Types-(7-sushruta)

1. Vataja, 2. pittaja, 3. kaphaja, 4. kshyaja, 5. kshataja, 6. aamaja, 7. annaja

1

LAKSHANA

GENERAL SIGNS AND SYMPTOMS OF EXCESS THIRST:

Mukhashosha – Dryness of the mouth

Svarabheda – Hoarseness of the voice

Bhrama – giddiness

Santapa – burning sensation

Pralapa – delirium

Stambha- stiffness

Taluosthakanthajihvakarkasha – roughness of the palate, lips, throat and tongue

Chittanasham – unconsciousness

Jihvanirgaman – Protrusion of the tongue

Aruchi – anorexia

Badhirya – Deafness

Marmaangasada – pain in the vital parts of the body and prostration

Hereafter, the signs and symptoms of each of the 5 varieties of morbid thirst will be described. [9-10]

2

NIDANA

CAUSES OF MORBID THIRST / DRYNESS OF MOUTH:

Vata and Pitta get excessively aggravated because of the following:

1. Ksobha – Irritation, Bhaya -fear, Shrama – fatigue, Shoka – grief, Krodha – anger and Langhana – fasting

2. Madyapana – Intake of alcohol

3. Consumption of food ingredients which are Kshara (alkaline), Amla (sour), Lavana (Saline) Katu (pungent), Ushna (hot), Ruksha (ununctuous) and Sushka (dry)

4. Dhatukshaya – Diminution of tissue elements

5. Gadakarshana – Emaciation of the body because of suffering from chronic diseases

6. Ativamana – Excessive administration of emetic therapy etc and

7. Surya santapa – Excessive exposure to the rays of the sun.

3

PURVARUPA

Mukhashosha (Dryness of the mouth).

Constant desire to drink water is the invariable characteristic feature of this ailment.

The signs and symptoms are manifested in a lighter or less prominent form at the premonitory stage, and at times, some of these signs and symptoms are not manifested at all at this stage. [8]

4

SAMPRAPTI

Nidana sevana-> vata pitta dosha prakopa-> udharvagamana-> talu kloma shosha

GENERAL PATHOGENENSIS OF MOUTH DRYNESS:

These excessively aggravated Vata and Pitta cause dehydration of the tissue elements of the body which are liquid in nature (like Kapha, Rasa (taste)or Plasma and Udaka or Lymph) and the channels carrying Rasa (taste) or Plasma, root of the tongue, throat, Palate and Kloman (lungs). As a result of this, morbid thirst is manifested in the body because of these 2 powerful Doshas (excessively aggravated Vata and Pitta).

The patient afflicted with this ailment drinks water very frequently which gets dried up. As a result of this, his thirst is never quenched. This type of morbid thirst also comes as a complication in a patient who is emaciated because of his suffering from serious diseases. [4-7]

5

SAMPRAPTI GHATAKA

DOSHA- pitta vata

DUSHYA- udak

ADHISTHANA- talu kloma

SHROTAS- rasa & udakvaha

SVABHAVA- ashukari

SADHYAASADHYATA- sadhya

6

PATHOGENESIS, SING AND SYMPTOMS ACCORDING DOSHA INVOLVE

1. PATHOGENESIS, SIGNS AND SYMPTOMS OF THE VATIKATRISHNA:

When the aggravated Vata absorbs the tissue elements in the body which are liquid in nature, the patient becomes dehydrated by their diminution. Such as dehydrated patient suffers from Trushna (morbid thirst).

The signs and symptoms of Vatika type of Trushna (morbid thirst):

Nidranasha – Insomnia

Shirashabhrama – Giddiness in the head

Sushkavirasamukha – dryness as well as distaste in the mouth, and

Srotorodha – obstruction to the channels of circulation [11- 12]

2. PATHOGENESIS, SIGNS AND SYMPTOMS OF PAITTIKATRUSHNA:

Pitta is dominated by Agni- mahabhuta (having heating effect).

