / Line 871: @@
 ''Douhruda janita'' (pregnancy induced vomitting), ''satmya prakopaja'' (vomiting due to inadequacy of substances) and ''krimija'' (vomiting due to microbial infection) type of ''chhardi'' are other causes of ''chhardi''.<ref>Shastri Ambika Dutt, Sushruta Samhita, Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi</ref>
-===== ''Vataja chhardi'' =====
+==== ''Vataja chhardi'' ====
 There are many factors that increase ''vata'' in the ''sharira'' .<ref>Shastri Ambika Dutt, Sushruta Samhita, Sutra sthana 21/19. Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref> Particular ''ahara'' (food), ''vihara'' (lifestyle) and mental factors increase ''vata'' and its ''gunas'' (properties). This aggravation of ''vata gunas'' like ''rukshata'' (dryness), ''laghuta'' (lightness), etc. plays a role in causing ''vataja chhardi''. ([[Sutra Sthana]] 1/59) ''doshas'' conjugate (''sammurchhana'' ([[Sutra Sthana]] 18/46) with a particular organ (''mahasrotas, amashaya, marma'' (vital organ), ''urdhwabhaga'' (upper trunk, etc) as ''dushyas'' (affected ''dhatus'') to cause ''vataja chhardi'' (as ''utkshepana'' (upward movement), ''adhahkshepana'' (downward movement), etc are the ''karmas'' (actions) of ''vayu'')-(7-9).
-===== ''Pittaja chhardi'' =====
+==== ''Pittaja chhardi'' ====
 ''Nidanas'' of ''pittaprakopaka'' increase ''pitta'' in nature <ref>Shastri Ambika Dutt, Sushruta Samhita, Sutra sthana 21/21 Hindi commentary by Kaviraj 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref>and cause provocation of ''gunas'' like ''ushna'' (hot), ''tikshna'' (sharp), ''snigdha'' (unctous), etc. ([[Sutra Sthana]] 1/60) in the body. This aggravated ''pitta'' joins (''sammurchhana'') with a particular organ (''rasayani, amashaya, marma, urdhwabhaga,'' etc) as ''dushyas''. The conjugation of ''dosha'' and ''dushya'' has affinity towards ''urdhwabhaga'' which results in ''pittaja chhardi'' (10-11).
-===== ''Kaphaja chhardi'' =====
+==== ''Kaphaja chhardi'' ====
 ''Nidanas'' of ''kaphaprakopaka'' increase ''kapha'' in nature  which causes provocation of ''gunas'' like ''guru'' (heavyness), ''sheeta'' (coldness), ''manda'' (slowness), etc. ([[Sutra Sthana]] 1/60) in the body. This aggravated ''kapha'' joins (''sammurchhana'') with a particular organ (''urah'' (chest), ''shirah'' (head), ''rasayani marma, urdhwabhaga,'' etc.) as ''dushyas''. This amalgamation of ''dosha'' and ''dushya'' has affinity towards ''urdhwabhaga'' which results in ''kaphaja chhardi'' (12-13).
-===== ''Sannipataja chhardi'' =====
+==== ''Sannipataja chhardi'' ====
 Intake of diet containing all ''rasas'' or tastes ideal but the intake of food with imbalances in ''rasas'' leads to the vitiation of ''tridoshas''(Ch.Su.26/90-101)and causes ''sannipataja chhardi'' which has varied manifestations covering broad signs of ''tridosha'' involvement ( verses 14-15).
@@ Line 891: / Line 891: @@
 Excessive loss of any ''dhatu'' (''rasa-rakta-vasa'', etc) due to physical exercise or ''vamana vega'' (bouts) or arising out of any complications in the form of diseases like ''kasa'' (cough), ''shwasa'' (asthama), ''jwara'' (fever)<ref>Shastri Suderashan, Madhava Nidana of Madhavakara, 4th Edition, 1975, Chaukhamba Sanskrit Series, Varanasi, Ma. Ni 15</ref>, etc. are considered to be life threatening.
-==== Treatment ====
+=== Treatment ===
 *''Langhana'' becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where ''doshas'' are in ''utklishtha'' stage and ready to be expelled out. ''Vamana'' is recommended when ''doshas'' are accumulated in ''amashaya'' or ''amashayottha'' (originating from stomach or upper gastro-intestinal tract). Whereas ''virechana'' is recommended in case of post-''amashayottha'' (in lower gastro-intestinal tract) accumulated ''doshas'', considering nearest route of ''samshodhana''. The choice of drugs should be done as per the ''doshanashakatva'' (capacity to subside the vitiated ''doshas'') ( verse 20).
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 The selection of drugs plays very important role here. Most of the ''dravyas'' mentioned here are ''vichitrapratyarabhadha'' (extraordinary) in nature which achieve ''stambhana'' but would not increase ''vata''. The description about ''sarpiguda'' (a formulation), ''kalyanaka ghrita'' (a formulation), ''vrishya yoga'' (a formulation), ''avalehas'' (a formulation) etc. are the desired formulations for the management may have synergistic action.
