By Dr Raghuram Y.S.MD (Ay).
‘Want of water’ is expressed by the body in the form of ‘Thirst’. Thirst is manifested in the form of dryness of mouth. We all have experienced it. Generally dry mouth is relieved immediately after consuming water.

But when it remains unresolved and persistent even after frequent and adequate intake of water for longer period of time, it might hint a bigger picture!!

It is more than a mere THIRST factor….
Continuous excessive dry mouth or excess thirst is medically called ‘Xerostomia’ or ‘Dry Mouth syndrome’.
The clinical picture of a disease called ‘Trishna Roga’ explained in Ayurvedic texts resembles with that of Xerostomia.
We will try to know what exactly this ‘Dry Mouth disease’ is and everything related to it in this article and make a comparative study with ‘Trishna Roga’ explained in Ayurveda.

Tips to relieve dry mouth

Poly-pharmacy (taking many medicines) is also thought to be the major cause of xerostomia in older people. If you think you are taking too much medicines / supplements, talk to your doctor.
Anxiety is a major cause for dry mouth. 
Leave the habits of smoking, chewing tobacco and alcohol.
Try to avoid mouth breathing as much as you can.
Avoid excess sweets
Keep your oral cavity clean with regular flossing, brushing, tongue cleaning and oil pulling.
If you have tooth caries, consult a dentist and get it corrected.
Gargle with warm salt water 3-4 times daily
The best and simple option for excessive thirst and dry mouth is to increase fluid intake, especially drinking water to one’s content
Eat frozen chunks of water based fruits and vegetables like watermelon, cucumber, pineapple etc
Drink fruit juices, vegetable juices and smoothies
Coconut water is yet another option. Try drinking tender coconut water at least once or twice a day
Eat soft and liquid diet like stews and soups
Avoid excess coffee, tea, sodas and alcoholic drinks
Suck on sugar-free candy or chew sugar-free gum
Drink plenty of water, but avoid sipping slowly as this can wash off any saliva. Carry a drink bottle wherever you go
Use a room vaporizer to add moisture to the bedroom air
Avoid spicy foods
If you have an option then avoid taking medicines like diuretics, antihistamines and decongestants
Occasionally inhale steam to help moisturize your nasal passages and airways
Drink water while eating and chew your food thoroughly before swallowing. Chewing stimulates flow of saliva. After a meal, rinse your mouth with warm water or salt water.
Lower your intake of spicy and acidic foods as they can irritate the inside of your mouth.
Munch on snacks that have high water content like celery sticks to stimulate the salivary glands and to add moisture to your mouth.
Avoid crunchy foods that could injure the mouth (Crackers, potato chips and crisps etc)
Avoid acidic foods and beverages to protect your tooth enamel (soft drinks citrus fruits and citrus juices)
Avoid mint lollies and mint mouthwashes (they have a tendency to dry the oral mucosa and mouth tissue thereby increasing the risk of tooth decay
Ask your doctor and dentist for other dietary suggestions including a complete list of foods and drinks to limit or avoid dry mouth

• Increase Fluid / Water intake:
• The best and simple option for excessive thirst and dry mouth is to increase fluid intake, especially drinking water to one’s content
• Dehydration is one of the most common causes for dry mouth. So the best way you can help your body is to supply enough fluids and keep it hydrated. Proper hydration will help your body to produce saliva more easily.
• Water is the best fluid which you can supply to your body. Consume enough quantity of water regularly, everyday. If you can’t drink water, suck on small pieces of ice
• Eat frozen chunks of water based fruits and vegetables like watermelon, cucumber, pineapple etc
• Drink fruit juices, vegetable juices and smoothie’s
• Coconut water is yet another option. Try drinking tender coconut water at least once or twice a day
• Eat soft and liquid diet like stews and soups
• Avoid caffeinated beverages, sodas and alcoholic drinks

Self-Care suggestions:

