Water is an essential component of human body and excessive fluid loss causes dehydration which manifests with symptom of thirst. Thirst means a need for something to drink. Thirst is felt by hypothalamus which stimulates ADH hormone and aldosterone for the absorption of water and makes plasma to return to its normal state in order to maintain homeostasis. Trishna is one of integrated aspect of Udakavaha Srotas and is derived from the word 'Trish' which means thirst. In Ayurveda absorption of body fluids depends upon Vata and Agni. On Nidana Sevana when Vata and Pitta gets exacerbated it brings vitiation in Udakavaha Srotas, Mutravaha Srotas and in due course it does Dusti of Rasavaha Srotas. It causes depletion of Rasa and Udaka in the body and presented with Mukhashosha as premonitory symptom of Trishna Roga. Sarvadha Ambukamitavam is presented as cardinal feature of Trishna Roga. Trishna also manifests as complication in severe diseases like Jwara, Prameha, Kshaya, Shosha and Swasa. Concept of Trishna is interchangeably used in Ayurveda as pathological and physiological process which manifests in order to maintain fluid imbalance in the body. In the present article an attempt has been made to put forth the understanding of Thirst mechanism in Ayurveda enunciated in Samhita and modern science.

Figure 2.
Understanding the mechanism with Lakshanas of Trishna.

Figures - uploaded by Monika Gupta

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UNDERSTANDING OF THIRST MECHANISM IN AYURVEDA

Monika Gupta1*, Rashmi Pujar2 and Gopikrishna S.3

*1 Post Graduate Scholar, Department of Roga Nidana and Vikruti Vijnana, Sri Dharmasthala

Manjunatheshwara College of Ayurveda and Hospital Hassan, Karnataka, India.

2Assistant Professor, Department of Roga Nidana and Vikruti Vijnana, Sri Dharmasthala

Manjunatheshwara College of Ayurveda and Hospital Hassan, Karnataka, India.

3Professor and Head of Department, Department of Roga Nidana and Vikruti Vijnana, Sri

Dharmasthala Manjunatheshwara College of Ayurveda and Hospital Hassan, Karnataka,

India.

ABSTRACT

Water is an essential component of human body and excessive fluid

loss causes dehydration which manifests with symptom of thirst. Thirst

means a need for something to drink. Thirst is felt by hypothalamus

which stimulates ADH hormone and aldosterone for the absorption of

water and makes plasma to return to its normal state in order to

maintain homeostasis. Trishna is one of integrated aspect of

Udakavaha Srotas and is derived from the word 'Trish' which means

thirst. In Ayurveda absorption of body fluids depends upon Vata and

Agni. On Nidana Sevana when Vata and Pitta gets exacerbated it

brings vitiation in Udakavaha Srotas, Mutravaha Srotas and in due

course it does Dusti of Rasavaha Srotas. It causes depletion of Rasa

and Udaka in the body and presented with Mukhashosha as

premonitory symptom of Trishna Roga . Sarvadha Ambukamitavam is

presented as cardinal feature of Trishna Roga. Trishna also manifests as complication in

severe diseases like Jwara, Prameha, Kshaya, Shosha and Swasa. Concept of Trishna is

interchangeably used in Ayurveda as pathological and physiological process which manifests

in order to maintain fluid imbalance in the body. In the present article an attempt has been

made to put forth the understanding of Thirst mechanism in Ayurveda enunciated in Samhita

and modern science.

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

SJIF Impact Factor 7.632

Volume 9, Issue 2, 1238 -1247 Research Article ISSN 2278 – 4357

Article Received on

14 Dec. 2019,

Revised on 03 Jan. 2020,

Accepted on 24 Jan. 2020,

DOI: 10.20959/wjpps20202-15539

*Corresponding Author

Dr. Monika Gupta

Post Graduate Scholar,

Department of Roga Nidana

and Vikruti Vijnana, Sri

Dharmasthala

Manjunatheshwara College

of Ayurveda and Hospital

Hassan, Karnataka, India.

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Gupta et al. World Journal of Pharmacy and Pharmaceutical Sciences

KEYWORDS: Ayurveda , Thirst mechanism, Trishna, Udakavaha Srotas, Mutravaha Srotas,

Homeostasis.

