Charaka Chardi Chikitsa – 20th Chapter | Vomiting Treatment

20th chapter of Charaka Samhita, Chikitsa Sthana is called Chardi Chikitsa Adhyaya. It deals with causes, types and Ayurevdic treatment for vomiting. We shall now expound the chapter on the Treatment of Chardi (vomiting). Thus, said Lord Atreya [1-2]

Prologue

Agnivesha, the disciple, asked Punarvasu Atreya, a reputed physician, dazzling with luster of divine knowledge and penance, who was endowed with the brilliance like that of fire and the sun, and who was dedicated to the well-being of all living beings, as follows: [3]

Dialogue

Oh! Revered Physician, please let us know the treatment of the 5 types of Chardi (vomiting) described by you earlier, while discussing the classification of diseases (in Charaka Sutrasthana 19/3-4) together with their etiology, signs and symptoms comprehensively, for the well-being of human beings.
After hearing this query of Agnivesha, the eminent physician (Punarvasu Atreya) was pleased and said, “I shall earlier, in greater details. Listen”. [4-5]

Types of Chardi

Chardi is of 5 types as follows:
1. Vatika Chardi (vomiting caused by Vata)
2. Paittika Chardi (caused by Pitta)
3. Kaphaja Chardi (caused by Kapha)
4. Sannipatika chardi (caused by vitiation of all the 3 Doshas) and
5. Dvishtartha -yojana-Chardi (vomiting caused due to unwanted objects). [ ½ 6]

Purvaroopa

Chardhi Purvaroopa:
Premonitory Signs and Symptoms of Chardi:
1. Hrudaya utklesha – Nausea with uneasy feeling in the cardiac region
2. Kapha praseka – Excessive Salivation and
3. Ashana dvesha – Hateful disposition toward food [6 ½ ]
Vataja Chardi – Nidana, Samprapti, Lakshana:
Etiology, Pathogenesis, signs and Symptoms of Vatika Chardi:
In a person, emaciated because of
Ati vyayama (excessive exercise)
Tikshna aushadha sevana (intake of medicines having sharp attributes)
Shoka (Grief)
Bhaya (fear)
Upavasa (fasting) etc
Vata gets aggravated in the gastro intestinal tract (Maha- srotas or Kostha), incites the local Doshas amend pushes them upward. These Doshas cause agitation in the stomach (Amashaya), and after afflicting the vital organs (Marman) (viz heart) gives rise to Chardi (vomiting).

Vataja Chardi

Vatika Chardi – Lakshana – signs and symptoms:
Hrit parshva peeda – Pain in the cardiac region and sides of the chest
Mukha shosha – Dryness of the mouth
Murdha nabhya arti – Pain in the head and umbilical region
Kasa – Coughing
Swara bheda -hoarseness of the voice and
Toda – pricking pain
Udgara shabda prabala – Eructation with loud noise
Sa phena, vicchinna, krshna, tanu kashayam – Vomiting of material which is frothy, scattered, black in color, thin and astringent in taste.
Krchrena alpam – The urge for vomiting is forceful, but the patient vomits only in small quantities with pain and
The patient feels miserable. [7-9]

Pittaja Chardi

Pittaja Chardi Nidana, Samprapti, Lakshana:
Etiology, Pathogenesis, signs and Symptoms of Paittika Chardi:
Because of the intake of food before the previous meal is digested, and because of the intake of Katu (pungent), Amla (sour), Vidahi (which cause burning sensation) and Ushna ahara (hot foods and drinks), Pitta Dosha in the Amashaya (stomach) gets aggravated. This aggravated Pitta circulates through the channels (Rasayani) and afflicts the vital organs located in the upper part of the body giving rise to vomiting:
Signs and symptoms of this Paittika Chardi
1. Moorcha – Fainting, Pipasa – Morbid thirst and Mukha shosha – dryness of the mouth
2. Santapa – Burning (or heating) sensation in the head, Palates and eyes
3. Tamo pravesha- A feeling as if the entering into darkness
4. Bhrama – Giddiness
5. Pitam bhrsoshanam haritam satiktam dhumram-Vomiting of material which is yellow, excessively hot, green, bitter and smoky in appearance and
6. Sa daham – Vomiting takes place with burning sensation [10-11]

Kaphaja Chardi

Kaphaja Chardi Nidana, Samprapti, Lakshana:
Etiology, Pathogenesis, Signs and symptoms of Kaphaja Chardi:
Because of the intake of food, the ingredients of which are
Snigdha (unctuous), Ati guru (excessively heavy),
Aama (uncooked) and Vidahi anna and
sleeping in the day time and such other factors,
Kapha Dosha gets excessively aggravated. This aggravated Kapha afflicts (occludes) the chest, head, vital organs and all the (concerned) channels to cause Chardi (vomiting).

