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Trishna Chikitsa (view source)

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{{#seo:

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|title=Trishna Chikitsa

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|titlemode=append

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|keywords=trishna, vata, pitta, mukha shosha, jala, thirst, polydipsia, water and fluid balance, osmosis, ion balance

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|description=Chikitsa Sthana Chapter 22. Management of Trishna (Morbid thirst)

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}}

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<big>''' [[Chikitsa Sthana]] Chapter 22. Management of Trishna (Morbid thirst) </big>'''

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

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अथातस्तृष्णाचिकित्सितं व्याख्यास्यामः ||१||

इति ह स्माह भगवानात्रेयः ||२||

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athātastrishnacikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH ||2||

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</div></div>

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

Thus said the Lord atreya. [1-2]

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ज्ञानप्रशमतपोभिः ख्यातोऽत्रिसुतो जगद्धितेऽभिरतः |

तृष्णानां प्रशमार्थं चिकित्सितं प्राह पञ्चानाम् ||३||

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jñānapraśamatapōbhiḥ khyātō'trisutō jagaddhitē'bhirataḥ|

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tRuṣṇanAM prashamArthaM cikitsitaM prAha pa~jcAnAm ||3||

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</div></div>

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]

==== Etio-pathogenesis ====

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क्षोभाद्भयाच्छ्रमादपि शोकात्क्रोधाद्विलङ्घनान्मद्यात् |

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घोरव्याधिकृशानां प्रभवत्युपसर्गभूता सा ||७||

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kṣōbhādbhayācchramādapi śōkātkrōdhādvilaṅghanānmadyāt|

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ghoravyAdhikRushAnAM prabhavatyupasargabhUtA sA ||7||

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</div></div>

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]

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

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प्राग्रूपं मुखशोषः, स्वलक्षणं सर्वदाऽम्बुकामित्वम् |

तृष्णानां सर्वासां लिङ्गानां लाघवमपायः ||८||

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prāgrūpaṁ mukhaśōṣaḥ, svalakṣaṇaṁ sarvadā'mbukāmitvam|

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tRuṣṇanAM sarvAsAM li~ggAnAM lAghavamapAyaH ||8||

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</div></div>

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]

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

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मुखशोषस्वरभेदभ्रमसन्तापप्रलापसंस्तम्भान् |

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तृष्णोद्भूता कुरुते, पञ्चविधां लिङ्गतः शृणु ताम् ||१०||

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mukhaśōṣasvarabhēdabhramasantāpapralāpasaṁstambhān|

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tRuShNodbhUtA kurute, pa~jcavidhAM li~ggataH shRuNu tAm ||10||

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</div></div>

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]

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

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अब्धातुं देहस्थं कुपितः पवनो यदा विशोषयति |

तस्मिञ्शुष्के शुष्यत्यबलस्तृष्यत्यथ विशुष्यन् ||११||

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abdhātuṁ dēhasthaṁ kupitaḥ pavanō yadā viśōṣayati|

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tasmi~jshuShke shuShyatyabalastRuShyatyatha vishuShyan ||11||

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</div></div>

Vitiated ''vata'' absorbs the watery elements in the body. As a result of absorption of these fluids, the weak person gets dehydrated and consequently suffers from morbid thirst. [11]

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निद्रानाशः शिरसो भ्रमस्तथा शुष्कविरसमुखता च स्रोतोऽवरोध इति च स्याल्लिङ्गं वाततृष्णायाः ||१२||

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nidrānāśaḥ śirasō bhramastathā śuṣkavirasamukhatā ca

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nidrAnAshaH shiraso bhramastathA shuShkavirasamukhatA ca sroto~avarodha iti ca syAlli~ggaM VātatRuṣṇayAH ||12||

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</div></div>

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

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

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पित्तं मतमाग्नेयं कुपितं चेत्तापयत्यपां धातुम् |

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पीताक्षिमूत्रवर्चस्त्वमाकृतिः पित्ततृष्णायाः ||१४||

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pittaṁ matamāgnēyaṁ kupitaṁ cēttāpayatyapāṁ dhātum|

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pItAkShimUtravarcastvamAkRutiH pittatRuṣṇayAH ||14||

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</div></div>

The ''pitta'' is regarded as the thermal elements in the body which on vitiation, heats the watery elements to cause morbid thirst and person suffers from excessive burning sensation.