• Keep getting guidance by your doctor and dentist. There is no alternative to that. But general self-care suggestions which you may follow include:
• Brush and floss your teeth at least twice daily
• Regularly use fluoride-containing products (take dentist’s opinion)
• Use Vaseline for dry lips (or any greasy balm like lanolin)
• Keep a room humidifier in your room
• You can have some sprays, lozenges or pastes that moisten your mouth at your disposal
• Keep intimated and updated about your dentures from your dentist (if you are wearing), adhesive dental products may be recommended
• Take out partial or full dentures while you sleep
• Visit dentist for regular check-ups and treatment if necessary
• Don’t change any medication without your doctor’s consent

Home remedies

Cayenne Pepper

• It is known to stimulate saliva production. It will also bolster your taste buds so that you can distinguish and appreciate different tastes and flavours
• Rub a small amount of cayenne pepper around your tongue with wet finger. Initially it will cause some burning sensation but it will stimulate your salivary glands
• Its powder can be sprayed in soups, salads and other dishes
• Ask your doctor if you can take cayenne pepper in capsule form!

Fennel Seeds

• Fennel seeds consist of flavonoids. These will stimulate the flow of saliva and hence get rid of dry mouth.
• Fennel seeds have aromatic flavour. This helps combating the bad breath which often accompanies dry mouth
• You can munch these seeds many times in a day
• You can also mix equal amount of fenugreek seeds with it and dry roast them in a pan. Grind them and add a little salt. Eat ¼ – ½ teaspoon of this mixture after each meal.

Slippery elm (Ulmus rubra) 

• It contains mucilage. Due to this it becomes a slick gel when mixed with water. This gel helps to coat and soothe the mouth and throat. It also alleviates dry mouth condition.
• Add 1-2 tablespoons of slippery elm to a cup of hot water. Cover it and allow for 10 minutes. Strain and add honey. Drink at least 2 times in a day.
• Prepare a paste with slippery elm bark powder and water. Apply it inside the mouth, leave it for a few minutes and then rinse your mouth with water

Oil pulling

• It is similar to Gandusha and Kavala explained in Ayurveda.
• It keeps your mouth moist and hence is useful in dry mouth.
• It is also good for maintaining oral health and eliminating bad breathe.
• For oil pulling, coconut oil, sesame oil, any edible vegetable oil or Ayurvedic herbal oils are used.

How to do?

• Put the oil in your mouth (1 spoon)
• Swish the oil thoroughly in your mouth for 15-20 minutes
• Spit it out and rinse your mouth with warm water
• Brush your teeth
• Do it first thing in the morning and at evening before dinner
• Do not gargle or swallow the oil

Aloe Vera

• It helps to protect the sensitive tissue in the mouth and enhances the taste buds
• Drink ¼ cup of Aloe vera juice daily to cure dry mouth
• Use its juice for rinsing your mouth once or twice daily
• Apply pure Aloe vera gel around your mouth using a cotton swab. Leave it for a few minutes and then rinse your mouth with water. apply 3-4 times in a day. 

Grape-seed oil

• It is a good and effective remedy to eliminate symptoms of dry mouth. It has a moisturizing property which coats your mouth and keeps it moist for a longer period of time. It is high in Vitamin E and thus can heal mouth sores
• Rub some oil on your tongue and inside your cheeks with your fingers. Leave it overnight.
• Next morning, rinse your mouth with warm water and then brush your teeth
• Repeat daily before going to bed.

Lemon

• Lemon juice can stimulate saliva production and relieve dry mouth
• Its acidic nature can help to cleanse your mouth and eliminate bad breath.