Signs and symptoms of  Kaphaja type of Chardi:
1. Tandra – Drowsiness, Madhura aasya – sweet taste in the mouth and Kapha praseka –  excessive salivation
2. Santosha – Sense of satisfaction, Nidra – sleep, Aruchi – anorexia and Gauravam – heaviness of the body
3. Vomiting of material which is Snigdha – unctuous, Ghana – thick, Svadu – sweet and free from any undesirable smell and
4. Loma harsha – Horripilation and Alpa ruja – less of pain [12- 13]

Sannipataja Chardi

Sannipatika Chardi Nidana, Samprapti, Laskhana:

Etiology, Pathogenesis, signs and Symptoms of Sannipatika Chardi:
Because of the habitual intake of wholesome and unwholesome ingredients together, having all the different tastes, because of Ama- dosha (ailments caused by improper digestion) and because of seasonal perversions, all the 3 Doshas get simultaneously aggravated to cause Sannipatika type of Chardi.
Signs and symptoms:
1. Shula – Colic pain, Avipaka – indigestion, Aruchi – Anorexia, Daha – burning sensation, trishna – morbid thirst, Shwasa – dyspnoea and fining which are of serious nature and persistent and
2. Vomiting of material which is Lavana – saline, amla-sour, Anila – blue, Sandra -dense, Ushna -hot and Rakta – red (mixed with blood). [14- 15]

Complications

Complications leading to Incurability of Chardi:
When the aggravated Vata Dosha occludes the channels carrying stool, sweet, urine and ambu (aqueous material) and moves upwards, then the morbid matter (dosha) from the gastro- intestinal tract (kostha) of the person who’s Doshas are aggravated, gets incited to cause vomiting. This type of vomiting has the following signs and symptoms:
1. Vin mutra sama varna – Vomiting of the material having the same color and smell of the urine and stool
2. Trut – Persistent thirst, Shwasa – dyspnoea and Hikka – hiccup
3. Vomiting of foul smelling or putrid material (Dusta) and
4. Prachardana – Bouts of vomiting with great force
Such a patient succumbs to death instantaneously. [16-17]

Dvistartha Yogaja Chardi

Smelling, eating and seeing unpleasant, antagonistic, unclean, putrid, unholy and gruesome ingredients and objects afflicts the mind. This mental disgust gives rise to vomiting which is called Dvistartha- Yogaja Chardi or vomiting caused by the contact with the unwanted objects. [18]

Incurability of Chardi

If in an emaciated person, vomiting continues incessantly, if there are complications, and if the vomitus is associated with blood, pus and Chandrika (circular patches with variegated color like the one at the top of pea-cock feather), then the patient is incurable (Asadhya).
The physician should treat only curable types of vomiting which are not associated with any complications. [19]

Chikitsa Sutra

Chardi Chikitsa Sutra – Line of treatment
Langhana therapy – All except Vatika chardi (Because the Doshas are vitiated by the agitation of Doshas in the stomach)
Samshodhana therapy – Kapha and Pitta chardi (Because the Doshas are aggravated in excess)
Along with honey, the powder of Abhaya – Terminalia chebula is given in a linctus form for the purpose of purgation. Such other purgative drugs which are cardio- tonics may also be given appropriately along with alcohol or milk. These recipes cause downward movement of the aggravated Doshas having the tendency to move upwards.
Such patients may also be given Vamana therapy, with the recipes containing Valli-Phala etc.
If the patient is weak, then he is treated with Shamana or alleviation therapy for which delicious soups and light as well as dry food is given for eating along with different types of drinks. [20-22]

Vataja Chardi Chikitsa

Treatment of Vataja Chardi:
The following cure Vataja type of Chardi (vomiting):
1. The well sizzled soup of the meat of Tittiri, Barhi and Lava
2. Vegetable soup of Kola, Kulattha, Dhanya, Bilva – Aegle marmelos (Shyonaka – Oroxylum indicum, Gambhari – Gmelina arborea, Patali – Stereospermum sauveolens, Ganikarika – Clerodendrum phlomidis), Mulamla (sour drink prepared of radish) and yava;
3. Ghee with rock- salt (cooked with rock salt). This recipe is given to the patient of Vatika Chardi, associated with the palpitation of the heart.
4. Ghee cooked with Dhanyaka –Coriandrum sativum , Nagara – Zingiber officinale, Yogurt and the juice of Dadima – Pomegranate – Punica granatum and
5. Ghee added with the powder of Sunthi – Zingiber officinale, Pippali – Long pepper fruit – Piper longum ,Maricha – Black pepper fruit – piper nigrum and Saindhava, Sauvarchala and Vida type of salt;
The patient of Vataja Chardi is given food which is unctuous and pleasing to the heart along with meat- soup, vegetable- soup, yogurt and sour pomegranate. [23-25]

Pittaja Chardi Chikitsa

Treatment of Paittaja type of Chardi, the patient is given the powder of Trivrt – Operculina turpethum along with the juice of Draksha – Raisin – Vitis vinifera, Vidari (Ipomoea paniculata / Pueraria tuberosa) and sugarcane for causing Anulomana or downward movement of the morbid matter, i.e purgation. When Pitta is over- aggravated in chest (in the region above the abode of kapha- stomach), then (emetic therapy with the help of) drugs having sweet taste is administered.

