Charaka Trishna Chikitsa – Dry Mouth- 22nd Chapter

22nd Chapter of Charaka Samhita Chikitsa Sthana deals with Trishna Chikitsa – treatment for dry mouth or excessive thirst. The chapter is called Trishna Chikitsa Adhyaya. 

अथातस्तृष्णा चिकित्सितं व्याख्यास्यामः||१||
इति ह स्माह भगवानात्रेयः||२||
athātastṛṣṇā cikitsitaṃ vyākhyāsyāmaḥ||1||
iti ha smāha bhagavānātreyaḥ||2||

Let us explore the chapter on the treatment of Trishna (morbid thirst). Thus said Lord Atreya [1-2]

Prologue

ज्ञान प्रशमतपोभिः ख्यातोऽत्रिसुतो जगद्धितेऽभिरतः|
तृष्णानां प्रशमार्थं चिकित्सितं प्राह पञ्चानाम्||३||
jñāna praśamatapobhiḥ khyāto’trisuto jagaddhite’bhirataḥ|
tṛṣṇānāṃ praśamārthaṃ cikitsitaṃ prāha pañcānām||3||

The son of Atri (Lord Punarvasu) reputed as an abode of knowledge, peace and penance, and deeply interested in the well-being of the world, explained the treatment for the alleviation of the 5 categories of Trishna (excess thirst). [3]

Read related:
Dry Mouth Causes, Ayurvedic Treatment, Remedies, Tips, Diet
Excessive Thirst – Ayurvedic Understanding And Treatment

Nidana, Samprapti

Trishna Nidana and Samanya Samprapti: 
क्षोभाद्भयाच्छ्रमादपि शोकात्क्रोधाद्विलङ्घनान्मद्यात्|
क्षाराम्ल लवण कटुकोष्ण रूक्ष शुष्कान्न सेवाभिः||४||
धातुक्षयगदकर्षणवमनाद्यतियोग सूर्य सन्तापैः|
पित्तानिलौ प्रवृद्धौ सौम्यान्धातूंश्च शोषयतः||५||
रसवाहिनीश्च नाली र्जिह्वामूल गलतालुक क्लोम्नः |
संशोष्य नृणां देहे कुरुतस्तृष्णां महाबलावेतौ||६||
पीतं पीतं हि जलं शोषयतस्तावतो न याति शमम्|
घोर व्याधि कृशानां प्रभवत्युपसर्गभूता सा||७||
kṣobhādbhayācchramādapi śokātkrodhādvilaṅghanānmadyāt|
kṣārāmla lavaṇa kaṭukoṣṇa rūkṣa śuṣkānna sevābhiḥ||4||
dhātukṣayagadakarṣaṇavamanādyatiyoga sūrya santāpaiḥ|
pittānilau pravṛddhau saumyāndhātūṃśca śoṣayataḥ||5||
rasavāhinīśca nālī rjihvāmūla galatāluka klomnaḥ |
saṃśoṣya nṛṇāṃ dehe kurutastṛṣṇāṃ mahābalāvetau||6||
pītaṃ pītaṃ hi jalaṃ śoṣayatastāvato na yāti śamam|
ghora vyādhi kṛśānāṃ prabhavatyupasargabhūtā sā||7||

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. Dhatu kshaya – Diminution of tissue elements
5. Gada karshana – Emaciation of the body because of suffering from chronic diseases
6. Ati vamana – Excessive administration of emetic therapy etc and
7. Surya santapa – Excessive exposure to the rays of the sun.