-==== Current clinical practice for management of chhardi (referred from Chikitsa Pradeep page 25) ====
+=== Current clinical practice for management of chhardi (referred from Chikitsa Pradeep page 25) ===
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-==== Further researches ====
+=== Further researches ===
 Many parenteral and oral medicines are available in conventional medical systems for management of dehydration and emergency conditions. The ayurveada drugs listed in this chaper need to be researched further for evaluating their efficacy specifically in conditions where the parenteral administration is contra-indicated and in case of drug intorerance.
-=== Glossary ===
+== References ==
-#Āmāśayōtklēśabhavā  (आमाशयोत्क्लेशभवा): originated from agitatied Doshas in stomach
-#Āmāśayōtklēśakr̥tāṁ (आमाशयोत्क्लेशकृतां ): morbid humor which are agitating Amasaya (stomach) and likely to come out
-#Āśuchipūtyamēdhyabībhatsagandhāśanadarśanaiśca (अशुचिपूत्यमेध्यबीभत्सगन्धाशन- दर्शनैश्च): contact with diet or sights having despicable, antagonistic unclean, putried, unholy and loathsome odor
-#Brahmatapōdyutibhyāṁ (ब्रह्मतपोद्युतिभ्यां): lustre of divine knowledge and penance
-#Chhardi (छर्दि): vomitting
-#Chhardīnāṁ Praśamārthaṁ (छर्दीनां प्रशमार्थं ): management for the relief of vomiting
-#Chhardiratipravr̥ddhā (छर्दिरतिप्रवृद्धा): incessantly vomiting
-#Chhardyutthitānāṁ (छर्द्युत्थितानां): treatment of complications arising from vomiting
-#Chikitsitāt Svachchikitsitaṁ (चिकित्सितात् स्वाच्चिकित्सितं): treatment should be done according to the lines suggested in respect of each of those ailments
-#Chirapravr̥ttāsvanilāpahāni (चिरप्रवृत्तास्वनिलापहानि ): chronic vomiting
-#Chūrṇāni Lihyān (चूर्णानि लिह्यान): powder with honey
-#Dhātukṣayāddhr̥ddhimupaiti (धातुक्षयाद्धृद्धिमुपैति):  loss of tiussue elements
-#Dōṣarturōgāgnibalānyavēkṣya (दोषर्तुरोगाग्निबलान्यवेक्ष्य ): considering of preponderance of Dosas, season of occurring of the disease, digestive power and strength of patient
-#Durbalastaṁ Śamanaiścikitsēt (दुर्बलस्तं शमनैश्चिकित्सेत्): weak patient should be treated with pacification therapy
-#Dviṣṭapratīp (द्विष्टप्रतीप): mental disgust occasioned by sense
-#Hitā Vihārāḥ (हिता विहाराः): healthy life style
-#Hr̥tpārśvapīḍā (हृत्पार्श्वपीडा): pain in the cardiac region and sides of the chest
-#Jvalantamagnyarkasamaprabhāvam (ज्वलन्तमग्न्यर्कसमप्रभावम्): brilliance like that of fire and the sun
-#Kaphāmāśayaśōdhanārtham (कफामाशयशोधनार्थम्): to clean the seat of Kapha and Āmāshaya (stomach)
-#Kaphāśayasthaṁ Tvatimātravr̥Ddhaṁ (कफाशयस्थं त्वतिमात्रवृद्धं): aggravated Pitta is located in Kapahasthana (chest/stomach)
-#Kaphātmikāyāṁ Vamanaṁ Praśastaṁ (कफात्मिकायां वमनं प्रशस्तं):- Vamana (therapeutic emesis) is supposed to be the most suitable therapy in Kaphaja type
-#Kāryāṇyupastambhanabr̥ṁhaṇāni (कार्याण्युपस्तम्भनबृंहणानि): medications that are bulk promoting, anti-Vāta Upastambhana (anti-diarrhoeal) and Brimhana  (nutritive)
-#Kāsasvarabhēdatōdaiḥ (कासस्वरभेदतोदैः): cough, hoarseness of voice and pricking pain
-#Kr̥cchrēṇa Cālpaṁ Mahatā  (कृच्छ्रेण चाल्पं महता): vomiting urge is forceful, but the patient vomits only small quantity with pain
-#Kṣīṇasya (क्षीणस्य ): emaciated
-#Laṅghanamēva (लङ्घनमेव): fasting therapy
-#Lōkaprasiddhāḥ Śrutayō Vayasyāḥ (लोकप्रसिद्धाः श्रुतयो वयस्याः): Popular legends and stories and congenial companions
-#Manōbhighātē (मनोभिघाते): mental disgust
-#Manōnukūlā (मनोनुकूला): pleasing and conforting
-#Marma Prapīḍayaṁ (मर्म प्रपीडयं): afflicting the Marma (vital organs),
