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''Trishna'' and ''pipasa'' are two commonly used words denoting desire for water, the difference between the two is, ''trishna'' is pathological and ''pipasa'' is physiological. Generally, desire for water is physiological process to maintain fluid balance but if ''dosha'' are vitiated then they can lead to excessive thirst and can produce ''trishna'', a disease in which person constantly craves for the water. Beside independent disease, ''trishna'' or thirst is also seen as prodromal symptom, clinical feature, complication, poor prognostic sign etc. in various clinical conditions. In this chapter, etiological factors, premonitory symptoms, pathogenesis, clinical features and complications of trishna as a disease are discussed.

''Trishna'' and ''pipasa'' are two commonly used words denoting desire for water, the difference between the two is, ''trishna'' is pathological and ''pipasa'' is physiological. Generally, desire for water is physiological process to maintain fluid balance but if ''dosha'' are vitiated then they can lead to excessive thirst and can produce ''trishna'', a disease in which person constantly craves for the water. Beside independent disease, ''trishna'' or thirst is also seen as prodromal symptom, clinical feature, complication, poor prognostic sign etc. in various clinical conditions. In this chapter, etiological factors, premonitory symptoms, pathogenesis, clinical features and complications of trishna as a disease are discussed.

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'''Keywords''': ''trishna, vata, pitta, mukha shosha, jala,'' thirst, polydipsia, water and fluid balance, osmosis, ion balance.

'''Keywords''': trishna, [[vata]], [[pitta]], mukha shosha, jala, thirst, polydipsia, water and fluid balance, osmosis, ion balance.

The other meaning of ''trishna'' is greed or insatiable desire for something. It can be referred that word ''trishna'' not only denotes physical craving but includes psychological desires also. In morbid thirst both body and mind crave and there are conditions like psychogenic polydypsia in which thirst is only due to mental involvement. As mind plays an important role in thirst as a disease this chapter has been named as ''trishna chikitsitam'' (or [[Trishna Chikitsa]]) not ''pipasa chikitsitam''.  

The other meaning of ''trishna'' is greed or insatiable desire for something. It can be referred that word ''trishna'' not only denotes physical craving but includes psychological desires also. In morbid thirst both body and mind crave and there are conditions like psychogenic polydypsia in which thirst is only due to mental involvement. As mind plays an important role in thirst as a disease this chapter has been named as ''trishna chikitsitam'' (or [[Trishna Chikitsa]]) not ''pipasa chikitsitam''.  

''Trishna'' word in [[Ayurveda]] is interchangeably used for physiological as well as pathological thirst. Normally, ''vata'' and ''pitta'' are the two ''dosha'' inseparably involved in causing ''trishna'' as they have ''shoshana guna'' (property to absorb the water element) but the difference is ''vata'' absorbs the moisture by its dry property, whereas ''pitta'' does it by its hot property. Thirst is function of unvitiated ''pitta'' and clinically presents as ''mukha shosha'' (dry mouth) which occurs due to ''vata''. So, it can be said that both ''dosha'' are inseparably involved in thirst production. When they are ‘unvitiated’, physiological thirst is produced and when ‘vitiated’ they can cause ''trishna''. Based on etiological factor and pathogenesis involved, ''trishna'' is classified into five types – ''vataja, pittaja, amaja, kshayaja'' and ''upasargaja''. These ''dosha'' absorb water from the ''saumya dhatu'' like ''rasa, udaka'' and ''kapha'' (tissues in which water content is more). Three more types – ''kaphaja, bhaktodhabhavaja'' (after excess eating) and ''kshataja'' (thirst produced due to external injury).  

''Trishna'' word in [[Ayurveda]] is interchangeably used for physiological as well as pathological thirst. Normally, [[vata]] and [[pitta]] are the two [[dosha]] inseparably involved in causing ''trishna'' as they have ''shoshana guna'' (property to absorb the water element) but the difference is [[vata]] absorbs the moisture by its dry property, whereas [[pitta]] does it by its hot property. Thirst is function of unvitiated [[pitta]] and clinically presents as ''mukha shosha'' (dry mouth) which occurs due to [[vata]]. So, it can be said that both [[dosha]] are inseparably involved in thirst production. When they are ‘unvitiated’, physiological thirst is produced and when ‘vitiated’ they can cause ''trishna''. Based on etiological factor and pathogenesis involved, ''trishna'' is classified into five types – [[vata]]ja, [[pitta]]ja, amaja, kshayaja and ''upasargaja''. These [[dosha]] absorb water from the saumya [[dhatu]] like [[rasa dhatu]], udaka and [[kapha]] (tissues in which water content is more). Three more types – [[kapha]]ja, bhaktodhabhavaja'' (after excess eating) and ''kshataja'' (thirst produced due to external injury).  

Presently we rely only on fluid and electrolyte supplementation to treat thirst. Treatment of ''trishna'' by ayurvedic principles may open newer vistas in the cases where thirst is difficult to treat. Increased mortality due to dehydration, especially in vulnerable populations, it is commonly observed during periods of abnormally warm weather.<ref> Maughan RJ.,Nutr Rev. 2012 Nov;70 Suppl 2:S152-5, Hydration, morbidity, and mortality in vulnerable populations.</ref> Mortality rate is high in remote areas where health care facilities are not good enough. Ayurvedic preparations mentioned in this chapter are easy to make, can be life saving where sophisticated medical care is not available. Based on Ayurvedic principles, rules regarding use of water in various diseases have been also given in this chapter.

Presently we rely only on fluid and electrolyte supplementation to treat thirst. Treatment of ''trishna'' by ayurvedic principles may open newer vistas in the cases where thirst is difficult to treat. Increased mortality due to dehydration, especially in vulnerable populations, it is commonly observed during periods of abnormally warm weather.<ref> Maughan RJ.,Nutr Rev. 2012 Nov;70 Suppl 2:S152-5, Hydration, morbidity, and mortality in vulnerable populations.</ref> Mortality rate is high in remote areas where health care facilities are not good enough. Ayurvedic preparations mentioned in this chapter are easy to make, can be life saving where sophisticated medical care is not available. Based on Ayurvedic principles, rules regarding use of water in various diseases have been also given in this chapter.

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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]

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 ===

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

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]

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'' ===

=== [[Vata]] dominant ''trishna'' ===

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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]

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

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

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

=== [[Pitta]] dominant ''trishna'' ===

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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.

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.

Bitter taste in the mouth, burning sensation in the head, cravings for cold things, fainting and yellowish discoloration of eyes, urine and feces, are the clinical features of ''pittaja'' morbid thirst.[13-14]

Bitter taste in the mouth, burning sensation in the head, cravings for cold things, fainting and yellowish discoloration of eyes, urine and feces, are the clinical features of [[pitta]]ja morbid thirst.[13-14]

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

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

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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]

Morbid thirst, which originates from incomplete transformation or metabolism of food, is also a [[pitta]]ja 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 ===

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

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]

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'' ===

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

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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.

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.

In a condition where person after indulging in heavy food, milk and unctuous articles, which during the digestive process cause thirst by obstructing the channels, in such condition ''vata'' and the thermal elements act as the causative factors.

In a condition where person after indulging in heavy food, milk and unctuous articles, which during the digestive process cause thirst by obstructing the channels, in such condition [[vata]] and the thermal elements act as the causative factors.

