Chardi Roga Chikitsa: Ayurvedic Treatment For Vomiting, Limitations

Article by Dr Raghuram Y.S. MD(Ayu)
General principles of treatment and role of Panchakarma (vamana and virechana) in the management of vomiting –

Langhana

All types of chardi or vomiting occur due to amashaya utklesha (irritability and provocation in the stomach). The initial line of treatment obviously lies in allowing the stomach to settle down. For this, rest and relaxation to the stomach should be given in the form of Langhana (fasting). Though Langhana is of 10 types, langhana in terms of upavasa (fasting) or kshudha nigrahana (abstinence from food or heavy foods) is the important strategy to be adopted in treating chardi.

Not taking food doesn’t mean totally keeping away from taking foods. This will lead to inadequate nutrition and will cause severe complications.
Read related: Vomiting: Causes, Complications, Pathophysiology, Treatment

The patient should watch for few hours after vomiting. No attempts should be made to meddle with the process as the body is trying to throw unwanted things out of the system. When the vomiting settles down, the patient is asked to fast (with consumption of only water and juices, electrolytes) until the bouts are gone and until the patient feels hungry and lightness in the body.

Feeling of hunger and lightness are the signs that the irritation of stomach has settled down. In this condition, light digestible foods in the form of gruels and soups garnished with appetizers and digestant herbs shall be given. Gradually the normal food should be commenced in a day or two.

Vamana

Vamana or Therapeutic emesis should be given in chardi. This looks a strange approach, but is practical. This is not a treatment for vomiting which occurs as a passing affair due to consumption of bad foods or travel sickness, which will settle by self. Vamana shall be administered in chronic and stubborn cases of vomiting, which is a disease and not a symptom any more.

Vamana should be administered in the avega stage of the disease (stage of the disease when it has not been entirely cured but is not associated with active or acute bouts / spells of vomiting). Say for example, when the vomiting has stopped and has not occurred for certain duration of time, think about administering vamana. The vomiting, in this condition has stopped but has not gone away. The symptom has come down, but the pathology or irritability has just subsided and not rooted out. These people have a tendency to vomit every now and then because over a period of time, the stomach becomes very sensitive. Even a small irritant can trigger vomiting or nausea. This not only is an embarrassing condition but is also annoying condition for the patient. This we call it as ‘chardi roga’ or ‘vomiting disease’. This is different from Vomiting symptom.
Thus vamana is an ideal treatment in the chardi manifested due to vitiated kapha.
Read related: 21 Lifestyle And Prevention Tips To Stop Vomiting And Nausea

Medicines for Vamana:
The medicines prepared using valliphalas (fruits having emetic properties and are grown in creepers) should be used to induce therapeutic emesis (vamana) in chardi roga. Example – Jeemutaka (Luffa echinata), Ikshwaku (Lagenaria siceraria) etc.
If the patient is weak and debilitated, shaman chikitsa (palliative treatments) should be done
The foods having taste which is compatible to the mind, light to digest and dry in nature shall be given to the patient as a part of the diet.

Virechana

Virechana or Therapeutic Purgation is also an essential treatment in chardi and like vamana should be administered in avega stage (asymptomatic stage of the disease). Chardi occurs chiefly due to the morbidity in the stomach and excess kapha in the stomach is also associated with chardi. Similarly excess pitta also causes chardi. When there is high kapha in the stomach, naturally there will be low pitta. Vamana will expel the vitiated kapha and help in recovery of the stomach. On the other hand the vitiation of pitta still persists. Virechana would expel the morbid pitta and help in total recovery of the stomach. Virechana should be usually administered after vamana. In cases where there is only high pitta in the stomach causing chardi, virechana will be sufficient. Thus, virechana can be administered both in pittaja and kaphaja chardi.

