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Introduction

Chhardi (Vomiting) is one of the commonest diseases found in paediatric practice. When it occurs in children, it is a cause of concern for the parents as the child will have severely ill look and weak, even if vomiting occurs for a day or two. Chhardi (Vomiting) is a condition, in which abnormal expulsion of food stored in stomach occurs through mouth causing distress and discomfort.[1] it may lead to severe complications in the children, if not treated at the earliest, Chhardi is highly prevalent in childhood period associated with nausea, dehydration, abdominal pain and sometimes with distress in vomiting. The utilization of food for the nourishment of the body depends on Agni (responsible for digestion and metabolism). It is obvious that the body elements or Sharira Dhatu can not be nourished and developed when the food is not properly digested by Agni and Vomiting is the outcome of Mandagni (Low digestive power). Vidahiaharsevan, ajirna and mandagni forms ama which play significant role in the pathogenesis of chhardi.[2] Chhardi is a disease which is caused mainly due to Kapha and Vata Doshaand is also caused due to so many different types of vitiations of the Doshas, the symptoms are also markedly different from each other. [3] There are various types of Chhardi according to Ayurveda Vataja, Pittaja, Kaphaja, Sannipatika, Agantuja and Krimija. In Vataja chhardi there is expulsion of frothy and scanty content with astringent taste associated with abdomen pain. Pittaja chhardi expel out sour, yellow and pungent content with burning sensation. [4] Kaphaja chhardi involves vomiting of sweet, white and cold material associated with heaviness and malaise. Sannipatika Chhardi persisted symptoms such as; abdomen pain, thirst, dyspnoea and fainting. Agantuja chhardi possess irritating and dirty smell while Krimija chhardi occur due to worm infestation. Vidahiaharsevan, ajirna and mandagni forms ama which play significant role in the pathogenesis of chhardi. The children being very soft, tender, fast growing and developing individuals, any therapy should be given with due caution. This therapy should be avoided in the children below 12 years of age. The Shamana line of treatment that includes oral administration of medicine is of utmost importance as the administration is very easy and also effective compared to Shodhana in children.

Ayurvedic Review

Vyutpatti (Derivation) of Chhardi: [5]

1)Chard + Ghay = Vamanam

2)Chard + Lyut = Vamanam

Nirukti: Since it covers the mouth by coming out bouts (of food etc.), causes discomfort by bending of the body and Dosha coming out of the mouth, it is called Chhardi.

Definition: [6]  Chhardi is a disease in which the Doshas are expelled out from the Amashaya (Stomach) via the oral route.

Paryaya (Synonyms): PraChhardika, Chardam, Vamathuhu, Vamanam, Vamihi, Chhardika, Vantihi, Udgaraha, Utkasika, Chardanam, Vantau, Vamana, Chardauka.

Samanya Chikitsa of Chhardi[7]

All types of chhardi are caused due to irritation of Amashaya hence langhana (fasting) is first line of treatment in Chhardi.

Vataja Chhardi Chikitsa: Mamsa Rasa (Meat Soup) i.e. well processed soup of Tittira, peacock (Mayura) and lava bird’s meat is recommended orally. Yoosha prepared with Badara, Kulatha, Dhanyaka, Bilwadi panchamoola, Amla Dravya and Yava in the form of Shadanga Paaniya. Dhanyakadi Yoga is also a Yoosha preparation mentioned in Yoga Ratnakara. If patient suffers from palpitation (Hruddrava), Saindhava Lavana is mixed with Ghrita and recommended orally.

Pittaja Chhardi Chikitsa: Anulomana–Trivrut Churna2-3g. followed by Draksha, Vidarikanda and Ikshurasa is recommended to drink. By Anulomana the upward movements of Doshas are brought to downward by increasing peristalsis and Chhardi is controlled. Vamana – If Kapha Dosha is collected in Amashaya and there are symptoms of irritation of gastrium and nausea is present, mild Vamana is induced. After Shodhana Laja Mantha, Madhu, Sharkara, Peya, Mudgayoosha, Mamsarasa with Shali rice advised (any one or two of these at time). Kanchana gairika and Balaka advised with Tandulodaka. Draksharasa or Ikshurasa or Ksheera advised. Chandana, Usheera, Jatamamshi, Draksha, Balaka, Swarna Gairika Kalka.

Kaphaja Chhardi Chikitsa: Vamana If the patient of Kaphaja Chhardi is severely suffering from nausea Vamana is induced. So as to eliminate Kapha Dosha from Amashaya, the Kwatha prepared with Pippali, Sarshapa and Nimba is used. Finally Madanaphala powder and a pinch of saindhava lavana is added to the Kwatha and recommended orally. The juice of Draksha, Kapittha and Phalapooraka is advised to take orally. Jambu Churna, Badaramla Churna mixed in equal quantity is recommeded orally. Musta Churna and Karkata Shringi Churna are recommended orally. Mayurapuccha bhasma and Sootashekhara rasa are used for internal administration.