After the body is cleansed from the morbid matter, the patient is given during meal- time the Laja-mantha (flour of popped- rice, Diluted in water) or Laja-Peya (thin gruel made of popped- rice) along with honey and sugar. The patient may also be given boiled Shali- rice along with the soup of Mudga – Vigna radiata or the soup of the meat of animals inhabiting an arid zone.

Kulmasha (the paste of boiled green gram, Masura (red lentil) etc.,) Laja (popped paddy), Yava – Barley (Hordeum vulgare) – Saku (flour of roasted barley), Grnja (boiled barley along with its scum), or the pulp of Kharjura – Phoenix dactyliera, Coconut, Draksha – Raisin – Vitis vinifera or Kola is made to a linctus by adding Sitopala (sugar having big crystals), honey and Pippali – Long pepper fruit – Piper longum. These recipes are given to the patient suffering from Paittika type of vomiting.
The powder of Srotonjana Laja (popped paddy), Utpala (Nymphaea alba), the seed- pulp of Kola (ber fruit) and Abhaya – Terminalia chebula is made to a linctus by adding honey, and given to the patient. Similarly the seed- pulp of Kola, Anjana, and stool of fly, Laja (popped paddy), sugar and grains of Pippali – Piper longum mixed with honey may be given to the patient.

The patient may drink cooled juice of Draksha – Raisin – Vitis vinifera or the leaves of jambu –Syzygium cumini and Amra by adding honey (after the decoction is cooled).
Water is added with the powder of mudga – Vigna radiate, Pippali – Long pepper fruit – Piper longum, Ushira – Vetiver – Vetiveria zizanioides and Dhanya – Coriandrum sativum and kept overnight. In the morning the powder is strained out and the filtered water is taken by the patient. Similarly the water added with the powder of chanaka (Bengal gram) or Gavedhuka- root or Guduchi – Tinospora cordifolia and kept to overnight can be given to the patient.
The patient may be given sugarcane juice or milk to drink.

Recipes which are useful for curing Trishna (excess thirst) and Chardi:
1. The powder of Sevya and Balaka along with rice- water (tandulodaka) and honey);
2. Powder of Kancana- Gairika and Balaka along with rice- water and honey and
3. The paste of white variety of Chandana – Santalum album mixed with the juice of Amalaki – Emblica officinalis along with honey.
The following recipes also cure Paittika type of vomiting:
1. The paste of Chandana – Santalum album, Chavya – Piper retrofractum, Mamsi – Nardostachys jatamamsi, Draksha – Raisin – Vitis vinifera of good quantity,
2. Powder of Gairika and Shali along with cold water and honey
3. Powder of Murva – Marsedenia tenacissima along with rice- water (Tandulodaka) and honey.

Kaphaja Chardi Chikitsa

Treatment of kaphaja Chardi:
In Kaphaja type of Chardi (vomiting), emetic therapy gives the best results. For this purpose, the patient is given the decoction of Pippali – Long pepper fruit – Piper longum, Sarsapa – Brassica campestris and Nimba – Neem (Azadirachta indica) added with the powder of Pinditaka (Madana-Phala – Randia dumetorum) and rock salt. This cleanses (eliminates) Kapha from Amashaya (stomach).

The patient is given wheat, rice and barley which are old (more than 6 months old after harvesting) as food. Along with this food, he is given the following side –dishes and drinks
1. Vegetables soup of Patola – Trichosanthes dioica, Amrta and Chitraka – Leadword – Plumbago zeylanica
2. Butter-milk cooked by adding Sunthi – Zingiber officinale, Pippali – Long pepper fruit – Piper longum, and Maricha – Black pepper fruit – piper nigrum
3. Butter- milk cooked by adding Nimba – Neem (Azadirachta indica)
4. Soup of sour fruits along with pungent drugs
5. Soup of the meat of animals inhabiting arid zone (Jangala). The spit-roasted meat these animals may also be given along with food.
6. Old honey, Sidhu (alcohol prepared of sugar-cane- juice) and Arishta (a type of alcoholic drink) and
7. Raga (condiments), sasava (pickles) and Panaka (syrup) prepared of Draksha – Vitis vinfera, Kapittha (Feronia limonia) and Phala- Puraka (bija-Puraka) – Citrus medica.

