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By Alakananda Ma
" Ambuvaha (uddakavaha) srotas: its chief organs are talu (palate) and kloma (pancreas), it gets vitiated by ama, fear, excess of alcoholic drinks, dry foods, suppression of thirst etc. Severe thirst, dryness of the mouth, ringing of the ears and unconsciousness are signs of its vitiation, treatment for these is the same as that of trishna (thirst)." (1)
Ambu vaha srotas does not correspond to any distinctive and separate physiological system, sharing functional integrity with anna vaha srotas, the upper digestive tract. Dr Vasant Lad indicates that " the mucous lining of the gastrointestinal (GI) tract is ambu vaha srotas and the muscular structure of the GI tract is anna vaha srotas." (2) However, Ambu vaha srotas does correspond to the vital physiological function of fluid and electrolyte balance, in which kloma (the pancreas) plays an essential role via its endocrine aspect, the Islets of Langerhans, responsible for insulin production.
Dehydration is a key disorder of ambu vaha srotas. In situations of excess fluid loss, thirst (trishna) and dry mouth (talu) are signals of the need to replace fluid through drinking. When fluid cannot be adequately replaced, dehydration results. Among the most common causes of dehydration worldwide are diarrhea and vomiting, the main cause of dehydration in infants and children. Dehydration through sweating is another significant issue, especially in hot season. For example, with current temperatures in Maharashtra, India reaching 50'C (122'F) at the time of writing, heat-related deaths may occur as a result of insufficient access to potable water. Excess sweating and subsequent dehydration can also result from high fevers. Diabetes is cause of thirst, polydypsia (excess drinking) polyuria (excess urination) and dehydration affecting over 250 million people worldwide. And as mentioned by Vagbhat, alcohol causes significant dehydration due to its diuretic effect. In fact, the same can be said of caffeine also. Wounds, ulcers and burns can cause dehydration due to loss of blood or exudate.
In Western medicine, the accepted symptoms of dehydration include dry mouth, dry eyes, lack of sweating, yellow coloration of urine, muscle cramps, nausea and vomiting, confusion, dizziness, and eventually coma and death. These symptoms can initiate dangerous positive feedback loops, such as reduced sweating leading to overheating in heat-related dehydration; nausea and vomiting adding to the existing state of dehydration; confusion leading to inability to obtain or consume water. Because electrolyte loss is a key feature in dehydration, fluid cannot effectively be replaced by drinking plain water; while in certain types of dehydration (alcoholic, diabetic) as soon as water is drunk it is lost through urination, so drinking does not relieve the symptom of thirst.
" Due to evaporation of saumya (watery) dhatus, (trishna) leads on to dizziness, increased tremors all over the body, feeling of increased heat, burning sensation and delusion...general features are dryness of the mouth, non-contentment by drinking water, aversion to food, feeble voice, roughness of the throat, lips and tongue...disorderliness of the mind." (3).
Essentially, dehydration and thirst are due to a combination of pitta and vata (3, 4), although seven types can be delineated, related to vata, pitta, kapha, wounds and ulcerations, rasa dhatu depletion, ama and food poisoning (5). With vataja trishna, thirst is increased by drinking cold water, while pittaja trishna is relieved by cold water and is accompanied by burning sensations (6). Kaphaja trishna has classic symptoms of type 1diabetes including a sweet taste in the mouth, stupor and rapid emaciation (7).
In any situation of acute dehydration, referral for emergency medical treatment is required. Intravenous rehydration can circumvent dangerous positive feedback loops, which are potentially fatal. Such situations include surgical shock (blood loss), severe gastroenteritis and impending diabetic coma. In milder or chronic situations, Ayurvedic interventions may prevent the condition developing to the point where a hospital stay is necessary. Hospital stays are especially distressing to children and can often be prevented by the use of oral rehydration solution (ORS). Every parent should be aware of this simple yet vital recipe, for use in situations such as gastroenteritis (8).
8 Teaspoons of Sugar
½ Teaspoon of Salt (or ¼ Teaspoon of salt for children/babies)
1 Litre of Water
For the Ayurvedic version we use an unrefined sugar such as sucanat or turbinado and Natural Mineral Salt.
The Ayurvedic texts recommend external and internal cooling treatments for trishna. Both the virya and the temperature should be cold. (Do not use these cooling treatments as first aid for surgical shock. Warm blankets and warm drinks are needed for surgical shock). Pure water mixed with honey or sugar and treated with heated stone or terracotta provided the ancient version of today's ORS. You can also give dashamoola tea or thin barley gruel, an Ayurvedic recipe which became well known in Old London and was invariably given to me as a child whenever I had gastroenteritis. Cold baths are useful especially for dehydration due to heatstroke or fever. Chicken soup or mung soup can be mixed with jivaniya (invigorating) herbs such as Ashwagandha and Vidari. Cooling infusions such as Rehydration teas and Ultimate Pitta Soothing Milk are useful as well as brahmi ghee nasya. (9).
