Chapter 16 – Trshna Nidana

The 16th chapter of Trshna Nidana that is it deals with the diagnosis of thirst. Thirst is normally just the brain’s way of warning that you’re dehydrated because you’re not drinking enough fluid. But excessive and persistent thirst (known as polydipsia) could be a sign of an underlying problem such as diabetes.

Causes of Trshna — 

भय – श्रमाभ्यां बल संक्षयाद्वा ह्युर्ध्वं चितं पित्तविवर्धनैश्च |
पित्तं सवातं कुपितं नराणां तालुप्रपन्नं जनयेत् पिपासाम् |
स्रोतस्स्वपांवाहिषु दूषितेषु दोषैश्च तृट् सम्भवतीह जन्तौः || १ ||

bhaya – śramābhyāṁ bala saṅkṣayādvā hyurdhvaṁ citaṁ pittavivardhanaiśca |
pittaṁ savātaṁ kupitaṁ narāṇāṁ tāluprapannaṁ janayēt pipāsām |
srōtassvapānvāhiṣu dūṣitēṣu dōṣaiśca tr̥ṭ sambhavatīha jantauḥ || 1 ||

Due to fear, physical exertion, loss of strength or activeness of pitta aggravating factors, the pitta is accumulated and subsequently the vaayu is vitiated. The vayu thus aggravated moves upwards and reaches the palatal region. This condition produces a morbid thirst. 1

[ ताल्वोष्ट – कण्ठास्य – विशेषदाह – सन्ताप – मोह – भ्रम – विप्रलापाः |
पूर्वाणि रूपाणि भवन्ति तासामुत्पत्तिकाले तु विशेषतो हि || ]

[ tālvōṣṭa – kaṇṭhāsya – viśēṣadāha – santāpa – mōha – bhrama – vipralāpāḥ |
pūrvāṇi rūpāṇi bhavanti tāsāmutpattikālē tu viśēṣatō hi || ]

Before the onset of the disease trsna, as it prodromal features, one may notice that the organs like palate, lips, throat and mouth of patient start getting dried. There is burning sensation in them. Gradually, the burning sensation spreads to the entire body of the patient. There is fainting, giddiness as well; the patient starts uttering incoherent speeches. These symptoms appear prominently once the disease (trshna) gets maturity.

The Varieties of trshna — 

तिस्रः स्मृतास्ताः क्षतजा चतुर्थी क्षयात्तथा ह्यामसमुद्भवा च |
भक्तोद्भवा सप्तमिकेति तासां निबोधं लिङ्गान्यनुपूर्वशस्तु || २ ||

tisraḥ smr̥tāstāḥ kṣatajā caturthī kṣayāttathā hyāmasamudbhavā ca |
bhaktōdbhavā saptamikēti tāsāṁ nibōdhaṁ liṅgānyanupūrvaśastu || 2 ||

The morbid thirst is of seven varieties,

• 3 of them from each of the three doshas
• Kshataja — The 4th from ulcerations
• Kshayaja — The 5th from depletion or loss of body tissues
• Aamaja — The 6th from aama (accumulation of undigested material)
• Bhaktodbhava — And the 7th from irregular food;

Features of these varieties are described below in a systemic form. 2

Vata Type of Trshna –

क्षमास्यता मारुत संभवायां तोदस्तथा शङ्ख – शिरसुः चापि |
स्रोतोनिरोधो विरसं च वक्त्रं शीताभिरद्भिश्च विवृद्धिमेति || ३ ||

kṣamāsyatā māruta sambhavāyāṁ tōdastathā śaṅkha – śirasuḥ cāpi |
srōtōnirōdhō virasaṁ ca vaktraṁ śītābhiradbhiśca vivr̥ddhimēti || 3 ||

In the vata type of trsna ,

• The face of the patient becomes weak;
• There is a pining sensation in his temples and head.

Moreover, there is obstruction of channels, adverse taste in the mouth. The thirst increases by cold water as well. 3

Pitta Type of Trshna –

मूर्च्छान्नविद्वेष – विलाप – दाहा – रक्तेक्षणत्वं प्रततश्च शोषः |
शीताभिनन्दा मुखतिक्तता च पित्तात्मिकायां परिदूयनम् च || ४ ||

mūrcchānnavidvēṣa – vilāpa – dāhā – raktēkṣaṇatvaṁ pratataśca śōṣaḥ |
śītābhinandā mukhatiktatā ca pittātmikāyāṁ paridūyanam ca || 4 ||

The features of pittaja type of morbid thirst include –

• Murchha — Fainting
• Anna vidvesha — Aversion of food
• Vilapa — Delirium
• Daha — Burning sensation
• Rakta Akshanam — Reddish eyes
• Pratata — Insatiable thirst
• Sheetabhi nanda — And comfort by cold and
• Mukha Tikta — Bitter taste in the mouth.

Moreover, the patient passes

• Yellowish urine and faeces and his eyes turns red. 4

Kapha Type of Trshna —

वाष्पावरोधात् कफसंवृते अग्नौ तृष्णा बलासेन भवेत्तथा तु |
निद्रा गुरुत्वं मधुरास्यता च तृष्णार्दितः शुष्यति चातिमात्रम् || ५ ||

vāṣpāvarōdhāt kaphasanvr̥tē agnau tr̥ṣṇā balāsēna bhavēttathā tu |
nidrā gurutvaṁ madhurāsyatā ca tr̥ṣṇārditaḥśuṣyati cātimātram || 5 ||

The kaphaja type of chardi develops through blockage of the heat of pitta inside the body (Vashpa avarodha) by the vitiated kapha.

