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AIAPGET Points

–        Seven types of TRSNA – Vataja, Pittaja, Kaphaja, Kshataja, Kshayaja, Amaja & Bhakta Nimittaja (Su.Ut.48/6)

–        In Kaphaja Trshna, the person does not have a desire for more water. (Su.Ut.48/10,11)

–        In Kshataja Trshna – the person suffers from severe dukha (thirst here) during both night and day, in spite of consuming water. (Su.Ut.49/12)

–        Kapha becomes dried up when its Avarana takes place by Anila (Vata) & Anala (Pitta) and causes Kaphaja Trshna. (Su.Ut.48/10)

–        Wasting, Burning sensation and Desire to drink more water are the features of KSHAYAJA TRSHNA (Su.Ut.48/13)

–        Symptoms of all the three doshas are present in Amaja Trshna.

–        Hrt-shula, Nishtivana and Sada – are the specific and special symptoms of Amaja Trshna. (Su.Ut.48/14)

–        One should reject TRSNA in the presence of – Kshinam (emaciation), Vichittam (disordered mind), Badhiram (deafness) & Nirgata Jihva (protrusion of tongue). (Su.Ut.48/15)

–        Vataja, Pittaja and Kaphaja Trshna should be treated with herbs having shita rasa and shita virya. (Su.Ut.48/17)

–        In Vataja Trshna – Water processed with five Panchamulas or with prathama gana – Vidarigandhadi Gana should be consumed warm. (Su.Ut.48/19).

–        PITTAGHNA GANA Siddha Kashaya (Utpaladi and Sarivadi Gana Siddha) or milk processed with JIVANIYA GANA pacify Pittaja Trshna. (Su.Ut.48/20)

–        All kinds of treatments to mitigate PITTA should be done in all kinds of TRSHNA. (Su.Ut.48/22)

–        JWAROKTA PACHANA KASHAYAS shall be administered to cure all kinds of TRSHNA. (Su.Ut.48/32)

 

The 48th chapter of Uttaratantra of Sushruta Samhita is named as Tṛṣṇā Pratiṣedha Adhyaya. This chapter deals with the Treatment of Excessive Thirst.  

अथातस्तृष्णाप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Tṛṣṇā pratişedha – treatment of severe thirst; as revealed by the venerable Dhanvantari.

Trsnā nispatti – definition

सततं यः पिबेद्वारि न तृप्तिमधिगच्छति |
पुनः काङ्क्षति तोयं च तं तृष्णार्दितमादिशेत् ||३||

A person is said to be suffering from trsna – thirst (thirst disease) when he in spite of drinking water continuously does not get satisfied and still wants to drink more and more water.

Nidāna-samprāpti – causes and pathogenesis

सङ्क्षोभशोकश्रममद्यपानाद्रूक्षाम्लशुष्कोष्णकटूपयोगात् |
धातुक्षयाल्लङ्घनसूर्यतापात् पित्तं च वातश्च भृशं प्रवृद्धौ ||४||
स्रोतांसि सन्दूषयतः समेतौ यान्यम्बुवाहीनि शरीरिणां हि |
स्रोतःस्वपांवाहिषु दूषितेषु जायेत तृष्णाऽतिबला ततस्तु ||५||

Causative factors –

Below mentioned causative factors when done in excess, will cause trsna – 

–        exertion,

–        sorrow,

–        fatigue,

–        drinking of wine,

–        eating foods which are dry, sour, dried, hot and pungent,

–        decrease / depletion of tissues of the body,

–        fasting and

–        exposure to sunlight

Pathogenesis – Due to the above said causes, pitta and vata would become greatly aggravated. These aggravated doshas would vitiate the channels of water in the body and subsequently give rise to severe thirst.