INTRODUCTION

Thirst is a subjective perception that arises due to deficit in either intracellular or extracellular

fluid volume which may arise due to habitual, cultural and psychogenic drives . It leads to

activation of compensatory response which includes Vasopressin secretion, stimulation of

Renin-Angiotensin Aldosterone system, sympathetic activation which act directly or

indirectly to retain sodium and water or to reallocate blood and interstitial fluids in an effort

to sustain critical regional blood flows and thus minimises the changes in body fluids volume

and its composition.[1]

Trishna is derived from word 'Trish Dhatu' which means Akansha or Lobha(desire). Trishna

Roga manifests when person does not get satisfied on drinking sufficient amount of water.[2]

Acharya Sushruta has mentioned Trishna as Swabhava Bala Pravritta Vyadhi.[3]

Trishna occurs due to Sankshobha, Shoka, Shrama, Madyapana, Rukshamla Shushka Katu

Ushna Bhojana, Dhatu Kshaya etc. These etiological factors vitiates Vata and Pitta

Dosha.which brings obstruction in Udakavaha Srotas and produces symptoms like

Mukhashosha and constant desire to drink water, Bhrama Talu Oshtha Kantha Jihwa

Karkashata, Badirya, Daha, Santapa, Jihwa- nishkramana, Sammoha, Hridaya-vyatha and

Anga Sada.[3 -5] On the basis of Doshic involvement Trishna is categorised into several types

as mentioned in Table 1 below.

Table 1: Classification of Trishna Roga, C.S –Charaka Samhita, S.S –Sushruta Samhita,

M.N. - Madhava Nidana.

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Gupta et al. World Journal of Pharmacy and Pharmaceutical Sciences

AIMS AND OBJECTIVES

To understand the Mechanism of Thirst in Ayurveda.

MATERIAL AND METHODS

Concepts related to the title are compiled from Ayurvedic literature, modern textbooks,

various scientific journals, internet source and analysis has been done and further

understanding has been proposed.

DISCUSSION

Hormonal regulation[6]

ADH is secreted by hypothalamus which regulates water re-absorption. When the blood

osmotic pressure is raised, osmo-receptors in hypothalamus stimulate the posterior pituitary

gland. It increases the secretion of ADH and re-absorption of water by kidneys, which

thereby lowers the blood osmotic pressure.

Aldosterone is secreted by Zona Glomerulosa of Adrenal Cortex of kidney due to renal

plasma flow. With the decrease in extra cellular fluid the enzyme Renin is released by the

Juxta Glomerular cells which acts on Angiotensinogen and convert it into Angiotensin I and

Angiotensin II which causes vasoconstriction and increase in Blood Pressure and also inhibits

Renin release and thus maintain sodium and water balance in body.

Nidana in Trishna Roga[2,4]

Doshas in their Vaikruta Avastha leads to causation of disease, Dosha Prakopaka Nidana

exhibit Dosha Prakopaka Lakshanas and initiate disease pathology. Nidana for the Trishna

have been mentioned in Table 2.

Table 2: Evaluation of Nidanas of Trishna.

Vata Dosha due to Ruksha Guna

Katu, Kshara, Lavana,Ushna Anna

Pitta Dosha due to predominance of Agni

Mahabhuta

Pitta Dosha and Rakta Dusti due to

Ushna, Snighda and Laghu Guna

Pitta Dosha due to Ushna and Teekshana

Guna

Vata dosha due to Chala Guna

Vata dosha due to Laghu Guna

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Gupta et al. World Journal of Pharmacy and Pharmaceutical Sciences

Pitta Dosha due to Ushna and Teekshana

Guna

Dhatu Kshaya due to Gadatichara,

improper Vamana

Sankshobha, Shoka, Krodha

Vata Dosha due to Rajo Guna, Pitta

Dosha due to Manas affliction and is seat

of Sadhaka Pitta

Understanding of Lakshanas of Trishna Roga

Mukha Shosha[4]

Due to Vata and Pitta Pravruddhi, Ruksha Guna of Vata and Ushna Guna of Pitta are

affected. Ruksha Guna and Ushna Guna is responsible for Shoshana. It thus does the

Shoshana of Saumya Dhatu. Saumya Dhatu can be Rasa Dhatu, Kapha, Udaka, Mutra. It

leads to Rasa Kshaya, Kledha Kshaya and Kapha Kshaya which thereby produces Jihwa Talu

Kantha Shoshana and Mukha Shosha. Mukha shosha is one of feature explained in Mutra

Kshaya.[7] Mukha Shosha is also mentioned as Vata Nanatmaja Vikara .[8] Due to increase in

plasma osmolarity, the decrease in production of saliva occurs.[9] It can be interpreted as

Mukhashosha (Figure 1).