Tri-Doshaja Chhardi Chikitsa: The prognosis of TriDoshaja Chhardi is not good. However on the basis of predominancy of Doshas involved, rutu (season), digestive power (agnibala) and of the disease the physician should apply the principles already explained in Chhardi carefully and treat. Guduchi Kashaya mixed with honey is recommended orally. Guduchi is sangrahaka, Deepaniya, Vatahara, Shleshma hara therfore it controls the Chhardi

Also Masura Saktu, Madhu and Dadima Rasa all combined together and should be used as Panaka, it relieves TriDoshaja Chhardi

Dwishtarthaja/Beebhatsaja Chhardi Chikitsa: Vomiting caused due to psychological disturbance of an individual is called Dwishtarthaja Chhardi and also named it as Beebhatsaja Chhardi. The unpleasant smell sight and food are the main cause of Chhardi. Therefore the treatment also should be aimed at relieving the psychic stress by encouraging favorite talk, palatable food, wholesome food, consolation, favorite odor of flower, sour fruit juice.

Other Yogas

- Lajadi, Yusha, Chandanaavalehya, Mudga Kashaya, Parpataka, Kvatha, Maakshikaavid avalehha Eladi Churna, Bilvaadi Yoga, Koladi Avalehya, Manashiladi Yoga, Bijapuradi Yoga, Hingvadi Yoga, Jirakadi Dhupa.

Pathya in Chhardi: [8]

1.Parishushka Chhardi – Dry food

2.Priya Bhojana – Favorite food

3.Laghu Bhojana – Light food

4.Saatmya Bhojana – Compatible food

5.Upavasa Yusha – Fasting with Yusha

6.Mamsarasa – Soup of meat

 7. Shaaka – Vegetable soup

8. Panaka – Juice

9. Vichitraphalani – Varieties of fruits

10.Sugandhasnana Churna – Bathing with the powder of good fragrance

11.Gandha Dravya – Fragranced facial creams

12.Gandhapushpa AnnaPaanaja – Using food, flower, fruits of desirable taste and fragrance

13.Bhuktamaatrasya Sheetaambu Sevana – Cold water or drink soon after food

Apathya in Chhardi: Nasya, Swedana, Snehapana, Rakta Mokshana, Danta Kashta, Dravanna Liquidfood,

 Beebhotseksha – Beholding disgusting scenes,  Bhaya – fear, Udvega – Emotional intensity, Ushna and Snidgha Anna

Discussion

Eladi Gutika a traditional Ayurvedic polyherbal formulation is used as a remedy for Kasa(Cough), Svasa(Asthma), Bhrama(Vertigo), Raktapitta (Bleeding disorders), Jvara(Fever), Amvata (Rheumatism) etc.[9] It helps to relieve cough, cold, fever, hiccups, vomiting, dizziness, haematemesis and abdominal pain, hence most useful drug in paediatric practice.

Table 1 -Showing Ayurvedic Pharmacological properties of drugs[10]

Probable Mode of Action: Vata and Kapha is responsible for vomiting in children. Though vitiation of all the Doshas is there but vitiation of Vata-Kapha plays the dominant in Chhardi. Most of the drugs in Eladi gutika are Vata-Kapha Shamaka. In pathogenesis of chhardi Ama is formed as resultant of Agnimandya in tern Kapha vitiation occurs where by which Sanga has been takes place. Due to this Sanga, Vata gets obstructed and Vimanagamana of Dushita Kapha by Vata takes place. In this combination Ela, Talisa Patra, Twak, Pippali drugs possess Agnideepaka property. When the Agni is improved the further production of Ama is checked at root level by relieving Sanga. Most of the medicines are Vatahara Guna and hence helps in Vatanulomana. So combination was effective to relieve the anorexia, nausea, abdominal pain which were the chief associated complaints of the patients. Eletaria cardamomum have gastro protective action.[11] The essential oils of Elettaria cardamomum have effect on decrease in gastric motility and they have inhibitory effect in over production of some products of 5-lipoxygenase pathway.[12]  Also piper longum - piplartine suppressed the ciliary movements of oesophagus in tern helps in reducing the vomiting reflex. Piper longuminine showed marked antispasmodic action,[13]  on isolated tissues means it helps in reducing the intrabdominal pressure by establishing peristalsis movements and it helps to check the vomiting.

Conclusion

Chhardi is an unpleasant activity that results in the expulsion of stomach contents through the mouth and clearly associated with gastrointestinal motor activity. In Eladi gutikka Maximum drugs are having Katu, Tikta, and Madhura Rasa which is Kapha-Vata shamaka also drugs are of Laghu Ruksha and Snidgha property which is reduce the symptoms of Chhardi in paediatrics age. Also formulation is having antiemetic, antispasmodic, gastroprotective, and anti-inflammatory properties.