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{{#seo:

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|title=Chhardi Chikitsa

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|titlemode=append

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|keywords=atisara, diarrhea, ama, nirama, sangrahi treatment, pichcha basti,Ayurveda, Indian system of medicine, charak samhita.

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|description=Chikitsa Sthana Chapter 20. Management of Chhardi (vomiting)

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|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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|image_alt=charak samhita

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|type=article

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}}

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<big>'''[[Chikitsa Sthana]] Chapter 20. Management of Chhardi (vomiting) </big>'''

{{Infobox

|title = Chhardi Chikitsa

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|label5 = Other Sections

|data5 = [[Sutra Sthana]], [[Nidana Sthana]], [[Vimana Sthana]], [[Sharira Sthana]], [[Indriya Sthana]], [[Kalpa Sthana]], [[Siddhi Sthana]]

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|label6 = Translator and commentator

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|~~header3~~ =

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|data6 = Murthy A.R.V.,Jani D.

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|label7 = Reviewer

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|data7 = Prasad B.S.

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|label8 = Editors

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|data8 = Singh G., Goyal M., Deole Y.S., Basisht G.

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|label9 = Year of publication

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|data9 = 2020

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|label10 = Publisher

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|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

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|label11 = DOI

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|data11 = [https://doi.org/10.47468/CSNE.2020.e01.s06.021 10.47468/CSNE.2020.e01.s06.021]

}}

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~~==[[Chikitsa Sthana]] Chapter 20, Chapter on the Management of~~ ''~~Chhardi~~'' ~~(vomiting) ==~~

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

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=~~== Abstract ===~~

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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.

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</div>

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

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~~=== Introduction ===~~

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After explaining the [[Atisara Chikitsa]] (treatment of diarrhea), there is description of [[Chhardi Chikitsa]]. The word ''chhardi'' is derived from the root ''chhard vamane''. The word ''chhad'' means gripping (''avritta'' or ''achhadana'') and ''ard'' means pain (''peedha''). The other words like ''chhardah, chhardana, chhardi, chhardika,'' etc. are considered as the synonyms of ''chhardi''. The words ''chhardi'' and ''vamana'', both are used in the sense of vomiting but have basic difference. ''Chhardi'' is a pathological condition where the sufferer is exposed to particular predisposing factors for vomiting and as a result suffers from the particular condition called ''chhardi''. On the other hand ''vamana'' is one of the purification therapies of [[Panchakarma]] (five purification procedures in Ayurveda) where the physician intends to induce vomiting to expel out vitiated ''kapha'' and ''pitta''. In general, the vitiated ''doshas'' accumulate in stomach and are thrown out from the body through various channels. There are two major channels from which the body generally does such excretary mechanism. The one is adhomārga (excretion through downword channel) for which the description of ''atisara'' is given in previous chapter and the other one is ''urdhvabhaga'' (excretion through upward channel) where the description of ''chhardi'' is discussed here. ''Chhardi'' comes under the category of ''koshtha rasayani shrita vyadhi'' (diseases of GI tract) whose roots are in ''mahasrotas'' (GI tract) and ''manovaha'' (mind) ''srotasa''. The ''amashaya'' and ''rasayani'' are the involved ''avayavas'' (organs) in this disease. The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological counseling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors. The curative treatment focuses on pharmacotherapy depending upon ''dosha'' dominance and mild ''samshodhana'' (expelling out the vitiated ''dosha'').