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]

Purvaroopa

Trushna Purvaroopa:
प्राग्रूपं मुखशोषः, स्वलक्षणं सर्वदाऽम्बुकामित्वम्|
तृष्णानां सर्वासां लिङ्गानां लाघवमपायः||८||
prāgrūpaṃ mukhaśoṣaḥ, sva lakṣaṇaṃ sarvadā’mbukāmitvam|
tṛṣṇānāṃ sarvāsāṃ liṅgānāṃ lāghavamapāyaḥ||8||

Premonitory Signs and Symptoms of morbid thirst: 
Mukha shosha (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]

Samanya Lakshana

Trushna Samanya Lakshana: 
मुखशोष स्वरभेद भ्रम सन्ताप प्रलाप संस्तम्भान्|
ताल्वोष्ठ कण्ठ जिह्वा कर्कशतां चित्तनाशं च||९||
जिह्वा निर्गममरुचिं बाधिर्यं मर्मदूयनं सादम्|
तृष्णोद्भूता कुरुते, पञ्चविधां लिङ्गतः शृणु ताम्||१०||
mukhaśoṣa svarabheda bhrama santāpa pralāpa saṃstambhān|
tālvoṣṭha kaṇṭha jihvā karkaśatāṃ cittanāśaṃ ca||9||
jihvā nirgamamaruciṃ bādhiryaṃ marmadūyanaṃ sādam|
tṛṣṇodbhūtā kurute, pañcavidhāṃ liṅgataḥ śṛṇu tām||10||

General signs and symptoms of excess thirst:
Mukha shosha – Dryness of the mouth
Svara bheda – Hoarseness of the voice
Bhrama – giddiness
Santapa – burning sensation
Pralapa – delirium
Stambha- stiffness
Talu ostha kantha jihva karkasha – roughness of the palate, lips, throat and tongue
Chitta nasham – unconsciousness
Jihva nirgaman – Protrusion of the tongue
Aruchi – anorexia
Badhirya – Deafness
Marma anga sada – 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]

Vataja Trishna

Vatika Trushna Nidana, Samanya Samprapti: 
अब्धातुं देहस्थं कुपितः पवनो यदा विशोषयति|
तस्मिञ्शुष्के शुष्यत्यबलस्तृष्यत्यथ विशुष्यन्||११||
निद्रानाशः शिरसो भ्रमस्तथा शुष्क विरसमुखता च स्रोतोऽवरोध इति च स्याल्लिङ्गं वात तृष्णायाः||१२||
abdhātuṃ dehasthaṃ kupitaḥ pavano yadā viśoṣayati|
tasmiñśuṣke śuṣyatyabalastṛṣyatyatha viśuṣyan||11||
nidrānāśaḥ śiraso bhramastathā śuṣka virasamukhatā ca sroto’varodha iti ca syālliṅgaṃ vāta tṛṣṇāyāḥ||12||

Pathogenesis, Signs and symptoms of the Vatika Trishna:
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):
Nidra nasha – Insomnia
Shirasha bhrama – Giddiness in the head
Sushka virasa mukha – dryness as well as distaste in the mouth, and
Sroto rodha – obstruction to the channels of circulation [11- 12]

Pittaja Trishna

Paittika Trushna Nidana, Samprapti: 
पित्तं मतमाग्नेयं कुपितं चेत्तापयत्यपां धातुम्|
सन्तप्तः स हि जनयेत्तृष्णां दाहोल्बणां नॄणाम्||१३||
तिक्तास्यत्वं शिरसो दाहः शीताभिनन्दता मूर्च्छा|
पीताक्षि मूत्रवर्चस्त्वमाकृतिः पित्त तृष्णायाः||१४||
pittaṃ matamāgneyaṃ kupitaṃ cettāpayatyapāṃ dhātum|
santaptaḥ sa hi janayettṛṣṇāṃ dāholbaṇāṃ nṝṇām||13||
tiktāsyatvaṃ śiraso dāhaḥ śītābhinandatā mūrcchā|
pītākṣi mūtravarcastvamākṛtiḥ pitta tṛṣṇāyāḥ||14||

Pathogenesis, Signs and Symptoms of Paittika Trushna:
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]

Amaja Trishna

Signs and Symptoms of Amaja Trishna:
तृष्णा याऽऽम प्रभवा साऽप्याग्नेयाऽऽमपित्त जनितत्वात् |
लिङ्गं तस्याश्चारुचिराध्मान कफप्रसेकौ च||१५||
tṛṣṇā yā”ma prabhavā sā’pyāgneyā”mapitta janitatvāt |
liṅgaṃ tasyāścārucirādhmāna kaphaprasekau ca||15||

