Chapter 15 – Chardi Nidana

The 15th chapter of Madhava Nidana deals with Chardi Nidana i.e. vomiting. Vomiting, or throwing up, is a forceful discharge of stomach contents. It can be a one-time event linked to something that doesn’t settle right in the stomach. Recurrent vomiting may be caused by underlying medical conditions.

Types of Chardi — 

दुष्तैर्दोषैः पृथक् सर्वैर्बिभत्सालोचनादिभिः |
छर्दयः पञ्च विज्ञेयास्तासां लक्षणमुच्यते || १ ||

duṣtairdōṣaiḥ pr̥thak sarvairbibhatsālōcanādibhiḥ |
chardayaḥ pañca vijñēyāstāsāṁ lakṣaṇamucyatē || 1 ||

The chardi (vomiting) is of five varieties,

• Three of them are produced by the vitiation of each of the three doshas
• Fourth from the combination of all the three doshas together while
• The fifth emerges from the sight of unpleasant things and the like.

Causes of Chardi — 

अतिद्रवैरतिस्निग्धैरह्रुद्यैर्लवणैरति |
अकाले चातिमात्रैश्च तथा सात्म्यैश्च भोजनैः || २ ||
श्रमाद्भयात्तथोद्वेगादजीर्णात् क्रिमिदोषतः |
नार्याश्चापन्नसत्त्वायास्तथा अतिद्रुतमश्नतः || ३ ||
बिभत्सैर्हेतुभिश्चान्यैर्द्रुतमुत्क्लेशितो बलात् |
छादयन्नाननं वेगैर्दयन्नङ्गभञ्जनैः |
निरुच्यते च्छर्दिरिति दोषो वक्त्रं प्रधावितः || ४ ||

atidravairatisnigdhairahrudyairlavaṇairati |
akālē cātimātraiśca tathā sātmyaiśca bhōjanaiḥ || 2 ||
śramādbhayāttathōdvēgādajīrṇāt krimidōṣataḥ |
nāryāścāpannasattvāyāstathā atidrutamaśnataḥ || 3 ||
bibhatsairhētubhiścānyairdrutamutklēśitō balāt |
chādayannānanaṁ vēgairdayannaṅgabhañjanaiḥ |
nirucyatē cchardiriti dōṣō vaktraṁ pradhāvitaḥ || 4 ||

Chardi is mainly caused by

• consuming large amounts of liquids, oily foods, unpleasant and incompatible foods and salty foods,
• Due to taking meal untimely and in higher doses

It is also caused due to –

• Over exertion
• Fear
• Anxiety
• Due to indigestion
• Worm infestation
• Pregnancy
• Taking food hurriedly and
• Due to things that produce abhorrence.

The doshas suddenly comes to the mouth and fill it. They produce pain all over the body and are expelled out only with a force. The wise persons call this process chardi. 2-4

Prodromal features of chardi —

हृल्लसोद्गाररोधौ च प्रसेको लवणस्तनुः |
द्वेषो अन्नपाने च भृशं वमीनां पूर्वलक्षणम् || ५ ||

hr̥llasōdgārarōdhau ca prasēkō lavaṇastanuḥ |
dvēṣō annapānē ca bhr̥śaṁ vamīnāṁ pūrvalakṣaṇam || 5 ||

The premonitory features of vomiting include –

• Oppression in the chest
• Blockage of belching
• Thin and salty salivation and
• Aversion to food and drinks. 5

Vata Type of chardi –

हृत्पार्श्वपीडा – मुखशोष – शीर्षनाभ्यर्ति – कास – स्वरभेद – तोदैः |
उद्गारशब्दप्रबलं सफेनं विच्छिन्न – कृष्णं तनुकं कषायं |
कृच्छ्रेण चाल्पं महता च वेगेनार्तो अनिलाच्छर्दयतीह दुःखम् || ६ ||

hr̥tpārśvapīḍā – mukhaśōṣa – śīrṣanābhyarti – kāsa – svarabhēda – tōdaiḥ |
udgāraśabdaprabalaṁ saphēnaṁ vicchinna – kr̥ṣṇaṁ tanukaṁ kaṣāyaṁ |
kr̥cchrēṇa cālpaṁ mahatā ca vēgēnārtō anilācchardayatīha duḥkham || 6 ||

In a case of Vataja emesis there is

• Hrut Parshva Pida — Pain in the region of heart and flanks;
• Mukha Shosha — Dryness of the mouth
• Discomfort in the head and umbilicus
• Kasa — Cough and
• Svara Bheda — hoarseness of the voice
• Kruchrena Alpa mahata Veganarta — Production of great sound during belching;
• Anila Chardi — Interrupted bouts of vomiting.