Types

तिस्रः स्मृतास्ताः क्षतजा चतुर्थी क्षयात्तथाऽन्याऽऽमसमुद्भवा च |
स्यात् सप्तमी भक्तनिमित्तजा तु निबोध लिङ्गान्यनुपूर्वशस्तु ||६||

Trsna is of seven kinds –

–        the first three types are caused by each dosha separately – vataja, pittaja and kaphaja,

–        the fourth one is caused by kshata – injury

–        the fifth kind is from dhatu ksaya – decrease of tissues, especially the water content of the body,

–        the sixth type is by ama – undigested food and

–        the seventh kind is due to bhakta / anna – nature of food

Now, their symptoms will be enumerated in succeeding order, listen to the same.

Pūrvarūpa – premonitory symptoms-

ताल्वोष्ठकण्ठास्यविशोषदाहाः सन्तापमोहभ्रमविप्रलापाः |
पूर्वाणि रूपाणि भवन्ति तासामुत्पत्तिकालेषु विशेषतस्तु ||७||

Below mentioned are the premonitory symptoms of trsna,

–        extreme dryness and feeling of burning sensation, mainly in the palate, throat and mouth,

–        exhaustion by heat,

–        delusion,

–        giddiness and

–        delirium

They appear especially at the time of onset of the disease.

Vātaja trsnā

शुष्कास्यता मारुतसम्भवायां तोदस्तथा शङ्खशिरःसु चापि |
स्रोतोनिरोधो विरसं च वक्त्रं शीताभिरद्भिश्च विवृद्धिमेति ||८||

Below mentioned are the symptoms of thirst produced by vata –

–        dryness of the mouth,

–        pricking pain in the temples and head,

–        obstruction of channels (channels of the ears according to Acharya Dalhana),

–        experiencing bad taste in the mouth and

–        thirst which increases by drinking cold water

स्त्रोतोनिरोधोविरसंचवक्रंशीताभिरद्धिश्चविवृद्धिमेति – Sroto Nirodha, Virasa Vaktrata, Shitabhiradbhischa Abhivruddhih – are the specific and special features of Vataja Trshna. (Su.Ut.48/8)

Pittaja trsnā

मूर्च्छाप्रलापारुचिवक्त्रशोषाः पीतेक्षणत्वं प्रततश्च दाहः |
शीताभिकाङ्क्षा मुखतिक्तता च पित्तात्मिकायां परिधूपनं च ||९||

Below mentioned are the symptoms of thirst produced by pitta –

–        Fainting,

–        Delirium,

–        Loss of Taste,

–        Dryness of the mouth,

–        Yellow colour in the eyes,

–        feeling of burning sensation constantly,

–        desire for cold things,

–        bitter taste in the mouth and

–        feeling of hot fumes coming out

Kaphaja tṛṣṇā

कफावृताभ्यामनिलानलाभ्यां कफोऽपि शुष्कः प्रकरोति तृष्णाम् |
निद्रा गुरुत्वं मधुरास्यता च तयाऽर्दितः शुष्यति चातिमात्रम् ||१०||
कण्ठोपलेपो मुखपिच्छिलत्वं शीतज्वरश्छर्दिररोचकश्च |
कफात्मिकायां गुरुगात्रता च शाखासु शोफस्त्वविपाक एव |
एतानि रूपाणि भवन्ति तस्यां तयाऽर्दितः काङ्क्षति नाति चाम्भः ||११||

Kapha becomes dried and devoid of moistness when it gets enveloped by pitta and vata and produces thirst.

Below mentioned are the symptoms of thirst produced by kapha –

–        excessive sleep,

–        feeling of heaviness in the body,

–        experiencing sweet taste in the mouth,

–        great emaciation,

–        adherence of kapha in the throat,

–        sliminess of the mouth,

–        fever with rigors,

–        vomiting,

–        anorexia,

–        swelling in the extremities,

–        improper digestion

–        no desire for more water or drink

Kşataja tṛṣṇā

क्षतस्य रुक्शोणितनिर्गमाभ्यां तृष्णा चतुर्थी क्षतजा मता तु |
तयाऽभिभूतस्य निशादिनानि गच्छन्ति दुःखं पिबतोऽपि तोयम् ||१२||

The fourth kind of thirst is called as Ksataja Trsna i.e. thirst arising from injury. It is produced by the pain and flow of blood from the wound. In this condition, the person suffers from thirst both during night and day, in spite of consuming water.