Therefore, its aggravation causes heating of the liquid tissue elements of the body. Because of this hot attribute, these tissue elements produce Trushna (morbid thirst) dominated by burning sensation in human beings. [13-14]

3. FEATURES OF KAPHAJATRISHNA:

Thirst with the desire of warm beverages, sleepiness, heaviness and sweetness of the mouth are the features of KaphajaTrishna.

4. SIGNS AND SYMPTOMS OF AMAJATRISHNA:

AmajaTrishna is caused by Ama (product of undigested food) and Pitta. Therefore, it is also Agneya (caused by Heat) in nature. Its signs and symptoms are

Aruchi – anorexia

Aadhmana – flatulence and

Kaphapraseka – excessive salivation [15]

5. PATHOGENESIS, SIGNS AND SYMPTOMS OF KSHAYAJATRISHNA:

The body is made of Rasa (plasma), and this Plasma is made of aqueous elements (Ambu). Thus, the diminution of Rasa gives the rise to (Kshayaja type of) Trishna or morbid thirst. In such patients, the voice becomes low; he trembles; and his heart, throat and palate become parched (dry) [16]

6. FEATURES OF KSHATAJATRISHNA:

Kshata means injury. This type of thirst is resulted following an injury and hemorrhage. This type is associated with burning sensation and fatigue.

7. FEATURES OF BHAKTODBHAVATRISHNA:

Bhakta means meals. This type of thirst is caused due to intake of excessive unctuous (oily), sour, saline and heavy foods.

UPASARGAJATRISHNA (THIRST MANIFESTED AS COMPLICATION):

Trushna (Thirst) is manifested as an Upasarga (complication) in a patient afflicted with diseases like

Jwara – fever,

Meha (obstinate urinary disorders including diabetes),

Kshaya (Phthisis),

Sosha (consumption) and

Shvasa (Asthma).

This causes emaciation (dehydration) of the body, and this ailment is difficult of cure. [17]

PROGNOSIS OF TRUSHNA

If morbid thirst persists for a long time in a patient emaciated because of his suffering from other diseases, if vomiting persists along with morbid thirst, and if thirst is associated with serious types of complications, then this leads to the death of the patient. [18]

PITTA VATADOSHA INVOLVEMENT

Thirst is never manifested without Agni (pitta) and VataDosha, because these 2 are responsible for absorption of liquids in the body. When these 2 Doshas are excessively aggravated, then a person suffers from morbid thirst.

Even when a person taking heavy food, milk and fat, suffers from thirst during digestion because of obstruction of the channels by their digestion,because of obstruction of the channels by their mixture, it is the Vata and Pitta dosha which are responsible for the manifestation of this ailment.

Alcohol, because of its sharpness, heat and ununctuousness, aggravates Pitta and Vayu leading to the absorption of the aqueous elements or to dehydration resulting in morbid thirst in a habitual drunkard.

Sprinkling of water over hot sand gets dried up soon. Likewise, the tissue elements which are hot [because of affliction by aggravated Pitta and Vayu], get pacified by the drinking of ice- cold water. [19-22]

7

DISEASE CONDITIONS WHEREIN THIRST OCCURS AS A SYMPTOM:

Diabetes mellitus – Type 1 and type 2, Diabetes insipidus, burns, dehydration, diarrhea, fever, heart failure, kidney disorders, kidney failure, multiple myeloma, sepsis.

8

CHIKITSA SUTRA

GENERAL LINE OF TREATMENT:

In all the varieties of Trushna, aggravation of Vayu, diminution of aqueous elements and aggravation of Pitta take place. But these are caused by different etiological factors (Agama). Therefore, treatment of all these varieties of Trushna will be described separately hereafter. [24]

TREATMENT OF VATIKA TRUSHNA:

For the treatment of VatikaTrushna, food and drinks which are the alleviations of vayu and which are soft, light and cooling are useful.

