Ashtanga Hridayam Chikitsa sthanam Chapter 6: Chardi Hridroga Trishna Chikitsitam Adhyaya (Treatments of vomiting, heart diseases and thirst disorders)        

The 6th chapter of Chikitsasthanam of Ashtanga Hridayam is named as Chardi Hridroga  Trishna Chikitsam Adhyayah. This chapter deals with the explanation of ‘treatment of vomiting, heart diseases and thirst disease’.

The topics covered in this chapter include –

–        Virechana – purgation therapy
–        Vataja Chardi Chikitsa
–        Pittaja Chardi Chikitsa
–        Kaphaja Chardi Chikitsa
–        Anya Cardi Chikitsa – treatment of other kinds of vomiting
–        Hridroga Chikitsa: Treatment of heart diseases
–        Pittaja Hridroga Chikitsa
–        Kaphaja Hridroga Chikitsa
–        Trishna Chikitsa – treatment of thirst
–        Vataja Trishna Chikitsa
–        Pittaja Trishna Chikitsa
–        Kaphaja Trishna Chikitsa
–        Amaja Trishna Chikitsa
–        Annatyaya Trishna Chikitsa
–        Sramaja Trishna Chikitsa
–        Atapajanya Trishna Chikitsa
–        Madyajanya Trishna Chikitsa
–        Snehaja Trishna Chikitsa
–        Snigdhannajanya Trishna Chikitsa
–        Gurvadiannajanya Trishna Chikitsa
–        Ksayajanya Trishna Chikitsa
–        Use of goats milk and meat juice and treatment of Ksayakasa in Trishna
–        Aupasargika Trishna Chikitsa

Pledge by the author(s)

अथातश्छर्दिहृद्रोगतृष्णाचिकित्सितं व्याख्यास्याम: ।
इति ह स्माहुरात्रेयादयो महर्षय: ।
After having offered prayers to the God, henceforth we are going to explain the chapter pertaining to the explanation of ‘treatment of vomiting, heart diseases and thirst diseases’. Thus say (pledge) Atreya and other sages.

Principles of Langhana (Fasting) and Vamana (Emesis)

आमाशयोत्क्लेशभवाः प्रायश्छर्द्यो हितं ततः ।
लङ्घनं प्राग्ऋते वायोर्वमनं तत्र योजयेत् ॥ १ ॥
बलिनो बहुदोषस्य वमतः प्रततं बहु ।
Generally vomiting disorder, arises from the upward movement of the dosas localized in the amasaya (stomach) hence, for them, fasting at the beginning stage, is ideal, except in that caused by vata. Next, for those who are strong, have great increase of dosas and who continue to vomit large quantities repeatedly, a vamana (emesis) should be administered.

Virechana: Purgation therapy

ततो विरेकं क्रमशो हृद्यं मद्यैः फलाम्बुभिः ॥ २ ॥
क्षीरैर्वा सह स ह्यूर्ध्वं गतं दोषं नयत्यधः ।
शमनं चौषधं रूक्षदुर्बलस्य तदेव तु ॥ ३ ॥
Next, purgation should be administered, using wine, fruit juice or milk (as adjuvants to the purgative drug) in that order, which are good for heart, this (purgation) will make the dosas accumulated at the upper parts, to move in downward direction. For those, who are dry and debilitated, herbs which mitigate the doshas should only be administered.

Virechana: Purgation therapy

परिशुष्कं प्रियं सात्म्यमन्नं लघु च शस्यते ।
उपवासस्तथा यूषा रसाः काम्बलिकाः खलाः ॥ ४ ॥
शाकानि लेहा भोज्यानि रागषाडवपानकाः ।
भक्ष्याः शुष्का विचित्राश्च फलानि स्नानघर्षणम् ॥ ५ ॥
गन्धाः सुगन्धयो गन्धफलपुष्पान्नपानजाः ।
भुक्तमात्रस्य सहसा मुखे शीताम्बुसेचनम् ॥ ६ ॥
Foods which are dry (non-fatty), liked, accustomed and easily digestible are ideal; so also fasting, drinking soups, meat juice (soup), liquid foods prepared from vegetables, buttermilk, curds processed with spices and salt. Leafy vegetables, confection, eatables, fruit juices, sour syrups, snacks, different kinds of dry fruits; daily bath, and massage, perfumes, sweet smell of fruits, flowers, foods and drinks, splashing of cold water on the face immediately after meals (are beneficial).

Vataja Chardi Chikitsa

हन्ति मारुतजां छर्दिं सर्पिः पीतं ससैन्धवम् ।
किञ्चिदुष्णं विशेषेण सकासहृदयद्रवाम् ॥ ७ ॥
व्योषत्रिलवणाढ्यं वा सिद्धं वा दाडिमाम्बुना ।
सशुण्ठीदधिधान्येन शृतं तुल्याम्बु वा पयः ॥ ८ ॥
व्यक्तसैन्धवसर्पिर्वा फलाम्लो वैष्किरो रसः ।
स्निग्धं च भोजनं शुण्ठीदधिदाडिमसाधितम् ॥ ९ ॥
कोष्णं सलवणं चात्र हितं स्नेहविरेचनम् ।
Ghee mixed with saindhava, made warm and drunk cures vomiting caused by vata especially also cough and palpitation; or that (ghee) mixed with more of trikatu and 3 types of salt; or that prepared with the decoction of Punica granatum, with śuṇṭhī – Zingiber officinale, dadhi – curds, dhānya – Coriandrum sativum, payaḥ – or milk mixed with equal quantity of water or soup of meat of gallinaceous birds or juice of sour fruits mixed with rock salt and ghee; foods which are mixed with fat and prepared from Zingiber officinale, curds and Punica granatum, warm and added with salt are ideal, so also lubricant purgatives.

