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AIAPGET Points

–       The Main Doshas involved in causation of Chardi are Udana and Vyana Vata.

–       ABHAKTA RUK – pain when no food is taken – is a feature of Kaphaja Chardi.

–       The symptoms of KRIMIJA HRDROGA are also present in KRIMIJA CHARDI.

–       JWARAGHNA KASHAYAS can be given to patients suffering from Chardi. (Su.Ut.49/17-18)

–       Ksheera-Ghrtam cures Vataja Chardi. (Su.Ut.49/18)

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The 49th chapter of Uttaratantra of Sushruta Samhita is named as Chardi Pratiședha. This chapter deals with Treatment of Vomiting.

अथातश्छर्दिप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Chardi pratiṣedha- treatment of vomiting; as revealed by the venerable Dhañvañtari.

Nidāna – causes and pathogenesis

अतिद्रवैरतिस्निग्धैरहृद्यैर्लवणैरति |
अकाले चातिमात्रैश्च तथाऽसात्म्यैश्च भोजनैः ||३||
श्रमात् क्षयात्तथोद्वेगादजीर्णात् कृमिदोषतः |
नार्याश्चापन्नसत्त्वायास्तथाऽतिद्रुतमश्नतः ||४||
अत्यन्तामपरीतस्य छर्देर्वै सम्भवो ध्रुवम् |
(बीभत्सैर्हेतुभिश्चान्यैर्द्रुतमुत्क्लेशितो बलात्) ||५||

Below mentioned are the causes of chardi – vomiting –

–       consumption of foods which are very liquid, very unctuous (fatty), unpleasant and very salty;

–       foods consumed at improper time,

–       consumption of foods in more quantity and

–       consumption of unaccustomed foods,

–       excessive exertion,

–       decrease / depletion of tissues,

–       mental fluctuations,

–       indigestion,

–       infestation by worms (intestinal parasites),

–       pregnancy,

–       consuming food very quickly,

–       too much accumulation of ama (undigested food in the alimentary canal),

–       horrifying causes (such as sight of blood, worms, pus, foul smell etc) and

–       sudden bouts of emotions

These causes will definitely cause vomiting.

Nirukti – definition

छादयन्नाननं वेगैरर्दयन्नङ्गभञ्जनैः |
निरुच्यते छर्दिरिति दोषो वक्त्राद्विनिश्चरन् ||६||

This disease is called chardi because –

–        it covers the mouth by the bouts of food and other materials coming up,

–        produces discomfort to the body by causing bending of the body and

–        the doshas are expelled out from the mouth

Samprapti – Pathogenesis

दोषानुदीरयन् वृद्धानुदानो व्यानसङ्गतः |
ऊर्ध्वमागच्छति भृशं विरुद्धाहारसेवनात् ||७||

Firstly, the Udana Vata and Vyana Vata would get aggravated (on exposure to the causative factors). The aggravated vata sub-types force the doshas to move upwards. These doshas come out of the mouth. All these happen due to consumption of incompatible (mutually antagonistic) foods.

Pūrvarūpa – premonitory symptoms

प्रसेको हृदयोत्क्लेशो भक्तस्यानभिनन्दनम् |
पूर्वरूपं मतं छर्द्या यथास्वं च विभावयेत् ||८||

Below mentioned are the premonitory symptoms of vomiting –

–        excessive salivation,

–        oppression in the chest (nausea),

–        dislike for food

The same symptoms will be present even in the next stage also (i.e. when the disease gets manifested, the same premonitory symptoms will become the symptoms of the disease also).

Rūpa – clinical features

प्रच्छर्दयेत् फेनिलमल्पमल्पं शूलार्दितोऽभ्यर्दितपार्श्वपृष्ठः |
श्रान्तः सघोषं बहुशः कषायं जीर्णेऽधिकं साऽनिलजा वमिस्तु ||९||

Features (symptoms) of Vataja Chardi – vomiting caused by aggravated vata –

–        frequent vomiting,

–        the material is frothy and less in quantity,

–        is accompanied by pain in flanks and back,

–        tiredness,

–        vomiting happens with great sound,

–        material which is vomited is astringent in taste and

–        more often, vomiting happens after digestion of food

योऽम्लं भृशं वा कटुतिक्तवक्त्रः पीतं सरक्तं हरितं वमेद्वा |
सदाहचोषज्वरवक्त्रशोषो मूर्च्छान्वितः पित्तनिमित्तजा सा ||१०||

Features (symptoms) of Pittaja Chardi – vomiting caused by aggravated pitta –

–        the material which has been vomited is very sour,

–        taste in mouth is pungent or bitter,

–        the material is yellow, mild-red or green in colour,

–        associated with – burning sensation, sucking pain, fever, dryness of throat and fainting

यो हृष्टरोमा मधुरं प्रभूतं शुक्लं हिमं सान्द्रकफानुविद्धम् |
अभक्तरुग्गौरवसादयुक्तो वमेद्वमी सा कफकोपजा स्यात् ||११||

Features (symptoms) of Kaphaja Chardi – vomiting caused by aggravated vata –

–        presence of horripilations,

–        vomited material is sweet in taste,

–        is large in quantity,

–        white in colour,

–        cold,

–        mixed with thick kapha (mucus, phlegm),

–        pain when no food is taken,

–        feeling of heaviness and

–        debility of the body

सर्वाणि रूपाणि भवन्ति यस्यां सा सर्वदोषप्रभवा मता तु |१२|

Features (symptoms) of Chardi – vomiting caused by all three doshas – In this kind of vomiting, all symptoms of all the three doshas are present mixed together.