Milk and ghee which are boiled with drugs used for the treatment of Ksayaja- Kasa, cure Urdhva-Vata (Svasa or asthma) and morbid thirst

Milk and ghee boiled with drugs belonging to the Jivaniya group cure thirst caused by Vayu and Pitta. [40- ½ 41]

TREATMENT OF PAITTIKA TRUSHNA:

For the cure of Paittika type of Trushna the following recipes are useful:

1. Intake of water boiled with Raisin, sandalwood, dates and Ushira – Vetiver – Vetiveriazizanioides and added with honey

2. Intake of cold water added with red variety of Shali- rice, Kharjura – dates, Parusaka – Grewiaasiatica, Utpala (Nymphaea alba), Draksha – Raisin, honey and baked cold of earth.

3. 1 Prastha (768 g) of red variety of Shali-rice and (1 Pala each of), Lodhra (Symplocosracemosa), Madhuka – Madhucalongifolia, Rasanjana (Aqueous extract of Berberisaristata) and Utpala (Nymphaea alba) is made into a coarse powder. Water is added to this powder. A freshly baked cold of earth is immersed into it. By adding (1/4th in quantity of) honey, this water is taken in an earthen breaker.

4. Decoction is prepared by boiling water with Vata – Ficusbengalensis, Matulunga – Citrus medica, leaves of vetasa, Roots of Kusha (Desmostachyabipinnata) and Kasha, and Yastimadhu – Glycyrrhizaglabra. Black soil or black sand or heated till they become red. This soil or sand or heated Kapala (pieces of earthen pot) is immersed in the decoction. The water is then filled and given to the patient suffering from Trushna

5. The decoction of Amrta-Valli (Guduchi – Tinosporacordifolia) is cooked with sugar till it becomes a syrup cures Trushna and

6. The cold infusion (Hima) of ingredient having milky- latex, sweet taste and cold potency is immersed with a roasted cold of earth. The decocted fluid should then be added with sugar and honey. Intake of this cures Paittika type of Trushna. [44 ½ – 46]

AMAJA TRUSHNA CHIKITSA

The decoction of Sunthi – Zingiberofficinale, Pippali – Long pepper fruit – Piper longum, Maricha – Black pepper fruit – piper nigrum, Vacha (Acoruscalamus Linn.), Bhallataka and Tiktaka (Kirata- Tikta – Swertiachirata) cures Amaja type of Trushna. Therapies prescribed for the treatment of Kaphaja type of Chardi (vomiting) are also useful for the treatment of Amaja type of Trushna.

Association of aggravated kapha in Trushna is to be determined from the signs and symptoms like

Stambha – stiffness

Aruchi – anorexia

Vipaka – indigestion

Laziness and

Chardi – vomiting

In such a condition, emetic therapy is administered with the recipe containing curd, honey, tarpana (demulcent drink containing roasted corn- flour), salt and warm water. Such emetic therapies also be given with the recipes of decoction and linctus (describes in kapha section) by adding Dadima – Pomegranate or sour Fruit- Juice.

The patient suffering from Amaja type of Trushna may also be given a drink added with sugar and Rajani (haridra) [47- 49]

KSHAYAJA TRUSHNA CHIKITSA

KshayajaTrushna like Kshayajakasa is a serious ailment. Therefore, such a patient is given the therapies prescribed for the treatment of Kshina(kshayajaKasa), Kshata (urah-Ksata or Phthisis) and Sosha (consumption). [50]

UPASARGAJA TRUSHNA CHIKITSA

[Morbid thirst may be caused as a complication of inappropriate food, drinks or regimens. Treatments of such types of morbid thirst is as follows]

If Trishna is caused by the intake of alcohol in excess, then the patient is given alcohol drinks diluted with half the quantity of water, and added profusely with ingredients which are sour, Saline or aromatic .