Cardamom

• Chewing a pod of cardamom will moisten the mouth as well as eliminate bad breath associated with dry mouth
• Chew a pod of cardamom after every meal or whenever your mouth is dry
• Add 1 tablespoon of cardamom powder to a glass of hot water. Let it steep for 10 minutes and then drink. Do it twice or thrice daily.
• You can also rinse your mouth with lukewarm tea of cardamom

Ginger

• Ginger stimulates saliva and can make your mouth feel fresh for long
• Chew a piece of fresh ginger slowly. Do it several times in a day
• You can drink 2-3 cups of ginger tea mixed with honey to stimulate your glands

Silica Gel Take 1 teaspoon of the gel and swirl it around in your mouth before swallowing. Silica is said to be useful for binding water in our cells.

Cloves – Put 4-5 cloves in your mouth and swirl them around or suck on them. They are effective in stimulating saliva & they can make your mouth feel fresher.

Gentian Herbal liquid extract – 5-10 drops swirled around your mouth

Dendrobian

• It is used in the form of a tea or possibly as a regular herbal supplement
• According to Chinese herbalists it is said to produce copious amount of saliva in the mouth
• It can be used along with licorice in the team
• American Ginseng liquid extract: 8-10 drops for swirling in the mouth

Derivation of Xerostomia:
The word Xerostomia is derived from 2 Greek word –

• Xeros – meaning Dry
• Stoma – meaning Mouth

Thus Xerostomia means Dry Mouth

Definition of Xerostomia (Dry Mouth)

• Xerostomia is the subjective feeling of oral dryness.
• It is often (not always) associated with hypofunction (less functioning) of salivary glands

Dryness in the mouth may be associated with:

• Change in salivary composition
• Reduced salivary flow (Hyposalivation)
• No identifiable causes
• Psychogenic changes

Xerostomia (Dry mouth) – Related terms

Saliva:
Saliva is a watery substance located in the mouths of animals, secreted by the salivary glands. Human saliva is 99.5% water, while the other 0.5% consists of electrolytes, mucus, glycol-proteins, enzymes, antibacterial and bacteria compounds such as secretory IgA and lysozyme

Salivary glands:
They are located around the mouth and throat
These glands make saliva, which is pumped into the mouth along tiny channels called salivary duct.
The salivary glands are:

• Parotid Glands – They are located in front of your ears and behind the angle of the jaw
• Sub-mandibular Salivary Glands – They are located beneath the tongue on both sides of the jaw (mandible)
• Sublingual Salivary Glands – They are found in the floor of the mouth
• Minor Salivary Glands – They are found in various locations around the mouth, including the inner cheeks and throat.

Note:

• A steady flow of saliva keeps the mouth moist at all the times
• Chewing and swallowing food increases the flow of saliva
• Just looking at appetizing, favorite or most tasted foods can also cause an increased saliva flow

Functions of Saliva:

• Having enough saliva keeps our mouth healthy as it:
• Saliva contains components that can directly attack the bacteria that cause decay. Thus any infection is checked at the mouth itself.
• Saliva has anti-fungal properties
• Saliva helps to destroy viruses
• Saliva neutralizes the acids produced by the plaques
• Saliva contains phosphorus and calcium. These substances are vital to the ongoing process of remineralisation, which is the rebuilding of tooth enamel (hard surface layer that protects the tooth) to prevent tooth decay
• Saliva moistens food, which enables comfortable swallowing
• Saliva helps with the formation of particular sounds in speech
• Saliva boosts sensation inside the mouth and allows the experience of pain, food texture and taste.

Hypo-salivation – Hypo-salivation means less production of saliva or spit.