Amaja Trishna 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
Kapha praseka – excessive salivation [15]

Kshayaja Trishna

Pathogenesis, Signs and Symptoms of Kshayaja Trishna:
देहो रसजोऽम्बुभवो रसश्च तस्य क्षयाच्च तृष्येद्धि|
दीन स्वरः प्रताम्यन् संशुष्कहृदयगलतालुः ||१६||
deho rasajo’mbubhavo rasaśca tasya kṣayācca tṛṣyeddhi|
dīna svaraḥ pratāmyan saṃśuṣkahṛdayagalatāluḥ ||16||

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]

Upasargaja Trishna

Upasargaja Trishna (Thirst Manifested as Complication):
भवति खलु योपसर्गात्तृष्णा सा शोषिणी कष्टा|
ज्वर मेहक्षय शोष श्वासाद्युपसृष्ट देहानाम् ||१७||
bhavati khalu yopasargāttṛṣṇā sā śoṣiṇī kaṣṭā|
jvara mehakṣaya śoṣa śvāsādyupasṛṣṭa dehānām ||17||

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

सर्वास्त्वतिप्रसक्ता रोगकृशानां वमि प्रसक्तानाम्|
घोरोपद्रवयुक्तास्तृणा मरणाय विज्ञेयाः||१८||
sarvāstvatiprasaktā rogakṛśānāṃ vami prasaktānām|
ghoropadravayuktāstṛṇā maraṇāya vijñeyāḥ||18||

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 Vata dosha involvement

Important role of Pitta and Vata Dosha in the Pathogenesis of Thirst:
नाग्निं विना हि तर्षः पवनाद्वा तौ हि शोषणे हेतू|
अब्धातोरतिवृद्धावपां क्षये तृष्यते नरो हि||१९||
गुर्वन्नपयःस्नेहैः सम्मूर्च्छद्भिर्विदाहकाले च|
यस्तृष्येद्वृतमार्गे तत्राप्यनिलानलौ हेतू||२०||
तीक्ष्णोष्ण रूक्ष भावान्मद्यं पित्तानिलौ प्रकोपयति|
शोषयतोऽपां धातुं तावेव हि मद्य शीलानाम्||२१||
तप्तास्विव सिकतासु हि तोयमाशु शुष्यति क्षिप्तम्|
तेषां सन्तप्तानां हिम जलपानाद्भवति शर्म||२२||
nāgniṃ vinā hi tarṣaḥ pavanādvā tau hi śoṣaṇe hetū|
abdhātorativṛddhāvapāṃ kṣaye tṛṣyate naro hi||19||
gurvannapayaḥsnehaiḥ sammūrcchadbhirvidāhakāle ca|
yastṛṣyedvṛtamārge tatrāpyanilānalau hetū||20||
tīkṣṇoṣṇa rūkṣa bhāvānmadyaṃ pittānilau prakopayati|
śoṣayato’pāṃ dhātuṃ tāveva hi madya śīlānām||21||
taptāsviva sikatāsu hi toyamāśu śuṣyati kṣiptam|
teṣāṃ santaptānāṃ hima jalapānādbhavati śarma||22||

Thirst is never manifested without Agni (pitta) and Vata Dosha, 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]

Prohibition of Cold water bath: 
शिशिर स्नातस्योष्मा रुद्धः कोष्ठं प्रपद्य तर्षयति|
तस्मान्नोष्ण क्लान्तो भजेत सहसा जलं शीतम् ||२३||
śiśira snātasyoṣmā ruddhaḥ koṣṭhaṃ prapadya tarṣayati|
tasmānnoṣṇa klānto bhajeta sahasā jalaṃ śītam ||23||

However bath with exceedingly cold water obstructs the dissipation of heat. The heat thus, enters the Kostha (gastro intestinal tract) and causes thirst. Therefore, a person fatigued by exposure to heat should not instantaneously resort to cold water (bath) [23]