Moreover, the patient brings out

• Frothy, scanty, blackish, thin, astringent materials
• And that too with great effort accompanied with pain all over the body. 6

Pitta type of chardi –

मूर्च्छा – पिपासा – मुखशोष – मूर्धताल्वक्षिसन्ताप – तमो – भ्रमार्तः |
पीतं भृशोष्णं हरितं सतिक्तं धूम्रं च पित्तेन वमेत् सदाहम् || ७ ||

mūrcchā – pipāsā – mukhaśōṣa – mūrdhatālvakṣisantāpa – tamō – bhramārtaḥ |
pītaṁ bhr̥śōṣṇaṁ haritaṁ satiktaṁ dhūmraṁ ca pittēna vamēt sadāham || 7 ||

The major symptoms of pittaja vomiting include –

• Murccha — Fainting
• Pipasa — Severe thirst
• Mukha Shosha — Dryness of mouth
• Murdha, Taalu, Akshi Santapa — Burning sensation in the head, palate and eyes;
• Tama — Darkness before the eyes
• Bhrama — Giddiness
• Peetam brusham haritam vami — Bringing out yellowish, greenish, or black substance with reddish tinge
• Dhumra sa tiktam sa daha vami — Very hot, bitter material with burning sensation.

Kapha Type of chardi –

तन्द्रास्यमाधुर्यं – कफप्रसेक – सन्तोष – निद्रारुचि – गौरवार्तः |
स्निग्धं घनं स्वादु कफाद्विशुद्धं सरोमहर्षो अल्परुजं वमेत्तु || ८ ||

tandrāsyamādhuryaṁ – kaphaprasēka – santōṣa – nidrāruci – gauravārtaḥ |
snigdhaṁ ghanaṁ svādu kaphādviśuddhaṁ sarōmaharṣō alparujaṁ vamēttu || 8 ||

In the kaphaja type of chardi, the patient suffers from –

• Tandra — Stupor
• Aasya Madhurya — A morbid sweet taste in the mouth
• Kapha Praseka — Excessive salivation
• Santosha — A feeling of sensical happiness
• Nidraa – Sleepiness
• Aruchi — Anorexia
• Gaurava — Feeling of heaviness in the body
• Snigdham ghanam svadu kapha — Bringing out fatty, thick, sweetish, white colored material
• Romaharsho alpa rujam — Accompanied with horripilation and little or no pain. 8

Tridosha Type of chardi –

शूलाविपाकारुचि – दाह – तृष्णा – श्वास – प्रमोहप्रबला प्रसक्तम् |
छर्दिस्त्रिदोषाल्लवणाम्ल – नील – सान्द्रोष्ण – रक्तं वमतां नृणां स्यात् || ९ ||

śūlāvipākāruci – dāha – tr̥ṣṇā – śvāsa – pramōhaprabalā prasaktam |
chardistridōṣāllavaṇāmla – nīla – sāndrōṣṇa – raktaṁ vamatāṁ nr̥ṇāṁ syāt || 9 ||

A person with vomiting has a persistent and severe colic pain, indigestion, anorexia, a burning sensation, thirst, dyspnea and fainting. In addition, he brings out salted, sour, bluish, thick, warm, and sanguineous vomit. 9