Medicines for Virechana:
Haritaki churna (powder of Terminalia chebula) mixed in honey
Any purgative or laxative (herbal) which is wholesome, which doesn’t produce any complication, tasty should be mixed in madira (fermented wines, medicated) or milk and given to the patient.
Read related: 25 Easy, Effective Home Remedies for Vomiting And Nausea

Why should be vamana and Virechana be given in Chardi?
As we have already discussed, the chardi starts from the stomach. It occurs due to the dosha dushti (dosha morbidity and onset of pathology) in the stomach or amashaya. Amashaya is a seat for kledaka kapha, pachaka pitta, ranjaka pitta and samana vayu. Imbalance or mutual affliction of these elements leads to the pathogenesis of chardi disease. As long as these elements are vitiated or as long as these elements occupy the stomach in provoked forms and pathological proportions, they tend to initiate the vomiting process. The amashaya (stomach and upper part of small intestine) gradually gets weakened and damage. Its physiology too will be hampered and the stomach learns to throw away the things as a result of practice and trained mechanism.

Vamana is the best treatment to expel morbid kapha (predominantly) and pitta (partially). Likewise Virechana is the best treatment to expel morbid pitta (predominantly) and kapha (partially). Virechana also subside vitiated vata.

By administration of vamana and virechana,

• The sites of pitta and kapha (which initiate vomiting process when in morbid proportions) will be taken into control.
• The morbid pitta and kapha would have been eliminated.
• These procedures help the stomach and intestines to recover and reverse the pathology.
• The irritability and provocation in the stomach ceases with time.
• The bouts and episodes and the intensity of vomiting will come down gradually and with passage of time, the disease will be cured. Recurrences will come down.
• These treatments also provide long standing immunity to the stomach and intestines and will prevent the vitiation of kapha and or pitta in future, if the person is stringent with diet and lifestyle practices.

Note – Langhana, Vamana or Virechana should not be administered in Vataja Chardi. They tend to further vitiate the vata and enhance vomiting.

Vataja chardi chikitsa

Treatment of Vataja Chardi
Mamsa – processed meat of lava (common quail), tittira (black partridge) and barhi (peacock)
Yusha – Yusha or soup prepared from one or all of the below mentioned should be given:

• Kola – jujube fruit
• Kulattha – horse gram
• Dhanyaka = coriander
• Amla rasa – sour juices of fruits like that of pomegranate
• Yava – barley
• Brihat Panchamula – Roots of Bilwa (Aegle marmelos), Agnimantha (Clerodendrum phlomidis), Shyonaka (Oroxylum indicum), Patala (Stereospermum suaveolens) and Gambhari (Gmelina arborea)
• Yusha (soups) – Soups added with ghee, soured by the addition of soud curds and sour pomegranate juice is served fresh

Read related: Chardi Roga – Vomiting: Ayurveda Explanation, Types, Symptoms
Ghrita pana (oral intake of medicated ghee) –
Ghrita (ghee) mixed with Saindhava Lavana (rock salt) – would help if the heart has become weak after vomiting
Ghee processed with Dhanyaka (coriander), shunti (ginger), dadhi (curds) and dadima (pomegranate)
Ghee mixed with powders of shunti (ginger), pippali (long pepper), maricha (pepper), saidnhava lavana (rock salt), souvarchala lavana (sauchal salt) and vida lavana (bida salt)

Pittaja chardi chikitsa

Treatment of Pittaja Chardi
Trivrit Churna (powder of Operculina turpethum) mixed with juices (decoction) of draksha (raisins), Vidari kanda (Pueraria tuberosa) and ikshu rasa (sugarcane juice) should be given in order to expel the doshas

Vamana – if excessive pitta has accumulated in the amashaya (stomach), vamana (therapeutic emesis) should be administered using madhura dravyas (medicines or formulations prepared with sweet tasting herbs, which are antagonistic to pitta).

Mantha and Peya (herbal drinks) – After shodhana (vamana or virechana), Laja mantha (refreshing drink prepared by churning parched rice or popped rice with other pitta alleviating herbs) or Laja peya (soothing drink prepared by heat processing popped rice with herbs) should be given after mixing honey and sugar.