Chikitsa Sutra

Trushna Samanya Chikitsa Sutra: 
लिङ्गं सर्वास्वेतास्वनिलक्षय पित्तजं भवत्यथ तु|
पृथगागमाच्चिकित्सितमतः प्रवक्ष्यामि तृष्णानाम्||२४||
liṅgaṃ sarvāsvetāsvanilakṣaya pittajaṃ bhavatyatha tu|
pṛthagāgamāccikitsitamataḥ pravakṣyāmi tṛṣṇānām||24||

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]

Use of Rain Water

अपां क्षयाद्धि तृष्णा संशोष्य नरं प्रणाशयेदाशु|
तस्मादैन्द्रं तोयं समधु पिबेत्तद्गुणं वाऽन्यत्||२५||
किञ्चित्तुवरानुरसं तनु लघु शीतलं सुगन्धि सुरसं च|
अनभिष्यन्दि च यत्तत्क्षितिगतमप्यैन्द्रवज्ज्ञेयम्||२६||
apāṃ kṣayāddhi tṛṣṇā saṃśoṣya naraṃ praṇāśayedāśu|
tasmādaindraṃ toyaṃ samadhu pibettadguṇaṃ vā’nyat||25||
kiñcittuvarānurasaṃ tanu laghu śītalaṃ sugandhi surasaṃ ca|
anabhiṣyandi ca yattatkṣitigatamapyaindravajjñeyam||26||

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

शृतशीतं ससितोपलमथवा शर पूर्व पञ्चमूलेन|
लाजा सक्तु सिताह्वा मधुयुतमैन्द्रेण वा मन्थम्||२७||
वाट्यं वाऽऽमयवानां शीतं मधु शर्करायुतं दद्यात्|
पेयां वा शालीनां दद्याद्वा कोरदूषाणाम्||२८||
पयसा शृतेन भोजनमथवा मधु शर्करायुतं योज्यम्|
पारावतादिकरसैर्घृतभृष्टैर्वाऽप्यलवणाम्लैः||२९||
तृणपञ्चमूलमुञ्जातकैः प्रियालैश्च जाङ्गलाः सुकृताः|
शस्ता रसाः पयो वा तैः सिद्धं शर्करा मधुमत्||३०||
शतधौत घृतेनाक्तः पयः पिबेच्छीततोयमवगाह्य|
मुद्ग मसूर चणकजा रसास्तु भृष्टा घृते देयाः||३१||
मधुरैः सजीवनीयैः शीतैश्च सतिक्तकैः शृतं क्षीरम्|
पानाभ्यञ्जनसेकेष्विष्टं मधु शर्करायुक्तम्||३२||
तज्जं वा घृतमिष्टं पानाभ्यङ्गेषु नस्यमपि च स्यात्|
नारी पयः सशर्करमुष्ट्र्या अपि नस्यमिक्षुरसः||३३||

śṛtaśītaṃ sasitopalamathavā śara pūrva pañcamūlena|
lājā saktu sitāhvā madhuyutamaindreṇa vā mantham||27||
vāṭyaṃ vā”mayavānāṃ śītaṃ madhu śarkarāyutaṃ dadyāt|
peyāṃ vā śālīnāṃ dadyādvā koradūṣāṇām||28||
payasā śṛtena bhojanamathavā madhu śarkarāyutaṃ yojyam|
pārāvatādikarasairghṛtabhṛṣṭairvā’pyalavaṇāmlaiḥ||29||
tṛṇapañcamūlamuñjātakaiḥ priyālaiśca jāṅgalāḥ sukṛtāḥ|
śastā rasāḥ payo vā taiḥ siddhaṃ śarkarā madhumat||30||
śatadhauta ghṛtenāktaḥ payaḥ pibecchītatoyamavagāhya|
mudga masūra caṇakajā rasāstu bhṛṣṭā ghṛte deyāḥ||31||
madhuraiḥ sajīvanīyaiḥ śītaiśca satiktakaiḥ śṛtaṃ kṣīram|
pānābhyañjanasekeṣviṣṭaṃ madhu śarkarāyuktam||32||
tajjaṃ vā ghṛtamiṣṭaṃ pānābhyaṅgeṣu nasyamapi ca syāt|
nārī payaḥ saśarkaramuṣṭryā api nasyamikṣurasaḥ||33||