Kşayaja trşnā

रसक्षयाद्या [७] क्षयजा मता सा तयाऽर्दितः शुष्यति दह्यते च |
अत्यर्थमाकाङ्क्षति चापि तोयं तां सन्निपातादिति केचिदाहुः ||१३||
रसक्षयोक्तानि च लक्षणानि तस्यामशेषेण भिषग्व्यवस्येत् |१४|
Ksayaja Trsna is a condition wherein thirst is produced by loss or decrease of rasa (plasma).

Below mentioned are the symptoms produced by thirst caused due to ksaya –

–        wasting,

–        burning sensation and

–        desire to drink more water

According to some scholars, this condition is produced by all three doshas together.

The physician should expect all symptoms of rasa ksaya – depletion or decrease of rasa tissue, to be present in this condition.

Amaja trsnā

त्रिदोषलिङ्गाऽऽमसमुद्भवा च हृच्छूलनिष्ठीवनसादयुक्ता ||१४||

Symptoms of thirst produced by ama –

–        symptoms of all the three doshas,

–        pain in the region of the heart,

–        expectoration and

–        debility of the body

Annaja trşnā

स्निग्धं तथाऽम्लं लवणं च भुक्तं गुर्वन्नमेवातितृषां करोति |१५|

Thirst is also produced by foods which are fatty (unctuous), sour, salty and hard / difficult for digestion.

Cikitsā – treatment

क्षीणं विचित्तं बधिरं तृषार्तं विवर्जयेन्निर्गतजिह्वमाशु ||१५||

The patients of thirst should be rejected when –

–        they are emaciated,

–        have disordered mind,

–        have deafness and

–        have protrusion of the tongue

तृष्णाभिवृद्धावुदरे च पूर्णे तं वामयेन्मागधिकोदकेन |
विलोभनं  चात्र हितं विधेयं स्याद्दाडिमाम्रातकमातुलुङ्गैः ||१६||
तिस्रः प्रयोगैरिह सन्निवार्याः शीतैश्च सम्यग्रसवीर्यजातैः |१७|

Vomiting should be administered with decoction of Magadhika in patients having severe thirst and fullness of abdomen.

He should be shown sour fruits like dadima, amra, amrataka and matulunga and tempted.

The first three kinds of thirst i.e. those produced by each dosha should be treated with herbs which are cold in taste and potency.

गण्डूषमम्लैर्विरसे च वक्त्रे कुर्याच्छुभैरामलकस्य चूर्णैः ||१७||

Gandusha (holding liquids in mouth) should be done with sour liquids including fermented gruels, sour fruit juices etc when there is bad taste in the mouth. These liquids should be added with Amalaka powder before using them.

सुवर्णरूप्यादिभिरग्नितप्तैर्लोष्टैः कृतं वा सिकतादिभिर्वा |
जलं सुखोष्णं शमयेत्तु तृष्णां सशर्करं क्षौद्रयुतं हिमं वा ||१८||

Balls of gold, silver, stone or sand are heated red hot on fire. These balls are immersed in the water and the water is made hot. This water is used for drinking comfortably warm or cold by adding sugar and honey. This water relieves thirst.

पञ्चाङ्गिकाः पञ्चगणा य उक्तास्तेष्वम्बु सिद्धं प्रथमे गणे वा |
पिबेत् सुखोष्णं मनुजोऽचिरेण तृषो विमुच्येत हि वातजायाः ||१९||

Water should be boiled and prepared with five kinds of Pancamulas (mahat, laghu, valli, trna and kantaki pancamula) and consumed when it is comfortably warm. Alternatively, water processed with the herbs belonging to the first gana i.e. vidarigandhadi gana group should also be consumed comfortably warm. These waters will quickly relieve the thirst produced by vata.