Pittaja Chardi Chikitsa

पित्तजायां विरेकार्थं द्राक्षेक्षुस्वरसैस्त्रिवृत् ॥ १० ॥
सर्पिर्वा तैल्वकं योज्यं वृद्धं च श्लेष्मधामगम् ।
ऊर्ध्वमेव हरेत्पित्तं स्वादुतिक्तैर्विशुद्धिमान् ॥ ११ ॥
पिबेन्मन्थं यवागूं वा लाजैः समधुशर्कराम् ।
मुद्गजाङ्गलजैरद्याद्व्यञ्जनैः शालिषष्टिकम् ॥ १२ ॥
मृद्भृष्टलोष्टप्रभवं सुशीतं सलिलं पिबेत् ।
मुद्गोशीरकणाधान्यैः सह वा संस्थितं निशाम् ॥ १३ ॥
द्राक्षारसं रसं वेक्षोर्गुडूच्यम्बु पयोऽपि वा ।
जम्ब्वाम्रपल्लवोशीरवटशुङ्गावरोहजः ॥ १४ ॥
क्वाथः क्षौद्रयुतः पीतः शीतो वा विनियच्छति ।
छर्दिं ज्वरमतीसारं मूर्छां तृष्णां च दुर्जयाम् ॥ १५ ॥
धात्रीरसेन वा शीतं पिबेन्मुद्गदलाम्बु वा ।
कोलमज्जसितालाजामक्षिकाविट्कणाञ्जनम् ॥ १६ ॥
लिह्यात्क्षौद्रेण पथ्यां वा द्राक्षां वा बदराणि वा ।
For vomiting arising from pitta, in order to produce purgation trivṛt – powder of Operculina turpethum, drākṣā – mixed with juice of Vitis vinifera and ikṣu – Saccharum officinarum (chapter 3 verses 152-153) should be administered. Pitta which is generally increased, and localized in the seat of kapha (stomach), should be brought out by the upward method (emesis) by using herbs of sweet and bitter tastes. After these purifications, he should drink fruit squash, thin gruel or fried paddy mixed with honey and sugar, śāli – Oryza sativa, ṣaṣṭikam – rice harvested in 60 days, should be partaken along with soup of mudga – Vigna radiata, soup of meat of desert like lands and condiments, drink the water, into which heated mud balls have been immersed often (then filtered through thick cloth), after it gets cooled; mudga – Vigna radiata, uśīra – Vetiveria zizanioides, kaṇā – Piper longum, dhānya – Coriandrum sativum are soaked and kept overnight ; juice of drākṣā – Vitis vinifera, rasaṃ vā ikṣo: – or juice of Saccharum officinarum, guḍūcī ambu – decoction of Tinospora cordifolia or milk. Decoction of – tender leaves of jambu – Cyzygium cumini, āmra pallava – and Mangifera indica, uśīra – Vetiveria zizanioides , sprouts and tips of areal roots of vaṭa – Ficus benghalensis mixed with honey consumed warm or cold cures chardiṃ –  vomiting, jvaraṃ –  fever, atīsāraṃ – diarrhea, mūrchāṃ – fainting, tṛṣṇāṃ ca – and thirst which are difficult to cure. Water boiled with mudgadala cooled and mixed with juice of Emblica officinalis should be drunk (powder of) marrow / pulp of Ziziphus mauritiana, sitā – sugar, lājā – parched grains, makṣikā viṭ – bees wax, kaṇa – Piper longum, añjanam – antimony, should be licked with honey or powder of pathyā -Terminalia chebula, drākṣā – Vitis vinifera, badara – Ziziphus mauritiana(may be licked with honey).

Kaphaja Chardi Chikitsa

कफजायां वमेन्निम्बकृष्णापिण्डीतसर्षपैः ॥ १७ ॥
युक्तेन कोष्णतोयेन दुर्बलं चोपवासयेत् ।
आरग्वधादिनिर्यूहं शीतं क्षौद्रयुतं पिबेत् ॥ १८ ॥
मन्थान्यवैर्वा बहुशश्छर्दिघ्नौषधभावितैः ।
कफघ्नमन्नं हृद्यं च रागाः सार्जकभूस्तृणाः ॥ १९ ॥
लीढं मनःशिलाकृष्णामरिचं बीजपूरकात् ।
स्वरसेन कपित्थस्य सक्षौद्रेण वमिं जयेत् ॥ २० ॥
खादेत्कपित्थं सव्योषं मधुना वा दुरालभाम् ।
लिह्यान्मरिचचोचैलागोशकृद्रसमाक्षिकम् ॥ २१ ॥|
In vomiting arising from kapha, vomiting should be induced by administering (the powder of) nimba – Azadirachta indica, kṛṣṇā – Piper longum, piṇḍīta – Randia dumetorum, sarṣapaiḥ – Brassica nigra with warm water. The weak patient should be made to fast. Decoction of herbs of aragvadhadi gana (chapter 15 of Sutrasthana) made cold and should be drunk after mixing with honey. Solution of flour added with sugar and ghee prepared from yava – Hordeum vulgare or other bahuśah chardighn auṣadha bhāvitaiḥ – soaked and ground many times in the decoction of herbs which cure vomiting; foods which mitigate kapha and are pleasing, sweet syrups, scented with sārjaka – Ocimum basilicum bhūstṛṇāḥ – Cymbopogon citratus – should be consumed. Licking (the powder of) manaḥśilā – realgar, kṛṣṇā – Piper longum, maricaṃ – Piper nigrum in the juice of bījapūraka – Citrus medica, and kapittha – Limonia acidissima and mixed with honey cures vomiting. The patient should consume kapittha – Limonia acidissima along with Piper longum, Piper nigrum and Zingiber officinale, durālabhā – Fagonia cretica along with honey.  With honey, marica – powder of Piper nigrum, coca – Cinnamomum zeylanicum, elā – Elettaria cardamomum, juice of fresh cow dung should be licked.   