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== Introduction ==

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After explaining the [[Atisara Chikitsa]] (treatment of diarrhea), there is description of [[Chhardi Chikitsa]]. The word ''chhardi'' is derived from the root ''chhard vamane''. The word ''chhad'' means gripping (''avritta'' or ''achhadana'') and ''ard'' means pain (''peedha'')<ref>Madhavakara. Chardi praarana verse 15, In:Shastri Suderashan,editor, Madhava Nidanam (Roga vinischaya). 4th ed. Varanasi: Chaukhamba Sanskrit Series,1975.pp--</ref>. The other words like ''chhardah, chhardana, chhardi, chhardika,'' etc. are considered as the synonyms of ''chhardi''.<ref>Charak. Chikitsa Sthana, Cha.20 Chhardi Chikitsa Adhyaya. In: Bramhanand Tripathi Editor. Charak Samhita.,? ed. Varanasi: Chaukhamba Sanskrit Pratisthan,2015. p.?.</ref> The words ''chhardi'' and ''vamana'', both are used in the sense of vomiting but have basic difference. ''Chhardi'' is a pathological condition where the sufferer is exposed to particular predisposing factors for vomiting and as a result suffers from the particular condition called ''chhardi''. On the other hand ''vamana'' is one of the purification therapies of [[Panchakarma]] (five purification procedures in [[Ayurveda]]) where the physician intends to induce vomiting to expel out vitiated ''kapha'' and ''pitta''. In general, the vitiated ''doshas'' accumulate in stomach and are thrown out from the body through various channels. There are two major channels from which the body generally does such excretary mechanism.<ref>Sushruta. Sharira Sthana, Cha.5 Shareerasankhyavyakarana Sharira Adhyaya verse 10. In: Kaviraj Shastri Ambika Dutt, Editors. Sushruta Samhita. 5th ed. Varanasi: Chaukhamba Sanskrit Series,1982. p.?.</ref> The one is adhomārga (excretion through downword channel) for which the description of ''atisara'' is given in previous chapter and the other one is ''urdhvabhaga'' (excretion through upward channel) where the description of ''chhardi'' is discussed here. ''Chhardi'' comes under the category of ''koshtha rasayani shrita vyadhi'' (diseases of GI tract) whose roots are in ''mahasrotas'' (GI tract) and ''manovaha'' (mind) ''srotasa''. The ''amashaya'' and ''rasayani'' are the involved ''avayavas'' (organs) in this disease.<ref>Chakrapani, Charak. Vimana Sthana, Cha.5 Srotovimna Adhyaya ver.7-3. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.1st ed. Varanasi: Krishnadas Academy;2000.p.4</ref> The management of this disease is by the pharmacological treatment through various herbs/combinations, dietary modifications and psychological counseling. The preventive aspect includes avoidance of causative factors and enhancement in psychological strength to specific items/factors.<ref>Chakrapani, Charak. Vimana Sthana, Cha.5 Srotovimna Adhyaya ver.25. In: Jadavaji Trikamji Aacharya, Editor. Charak Samhita.1st ed. Varanasi: Krishnadas Academy;2000.p.4</ref> The curative treatment focuses on pharmacotherapy depending upon ''dosha'' dominance and mild ''samshodhana'' (expelling out the vitiated ''dosha'').

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

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== Sanskrit Text, Transliteration and English Translation ==

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अथातश्छर्दिचिकित्सितं व्याख्यास्यामः||१||

इति ह स्माह भगवानात्रेयः||२||

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athātaśchardicikitsitaṁ vyākhyāsyāmaḥ||1||

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iti ha smAha bhagavAnAtreyaH||2||

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</div></div>

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

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

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यशस्विनं ब्रह्मतपोद्युतिभ्यां ज्वलन्तमग्न्यर्कसमप्रभावम्|

पुनर्वसुं भूतहिते निविष्टं पप्रच्छ शिष्योऽत्रिजमग्निवेशः||३||

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yaśasvinaṁ brahmatapōdyutibhyāṁ jvalantamagnyarkasamaprabhāvam|

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

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</div></div>

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

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==== Queries by Agnivesha ====

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=== Queries by Agnivesha ===

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याश्छर्दयः पञ्च पुरा त्वयोक्ता रोगाधिकारे भिषजां वरिष्ठ!|

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याश्छर्दयः पञ्च पुरा मयोक्तास्ता विस्तरेण ब्रुवतो निबोध||५||

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yāśchardayaḥ pañca purā tvayōktā rōgādhikārē bhiṣajāṁ variṣṭha!|

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

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</div></div>

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 well-being of humanity.

