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<big>'''Abstract </big>'''

<big>'''Abstract </big>'''

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''Chhardi'' (vomiting), is a common gastrointestinal disorder characterized by bouts of vomiting, nausea, pain and black outs. The causative factors of ''chhardi'' can be categorized under dietary, lifestyle and psychological factors. Dietary factors include excessive ''upavasa'' (starvation), over intake of ''vidahi'' or ''snigdha-guru dravya'' (drugs which are very acrid, unctuous and heavy to digest), etc. Lifestyle aspects include excessive exercise, ''divasvapna'' (day sleep), etc. whereas the psychological stressors like excess worries, grief, anger, fear can precipitate it. ''Amashaya'' (stomach) and ''rasayani'' (channels) are the sites of origin of ''chhardi''. Vitiated ''doshas'' accumulate in ''amashaya'' and ''rasayani'' and are thrown out forcefully from the upper part of body causing ''pida'' (pain) to ''urdhva avayavas'' (organs situated above supraclavicular region). Comprehensive management includes avoidance of etiological factors with pharmacological treatment through medicament as well as non-pharmacological methods.  

''Chhardi'' (vomiting), is a common gastrointestinal disorder characterized by bouts of vomiting, nausea, pain and black outs. The causative factors of ''chhardi'' can be categorized under dietary, lifestyle and psychological factors. Dietary factors include excessive ''upavasa'' (starvation), over intake of ''vidahi'' or ''snigdha-guru dravya'' (drugs which are very acrid, unctuous and heavy to digest), etc. Lifestyle aspects include excessive exercise, ''divasvapna'' (day sleep), etc. whereas the psychological stressors like excess worries, grief, anger, fear can precipitate it. ''Amashaya'' (stomach) and ''rasayani'' (channels) are the sites of origin of ''chhardi''. Vitiated [[dosha]] accumulate in ''amashaya'' and ''rasayani'' and are thrown out forcefully from the upper part of body causing ''pida'' (pain) to ''urdhva avayavas'' (organs situated above supraclavicular region). Comprehensive management includes avoidance of etiological factors with pharmacological treatment through medicament as well as non-pharmacological methods.  

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'''Keywords''': ''Chhardi chikitsa, chhardi,'' vomiting, emesis

'''Keywords''': ''Chhardi chikitsa, chhardi,'' vomiting, emesis

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

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

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

=== Treatment of [[kapha]]ja chhardi ===

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''Vamana'' (therapeutic emesis) is supposed to be the most suitable therapy in ''kaphaja'' type of ''chhardi'' (vomiting). In order to clean the seat of ''kapha'' and ''amashaya'', the patient should be given the decoction of ''pippali, sarsapa'' (yellow sarson/Indian colza/Brassica campestris) and ''nimba'' (neem tree/Margosa/Indian lilac/Azadirachta indica) added with powder of ''pinditaka'' (madanaphala/emetic nut/bushy gardenia/Randia dumetorum) and ''saindhava'' (rock-salt).  

''Vamana'' (therapeutic emesis) is supposed to be the most suitable therapy in [[kapha]]ja type of ''chhardi'' (vomiting). In order to clean the seat of [[kapha]] and ''amashaya'', the patient should be given the decoction of ''pippali, sarsapa'' (yellow sarson/Indian colza/Brassica campestris) and ''nimba'' (neem tree/Margosa/Indian lilac/Azadirachta indica) added with powder of ''pinditaka'' (madanaphala/emetic nut/bushy gardenia/Randia dumetorum) and ''saindhava'' (rock-salt).  

The patient should be given old wheat, rice and barley along with  

The patient should be given old wheat, rice and barley along with  

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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]

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

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

   

   

The following recipes are useful in chronic type of vomiting.

The following recipes are useful in chronic type of vomiting.

   

   

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

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

=== Summary ===

=== Summary ===

== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

*''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).

*''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 [[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.  

*Mind and sense objects play significant role in pathogenesis of ''chhardi'' due to exposure to unwholesome objects.   