Shaali, Mudga Yusha and Mamsarasa – cooked rice should be served with mudga yusha (soup prepared from green gram) or with meat soup prepared from the meat of animals and birds dwelling in jangala pradesha (desert regions).

Avaleha (confection) – made up of

• Kulmasha (Cassia absus), mixed with sugar, powder of pippali (long pepper) and honey
• Yava sattu (flour of barley) mixed with sugar, powder of pippali (long pepper) and honey
• Grunjha (soup of barley mixed with rice gruel) mixed with sugar, powder of pippali (long pepper) and honey
• Pulp of kharjura (dates) mixed with sugar, powder of pippali (long pepper) and honey
• Narikela (coconut grating) mixed with sugar, powder of pippali (long pepper) and honey
• Draaksha (raisins) mixed with sugar, powder of pippali (long pepper) and honey
• Badara (powder of jujube fruit) mixed with sugar, powder of pippali (long pepper) and honey

Peya (refreshing drinks)

• Draksha rasam – cool juice of raisins
• Jambu-Amra Peya – Cool decoction prepared from tender leaves of Jabmu (Syzygium cumini) and Amra (mango) mixed with honey
• Mudgadi peya – Powders of Mudga (green gram), Pippali (Long pepper), Usheera (Vetiveria zizanioides), Dhanyaka (coriander) should be left mixed overnight in 6 times quantity of water. This should be filtered and consumed early in the morning.
• Chanaka Peya – Powder of Chanaka (Bengal gram) or Chanaka should be left mixed overnight in 6 times water. This should be filtered and consumed in the morning.
• Gavedhuka Peya – Powder of Gavedhuka (Coix lacryma) roots should be left mixed overnight in 6 times water. This should be filtered and consumed in the morning.
• Guduchi Peya – Coarse powder of Guduchi (Tinospora cordifolia) should be left mixed overnight in 6 times water. This should be filtered and consumed in the morning.
• Ikshu rasa – Sugarcane juice should be exposed at night to the rays of moonlight, this should be taken orally in the morning
• Paya – Milk should be exposed at night to the rays of moonlight, this should be taken orally in the morning

Other useful Ayurvedic medicines for vomiting –

• Sevyadi churnam – Powder of Sevya or ushira (Vetiveria zizanioides) and Sugandhabala (Valeriana wallichii) should be mixed in rice water and taken after adding honey
• Gairikadi churnam – Powder of Gairika (Ochre, hematite calx) and Sugandhabala (Valeriana wallichii) should be mixed in rice water and taken after adding honey
• Chandandi yoga – Sandal wood should be rubbed and its paste obtained, it should be mixed with amalaki swarasa (fresh juice of Indian Gooseberry) and honey and taken orally
• Chandanadi kalka – paste of chandana (sandal wood), usheera (Vetiveria zizanioides), draksha (raisins), sugandhabala (Valeriana wallichii) and swarna gairika (Red ochre) should be taken mixed in cold water
• Gairikadi yoga – powder of swarna gairika (red ochre) and rice should be taken mixed with water
• Murva churna – Powder of Murva (Marsdenia tenacissima) should be taken mixed in rice water
• Haritaki Churna – Powder of Terminalia chebula mixed with honey

Kaphaja chardi chikitsa

Treatment of Kaphaja Chardi
Vamana – Therapeutic emesis is the treatment of choice to treat kaphaja chardi. Vomiting should be administered with compound made up of decoction of Pippali (long pepper), sarshapa (mustard) and nimba kwatha (decoction of neem), mixed with powders of madana phala (Randia dumetorum) and saindhava lavana (rock salt)

Diet – Food prepared and predominantly consisting of purana godhuma (old wheat), purana shali (old rice) and purana yava (old barley) should be consumed with yusha (soup) prepared with Patola (pointed gourd), guduchi (Tinospora cordifolia), chitrakamula (roots of Plumbago zeylanica)