The patient suffering from morbid thirst is given the following recipes:
1. Water boiled by adding Shara-Pancha-Mula (the roots of Sara, Iksu – Saccharum officinarum, Darbha – Demostachya bipinnata, 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 Paravata etc, 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 (Desmostachya bipinnata), Kasa, Sara, Darbha – Demostachya bipinnata and iksu – Saccharum officinarum , or Munjataka or Priyala (Buchanania lanzan)
8. Milk boiled with the roots of Kusha (Desmostachya bipinnata), kasha Sara, Darbha – Demostachya bipinnata and Iksu – Saccharum officinarum , or with Munjataka or with Priyala (Buchanania lanzan) by adding sugar and honey.
9. Milk mixed with Shata Dhauta-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

क्षीरेक्षुरस गुडोदक सितोपला क्षौद्र सीधु मार्द्वीकैः |
वृक्षाम्ल मातुलुङ्गैर्गण्डूषास्तालुशोषघ्नाः||३४||
जम्ब्वाम्रातक बदरी वेतस पञ्चवल्क पञ्चाम्लैः|
हृन्मुख शिरःप्रदेहाःसघृता मूर्च्छा भ्रम तृष्णाघ्नाः स्युः||३५||
दाडिम दधित्थ लोध्रैः सविदारी बीजपूरकैः शिरसः|
लेपो गौरामलकैर्घृतारनालायुतैश्च हितः||३६||
शैवल पङ्काम्बुरुहैः साम्लैः सघृतैश्च शक्तुभिर्लेपः|
मस्त्वारनालार्द्रवसनकमलमणिहार संस्पर्शाः||३७||
शिशिराम्बु चन्दनार्द्रस्तनतट पाणितल गात्र संस्पर्शाः|
क्षौमार्द्रनिवसनानां वराङ्गनानां प्रियाणां च||३८||
हिमवद्दरीवनसरित्सरोऽम्बुजपवनेन्दुपाद शिशिराणाम्|
रम्य शिशिरोदकानां स्मरणं कथाश्च तृष्णाघ्नाः||३९||
kṣīrekṣurasa guḍodaka sitopalā kṣaudra sīdhu mārdvīkaiḥ |
vṛkṣāmla mātuluṅgairgaṇḍūṣāstāluśoṣaghnāḥ||34||
jambvāmrātaka badarī vetasa pañcavalka pañcāmlaiḥ|
hṛnmukha śiraḥpradehāḥsaghṛtā mūrcchā bhrama tṛṣṇāghnāḥ syuḥ||35||
dāḍima dadhittha lodhraiḥ savidārī bījapūrakaiḥ śirasaḥ|
lepo gaurāmalakairghṛtāranālāyutaiśca hitaḥ||36||
śaivala paṅkāmburuhaiḥ sāmlaiḥ saghṛtaiśca śaktubhirlepaḥ|
mastvāranālārdravasanakamalamaṇihāra saṃsparśāḥ||37||
śiśirāmbu candanārdrastanataṭa pāṇitala gātra saṃsparśāḥ|
kṣaumārdranivasanānāṃ varāṅganānāṃ priyāṇāṃ ca||38||
himavaddarīvanasaritsaro’mbujapavanendupāda śiśirāṇām|
ramya śiśirodakānāṃ smaraṇaṃ kathāśca tṛṣṇāghnāḥ||39||

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 – Sygyzium cumini, Amrataka – Spondias pinnata, Badari, Vetasa, Pancha-Valkala (bark of 5 trees). Viz Nyagrodha – Ficus bengalensis, Udumbara – Ficus racemosa, Ashvattha – Ficus religiosa, 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 (Symplocos racemosa) and Vidari (Ipomoea paniculata / Pueraria tuberosa) 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 (Vallisneria spiralis), 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]