Vomiting caused by dislike

अनुकूलोपचारेण याति द्विष्टार्थजा शमम् ।
Vomiting caused by dislike gets relieved by appropriate, comforting methods.

Anya Cardi Chikitsa: Treatment of other kinds of vomiting

कृमिजा कृमिहृद्रोगगदितैश्च भिषग्जितैः ॥ २२ ॥
यथास्वं परिशेषाश्च तत्कृताश्च तथामयाः ॥ २२ऊअब् ॥
Vomiting arising from worms (intestinal parasites) gets cured by adopting treatments indicated for heart diseases caused by worms (in this chapter only) and also the remaining types of vomiting, and other diseases caused by them (krimi).

Anya Chardi Chikitsa: Treatment of other kinds of vomiting

छर्दिप्रसङ्गेन हि मातरिश्वा धातुक्षयात् कोपमुपैत्यवश्यम् ।
कुर्यादतोऽस्मिन्वमनातियोगप्रोक्तं विधिं स्तम्भनबृंहणीयम् ॥ २३ ॥
By the bouts of vomiting, caused due to depletion of tissues, vata undergoes increase inevitably. Those therapies should be adopted – with-holding the expulsion of fluids from the body, nourishing which are mentioned in excess bouts of emesis therapy. 

Anya Chardi Chikitsa: Treatment of other kinds of vomiting

सर्पिर्गुडा मांसरसा घृतानि कल्याणकत्र्यूषणजीवनानि ।
पयांसि पथ्योपहितानि लेहाश्छर्दिं प्रसक्तां प्रशमं नयन्ति ॥ २४ ॥
Administration of sarpirguda recipe, meat soup, medicated ghee such as – kalyanaghrta (vide chapter 6 uttarathana), tryusanaghrta (chapter 14), jivaniyaghrta or milk boiled with suitable herbs and confections prepared from them, relieves vomiting which is persisting.

इति छर्दि चिकित्सितम्
Thus ends the treatment of vomiting.

Hridroga Chikitsa: Treatment of heart diseases

अथ हृद्रोगचिकित्सितम् ॥ २४+१ ॥

हृद्रोगे वातजे तैलं मस्तुसौवीरतक्रवत् ॥ २५ ॥
तैलं च लवणैः सिद्धं समूत्राम्लं तथागुणम् ॥ २६+ ॥
पिबेत्सुखोष्णं सविडं गुल्मानाहार्तिजिच्च तत् ।
तैलं च लवणैः सिद्धं समूत्राम्लं तथागुणम् ॥ २६ ॥
In heart disease caused by vata, oil processed with whey, fermented liquor, buttermilk should be drunk after making it warm. And the same mixed with vida salt cures gulma – abdominal tumour, ānāha – flatulence arti – and colic. Oil processed with salt along with mutra cow urine, sour substances also has similar properties

Hridroga Chikitsa: Treatment of heart diseases

बिल्वं रास्नां यवान्कोलं देवदारुं पुनर्नवाम् ।
कुलत्थान्पञ्चमूलं च पक्त्वा तस्मिन्पचेज्जले ॥ २७ ॥
तैलं तन्नावने पाने बस्तौ च विनियोजयेत् ।
bilvaṃ – Aegle marmelos, rāsnāṃ – Pluchea lanceolata, yava – Hordeum vulgare, kola – Ziziphus mauritiana, devadāru – Cedrus deodara, punarnava – Boerhavia diffusa, kulattha – Dolichos biflorus, herbs of pancamula should be boiled in water and decoction is prepared. Medicated oil prepared by using this decoction should be used for – nasal medication, drinking and enema.

Hridroga Chikitsa: Treatment of heart diseases

शुण्ठीवयःस्थालवणकायस्थाहिङ्गुपौष्करैः ॥ २८ ॥
पथ्यया च शृतं पार्श्वहृद्रुजागुल्मजिद्घृतम् ।
Medicated ghee prepared with the decoction of śuṇṭhī – Zingiber officinale, vayaḥsthā – Emblica officinalis / Tinospora cordifolia, lavaṇa – rock salt, kāyasthā – Ocimum sanctum / Lilium polyphyllum, hiṅgu – Ferula narthex, pauṣkara – Inula racemosa, pathyā – and Terminalia chebula – cures pain of the flanks and heart and tumors of the abdomen.

Hridroga Chikitsa: Treatment of heart diseases

सौवर्चलस्य द्विपले पथ्यापञ्चाशदन्विते ॥ २९ ॥
घृतस्य साधितः प्रस्थो हृद्रोगश्वासगुल्मजित् ।
Medicated ghee prepared with two pala (96 g) of sauvarcalasya – sauvchal salt, fifty (pala) of Terminalia chebyla(2400 g), one prastha(768 ml) of ghee, and this cures heart diseases, dyspnoea and abdominal tumour.