बीभत्सजा दौहृदजाऽऽमजा च सात्म्यप्रकोपात् कृमिजा च या [६] हि |
सा पञ्चमी तां च विभावयेत्तु दोषोच्छ्रयेणैव यथोक्तमादौ ||१२||

Añya vidha – Other kind of (fifth) vomiting –

Vomiting caused by the below mentioned factors is considered as fifth kind of the disease –

–        that caused by sight, smell etc. of horrifying things,

–        pregnancy,

–        indigestion,

–        consumption of unaccustomed foods and

–        presence of worms – intestinal parasites / worms

The aggravation of doshas in this type of chardi should be determined accordingly.

शूलहृल्लासबहुला कृमिजा च विशेषतः |
कृमिहृद्रोगतुल्येन लक्षणेन च लक्षिता ||१३||

Pain and nausea are the prominent symptoms of vomiting caused by krimis – worms. Symptoms of heart disease produced by krimi – worms – will also be present.

क्षीणस्योपद्रवैर्युक्तां सासृक्पूयां सचन्द्रिकाम् |
छर्दि प्रसक्तां कुशलो नारभेत चिकित्सितुम् ||१४||

The physician should not commence treatment for vomiting when it is associated with the below mentioned features / symptoms –

–        vomiting occurring in emaciated persons which is accompanied with complications,

–        vomited material is mixed with blood, pus and shining particles and

–        there is continuous vomiting

आमाशयोत्क्लेशभवा हि सर्वास्तस्माद्धितं लङ्घनमेव तासु ||१५||
वमीषु बहुदोषासु छर्दनं हितमुच्यते |
विरेचनं वा कुर्वीत यथादोषोच्छ्रयं भिषक् ||१६||
संसर्गश्चानुपूर्वेण यथास्वं भेषजायुतः |१७|

All kinds of vomiting arise from vitiation of the stomach. Therefore fasting is beneficial in all kinds of vomiting.

Vomiting or Purgation should be administered depending on doshas aggravated is beneficial in cases of vomiting caused by great aggravation of doshas.

After this, regimen of liquid diet i.e. peya, vilepi etc. should be administered along with suitable medicines.

लघूनि परिशुष्काणि सात्म्यान्यन्नानि चाचरेत् ||१७||
यथास्वं च कषायाणि ज्वरघ्नानि प्रयोजयेत् |१८|

Light to digest (easily digestible), well dried and accustomed foods should be consumed. Decoctions mentioned in the treatment (cure) of fevers may also be administered here.

Vataja chardi cikitsă

हन्यात् क्षीरघृतं पीतं छर्दिं पवनसम्भवाम् ||१८||
ससैन्धवं पिबेत् सर्पिर्वातच्छर्दिनिवारणम् |
मुद्गामलकयूषो वा ससर्पिष्कः ससैन्धवः |
यवागूं मधुमिश्रां वा पञ्चमूलीकृतां पिबेत् ||१९||
पिबेद्वा व्यक्तसिन्धूत्थं फलाम्लं वैष्किरं रसम् |
सुखोष्णलवणं चात्र हितं स्नेहविरेचनम् ||२०||
Vomiting produced by vata is cured by consumption of ghee made from milk.

The other useful recipes / formulations which can be used to cure vataja chardi include –

–        ghee mixed with saindhava lavana or

–        soup of mudga and amalaka added with ghee and saindhava or

–        yavagu – thick gruel prepared with laghu pancamula herbs added with honey or

–        juice of sour fruits, soup of meat of viskira birds, added with saindhava lavana or

–        oily purgative mixed with salt and made comfortably warm

Pittaja chardi chikitsa

पित्तोपशमनीयानि पाक्यानि शिशिराणि च |
कषायाण्युपयुक्तानि घ्नन्ति पित्तकृतां वमीम् ||२१||
शोधनं मधुरैश्चात्र द्राक्षारससमायुतैः |
बलवत्यां प्रशंसन्ति सर्पिस्तैल्वकमेव च ||२२||

Vomiting caused by pitta is cured by drinking decoctions of herbs which mitigate pitta and which are cold in potency.

Purgation should be given with the below mentioned recipes –

–        herbs of sweet taste mixed with juice of draksa or

–        Tilvaka Ghrta – in strong persons (as explained in chikitsa sthana, chapter 4)

Kaphaja chardi chikitsa

आरग्वधादिनिर्यूहं दशाङ्गयोगमेव वा |
पाययेताथ सक्षौद्रं कफजायां चिकित्सकः ||२३||

Decoction prepared from the herbs of aragvadhadi gana group or of dasanga yoga (dasamula kwatha) group added with honey should be administered by the physician in cases of vomiting produced by kapha.