पित्तघ्नवर्गैस्तु कृतः कषायः सशर्करः क्षौद्रयुतः सुशीतः |
पीतस्तृषां पित्तकृतां निहन्ति क्षीरं शृतं वाऽप्यथ जीवनीयैः ||२०||

Decoction should be prepared with herbs belonging to Pittaghna Gana group i.e. Utpaladi Gana and Sarivadi Gana (a group of herbs which are useful in mitigating pitta). Sugar and honey are added to it and consumed cold.

Milk boiled and prepared with herbs belonging to the Jivaniya Gana group should be consumed cold.

Both these recipes mitigate thirst produced by pitta.

बिल्वाढकीकन्यकपञ्चमूलीदर्भेषु सिद्धं कफजां निहन्ति |
हितं भवेच्छर्दनमेव चात्र तप्तेन निम्बप्रसवोदकेन ||२१||

Decoction should be prepared with the below mentioned herbs –

–        bilva,

–        adhaki,

–        laghu pancamula and

–        darbha

This decoction relieves thirst caused by kapha.

Also beneficial in this condition will be administering emesis by using decoction of nimba leaves.

सर्वासु तृष्णास्वथवाऽपि पैत्तं कुर्याद्विधिं तेन हि ता न सन्ति |
पर्यागतोदुम्बरजो रसस्तु सशर्करस्तत्क्वथितोदकं वा ||२२||
वर्गस्य सिद्धस्य च सारिवादेः पातव्यमम्भः शिशिरं तृषार्तैः |२३|

Since trsna and all its kinds are not produced without pitta, treatments to mitigate pitta should be done in all kinds of trsna – thirst.

Juice of ripe Udumbara or water boiled with Udumbara should be taken. Sugar should be added to this and consumed. Alternatively, water boiled with herbs belonging to the Sarivadi Gana group can be consumed cold. This would alleviate the person from his thirst.

कशेरुशृङ्गाटकपद्ममोचबिसेक्षुसिद्धं क्षतजां निहन्ति ||२३||

Water boiled and processed with the below mentioned herbs should be consumed –

–        Kaseru,

–        Srngataka,

–        Padma,

–        Moca,

–        Bisa and

–        Iksu

Consumption of water boiled with the above said would cure thirst caused by blood.

लाजोत्पलोशीरकुचन्दनानि दत्त्वा प्रवाते निशि वासयेत्तु |
तदुत्तमं तोयमुदारगन्धि सितायुतं क्षौद्रयुतं वदन्ति ||२४||
द्राक्षाप्रगाढं च हिताय वैद्यस्तृष्णार्दितेभ्यो वितरेन्नरेभ्यः |२५|

Powder of the below mentioned ingredients is prepared –

–        laja,

–        utpala,

–        usira and

–        kucandana

This powder is put into a pot of water at night. This pot is kept exposed to the breeze. Sugar and honey are mixed in this water which now has a good fragrance and is administered to the patient. Alternatively, more quantity of draksa should be mixed in the above said water and administered by the physician to the patient. These recipes would cure the thirst.

ससारिवादौ तृणपञ्चमूले तथोत्पलादौ प्रथमे [४] गणे च ||२५||
कुर्यात् कषायं च यथेरितेन मधूकपुष्पादिषु चापरेषु |
राजादनक्षीरिकपीतनेषु षट् पानकान्यत्र हितानि च स्युः ||२६||
सतुण्डिकेराण्यथवा पिबेत्तु पिष्टानि कार्पाससमुद्भवानि |२७|

Below mentioned six kinds of panaka – syrups are useful –

–        that prepared from decoctions of sarivadi gana group of herbs

–        that prepared from trna pancamula group of herbs,

–        that prepared from utpaladi gana group of herbs or

–        that prepared from the first gana (vidarigandhadi gana) group of herbs or

–        that prepared from madhuka puspa or

–        that prepared from rajadana, ksirikapitana (moist Sirisa)

Paste of Tundikeri (vana karpasi) or fruits of Karpasa is prepared. This paste is consumed after adding honey and sugar to it.