If it is caused by bath with excessively cold water, then the patient is given Madyambu (alcohol diluted with water) or Gudambu (Jaggery made to a solution by adding water) to drink.

If it is caused by Bhaktoparodha (fasting) or if it is caused by the inappropriate administration of Sneha (ghee, oil etc) then the patient is given thin gruel to drink.

If it is caused by the intake of heavy food, the ingested food is made to vomit out. If the patient is physically strong, then he is given Madyambu (alcohol diluted with water) or tepid water to cause emesis. Alternately, he is given Magadhika (Pippali) to chew for the cleansing of his mouth, and thereafter, he is given Mantha (demulcent drink) along with sugar to drink.

If the patient, suffering from the parching of the palate, is strong, then he is given (medicated) ghee to drink, and is given such food as are alleviators of thirst, to eat. If however, he is weak, he is given milk sizzled with ghee or the soup of the meat of fatty animals.

The thirst of excessively ununctuous and weak patients is quenched immediately by milk. The soup of the meat of goat which is sizzled with ghee, which is sweet and which is cool works as a cardiac tonic for such patients.

If the morbid thirst is caused by the excessive intake of unctuous food, then it is alleviated by Gudambu (jaggery solution made by adding water).

The thirst of the patient afflicted with Murccha (fainting) is cured by the administration of therapies prescribed for the treatment of Rakta-Pitta (a condition characterized by bleeding from different parts of the body). [51-66]

PATHYA FOR HRIDROGA (BENEFICIAL AND WHOLESOME THINGS)

• Shali Dhanya – Rice

• Mudga – Green gram

• Yava – Barley

• JangalaMamsa Rasa – Meat soup of meat of animals living in the desert areas

• MarichaChoorna with Patola – Black Pepper powder mixed with pointed gourd

• Karavellakam – Bitter gourd

APATHYA FOR HRIDROGA (UNWHOLESOME THINGS FOR HRIDROGA)

• Taila – Oil

• Amla – sour things or food substances and drinks

• Takra – butter

• Guru anna – heavy to digest foods

• Kashaya – astringent tastes, foods prepared with astringent substances

• Shrama – excessive physical exhaustion

• Aatapam – exposure to excessive heat of Sun

• Rosham – Anger

• Stree – Excessive indulgence in sex

• Chinta – Excessive thinking, stress, anxiety

• Bhaasya – Excessive speaking

USE OF RAIN WATER

Since Trushna causes death by dehydration because of the diminution of aqueous elements in the body, the patient is given Aindra type of water (rain- water which is collected from the sky before it falls on the earth) by adding honey.

Other types of water [collected from the ground] having properties of Aindra or rain water may also be used by the patient.

This water should be slightly astringent in Anurasa (sub-taste), thin, light, cold, free from any bad smell or taste and Anabhisyandi (which does not cause obstruction to the channels of circulation). The ground water having the above mentioned properties are like Aindra water (rain –water collected from the sky before it falls on the earth). [25-26]

RECIPES OF MEDICATED DRINKS

The patient suffering from morbid thirst is given the following recipes:

1. Water boiled by adding Shara-Pancha-Mula (the roots of Sara, Iksu – Saccharumofficinarum, Darbha – Demostachyabipinnata, kasa and Shali (rice)). This boiled water is cooled after boiling and adding with sitopala (large crystal sugar).

2. Mantha (demulcent drink) prepared of the flour of laja (propped paddy), in rain water by adding sugar and honey

3. The Cooled Vatya (paste) prepared of immature barley grains (by slightly roasting and then smashing) is given along with honey and sugar

4. The Peya (thin gruel) prepared of Shali rice or Koradusa

5. Food prepared by boiling milk along with honey and sugar

6. The soup of the meat of Paravataetc, sizzled with ghee, and not added with salt and sour ingredients

7. Soup of the meat of animals inhabiting arid zone well prepared by boiling with the roots of Kusa (Desmostachyabipinnata), Kasa, Sara, Darbha – Demostachyabipinnata and iksu – Saccharumofficinarum , or Munjataka or Priyala (Buchananialanzan)

8. Milk boiled with the roots of Kusha (Desmostachyabipinnata), kasha Sara, Darbha – Demostachyabipinnata and Iksu – Saccharumofficinarum , or with Munjataka or with Priyala (Buchananialanzan) by adding sugar and honey.