Vataja Trushna Chikitsa

वातघ्नमन्नपानं मृदु लघु शीतं च वात तृष्णायाम्|
क्षय कासनुच्छृतं क्षीर घृतमूर्ध्ववात तृष्णाघ्नम् ||४०||
स्याज्जीवनीय सिद्धं क्षीरघृतं वात पित्तजे तर्ष|४१|
vātaghnamannapānaṃ mṛdu laghu śītaṃ ca vāta tṛṣṇāyām|
kṣaya kāsanucchṛtaṃ kṣīra ghṛtamūrdhvavāta tṛṣṇāghnam ||40||
syājjīvanīya siddhaṃ kṣīraghṛtaṃ vāta pittaje tarṣa|41|

Treatment of Vatika Trushna:
For the treatment of Vatika Trushna, 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]

Pittaja Trisna Chikitsa

पैत्ते द्राक्षा चन्दन खर्जूरोशीर मधुयुतं तोयम्||४१||
लोहित शालि तण्डुल खर्जूर परूषकोत्पल द्राक्षाः|
मधु पक्वलोष्टमेव च जले स्थितं शीतलं पेयम्||४२||
लोहित शालि प्रस्थः सलोध्र मधुकाञ्जनोत्पलः क्षुण्णः|
पक्वामलोष्ट जल मधु समायुतो मृन्मये पेयः||४३||
वट मातुलुङ्ग वेतस पल्लव कुश काश मूल यष्ट्याह्वैः|
सिद्धेऽम्भस्यग्निनिभां कृष्णमृदं कृष्णसिकतां वा||४४||
तप्तानि नवकपालान्यथवा निर्वाप्य पाययेताच्छम्|
आपाक शर्करं वाऽमृतवल्ल्युदकं तृषां हन्ति||४५||
क्षीरवतां मधुराणां शीतानां शर्करा मधु विमिश्राः|
शीत कषाया मृद्भृष्टसंयुताः पित्त तृष्णाघ्नाः||४६||
paitte drākṣā Chandana kharjūrośīra madhuyutaṃ toyam||41||
lohita śāli taṇḍula kharjūra parūṣakotpala drākṣāḥ|
madhu pakvaloṣṭameva ca jale sthitaṃ śītalaṃ peyam||42||
lohita śāli prasthaḥ salodhra madhukāñjanotpalaḥ kṣuṇṇaḥ|
pakvāmaloṣṭa jala madhu samāyuto mṛnmaye peyaḥ||43||
vaṭa mātuluṅga vetasa pallava kuśa kāśa mūla yaṣṭyāhvaiḥ|
siddhe’mbhasyagninibhāṃ kṛṣṇamṛdaṃ kṛṣṇasikatāṃ vā||44||
taptāni navakapālānyathavā nirvāpya pāyayetāccham|
āpāka śarkaraṃ vā’mṛtavallyudakaṃ tṛṣāṃ hanti||45||
kṣīravatāṃ madhurāṇāṃ śītānāṃ śarkarā madhu vimiśrāḥ|
śīta kaṣāyā mṛdbhṛṣṭasaṃyutāḥ pitta tṛṣṇāghnāḥ||46||

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 – Vetiveria zizanioides and added with honey
2. Intake of cold water added with red variety of Shali- rice, Kharjura – dates, Parusaka – Grewia asiatica, 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 (Symplocos racemosa), Madhuka – Madhuca longifolia, Rasanjana (Aqueous extract of Berberis aristata) 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 – Ficus bengalensis, Matulunga – Citrus medica, leaves of vetasa, Roots of Kusha (Desmostachya bipinnata) and Kasha, and Yastimadhu – Glycyrrhiza glabra. 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 – Tinospora cordifolia) 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