*Mind and sense objects play significant role in pathogenesis of ''chhardi'' due to exposure to unwholesome objects.   

*The prognosis of ''chhardi'' depends upon strength of patient, bouts, presence of associated disorders and complications, contents of vomitus.  

*The prognosis of ''chhardi'' depends upon strength of patient, bouts, presence of associated disorders and complications, contents of vomitus.  

*All the types of vomiting are considered originating from the agitations of the ''doshas'' in the stomach. Therefore, fasting therapy is first principle of treatment. Purification therapies of ''kapha'' and ''pitta'' are administered to expel out vitiated ''doshas''. These therapies are contraindicated in cases of ''vata'' dominance. The choice of therapy depends upon strength of patient and type of vitiated ''dosha''.  

*All the types of vomiting are considered originating from the agitations of the [[dosha]] in the stomach. Therefore, fasting therapy is first principle of treatment. Purification therapies of [[kapha]] and [[pitta]] are administered to expel out vitiated [[dosha]]. These therapies are contraindicated in cases of [[vata]] dominance. The choice of therapy depends upon strength of patient and type of vitiated [[dosha]].  

*The drugs having nutritive properties, carminative, ''dosha'' pacifying actions are prescribed in the treatment of ''chhardi''.  

*The drugs having nutritive properties, carminative, [[dosha]] pacifying actions are prescribed in the treatment of ''chhardi''.  

*Sublingual, pleasant tasting linctus, mild purgative to open the channel to lower G I tract.

*Sublingual, pleasant tasting linctus, mild purgative to open the channel to lower G I tract.

*During initial stage of ''chhardi'', because of irritated stomach, anti-emetic treatment is not advised. Soothing, taste enhancing and nutritive liquid substances should be given. Mind diverting and entertaining activities are also advised.

*During initial stage of ''chhardi'', because of irritated stomach, anti-emetic treatment is not advised. Soothing, taste enhancing and nutritive liquid substances should be given. Mind diverting and entertaining activities are also advised.

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

*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, ''vata'' pacifying, ''upastambhana'' (astringents) and ''brimhana'' (nutritive) should be administered.

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

== Vidhi Vimarsha (Applied Inferences ) ==

== 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.  

''Mahasrotus'' (gastrointestinal tract) has two parts, upper part is ''annavaha srotus'' and lower part is [[purisha]]vaha srotus. ''Atisara'' is related to [[purisha]]vaha 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. Sa. [[Sutra Sthana]] 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''.  

Diseases are classified according to the dominance of [[dosha]]-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. Sa. [[Sutra Sthana]] 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''.  

''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>Sushruta. Sushruta Samhita . In: Kaviraj Shastri Ambika Dutt,  Editors. 5th ed. Varanasi: Chaukhambha Sanskrit Series;1982. p.?.</ref>  

''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>Sushruta. Sushruta Samhita . In: Kaviraj Shastri Ambika Dutt,  Editors. 5th ed. Varanasi: Chaukhambha Sanskrit Series;1982. p.?.</ref>  

==== ''Vataja chhardi'' ====   

==== [[Vata]]ja chhardi ====   

    

    

There are many factors that increase ''vata'' in the ''sharira'' .<ref> Sushruta. Sutra sthana cha 21  Vranaprashna Adhyaya verse 19. In: Kaviraj Shastri Ambika Dutt, editors, 5th Edition, Varanasi :  Chaukhamba Sanskrit Series,1982.</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''. [ Cha. Sa. [[Sutra Sthana]] 1/59] ''doshas'' conjugate (''sammurchhana'' [ Cha. Sa.[[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).