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]

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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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]

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 ===

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

The thinking of or listening to the description of Himalayan caves, woods, streams, lakes, lotuses, breezes, moonlight, and other cool things as well as of lovely cool waters- these have an allaying effect on morbid thirst.[34-39]

The thinking of or listening to the description of Himalayan caves, woods, streams, lakes, lotuses, breezes, moonlight, and other cool things as well as of lovely cool waters- these have an allaying effect on morbid thirst.[34-39]

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

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

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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]

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'' ===

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

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

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

In ''pittaja'' morbid thirst, water mixed with grapes, sandalwood, dates, vetiveria zizanioidis, honey and cold water in which red ''shali'' rice, dates, ''parushaka'', blue water lily, grapes, honey and a baked lump of earth have been kept, may be given or water kept in earthen pot in which 64 tola of red ''shali'' rice, pounded with ''lodhra'', liquorice, antimony and blue water lily are put and in which a baked clod of clay, water and honey have been integrated. This is a curative drink in morbid thirst.

In [[pitta]]ja morbid thirst, water mixed with grapes, sandalwood, dates, vetiveria zizanioidis, honey and cold water in which red ''shali'' rice, dates, ''parushaka'', blue water lily, grapes, honey and a baked lump of earth have been kept, may be given or water kept in earthen pot in which 64 tola of red ''shali'' rice, pounded with ''lodhra'', liquorice, antimony and blue water lily are put and in which a baked clod of clay, water and honey have been integrated. This is a curative drink in morbid thirst.

In the water prepared with sprouts of banyan, citrus medica, country willow, roots of sacrificial and thatch grass and liquorice and quench black earthen or black sand or pieces of new earthen vessel which have been heated up to red hot. Use supernatant part of this mixture and give it to the patient.

In the water prepared with sprouts of banyan, citrus medica, country willow, roots of sacrificial and thatch grass and liquorice and quench black earthen or black sand or pieces of new earthen vessel which have been heated up to red hot. Use supernatant part of this mixture and give it to the patient.

Quench red hot stones in decoction of ''guduchi'' and use it after cooling it.

Quench red hot stones in decoction of ''guduchi'' and use it after cooling it.

The cold infusions prepared from ''kshiri'' and ''madhur, shita'' group of plants should be given after adding sugar and honey quenching of baked clay should be done as described earlier. It is useful in ''pittaja trishna''. [41-46]

The cold infusions prepared from ''kshiri'' and ''madhur, shita'' group of plants should be given after adding sugar and honey quenching of baked clay should be done as described earlier. It is useful in [[pitta]]ja trishna. [41-46]

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

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

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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.

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

Rigidity, anorexia, indigestion, lethargy and regurgitation are suggestive of ''kaphaja'' type of thirst. In such condition, a dose of prepared curds, honey demulcent drink, salt and warm water should be used to induce vomiting.

Rigidity, anorexia, indigestion, lethargy and regurgitation are suggestive of [[kapha]]ja type of thirst. In such condition, a dose of prepared curds, honey demulcent drink, salt and warm water should be used to induce vomiting.

The physician may also give pomegranate or other sour fruits or the linctus mixed with astringent substances or he may give a potion containing turmeric and sugar.[47-49]

The physician may also give pomegranate or other sour fruits or the linctus mixed with astringent substances or he may give a potion containing turmeric and sugar.[47-49]

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

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

In thirst caused by ''sannipata'' (vitiation of all ''dosha'') ''tridoshaja'', water cooled after boiling is beneficial.

In thirst caused by ''sannipata'' (vitiation of all [[dosha]]) ''tridoshaja'', water cooled after boiling is beneficial.

Warm water is useful in condition like hiccough, dyspnea, acute fever, coryza, after consumption of ghee, disorders of flanks and throat, diseases caused by ''kapha'' and ''vata'', or when the ''dosha'' are still not moving properly in the body and just after the purificatory treatment.

Warm water is useful in condition like hiccough, dyspnea, acute fever, coryza, after consumption of ghee, disorders of flanks and throat, diseases caused by [[kapha]] and [[vata]], or when the [[dosha]] are still not moving properly in the body and just after the purificatory treatment.

In anemia, abdominal disease, ''gulma, meha,'' depleted digestive power, diarrhea and splenic disorders water intake is not beneficial; but if the thirst is unbearable, the patient may drink  water in less quantity.

In anemia, abdominal disease, ''gulma, meha,'' depleted digestive power, diarrhea and splenic disorders water intake is not beneficial; but if the thirst is unbearable, the patient may drink  water in less quantity.

Here is the recapitulatory verse-

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]

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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== Tattva Vimarsha (Fundamental Principles) ==

== Tattva Vimarsha (Fundamental Principles) ==

*Morbid thirst is caused by severe vitiation of ''pitta'' and ''vata dosha''.  

*Morbid thirst is caused by severe vitiation of [[pitta]] and [[vata]] [[dosha]].  

*Etiological factors for ''trishna'' are vitiated ''vata'' and ''pitta'' as both ''dosha'' have absorbent (''shoshaka'') property which damage the ''rasavaha'' and ''udakavaha srotas'' and manifest the symptom of constant craving for water.

*Etiological factors for ''trishna'' are vitiated [[vata]] and [[pitta]] as both [[dosha]] have absorbent (''shoshaka'') property which damage the ''rasavaha'' and ''udakavaha srotas'' and manifest the symptom of constant craving for water.

*Severely vitiated ''dosha'' vigorously dehydrate the fluid carrying ducts and channels situated at the base of the tongue, throat, palate and ''kloma'' leading to morbid thirst in a person.

*Severely vitiated [[dosha]] vigorously dehydrate the fluid carrying ducts and channels situated at the base of the tongue, throat, palate and ''kloma'' leading to morbid thirst in a person.

*Constant craving for water is the cardinal symptom of pathological thirst.  

*Constant craving for water is the cardinal symptom of pathological thirst.  

*The morbid thirst is classified into ''vata'' dominant, ''pitta'' dominant, that due to vitiation of ''ama'', due to excess depletion of body elements and as a complication of other diseases.  

*The morbid thirst is classified into [[vata]] dominant, [[pitta]] dominant, that due to vitiation of ''ama'', due to excess depletion of body elements and as a complication of other diseases.  

*Rain water is the best remedy to pacify thirst. The water, that has slight astringent taste, light to digest, cool properties, possess good smell and taste and is devoid of channel blocking quality, should be considered equal to rain water in effect though it may be terrestrial. Various recipes having same properties are used in management of thirst.

*Rain water is the best remedy to pacify thirst. The water, that has slight astringent taste, light to digest, cool properties, possess good smell and taste and is devoid of channel blocking quality, should be considered equal to rain water in effect though it may be terrestrial. Various recipes having same properties are used in management of thirst.

*The management principle of ''trishna'' includes rehydration with pure rain water, medicated water, external application of medicinal pastes.

*The management principle of ''trishna'' includes rehydration with pure rain water, medicated water, external application of medicinal pastes.

*The temperature of water plays key role in the management of ''trishna''. Hot water, normal water and cold water shall be used after proper assessment of ''dosha'' dominant condition.   

*The temperature of water plays key role in the management of ''trishna''. Hot water, normal water and cold water shall be used after proper assessment of [[dosha]] dominant condition.   

*Nourishment of all body elements (''dhatu'') depends on ''ahara rasa''. ''Rasa'' is predominantly ''apya'' (dominated by water element) in nature. So, diminution of ''rasa dhatu'' ultimately leads to loss of water content in body and production of ''trishna''.