व्योष वचा भल्लातक तिक्त कषायास्तथाऽऽमतृष्णाघ्नाः|
यच्चोक्तं कफजायां वम्यां तच्चैव कार्यं स्यात्||४७||
स्तम्भारुच्य विपाकालस्यच्छर्दिषु कफानुगां तृष्णाम्|
ज्ञात्वा दधि मधु तर्पण लवणोष्ण जलै र्वमनमिष्टम्||४८||
दाडिममम्लफलं वाऽप्यन्यत् सकषायमथ लेहम्|
पेयमथवा प्रदद्याद्रजनी शर्करायुक्तम् ||४९||
vyoṣa vacā bhallātaka tikta kaṣāyāstathā”matṛṣṇāghnāḥ|
yaccoktaṃ kaphajāyāṃ vamyāṃ taccaiva kāryaṃ syāt||47||
stambhārucya vipākālasyacchardiṣu kaphānugāṃ tṛṣṇām|
jñātvā dadhi madhu tarpaṇa lavaṇoṣṇa jalai rvamanamiṣṭam||48||
dāḍimamamlaphalaṃ vā’pyanyat sakaṣāyamatha leham|
peyamathavā pradadyādrajanī śarkarāyuktam ||49||

The decoction of Sunthi – Zingiber officinale, Pippali – Long pepper fruit – Piper longum, Maricha – Black pepper fruit – piper nigrum, Vacha (Acorus calamus Linn.), Bhallataka and Tiktaka (Kirata- Tikta – Swertia chirata) 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

क्षय कासेन तु तुल्या क्षय तृष्णा सा गरीयसी नॄणाम्|
क्षीण क्षत शोष हितैस्तस्मात्तां भेषजैः शमयेत्||५०||
kṣaya kāsena tu tulyā kṣaya tṛṣṇā sā garīyasī nṝṇām|
kṣīṇa kṣata śoṣa hitaistasmāttāṃ bheṣajaiḥ śamayet||50||

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

Upasargaja Trushna Chikitsa

पान तृषार्तः पानं त्वर्धोदकमम्ल लवण गन्धाढ्यम्|
शिशिर स्नातः पानं मद्याम्बु गुडाम्बु वा तृषितः||५१||
भक्तोपरोध तृषितः स्नेह तृषार्तोऽथवा तनु यवागूम्|
प्र पिबेद्गुरुणा तृषितो भुक्तेन तदुद्धरेद्भुक्तम्||५२||
मद्याम्बु वाऽम्बु कोष्णं बलवांस्तृषितः समुल्लिखेत् पीत्वा|
मागधिका विशद मुखः सशर्करं वा पिबेन्मन्थम्||५३||
बलवांस्तु तालु शोषे पिबेद्धृतं तृष्यमद्याच्च|
सर्पिर्भृष्टं क्षीरं मांस रसांश्चाबलः स्निग्धान्||५४||
अतिरूक्ष दुर्बलानां तर्षं शमयेन्नृणामिहाशु पयः|
छागो वा घृतभृष्टः शीतो मधुरो रसो हृद्यः||५५||
स्निग्धेऽन्ने भुक्ते या तृष्णा स्यात्तां गुडाम्बुना शमयेत्|
तर्षं मूर्च्छाभिहतस्य रक्तपित्तापहैर्हन्यात्||५६||
pāna tṛṣārtaḥ pānaṃ tvardhodakamamla lavaṇa gandhāḍhyam|
śiśira snātaḥ pānaṃ madyāmbu guḍāmbu vā tṛṣitaḥ||51||
bhaktoparodha tṛṣitaḥ sneha tṛṣārto’thavā tanu yavāgūm|
pra pibedguruṇā tṛṣito bhuktena taduddharedbhuktam||52||
madyāmbu vā’mbu koṣṇaṃ balavāṃstṛṣitaḥ samullikhet pītvā|
māgadhikā viśada mukhaḥ saśarkaraṃ vā pibenmantham||53||
balavāṃstu tālu śoṣe pibeddhṛtaṃ tṛṣyamadyācca|
sarpirbhṛṣṭaṃ kṣīraṃ māṃsa rasāṃścābalaḥ snigdhān||54||
atirūkṣa durbalānāṃ tarṣaṃ śamayennṛṇāmihāśu payaḥ|
chāgo vā ghṛtabhṛṣṭaḥ śīto madhuro raso hṛdyaḥ||55||
snigdhe’nne bhukte yā tṛṣṇā syāttāṃ guḍāmbunā śamayet|
tarṣaṃ mūrcchābhihatasya raktapittāpahairhanyāt||56||

[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]