Shuntyadi Yusha – Soup prepared from water processed with Shunti (ginger), Pippali (Long pepper) and Maricha (black pepper)

Nimbadi Yusha – Soup prepared from water processed with neem and buttermilk, added with juice of sour pomegranate and sprinkled with maricha churna (powder of black pepper)

The below mentioned should be used as diet –

• Jangala mamsarasa – meat soup prepared from the meat of animals and birds living in desert regions
• Jangala shulya mamsa – meat of animals and birds processed by piercing the meat with iron rod and baking it on fire
• Purana madhu – old honey
• Purana seedhu, arishta, raga, shadava – old fermented alcoholic herbal drinks
• Panaka – soothing and refreshing drink prepared from draksha (raisins), kapitta (Limonia acidissima, wood apple) and phala puraka / bijora nimbu, matulunga (Citron, Citrus medica)
• Mudgadi sattu – Sttu or refreshing drink prepared from mixing flours of mudga (green gram), masura (Lens culinaris), chanaka (Bengal gram) and kalaya (peanut) mixed with powder of shunti (ginger) and honey

Useful formulations –

• Amalakyadi churna – powders of amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Bibhitaki (Terminalia bellirica) and Vidanga (Embelia ribes) mixed with shunti churna (ginger powder) and honey
• Vidangadi rasa – Fresh juice of Vidanga (Embelia ribes) and Plava (Cyperus bulbosus) mixed with Shunti churna (ginger juice) and madhu (honey)
• Jambwadi churna – Powder of Jambu (Syzygium cumini) and Amla Badara (Jujube fruit) with honey
• Mustadi Churna – Powder of Musta (Cyperus rotundus) and Karkatasringi (Pistacia integerrima) with honey
• Duralabha Churna – Powder of Duralabha (Fagonia cretica) with honey
• Manashiladi yoga – Powder of purified Manashila mixed in phalapooraka rasa (matulunga, Citron fruit) and honey
• Pippalyadi Yoga – Powder of Pippali (long pepper) and maricha (black pepper) mixed in honey and Kapitta rasa (juice of Limonia acidissima, wood apple)

Tridoshaja chardi chikitsa

Treatment of Tridoshaja or Sannipataja Chardi
The treatments and medicines used in the chardi caused due to individual dosha vitiation (explained above) shall be combined skilfully in treatment of sannipataja chardi, after having considered the minute aspects of dosha involved, rutu (climate and seasonal impact), roga (nature of disease and disease pathology) and agnibala (strength of metabolism.

Drishtartha samyogaja chardi chikitsa

Treatment of Drishtartha Samyogaja Chardi
This type of chardi is caused by disturbance and affliction of mind. Naturally the mind should be brought under control to cure the vomiting. The below mentioned methods shall be adopted –

Mano anukula vaachaha – words and discussions which are soothing, strengthening and beneficial to the mind
Aashwasana – counselling, giving confidence to the patient|
Harshana – entertaining things to keep the mind pleasant
Loka prasiddha sruthayaha – narrating world famous tales, fables, and poetries to divert the mind and keep it balanced and pleasant
Srungaarikaaha – narrating romantic tales which are pleasing to the mind
Hita vihaaraha – activities whicha re pleasing to the mind like walking, jogging, strolling along river bank etc
Gandhaa vichitraa manaso anukoolaa – exposure to smells and fragrances beneficial, soothing and pleasant to the mind, especially those comeing from mud, flowers, fruits, sour fruits, fermented herbal drinks etc.
Mano anukula ahara – foods which are beneficial and pleasing to the mind, like vegetables, foods, juices, refreshing drinks, confections, soups, meat soups, meat, grains and pulses etc
Phala mulani – flowers and roots which have likable smell, colour and taste