Hridroga Chikitsa: Treatment of heart diseases

दाडिमं कृष्णलवणं शुण्ठीहिङ्ग्वम्लवेतसम् ॥ ३० ॥
अपतन्त्रकहृद्रोगश्वासघ्नं चूर्णमुत्तमम् ।
Powder of dāḍima – Punica granatum, kṛṣṇalavaṇaṃ – black salt, śuṇṭhī – Zingiber officinale, hiṅgu – Ferula narthex, amlavetasa – Garcinia pedunculata is best to cure tetanus, heart disease and dysnoea.

Hridroga Chikitsa: Treatment of heart diseases

पुष्कराह्वशठीशुण्ठीबीजपूरजटाभयाः ॥ ३१ ॥
पीताः कल्कीकृताः क्षारघृताम्ललवणैर्युताः ।
विकर्तिकाशूलहराः क्वाथः कोष्णश्च तद्गुणः ॥ ३२ ॥
यवानीलवणक्षारवचाजाज्यौषधैः कृतः ।
सपूतिदारुबीजाह्वपलाशशठिपौष्करैः ॥ ३३ ॥
Paste of – puṣkarāhva – Inula racemosa, śaṭhī – Curcuma zedoaria, śuṇṭhī – Zingiber officinale, bījapūra – root of Citrus medica, jaṭā – Nardostachys jatamamsi, abhayā – and Terminalia chebula, alkali of Hordeum vulgare plant ghee, sours and salt cures cutting type pain in the heart, when consumed; similar is the action of decoction of yavānī – Trachyspermum ammi, rock salt, alkali of Hordeum vulgare, vacā – Acorus calamus, ajāji – Cuminum cyminum and Zingiber officinale, pūtidāru – Sterculia foetida, bījāhva – Citrus medica, palāśa – Butea monosperma, śaṭhi – Curcuma zedoaria, pauṣkara – Inula racemosa consumed warm.

Hridroga Chikitsa: Treatment of heart diseases

यवक्षारो यवानी च पिबेदुष्णेन वारिणा ।
एतेन वातजं शूलं गुल्मं चैव चिरोत्थितम् ॥ ३३+(१) ॥
भिद्यते सप्तरात्रेण पवनेन यथा घनः ॥ ३३+(१ऊ)अब् ॥
Powder of – Alkali of yava – Hordeum vulgare, yavānī – Trachyspermum ammi mixed with warm water should be drunk. By this pain in the abdomen gulmaṃ ca – and abdominal tumour caused by vitiated vata, persisting for long time get cured within seven days just as the clouds get split by the wind.

Hridroga Chikitsa: Treatment of heart diseases

पञ्चकोलशठीपथ्यागुडबीजाह्वपौष्करम् ।
वारुणीकल्कितं भृष्टं यमके लवणान्वितम् ॥ ३४ ॥
हृत्पार्श्वयोनिशूलेषु खादेद्गुल्मोदरेषु च ।
Powder of pancakola, śaṭhī – Curcuma zedoaria, pathyā – Terminalia chebula, guḍa – jaggery, bījāhva – Citrus medica, pauṣkaram – and Inula racemosa made into a paste with a sap liquor of Borassus flabellifer (Varuni) – fried in mixture of two fats (oil and ghee) and added with salt should be consumed in case of pain in the heart, flanks and vagina, gulma – abdominal tumour and enlargement of the abdomen.

Hridroga Chikitsa: Treatment of heart diseases

स्निग्धाश्चेह हिताः स्वेदाः संस्कृतानि घृतानि च ॥ ३५ ॥
In this (heart diseases of vata origin) lubricating sudation and ghee processed with herbs (which mitigate vata) are beneficial.

Hridroga Chikitsa: Treatment of heart diseases

लघुना पञ्चमूलेन शुण्ठ्या वा साधितं जलम् ।
वारुणीदधिमण्डं वा धान्याम्लं वा पिबेत्तृषि ॥ ३६ ॥
When there is thirst, water boiled with herbs of laghu pancamula or Zingiber officinale, or sap liquor of Borassus flabellifer (Varuni), thin liquid of curds or fermented water boiled with corns should be administered.

Hridroga Chikitsa: Treatment of heart diseases

सायामस्तम्भशूलामे हृदि मारुतदूषिते ।
These are the treatments when there is expanding type of pain in the heart, stiffness, stoppage of movements, sharp pain, ama associated with heart disease, and when heart is afflicted by Vata Dosha.

Hridroga Chikitsa: Treatment of heart diseases

क्रियैषा सद्रवायामप्रमोहे तु हिता रसाः ॥ ३७ ॥
स्नेहाढ्यास्तित्तिरिक्रौञ्चशिखिवर्तकदक्षजाः ।

When there is increased heart rate, expanding type of pain and loss of consciousness, following should be administered; meat soup prepared out of – tittiri – part-ridge, krauñca – heron, śikhi – peacock, vartaka – bird-button quail, dakṣajāḥ – cock added with more of fats (ghee or oil) are beneficial.

Hridroga Chikitsa: Treatment of heart diseases

बलातैलं सहृद्रोगः पिबेद्वा सुकुमारकम् ॥ ३८ ॥
यष्ट्याह्वशतपाकं वा महास्नेहं तथोत्तमम् ।
The patient of heart diseases should drink Bala taila (vide chapter 2 of sarirasthana) or Sukumara (chapter 13 of Chikitsa sthana) or satapakayasti taila (chapter 22-Chikitsasthana) or mahasneha (vide chapter 21 of cikisthasthana) which are best suited.