क्षतोद्भवां रुग्विनिवारणेन जयेद्रसानामसृजश्च पानैः ||२७||
क्षयोत्थितां क्षीरघृतं निहन्यान्मांसोदकं वा मधुकोदकं वा |२८|

Thirst produced by injury should be relieved by –

–        alleviating pain and

–        drinking meat-soup and blood

Thirst produced by decrease / depletion of tissues should be treated by administering –

–        ghee prepared from the milk,

–        meat soup or

–        water boiled and processed with madhuka

आमोद्भवां बिल्ववचायुतैस्तु जयेत् कषायैरथ दीपनीयैः ||२८||
आम्रातभल्लातबलायुतानि पिबेत् कषायाण्यथ दीपनानि |२९|

Decoction should be prepared with Bilva and Vacha. Or, decoction of Amrta, Bhallataka and Bala should be prepared. These recipes cure thirst produced by ama. They also will kindle digestive fire.

गुर्वन्नजातां वमनैर्जयेच्च क्षयादृते सर्वकृतां च तृष्णाम् ||२९||

Vomiting should be induced to treat thirst produced by consuming indigestible foods. Emesis is beneficial in treatment of all kinds of thirst except ksayaja trsna – thirst caused due to decrease of body tissues.

श्रमोद्भवां मांसरसो निहन्ति गुडोदकं वाऽप्यथवाऽपि मन्थः |३०|
भक्तोपरोधात्तृषितो यवागूमुष्णां पिबेन्मन्थमथो हिमं च ||३०||
या स्नेहपीतस्य भवेच्च तृष्णा तत्रोष्णमम्भः प्रपिबेन्मनुष्यः |३१|

Thirst caused by exertion can be cured by consuming –

–        meat-soup,

–        jaggery water or

–        mantha – corn-flour solution mixed with sugar and ghee, well churned

Yavagu – thick gruel or Mantha shall be consumed warm in thirst caused by obstruction of food.

Person suffering from thirst caused by drinking fats (in oleation therapy) should drink hot water in more quantity.

मद्योद्भवामर्धजलं निहन्ति मद्यं तृषां याऽपि च मद्यपस्य ||३१||
तृष्णोद्भवां हन्ति जलं सुशीतं सशर्करं सेक्षुरसं तथाऽम्भः |३२|

Drinking wine diluted with half its quantity of water would relieve the thirst produced by consuming wine.

Drinking cooled water added with either sugar or sugarcane juice would cure thirst caused by severe heat.

स्वैः स्वैः कषायैर्वमनानि तासां तथा ज्वरोक्तानि च पाचनानि ||३२||

Below mentioned treatments shall be administered in all kinds of thirsts –

–        vomiting should be produced by administering (for drinking) decoction of herbs specified in their treatments,

–        digestive decoctions mentioned in treatment of jvara (fever)

लेपावगाहौ परिषेचनानि कुर्यात्तथा शीतगृहाणि चापि |
संशोधनं क्षीररसौ घृतानि सर्वासु लेहान्मधुरान् हिमांश्च ||३३||

Below mentioned treatments are beneficial in all varieties of thirst –

–        application of medicinal pastes on the body, in cold state

–        pouring medicinal liquids on the body, in cold state,

–        living in cold houses,

–        administration of purificatory therapies,

–        consuming milk, meat soup, ghee and confections which are sweet in taste and cold in potency

इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे (दशमोऽध्यायः,आदितः) अष्टचत्वारिंशोऽध्यायः।।४८।।

Thus ends the forty-eighth chapter by name Tṛṣṇā Pratiṣedha in Uttara Sthana of Suśruta Samhita.