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

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

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=== Classification and premonitory symptoms ===

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दोषैः पृथक्त्रिप्रभवाश्चतस्रो [१] द्बिष्टार्थयोगादपि पञ्चमी स्यात्|

तासां हृदुत्क्लेशकफप्रसेकौ द्वेषोऽशने चैव हि पूर्वरूपम्||६|

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dōṣaiḥ pr̥thaktriprabhavāścatasrō dbiṣṭārthayōgādapi pañcamī syāt|

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

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</div></div>

''Chhardi'' (vomiting) is of five types; three types of vomiting caused by a ''dosha'' each i.e. ''vatika, paittika, kaphaja,'' fourth is ''sannipatika'' 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]

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

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

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व्यायामतीक्ष्णौषधशोकरोगभयोपवासाद्यतिकर्शितस्य|

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कृच्छ्रेण चाल्पं महता च वेगेनार्तोऽनिलाच्छर्दयतीह दुःखम्||९||

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vyāyāmatīkṣṇauṣadhaśōkarōgabhayōpavāsādyatikarśitasya|

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kRucchreNa cAlpaM mahatA ca vegenArto~anilAcchardayatIha duHkham||9||

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</div></div>

In a person extremely emaciated because of disease, excessive intake of medicines having ''tikshna'' (sharply acting) attributes and indulging in grief, fear, fasting, etc. ''vata'' gets excessively aggravated in the ''maha-srotas'' (gastrointestinal tract), vitiates the local ''doshas'' and pushes them upwards. These ''doshas'' cause agitation in the ''amashaya'' (stomach), and after afflicting the ''marma'' (vital organs-heart) gives rise to ''chhardi'' (vomiting). This ''vataja'' type of vomiting is characterized by the following signs and symptoms:

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#The patient feels miserable [7-9]

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

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

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अजीर्णकट्वम्लविदाह्यशीतैरामाशये पित्तमुदीर्णवेगम्|

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पीतं भृशोष्णं हरितं सतिक्तं धूम्रं च पित्तेन वमेत् सदाहम्||११||

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ajīrṇakaṭvamlavidāhyaśītairāmāśayē pittamudīrṇavēgam|

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pItaM bhRushoShNaM haritaM satiktaM dhUmraM ca pittena vamet sadAham||11||

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</div></div>

As a result of intake of food before the previous meal is digested, or taking pungent, sour, ''vidahi'' (which cause burning sensation) and cold diet, the ''pitta'' in the stomach gets aggravated. This aggravated ''pitta'' spreads through the ''rasayani'' (channels) and stresses the vital organs located in the upper part of the body which results in vomiting:

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

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

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

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स्निग्धातिगुर्वामविदाहिभोज्यैः स्वप्नादिभिश्चैव कफोऽतिवृद्धः|

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स्निग्धं घनं स्वादु कफाद्विशुद्धं सलोमहर्षोऽल्परुजं वमेत्तु||१३||

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snigdhātigurvāmavidāhibhōjyaiḥ svapnādibhiścaiva kaphō'tivr̥ddhaḥ|

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snigdhaM ghanaM svAdu kaphAdvishuddhaM salomaharSho~alparujaM vamettu||13||

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</div></div>

As a result of the intake of unctuous, excessively heavy, ''ama'' (raw/uncooked) and ''vidahi'' (causing burning sensation) food and because of excessive sleep and similar other factors, ''kapha'' gets excessively aggravated. This ''kapha'' occludes the chest, head, vital organs and all the (concerned) channels to cause ''chhardi'' (vomiting). The signs and symptoms of this ''kaphaja'' type of ''chhardi'' are as follows:

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

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

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

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समश्नतः सर्वरसान् प्रसक्तमामप्रदोषर्तुविपर्ययैश्च|

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छर्दिस्त्रिदोषाल्लवणाम्लनीलसान्द्रोष्णरक्तं वमतां नृणां स्यात्||१५||

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samaśnataḥ sarvarasān prasaktamāmapradōṣartuviparyayaiśca|

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chardistridoShAllavaNAmlanIlasAndroShNaraktaM vamatAM nRuNAM syAt||15||

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</div></div>

Because of constant indulgence in diet consisting of wholesome and unwholesome diet together, having all categories of taste together because of ''ama-dosha'' (ailments caused by improper digestion) and because of seasonal perversions, all the three ''doshas'' get simultaneously aggravated and cause ''sannipatika chhardi''.