• Saliva flows from each salivary glands located in our mouth. If the flow rate of saliva from the whole or individual gland reduces and if the reduced flow can be demonstrated, it is called Salivary gland Hypo-function or Hypo-salivation
• Un-stimulated saliva flow rate: Whole saliva flow rate in a normal person is 0.3-0.4 ml/minute (when salivary gland is not stimulated). If it is less than 0.1ml/minute it is said to be significantly abnormal.
• Stimulated saliva flow rate: When the salivary glands are stimulated, if the saliva flow rate is less than 0.5ml/gland in 5 minutes or less than 1ml per gland in 10 minutes, it is said to be decreased

Subjective Xerostomia: When we cannot find any detectable abnormality or cause for dry mouth the condition will be called Subjective Xerostomia. Xerostomia can also result from a change in composition in saliva (from serous to mucous)

Salivary Gland Dysfunction – It is an umbrella term (common term) used to denote the presence of either Xerostomia or Salivary Gland Hypo-function (SGH)

Hypo-salivation is a clinical diagnosis. It is made based on the clinical history and examination

Important points

• Common symptom: Dry Mouth is a very common symptom
• Dry mouth is also called as xerostomia
• Not a disease: A Dry Mouth is a symptom of an underlying health problem rather than being a disease itself.
• Side effect: It can be seen as a side effect of many types of medication
• Occurrence: About 10% of the general population and 25% of older people have dry mouth syndrome
• Old people: It is more common in older people
• Mouth breathing: It is also common in those people who breathe through their mouth
• Persistent dry mouth: It is generally due to prescriptions medications, medical treatments and certain autoimmune diseases such as Sjogren’s syndrome
• Treatment: It includes products that help to moisten the mouth

Causes

• Physiological causes:
• Salivary flow rate is decreased during sleep. This may lead to a transient sensation of dry mouth on waking up. This usually disappears when you eat or drink. It also gets fine when you maintain a good oral hygiene.
• When dry mouth is associated with halitosis (bad breath) – it is termed as ‘Morning Breath’ (Morning breath = dry mouth + bad breath from mouth)
• Dry mouth commonly occurs during periods of anxiety (enhanced sympathetic drive)
• Dehydration causes hypo-salivation (body trying to conserve fluid)
• Xerostomia has increased prevalence in old people because of physiological age-related changes in the salivary gland tissues leading to reduction in salivary output.

Note: Poly-pharmacy (taking many medicines) is also thought to be the major cause of xerostomia in older people

Side effect of certain medications:
Dry mouth is often a side effect of certain medications. These include the drugs prescribed (or taken without prescription) for:

• Depression, Anxiety
• Pain
• Allergies, Colds (antihistamines and de-congestants)
• Obesity
• Acne
• Epilepsy, Parkinson’s disease
• Hypertension (diuretics)
• Diarrhoea, Nausea
• Psychotic disorders
• Urinary incontinence
• Asthma (certain broncho-dilators)
• Muscle relaxants, Sedatives

Allopathic Medicines that cause dry mouth: (with or without objective hypo-salivation and / or altered saliva consistency)

• Atropine, Atropinics and Hyoscine
• Antidepressants (Tricyclic antidepressants, Selective Seortonin reuptake inhibitors, Lithium)
• Anti-hypertensives (Terazosin, Prazosin, Clonidine, Atenolol, Propranolol)
• Pheothiazines
• Antihistamines
• Anti-reflux drugs (proton pump inhibitors ex. Omeprazole)
• Opioids, Cannabinoids, Retinoids
• Cytotoxic drugs
• Bupropion
• Protease inhibitors
• Diadanosine
• Diuretics
• Ephedrine
• Benzodiazepines
• Interleukin-2

Note: 

• A medication that causes Xerostomia is called Xerogenic.
• Over 500 medications that are available produce Xerostomia as a side effect
• Out of 200 most commonly prescribed drugs in US, 63% are Xerogenic
• The likelihood of Xerostomia increases in relation to the total number of medications taken.
• Anticholinergic, sympathomimetic or diuretic drugs are usually responsible

Side effects of certain diseases and infections:
Dry mouth can be a side effect of certain medical conditions like:

• Sjogren’s Syndrome
• HIV/AIDS
• Alzheimer’s disease
• Diabetes mellitus
• Anaemia
• Cystic fibrosis
• Rheumatoid arthritis
• Hypertension
• Parkinson’s disease
• Stroke
• Mumps
• Hyperparathyroidism
• Cholinergic dysfunction
• Salivary gland aplasia or atresia
• Sarcoidosis
• Graft-versus-host disease
• Renal failure
• Hepatitis-C virus infection
• Lambert-Eaton syndrome
• Amyloidosis
• Cerebral palsy
• Primary biliary cirrhosis
• Lupus

Sjogren’s syndrome:
I would like to make a special mention about this disease among the above lot because in this disease xerostomia is caused by an auto-immune damage to the salivary glands. (Autoimmunity – the protective system of our body loses its intelligence and starts destroying its own cells, tissues and organs).

Sjogren’s syndrome also causes other symptoms like dry eyes (xeropthalmia), dry vagina, fatigue, myalgia (muscle pain) and arthralgia (joint pain)

Side effect of certain medical treatments:
Radiation to the head and neck
Chemotherapy for cancer
These treatments can damage the salivary glands and reduce the amount of saliva

Nerve Damage: Dry mouth can result from a nerve damage occurring to the nerves of head and neck area from an injury or surgery

Dehydration (Water or metabolite loss):
Conditions that lead to dehydration are:

• Fever, Excessive sweating
• Vomiting, Diarrhoea
• Blood Loss
• Burns
• Diabetes (rare)

Surgical removal of the salivary glands

Lifestyle:

• Smoking, Alcohol, Chewing tobacco

Mouth-breathing: Habitual breathing through mouth usually caused by partial obstruction of the upper respiratory tract, persistent stuffy nose or blocked sinuses or hormonal changes from pregnancy or menopause

Sicca Syndrome:
Sicca means dryness. Sicca syndrome is not a specific condition, the term can be used to describe mouth and eye dryness that is not caused by autoimmune diseases like Sjogren’s syndrome

Other causes:

A bacterial or viral infection of the salivary glands (such as mumps) can cause inflammation and restrict saliva production

Salivary duct obstructions – Ex. Tiny stones made from saliva minerals may lodge in the salivary ducts and restrict saliva flow

Recreational drugs such as:
Methamphetamine, Cannabis, Hallucinogens, Heroin

Symptoms

• Sticky and dry feeling in the mouth
• Frequent thirst
• Sores in the mouth
• Sores (split skin) at the corners of the mouth
• Cracked and dry lips
• Dry feeling in the throat
• Burning or tingling sensation in the mouth (especially in the tongue)
• Dry, red, tough, raw tongue
• Tongue always tends to stick to the roof of the mouth
• Problems speaking
• Trouble in tasting, chewing and swallowing (particularly dry foods such as biscuits)
• Dry nasal passages
• Hoarseness, sore throat
• Bad breath
• Saliva that feels thick and stringy
• Susceptibility to oral thrush infections
• High rate of tooth decay
• Pricking and burning sensation in the mouth
• Loose acrylic dentures (as saliva helps to create the suction between the gum tissues and the acrylic base of the denture)

Signs and Symptoms of Hypo-salivation:
Dental caries (xerostomia related caries)
Saliva has an anti-carcinogenic action.
Without saliva tooth decay is common feature.
Rampant caries – Tooth decay progression is very aggressive in the absence of saliva
Often seen in patients who have had radiotherapy involving major salivary glands (radiation induced caries)

