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After explaining the atisāra chikitsā (treatment of diarrhoea), there is description of chhardi chikitsā. The word ‘chhardi’ is derived from the root ‘chard vamane’. The word ‘chhad’ means gripping (avrutta or achchhadana) and ‘ard’ means pain (peeda).  The other words like chhardah, chhardana, chhardi, chhardika, etc. are considered as the synonyms of chhardi.  The words chhardi & vamana, both are used in the sense of vomiting but have basic difference. Chhardi is a pathological condition where the sufferer is exposed to particular predisposing factors for vomiting and as a result suffers from the particular condition called chhardi. On the other hand vamana is one of the purificatory therapies of panchakarma (five purificatory procedures in Ayurveda) where the physician intends to induce vomiting to expel out vitiated kapha & pitta. In general, the vitiated doshas accumulate in stomach and are thrown out from the body through various channels. There are two major channels from which the body generally does such excretary mechanism.  The one is adhomārga (excretion through downword channel) for which the description of atisāra is given in previous chapter and the other one is urdhvabhāga (excretion through upword channel) where the description of chhardi is discussed here.  Chhardi comes under the category of koshtha rasāyani shrita vyādhi (diseases of GI tract)  whose roots are in mahasrotas (GI tract) and manovaha (mind) srotasas. The amāshaya and rasāyani are the involved avayavas (organs) in this disease.  The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological conselling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors.  The curative treatment focuses on pharmacotherapy depending upon dosha dominance and mild samshodhana (expelling out the vitiated dosha).
 
After explaining the atisāra chikitsā (treatment of diarrhoea), there is description of chhardi chikitsā. The word ‘chhardi’ is derived from the root ‘chard vamane’. The word ‘chhad’ means gripping (avrutta or achchhadana) and ‘ard’ means pain (peeda).  The other words like chhardah, chhardana, chhardi, chhardika, etc. are considered as the synonyms of chhardi.  The words chhardi & vamana, both are used in the sense of vomiting but have basic difference. Chhardi is a pathological condition where the sufferer is exposed to particular predisposing factors for vomiting and as a result suffers from the particular condition called chhardi. On the other hand vamana is one of the purificatory therapies of panchakarma (five purificatory procedures in Ayurveda) where the physician intends to induce vomiting to expel out vitiated kapha & pitta. In general, the vitiated doshas accumulate in stomach and are thrown out from the body through various channels. There are two major channels from which the body generally does such excretary mechanism.  The one is adhomārga (excretion through downword channel) for which the description of atisāra is given in previous chapter and the other one is urdhvabhāga (excretion through upword channel) where the description of chhardi is discussed here.  Chhardi comes under the category of koshtha rasāyani shrita vyādhi (diseases of GI tract)  whose roots are in mahasrotas (GI tract) and manovaha (mind) srotasas. The amāshaya and rasāyani are the involved avayavas (organs) in this disease.  The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological conselling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors.  The curative treatment focuses on pharmacotherapy depending upon dosha dominance and mild samshodhana (expelling out the vitiated dosha).
    +
=== Sanskrit Text, Transliteration and English Translation ===
    
अथातश्छर्दिचिकित्सितं व्याख्यास्यामः||१||  
 
अथातश्छर्दिचिकित्सितं व्याख्यास्यामः||१||  
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punarvasuM bhUtahite niviShTaM papraccha shiShyo~atrijamagniveshaH||3||
 
punarvasuM bhUtahite niviShTaM papraccha shiShyo~atrijamagniveshaH||3||
 
Agnivesha the disciple enquired Punarvasu, the illustratious son of Atri, who was engrossed in  the thinking of the wellbeing of humanity and who was dazzling with lustre of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the wellbeing of all living beings (3).
 