Other medicines which are fruitful in chardi –

• Sarpiguda (explained in kshataksheena chapter, treatment of chest injuries)
• Kalyana ghrita (explained in treatment of unmade or insanity)
• Tryushana ghrita (explained in the treatment of kasa or cough)
• Jeevaneeya ghrita (explained in the treatment of vatarakta or gout)
• Vrushya yoga (aphrodisiac formulations mentioned in vajikarana)
• Mamsarasa (meatsoups)
• Avaleha (confections)

Pathya

Pathya (wholesome things) in Chardi

• Kalaya – chickpea
• Yava – barley
• Godhuma – wheat
• Mudga – green gram
• Shashtika shali – paddy or rice which is matured and reaped within 60 days
• Shasha mamsa – meat of rabbit
• Tittira mamsa – meat of
• Lava mamsa – meat of
• Jangala mamsa – meat of animals living in the desert regions
• Raga-shadava – confection like / jam like herbal preparations
• Vetragra – tender bamboo shoots
• Kola – jujube fruit
• Draksha – raisins

Apathya

Apathya (unwholesome things) in chardi –

• Tumbee
• Bimbi
• Koshataki
• Madhooka – Madhuca longifolia
• Chitraam (indravaruni) –
• Ela – cardamom
• Sarshapa – mustard
• Devadali
• Vyaayama – excessive exercise
• Asatmya pana anna – foods and drinks which are incompatible
• Dushta pana anna – contaminated foods and drinks

Single herbs

Single herbs used in treatment of chardi –

• Kalaya – Garden pea, Field pea (Pisum sativum)
• Yava – barley
• Godhuma – wheat
• Mudga – green gram
• Shashtika shali – paddy or rice which is matured and reaped within 60 days
• Vetragra – tender bamboo shoots
• Kola – jujube fruit
• Draksha – raisins
• Kulattha – horse gram
• Dhanyaka – coriander
• Bilwa (Aegle marmelos)
• Agnimantha (Clerodendrum phlomidis)
• Shyonaka (Oroxylum indicum)
• Patala (Stereospermum suaveolens)
• Gambhari (Gmelina arborea)
• Dadima – pomegranate
• Shunti – ginger
• Ghrita – ghee
• Saindhava lavana – rock salt
• Pippali – long pepper
• Maricha – black pepper
• Trivrit – Operculina turpethum
• Ikshurasa – sugarcane juice
• Kharjura – dates
• Narikela – coconut
• Badara – jujube
• Haritaki – Terminalia chebula
• Jambu – Syzygium cumini
• Amra – mango
• Usheera – Vetiveria zizanioides
• Gavedhuka – Coix lacryma
• Guduchi – Tinospora cordifolia
• Sugandhabala – Valeriana wallichii
• Amalaki – Emblica officinalis
• Chandana – sandalwood
• Swarna Gairika – Red ochre
• Murva – Marsdenia tenacissima
• Gairika – Ochre / Hematite calx
• Nimba – neem
• Madana – Randia dumetorum
• Patola – pointed gourd
• Chitraka – Plumbago zeylanica
• Madhu – honey
• Kapittha – Limonia acidissima (wood apple)
• Bijora nimbu (Matulunga) – Citron, Citrus medica
• Masura – lentil (Lens culinaris)
• Chanaka – bengal gram
• Kalaya – peanut
• Bibhitaka – Terminalia bellirica
• Vidanga – Embelis ribes
• Musta – Cyperus rotundus
• Makshika – Chalcopyrite

Ayurvedic medicines

Classical formulations for Chardi –

• Drakshadi Kashayam
• Drakshadi churnam
• Bala chaturbhadrika churnam
• Trikatu churnam
• Hingwashtak churna
• Vilwadi leham
• Gudardraka leham
• Eladi gulika / gutika
• Shiva gutika
• Paityantaka rasa
• Sutasekara rasa
• Swarna sutasekara rasa
• Saptamruta lauha
• Panchamrita parpati
• Pravala bhasma
• Mayura pichcha bhasma
  