Hridroga Chikitsa: Treatment of heart diseases

रास्नाजीवकजीवन्तीबलाव्याघ्रीपुनर्नवैः ॥ ३९ ॥
भार्गीस्थिरावचाव्योषैर्महास्नेहं विपाचयेत् ।
दधिपादं तथाम्लैश्च लाभतः स निषेवितः ॥ ४० ॥
तर्पणो बृंहणो बल्यो वातहृद्रोगनाशनः ।
Mixture of all the four fats – ghee, oil, muscle fat and marrow should be prepared with the decoction and paste of – rāsnā – Pluchea lanceolata, jīvaka – Malaxis muscifrea, jīvantī – Leptadenia reticulate, balā – Sida cordifolia, vyāghrī – Solanum xanthocarpum, punarnavaiḥ – Boerhavia diffusa, bhārgī – Clerodendrum serratum, sthirā – Terminalia chebula, vacā – Acorus calamus, vyoṣai: – and trikatu, one fourth part of curds sour liquids as many as available this recipe when consumed acts as : restorative, nutritive, strengthening and cures heart disease arising from vata.

Hridroga Chikitsa: Treatment of heart diseases

दीप्तेऽग्नौ सद्रवायामे हृद्रोगे वातिके हितम् ॥ ४१ ॥
क्षीरं दधि गुडः सर्पिरौदकानूपमामिषम् ।
एतान्येव च वर्ज्यानि हृद्रोगेषु चतुर्ष्वपि ॥ ४२ ॥
शेषेषु स्तम्भजाड्यामसंयुक्तेऽपि च वातिके ।
कफानुबन्धे तस्मिंस्तु रूक्षोष्णामाचरेत् क्रियाम् ॥ ४३ ॥
In heart diseases caused by vata, if there is increased heart rate and expanding type of pain and if the patient has strong digestive power, then consuming milk, curds, jaggery (molasses), ghee and meat of animals living in water and marshy regions is suitable. These are to be avoided in the remaining four kinds of heart diseases, and even in vataja kind, if there is rigidity and inactivity (in the body) and association of ama, if there is kapha as the secondary dosa in it (vataja heart disease) therapies which bring about dryness and heat should be adopted.

Pittaja Hridroga Chikitsa

पैत्ते द्राक्षेक्षुनिर्याससिताक्षौद्रपरूषकैः ।
युक्तो विरेको हृद्यः स्यात्क्रमः शुद्धे च पित्तहा ॥ ४४ ॥
क्षतपित्तज्वरोक्तं च बाह्यान्तः परिमार्जनम् ।
कट्वीमधुककल्कं च पिबेत्ससितमम्भसा ॥ ४५ ॥
In Hridroga arising from pitta, vireka (purgation) is ideal, with the juice of Vitis vinifera, juice of Saccharum officinarum, sugar, honey, Grewia asiatica (as adjuvants to the purgative drug); after such a purification, all treatments which mitigate pitta should be done, such as the internal and external treatment enumerated in chest injury and fever caused by pitta paste of Picrorhiza kurroa and Glycyrrhiza glabra should be consumed along with sugar water.

Pittaja Hridroga Chikitsa

श्रेयसीशर्कराद्राक्षजीवकर्षभकोत्पलैः।
बलाखर्जूरकाकोलीमेदायुग्मैश्च साधितम्॥४६॥
सक्षीरं माहिषं सर्पिः पित्तहृद्रोगनाशनम्।
shreyasi – Scindapsus officinalis, sharkara – sugar, draksha – Vitis vinifera, jivaka – Malaxis muscifrea, rishabhako – Malaxis acuminate, utpalaih – Nymphaea stellata, bala – Sida cordifolia, kharjura – Phoenix dactylifera, kakoli – Lilium polyphyllum, meda yugmaih cha – and Polygonatum verticillatum and Polygonatum cirrhifolium medicated ghee prepared with (decoction and paste of) these herbs – with milk and ghee obtained from buffalo milk cures pittaja Hridroga .

Pittaja Hridroga Chikitsa

प्रपौण्डरीकमधुकबिसग्रन्थिकसेरुकाः ॥ ४७ ॥
सशुण्ठीशैवलास्ताभिः सक्षीरं विपचेद्घृतम् ।
शीतं समधु तच्चेष्टं स्वादुवर्गकृतं च यत् ॥ ४८ ॥
वस्तिं च दद्यात्सक्षौद्रं तैलं मधुकसाधितम् ।
Medicated ghee prepared with (decoction and paste of) prapauṇḍarīka – Nymphaea lotus, madhuka – Glycyrrhiza glabra, bisagranthi – knot on a stalk of Nymphaea lotus, kaserukā – Scirpus grossus, śuṇṭhī – Zingiber officinale, śaivalā: – Ceratophyllum demersum, milk and sugar, is desirable to be consumed with honey and ghee prepared with herbs of sweet taste is also suitable. Enema should be administered oil processed with madhuka and mixed with honey.