There are many factors that increase [[vata]] in the ''sharira'' .<ref> Sushruta. Sutra sthana cha 21  Vranaprashna Adhyaya verse 19. In: Kaviraj Shastri Ambika Dutt, editors, 5th Edition, Varanasi :  Chaukhamba Sanskrit Series,1982.</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 [[vata]]ja chhardi. [ Cha. Sa. [[Sutra Sthana]] 1/59] [[dosha]] conjugate (''sammurchhana'' [ Cha. Sa.[[Sutra Sthana]] 18/46] with a particular organ (''mahasrotas, amashaya, marma'' (vital organ), ''urdhwabhaga'' (upper trunk, etc) as ''dushyas'' (affected [[dhatu]]) to cause [[vata]]ja chhardi (as ''utkshepana'' (upward movement), ''adhahkshepana'' (downward movement), etc are the ''karmas'' (actions) of [[vayu]])-(7-9).

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

==== [[Pitta]]ja chhardi ====

''Nidanas'' of ''pittaprakopaka'' increase ''pitta'' in nature <ref> Sushruta, Sutra sthana c21/21 Hindi commentary by Kaviraj, Shastri Ambika Dutt, 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref>and cause provocation of ''gunas'' like ''ushna'' (hot), ''tikshna'' (sharp), ''snigdha'' (unctous), etc. [ Cha. Sa. [[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).

''Nidanas'' of [[pitta]]prakopaka increase [[pitta]] in nature <ref> Sushruta, Sutra sthana c21/21 Hindi commentary by Kaviraj, Shastri Ambika Dutt, 5th Edition, 1982, Chaukhamba Sanskrit Series, Varanasi </ref>and cause provocation of ''gunas'' like ''ushna'' (hot), ''tikshna'' (sharp), ''snigdha'' (unctous), etc. [ Cha. Sa. [[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 [[pitta]]ja chhardi (10-11).

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

==== [[Kapha]]ja chhardi ====

''Nidanas'' of ''kaphaprakopaka'' increase ''kapha'' in nature  which causes provocation of ''gunas'' like ''guru'' (heavyness), ''sheeta'' (coldness), ''manda'' (slowness), etc. [ Cha. Sa.[[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).

''Nidanas'' of [[kapha]]prakopaka increase [[kapha]] in nature  which causes provocation of [[guna]] like ''guru'' (heavyness), ''sheeta'' (coldness), ''manda'' (slowness), etc. [ Cha. Sa.[[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 [[kapha]]ja 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''[Cha.Sa.Sutra Sthana 26/90-101]and causes ''sannipataja chhardi'' which has varied manifestations covering broad signs of ''tridosha'' involvement ( verses 14-15).  

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

The ''sama-varna-gandha'' (color & smell similar to) of vomitus is due to conjugation with ''purisha'' (stool) and ''mutra'' (urine). This conjugation indicates involvement of multiple ''srotasas'' and have tendency towards ''asadhyata'' (incurable)[Cha. Sa. [[Vimana Sthana]] 5/3] ( verses 16-17).

The ''sama-varna-gandha'' (color & smell similar to) of vomitus is due to conjugation with [[purisha]] (stool) and [[mutra]] (urine). This conjugation indicates involvement of multiple ''srotasas'' and have tendency towards ''asadhyata'' (incurable)[Cha. Sa. [[Vimana Sthana]] 5/3] ( verses 16-17).

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>Madhavakara. Madhava Nidanam (Roga vinischaya) cha 15. Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</ref>, etc. are considered to be life threatening.

Excessive loss of any [[dhatu]] ([[rasa dhatu]]-[[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>Madhavakara. Madhava Nidanam (Roga vinischaya) cha 15. Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</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).   

*[[Langhana]] becomes the first line of treatment in ''chhardi'' as ''shamana chikitsa'' (pacificatory treatment). ''Samshodha'' can be preferred where [[dosha]] are in ''utklishtha'' stage and ready to be expelled out. [[Vamana]] is recommended when [[dosha]] 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 [[dosha]], considering nearest route of ''samshodhana''. The choice of drugs should be done as per the [[dosha]]nashakatva(capacity to subside the vitiated [[dosha]]) ( verse 20).   