*Nourishment of all body elements ([[dhatu]]) depends on ''ahara rasa''. ''Rasa'' is predominantly ''apya'' (dominated by water element) in nature. So, diminution of [[rasa dhatu]] ultimately leads to loss of water content in body and production of ''trishna''.

== Vidhi Vimarsha (Applied Inferences ) ==

== Vidhi Vimarsha (Applied Inferences ) ==

=== Differentiation between ''trishna'' and ''pipasa'' ===

=== Differentiation between ''trishna'' and ''pipasa'' ===

''Trishna'' and ''pipasa'' are two commonly used terms. ''Trishna'' is pathological thirst while ''pipasa'' is physiological. Physiological thirst is relieved after adequate water intake, whereas, pathological thirst is not relieved even after repeated water intake. Both of them are due to ''vata'' and ''pitta dosha''. In ''pipasa'' they are in balanced state while in ''trishna'' they are vitiated. ''Trishna'' is manifestation of decrease in ''saumya dhatu'' (body elements composed of predominantly water) in body ''rasa, rakta, lasika, kleda, medas,'' and urine. One common channel, ''udakavaha srotas'' regulates all the water content of the body. It is situated between palate, tongue and throat.

''Trishna'' and ''pipasa'' are two commonly used terms. ''Trishna'' is pathological thirst while ''pipasa'' is physiological. Physiological thirst is relieved after adequate water intake, whereas, pathological thirst is not relieved even after repeated water intake. Both of them are due to [[vata]] and [[pitta]] [[dosha]]. In ''pipasa'' they are in balanced state while in ''trishna'' they are vitiated. ''Trishna'' is manifestation of decrease in saumya [[dhatu]] (body elements composed of predominantly water) in body [[rasa dhatu]], [[rakta dhatu]], lasika, kleda, [[meda dhatu]], and urine. One common channel, ''udakavaha srotas'' regulates all the water content of the body. It is situated between palate, tongue and throat.

==== ''Udakavaha srotasa'' ====

==== ''Udakavaha srotasa'' ====

=== Mechanisms of fluid balance ===

=== Mechanisms of fluid balance ===

*Osmosis is the primary means of water movement between intracellular fluid and interstitial fluid, the concentration of solutes in these fluids determines the direction of water movement. Because most solutes in body fluids are electrolytes, inorganic compounds that dissociate into ions, fluid balance is closely related to electrolyte balance. Because intake of water and electrolytes rarely occurs in exactly the same proportions as their presence in body fluids, the ability of the kidneys to excrete excess water by producing dilute urine, or to excrete excess electrolytes by producing concentrated urine, is of utmost importance in the maintenance of homeostasis. ''Sama anayati iti samanam'' is the definition of ''samana vayu''. ''Samana'' has a seat in ''sweda, dosha'' and ''ambhuvaha srotas''. As discussed above maintaining the pH (''sami karoti'') is brought about by specific ionic movement and this particular force is provided by ''samana vayu''. It maintains the pH by maintaining a specific ratio of solutes and solvents and if this specific ratio is disturbed it leads to various diseases for e.g. a decrease in blood volume causes blood pressure to fall. This change stimulates the kidneys to release renin, which promotes the formation of angiotensin II. Increased nerve impulses from osmo-receptors in the hypothalamus, triggered by increased blood osmolarity, and increased angiotensin II in the blood both stimulate the thirst center in the hypothalamus. Other signals that stimulate thirst come from (1) neurons in the mouth that detect dryness due to a decreased flow of saliva and (2) baroreceptors that detect lowered blood pressure in the heart and blood vessels. As a result, the sensation of thirst increases, which usually leads to increased fluid intake (if fluids are available) and restoration of normal fluid volume. Overall, fluid gain balances fluid loss. Sometimes, however, the sensation of thirst does not occur quickly enough or access to fluids is restricted, and significant dehydration ensues. This happens most often in elderly people, in infants, and in those who are in a confused mental state. Even though the loss of water and solutes through sweating and exhalation increases during exercise, elimination of excess body water or solutes occurs mainly by control of their loss in urine.

*Osmosis is the primary means of water movement between intracellular fluid and interstitial fluid, the concentration of solutes in these fluids determines the direction of water movement. Because most solutes in body fluids are electrolytes, inorganic compounds that dissociate into ions, fluid balance is closely related to electrolyte balance. Because intake of water and electrolytes rarely occurs in exactly the same proportions as their presence in body fluids, the ability of the kidneys to excrete excess water by producing dilute urine, or to excrete excess electrolytes by producing concentrated urine, is of utmost importance in the maintenance of homeostasis. ''Sama anayati iti samanam'' is the definition of ''samana vayu''. ''Samana'' has a seat in ''sweda, [[dosha]] and ''ambhuvaha srotas''. As discussed above maintaining the pH (''sami karoti'') is brought about by specific ionic movement and this particular force is provided by ''samana vayu''. It maintains the pH by maintaining a specific ratio of solutes and solvents and if this specific ratio is disturbed it leads to various diseases for e.g. a decrease in blood volume causes blood pressure to fall. This change stimulates the kidneys to release renin, which promotes the formation of angiotensin II. Increased nerve impulses from osmo-receptors in the hypothalamus, triggered by increased blood osmolarity, and increased angiotensin II in the blood both stimulate the thirst center in the hypothalamus. Other signals that stimulate thirst come from (1) neurons in the mouth that detect dryness due to a decreased flow of saliva and (2) baroreceptors that detect lowered blood pressure in the heart and blood vessels. As a result, the sensation of thirst increases, which usually leads to increased fluid intake (if fluids are available) and restoration of normal fluid volume. Overall, fluid gain balances fluid loss. Sometimes, however, the sensation of thirst does not occur quickly enough or access to fluids is restricted, and significant dehydration ensues. This happens most often in elderly people, in infants, and in those who are in a confused mental state. Even though the loss of water and solutes through sweating and exhalation increases during exercise, elimination of excess body water or solutes occurs mainly by control of their loss in urine.

*The extent of urinary salt (NaCl) loss is the main factor that determines body fluid volume. The reason for this is that “water follows solutes” in osmosis, and the two main solutes in extracellular fluid (and in urine) are sodium ions (Na) and chloride ions (Cl). In a similar way, the main factor that determines body fluid osmolarity is the extent of urinary water loss. Because our daily diet contains a highly variable amount of NaCl, urinary excretion of Na and Cl must also vary to maintain homeostasis. Hormonal changes regulate the urinary loss of these ions, which in turn affects blood volume. The increased intake of NaCl produces an increase in plasma levels of Na and Cl (the major contributors to osmolarity of extracellular fluid). As a result, the osmolarity of interstitial fluid increases, which causes movement of water from intracellular fluid into interstitial fluid and then into plasma. Such water movement increases blood volume.  

*The extent of urinary salt (NaCl) loss is the main factor that determines body fluid volume. The reason for this is that “water follows solutes” in osmosis, and the two main solutes in extracellular fluid (and in urine) are sodium ions (Na) and chloride ions (Cl). In a similar way, the main factor that determines body fluid osmolarity is the extent of urinary water loss. Because our daily diet contains a highly variable amount of NaCl, urinary excretion of Na and Cl must also vary to maintain homeostasis. Hormonal changes regulate the urinary loss of these ions, which in turn affects blood volume. The increased intake of NaCl produces an increase in plasma levels of Na and Cl (the major contributors to osmolarity of extracellular fluid). As a result, the osmolarity of interstitial fluid increases, which causes movement of water from intracellular fluid into interstitial fluid and then into plasma. Such water movement increases blood volume.  