The following recipes are useful for the patient suffering from kaphaja type of vomiting:
1. Linctus prepared with the powder of the roasted Mudga – green gram, Masura – Lens esculenta (red lentil), Chanaka (bengal gram) and kalaya (peanut) mixed with the powder of Sunthi – Zingiber officinale and honey.
2. Linctus prepared of the powder of Haritaki – Terminalia chebula, Bibhitaka – Terminalia bellerica, Amalaki – Emblica officinialis and Vidanga – Embelia ribes mixed with the powder of Sunthi – Zingiber officinale and honey.
3. Linctus prepared of the powder of Vidanga – Embelia ribes and Plava (Kaivarta mustaka) mixed with the powder of sunthi and honey.
4. Powder of Jambu (Jamun seed) and sour fruits of Badara – Zizyphus jujuba mixed with honey
5. Powder of Musta (Cyperus rotundus) and Karkata- srngi – Rhus succedanea mixed with honey and
6. Powder (or juice) of Duralabha – Fagonia cretica mixed with honey.

The following recipes subside the forcefully generated urge for vomiting:
Powder of (purified) Manahsila with the juice of Bija-Puraka – Citrus medica, Honey and powder of Maricha – Black pepper fruit – piper nigrum and
Powder of Pippali – Long pepper fruit – Piper longum mixed with the juice of Kapittha (Feronia limonia), honey and the powder of Maricha – Black pepper fruit – piper nigrum. [34-39]

Sannipatika Chardi Chikitsa

Various types of treatment suggested by me (by Atreya) for the treatment of different types of Chardi,(Viz, Vatika,pattika and Kaphaja Chardi) is appropriately and judiciously combined, and given by the physician to the patient suffering from Sannipatika type of Chardi. The physician well versed in ayurvedic scriptures is (specially) vigilant (with regard to the Sannipatika type of Chardi) keeping in view the relative preponderance of the Doshas involved, the season when the disease has occurred, the stage of the disease and the power of digestion of the patient [40]

Dvistartha Samyogaja Chardi Chikitsa

For the treatment of vomiting caused by the mental disgust or affliction of the mind (Manobhighata), the following steps are taken:
• Mano anukula – The patient is made to hear pleasing talks
• Ashvasana – He is consoled and encouraged.
• Loka prasiddha sruta – He is made to hear reputed folk tales including mythological stories
• He is attended to by congenial companions and he should resort to amorous and wholesome regimes (games)
• He is made to smell various types of pleasing perfumes emanating from the earth, flowers, Sukta (vinegar) and Sour fruits
• He is given to eat well prepared vegetables, eatables, syrups, Shadavas (Pickles), raga (condiments) and Lehas (preparations in the form of linctus or jam).
• Eatables like vegetable- soup, meat- soups, Kambalika (sour curry of fish and meat), Khada (sour drinks prepared of fruits), meat preparations, popped cereals, different food preparations, fruits and roots having pleasing smell, color and taste cure vomiting caused by mental disgust and
• In general, whatever smell, taste, touch, sound or vision is pleasing to such patients is administered even though some of these might be unwholesome, because the aliments caused by such unwholesome contacts can be treated easily. [41-44]

Upadrava Chikitsa

Treatment of Complications:
Complications associated with the disease (vomiting) are treated on the lines suggested in respect of each of these ailments. If there is excess of vomiting, then the therapeutic measures to be suggested in Siddhi 6: 52- 56 is administered to the patient. [45]

Management of Chronic Chardi

If vomiting persists continuously for a long time, then because of the diminution of tissue elements (Dhatus), the Vata Dosha certainly gets aggravated. Therefore, if the vomiting has become chronic, then therapeutic measures which are upastambhana (anti- emetic) and Brmhana (nourishing) is administered.
Recipes like Sarpirguda (vide Chikitsa 11: 50- 77), Ksheera-Vidhi (milk boiled by adding Vata balancing herbs), Kalyanaka Ghrita (vide Chikitsa 9: 33-42), Tryushana- Ghrita (vide Chikitsa 18: 39- 42), Jivaniya –ghrita (vide Chikitsa 29: 55- 57), meat- soup and different types of linctus cure chronic type of Chardi (vomiting). [46-47]

Summary

In this chapter, the reputed saint (lord Atreya) propounded the following topics:
Etiology of Chardi
Enumeration of different varieties of Chardi
Signs and symptoms of different types of Chardi
Complications of Chardi
Curability and incurability of different types of Chardi and
Recipes for the treatment of different types of Chardi
Thus, ends the 20th chapter in Chikitsa- Sthana (section on the treatment of diseases) dealing with the treatment of Chardi (vomiting) in the work of Agnivesha which was redacted by Charaka, and because of its non- availability (subsequently) supplemented by Dridhabala