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

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तृष्णा याऽऽमप्रभवा साऽप्याग्नेयाऽऽमपित्तजनितत्वात् |

लिङ्गं तस्याश्चारुचिराध्मानकफप्रसेकौ च ||१५||

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trishna yā''maprabhavā sā'pyāgnēyā''mapittajanitatvāt [1] |

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li~ggaM tasyAshcArucirAdhmAnakaphaprasekau ca ||15||

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</div></div>

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]

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

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देहो रसजोऽम्बुभवो रसश्च तस्य क्षयाच्च तृष्येद्धि |

दीनस्वरः प्रताम्यन् संशुष्कहृदयगलतालुः ||१६||

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dēhō rasajō'mbubhavō rasaśca tasya kṣayācca tr̥ṣyēddhi|

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dInasvaraH pratAmyan saMshuShkahRudayagalatAluH ||16||

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</div></div>

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]

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

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भवति खलु योपसर्गात्तृष्णा सा शोषिणी कष्टा |

ज्वरमेहक्षयशोषश्वासाद्युपसृष्टदेहानाम् ||१७||

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bhavati khalu yōpasargāttrishna sā śōṣiṇī kaṣṭā|

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jvaramehakShayaśōṣashvAsAdyupasRuShTadehAnAm ||17||

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</div></div>

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]

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

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सर्वास्त्वतिप्रसक्ता रोगकृशानां वमिप्रसक्तानाम् |

घोरोपद्रवयुक्तास्तृणा मरणाय विज्ञेयाः ||१८||

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sarvāstvatiprasaktā rōgakr̥śānāṁ vamiprasaktānām|

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ghoropadravayuktAstRuNA maraNAya vij~jeyAH ||18||

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</div></div>

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]

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

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नाग्निं विना हि तर्षः पवनाद्वा तौ हि शोषणे हेतू |

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तेषां सन्तप्तानां हिमजलपानाद्भवति शर्म ||२२||

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nāgniṁ vinā hi tarṣaḥ pavanādvā tau hi śōṣaṇē hētū|

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teShAM santaptAnAM himajalapAnAdbhavati sharma ||22||

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</div></div>

Thirst can‘t occur without ''pitta'' (heat) and ''vata''; the excessive increase in these two elements results in absorption of the watery element, and loss of water in body leads to thirst.

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Alcohol by its quality being ''tikshna'' (the property which causes sharp action and quick penetration), salty, sultry and dry, provokes ''pitta'' and ''vata''. These two factors (''pitta'' and ''vata'') dry up the watery elements of the body in alcohol addicts. Just as hot sand absorbs and dries up the water poured on it, similarly relief is obtained by pouring of the cold water.[19-22]

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शिशिरस्नातस्योष्मा रुद्धः कोष्ठं प्रपद्य तर्षयति |

तस्मान्नोष्णक्लान्तो भजेत सहसा जलं शीतम् ||२३||

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śiśirasnātasyōṣmā ruddhaḥ kōṣṭhaṁ prapadya tarṣayati|

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tasmAnnoShNaklAnto bhajeta sahasA jalaM shItam ||23||

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</div></div>

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]

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

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लिङ्गं सर्वास्वेतास्वनिलक्षयपित्तजं भवत्यथ तु |

पृथगागमाच्चिकित्सितमतः प्रवक्ष्यामि तृष्णानाम् ||२४||

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liṅgaṁ sarvāsvētāsvanilakṣayapittajaṁ bhavatyatha tu|

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pRuthagAgamAccikitsitamataH pravakShyAmi tRuṣṇanAm ||24||

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</div></div>

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]

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

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अपां क्षयाद्धि तृष्णा संशोष्य नरं प्रणाशयेदाशु |

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अनभिष्यन्दि च यत्तत्क्षितिगतमप्यैन्द्रवज्ज्ञेयम् ||२६||

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apāṁ kṣayāddhi trishna saṁśōṣya naraṁ praṇāśayēdāśu|

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anabhiShyandi ca yattatkShitigatamapyaindravajj~jeyam ||26||

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</div></div>

Due to the loss of watery elements, man becomes dehydrated and dies soon due to thirst; the patients should therefore drink pure rain water mixed with honey, or any other water having similar properties that of rain water.

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

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शृतशीतं ससितोपलमथवा शरपूर्वपञ्चमूलेन |

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नारीपयः सशर्करमुष्ट्र्या अपि नस्यमिक्षुरसः ||३३||

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śr̥taśītaṁ sasitōpalamathavā śarapūrvapañcamūlēna|

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nArIpayaH sasharkaramuShTryA api nasyamikShurasaH ||33||

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</div></div>

The physician may give the decoction of roots of the ''shara panchamula'' after cooling and mixing with sugar or the demulcent drink prepared of roasted paddy powder, sugar, honey and rain water; or he may give the top part of half cooked barley gruels cooled and mixed with sugar or he may give the thin gruel of ''shali'' rice or of common millets.