*Water balance and electrolyte balance are closely linked. The body works to keep the total amount of water and the levels of electrolytes in the blood constant. For example, when the sodium level becomes too high, thirst develops, leading to an increased intake of fluids. In addition, vasopressin (also called antidiuretic hormone), a hormone secreted by the brain in response to dehydration, causes the kidneys to excrete less water. The combined effect is an increased amount of water in the blood. As a result, sodium is diluted and the balance of sodium and water is restored. When the sodium level becomes too low, the kidneys excrete more water, which decreases the amount of water in the blood, again restoring the balance. Water flows passively (by osmosis) from one area or compartment of the body to another. This passive flow allows the larger volumes of fluid in the cells and the area around the cells to act as reservoirs to protect the more critical but smaller volume of fluid in the blood vessels from dehydration.

*Water balance and electrolyte balance are closely linked. The body works to keep the total amount of water and the levels of electrolytes in the blood constant. For example, when the sodium level becomes too high, thirst develops, leading to an increased intake of fluids. In addition, vasopressin (also called antidiuretic hormone), a hormone secreted by the brain in response to dehydration, causes the kidneys to excrete less water. The combined effect is an increased amount of water in the blood. As a result, sodium is diluted and the balance of sodium and water is restored. When the sodium level becomes too low, the kidneys excrete more water, which decreases the amount of water in the blood, again restoring the balance. Water flows passively (by osmosis) from one area or compartment of the body to another. This passive flow allows the larger volumes of fluid in the cells and the area around the cells to act as reservoirs to protect the more critical but smaller volume of fluid in the blood vessels from dehydration.

*Function of ''samana vayu'' needs to be understood. ''Sweda dosha ambuvaha srotas'' is the seat for ''samana vayu''. Maintaining the balance is the function of ''samana vayu'' and it is brought about by ''grahanati'' (to retain food until digested), ''pachati'' (to digest) , ''vivechayati'' (differentiating between waste and useful product) and ''munchati'' (to release waste to ''apana'') action. ''Samana vayu'' is vital for organisms to be able to maintain their fluid levels in very narrow ranges. One set of receptors responsible for thirst detects the concentration of interstitial fluid. The other set of receptors detects blood volume. Arterial baroreceptors sense a decreased arterial pressure, and signal to the central nervous system in the area postrema and nucleus tractus solitarii. Cardiopulmonary receptors sense a decreased blood volume, and signal to area postrema and nucleus tractus solitarii as well. This explains the function of ''srotas sthita maruta'' (''vyana vayu'') and ''mana'' due to its ''satva guna'' helps in getting knowledge about the surrounding.

*Function of ''samana vayu'' needs to be understood. Sweda [[dosha]] ambuvaha srotas is the seat for ''samana vayu''. Maintaining the balance is the function of ''samana vayu'' and it is brought about by ''grahanati'' (to retain food until digested), ''pachati'' (to digest) , ''vivechayati'' (differentiating between waste and useful product) and ''munchati'' (to release waste to ''apana'') action. ''Samana vayu'' is vital for organisms to be able to maintain their fluid levels in very narrow ranges. One set of receptors responsible for thirst detects the concentration of interstitial fluid. The other set of receptors detects blood volume. Arterial baroreceptors sense a decreased arterial pressure, and signal to the central nervous system in the area postrema and nucleus tractus solitarii. Cardiopulmonary receptors sense a decreased blood volume, and signal to area postrema and nucleus tractus solitarii as well. This explains the function of ''srotas sthita maruta'' (vyana [[vayu]]) and [[manas]] due to its ''satva guna'' helps in getting knowledge about the surrounding.

*Osmometric thirst occurs when the solute concentration of the interstitial fluid increases. This increase draws water out of the cells, and they shrink in volume. The solute concentration of the interstitial fluid increases by high intake of sodium in diet or by the drop in volume of extracellular fluids (such as blood plasma and cerebrospinal fluid) due to loss of water through perspiration, respiration, urination and defecation. The increase in interstitial fluid solute concentration causes water to migrate from the cells of the body, through their membranes, to the extracellular compartment, by osmosis, thus causing cellular dehydration.

*Osmometric thirst occurs when the solute concentration of the interstitial fluid increases. This increase draws water out of the cells, and they shrink in volume. The solute concentration of the interstitial fluid increases by high intake of sodium in diet or by the drop in volume of extracellular fluids (such as blood plasma and cerebrospinal fluid) due to loss of water through perspiration, respiration, urination and defecation. The increase in interstitial fluid solute concentration causes water to migrate from the cells of the body, through their membranes, to the extracellular compartment, by osmosis, thus causing cellular dehydration.

=== Etiopathogenesis of ''trishna'' ===

=== Etiopathogenesis of ''trishna'' ===

In morbid thirst, ''vata'' and ''pitta dosha'' are predominately involved. Etiological factors aggravate either ''vata, pitta'' or both and manifest ''trishna''. Both ''dosha'' have absorbent (''soshaka'') property, ''vata dosha'' by its drying property and ''pitta'' by its heating property. Therefore excess exposure to various factors in diet and lifestyles leading to dryness and heat inside the body are considered as causative factors for ''trishna''. Some of the commonly observed factors are enlisted below:  

In morbid thirst, [[vata]] and [[pitta]] [[dosha]] are predominately involved. Etiological factors aggravate either [[vata]], [[pitta]] or both and manifest ''trishna''. Both [[dosha]] have absorbent (''soshaka'') property, [[vata]] [[dosha]] by its drying property and [[pitta]] by its heating property. Therefore excess exposure to various factors in diet and lifestyles leading to dryness and heat inside the body are considered as causative factors for ''trishna''. Some of the commonly observed factors are enlisted below:  

*'''Dietary causes''': Regular use of alkaline & sour substances, use of excessive salt, pungent, salty, dry and dehydrated food, extreme starvation, alcoholism

*'''Dietary causes''': Regular use of alkaline & sour substances, use of excessive salt, pungent, salty, dry and dehydrated food, extreme starvation, alcoholism

*'''Lifestyle causes''': Excess exercise [Cha.Sa. [[Sura Sthana]] 7/33], excess distress, excessive exposure to sunlight, fatigue.

*'''Lifestyle causes''': Excess exercise [Cha.Sa. [[Sura Sthana]] 7/33], excess distress, excessive exposure to sunlight, fatigue.