*''Haritaki'' is known for its laxative action (''anulomaneeya''). It not only ''tridoshahara'' but also possesses many more qualities [Cha. Sa. [[Chikitsa Sthana]] 1/1/29-34] which can be helpful for ''samprapti vighanatana'' (breaking pathogenesis) in ''chhardi''.  The choice of ''hridaya dravya'' (liking to mind) is recommended in ''chhardi'' which should be given with ''madya'' (alcohol) and ''dugdha'' (cow milk) as an ''anupana''. ''Madya'' due to its specific ''guna'' [Cha.Sa. [[Sutra Sthana]] 27/ 193-195] results in quick absorption of the ''dravya'' and hastens the mode of action. ''Dugdha'' (cow milk) along with many other qualities [ Cha. Sa.[[Sutra Sthana]] 27/217-18] is naturally ''saraka'' (purgative) in nature which makes ''anulomana gati'' (natural movements) of ''vayu''.  

*''Haritaki'' is known for its laxative action (''anulomaneeya''). It not only ''tridoshahara'' but also possesses many more qualities [Cha. Sa. [[Chikitsa Sthana]] 1/1/29-34] which can be helpful for ''samprapti vighanatana'' (breaking pathogenesis) in ''chhardi''.  The choice of ''hridaya dravya'' (liking to mind) is recommended in ''chhardi'' which should be given with ''madya'' (alcohol) and ''dugdha'' (cow milk) as an ''anupana''. ''Madya'' due to its specific [[guna]][Cha.Sa. [[Sutra Sthana]] 27/ 193-195] results in quick absorption of the ''dravya'' and hastens the mode of action. ''Dugdha'' (cow milk) along with many other qualities [ Cha. Sa.[[Sutra Sthana]] 27/217-18] is naturally ''saraka'' (purgative) in nature which makes ''anulomana gati'' (natural movements) of [[vayu]].  

*As the ''doshas'' are already in ''utklishta avastha''(stage of aggravation or ready to come out), the choice of ''valliphala'' for ''vamana'' is considered as a ''mridu'' (mild). On the other hand if the patient is weak and cannot tolerate the ''vamana'' effort, ''shamana chikitsa'' should be considered. The treatment planning should be done keeping ''manah'' as center point. The diet or ''pathya'' should be a ''manah prasannakara'' (mind pleasing) [ Cha. Sa.[[Chikitsa Sthana]] 20/ 41-42] . It should be preferably ''mamsarasa'', dry food or liquid diet which is easily digestible ( verses 21-22).   

*As the [[dosha]] are already in ''utklishta avastha''(stage of aggravation or ready to come out), the choice of ''valliphala'' for [[vamana]] is considered as a ''mridu'' (mild). On the other hand if the patient is weak and cannot tolerate the [[vamana]] effort, ''shamana chikitsa'' should be considered. The treatment planning should be done keeping ''manah'' as center point. The diet or ''pathya'' should be a ''manah prasannakara'' (mind pleasing) [ Cha. Sa.[[Chikitsa Sthana]] 20/ 41-42] . It should be preferably ''mamsarasa'', dry food or liquid diet which is easily digestible ( verses 21-22).   

*In ''vataja chhardi'', ''laghu susanskrita mamsarasa'' (processed meat soup) is helpful in easy digestion and gives strength due to ''vata'' pacifying property. The ''yusha'' prepared from ''amlarasatmaka'' (sour taste) is not only ''vata'' pacifying but also stimulates the heart and leads to ''anulomana gati'' of ''vayu''. ''Ghrita'' as ''sanskaranuvartana'' (synergistically increases the properties of associated drugs) [ Cha. Sa.[[Sutra Sthana]] 27/231-32] and [ Cha. Sa. [[Sutra Sthana]] 13/13] can be beneficial in ''vataja hridroga''.  