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==== Various therapeutics modalities ====

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क्षीरेक्षुरसगुडोदकसितोपलाक्षौद्रसीधुमार्द्वीकैः |

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रम्यशिशिरोदकानां स्मरणं कथाश्च तृष्णाघ्नाः ||३९||

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kShIrekShurasaguDodakasitopalAkShaudrasIdhumArdvIkaiH |

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ramyashishirodakAnAM smaraNaM kathAshca tRuṣṇaghnAH ||39||

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</div></div>

The gargles of milk, sugarcane juice, jaggery water, sugar, honey, and wine prepared from sugarcane, grape wine, ''kokam'' (Garcinia cambogia) and citron fruit are beneficial in curing dryness of the palate.

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

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वातघ्नमन्नपानं मृदु लघु शीतं च वाततृष्णायाम् |

क्षयकासनुच्छृतं क्षीरघृतमूर्ध्ववाततृष्णाघ्नम् ||४०||

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vātaghnamannapānaṁ mr̥du laghu śītaṁ ca vātatrishnayām|

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kShayakAsanucchRutaM kShIraghRutamUrdhvaVātatRuṣṇaghnam ||40||

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</div></div>

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]

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

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स्याज्जीवनीयसिद्धं क्षीरघृतं वातपित्तजे तर्ष |४१|

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शीतकषाया मृद्भृष्टसंयुताः पित्ततृष्णाघ्नाः ||४६||

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syājjīvanīyasiddhaṁ kṣīraghr̥taṁ vātapittajē tarṣa|41|

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shItakaShAyA mRudbhRuShTasaMyutAH pittatRuṣṇaghnAH ||46||

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</div></div>

In morbid thirst due to ''vata'' and ''pitta'', the ghee taken out of milk prepared with drugs of life promoter group, is recommended.

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

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व्योषवचाभल्लातकतिक्तकषायास्तथाऽऽमतृष्णाघ्नाः |

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पेयमथवा प्रदद्याद्रजनीशर्करायुक्तम् ||४९||

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vyōṣavacābhallātakatiktakaṣāyāstathā''matrishnaghnāḥ|

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pēyāmathavA pradadyAdrajanIsharkarAyuktam ||49||

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</div></div>

In ''amaja trishna'', decoctions prepared form ''trikatu'', sweet flag, marking nut and drugs of bitter groups are useful; or treatment principles of ''kaphaja chhardi'' can be used.

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

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क्षयकासेन तु तुल्या क्षयतृष्णा सा गरीयसी नॄणाम् |

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तर्षं मूर्च्छाभिहतस्य रक्तपित्तापहैर्हन्यात् ||५६||

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kṣayakāsēna tu tulyā kṣayatrishna sā garīyasī nr̥̄ṇām|

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tarShaM mUrcchAbhihatasya raktapittApahairhanyAt ||56||

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</div></div>

''Kshayaja trishna'' is serious in nature as like ''kshayaja kasa'' (cough due to wasting), therefore this type of thirst should be treated with medications mentioned in cough due to wasting. Medications mentioned in ''kshatakshina'' and ''shosha'' are helpful.

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

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तृट्दाहमूर्च्छाभ्रमक्लममदात्ययास्रविषपित्ते |

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तस्मात्तृष्णां पूर्वं जयेद्बहुभ्योऽपि रोगेभ्यः ||६२||

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tr̥ṭdāhamūrcchābhramaklamamadātyayāsraviṣapittē |

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tasmAttRuṣṇaM pUrvaM jayedbahubhyo~api rogebhyaH ||62||

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</div></div>

Fresh cold water is beneficial in thirst associated with fainting, giddiness, exhaustion, alcoholism, poisoning and disorder of ''rakta'' and ''pitta''.

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==== Summary ====

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तत्र श्लोकः-

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तृष्णानां पृथगाकृतिरसाध्यता साधनं चोक्तम् ||६३||

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tatra ślōkaḥ-

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tRuṣṇanAM pRuthagAkRutirasAdhyatA sAdhanaM coktam ||63||

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</div></div>

Here is the recapitulatory verse-

How the thermal factors and ''vata'' are the two causative factors for five kinds of ''trishna'', their separate characteristics, the incurable condition and the method of remedy have all been described.[63]

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इत्यग्निवेशकृते तन्त्रे चरकप्रतिसंस्कृतेऽप्राप्ते दृढबलसम्पूरिते चिकित्सास्थाने तृष्णारोगचिकित्सितं नाम द्वाविंशोऽध्यायः ||२२||

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ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē trishnarōgacikitsitaṁnāma dvāviṁśō'dhyāyaḥ||22||

ityagniveshakRute tantre carakapratisaMskRute~aprApte dRuDhabalasampUrite cikitsāsthAne tRuṣṇarogacikitsitaM nAma dvAviMsho~adhyAyaH ||22||

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</div></div>

Thus, in the section of therapeutics in the treatise complied by Agnivesha and revised by Charak, the twenty second chapter entitled [[Trishna Chikitsa]] not being available, annotated by Charak and redacted by Dridhabala, is completed.[22]

Agnivesha

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