*'''Iatrogenic causes''': Excessive use of purification procedures, improper ''snehapana'' (administration of therapeutic medicated ghee or similar unctuous substance) [Cha. Sa.[[Sutra Sthana]] 13/71]

*'''Iatrogenic causes''': Excessive use of purification procedures, improper ''snehapana'' (administration of therapeutic medicated ghee or similar unctuous substance) [Cha. Sa.[[Sutra Sthana]] 13/71]

*Due to chronic diseases leading to emaciation and excessive loss of basic body forming elements  

*Due to chronic diseases leading to emaciation and excessive loss of basic body forming elements  

*Associated symptom of diseases like ''shotha'' [Cha. Sa. [[Sutra Sthana]] 18/18], ''pitta'' dominant ''gulma'' [Cha.Sa. [[Chikitsa Sthana]] 5/36], ''vrana'' [Cha. Sa. [[Chikitsa Sthana]] 25/30], ''udavarta'' [Cha.Sa. [[Chikitsa Sthana]] 26/9], ''prameha'' [Cha.Sa. [[Nidana Sthana]] 4/48], ''kushtha'' [Cha. Sa.[[Nidana Sthana]] 5/11], ''antarvega jwara'' [Cha.Sa.[[Chikitsa Sthana]] 3/39], ''bahirvegi jwara'' [Cha. Sa. [[Chikitsa Sthana]] 3/41], ''rakta dhatugata jwara''[Cha. Sa. [[Chikitsa Sthana]] 3/77] , ''vata pitta jwara'' [ Cha.Sa.[[Chikitsa Sthana]] 3/85], ''shleshma-paittika jwara'' [Cha.Sa. [[Chikitsa Sthana]] 3/88], ''pitta kapholvana hina vata sannipata jwara''[Cha.Sa.[[Chikitsa Sthana]] 3/93] , ''vatolvana kapha pitta hina sannipata jwara'' [Cha.Sa.[[Chikitsa Sthana]] 3/94], ''pittolvana madhya kapha hina vata jwara'' [Cha.Sa. [[Chikitsa Sthana]] 3/98], ''sama sannipata jwara''[Cha.Sa.[[Chikitsa Sthana]] 3/102], ''pittolvana vata madhya kapha hina jwara''[Cha.Sa. [[Chikitsa Sthana]] 3/106], ''pachyamana jwara'' [Cha.Sa.[[Chikitsa Sthana]] 3/136], ''romantika'' [Cha.Sa.[[Chikitsa Sthana]] 12/92], ''pittodara'' [Cha.Sa.[[Chikitsa Sthana]] 13/28], ''badhagudodara'' [Cha.Sa.[[Chikitsa Sthana]] 13/41],''chhidrodara'' [Cha. Sa. [[Chikitsa Sthana]] 13/44], ''sahaja arsha''[Cha. Sa. [[Chikitsa Sthana]] 14/8 ], ''paittika ajirna'' [Cha. Sa.[[Chikitsa Sthana]] 15/46], ''grahani'' [Cha. Sa. [[Chikitsa Sthana]] 15/53] ,''vataja grahani'' [Cha.Sa.[[Chikitsa Sthana]] 15/61],''paittika pandu'' [Cha. Sa. [[Chikitsa Sthana ]] 16 /20], ''halimaka'' [Cha.Sa. [[Chikitsa Sthana]] 16/133],''vyapeta hikka'' [Cha.Sa. [[Chikitsa Sthana]] 17/32], ''paittika kasa'' [Cha.Sa.[[Chikitsa Sthana]] 18/15], ''kshataja kasa'' [Cha.Sa.[[Chikitsa Sthana]] 18/23], ''paittika atisara'' [Cha. Sa.[[Chikitsa Sthana]] 19/6],''raktatisara''  [Cha.Sa. [[Chikitsa Sthana]] 19/70], ''sannitpatika chhardi'' [Cha. Sa. [[Chikitsa Sthana]] 20/15], ''abhyantara visarpa'' [Cha. Sa. [[Chiktsa Sthana]] 21/16], ''paittika visarpa'' [Cha.Sa. [[Chikitsa Sthana]] 21/32],''vata-paittika visarpa'' [Cha.Sa.[[Chikitsa Sthana]] 21/36],''paittika madatyaya'' [Cha.Sa.[[Chikitsa Sthana]] 24/94], ''madatyaya'' general symptom [Cha.Sa.[[Chikitsa Sthana]] 24/101], ''tikshna madatyaya'' [Cha.Sa.[[Chikitsa Sthana]] 24/113],''vikshaya'' [Cha.Sa. [[Chikitsa Sthana]] 24/ 102],''paittika vrana'' [Cha.Sa.[[Chikitsa Sthana]] 25/13], ''paittika mukharoga'' [Cha.Sa.[[Chikitsa Sthana]] 26/120],''pittavrita vayu'' [Cha.Sa.[[Chikitsa Sthana]] 28 /61], ''paittika vatarakta'' [Cha.Sa. [[Chikitsa Sthana]] 29/ 28], ''dhvaja bhanga'' [Cha. Sa.[[Chikitsa Sthana]] 30/171], ''paittika shiroroga'' [Cha.Sa.[[Sutra Sthana]] 17/23], ''paittika hridroga'' [Cha.Sa.[[Sutra Sthana]] 17 /33], ''vata-kapha kshaya pitta vriddhi'' [Cha.Sa.[[Sutra Sthana]] 17 /60], ''alaji'' [Cha.Sa.[[Sutra Sthana]].17/88],''vata-pittajanya vidradhi'' [Cha.Sa.[[Sutra Sthana]] 17/ 96], ''pitta nanatmaja vikara'' [Cha.Sa.[[Sutra Sthana]] 20 /14 ], ''ambuvaha sroto dushti'' [Cha.Sa.[[ Vimana Sthana]] 5 /11],''paittika jwara'' [Cha.Sa. [[Nidana Sthana]] 1/24].  