Kaphaja Hridroga Chikitsa

कफोद्भवे वमेत्स्विन्नः पिचुमन्दवचाम्भसा ॥ ४९ ॥
कुलत्थधन्वोत्थरसतीक्ष्णमद्ययवाशनः ।
पिबेच्चूर्णं वचाहिङ्गुलवणद्वयनागरात् ॥ ५० ॥
सैलायवानककणायवक्षारात् सुखाम्बुना ।
फलधान्याम्लकौलत्थयूषमूत्रासवैस्तथा ॥ ५१ ॥
पुष्कराह्वाभयाशुण्ठीशठीरास्नावचाकणात् ।
क्वाथं तथाभयाशुण्ठीमाद्रीपीतद्रुकट्फलात् ॥ ५२ ॥
In that caused by kapha, after making the patient perspire (by sudation therapy), emesis should be administered with decoction of picumanda – Azadirachta indica, vacā – Acorus calamus (as adjuvant to the emetic herbs), along with soup of kulattha – Dolichos biflorus and meat of animals of desert like regions and strong wines. He should consume food prepared from Hordeum vulgare. Powder of vacā – Acorus calamus, hiṅgu – Ferula narthex, lavaṇadvaya – the two salts, nāgarāt – Zingiber officinale, elā – Elettaria cardamomum, yavānaka – Trachyspermum ammi, kaṇā – Piper longum, yavakṣārāt – alkali of Hordeum vulgare should be consumed with warm water, or with fruit juice, dhānya amla – fermented gruel, soup of kaulattha – Dolichos biflorus, cow’s urine or fermented infusion, Decoction of puṣkarā – Inula racemosa, abhayā – Terminalia chebula, śuṇṭhī – Zingiber officinale, śaṭhī – Curcuma zedoaria, rāsnā – Pluchea lanceolata, vacā – Acorus calamus, kaṇāt – Piper longum, kvāthaṃ – or decoction of abhayā – Terminalia chebula, śuṇṭhī – Zingiber officinale, ṃādrī – Aconitum heterophyllum, pītadru – Berberis aristata, kaṭphala – Myrica esculenta (should be consumed).

Kaphaja Hridroga Chikitsa

क्वाथे रोहीतकाश्वत्थखदिरोदुम्बरार्जुने ।
सपलाशवटे व्योषत्रिवृच्चूर्णान्विते कृतः ॥ ५३ ॥
सुखोदकानुपानश्च लेहः कफविकारहा ।
In the decoction of rohītaka – Tecomella undulata, aśvattha – Ficus religiosa, khadira – Acacia catechu, udumbara – Ficus racemosa, arjune – Terminalia arjuna, palāśa – Butea monosperma, vaṭa – Ficus benghalensis, powder of vyosa and trivṛt – Operculina turpethum is put in and confection prepared; consumed with warm water it cures diseases (of heart) arising from kapha.

Kaphaja Hridroga Chikitsa

श्लेष्मगुल्मोदिताज्यानि क्षारांश्च विविधान्पिबेत् ॥ ५४ ॥
प्रयोजयेच्छिलाह्वं वा ब्राह्मं वाऽत्र रसायनम् ।
तथामलकलेहं वा प्राशं वाऽगस्त्यनिर्मितम् ॥ ५५ ॥
Medicated ghee and different alkalies described in kapha gulma (vide chapter 14 of Chikitsathana) should be drunk either (silajatu) rasayana (vide chapter 39 of uttarasthana) or brahma Rasayana or amalaka rasayana or that prepared by sage Agastya i.e., Agastya Rasayana (all these are mentioned in chapter 39 of uttarasthana) should be administered.

Kaphaja Hridroga Chikitsa

स्याच्छूलं यस्य भुक्तेऽति जीर्यत्यल्पं जरां गते ।
शाम्येत् स कुष्ठकृमिजिल्लवणद्वयतिल्वकैः ॥ ५६ ॥
सदेवदार्वतिविषैश्चूर्णमुष्णाम्बुना पिबेत् ।
If the pain is more soon after meals, mild during digestion and subsides after complete digestion, such a patient should consume the powder of kuṣṭha – Saussurea lappa, kṛmijit – Embelia ribes, lavaṇadvaya – two types of salt, tilvaka – Symplocos racemosa, devadāru – Cedrus deodara, ativiṣa – Aconitum heterophyllum along with warm water.

Kaphaja Hridroga Chikitsa

यस्य जीर्णेऽधिकं स्नेहैः स विरेच्यः फलैः पुनः ॥ ५७ ॥
जीर्यत्यन्ने तथा मूलैस्तीक्ष्णैः शूले सदाधिके ।
He who has severe pain after digestion, should be given a purgative consisting of fats; when pain is severe during digestion a purgative consisting of fruits; when pain is severe at all times a purgative consisting of roots.

Kaphaja Hridroga Chikitsa

प्रायोऽनिलो रुद्धगतिः कुप्यत्यामाशये गतः ॥ ५८ ॥
तस्यानुलोमनं कार्यं शुद्धिलङ्घनपाचनैः ।
Generally vata getting obstructed in its movements, gets increased in the stomach, hence it should be made to move in the downward direction with purifactory therapies (purgation and enema), fasting and digestive herbs.

Kaphaja Hridroga Chikitsa

कृमिघ्नमौषधं सर्वं कृमिजे हृदयामये ॥ ५९ ॥
In diseases of the heart caused by worms (intestinal parasites), all treatments which eradicate the worms should be adopted.

इति हृद्रोग चिकित्सितम्

Thus ends the treatment of heart diseases.