Sarvada Ambukamitvam

Due to insufficient water in body there happens to be decrease in blood pressure. Low blood

pressure decreases the renal perfusion which makes granular cells of kidney to activate

reticulo endothelial system with Angiotension II. It stimulates hypothalamus which has

sensory receptors called osmoregulators which detects change in osmotic pressure and creates

sensation of thirst that can be regarded as 'Peetam Peetam Jalashoshata'.[4,6] (Figure 2)

Angasada

Angasada means weakness. Udaka is circulating through Rasa-Rakta complex which has

important vital function of Preenana and Jeevana. Due to Chalaguna of Vata, Preenana

Karma and Jeevana Karma is affected causing Anga Sada.[10] On fluid loss dehydration

occurs, it causes intracellular acidosis and thereby inhibition of glycolysis enzymes and slows

ATP production and loss of oxidative phosphorylation. Less energy production causes

weakness in the body.[11] (Figure 3)

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Sammoha and Bhrama

Bhrama refers to giddiness. On Nidana Sevana, Pitta and Vata Pravridhi causes Rasa

Kshaya and Kapha Kshaya. Sarvangasundar states that Kapha Kshaya results in Bhrama.

Due to Ra sa Raktadi Kshaya, Majja Dhatu Kshaya occurs which also results in Bhrama.[10]

Bhrama is also explained as Vata Nanatmaja Vikara. [8] Due to Rasa Kshaya, there happens to

be Abhava of Sneha Amsha and Shoshana of Rasa Dhatu which causes Sammoha.[12]

Hydration plays an important role in homeostasis. Dehydration of 2% or more body mass loss

can induce impairment in cognitive functions, dizziness and mental confusion.[13] (Figure 4)

Badirya

Vata and Pitta vitiates Rasa Dhatu which is homologous to Kapha Dosha. Kapha Dosha

brings Avarana to Vata Dosha and causes Badirya.[14] The inner ear an organ is encased in

bone and filled with fluid endo-lymph and peri-lymph which is maintained by charged

particles that maintain body equilibrium. The endo-lymph and peri-lymph are influenced by

number of factors and hormones which incude aldosterone, vasopressin. Due to dehydration,

hypovolemia occurs and it affects ADH and decrease in fluid affecting blood supply in inner

ear leads to tinnitus and even hearing loss.[15] (Figure 5)

Shrama

Shrama refers to tiredness. It is mentioned in features of Rasa Kshaya and Mutra Kshaya.

Due to Ashraya Ashrayi Sambandha it vitiates Vata Dosha . [10] Dehydration of 2% or more

body mass loss can increase the perception of fatigue.[13] (Figure 6)

Hridaya-vyatha

Due to Vata Dusti, Rasa Dhatu gets vitiated and Rasavaha Srotomula is affected and causes

Hridaya Vyatha. Disturbed plasma volume with disturbance in cardiac output causes cardiac

manifestation. Due to fluid loss, levels of calcium decreases which alters heart muscle

functioning, loss of magnesium ions causes cardiac arrhythmias, loss of potassium ions

results in cardiac ventricular arrhythmias.[16-18] (Figure 7)

Daha, Jihwanishkramana

Insufficient amount of water intake leads to enhancement of body heat followed by decreased

in fluid quantity which is characterised by burning sensation, protruded tongue.[19] (Figure 8)

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Santapa

Dusti of Vata produces Ama and leads to manifestation of Trishna in Vatapittaja Jwara .[20]

Due to dehydration, waste products get accumulated in extracellular fluid and leads to

manifestation of hyperthermia.[21] (Figure 9)

Figure 1. Figure 2.

Figure 3. Figure 4.

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Gupta et al. World Journal of Pharmacy and Pharmaceutical Sciences

Figure 5. Figure 6.