*Associated symptom of diseases like ''shotha'' [Cha. Sa. [[Sutra Sthana]] 18/18], [[pitta]] dominant ''gulma'' [Cha.Sa. [[Chikitsa Sthana]] 5/36], ''vrana'' [Cha. Sa. [[Chikitsa Sthana]] 25/30], ''udavarta'' [Cha.Sa. [[Chikitsa Sthana]] 26/9], ''prameha'' [Cha.Sa. [[Nidana Sthana]] 4/48], ''kushtha'' [Cha. Sa.[[Nidana Sthana]] 5/11], ''antarvega jwara'' [Cha.Sa.[[Chikitsa Sthana]] 3/39], ''bahirvegi jwara'' [Cha. Sa. [[Chikitsa Sthana]] 3/41],[[rakta dhatu]]gata jwara[Cha. Sa. [[Chikitsa Sthana]] 3/77] , [[vata]] [[pitta]] jwara[ Cha.Sa.[[Chikitsa Sthana]] 3/85], ''shleshma-paittika jwara'' [Cha.Sa. [[Chikitsa Sthana]] 3/88], [[pitta]] kapholvana hina [[vata]] sannipata jwara''[Cha.Sa.[[Chikitsa Sthana]] 3/93] , ''vatolvana [[kapha]] [[pitta]] hina sannipata jwara'' [Cha.Sa.[[Chikitsa Sthana]] 3/94], ''pittolvana madhya [[kapha]] hina [[vata]] jwara'' [Cha.Sa. [[Chikitsa Sthana]] 3/98], ''sama sannipata jwara''[Cha.Sa.[[Chikitsa Sthana]] 3/102], ''pittolvana [[vata]] madhya [[kapha]] hina jwara''[Cha.Sa. [[Chikitsa Sthana]] 3/106], ''pachyamana jwara'' [Cha.Sa.[[Chikitsa Sthana]] 3/136], ''romantika'' [Cha.Sa.[[Chikitsa Sthana]] 12/92], ''pittodara'' [Cha.Sa.[[Chikitsa Sthana]] 13/28], ''badhagudodara'' [Cha.Sa.[[Chikitsa Sthana]] 13/41],''chhidrodara'' [Cha. Sa. [[Chikitsa Sthana]] 13/44], ''sahaja arsha''[Cha. Sa. [[Chikitsa Sthana]] 14/8 ], ''paittika ajirna'' [Cha. Sa.[[Chikitsa Sthana]] 15/46], ''grahani'' [Cha. Sa. [[Chikitsa Sthana]] 15/53] ,[[vata]]ja grahani  [Cha.Sa.[[Chikitsa Sthana]] 15/61],''paittika pandu'' [Cha. Sa. [[Chikitsa Sthana ]] 16 /20], ''halimaka'' [Cha.Sa. [[Chikitsa Sthana]] 16/133],''vyapeta hikka'' [Cha.Sa. [[Chikitsa Sthana]] 17/32], ''paittika kasa'' [Cha.Sa.[[Chikitsa Sthana]] 18/15], ''kshataja kasa'' [Cha.Sa.[[Chikitsa Sthana]] 18/23], ''paittika atisara'' [Cha. Sa.[[Chikitsa Sthana]] 19/6],''raktatisara''  [Cha.Sa. [[Chikitsa Sthana]] 19/70], ''sannitpatika chhardi'' [Cha. Sa. [[Chikitsa Sthana]] 20/15], ''abhyantara visarpa'' [Cha. Sa. [[Chiktsa Sthana]] 21/16], ''paittika visarpa'' [Cha.Sa. [[Chikitsa Sthana]] 21/32],''vata-paittika visarpa'' [Cha.Sa.[[Chikitsa Sthana]] 21/36],''paittika madatyaya'' [Cha.Sa.[[Chikitsa Sthana]] 24/94], ''madatyaya'' general symptom [Cha.Sa.[[Chikitsa Sthana]] 24/101], ''tikshna madatyaya'' [Cha.Sa.[[Chikitsa Sthana]] 24/113],''vikshaya'' [Cha.Sa. [[Chikitsa Sthana]] 24/ 102],''paittika vrana'' [Cha.Sa.[[Chikitsa Sthana]] 25/13], ''paittika mukharoga'' [Cha.Sa.[[Chikitsa Sthana]] 26/120],''pittavrita vayu'' [Cha.Sa.[[Chikitsa Sthana]] 28 /61], ''paittika vatarakta'' [Cha.Sa. [[Chikitsa Sthana]] 29/ 28], ''dhvaja bhanga'' [Cha. Sa.[[Chikitsa Sthana]] 30/171], ''paittika shiroroga'' [Cha.Sa.[[Sutra Sthana]] 17/23], ''paittika hridroga'' [Cha.Sa.[[Sutra Sthana]] 17 /33], [[vata]]-[[kapha]] kshaya [[pitta]] vriddhi[Cha.Sa.[[Sutra Sthana]] 17 /60], ''alaji'' [Cha.Sa.[[Sutra Sthana]].17/88],[[vata]]-[[pitta]]janya vidradhi [Cha.Sa.[[Sutra Sthana]] 17/ 96], [[pitta]] nanatmaja vikara'' [Cha.Sa.[[Sutra Sthana]] 20 /14 ], ''ambuvaha sroto dushti'' [Cha.Sa.[[ Vimana Sthana]] 5 /11],''paittika jwara'' [Cha.Sa. [[Nidana Sthana]] 1/24].  

*Complication (''upasarga'') of diseases like ''jwara, meha, kshaya, shosha, shwasa'' [Cha.Sa. [[Chikitsa Sthana]] 22/17]

*Complication (''upasarga'') of diseases like ''jwara, meha, kshaya, shosha, shwasa'' [Cha.Sa. [[Chikitsa Sthana]] 22/17]

=== General pathogenesis ===

=== General pathogenesis ===

Due to above mentioned factors, ''vata'' and ''pitta dosha'' are vitiated and further affect channels carrying fluids like ''rasavaha'' and ''udakavaha srotasa''.

Due to above mentioned factors, [[vata]] and [[pitta]] [[dosha]] are vitiated and further affect channels carrying fluids like ''rasavaha'' and ''udakavaha srotasa''.

=== Etio-pathological factors in thirst ===

=== Etio-pathological factors in thirst ===

==== Principles of management ====

==== Principles of management ====

The treatment modalities intended to pacify ''vata'' and ''pitta dosha'' are applied for management of ''trishna''. Specifically rain water, water processed with drugs having ''manda'' (mild) and ''sheeta'' (cool) properties, various medicated ghee mentioned in the text are used to manage ''trishna''.

The treatment modalities intended to pacify [[vata]] and [[pitta]] [[dosha]] are applied for management of ''trishna''. Specifically rain water, water processed with drugs having ''manda'' (mild) and ''sheeta'' (cool) properties, various medicated ghee mentioned in the text are used to manage ''trishna''.

==== Various preparations used in management ====

==== Various preparations used in management ====

==== Food and beverages  ====

==== Food and beverages  ====

*''Trina panchamula'' medicated water

*''Trina panchamula'' medicated water

''Trina Panchamula'' contains five drugs namely ''kusha, kasha, nala, darbha'' and ''kandekshu''. It pacifies ''pitta'' and it is indicated in ''trishna''<ref> Sushruta. Sutra Sthana, Cha.38 Dravyasangrahaneeya Adhyaya verse 77. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. In ''Bhaisajya Ratnavali, Shara'' is given in place of ''Nala''. (''Bhaisajya Ratnavali, Mutrakricharogadhikar'' 10)

''Trina Panchamula'' contains five drugs namely ''kusha, kasha, nala, darbha'' and ''kandekshu''. It pacifies [[pitta]] and it is indicated in ''trishna''<ref> Sushruta. Sutra Sthana, Cha.38 Dravyasangrahaneeya Adhyaya verse 77. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. In ''Bhaisajya Ratnavali, Shara'' is given in place of ''Nala''. (''Bhaisajya Ratnavali, Mutrakricharogadhikar'' 10)

''Kusha – Desmostachya bipinnata''

''Kusha – Desmostachya bipinnata''

*''Yava'' medicated gruel: ''Yava'' (barley) is used in ''yava vatya'' (a gruel prepared out of one part of coarse powder of roasted ''yava'' (barley) and 14 parts of water).

*''Yava'' medicated gruel: ''Yava'' (barley) is used in ''yava vatya'' (a gruel prepared out of one part of coarse powder of roasted ''yava'' (barley) and 14 parts of water).

*''Peya'' is thin gruel of rice along with its solid portion (''sikta''). To prepare ''peya'', 14 parts of water and one part of broken rice are taken and boiled well till all the rice particles become soft. ''Peya'' prepared with ''shali'' and ''koradusha'' (type of cereal) pacifies thirst.

*''Peya'' is thin gruel of rice along with its solid portion (''sikta''). To prepare ''peya'', 14 parts of water and one part of broken rice are taken and boiled well till all the rice particles become soft. ''Peya'' prepared with ''shali'' and ''koradusha'' (type of cereal) pacifies thirst.

*Food boiled with milk and ''mamsa rasa'' mixed with honey and ''sita'' (kind of sugar) should be given. ''Sita'' pacifies ''vata'' and ''pitta dosha'' so it is useful in patient of thirst <ref>Bhavamishra. Bhavaprakasha -Volume II. Chapter 23, Verse 31, Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Krishnadas academy;2004.pp.-</ref>.

*Food boiled with milk and ''mamsa rasa'' mixed with honey and ''sita'' (kind of sugar) should be given. ''Sita'' pacifies [[vata]] and [[pitta]] [[dosha]] so it is useful in patient of thirst <ref>Bhavamishra. Bhavaprakasha -Volume II. Chapter 23, Verse 31, Translated from Sanskrit by K.R. Srikantha Murthy. Reprint ed. Varanasi: Krishnadas academy;2004.pp.-</ref>.