Usage of different types of water

तृट्दाह मूर्च्छा भ्रम क्लम मदात्ययास्र विष पित्ते |
शस्तं स्वभाव शीतं, शृतशीतं सन्निपातेऽम्भः||५७||
हिक्का श्वास नवज्वर पीनस घृत पीत पार्श्व गल रोगे|
कफवातकृते स्त्याने सद्यःशुद्धे च हितमुष्णम्||५८||
पाण्डूदर पीनस मेह गुल्म मन्दानलातिसारेषु|
प्लीह्नि च तोयं न हितं काममसह्ये पिबेदल्पम्||५९||
पूर्वामयातुरः सन् दीनस्तृष्णार्दितो जलं काङ्क्षन्|
न लभेत स चेन्मरणमाश्वेवाप्नुयाद्दीर्घरोगं वा||६०||
तस्माद्धान्याम्बु पिबेत्तृष्यन् रोगी सशर्करा क्षौद्रम्|
यद्वा तस्यान्यत्स्यात् सात्म्यं रोगस्य तच्चेष्टम्||६१||
तस्यां विनिवृत्तायां तज्जन्य उपद्रवः सुखं जेतुम्|
तस्मात्तृष्णां पूर्वं जयेद्बहुभ्योऽपि रोगेभ्यः||६२||
tṛṭdāha mūrcchā bhrama klama madātyayāsra viṣa pitte |
śastaṃ svabhāva śītaṃ, śṛtaśītaṃ sannipāte’mbhaḥ||57||
hikkā śvāsa navajvara pīnasa ghṛta pīta pārśva gala roge|
kaphavātakṛte styāne sadyaḥśuddhe ca hitamuṣṇam||58||
pāṇḍūdara pīnasa meha gulma mandānalātisāreṣu|
plīhni ca toyaṃ na hitaṃ kāmamasahye pibedalpam||59||
pūrvāmayāturaḥ san dīnastṛṣṇārdito jalaṃ kāṅkṣan|
na labheta sa cenmaraṇamāśvevāpnuyāddīrgharogaṃ vā||60||
tasmāddhānyāmbu pibettṛṣyan rogī saśarkarā kṣaudram|
yadvā tasyānyatsyāt sātmyaṃ rogasya tacceṣṭam||61||
tasyāṃ vinivṛttāyāṃ tajjanya upadravaḥ sukhaṃ jetum|
tasmāttṛṣṇāṃ pūrvaṃ jayedbahubhyo’pi rogebhyaḥ||62||

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]

Summary

तत्र श्लोकः-
हेतू यथाऽग्निपवनौ कुरुतः सोपद्रवां च पञ्चानाम्|
तृष्णानां पृथगाकृतिरसाध्यता साधनं चोक्तम्||६३||
tatra ślokaḥ-
hetū yathā’gnipavanau kurutaḥ sopadravāṃ ca pañcānām|
tṛṣṇānāṃ pṛthagākṛtirasādhyatā sādhanaṃ coktam||63||

In this chapter on the treatment of Trishna (morbid thirst), the following topics are discussed:
1. The manner in which Agni and Pavana cause Trushna (morbid thirst) along with its complications
2. Signs and symptoms of 5 varieties of Trushna separately
3. The signs and symptoms indicating the incurability of the disease and
4. Treatment of different types of Trishna (Morbid thirst) [63]

Colophon
इत्यग्निवेशकृते तन्त्रे चरक प्रति संस्कृतेऽप्राप्ते दृढबल सम्पूरिते चिकित्सा स्थाने तृष्णा रोग चिकित्सितं नाम द्वाविंशोऽध्यायः||२२||
ityagniveśakṛte tantre caraka prati saṃskṛte’prāpte dṛḍhabala sampūrite cikitsā sthāne tṛṣṇā roga cikitsitaṃ nāma dvāviṃśo’dhyāyaḥ||22||

Thus ends the 22nd chapter of Chikitsasthana (section on the treatment of diseases) dealing with the treatment of Trshna in the work of Agnivesha, which was redacted by Charaka, and supplemented by Dridhabala.