*In [[vata]]ja chhardi, ''laghu susanskrita mamsarasa'' (processed meat soup) is helpful in easy digestion and gives strength due to [[vata]] pacifying property. The ''yusha'' prepared from ''amlarasatmaka'' (sour taste) is not only [[vata]] pacifying but also stimulates the heart and leads to ''anulomana gati'' of [[vayu]]. ''Ghrita'' as ''sanskaranuvartana'' (synergistically increases the properties of associated drugs) [ Cha. Sa.[[Sutra Sthana]] 27/231-32] and [ Cha. Sa. [[Sutra Sthana]] 13/13] can be beneficial in [[vata]]ja hridroga.  

*If the aggravated ''doshas'' are in distal part of ''amashaya'' (post- ''amashaya'') the nearest route to remove ''pitta'' is through ''virechana'' procedure. If the aggravated ''pitta'' is in ''amashaya'' then the nearest route to remove ''pitta'' is through ''vamana''. Both these procedures should be adopted in ''balavana rogi'' (physically strong patient) judiciously clubbing with proper ''samsarjana krama'' (protocol after purification procedure) to prevent aggravation of ''vata dosha''.  

*If the aggravated [[dosha]] are in distal part of ''amashaya'' (post- ''amashaya'') the nearest route to remove [[pitta]] is through [[virechana]] procedure. If the aggravated [[pitta]] is in ''amashaya'' then the nearest route to remove [[pitta]] is through [[vamana]]. Both these procedures should be adopted in ''balavana rogi'' (physically strong patient) judiciously clubbing with proper ''samsarjana krama'' (protocol after purification procedure) to prevent aggravation of [[vata]] [[dosha]].  

*For ''shamana'' treatment the selection of drugs should be ''pitta'' pacifying, ''manapralhadakara'' (mind pleasing) and ''balya'' (strength of patient) criteria. The mechanism of action of these drugs can be through ''hetu viparita'' (anti-etiology), ''vyadhi viparita'' (anti-disease) or ''hetu-vyadhi veeparita chikitsa'' (anti-cause & disease treatment).  

*For ''shamana'' treatment the selection of drugs should be [[pitta]] pacifying, ''manapralhadakara'' (mind pleasing) and ''balya'' (strength of patient) criteria. The mechanism of action of these drugs can be through ''hetu viparita'' (anti-etiology), ''vyadhi viparita'' (anti-disease) or ''hetu-vyadhi veeparita chikitsa'' (anti-cause & disease treatment).  

*For ''kaphaja chhardi chikitsa'', as the ''doshas'' are situated in ''kaphashaya'' (''amashaya / ura'') the nearest and ideal route is ''vamana''. The choice of ''dravyas'' for ''vamana'' should be ''kaphahara'' like ''pippali, sarshapa, nimbatoya, madanaphala,'' etc. The choice of treatment is based on aggravated ''dosha, sanchayasthana'' (place of accumulation), ''sannikrishtha marga'' (nearest route), ''dosha-shamaka guna'' of ''dravyas'', etc.  

*For [[kapha]]ja chhardi chikitsa, as the [[dosha]] are situated in ''kaphashaya'' (''amashaya / ura'') the nearest and ideal route is [[vamana]]. The choice of ''dravyas'' for [[vamana]] should be [[kapha]]hara'' like ''pippali, sarshapa, nimbatoya, madanaphala,'' etc. The choice of treatment is based on aggravated ''dosha, sanchayasthana'' (place of accumulation), ''sannikrishtha marga'' (nearest route), ''dosha-shamaka guna'' of ''dravyas'', etc.  

*Various types of ''yusha, ragashadava, panaka'' [ Cha. Sa. [[Sutra Sthana]] 27/279-281] are ''kaphahara, madhura-amlarasatmaka'' (sweet & sour), ''deepaneeya-pachaneeya'' (appetizer & digestant) in nature.  

*Various types of ''yusha, ragashadava, panaka'' [ Cha. Sa. [[Sutra Sthana]] 27/279-281] are ''kaphahara, madhura-amlarasatmaka'' (sweet & sour), ''deepaneeya-pachaneeya'' (appetizer & digestant) in nature.  