Figure 7. Figure 8.

Figure 9.

Figure 1-9: Understanding the mechanism with Lakshanas of Trishna.

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Gupta et al. World Journal of Pharmacy and Pharmaceutical Sciences

Udakavaha Srotas and Mutravaha Srotas

Talu and Kloma are Moolasthana for Udakavaha Srotas which control the water regulation in

body and is the site of manifestation of disease. Rasa Vaha Dhamani and Hridaya are the

Moolasthana of Rasavaha Srotas which circulate Rasa all over the body. When Udakavaha

Srotas gets vitiated it causes Jihwa Shosha, Talu Shosha, Ostha Shosha, Kloma Shosha,

Kantha Shosha and Ati Pravriddam Pipasa. With the Dusti of Mutravaha Srotas there

develops obstruction in passing urine and Mutra Kshaya manifests with the symptoms of

Pipasa, Mukha Shosha. Reduction in extra cellular fluid releases enzyme Renin which acts

on Angiotensinogen and convert it into Angiotensin I and Angiotensin II which causes

vasoconstriction and increase in Blood Pressure and also inhibits Renin release to maintain

sodium and water balance in body.[6] Thus Srotas has its significance. If any of injury occurs

to the Udakavaha Srotas it manifests with symptoms Trishna and Sadyomarana.[22]

Trishna manifests due to Shoshana of Saumya Dhatu.

Sadyomaranam-Alteration in metabolism due to Rasa Dusti causes disturbed osmotic

pressure and reduced plasma volume which results in decrease in cardiac output. Lack of

supply of proper nutrition and water to body cell occurs with increase in nitrogenous waste

production in cell and causes early cellular death that can be interpreted as 'Sadyomaranam' .

CONCLUSION

Concept of Trishna is relevant in present scenario with an insight into physiological

understanding of Thirst mechanism. Trishna is considered an effect of altered body

mechanism and in context of water balance it can be said that control of thirst fall under the

per-view of Udakavaha Srotas and Mutravaha srotas.

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In outlook of the escalating evidences, most deaths are ascribed to non communicable diseases and half of these are outcome of cardiovascular disease. Hridroga is considered to be one of the incorporated facets related to Rasavaha Srotas (cardiovascular system). Yogvashishtha and Acharya Bhela has mentioned Hridaya as Shirohridaya and Urohridaya. Urohridaya has been accepted in correspondence to circulation of Rasa and Rakta. Due to etiological factors when Doshas get aggravated they cause Agnidusti which vitiates the Rasa, invades the components and causes affliction to Hridaya. Affliction to Hridaya results in manifestation of five types of Hridroga. Amongst the five types of Hridroga, the Vataja Hridroga is presented with the cardinal feature of Ruja (pain dominant heart disease) and shows cardiac affliction along with other symptoms as explained in Samhitas. Nidana Panchaka is a method to determine the progression of disease which includes Nidana (Etiological factors), Purvarupa (Prodromal symptoms), Rupa (Symptoms), Upashaya (Relieving factors), Anupashaya (Precipitating factors) and Samprapti (Pathogenesis). The present critique aims to confer the review on Nidana Panchaka of Vataja Hridroga in detail to elucidate different attributes based on Samhita.

Background: Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient's thirst can provide an accurate guide to fluid therapy. This systematic review examines the sensitivity of thirst in responding to changes in plasma osmolality in participants of any age with no condition directly effecting their sense of thirst. Methods: Medline and EMBASE were searched up to June 2017. Inclusion criteria were all studies reporting the plasma osmolality threshold for the sensation of thirst. Results: A total of 12 trials were included that assessed thirst intensity on a visual analogue scale, as a function of plasma osmolality (pOsm), and employed linear regression to define the thirst threshold. This included 167 participants, both healthy controls and those with a range of pathologies, with a mean age of 41 (20-78) years.The value ±95% CI for the pOsm threshold for thirst sensation was found to be 285.23 ± 1.29 mOsm/kg. Above this threshold, thirst intensity as a function of pOsm had a mean ± SEM slope of 0.54 ± 0.07 cm/mOsm/kg. The mean ± 95% CI vasopressin release threshold was very similar to that of thirst, being 284.3 ± 0.71 mOsm/kg.Heterogeneity across studies can be accounted for by subtle variation in experimental protocol and data handling. Conclusion: The thresholds for thirst activation and vasopressin release lie in the middle of the normal range of plasma osmolality. Thirst increases linearly as pOsm rises. Thus, osmotically balanced fluid administered as per a patient's sensation of thirst should result in a plasma osmolality within the normal range. This work received no funding.