9. Milk mixed with ShataDhauta-Ghrta (ghee washed for one hundred times). This is taken after taking bath in cold water.

10. The soup of Mudga (green gram), Masura (lentil) and Chanaka (bengal gram) sizzled with ghee.

11. Milk boiled by adding with ingredients which are sweet in taste, which belong to Jivaniya group, which are cooling in potency, and which are bitter in taste. This milk is added with honey and sugar, and used for drinking, massage and sprinkling over the body of the patient.

12. The ghee collected from the above mentioned milk is also useful for drinking, massage and inhalation therapy and

13. The women’s milk or camel milk mixed with sugar or the sugar cane juice may also be used for Nasya (inhalation therapy) [27-33]

RECIPES AND REGIMENS

Gargling with milk, sugarcane- juice, jaggery mixed with water, solution of Sitopala (sugar of large crystal), honey, Sidhu (a type of alcoholic drink),Mardvika ( drink prepared of Grapes), juice of Vrikshamla – Garcinia morella and juice of Matulunga – Lemon variety – Citrus decumana / Citrus limon cures dryness of the Palate.

Paste is prepared of Jambu – Sygyziumcumini, Amrataka – Spondiaspinnata, Badari, Vetasa, Pancha-Valkala (bark of 5 trees). VizNyagrodha – Ficusbengalensis, Udumbara – Ficusracemosa, Ashvattha – Ficusreligiosa, Vetasa and Plaksa) and Panchamla (5 sour preparations Viz., Kolamla, Cukrikamla, Matulunga – Lemon variety – Citrus decumana / Citrus limon, Amla-Vetasa – Garcinia pedunculata and Dadima – Pomegranate), and mixed with ghee. Application of this paste in the cardiac region, face and head cures fainting, giddiness and morbid thirst.

Paste is prepared of Dadima – Pomegranate, Dadhittha, Lodhra (Symplocosracemosa) and Vidari (Ipomoea paniculata / Puerariatuberosa) by triturating with the juice of Bija- Puraka – Citrus medica. Application of this paste on the head cures morbid thirst.

Similarly, application of the paste of Saivala (Vallisneriaspiralis), Panka (mud) and lotus along with sour juice and ghee or the paste of Saktu (roasted corn- flour) mixed with sour juice and ghee cures morbid thirst.

Touching the body of the patient with a cloth soaked with Mastu (upper part of the curd) or Aranala (a sour drink) or with a necklace made of gems cures morbid thirst.

Touch of the breasts, Palms, and bodies of beautiful and lovable ladies who are made wet by cold water or the paste of Chandana (Sandalwood – Santalum album) and who have worn wet silken cloth cures morbid thirst.

Thinking of the caves of the Himalayas, forests, rivers, ponds, lotus, wind, cooling moon- rays and beautiful lakes having cold water, and hearing talks about them cures morbid thirst. [34-39]

USAGE OF DIFFERENT TYPES OF WATER:

Naturally, cold water is useful in morbid thirst, burning syndrome, fainting, giddiness, mental fatigue, alcoholism, bleeding, poisoning and ailments caused by aggravated Pitta. The water cooled after boiling is useful in Sannipatika type of fever.

Hot Water is useful in hiccup, in Asthma, in freshly occurring (at the first stage of ) fever and in Pinasa (Rhinitis), after the intake of ghee, in the diseases of the sides of the chest and throat, diseases caused by Kapha and Vayu, when the Doshas have become Styana(thick) and immediately after the administration of elimination therapies.