Incurability of chardi –

विट् – स्वेद – मूत्राम्बुवहानि वायुः स्रोतांसि यदोर्ध्वमेति |
उत्सन्नदोषस्य समाचितं तं दोषं समुद्धुय नरस्य कोष्टात् || १० ||
विण्मूत्रयोस्तत्समगन्ध – वर्णं – तृट् – श्वास – हिक्कार्तियुतं प्रसक्तम् |
प्रच्छर्दयेद्दुष्टमिहातिवेगात्तया अर्दितश्चाशु विनाशमेति || ११ ||

viṭ – svēda – mūtrāmbuvahāni vāyuḥ srōtānsi yadōrdhvamēti |
utsannadōṣasya samācitaṁ taṁ dōṣaṁ samuddhuya narasya kōṣṭāt || 10 ||
viṇmūtrayōstatsamagandha – varṇaṁ – tr̥ṭ – śvāsa – hikkārtiyutaṁ prasaktam |
pracchardayēdduṣṭamihātivēgāttayā arditaścāśu vināśamēti || 11 ||

When vayu gets provoked, it obstructs the channels of faecal matter, sweat, and different liquid material and turns upwards in the alimentary canal. It, subsequently, produces morbid thirst, dyspnea, and hiccup. The vomiting done in such cases is full of vitiated matters and it appears with a speed. Such a patient dies very soon. 10 -11

Aagantu (sudden) type of chardi –

बिभत्सजा दौहृर्दजा आमजा च ह्यसात्म्यजा च क्रिमिजा च या हि |
सा पञ्चमी तां च विभावयेच्च दोषोच्छ्रयेणैव यथोक्तमादौ || १२ ||

bibhatsajā dauhr̥rdajā āmajā ca hyasātmyajā ca krimijā ca yā hi |
sā pañcamī tāṁ ca vibhāvayēcca dōṣōcchrayēṇaiva yathōktamādau || 12 ||

Vomiting due to unpleasant sight and the like, due to pregnancy, indigestion, intake of irregular food, parasitic infections has been described above as the fifth kind of chardi. Features of this type of chardi could be discussed as per the doshas involved and as per the concerned description presented above. 12

Chardi caused by krmi (worm infestation) –

शूल – हृल्लासबहुला क्रिमिजा च विशेषतः |
क्रिमिहृद्रोगतुल्येन लक्षणेन च लक्षिता || १३ ||

śūla – hr̥llāsabahulā krimijā ca viśēṣataḥ |
krimihr̥drōgatulyēna lakṣaṇēna ca lakṣitā || 13 ||

In the case of vomiting generated by parasitic infection (krimija), there is pain in the abdomen and Nausea. Moreover, symptoms of krimija hrdroga (heart disease generated by worms) are also manifest in the ailment.

Incurability of chardi –

क्षीणस्य या छर्दिरतिप्रसक्ता सोपद्रवा शोणित – पूययुक्ता |
सचन्द्रिकां तां प्रवदेदसाध्यां, साध्यां चिकित्सेन्निरुपद्रवां च || १४ ||

kṣīṇasya yā chardiratiprasaktā sōpadravā śōṇita – pūyayuktā |
sacandrikāṁ tāṁ pravadēdasādhyāṁ, sādhyāṁ cikitsēnnirupadravāṁ ca || 14 ||

Vomiting in an emaciated person, if persistent gets associated with different complications. If it contains blood and pus and reflects a glistening like the variegated colours of the peacock feathers, it could be understood to have reached an incurable level. Nevertheless, if the case of chardi is uncomplicated and if it is apparently curable, it should be managed. 14

Complications of Chardi —

( कासः श्वासो ज्वरो हिक्का तृष्णा वैचित्त्यमेव च |
हृद्रोगस्तमकः इव ज्ञेयश्च्छर्देरुपद्रवाः || १५ || )

( kāsaḥ śvāsō jvarō hikkā tr̥ṣṇā vaicittyamēva ca |
hr̥drōgastamakaḥ iva jñēyaścchardērupadravāḥ || 15 ||)

The implications of vomiting include –

• Kasa — Cough
• Shwasa — Dyspnea
• Jwara — Fever
• Hikka — Hiccup
• Trshna — Thirst
• Vaicitya Manas — Mental Torpidity
• Hrd roga — Heart ache
• Tamah — And feeling of being in darkness. 15

इति श्रीमाधवकरविरचिते माधवनिदाने छर्दिनिदानं समाप्तम् || 15 ||

iti śrīmādhavakaraviracitē mādhavanidānē chardinidānaṁ samāptam || 15 ||

Thus concludes the chapter on Chardi.

Source — 

1. Vomiting