*''Trina panchamula, munjataka, priyala'' drugs should be mixed with ''mamsa rasa'' or ''kshira paka'' prepared from these should be given after mixing honey and sugar to it. All above drugs pacify ''pitta'' hence quench the thirst.

*''Trina panchamula, munjataka, priyala'' drugs should be mixed with ''mamsa rasa'' or ''kshira paka'' prepared from these should be given after mixing honey and sugar to it. All above drugs pacify [[pitta]] hence quench the thirst.

==== External applications ====

==== External applications ====

External application of ''shatadhauta ghrita'' is ''pitta shamaka'' so it should be used. ''Yusha'' is a soup prepared from pulses. Drugs which are ''madhura, tikta, sheeta'' and having ''jeevaniya'' properties, pacify ''pitta''. They should be given to the patient for drinking as well as for external application.

External application of ''shatadhauta ghrita'' is [[pitta]] shamaka so it should be used. ''Yusha'' is a soup prepared from pulses. Drugs which are ''madhura, tikta, sheeta'' and having ''jeevaniya'' properties, pacify [[pitta]]. They should be given to the patient for drinking as well as for external application.

==== Medicated ghee ====

==== Medicated ghee ====

''Ghrita'' processed with drugs of ''madhuradi gana'' mentioned in [[Vimana Sthana]] 8th chapter should be used for drinking, massage and sprinkling purpose. ''Ghrita'' is best for pacifying ''pitta'' and ''vata''.[Cha.Sa. [[Sutra Sthana]] 25/40] When processed with ''madhura gana'' drugs its property increases as it is ''yogavahi'' in nature (the one that accelerates the properties of others).

''Ghrita'' processed with drugs of ''madhuradi gana'' mentioned in [[Vimana Sthana]] 8th chapter should be used for drinking, massage and sprinkling purpose. ''Ghrita'' is best for pacifying [[pitta]] and [[vata]].[Cha.Sa. [[Sutra Sthana]] 25/40] When processed with ''madhura gana'' drugs its property increases as it is ''yogavahi'' in nature (the one that accelerates the properties of others).

==== Nasal administration ====

==== Nasal administration ====

''Gandusha'' (filling the mouth to its full capacity with liquid without allowing its movement in oral cavity) with various sweet and sour drugs is useful in thirst. ''Madhura rasa'' pacify ''pitta'' whereas ''amla rasa'' is cold on external application and increases salivation so both have soothing effect in dry mouth.<ref>Sushruta. Sutra Sthana, Cha.42 Rasavishesha Vijnaniya  Adhyaya verse 10. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> Use of ''amla'' drugs in the form of external application has also been advocated as they have cooling effect on touch. Thinking about cold things and environment is a part of psychotherapy which helps patient to combat desire of water.

''Gandusha'' (filling the mouth to its full capacity with liquid without allowing its movement in oral cavity) with various sweet and sour drugs is useful in thirst. ''Madhura rasa'' pacify ''pitta'' whereas ''amla rasa'' is cold on external application and increases salivation so both have soothing effect in dry mouth.<ref>Sushruta. Sutra Sthana, Cha.42 Rasavishesha Vijnaniya  Adhyaya verse 10. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> Use of ''amla'' drugs in the form of external application has also been advocated as they have cooling effect on touch. Thinking about cold things and environment is a part of psychotherapy which helps patient to combat desire of water.

==== Management of ''vata'' dominant ''trishna'' ====

==== Management of [[vata]] dominant ''trishna'' ====

All dietary formulations and drugs used in ''vataja trishna'' must have property to pacify ''vata''. Milk and ''ghrita'' mentioned in ''kshayaja kasa'' (like ''dwipanchamuladi ghrita, guduchyadi ghrita, kasmardadi ghrita'' etc.) pacify ''vata dosha'' effectively and thus these preparations can also be used in ''vataja trishna''.

All dietary formulations and drugs used in [[vata]]ja trishna must have property to pacify [[vata]]. Milk and ''ghrita'' mentioned in ''kshayaja kasa'' (like ''dwipanchamuladi ghrita, guduchyadi ghrita, kasmardadi ghrita'' etc.) pacify [[vata]] [[dosha]] effectively and thus these preparations can also be used in [[vata]]ja trishna.

==== Management of ''pitta'' dominant ''trishna'' ====

==== Management of [[pitta]] dominant ''trishna'' ====

Various ''pitta'' pacifying drugs mixed with water are mentioned in treatment of ''pittaja trishna''. These drugs pacify ''pitta'' as well as they are useful in maintaining water homeostasis.

Various [[pitta]] pacifying drugs mixed with water are mentioned in treatment of [[pitta]]ja trishna''. These drugs pacify [[pitta]] as well as they are useful in maintaining water homeostasis.

Water obtained after quenching of baked earth is said to be best for pacifying excessive thirst in ''agrya prakarana''. This simple method can be clinically evaluated in patients of morbid thirst. [Cha. Sa. [[Sutra Sthana]] 25/40].

Water obtained after quenching of baked earth is said to be best for pacifying excessive thirst in ''agrya prakarana''. This simple method can be clinically evaluated in patients of morbid thirst. [Cha. Sa. [[Sutra Sthana]] 25/40].

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

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

To treat ''amaja trishna'', it is necessary that first ''ama'' is removed. For ''ama pachana'' drugs which increase ''agni'' can be used as well. Treatment of ''kaphaja chhardi'' can be followed as ''kapha nasaka'' treatment helps to remove ''ama''. If symptoms pertaining to ''ama'' are seen than ''ama'' should be removed by inducing emesis and warm water should be used to increase ''agni'' to remove ''ama''. As discussed earlier ''kshaya'' refers to emaciation of tissues. So, treatment which helps in revitalizing the tissue can be used as mentioned in ''kshatakshina, shosha'' can also be used.

To treat ''amaja trishna'', it is necessary that first ''ama'' is removed. For ''ama pachana'' drugs which increase [[agni]] can be used as well. Treatment of [[kapha]]ja chhardi can be followed as [[kapha]] nasaka'' treatment helps to remove ''ama''. If symptoms pertaining to ''ama'' are seen than ''ama'' should be removed by inducing emesis and warm water should be used to increase [[agni]] to remove ''ama''. As discussed earlier ''kshaya'' refers to emaciation of tissues. So, treatment which helps in revitalizing the tissue can be used as mentioned in ''kshatakshina, shosha'' can also be used.

==== Management of ''trishna'' due to ''madatyaya'' ====

==== Management of ''trishna'' due to ''madatyaya'' ====

==== Effect of cold water and hot water on body fluid balance ====

==== Effect of cold water and hot water on body fluid balance ====

In conditions of dehydration and where ''pitta'' is dominant (''Dhaha, bhrama, madatyaya'' etc) cold water should be given as it restores water content in body as well as pacify ''pitta'' by its ''sheeta guna''. After boiling, water becomes free from various micro-organisms. Boiled water should be used in ''sannipatika'' diseases after cooling, such diseases are difficult to treat. In a study it was found that temperature range from 55 to 65 degree C is critical for effective elimination of enteric/pathogenic bacterial components.<ref>  Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine, Chapter 11. Palliative and End-of-Life Care,16th ed. New York: McGraw Hill; 2005</ref> As all three ''dosha'' are involved we can’t use hot or cold water as they will aggravate at least one of the ''dosha'' (hot will increase ''pitta'', cold water will increase ''vata/kapha'') so normal water should be used.