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

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==== Bad prognostic symptoms ====

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=== Bad prognostic symptoms ===

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विट्स्वेदमूत्राम्बुवहानि वायुः स्रोतांसि संरुध्य यदोर्ध्वमेति|

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प्रच्छर्दयेद्दुष्टमिहातिवेगात्तयाऽर्दितश्चाशु विनाशमेति||१७||

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viṭsvēdamūtrāmbuvahāni vāyuḥ srōtāṁsi saṁrudhya yadōrdhvamēti|

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pracchardayedduShTamihAtivegAttayA~arditashcAshu vinAshameti||17||

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</div></div>

When the morbid ''vata'' occludes the channels carrying faeces, sweat, urine and body fluids and moves upwards, then the morbid matter from the ''koshtha'' (gastrointestinal tract), gets incited to cause vomiting, that has the following characteristics:

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

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

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

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द्विष्टप्रतीपाशुचिपूत्यमेध्यबीभत्सगन्धाशनदर्शनैश्च|

यच्छर्दयेत्तप्तमना मनोध्नैर्द्विष्टार्थसंयोगभवा मता सा||१८||

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dviṣṭapratīpāśucipūtyamēdhyabībhatsagandhāśanadarśanaiśca|

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yacchardayettaptamanA manodhnairdviShTArthasaMyogabhavA matA sA||18||

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</div></div>

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

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

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

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क्षीणस्य या छर्दिरतिप्रवृद्धा सोपद्रवा शोणितपूययुक्ता|

सचन्द्रिकां तां प्रवदन्त्यसाध्यां साध्यां चिकित्सेदनुपद्रवां च||१९||

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kṣīṇasya yā chardiratipravr̥ddhā sōpadravā śōṇitapūyayuktā|

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sacandrikAM tAM pravadantyasAdhyAM sAdhyAM cikitsedanupadravAM ca||19||

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</div></div>

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

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==== Principles of treatment ====

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=== Principles of treatment ===

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आमाशयोत्क्लेशभवा हि सर्वाश्छर्द्यो मता लङ्घनमेव तस्मात्|

प्राक्कारयेन्मारुतजां विमुच्य संशोधनं वा कफपित्तहारि||२०||

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āmāśayōtklēśabhavā hi sarvāśchardyō matā laṅghanamēva tasmāt|

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prAkkArayenmArutajAM vimucya saMshodhanaM vA kaphapittahAri||20||

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</div></div>

As all the types of vomiting are considered originating from the agitations of the ''doshas'' in the stomach, fasting therapy should first be prescribed or purificatory procedure curative of ''kapha'' and ''pitta'' should be administered except in cases of ''vata'' dominance. [20]

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चूर्णानि लिह्यान्मधुनाऽभयानां हृद्यानि वा यानि विरेचनानि|

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रसैर्मनोज्ञैर्लघुभिर्विशुष्कैर्भक्ष्यैः सभोज्यैर्विविधैश्च पानैः||२२||

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cūrṇāni lihyānmadhunā'bhayānāṁ hr̥dyāni vā yāni virēcanāni|

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rasairmanoj~jairlaghubhirvishuShkairbhakShyaiH sabhojyairvividhaishca pAnaiH||22||

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</div></div>

The patient shall take powder of ''abhaya'' (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.