-#Mukhaśōṣa (मुखशोष): dryness of mouth
-#Mukhaśōṣa (मुखशोष): dryness of the mouth
-#Mūrcchā (मूर्च्छा): unconsciousness
-#Mūrdhanābhyarti (मूर्धनाभ्यर्ति): Pain in the head and umbilical region
-#Mūrdhatālvakṣisantāpa (मूर्धताल्वक्षिसन्ताप):- burning sensation in head, palates and eyes
-#Nayantyadhō Dōṣamudīrṇamūrdhvam (नयन्त्यधो दोषमुदीर्णमूर्ध्वम् ): downward movement of the aggravated Doshas that are impelled to move upwards
-#Pavanō'pyavaśyaṁ (पवनोऽप्यवश्यं): Vāta invariably gets agrevated
-#Pipāsā (पिपासा): thirst
-#Pittamudīrṇavēgam (पित्तमुदीर्णवेगम् ): the aggravated Pitta spreads rapidly
-#Pittātmikāyāmanulōmanārthaṁ (पित्तात्मिकायामनुलोमनार्थं): patient of Paittika Chhardi should be given laxatives to cause downward movement of the morbid matter
-#Prapīḍya Marmōrdhva (प्रपीड्य मर्मोर्ध्व): stresses vital organs of upper parts of the body
-#Pravadantyasādhyāṁ (प्रवदन्त्यसाध्यां): only curable types
-#Pr̥thaktriprabhavāścatasrō (पृथक्त्रिप्रभवाश्चतस्रो): kinds each of which is caused by a single morbid humor
-#Rasairmanōjñairlaghubhirviśuṣkairbhakṣyaiḥ (रसैर्मनोज्ञैर्लघुभिर्विशुष्कैर्भक्ष्यैः): delicious soups and light as well as dry food articles for diet
-#Rasāyanībhirvisr̥taṁ (रसायनीभिर्विसृतं ): spreads through the Rasāyani (channels)
-#Sabhōjyairvividhaiśca Pānaiḥ (सभोज्यैर्विविधैश्च पानैः): along with various kinds of drinks
-#Sacandrikāṁ (सचन्द्रिकां): vomitus that contains Chandrika (circular patches with variegated colour like that at the top of pea-cock feather)
-#Samaśnataḥ (समश्नतः): constant indulgence in diet/eating nixture of wholesome and unwholesome food
-#Samāśvāsanaharṣaṇāni (समाश्वासनहर्षणानि ): counseling and encouraging
-#Samavarṇagandhaṁ (समवर्णगन्धं): having similar colour and odour
-#Samāvr̥tya  (समावृत्य): collectively
-#Saphēna  Vicchinnakr̥ṣṇaṁ Tanukaṁ Kaṣāyam (सफेनं विच्छिन्नकृष्णं तनुकं कषायम् ): frothy, scattered, black, thin and astringent vomitus
-#Sarvāśchardyō (सर्वाश्छर्द्यो): all the varieties of vomiting
-#Sarvē Prakōpaṁ Yugapat (सर्वे प्रकोपं युगपत्): all the three Dosas get simultaneously aggravated
-#Śōka (शोक): grief
-#Śōṇitapūyayuktā (शोणितपूययुक्ता): vomitus that contains blood and pus
-#Sōpadravā (सोपद्रवा): associated with complications
-#Svapnādibhiścaiva (स्वप्नादिभिश्चैव ): sense of sleep
-#Tāṁ Sannipāta'pi Samasya Buddhyā (तां सन्निपातेऽपि समस्य बुद्ध्या): Sannipatika Chhardi patient should carefully be examined for the relative preponderance of involved Dosas
-#Tamōbhramārtaḥ (तमोभ्रमार्तः): feeling as entering into darkness
-#Tīkṣṇauṣadha (तीक्ष्णौषध): sharp medicine
-#Udgāraśabdaprabalaṁ (उद्गारशब्दप्रबलं): eructation with loud sound
-#Utklēśya  (उत्क्लेश्य ): the morbid Doshas which are about to come out
-#Utsannadōṣasya Samācitaṁ (उत्सन्नदोषस्य समाचितं): morbid matter from the Kostha (gastro-intestinal tract) gets provoked
-#Vallīphalādyairvamanaṁ Pibēdvā (वल्लीफलाद्यैर्वमनं पिबेद्वा): emetic therapy prepared of the drugs of the Valliphala (group of cucurbitaceous fruits)
-#Vamiprasaṅgāt (वमिप्रसङ्गात्): persistant vomiting
-#Vāyuḥ Srōtāṁsi Saṁrudhya (वायुः स्रोतांसि संरुध्य): occlusion of channels by morbid Vāta
-#Viṭsvēdamūtrāmbuvahāni (विट्स्वेदमूत्राम्बुवहानि ): channels carrying faeces, sweat, urine and body fluids
-#Vyākhyā (व्याख्या): explanation
-#Vyāyāma (व्यायाम): physical excercise
-#Yaiṣā Pr̥thaktvēna Mayā Kriyōktā (यैषा पृथक्त्वेन मया क्रियोक्ता ): judicious synthesis of the separate lines of treatment
-=== References ===
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