Agnivesha the disciple enquired Punarvasu, the illustratious son of Atri, who was engrossed in  the thinking of the wellbeing of humanity and who was dazzling with lustre of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the wellbeing of all living beings (3).
Queries by Agnivesha:
+
 
 +
==== Queries by Agnivesha ====
 +
 
 
याश्छर्दयः पञ्च पुरा त्वयोक्ता रोगाधिकारे भिषजां वरिष्ठ!|  
 
याश्छर्दयः पञ्च पुरा त्वयोक्ता रोगाधिकारे भिषजां वरिष्ठ!|  
 
तासां चिकित्सां सनिदानलिङ्गां यथावदाचक्ष्व नृणां हितार्थम्||४||  
 
तासां चिकित्सां सनिदानलिङ्गां यथावदाचक्ष्व नृणां हितार्थम्||४||  
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yAshchardayaH pa~jca purA mayoktAstA vistareNa bruvato nibodha||5||  
 
yAshchardayaH pa~jca purA mayoktAstA vistareNa bruvato nibodha||5||  
 
Oh! Revered Physician, please describe the treatment of the five types of chhardi (vomiting) mentioned by you earlier in the context of the enumeration of diseases (in Sutra 19:3-4) along with their etiology, signs and symptoms comprehensively, for the sake of wellbeing of humanity.
 
Oh! Revered Physician, please describe the treatment of the five types of chhardi (vomiting) mentioned by you earlier in the context of the enumeration of diseases (in Sutra 19:3-4) along with their etiology, signs and symptoms comprehensively, for the sake of wellbeing of humanity.
 +
 
Having heard Agnivesha and being pleased the best among physicians Punarvasu Atreya said “I shall now expound all the five types of vomiting (briefly) stated earlier, in greater details. Listen to me." (4-5)
 
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 ====
दोषैः पृथक्त्रिप्रभवाश्चतस्रो [१] द्बिष्टार्थयोगादपि पञ्चमी स्यात्|                                  तासां हृदुत्क्लेशकफप्रसेकौ द्वेषोऽशने चैव हि पूर्वरूपम्||६| dōṣaiḥ pr̥thaktriprabhavāścatasrō  dbiṣṭārthayōgādapi pañcamī syāt|
+
 
 +
दोषैः पृथक्त्रिप्रभवाश्चतस्रो [१] द्बिष्टार्थयोगादपि पञ्चमी स्यात्|                                   
 +
तासां हृदुत्क्लेशकफप्रसेकौ द्वेषोऽशने चैव हि पूर्वरूपम्||६|  
 +
 
 +
dōṣaiḥ pr̥thaktriprabhavāścatasrō  dbiṣṭārthayōgādapi pañcamī syāt|
 
tāsāṁ hr̥dutklēśakaphaprasēkau dvēṣō'śanē caiva hi pūrvarūpam||6||
 
tāsāṁ hr̥dutklēśakaphaprasēkau dvēṣō'śanē caiva hi pūrvarūpam||6||
 +
 
doShaiH pRuthaktriprabhavAshcatasro [1] dbiShTArthayogAdapi pa~jcamI syAt|6|  
 
doShaiH pRuthaktriprabhavAshcatasro [1] dbiShTArthayogAdapi pa~jcamI syAt|6|  
 +
 
tAsAM hRudutkleshakaphaprasekau dveSho~ashane caiva hi pUrvarUpam||6||  
 
tAsAM hRudutkleshakaphaprasekau dveSho~ashane caiva hi pUrvarUpam||6||  
 +
 
Chhardi (vomiting) is of five types; three types of vomitings caused by a dosha each i.e. vātika, paittika, kaphaja, fourth is sannipātika and fifth is dvistartha-yogaja-chhardi (that results from contact with unpleasant sense objects).
 
Chhardi (vomiting) is of five types; three types of vomitings caused by a dosha each i.e. vātika, paittika, kaphaja, fourth is sannipātika and fifth is dvistartha-yogaja-chhardi (that results from contact with unpleasant sense objects).
 
The premonitory signs and symptoms of chhardi (vomiting) are nausea, excessive salivation and aversion to food (6).  
 