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

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

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

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सुसंस्कृतास्तित्तिरिबर्हिलावरसा व्यपोहन्त्यनिलप्रवृत्ताम्|

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स्निग्धानि हृद्यानि च भोजनानि रसैः सयूषैर्दधिदाडिमाम्लैः||२५||

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susaṁskr̥tāstittiribarhilāvarasā vyapōhantyanilapravr̥ttām|

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snigdhAni hRudyAni ca bhojanAni rasaiH sayUShairdadhidADimAmlaiH||25||

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</div></div>

The following recipes are useful in ''vataja'' type of vomiting (''chhardi''):

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

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

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

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पित्तात्मिकायामनुलोमनार्थं द्राक्षाविदारीक्षुरसैस्त्रिवृत् स्यात्|

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शीताम्बुना गैरिकशालिचूर्णं मूर्वां तथा तण्डुलधावनेन||३३||

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pittātmikāyāmanulōmanārthaṁ drākṣāvidārīkṣurasaistrivr̥t syāt|

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shItAmbunA gairikashAlicUrNaM mUrvAM tathA taNDuladhAvanena||33||

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</div></div>

The patient of ''pittaja'' type of ''chhardi'' should be given ''trivrit'' (Operculina turpethum) along with the juice of ''draksha'' (grapes/Vitis vinifera), ''vidari'' (Purera tuberosa) and ''ikshu'' (sugar-cane/Saccharaum officinarum) for causing downward movement of the morbid matter (laxation). When aggravated pitta is located in site of ''kapha'' (chest/stomach), then drugs having sweet taste should be administered for elimination of ''pitta'' (through emetic therapy).

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

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

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

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कफात्मिकायां वमनं प्रशस्तं सपिप्पलीसर्षपनिम्बतोयैः|

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क्षौद्रेण चूर्णं मरिचैश्च युक्तं लिहञ्जयेच्छर्दिमुदीर्णवेगाम्||३९||

+

kaphātmikāyāṁ vamanaṁ praśastaṁ sapippalīsarṣapanimbatōyaiḥ|

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kShaudreNa cUrNaM maricaishca yuktaM liha~jjayecchardimudIrNavegAm||39||

+

</div></div>

''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).

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#''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|

दोषर्तुरोगाग्निबलान्यवेक्ष्य प्रयोजयेच्छास्त्रविदप्रमत्तः||४०||

+

yaiṣā pr̥thaktvēna mayā kriyōktā tāṁ sannipātē'pi samasya buddhyā|

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doSharturogAgnibalAnyavekShya prayojayecchAstravidapramattaH||40||

+

</div></div>

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

−

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

+

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

+

मनोभिघाते तु मनोनुकूला वाचः समाश्वासनहर्षणानि|

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तदेव दद्यात् प्रशमाय तस्यास्तज्जो हि रोगः सुख एव जेतुम्||४४||

+

manōbhighātē tu manōnukūlā vācaḥ samāśvāsanaharṣaṇāni|

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tadeva dadyAt prashamAya tasyAstajjo hi rogaH sukha eva jetum||44||

+

</div></div>

In case of vomiting caused by mental disgust the following measures should be resorted to:

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#In general, whatever odor, taste, contact, sound or sights those are pleasing to such patients should be given though otherwise unsuitable and unwholesome because in this way disease can be treated easily [41-44]

−

==== Treatment of complications ====

+

=== Treatment of complications ===

+

छर्द्युत्थितानां च चिकित्सितात् स्वाच्चिकित्सितं कार्यमुपद्रवाणाम्|

अतिप्रवृत्तासु विरेचनस्य कर्मातियोगे विहितं विधेयम्||४५||

+

chardyutthitānāṁ ca cikitsitāt svāccikitsitaṁ kāryamupadravāṇām|

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atipravRuttAsu virecanasya karmAtiyoge vihitaM vidheyam||45||

+

</div></div>

−

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

+

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 [Cha. Sa.[[Siddhi Sthana]] 6/52-56] for excessive purgation should be carried out [45]

−

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

+

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

+

वमिप्रसङ्गात् पवनोऽप्यवश्यं धातुक्षयाद्धृद्धिमुपैति तस्मात्|

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वृष्यास्तथा मांसरसाः सलेहाश्चिरप्रसक्तां च वमिं जयन्ति||४७||

+

vamiprasaṅgāt pavanō'pyavaśyaṁ dhātukṣayāddhr̥ddhimupaiti tasmāt|

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vRuShyAstathA mAMsarasAH salehAshciraprasaktAM ca vamiM jayanti||47||

+

</div></div>

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.