Tridoşaja chardi chikitsa

कृतं गुडूच्या विधिवत् कषायं हिमसञ्ज्ञितम् |
तिसृष्वपि भवेत् पथ्यं माक्षिकेण समन्वितम् ||२४||

Cold infusion of Guduci should be prepared as per procedure. Honey should be added to this infusion and administered. It is best suited for vomiting caused by all the three doshas together.

Añya chardi chikitsa

बीभत्सजां हृद्यतमैर्दौहृदीं काङ्क्षितैः फलैः |
लङ्घनैर्वमनैश्चामां सात्म्यैः सात्म्यप्रकोपजाम् ||२५||
कृमिहृद्रोगवच्चापि कृमिजां साधयेद्वमीम् |
वितरेच्च यथादोषं शस्तं विधिमनन्तरम् ||२६||

Administering things which are pleasant to the mind is the remedy for vomiting caused by horrifying things.

Vomiting due to pregnancy should be treated by fulfilling her desires.

Administering vomiting and purgation therapies are the best ways of treating vomiting caused by ama.

If vomiting is caused by use of unaccustomed things, treatment should be given by providing accustomed things.

Likewise, therapies prescribed for krimija hrdroga should be administered in the treatment of vomiting caused by worms.

Afterwards, the treatments appropriate to the aggravated doshas should be administered.

दधित्थरससंसक्तां पिप्पलीं माक्षिकान्विताम् |
मुहुर्मुहुर्नरो लीढ्वा छर्दिभ्यः प्रवि(ति)मुच्यते ||२७||
समाक्षिका मधुरसा पीता वा तण्डुलाम्बुना |
तर्पणं वा मधुयुतं तिसृणामपि भेषजम् ||२८||
स्वयङ्गुप्तां सयष्ट्याह्वां तण्डुलाम्बुमधुद्रवाम् |
पिबेद्यवागूमथवा सिद्धां पत्रैः करञ्जजैः ||२९||
युक्ताम्ललवणाः पिष्टाः कुस्तुम्बुर्योऽथवा हिताः |
तण्डुलाम्बुयुतं खादेत् कपित्थं त्र्यूषणेन वा ||३०||

Vomiting would get cured by licking often the paste of pippali added and mixed in juice of dadhici (kapittha) and honey. 

Below mentioned are the ideal recipes for treating all three kinds of vomiting –

–        juice of madhurasa (murva) mixed with honey or rice-wash

–        tarpana i.e. mixture of corn flour, ghee and sugar, added with honey

Paste of Svayamgupta and Yasti should be made. This paste should be added with rice-wash and honey and consumed.

Alternatively Yavagu – thick gruel prepared from Karajna leaves may be consumed.

Also, paste of Kustumbari added with sour things and salt is also beneficial.

Kapittha also may be consumed along with rice-wash or tryushana.

सिताचन्दनमध्वाक्तं लिह्याद्वा मक्षिकाशकृत् |
पिबेत् पयोऽग्नितप्तं च निर्वाप्य गृहगोधिकाम् ||३१||
सर्पिःक्षौद्रयुतान् वाऽपि लाजशक्तून् पिबेत्तथा |
सर्पिःक्षौद्रसितोपेतां मागधीं वा लिहेत्तथा ||३२||
धात्रीरसे चन्दनं वा घृष्टं मुद्गदलाम्बुना |
कोलामलकमज्जानं लिह्याद्वा त्रिसुगन्धिकम् ||३३||
सक्षौद्रां शालिलाजानां यवागूं वा पिबेन्नरः |
घ्रेयाण्युपहरेच्चापि मनोघ्राणसुखानि च ||३४||
जाङ्गलानि च मांसानि शुभानि पानकानि च |
भोजनानि विचित्राणि कुर्यात्सर्वास्वतन्द्रितः ||३५||

For licking – excreta of flies added with sugar, sandalwood and honey should be used.

Grha Godha i.e. house lizards should be fried and made red hot in fire. It should then be put into milk and that milk may be consumed. Alternatively, powder of Magadhi may be licked mixed with ghee and honey.

Paste of Candana – sandalwood should be prepared with juice of Dhatri. This may be consumed along with water.

Also, soup of mudga or marrow (fleshy part) of kola and amalaka, added with trisugandha (trijataka) may be licked.

Yavagu should be prepared with Sali or Laja. It should be added with honey and may be consumed.

The patient should inhale substances which are pleasing to the mind and nose.

Below mentioned things should be used without any laxity –

–        meat of animals of arid lands,

–        good sweet syrups and snacks (eatables) of different kinds which are pleasing to the mind

इति श्री सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातन्त्रे छर्दिप्रतिषेधो नाम एकादशोऽध्यायः, आदितः) एकोनपञ्चाशत्तमोऽध्यायः।।४९।।

Thus ends the forty ninth chapter by name Chardi pratişedha in Uttarasthana of Suśruta samhita.