The premonitory signs and symptoms of chhardi (vomiting) are nausea, excessive salivation and aversion to food (6).  
   −
Vātika chhardi:
+
==== ''Vatika chhardi'' ====
 +
 
 
व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|  
 
व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|  
 
वायुर्महास्रोतसि  सम्प्रवृद्ध उत्क्लेश्य दोषांस्तत ऊर्ध्वमस्यन्||७||  
 
वायुर्महास्रोतसि  सम्प्रवृद्ध उत्क्लेश्य दोषांस्तत ऊर्ध्वमस्यन्||७||  
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8. The patient feels miserable (7-9).
 
8. The patient feels miserable (7-9).
   −
Paittika chhardi:
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==== ''Paittika chhardi'' ====
 +
 
 
अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|  
 
अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|  
 
रसायनीभिर्विसृतं प्रपीड्य मर्मोर्ध्वमागम्य वमिं करोति||१०||  
 
रसायनीभिर्विसृतं प्रपीड्य मर्मोर्ध्वमागम्य वमिं करोति||१०||  
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5. Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation (10-11).  
 
5. Vomitus is yellow, excessively hot, green, bitter and smoky in appearance with burning sensation (10-11).  
   −
Kaphaja chhardi:
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==== Kaphaja chhardi ====
 +
 
 
स्निग्धातिगुर्वामविदाहिभोज्यैः स्वप्नादिभिश्चैव कफोऽतिवृद्धः|  
 
स्निग्धातिगुर्वामविदाहिभोज्यैः स्वप्नादिभिश्चैव कफोऽतिवृद्धः|  
 
उरः शिरो मर्म रसायनीश्च सर्वाः समावृत्य वमिं करोति||१२||  
 
उरः शिरो मर्म रसायनीश्च सर्वाः समावृत्य वमिं करोति||१२||  
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3. Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain (12-13).
 
3. Vomitus is unctuous, dense, sweet and devoid of any undesirable smell; and is associated with horripilation and slight pain (12-13).
   −
Tridoshaja chhardi:
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==== Tridoshaja chhardi ====
 +
 
 
समश्नतः सर्वरसान् प्रसक्तमामप्रदोषर्तुविपर्ययैश्च|  
 
समश्नतः सर्वरसान् प्रसक्तमामप्रदोषर्तुविपर्ययैश्च|  
 
सर्वे प्रकोपं युगपत् प्रपन्नाश्छर्दिं त्रिदोषां जनयन्ति दोषाः||१४||  
 
सर्वे प्रकोपं युगपत् प्रपन्नाश्छर्दिं त्रिदोषां जनयन्ति दोषाः||१४||  
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2. Vomitus is salty, sour, blue, dense, hot and reddish (14-15).
 
2. Vomitus is salty, sour, blue, dense, hot and reddish (14-15).
   −
Bad prognostic symptoms:
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==== Bad prognostic symptoms ====
 +
 
 
विट्स्वेदमूत्राम्बुवहानि वायुः स्रोतांसि संरुध्य यदोर्ध्वमेति|  
 
विट्स्वेदमूत्राम्बुवहानि वायुः स्रोतांसि संरुध्य यदोर्ध्वमेति|  
 
उत्सन्नदोषस्य समाचितं तं दोषं समुद्धूय नरस्य कोष्ठात्||१६||  
 
उत्सन्नदोषस्य समाचितं तं दोषं समुद्धूय नरस्य कोष्ठात्||१६||  
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   Such a patient succumbs to death quickly (16-17).
 
   Such a patient succumbs to death quickly (16-17).
   −
Dviṣṭa chhardi:
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==== Dviṣṭa chhardi ====
 +
 
 
द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|  
 
द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|  
 
यच्छर्दयेत्तप्तमना मनोध्नैर्द्विष्टार्थसंयोगभवा मता सा||१८||  
 
यच्छर्दयेत्तप्तमना मनोध्नैर्द्विष्टार्थसंयोगभवा मता सा||१८||  
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As a result of mental disgust occasioned by senses contact with despicable, antagonistic, unclean, putried, unholy and loathsome odors, diet or sights, the chhardi(vomiting) is known as vomiting induced by contact with hateful things (18).
 