*For ''chhardinigrahana'' (anti-emetic group), the drugs should be ''kashaya rasatmaka'' (astringent taste), ''sheetaveerya'' (cool potency) and ''kaphaghna'' (''kapha'' alleviators) in nature. The ''manahshiladi yoga'' (a formulation) is considered to be ''vyadhiviparitarthakari'' (anti-disease) measures.

*For ''chhardinigrahana'' (anti-emetic group), the drugs should be ''kashaya rasatmaka'' (astringent taste), ''sheetaveerya'' (cool potency) and [[kapha]]ghna ([[kapha]] alleviators) in nature. The ''manahshiladi yoga'' (a formulation) is considered to be ''vyadhiviparitarthakari'' (anti-disease) measures.

*In case of ''dwistarthayoga chhardi'' (vomiting due to hate/ aversion), the treatment includes ''ashvasana'' (assurance), ''vartalapa'' (conversation), ''mitramandali'' (friend circle), ''mananusarena ahara-vihara'' (preferable food & lifestyle). By doing so one can easily overcome the disease for the time being and once the ''vegavastha'' (vomiting bouts) is overcome, actual conceptual treatment can be adopted.   

*In case of ''dwistarthayoga chhardi'' (vomiting due to hate/ aversion), the treatment includes ''ashvasana'' (assurance), ''vartalapa'' (conversation), ''mitramandali'' (friend circle), ''mananusarena ahara-vihara'' (preferable food & lifestyle). By doing so one can easily overcome the disease for the time being and once the ''vegavastha'' (vomiting bouts) is overcome, actual conceptual treatment can be adopted.   

*The ''vegakalina'' or chronic ''chhardi'', whether mild or severe,  involves constant irritation of involved body parts/systems which leads to poor nourishment of ''dhatus'' resulting in ''dhatuksheenata''. Such a long term ''dhatukshaya'' (loss of ''dhatus'') increases ''vata'' in the body. The management should be purely ''vatashamaka'' treatment especially ''stambhana'' (which restricts the ''vamana vega'') in combination with ''brimhana'' (nourishment to ''dhatus'').  

*The ''vegakalina'' or chronic ''chhardi'', whether mild or severe,  involves constant irritation of involved body parts/systems which leads to poor nourishment of [[dhatu]] resulting in [[dhatu]]ksheenata. Such a long term [[dhatu]]kshaya (loss of [[dhatu]]) increases [[vata]] in the body. The management should be purely [[vata]]shamaka treatment especially [[stambhana]] (which restricts the [[vamana]] vega) in combination with [[brimhana]] (nourishment to [[dhatu]]).  

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.

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) ===

!scope = "col"| ''Anupana''

!scope = "col"| ''Anupana''

|-

|-

| ''Vata'' dominant and ''vata-pitta'' dominant

| [[Vata]] dominant and [[vata]]-[[pitta]] dominant

| ''Shankha bhasma''

| ''Shankha bhasma''

| 60-120 mg

| 60-120 mg

| ''Nimbu Panaka'' (lemon water)

| ''Nimbu Panaka'' (lemon water)

|-

|-

| ''Pitta'' dominant

|[[Pitta]] dominant

| ''Sutashekhara kalpa''

| ''Sutashekhara kalpa''

| 500-1000 mg

| 500-1000 mg

| ''Dadimavaleha''

| ''Dadimavaleha''

|-

|-

| ''Kapha'' dominant

| [[Kapha]] dominant

| ''Mayu piccha mashi''

| ''Mayu piccha mashi''

| 1 - 3 gms

| 1 - 3 gms

| ''Ardrakavaleha''

| ''Ardrakavaleha''

|-

|-

| ''Tridoshaja''

| Tri[[dosha]]ja

| ''Brihad vata chintamani''

| ''Brihad vata chintamani''

| 50 - 100 mg

| 50 - 100 mg

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.

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.

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== References ==

== References ==