Chardi Nidanam – 15th Chapter Of Madhav Nidanam

Introduction

Chardi, which refers to vomiting, is an important disease entity defined in Ayurveda that involves expulsion of the contents of the stomach from the mouth due to vitiation and abnormal movement of Dosha. The Madhava Nidana, written by Acharya Madhavakara, gives extensive descriptions of Chardi Nidana along with its causative factors, types, symptoms (Purvarupa), presentation (Lakshana), outcome and complications (Upadrava). Various dietary and lifestyle and psychological factors are believed to cause the disturbance of Dosha and occurrence of Chardi. Knowledge of these factors is essential for prompt diagnosis and proper treatment. The present paper attempts to provide an overview of Chardi Nidana from the viewpoint of Madhava Nidana.

Chardi Nidanam – 15th Chapter Of Madhav Nidanam

Types Of Chardi Roga (Vomiting)

दुष्टैर्दोषः पृथक् सर्वेर्वीभत्सालोचनादिभिः | छर्दयः पञ्च विज्ञेयास्तासां लक्षणमुच्यते ||१||

There Are Five Types Of Vomiting:

Dvishtartha Samyogaja Chardi
Vataja Chardi
Pittaja Chardi
Kaphaja Chardi
Sannipataja Chardi

Chardi Roga Nidana (Etiology Of Vomiting)

अतिद्रवैरतिस्निग्धैरहहौर्लवणैरति ।
अकाले चातिमात्रैश्च तथाऽसाल्यैश्च भोजनैः ||२||
श्रमाद्भयात्तथोद्वेगादजीर्णात् क्रिमिदोषतः |
नार्याश्चापन्नसत्त्वायास्तथाऽतिद्रुतमश्रतः ॥३॥
बीभत्सैर्हेतुभिश्चान्यैर्द्धतमुत्क्लेशितो बलात् ।
छादयन्नात्तनं वेगैरर्दयेन्नङ्गभञ्जनैः । अत्यन्तमपरीतस्य च्छर्देर्वे सम्भवो ध्रुवम् |
निरुच्यते छर्दिरिति दोषो वक्त्रं प्रचावितः ||४|| (Sushruta Uttara Tantra Ch 49 shloka 3-6)

Aharaja Nidana (Dietary Aspects)

Overconsumption of liquid food (Atidrava), oily and fatty food (Ati-Snigdha), excessively salty food (Ati-Lavana), consuming food at the wrong time (Akala Bhojana), overeating (Atimatra Bhojana), and eating unhealthy food (Asatmya Ahara) can affect the normal functioning of Agni and Doshas. Eating habits can lead to indigestion and aggravation of Doshas, resulting in Chardi.

Viharaja Nidana (Lifestyle Aspects)

Doing excessive physical work (Shrama) and eating food at a fast pace (Atidruta Ashana) can disrupt the normal functions of the body and lead to Chardi.

Manasika Nidana (Psychological Aspects)

Fear (Bhaya), anxiety or mental tension (Udvega), and looking at unpleasant things (Bibhatsa Darshana) can trigger Chardi.

Samprapti (Development Of Chardi)

If a person continues to eat bad food, follows bad dietary habits and is under psychological or physical stress, the normal balance of the body will be upset. The aggravated Doshas will cause Utklesha to move upwards, resulting in Chardi.

Purvarupa (Premonitory Symptoms)

हल्लासोद्गाररोधौ च प्रसेको लवणस्तनुः ।
द्वेषोऽन्नपाने च भृशं वमीनां पूर्वलक्षणम् ||५|| (Sushruta Uttara Tantra Ch 49 shloka 7)

At the onset of the disease, the patient experiences what is called Hallasa, which refers to the sensations of nausea and discomfort in the stomach associated with the onset of the vomiting reflex. This may also be accompanied by Udgara Rodha, wherein normal belching is impaired or obstructed.As the disease progresses, the condition proceeds to Praseka, whereby the excessive salivation in the mouth of the patient occurs. Lavana Asyata may also be noted in such patients, where there exists an unusual taste in their mouths that tastes salty.

Vataja Chardi Lakshana

हृत्पार्श्वपीडामुखशोषशीर्षनाभ्यर्तिकासस्वरभेदतोदैः।
उद्गारशब्दप्रबलं सफेनं विच्छिन्नकृष्णं तनुकं कषायम्।
कृच्छ्रेण चाल्पं महता च वेगेनार्तोऽनिलाच्छर्दयतीह दुःखम्॥६॥ (Charaka chikitsa Ch 20 shloka 8 -9)

Vataja Chardi is characterized by the occurrence of vomiting in conjunction with pain in the chest, sides, head, and navel region. Other symptoms may include dryness in the mouth, cough, hoarseness, and a tingling sensation in the area. The vomit appears frothy, occurs in episodes, is dark in color, fluid, and acrid in nature. It is emitted with difficulty in small amounts.

Pittaja Chardi Lakshana

मूर्छापिपासामुखशोषमूर्धताल्वक्षिसन्तापतमोभ्रमार्तः।
पीतं भृशोष्णं हरितं सतिक्तं धूम्रं च पित्तेन वमेत् सदाहम्॥७॥ (Charaka chikitsa Ch 20 shloka 11)

Pittaja Chardi is caused when there is an increase in Pitta dosha. The individual affected has dizziness, acute dryness of mouth and severe thirst, and sensations of burning in the head, palate and eyes. One may also experience dizziness with blurred vision in the eyes. Characteristic features of the vomitus are that it is usually yellow colored, hot and greenish, bitter and sometimes too smoky as well. In addition, vomiting is related to the burning discomfort.