As a result of mental disgust occasioned by senses contact with despicable, antagonistic, unclean, putried, unholy and loathsome odors, diet or sights, the chhardi(vomiting) is known as vomiting induced by contact with hateful things (18).
   −
Symptoms of incurable chhardi:
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==== Symptoms of incurable chhardi ====
 +
 
 
क्षीणस्य या छर्दिरतिप्रवृद्धा सोपद्रवा शोणितपूययुक्ता|  
 
क्षीणस्य या छर्दिरतिप्रवृद्धा सोपद्रवा शोणितपूययुक्ता|  
 
सचन्द्रिकां तां प्रवदन्त्यसाध्यां साध्यां चिकित्सेदनुपद्रवां च||१९||
 
सचन्द्रिकां तां प्रवदन्त्यसाध्यां साध्यां चिकित्सेदनुपद्रवां च||१९||
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sacandrikAM tAM pravadantyasAdhyAM sAdhyAM cikitsedanupadravAM ca||19||  
 
sacandrikAM tAM pravadantyasAdhyAM sAdhyAM cikitsedanupadravAM ca||19||  
 
Vomiting that occurs in an emaciated person, that continues incessantly, that is associated with complications, and vomitus that contains blood, pus and chandrika (circular shiny patches with variegated colour) is incurable. The physician should treat only curable types that are not associated with complications (19).
 
Vomiting that occurs in an emaciated person, that continues incessantly, that is associated with complications, and vomitus that contains blood, pus and chandrika (circular shiny patches with variegated colour) is incurable. The physician should treat only curable types that are not associated with complications (19).
Principles of treatment:
+
 
 +
==== Principles of treatment ====
 +
 
 
आमाशयोत्क्लेशभवा हि सर्वाश्छर्द्यो मता लङ्घनमेव तस्मात्|  
 
आमाशयोत्क्लेशभवा हि सर्वाश्छर्द्यो मता लङ्घनमेव तस्मात्|  
 
प्राक्कारयेन्मारुतजां विमुच्य संशोधनं वा कफपित्तहारि||२०||  
 
प्राक्कारयेन्मारुतजां विमुच्य संशोधनं वा कफपित्तहारि||२०||  
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vallIphalAdyairvamanaM pibedvA yo durbalastaM shamanaishcikitset|  
 
vallIphalAdyairvamanaM pibedvA yo durbalastaM shamanaishcikitset|  
 
rasairmanoj~jairlaghubhirvishuShkairbhakShyaiH sabhojyairvividhaishca pAnaiH||22||
 
rasairmanoj~jairlaghubhirvishuShkairbhakShyaiH sabhojyairvividhaishca pAnaiH||22||
      The patient shall take powder of abhayā (chebulic myrobalans) with honey or such other palatable purgatives skillfully combined with madya (alcohol) or dugdha (milk). These recipes cause downward movement of the aggravated doshas that are impelled to move upwards.  
+
 
 +
The patient shall take powder of abhayā (chebulic myrobalans) with honey or such other palatable purgatives skillfully combined with madya (alcohol) or dugdha (milk). These recipes cause downward movement of the aggravated doshas that are impelled to move upwards.  
 
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).
 
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 vātika chhardi:
+
==== Treatment of vātika chhardi ====
 +
 
 
सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|
 
सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|
 
छर्दिं तथा कोलकुलत्थधान्यबिल्वादिमूलाम्लयवैश्च यूषः||२३||
 
छर्दिं तथा कोलकुलत्थधान्यबिल्वादिमूलाम्लयवैश्च यूषः||२३||
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6. The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour dadima (pomegranate/Punica granatum)- (23-25).
 