Rehydration Tea 1
- 1 quart of filtered or spring water
- 2 heaping tsp Peppermint
- 1 heaping tsp Brahmi
- ¼ tsp salt
1 small squeeze lime
Rehydration Tea 2
1 quart spring water
One quarter cup hibiscus
One eighth cup organic rose
Brew as a sun tea, add one tablespoon of Aloe Vera juice to each cup.
Ultimate Pitta Soothing Milk
1 cup milk
1 tsp cardamom powder
2tsp Rose petal jam.
Simmer the cardamom powder in the milk for 5 minutes. Pout into a cup, (preferably a white cup or a silver one), add the rose petal jam and stir.
For vattaja trishna, curds mixed with jaggery are given and also warm decoctions of herbs in the vidaryadi group, which include Vidari and dashamoola (10). For pittaja trishna with burning sensations, use cooling flower waters such as rose water and lavender or lilac water, essential oils such as vetiver and cold infusions of cooling herbs like shatavari, coriander, and mustha with raw sugar or honey (11) Sherbet can be prepared from bilva fruit powder and diluted concord grape juice can be given. For kaphaja trishna, neem, an important herb in lowering blood sugar, is recommended, along with bilva and dashamoola (12, 13). Barley gruel, having a low glycemic index (14), is also recommended and so is use of nasya oil.
Anorexia nervosa, another cause of dehydration, is recognized as 'thirst due to avoidance of food'. Nowadays, a patient whose anorexic condition has reached the point of dehydration would be admitted to an inpatient facility. In ancient times they were cautiously rehydrated using thin, warm gruel in summer and cool satu (roasted barley flour) cooked with water, ghee and sugar in the summer (15). And according to Vagbhat, alcoholic dehydration is treated by the old 'hair of the dog that bit you' method. "He should drink wine added with half its quantity of water mixed with sour and salt." (16).
Because dehydration can lead to death or to chronic illnesses such as kidney damage, it is essential to address dehydration as soon as it arises. Management of trishna takes priority in the treatment plan.
"The patient who is thirsty...if he does not get water in time, will either die or become a victim of chronic diseases. Hence his thirst should be controlled first by accustomed foods, drinks and medicines: when thirst is controlled it is easy to treat the other diseases. (17)
Trishna or thirst is a key disorder of ambu vaha srotas. By the use of cooling internal and external treatments including application of coconut brahmi oil, cold baths, ORS, rehydration teas and coriander teas, situations of mild dehydration can be addressed. Infusions of nourishing and invigorating herbs such as Vidari and shatavari are valuable in trishna, as are gruels with added herbal decoctions. Although serious cases of dehydration should be referred for emergency treatment, Ayurvedic interventions are of great use in milder cases.
1. KR Srikantha Murthy tr. Asthanga Sangraha Sharirasthan Ch 6 quoted from Ashtanga Hridayam Chowkhambha Krishnadas Academy Vol 1 p 403 footnote
2. Vasant Lad, Textbook of Ayurveda, Vol 2 pg 305
3. KR Srikantha Murthy tr. Ashtanga Hridayam Nidanasthanam ch V v 46-49 Chowkhambha Krishnadas Academy, Varanasi
4. KR Srikantha Murthy tr. Madhava Nidhanam Ch16 v 1 Chowkhambha Orientalia, Varanasi
5. ibid v 2
6. ibid v 3-4
7. ibid v 5
9. KR Srikantha Murthy tr. Ashtanga Hridayam op cit Chikitsa sthana Ch VI v 60-67.
10. ibid v 68
11. ibid v 69-72
12.ibid v 72-74
13. Khosla P, Bhanwra S, Singh J, Seth S, Srivastava RK. A study of hypoglycaemic effects of Azadirachta indica (Neem) in normal and alloxan diabetic rabbits. Indian J Physiol Pharmacol. 2000 Jan;44(1):69-74.
14. Y Granfeldt, H Liljeberg, A Drews, R Newman and I Bjorck Glucose and insulin responses to barley products: influence of food structure and amylose-amylopectin ratio, American Journal of Clinical Nutrition, Vol 59,1075-1082 1994
15. KR Srikantha Murthy tr. Ashtanga Hridayam op cit Chikitsa sthana Ch VI v 76
16. ibid v 78b
17. ibid v 83-84