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The following recipes are useful in chronic type of vomiting.

−

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

+

''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 ===

+

तत्र श्लोकः-

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छर्दीनां प्रशमार्थं प्राह चिकित्सितं मुनिवर्यः||४८||

+

tatra ślōkaḥ-

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chardInAM prashamArthaM prAha cikitsitaM munivaryaH||48||

+

</div></div>

To sum up, in this chapter the predisposing factors, numerals of the vomiting, symptoms, complications, prognosis, formulations and other measures of management for the relief of vomiting are described by the foremost of the sages [48]

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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.

−

==~~= ''~~Tattva Vimarsha~~'' =~~==

+

== 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).

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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.

−

=== ''~~Vidhi Vimarsha~~'' ===

+

== Vidhi Vimarsha (Applied Inferences ) ==

+

=== Pathogenesis ===

+

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

+

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

+

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''.

+

''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'' ====

+

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).

+

==== ''Pittaja 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).

+

==== ''Kaphaja 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).

+

==== ''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).

+

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.

+

=== 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).

+

*''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).

+

*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''.

+

*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''.

+

*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.

+

*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.

+

*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 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.

−

~~Work~~ in ~~Progress~~

+

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

+

{|class="wikitable"

+

!scope = "col"| Type

+

!scope = "col"| Medicine

+

!scope = "col"| Dosage

+

!scope = "col"| Time

+

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

+

|-

+

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

+

| ''Shankha bhasma''

+

| 60-120 mg

+

| Frequently

+

| ''Nimbu Panaka'' (lemon water)

+

|-

+

| ''Pitta'' dominant

+

| ''Sutashekhara kalpa''

+

| 500-1000 mg

+

| Frequently

+

| ''Dadimavaleha''

+

|-

+

| ''Kapha'' dominant

+

| ''Mayu piccha mashi''

+

| 1 - 3 gms

+

| Frequently

+

| ''Ardrakavaleha''

+

|-

+

| ''Tridoshaja''

+

| ''Brihad vata chintamani''

+

| 50 - 100 mg

+

| Frequently

+

| ''Ardraka swarasa'' + sugar + honey

+

|-

+

| ''Dauhridaja'' (in pregnancy)

+

| ''Swarnashekhara'' mixture

+

| 250-500 mg

+

| After meals

+

| ''Ardraka swarasa'' + ''Nimbu swarasa'' + rock salt

+

|-

+

| ''Krimija''

+

| ''Vidanga-yavani phanta''

+

| 20-40 ml

+

| Empty stomach, two times

+

| ''-''

+

|}

−

=== ~~Glossary~~ ===

+

=== Further researches ===

+

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

+

</div>

+

== References ==

−

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

−

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

−

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

−

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

−

~~#Chhardi (छर्दि): vomitting~~

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

−

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

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

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

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

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

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~~#Kṣīṇasya (क्षीणस्य ): emaciated~~

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

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

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

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

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

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

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

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~~#Mūrcchā (मूर्च्छा): unconsciousness~~

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

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

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

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

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~~#Pipāsā (पिपासा): thirst~~

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

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

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

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

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

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

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

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

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

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

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

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

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~~#Samāvr̥tya (समावृत्य): collectively~~

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

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

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

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~~#Śōka (शोक): grief~~

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

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

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

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

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

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

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

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

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

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

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

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

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

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~~#Vyākhyā (व्याख्या): explanation~~

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

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

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~~References:~~

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