6. The diet consisting of unctuous and palatable food, meat soups, vegetable-soup, curd sour dadima (pomegranate/Punica granatum)- (23-25).
   −
Treatment of paittika chhardi:
+
==== Treatment of paittika chhardi ====
 +
 
 
पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|  
 
पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|  
 
कफाशयस्थं त्वतिमात्रवृद्धं पित्तं हरेत् स्वादुभिरूर्ध्वमेव||२६||  
 
कफाशयस्थं त्वतिमात्रवृद्धं पित्तं हरेत् स्वादुभिरूर्ध्वमेव||२६||  
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• 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 kaphaja chhardi ====
 +
 
 
कफात्मिकायां वमनं प्रशस्तं सपिप्पलीसर्षपनिम्बतोयैः|  
 
कफात्मिकायां वमनं प्रशस्तं सपिप्पलीसर्षपनिम्बतोयैः|  
 
पिण्डीतकैः सैन्धवसम्प्रयुक्तैर्वम्यां कफामाशयशोधनार्थम्||३४||  
 
पिण्डीतकैः सैन्धवसम्प्रयुक्तैर्वम्यां कफामाशयशोधनार्थम्||३४||  
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3. Maricha (black pepper/Piper nigrum) with honey (34-39).
 
3. Maricha (black pepper/Piper nigrum) with honey (34-39).
    +
==== Treatment of sannipatika chhardi ====
   −
Treatment of sannipatika chhardi:
   
यैषा पृथक्त्वेन मया क्रियोक्ता तां सन्निपातेऽपि समस्य [१] बुद्ध्या|  
 
यैषा पृथक्त्वेन मया क्रियोक्ता तां सन्निपातेऽपि समस्य [१] बुद्ध्या|  
 
दोषर्तुरोगाग्निबलान्यवेक्ष्य प्रयोजयेच्छास्त्रविदप्रमत्तः||४०||
 
दोषर्तुरोगाग्निबलान्यवेक्ष्य प्रयोजयेच्छास्त्रविदप्रमत्तः||४०||
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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 occured, 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 doshas involved, the season when the disease has occured, the stage of the disease and the power of digestion of the patient (40).  
   −
Treatment of dvishta (manobjghataja) chhardi:
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==== Treatment of dvishta (manobjghataja) chhardi ====
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मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|  
 
मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|  
 
लोकप्रसिद्धाः श्रुतयो वयस्याः शृङ्गारिकाश्चैव हिता विहाराः||४१||  
 
लोकप्रसिद्धाः श्रुतयो वयस्याः शृङ्गारिकाश्चैव हिता विहाराः||४१||  
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5. In general, whatever odour, taste, contact, sound or sights those are pleasing to such patients should be given though otherwise unsuitable and unwholesome because in this way disease can be treated easily (41-44).  
 
5. In general, whatever odour, taste, contact, sound or sights those are pleasing to such patients should be given though otherwise unsuitable and unwholesome because in this way disease can be treated easily (41-44).  
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Treatment of complications:
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==== Treatment of complications ====
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छर्द्युत्थितानां च चिकित्सितात् स्वाच्चिकित्सितं कार्यमुपद्रवाणाम्|  
 
छर्द्युत्थितानां च चिकित्सितात् स्वाच्चिकित्सितं कार्यमुपद्रवाणाम्|  
 
अतिप्रवृत्तासु विरेचनस्य कर्मातियोगे विहितं विधेयम्||४५||  
 
अतिप्रवृत्तासु विरेचनस्य कर्मातियोगे विहितं विधेयम्||४५||  
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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 Siddhisthana (6/ 52-56) for excessive purgation should be carried out (45).
 
The treatment of complications arising from vomiting should be done according to the lines suggested in respect of each of those ailments. In case of excessive vomiting; treatment that is suggested in Siddhisthana (6/ 52-56) for excessive purgation should be carried out (45).
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Treatment of chronic chhardi:
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==== Treatment of chronic chhardi ====
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वमिप्रसङ्गात् पवनोऽप्यवश्यं धातुक्षयाद्धृद्धिमुपैति तस्मात्|  
 
वमिप्रसङ्गात् पवनोऽप्यवश्यं धातुक्षयाद्धृद्धिमुपैति तस्मात्|  
 
चिरप्रवृत्तास्वनिलापहानि कार्याण्युपस्तम्भनबृंहणानि||४६||  
 
चिरप्रवृत्तास्वनिलापहानि कार्याण्युपस्तम्भनबृंहणानि||४६||  
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Sarpirguda (Chikitsa 11:50-77), kshira-vidhi (milk boiled by adding vāta-alleviating drugs), Kalyanaka-ghrita (Chikitsa 9:33-42), tryushana-ghrita (Chikitsa 18:39-42), jivaniya-ghrita (Cikitsa 29:55-57), vrishya (virilific) recipes, mamsarasa (meat soup) and lehya like chyavanprasha (linctuses) –(46-47).
 