Muscle fatigue is a common complaint in clinical practice. In humans, muscle fatigue can be defined as exercise-induced decrease in the ability to produce force. Here, to provide a general understanding and describe potential therapies for muscle fatigue, we summarize studies on muscle fatigue, including topics such as the sequence of events observed during force production, in vivo fatigue-site evaluation techniques, diagnostic markers and non-specific but effective treatments.

Thirst is important for maintaining body fluid homeostasis and may arise from deficits in either intracellular or extracellular fluid volume. Neural signals arising from osmotic and hormonal influences on the lamina terminalis may be integrated within the brain, with afferent information relayed from intrathoracic baroreceptors via the hindbrain to generate thirst.

  • Richard A Nelesen
  • Yasmin Dar
  • KaMala Thomas
  • Joel E Dimsdale

Although characteristics such as heart rate (HR) and blood pressure (BP) are commonly reported in studies of the relationship between fatigue and cardiac functioning, few reports examine how cardiac function parameters such as cardiac output (CO) and stroke volume (SV) relate to fatigue. This study examined the relationship between self-reported fatigue and hemodynamic functioning at rest and in response to a public speaking stressor in healthy individuals. A total of 142 individuals participated in this study. Subjects were placed in low-, moderate-, or high-fatigue groups based on their Profile of Moods State fatigue scale. Heart rate, SV, and CO were determined using impedance cardiography at rest and during a speaking stressor. Stroke volume and CO values were converted to stroke index (SI) and cardiac index (CI) by adjusting for body surface area. Data were analyzed with hierarchical regression analysis and a 3 (group) x 3 (stress period) mixed model analysis of variance. At rest, fatigue was not associated with BP or HR but was significantly associated with decreased CI (P < .001; 95% confidence interval, -0.046 to -0.014) and stroke index (SI) (P = .002; 95% confidence interval -0.664 to -0.151), even after controlling for demographic variables and depressive symptoms. Heart rate and BP increased, as expected, from baseline to preparation to speaking stressor (F (1,124) = 118.6 and F (1,122) = 46.450, respectively) (P < .001 for both). More interestingly, there were effects on SI and CI of fatigue (P<.03 for both) and stress (P<.03 for both); high-fatigue individuals had lower SI and CI levels than moderate- and low-fatigue individuals both at rest and in response to the stressor. This study demonstrates that fatigue complaints may have hemodynamic correlates even in ostensibly healthy individuals.

Charaka Samhita with Ayurveda Deepika Commentary by Chakrapanidutta on Charaka Samhita of Agnivesha. chikitsasthana

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Agnivesha, Charaka, Dridabala, Acharya YT. Charaka Samhita with Ayurveda Deepika Commentary by Chakrapanidutta on Charaka Samhita of Agnivesha. chikitsasthana;

Astangasamgraha with Sasilekha Sanskrit Commentary of Sarvangasundara by Indu on Astangasamgraha of Vahata or Vrddha Vagbhata

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Textbook of medical laboratory technology. volume I, Chapter 14

  • B Praful
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  • Godkar

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Susruta Samhita With Ayurveda Tattva Sandipika Hindi Commentary By Kaviraja Ambikadutta Shastri on Susruta Samhita of Maharsi Susruta

  • Susruta

Susruta. Susruta Samhita With Ayurveda Tattva Sandipika Hindi Commentary By Kaviraja Ambikadutta Shastri on Susruta Samhita of Maharsi Susruta. Uttaratantra;

Histopatholgy of meniere's disease. Oper Tech Otolayngol Head Neck Surg

  • Rafael Sebahattin Cureoglu
  • Costa Da
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  • Paparella

Sebahattin cureoglu, Rafael da Costa Monsanto, Michael M, Paparella. Histopatholgy of meniere's disease. Oper Tech Otolayngol Head Neck Surg, 2016 Dec; 27(4): 194-204. www.wjpps.com Vol 9, Issue 2, 2020.