Trishna Chikitsa: Treatment of thirst

तृष्णासु वातपित्तघ्नो विधिः प्रायेण शस्यते ।
सर्वासु शीतो बाह्यान्तस्तथा शमनशोधनः ॥ ६० ॥
दिव्याम्बु शीतं सक्षौद्रं तद्वद्भौमं च तद्गुणम् ।
निर्वापितं तप्तलोष्टकपालसिकतादिभिः ॥ ६१ ॥
सशर्करं वा क्वथितं पञ्चमूलेन वा जलम् ।
दर्भपूर्वेण मन्थश्च प्रशस्तो लाजसक्तुभिः ॥ ६२ ॥
वाट्यश्चामयवैः शीतः शर्करामाक्षिकान्वितः ।
यवागूः शालिभिस्तद्वत्कोद्रवैश्च चिरन्तनैः ॥ ६३ ॥
शीतेन शीतवीर्यैश्च द्रव्यैः सिद्धेन भोजनम् ।
हिमाम्बुपरिषिक्तस्य पयसा ससितामधु ॥ ६४
रसैश्चानम्ललवणैर्जाङ्गलैर्घृतभर्जितैः ।
मुद्गादीनां तथा यूषैर्जीवनीयरसान्वितैः ॥ ६५ ॥
नस्यं क्षीरघृतं सिद्धं शीतैरिक्षोस्तथा रसः ।
निर्वापणाश्च गण्डूषाः सूत्रस्थानोदिता हिताः ॥ ६६ ॥
दाहज्वरोक्ता लेपाद्या निरीहत्वं मनोरतिः ।
महासरिद्ध्रदादीनां दर्शनस्मरणानि च ॥ ६७ ॥
In all types of thirst diseases, treatments which mitigate vata and pitta in all types of thirst, treatments which mitigate vata and pitta are beneficial generally. In all the types, cold treatment both external and internal, so also palliative and purificatory, the rain water which is cold and mixed with honey should be used; similarly,the ground water having similar qualities (as that of rain water) or the water into which heated stone, pot-sherd or sand has been immersed, or mixed with sugar bolied with (trna) pancamula, or mantha (solution of flour) prepared from flour of laja (fried paddy) is ideal or vatya (thin paste of flour) prepared from raw Hordeum vulgare mixed with sugar and honey and cooled; thin gruel prepared from rice similarly from kodrava which are old; foods prepared from substances of cold potency partaken cold; bathing in cold water, drinking milk added with sugar and honey, soup of meat of animals of desert-like lands, fried in ghee, without making it sour and salty soup of Vigna radiata etc., mixed with juice of herbs of jivaniyagana (vide chapter 5 of sutrasthana) should be used as food. Nasal drops prepared with milk and ghee, or juice of herbs of cold potency or of sugarcane; mouth gargles and application of paste over the body described in sutrastana (vide chapter 22) are beneficial, and anointments mentioned for fever with burning sensation (vide chapter 1 of cikisthana) mind which is not agitated and dispassionate; sight of or remembrance of great rivers, lakes etc – all these are beneficial.

Vataja Trishna Chikitsa

तृष्णायां पवनोत्थायां सगुडं दधि शस्यते ।
रसाश्च बृंहणाः शीता विदार्यादिगणाम्बु च ॥ ६८ ॥
In thirst caused by vata curds mixed with jaggery is suitable; so also meat soup which is nourishing and cold in potency or water boiled with herbs of vidaryadi guna (vide chapter 15 of sutrasthana).

Pittaja Trishna Chikitsa

सितायुक्तः पक्वोदुम्बरजो रसः ।
तत्क्वाथो वा हिमस्तद्वच्छारिवादिगणाम्बु वा ॥ ६९ ॥
तद्विधैश्च गणैः शीतकषायान्ससितामधून् ।
मधुरैरौषधैस्तद्वत् क्षीरिवृक्षैश्च कल्पितान् ॥ ७० ॥
बीजपूरकमृद्वीकावटवेतसपल्लवान् ।
मूलानि कुशकाशानां यष्ट्याह्वं च जले शृतम् ॥ ७१ ॥
ज्वरोदितं वा द्राक्षादि पञ्चसाराम्बु वा पिबेत् । In thirst caused by pitta,juice of ripe fruit of Ficus racemosaadded with sugaror its decoction made cool,similarly, the decoction or cold infusion off herbs of sarivadigana (videchapter 15 of sutrasthana)or other gana of similar properties, added with sugarand honey or cold infusionprepared from herbs of sweet taste, similarly (that prepared with) trees having milky sap;water boiled withtender leaves ofbījapūraka – Citrus medica,  mṛdvīkā – Vitis vinifera,vaṭa – Ficus benghalensis,vetasa – Garcinia pedunculataor with roots ofkuśa kāśānāṃ – Desmostachya bipinnata, yaṣṭyāhvaṃ ca – Glycyrrhiza glabra; drākṣā – draksadi phanta; described in the treatment of jvara (vide chapter1 of cikisthana)or panchasarambu (vide chapter 2 of cikisthana) should be consumed.

Kaphaja Trishna Chikitsa

कफोद्भवायां वमनं निम्बप्रसववारिणा ॥ ७२ ॥
बिल्वाढकीपञ्चकोलदर्भपञ्चकसाधितम् ।
जलं पिबेद्रजन्या वा सिद्धं सक्षौद्रशर्करम् ॥ ७३ ॥
मुद्गयूषं च सव्योषपटोलीनिम्बपल्लवम् ।
यवान्नं तीक्ष्णकवलनस्यलेहांश्च शीलयेत् ॥ ७४ ॥
In thirst caused by kapha emesis should be done, with decoction of tender leaves of Azadirachta indica; drink water boiled with bilva – Aegle marmelos, āḍhakī – Cajanus cajan, pañcakola – pancakola, darbhapancaka (trnapancamula) or with Rajanī – Curcuma longa added with honey and sugar; soup of mudga – Vigna radiata mixed with (powder of) vyosa, paṭolī – Trichosanthes diaoca and tender leaves of nimba -Azadirachta indica; food prepared from yava – Hordeum vulgare, mouth gargle and nasal medication and confections of strong potency should be made use of

Amaja Trishna Chikitsa

सर्वैरामाच्च तद्धन्त्री क्रियेष्टा वमनं तथा ।
त्र्यूषणारुष्करवचाफलाम्लोष्णाम्बुमस्तुभिः ॥ ७५ ॥
In thirst caused by ama and caused by all the three dosas treatments to mitigate them are vomiting should be induced by the use of tryusana, aruṣkara – Semecarpus anacardium, vacā – Acorus calamus, phalāmla – (matulunga) Citrus medica either with warm water or whey.