Sarpirguda (Chikitsa 11:50-77), kshira-vidhi (milk boiled by adding vāta-alleviating drugs), Kalyanaka-ghrita (Chikitsa 9:33-42), tryushana-ghrita (Chikitsa 18:39-42), jivaniya-ghrita (Cikitsa 29:55-57), vrishya (virilific) recipes, mamsarasa (meat soup) and lehya like chyavanprasha (linctuses) –(46-47).
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Summary:
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==== Summary ====
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तत्र श्लोकः-  
 
तत्र श्लोकः-  
 
हेतुं सङ्ख्यां लक्षणमुपद्रवान् साध्यतां न योगांश्च|  
 
हेतुं सङ्ख्यां लक्षणमुपद्रवान् साध्यतां न योगांश्च|  
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Thus the section on therapeutics in the treatise compiled by Agnivesha redacted by Charaka and reconstructed by Dridhabala as it was not available.
 
Thus the section on therapeutics in the treatise compiled by Agnivesha redacted by Charaka and reconstructed by Dridhabala as it was not available.
Tattva vimarsha:
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=== ''Tattva Vimarsha'' ===
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• 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.  
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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.
 
• The treatment of complications arising from vomiting should be done according to the lines suggested in respect of each of those ailments.
 
• In persistent vomiting vāta invariably gets aggravated because of loss of tissue elements. Therefore, in case of chronic vomiting medications that are bulk promoting, vāta pacifying, upastambhana (astringents) and brimhana (nutritive) should be administered.
 