In conditions of dehydration and where [[pitta]] is dominant (''Dhaha, bhrama, madatyaya'' etc) cold water should be given as it restores water content in body as well as pacify [[pitta]] by its sheeta [[guna]]. After boiling, water becomes free from various micro-organisms. Boiled water should be used in ''sannipatika'' diseases after cooling, such diseases are difficult to treat. In a study it was found that temperature range from 55 to 65 degree C is critical for effective elimination of enteric/pathogenic bacterial components.<ref>  Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors. Harrison’s principles of internal medicine, Chapter 11. Palliative and End-of-Life Care,16th ed. New York: McGraw Hill; 2005</ref> As all three [[dosha]] are involved we can’t use hot or cold water as they will aggravate at least one of the [[dosha]] (hot will increase [[pitta]], cold water will increase [[vata]]/[[kapha]]) so normal water should be used.

In conditions with ''vata/kapha/vata-kapha'' dominance like ''hikka-shwasa'' (''kapha vata tamako''), fever of recent origin (''nutana jwara'' in ''samavastha'') etc. Warm water should be given. After ''ghrita'' consumption, warm water should be used as it increases absorption of ''ghrita''. Warm water increases ''agni'' in ''nutan jwara''.[ Cha. Sa. [[Chikitsa Sthana]] 3/144], [ Cha. Sa. [[Vimana Sthana]] 3/40]

In conditions with [[vata]]/[[kapha]]/[[vata]]-[[kapha]] dominance like ''hikka-shwasa'' ([[kapha]] [[vata]] tamako''), fever of recent origin (''nutana jwara'' in ''samavastha'') etc. Warm water should be given. After ''ghrita'' consumption, warm water should be used as it increases absorption of ''ghrita''. Warm water increases [[agni]] in ''nutan jwara''.[ Cha. Sa. [[Chikitsa Sthana]] 3/144], [ Cha. Sa. [[Vimana Sthana]] 3/40]

In a study it was concluded that drinking hot fluids transiently increases nasal mucus velocity and so hot liquid is superior to cold liquids in the management of fluids in upper respiratory tract infections.<ref>Saketkhoo K, Januszkiewicz A, Sackner MA., Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance, Chest. 1978 Oct;74 (4):408-10.</ref>

In a study it was concluded that drinking hot fluids transiently increases nasal mucus velocity and so hot liquid is superior to cold liquids in the management of fluids in upper respiratory tract infections.<ref>Saketkhoo K, Januszkiewicz A, Sackner MA., Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance, Chest. 1978 Oct;74 (4):408-10.</ref>

In ''pandu'' there is presence of hemodilution and edema so water intake should be restricted to minimal. In ''gulma, mandagni'' is main causative factor. [Cha. Sa.[[Chikitsa Sthana]] 5/112]

In ''pandu'' there is presence of hemodilution and edema so water intake should be restricted to minimal. In ''gulma, mandagni'' is main causative factor. [Cha. Sa.[[Chikitsa Sthana]] 5/112]

Excessive intake of water causes ''mandagni'' and if, water is taken in ''mandagni'' stage excessively, strength of ''agni'' decreases further <ref>Madhavakara. Madhava Nidanam (Roga vinischaya) Chap 6 Verse 7. Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</ref>. So, water is contraindicated in ''mandagni'' stage. If needed, water can be given in less quantity.

Excessive intake of water causes ''mandagni'' and if, water is taken in ''mandagni'' stage excessively, strength of [[agni]] decreases further <ref>Madhavakara. Madhava Nidanam (Roga vinischaya) Chap 6 Verse 7. Translated from Sanskrit by K. R. Srikantha Murthy. 8th ed. Varanasi: Chaukhambha orientalia;2007.pp--</ref>. So, water is contraindicated in ''mandagni'' stage. If needed, water can be given in less quantity.

Nowadays we are using bottled water frequently. So, it is necessary that we analyze properties of bottled water also. Studies have shown that chemicals called phthalates, which are known to disrupt testosterone and other hormones, can leach into bottled water over time. One study found that water that had been stored for 10 weeks in plastic and in glass bottles contained phthalates, suggesting that the chemicals could be coming from the plastic cap or liner.<ref>Available from: http://www.nrdc.org/about </ref> The bacterial count in bottled water increased dramatically, from less than 1 colony per milliliter (col/mL) to 38,000 col/mL over 48 hours of storage at 37 degrees C. Bacterial growth was markedly reduced at cold temperatures (refrigeration) compared with room temperature, with 50% fewer bacterial colonies in 24 hours and 84% fewer colonies in 48 hours. Interestingly, tap water resulted in only minimal growth, especially at cold temperatures (< 100 col/mL at 48 hours). These findings may be useful to increase public awareness and development of guidelines on storage temperature and expiration time for bottled water once it is opened and used.<ref>Raj SD., Bottled water: how safe is it? Water Environ Res. 2005 Nov-Dec;77(7):3013-8.</ref> In a study it was suggested that various types of unfinished beverages have microorganism growth and can include food borne pathogens and bacterial toxins.<ref>Watanabe M, Ohnishi T, Araki E, Kanda T, Tomita A, Ozawa K, Goto K, Sugiyama K, Konuma H, Hara-Kudo Y., Characteristics of bacterial and fungal growth in plastic bottled beverages under a consuming condition model, J Environ Sci Health A Tox Hazard Subst Environ Eng. 2014;49(7):819-26.</ref> This suggests that proper and judicious use of water should be done in healthy as well as diseases condition.

Nowadays we are using bottled water frequently. So, it is necessary that we analyze properties of bottled water also. Studies have shown that chemicals called phthalates, which are known to disrupt testosterone and other hormones, can leach into bottled water over time. One study found that water that had been stored for 10 weeks in plastic and in glass bottles contained phthalates, suggesting that the chemicals could be coming from the plastic cap or liner.<ref>Available from: http://www.nrdc.org/about </ref> The bacterial count in bottled water increased dramatically, from less than 1 colony per milliliter (col/mL) to 38,000 col/mL over 48 hours of storage at 37 degrees C. Bacterial growth was markedly reduced at cold temperatures (refrigeration) compared with room temperature, with 50% fewer bacterial colonies in 24 hours and 84% fewer colonies in 48 hours. Interestingly, tap water resulted in only minimal growth, especially at cold temperatures (< 100 col/mL at 48 hours). These findings may be useful to increase public awareness and development of guidelines on storage temperature and expiration time for bottled water once it is opened and used.<ref>Raj SD., Bottled water: how safe is it? Water Environ Res. 2005 Nov-Dec;77(7):3013-8.</ref> In a study it was suggested that various types of unfinished beverages have microorganism growth and can include food borne pathogens and bacterial toxins.<ref>Watanabe M, Ohnishi T, Araki E, Kanda T, Tomita A, Ozawa K, Goto K, Sugiyama K, Konuma H, Hara-Kudo Y., Characteristics of bacterial and fungal growth in plastic bottled beverages under a consuming condition model, J Environ Sci Health A Tox Hazard Subst Environ Eng. 2014;49(7):819-26.</ref> This suggests that proper and judicious use of water should be done in healthy as well as diseases condition.

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