It is marked by

• Nidraa Gurutvam — feeling of a heaviness of the body
• Madhura Aasyata — sweet taste in the mouth
• Shushyati — quick emaciation. 5

Trshna due to injury –

क्षतस्य रुक्शोणित निर्गमाभ्यां तृष्णा चतुर्थी क्षतजा मता तु |

kṣatasya rukśōṇita nirgamābhyāṁ tr̥ṣṇā caturthī kṣatajā matā tu |

The fourth variety of the trshna is the one that is produced by injury and the subsequent loss of blood.

Trshna due to kshaya (emaciation) –

रसक्षयाद्या क्षयसम्भव सा तया अभिभूतश्च निशादिनेषु || ६ ||
पेपियते अम्भः स सुखं न याति तां सन्निपातादिति केचिदाहुः |
रसक्षयोक्तानि च लक्षणानि तस्यामशेषेण भिषग्व्यवस्येत || ७ ||

rasakṣayādyā kṣayasambhava sā tayā abhibhūtaśca niśādinēṣu || 6 ||
pēpiyatē ambhaḥ sa sukhaṁ na yāti tāṁ sannipātāditi kēcidāhuḥ |
rasakṣayōktāni ca lakṣaṇāni tasyāmaśēṣēṇa bhiṣagvyavasyēta || 7 ||

• Kshataja type of thirst is generated by pain and bleeding due to ulcerations on the body.
• The kshayaja thirst is produced due to depletion of rasa (plasma)
• The patient suffering from this continues to drink water repeatedly day and night without satisfied.
• Some learned physicians opine that this situation develops due to simultaneous vitiation of all the three doshas.
• One could note that all other features of Rasa Kshaya (plasma loss) are also manifest in the kshayaja type of thirst. 6-7

Trshna caused by Aama (undigested stuff) –

त्रिदोषलिङ्गा आमसमुद्भवा च हृच्छूल – निष्टिवन – सादकर्त्री |

tridōṣaliṅgā āmasamudbhavā ca hr̥cchūla – niṣṭivana – sādakartrī |

The aamaja type of morbid thirst also presents the features of all the three doshas. Moreover, it also reflects symptoms of precordial pain, salivation and malaise.

Bhuktodbhavaa Trshna (Thirst caused by eating certain foods) –

स्निग्धं तथा अम्लं लवणं च भुक्तं गुर्वन्नमेवाशु तृषां करोति || ८ ||

snigdhaṁ tathā amlaṁ lavaṇaṁ ca bhuktaṁ gurvannamēvāśu tr̥ṣāṁ karōti || 8 ||

Food those are oily, sour and salty in taste and heavy cause trsna immediately after eating. This is called bhaktodbhava type of trshna. 8

Upasargaja Trshna (thirst caused as a side effect of some other disease) –

दीनस्वरः प्रताम्यान् दीनः संशुष्कवक्त्र – गल – तालुः |
भवति खलु योपसर्गात्तृष्णा सा शोषिणी कष्टा || ९ ||

dīnasvaraḥ pratāmyān dīnaḥ sanśuṣkavaktra – gala – tāluḥ |
bhavati khalu yōpasargāttr̥ṣṇā sā śōṣiṇī kaṣṭā || 9 ||

There is another type of morbid thirst. It is produced by complication of some other diseases. In this type of morbidity, the patient has a feeble voice; he suffers from bouts of delusion; he might even get unconscious. There are also symptoms like restlessness, severe dryness of the mouth, throat and palate; as well as emaciation. 9

The complications of Trshna — 

ज्वर – मोह – क्षय – कास – श्वासाध्युपसृष्टदेहनाम् |

jvara – mōha – kṣaya – kāsa – śvāsādhyupasr̥ṣṭadēhanām |

The implications of a morbid thirst are –

• Jwara — Fever
• Moha –Delusion
• Kshaya — Emaciation
• Kasa –Cough
• Shvasa — Abnormal respiration, etc.

Incurability of Trshna –

सर्वास्त्वतिप्रसक्ता रोगकृशानां वमिप्रयुक्तानाम् |
घोरोपद्रव युक्तास्तृष्णा मरणाय विज्ञेयाः || १० ||

sarvāstvatiprasaktā rōgakr̥śānāṁ vamiprayuktānām |
ghōrōpadrava yuktāstr̥ṣṇā maraṇāya vijñēyāḥ || 10 ||

The morbid thirst which is very severe and that is seen among persons who are already debilitated by other diseases, who are having vomiting concurrently and that is associated with further complication is to be understood fatal. 10

इति श्रीमाधवकरविरचिते माधवनिदाने तृष्णानिदानं समाप्तम् ||16 ||

iti śrīmādhavakaraviracitē mādhavanidānē tr̥ṣṇānidānaṁ samāptam ||16 ||

thus concludes the chapter of Thirst.

Source —

1. Thirst