VOMITING (CHARDI) IN CHILDREN

VOMITING (CHARDI) IN CHILDREN – ETIOPATHOGENESIS, CLASSIFICATION, CLINICAL PRESENTATION AND MANAGEMENT

DEFINITION

• Vomiting (Chhardi) is the forceful expulsion of gastric contents through the mouth, which may be due to gastrointestinal or systemic causes.

• In Ayurveda, Chhardi is considered as a disorder of Urdhwaga Dosha Dushti, mainly involving Vata, Pitta, and Kapha in the Amashaya region.

ETIOPATHOGENESIS

MODERN VIEW

• Physiology: Vomiting is controlled by the vomiting center in the medulla oblongata. It receives input from the GI tract, vestibular system, higher cortical centers, and chemoreceptor trigger zone (CTZ).

• Common causes in children:

  • Gastrointestinal: gastritis, gastroenteritis, pyloric stenosis, GERD

  • Infectious: viral illness, UTI, sepsis

  • Neurological: increased intracranial pressure, meningitis

  • Metabolic: DKA, uremia

  • Toxins or medications

AYURVEDIC VIEW

• Chhardi is mainly due to vitiation of doshas in the Amashaya.

• The aggravated doshas travel in the urdhwa marga (upward tract), causing vomiting.

RELEVANT SHLOKAS

छर्दिर्वातात् पित्तात् कफात् त्रिभ्यश्च संश्रयात् तथा।
सन्निपातात् क्षुधास्वेदात् क्रोधभयात् क्षता भृशात्॥
(Ashtanga Hridaya, Uttarasthana 10/1)

Explanation: Chhardi is caused by vitiation of Vata, Pitta, Kapha individually or combined (Sannipata), and can also be triggered by hunger, exertion, anger, fear, or injury.

PATHOGENESIS (SAMPRAPTI)

• Dosha: Vata, Pitta, Kapha (single or combined)

• Dushya: Rasa, Anna, and Kleda

• Srotas: Annavaha, Rasavaha

• Marga: Urdhwamarga (upper tract)

• Udbhavasthana: Amashaya

• Vyaktisthana: Mukha (mouth), Kantha (throat), Jihva (tongue)

CLASSIFICATION

MODERN CLASSIFICATION

• Based on duration:

  • Acute vomiting (e.g., gastroenteritis)

  • Chronic vomiting (e.g., GERD, CNS causes)

• Based on cause:

  • Central: intracranial pressure, infection

  • Peripheral: GI infections, obstruction

  • Metabolic: uremia, acidosis

  • Functional: cyclic vomiting syndrome

AYURVEDIC CLASSIFICATION (BASED ON DOSHA)

1. VATAJA CHHARDI

   • Projectile, with dryness, abdominal pain, gas

2. PITTAJA CHHARDI

   • Yellow-green vomitus, sour smell, burning sensation

3. KAPHAJA CHHARDI

   • Thick, white, slimy vomiting; heaviness

4. TRIDOSHJA (SANNIPATAJA)

   • Mixed symptoms, severe, difficult to treat

5. AGANTUJA CHHARDI

   • Caused by psychological factors like fear, grief, etc.

CLINICAL PRESENTATION

MODERN VIEW

• Symptoms:

  • Nausea

  • Abdominal discomfort

  • Forceful ejection of stomach contents

  • Dehydration (dry mouth, sunken eyes, poor skin turgor)

  • Poor oral intake, lethargy

• Signs of severity:

  • Bilious vomiting (suggests obstruction)

  • Blood in vomit (suggests ulcer or tear)

  • Persistent vomiting with altered consciousness

AYURVEDIC VIEW

• Vataja: Pain, sound during vomiting, dryness

• Pittaja: Burning, yellow vomit, thirst

• Kaphaja: Heaviness, sweet taste, mucus in vomit

• Sannipataja: Mixed symptoms, foul smell, and weakness

• Agantuja: Induced by psychological factors

RELEVANT SHLOKA

तीव्रा सन्निपता या स्यात् छर्दिः कण्डूविवर्णिनी।
सावर्णा दुर्गता घोरा भृशरूक्षोष्णतिक्तता॥
(Ashtanga Hridaya, Uttarasthana 10/6)

Explanation: Sannipataja Chhardi is severe, dangerous, foul-smelling, and associated with discoloration and extreme dryness.

MANAGEMENT (CHIKITSA)

MODERN MANAGEMENT

• Assessment:

  • Hydration status, signs of shock, neurological signs

• Treatment principles:

  • Oral rehydration (ORS) or IV fluids

  • Antiemetics (Ondansetron, Domperidone)

  • Treat underlying cause (e.g., antibiotics in UTI)

  • Dietary management: Small, frequent feeds; avoid oily or spicy foods

AYURVEDIC MANAGEMENT

GENERAL PRINCIPLES

• Remove the causative factors (Nidana Parivarjana)

• Langhana and Pachana in initial stages

• Samsamana chikitsa depending on dosha

DOSHA-WISE CHIKITSA

1. VATAJA CHHARDI

   • Use of Snigdha and Ushna dravyas

   • Medications: Sukumara ghrita, Hingvastaka churna

2. PITTAJA CHHARDI

   • Use of Sheetala, Tikta, Madhura drugs

   • Medications: Guduchi, Draksha, Amalaki, Patoladi gana

3. KAPHAJA CHHARDI

   • Katu, Tikta, Laghu dravyas

   • Medications: Trikatu churna, Vyoshadi vati

4. SANNIPATAJA

   • Complex treatment with Tridosha hara approach

   • Medications: Vacha, Shunthi, Pippali

5. AGANTUJA CHHARDI

   • Manasika nidana nivarana (psychological support)

   • Medications: Brahmi, Shankhpushpi, Ashwagandha

SOME CLASSICAL YOGAS

• Chhardi Nigrahana Yoga:

  • Pathya: Mudga yusha, rice gruel

  • Haritakyadi yoga (Haritaki + Vacha + Shunthi + Saindhava)

  • Sutshekhar Rasa – for Pitta-Vata involvement

  • Karpuradi vati – for severe nausea

RELEVANT SHLOKA

छर्दिं निगृह्णाति हरीतकीवचासैन्धवयुक्तशुण्ठी च।
(Ashtanga Hridaya, Uttarasthana 10/13)

Explanation: A combination of Haritaki, Vacha, Saindhava, and Shunthi is effective in controlling vomiting.

PLAN FOR CHHARDI IN CHILDREN

1. Assess dosha dominance clinically

2. Correct dehydration using ORS or IV fluids

3. Dosha-specific herbal treatment

4. Dietary advice: Laghu, easily digestible, non-spicy food

5. Avoid nidana like oily, heavy food and psychological stress

6. Supportive care: Calm environment, rest

7. Follow-up and monitor for recurrence