Kaphaja Chardi Lakshana

तन्द्रास्यमाधुर्यकफप्रसेकसन्तोषनिद्रारुचिगौरवार्तः।
स्निग्धं घनं स्वादु कफाद्विशुद्धं सरोमहर्षोऽल्परुजं वमेत्तु॥८॥ (Charaka chikitsa Ch 20 shloka 13)

Kaphaja Chardi occurs due to the imbalance of Kapha dosha. Symptoms of this disorder include drowsiness, sweet flavor in the mouth, drooling, restlessness as well as too much drowsiness and lack of hunger.
Vomiting in this disorder is usually thick, oily and sweet. It can be accompanied by shivering and mild pain.

Sannipataja Chardi Lakshana

शूलाविपाकारुचिदाहतृष्णाश्वासप्रमोहप्रबला प्रसक्तम्।
छर्दिस्त्रिदोषाल्लवणाम्लनीलसान्द्रोष्णरक्तं वमतां नृणां स्यात्॥९॥ (Charaka chikitsa Ch 20 shloka 15)

Sannipataja Chardi is a condition resulting from the simultaneous aggravation of all three Doshas. Symptoms include severe and recurrent vomiting, abdominal pain, indigestion, loss of appetite, burning, excessive thirst, breathlessness, and confusion. The vomit might be salty, sour, bluish, thick and hot. It is a very severe form of Chardi with the features of Vata, Pitta, and Kapha combined.

Asadhya Chardi Lakshana

विट्वेदमूत्राम्बुवहानि वायुः स्रोतांसि संरुध्य यदोर्ध्वमेति।
उत्सन्नदोषस्य समाचितं तं दोषं समुद्धृत्य नरस्य कोष्ठात्॥१०॥
विण्मूत्रयोस्तत्समगन्धवर्णं तृष्णाश्वासहिक्कार्तियुतं प्रसक्तम्।
प्रच्छर्दयेद्दष्टमिहातिवेगात्तयाऽर्दितश्चाशु विनाशमेति॥११॥ (Charaka chikitsa Ch 20 shloka 16-17)

In this situation, excessive Vata blocks the pathways that help in the excretion of waste products from the body, which eventually leads to vomiting of waste material that has the same characteristics as that of waste products.
The symptoms of this condition include an extreme sense of thirst, difficulty in breathing, and hiccuping.

Aguntaja Chardi Lakshana

बीभत्सजा दौहृदजाऽऽमजा च
ह्यसात्मजा च क्रिमिजा च या हि।
सा पञ्चमी तां च विभावयेच्च
दोषोच्छ्रयेणैव यथोक्तमादौ॥१२॥ (Sushruta Uttara Tantra Ch 49 shloka 12)

Sushruta referred to the fifth category of Chardi as having variable causes like negative sensory impressions, pregnancy issues, problems in digestion and eating something inappropriate, and infections caused by different parasites.
While the causes differ among these factors, clinical signs should be analyzed based on Dosha predominance and aggravation which was advocated in the prior classification.

Krimija Chardi Lakshana

शूलहुल्लासबहुला क्रिमिजा च विशेषतः।
क्रिमिहृद्रोगतुल्येन लक्षणेन च लक्षिता॥१३॥ (Sushruta Uttara Tantra Ch 49 shloka 13)

Prognosis Of Chardi

क्षीणस्य या छर्दिरतिप्रसक्ता
सोपद्रवा शोणितपूययुक्ता।
सचन्द्रिकां तां प्रवदेदसाध्यां
साध्यां चिकित्सेन्निरुपद्रवां च॥१४॥ (Charaka chikitsa Ch 20 shloka 19)

In line with classical descriptions, Chardi that takes place in a critically ill individual and is marked by being remarkably frequent and accompanied by complications is deemed Asadhya (incurable). Contrarily, uncomplicated Chardi without complications is classified as Sadhya (curable). Clinical significance: Blood or pus-like materials found in vomit is an important red flag needing prompt evaluation.

Upadrava Of Chardi

कासः श्वासो ज्वरो हिक्कातृष्णा वैचित्त्यमेव च।
हृद्रोगस्तमकश्चैवज्ञेयाश्छर्देरुपद्रवाः॥१५॥

Madhava Nidana states that various complications may arise as a result of Chardi. One of these complications is cough, palpitations, fever, hiccups, and too much thirst, mental confusion, cardiac symptoms and Tamaka Shwasa.
In today’s medical language continual vomiting could also cause dehydration, loss of electrolytes and general fatigue.

Conclusion

Chardi Nidana described by Acharya Madhavakara in Madhava Nidana provides an insight into the causes, classification, clinical manifestations and consequences of vomiting in Ayurveda. The problem occurs due to different dietary, lifestyle, mental and other factors that disturb dosha balance and result in the development of Chardi. The characteristics of Vataja, Pittaja, Kaphaja, Sannipataja and other types of Chardi indicate the significance of knowing which dosha is predominant in clinical evaluation. Furthermore, the detailed description of Purvarupa, Lakshana, Krimija Chardi, its prognosis and consequences allows one to diagnose and evaluate the severity of the disease on time. Therefore, Madhava Nidana can be treated as one of the useful classical texts which provide information about Chardi and allow to point out the importance of finding Nidana, identifying the symptoms and detecting complications in Ayurvedic treatment.