Effective formulations for vomiting from Sahasrayoga Text book

9. Chardhihara kashaya
1 Tugadi choornam
2. Talisapatradi choornam
3Magdhajadi choornam
4.Karpasasthyadi choornam
5. Eladi choornam
6 Avipathi choornam
7 Karpooradi choornam
8.Bala Soolari choornam
9.Dasamoolarishtam
10. Bilwadi lehyam
11Dhanwantari gutika
12. Mudgadi kashayam
13.Panal veradi kashayam
14. Amrutashtaka kashayam
15.Bilwadi kashayam
16. Parpataka kashayam
17.Trayantyadi kashaym

Proprietary medicines for Chardi –

• Tab Amlaparimala (Pavaman)
• Tab Amlapittantak Yog (Baidyanath)
• Aditya lavanam powder (Kesari)
• Tab Calci-7 (Unjha)
• Tab and Syrup Dilapsin (Solumiks)
• Syrup Gason (Nagarjuna)
• Tab Himcocid (Himalaya)
• Jeeraka Rasayana (Nanjangud)
• Kandamla Rasayana (Nanjangud)
• Powder Kusuma Amrita Churna (Kumar)
• Syrup Madiphala Rasayana (Kesari)
• Maha Jeeraka Rasayana (Nanjangud)
• Syrup Ojus (Charak)
• Cap Oracid (Fizikem)
• Cap Plantacid (Solumiks)
• Tab Sooktyn (Alarsin)
• Cap and Syrup Mebarid (Phyto Pharma)
• Cap and Syrup Surasa (Srushti)
• Tab Vomiteb (Charak)
• Syrup L-Guard (Fizikem)
• Tab and Syrup Livomyn (Charak)
• Tab and Syrup Vasuliv (Vasu)
• Syp Zymoliv (Trio)
• Tab and Syrup Vimliv (Solumiks)

Clinical experience

My clinical experience with management of Chardi –
In my 20 long years of Ayurvedic clinical cases, I haven’t seen many patients coming for getting treated for vomiting. But whatever cases I have handled were of these categories – acute vomiting due to food poisoning or incompatible foods, vomiting during travel (travel sickness), vomiting associated with long standing illnesses or diseases like ulcers and erosions in stomach and intestines, constipation, migraine, indigestion, hyperacidity etc. Vomiting associated with indigestion and metabolic errors occupy the top position of number of patients seeking treatment for vomiting. Since it is secondary, I never found it difficult to handle these conditions. Correction of digestion and metabolic process would take care of vomiting in quick time.

Treating whatever cases of vomiting was never a big issue with wide range of medicines available in Ayurveda.
Among Panchakarma, I haven’t got chronic cases wherein I could diagnose vomiting as a disease (rather than symptom). In a couple of cases wherein the vomiting tendency was frequent in patients, having found high pitta in those patients I have advised nitya virechana (daily purgation with herbal laxatives) which yielded good results.

Psychogenic cases of vomiting were easy to handle through counselling, medication and suitable adjustments in lifestyle, diet and methods of de-stressing.

People would generally handle simple cases of vomiting through known or web-searched home remedies or over the counter medications.

Limitations

Limitations in handling vomiting through Ayurveda –
I would definitely say that Ayurveda provides wide array of options in treating acute and chronic vomiting, be it primary or secondary vomiting. Rather than primary, I have found majority of cases of vomiting being associated with one or the other primary disease, I mean secondary vomiting (developing on the backdrop of the main disease). The trick lay in handling and treating efficiently the main disease which is responsible for vomiting. Sometimes symptomatic treatment of vomiting will be essential, when it is very severe.

The actual limitation is ‘people seeking remedy for vomiting’. Most of them either know how to handle it at home or feel that they know that they can handle it.
Click to consult Dr Raghuram Y.S. MD(Ayu) – email / skype