Intake of water is not useful for the patient suffering from

Pandu – Anemia

Udara (obstinate abdominal diseases including ascites)

Pinasa (chronic Rhinits) at its later stage

Meha (obstinate urinary disorders including diabetes)

Gulma (Phantom Tumour)

Suppression of power of digestion

Atisara – Diarrhoea and

Pliha – splenic disorders.

However, if there is intolerable thirst in this patient, then water may be given only in small quantity. If the patients, suffering from the above mentioned diseases, become dehydrated because of morbid thirst, and because of not getting water even when they intensely need it, then this may cause instant death or may lead to long- standing diseases. Therefore such a thirsty patient is given water boiled by adding dhanyaka, and thereafter, by adding other ingredient which is wholesome for the disease. After overcoming the thirst, the complications caused by the intake of water can be cured easily.

Thereafter, treatment of the thirst is given priority over the treatment of several other diseases. [57-62]

.

SINGLE DRUGS

1. Kashmarya – Gmelinaarborea

2. Draksha – Raisin – Vitisvinifera

3. Kharjura – Dates – Pheonixdactylifera

4. Usheera–Vettiver – Vetiveriazizanoides

5. Chandana – Sandal wood – Santalum album

6. Yashtimadhu – Indian liquorice – Glycyrrhizaglabra

7. Matulunga – a variety of lemon – Citrus media

8. Kamala – Lotus – Nympheaorodata

9. Amalaki – Indian Gooseberry (Amla) – Emblicaoffiicinalisetc

AYURVEDIC MEDICINES FOR EXCESSIVE THIRST:

1. Kharjooradimantha – has sweet fruits like dates and pomegranate. Generally used in Kshayaja, Kshataja, Pitta and Vata types of Trishna.

2. Shadangapaneeya – has coolant and antipyretic (anti fever) herbs. Useful in Pittaja and UpasargajaTrishna.

3. Dhanyakadihima – made from coriander seed – specific to Pitta variety.

4. Parpatadyarishta – used in treating liver and splenic disorders. It is useful in Pittaja, Kaphaja and Upasargaja types.

5. Trinapanchamoolakashaya – made with five types of grasses. Used in urinary tract disorders. Useful in Kaphaja, Kshataja, Kshayaja and Upasargaja types.

6. Chandrakala rasa – useful in bleeding disorders. Hence helpful in Kshataja and Kshayaja type of thirst.

7. Kamadugha rasa, Pravalapishti – useful in Pittaja.

RASODHI/BHASMA/PISTI-(120-250MG WITH MADHU/USHNODAKA)

- Mahodadhi rasa-(tamra,rasasindura,vatankur)

- Kumudeshver rasa-(tamra,vanga,maduyasthi)

- Chandrakala rasa-(kajjali,abhrak,tamra)

- Praval pisti

- Pippaliyadi loha-(pippali,draksha,vidanga)

VATI-(250-500MG WITH USHNA JALA)

- Vatasringadi vati-(vata,kutha,laja)

- Rugadi vati-(kutha,nagamogara,vantakura)

- Rasadi vati-(parad,rajat)

- Eladi vati-(ela,tejapatra,dalcheeni)

CURNA-(3-6GM WITH MADHU/USHNODAKA)

- Rasadi curna-(parad,gandhak,karpoora,sarkara)

- Vatshringadi curna-(vatankur,lodhra,dadima)

KAVATH/ASAV/ARISHTA-(20-40ML WITH SAMABHAG WATER)

- Lodhrasava-(lodhra,ela,kuth)

- Usheerasava-(khas,kamal.priyangu)

- Chandanasava-(chandan,netravala,nagarmotha)

GHRITA(20-30ML WITH USHNODAKA)

- Jeevaniya ghrita-(jeevaniya gana,ghrita,ksheera)

- Amritaprasha-(jeevanti,kakoli)