• In persistent vomiting vāta invariably gets aggravated because of loss of tissue elements. Therefore, in case of chronic vomiting medications that are bulk promoting, vāta pacifying, upastambhana (astringents) and brimhana (nutritive) should be administered.
Vidhi vimarsha:
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Pathogenesis:
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Mahasrotus (gastrointestinal tract) has two parts, upper part is annavaha srotus and lower part is purishvaha srotus. Atisara is related to purishvaha srotus and chardi is to annavaha srotus. Etiological factors of chardi 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 udaanvata, therefore, there is no involvement of agni. Chhardi is a defense mechanism to expel the toxins out of the stomach.  There is vaccum 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.
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Types of chhardi:
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Diseases are classified according to the dominance of doshas-involved and their mutual amalgamation, which are of four types. The 5th type of chhardi (dvishtarthayoga) 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 dvistarthayoga 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.
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Vataja chhardi:   
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There are many factors that increase vata in the Shareera .  Particular ahara (food), vihara (lifestyle) and mental factors increase vata and its gunas (properties). This aggravation of vāta gunas like rukshata (dryness), laghuta (lightness), etc plays a role in causing Vātaja Chhardi. (Charaka sutrasthana 1/59) Doshas conjugate (Sammurchhana (Sutra sthana 18/46) with a particular organ (Mahasrotas, Āmāshaya, 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).
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Pittaja chhardi:
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Nidanas of pittaprakopaka increase pitta in nature    and cause provocation of gunas like ushna (hot), tikshna (sharp), snigdha (unctous), etc. (Charaka sutra sthana 1/60)  in the body. This aggravated pitta joins (Sammurchhana) with a particular organ (rasāyani, amāshaya, marma, urdhwabhaga, etc) as dushyas. The conjugation of dosha and dushya has affinity towards urdhwabhaga which results in pittaja chhardi (10-11).
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Kaphaja Chhardi:
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Nidānas of kaphaprakopaka increase kapha in nature  which causes provocation of gunas like guru (heavyness), sheeta (coldness), manda (slowness), etc. (Charaka Sutra sthana 1/60) in the body. This aggravated Kapha joins (sammurchhana) with a particular organ (urah (chest), shirah (head), rasāyani marma, urdhwabhaga, etc.) as dushyas. This amalgamation of dosha and dushya has affinity towards urdhwabhaga which results in kaphaja chhardi (12-13).
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Sannipataja Chhardi:
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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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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)(Charaka Vimana 5/3) ( verses 16-17).
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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), etc.  are considered to be life threatening.
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Treatment:
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• Langhana becomes the first line of treatment in chhardi as shamana chikitsa (pacificatory treatment). Samshodha can be preferred where doshas are in utklisht stage and ready to be expelled out. Vamana is recommended when doshas are accumulated in amashya 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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• Haritaki is known for its laxative action (anulomaneeya). It not only tridoshahara but also posseses many more qualities (Charaka Chikitsa 1/1/29-34) which can be helpful for samprapti vighanatana (breaking pathogenesis) in chhardi.  The choice of hridya 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. Su. 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 su 27/217-18) is naturally saraka (purgative) in nature which makes anulomana gati (natural movements) of vayu.
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• 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. Chi. 20/ 41-42) . It should be preferably mamsarasa, dry food or liquid diet which is easily digestible ( verses 21-22). 
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• In vataja chhardi, laghu susanskrita mamsarasa (processed meat soup) is helpful in easy digestion and gives strength due to vatapacifying 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. Su. 27/231-32, Cha. Su. 13/13) can be benifitial in vātaja hridroga.
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• If the aggravated doshas are in distal part of amāshaya (post- amāshaya) the nearest route to remove pitta is through virechana procedure. If the aggravated pitta is in amāshaya then the nearest route to remove pitta is through vamana. Both these procedures should be adopted in balavan rogi (physically strong) judiciously clubbing with proper samsarjana krama (protocol after purification procedure) to prevent aggravation of vata dosha.
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• 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).
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• For kaphaja chhardi chikitsa, as the doshas are situated in kaphashaya (amāshaya / 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.
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• Various types of Yusha, Ragashadava, Panaka (Cha.Su.27/279-281) are kaphahara, madhura-amlarasatmaka (sweet & sour), deepaneeya-pachaneeya (appetizer & digestant) in nature.
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• 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.
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• In case of dvistarthayoga chhardi (vomiting due to hate/ aversion) The treatment includes ashvāshana (assurance), vārtālāpa (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. 
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• 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).
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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 won’t 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.
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Current clinical practice for management of chhardi (referred from Chikitsa pradeep page 25):
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Type Medicine Dose Time Anupana
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Vata dominant and Vata-pitta dominant Shankha bhasma 60-120 mg Frequently Numbu panaka ( lemon water)
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Pitta dominant Sutashekhara kalpa 500-1000 mg Frequently Dadimavaleha
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Kapha dominant Mayu picchha mashi 1gram-3 grams Frequently Ardrakavaleha
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Tridoshaja Bruhad vata chintamani 50-100 mg Frequently Ardraka swarasa + sugar + honey
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Dauhridaja ( in pregnancy) Swarnashekhara mixture 250-500 mg After meals Ardraka swarasa + Nimbu swarasa + rock salt
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Krumija Vidanga-yavani phanta 20-40 ml Empty stomach two times --
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Further researches:
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=== Vidhi Vimarsha ===
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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Glossary
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Work in Progress
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=== Glossary ===
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 Āmāśayōtklēśabhavā  (आमाशयोत्क्लेशभवा): originated from agitatied Doshas in stomach
 
 Āmāśayōtklēśabhavā  (आमाशयोत्क्लेशभवा): originated from agitatied Doshas in stomach
 
 Āmāśayōtklēśakr̥tāṁ (आमाशयोत्क्लेशकृतां ): morbid humor which are agitating Amasaya (stomach) and likely to come out   
 
 Āmāśayōtklēśakr̥tāṁ (आमाशयोत्क्लेशकृतां ): morbid humor which are agitating Amasaya (stomach) and likely to come out   

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