Annatyaya Trishna Chikitsa

अन्नात्ययान्मण्डमुष्णं हिमं मन्थं च कालवित् ।
In thirst caused by avoidance of food, thin gruel which is warm or mantha (solution of flour mixed with sugar and ghee) which is cold should be consumed appropriate to the time (season).

Shramaja Trishna Chikitsa

तृषि श्रमान्मांसरसं मन्थं वा ससितं पिबेत् ॥ ७६ ॥
In thirst caused by exertion, meat juice (soup) or mantha added with sugar should be drunk

Atapajanya Trishna Chikitsa

आतपात्ससितं मन्थं यवकोलजसक्तुभिः ।
सर्वाण्यङ्गानि लिम्पेच्च तिलपिण्याककाञ्जिकैः ॥ ७७ ॥
शीतस्नानाच्च मद्याम्बु पिबेत् तृण्मान्गुडाम्बु वा ।
In thirst due to exposure to sunlight, mantha prepared with flour of yava and kola should be consumed mixed with sugar. The whole body should be anointed with paste of sesame mixed with sour rice wash take bath in cold water, drink (one who has thirst) wine mixed with more water or water in which jaggery is dissolved.

Madyajanya Trishna Chikitsa

मद्यादर्धजलं मद्यं स्नातोऽम्ललवणैर्युतम् ॥ ७८ ॥
In thirst due to drinking wine, he should drink wine added with half its quantity of water mixed with sour and salt, after taking bath.

Snehaja Trishna Chikitsa

स्नेहतीक्ष्णतराग्निस्तु स्वभावशिशिरं जलम् ।
स्नेहादुष्णाम्ब्वजीर्णात्तु जीर्णान्मण्डं पिपासितः ॥ ७९ ॥
He who has strong digestive activity caused by oleation therapy should drink water which by nature possess cold potency. He who has poor digestive activity due to oleation should drink hot water and when the food is well digested he feels thirsty then he should drink thin gruel.

Snigdhannajanya Trishna Chikitsa

पिबेत् स्निग्धान्नतृषितो हिमस्पर्धि गुडोदकम् ।
He who is thirsty after a fatty meal should drink water containing jaggery made very cold like the touch of ice.

Gurvadiannajanya Trishna Chikitsa

गुर्वाद्यन्नेन तृषितः पीत्वोष्णाम्बु तदुल्लिखेत् ॥ ८० ॥
He who is thirsty by consuming foods which are hard to digest should drink hot water and vomit it (food) .

Kshayajanya Trishna Chikitsa

क्षयजायां क्षयहितं सर्वं बृंहणं औषधम् ।
In thirst caused by consumption/ depletion of tissues of all methods which are suitable to consumption such as nourishing foods and medicines should be adopted.

Use of goat’s milk and meat juice and treatment of Kshayakasa in Trishna

कृशदुर्बलरूक्षाणां क्षीरं छागो रसोऽथवा ॥ ८१ ॥
क्षीरं च सोर्ध्ववातायां क्षयकासहरैः शृतम् ।
For persons who are emaciated, weak and dry, goats milk or juice of meat (of goat) are beneficial. When there is upward movement (of vata) milk boiled with herbs which cure ksayakasa (vide chapter 3 of cikisthana) is beneficial.

Aupasargika Trishna Chikitsa

रोगोपसर्गाज्जातायां धान्याम्बु ससितामधु ॥ ८२ ॥
पाने प्रशस्तं सर्वा च क्रिया रोगाद्यपेक्षया ।
In thirst caused by contagious diseases, water boiled with dhānyaka – Coriandrum sativum added with sugar and honey is ideal for drinking and all other treatment appropriate to the diseases.

Aupasargika Trishna Chikitsa

तृष्यन्पूर्वामयक्षीणो न लभेत जलं यदि ॥ ८३ ॥
मरणं दीर्घरोगं वा प्राप्नुयात् त्वरितं ततः ।
सात्म्यान्नपानभैषज्यैस्तृष्णां तस्य जयेत् पुरा ॥ ८४ ॥
तस्यां जितायामन्योऽपि व्याधिः शक्यश्चिकित्सितुम् ॥ ८४ऊअब् ॥
The patient who is thirsty and emaciated by earlier diseases, if he does not get water in time, will either die becomes a victim of chronic diseases or in quick time compatible (wholesome) foods and drinks, medicines should be used to cure his thirst as said earlier. When that (thirst) is controlled, other diseases become easy to treat.

इति श्री वैद्यपति सिंहगुप्तसूनु श्रीमद्वाग्भटविरचितायामष्टाङ्गहृदयसंहितायां चतुर्थे चिकित्सितस्थाने छर्दिहृद्रोगतृष्णाचिकित्सितं नाम षष्ठोऽध्याय: ॥ ६॥
Thus, ends the chapter- Chardihrudrogatrshnachikitsitam, – the sixth in Cikitsita Sthana of Asthanga hrdaya Samhita – composed by Srimad vagbhata, son of Sri Vaidyapati Simhagupta