• Acid erosion
  Saliva acts like a buffer and helps to prevent demineralization of teeth
  In the absence of saliva, the teeth undergo demineralization and get eroded
• Oral candidiasis
  Saliva provides antimicrobial action in the mouth.
  Its absence leads to opportunistic infections with Candida species
• Ascending (suppurative) sialadenitis –
  It is an infection of a major salivary gland (usually parotid gland) that may be recurrent
  Associated with hyposalivation
  There may be swollen salivary glands even without acute infection possible caused by an autoimmune involvement
• Dysgeusia – Altered taste sensation (ex. Metallic taste) and
• Dysosmia – Altered sense of smell
• Intraoral halitosis – Due to increased activity of halitogenic bio-film on the posterior dorsal tongue
• Oral dysthesia – Burning or tingling sensation in the mouth
• Saliva that appears thick or ropey
• Mucosa that appears dry
• Lack of saliva pooling in the oral floor during examination
• Dysphagia – Difficulty in swallowing and chewing. Happens mostly while eating dry foods. Food may stick to the tissues during eating
• Tongue may stick to the palate causing a clicking noise during speech or lips may stick together
• Gloves or a dental mirror of the physician may stick to the tissues while examination
• Fissured tongue with atrophy, lobulated erythematous appearance of the tongue
• Saliva cannot be milked (expressed) from the parotid gland
• Difficulty wearing dentures, areas covered by the denture may be sore or ulcerated
• Mouth soreness and oral mucositis
• Lipstick or food may stick to the teeth
• A need to sip drinks frequently while talking or eating
• Dry, sore and cracked lips and angles of mouth and thirst

Note:

Sometimes the clinical findings and the symptoms experienced do not match. Ex. A person with signs of hypo-salivation may not complain of xerostomia.

On the other hand, the person with xerostomia may not show signs of reduced salivary glands (subjective xerostomia). Here there are often other oral symptoms suggestive of oral dysesthesia (burning mouth syndrome).

Other symptoms outside the mouth may occur together with xerostomia.

The symptoms co-existing with xerostomia (Related symptoms in the rest of the body) are:

• Xerophthalmia (dry and itchy eyes)
• Inability to cry
• Blurred vision
• Photophobia (light intolerance)
• Dryness of other mucosa (ex. Nasal, laryngeal and or genital) i.e. Dry nose, Dry throat, Dry vagina etc
• Burning sensation
• Itching
• Grittiness
• Dysphonia (voice changes)
• Frequent coughing
• Reduced sense of smell
• Constipation
• Joint pains and stiffness
• Generally feeling unwell
• Unexplained weight loss
• Frequent vaginal thrush infections in women

Dry Mouth Syndrome and Tooth Decay:

• Poor oral hygiene and a sugar rich diet always predisposes to cause tooth decay (dental caries). This occurs in the biting surfaces and in between the teeth. Dry mouth syndrome too causes tooth decay but in a different pattern. The decay of teeth tends to start along the gum line (gingival margin) and in some cases, the gums draw-back to expose the underlying tooth layer (dentine)
• Unlike enamel, the dentine provides less resistance to the acids and decay tends to be rapid. Decay of the exposed dentine is called ‘root caries’
• Decay may also be seen on the lower front teeth which are normally well protected by saliva produced from beneath the tongue.

Why is dry mouth a problem?
Dry mouth is a big problem because besides causing the symptoms mentioned above, dry mouth also raises the risk of:

• Gingivitis (gum disease)
• Tooth decay
• Mouth infections such as thrush

Diagnosis

• Predominantly on the clinical signs and symptoms
• Physical examination includes:

Oral examination – Inner cheeks appear dry and rough
Tooth examination – Doctor or dentist may check the pattern of tooth decay

• Sialometry – objective test of salivary flow
• Scintiscanning using technetium (rarely used)
• Chest X-ray (to exclude sarcoidosis)
• Ultrasonography and MRI (to exclude Sjogren’s syndrome or neoplasia)
• Salivary gland biopsy (usually taken from the lip) – if there is suspicion of organic disease of the salivary glands
• Blood tests and urine analysis (to exclude a number of possible causes)
• Schirmer test of lacrimal flow or Slit lamp examination – to investigate xeropthalmia (dry eyes)

Dry Mouth Ayurvedic Concepts

Dry Mouth can be compared to a condition called Trishna explained in Ayurveda. Trishna actually means thirst. Thirst is a natural phenomenon wherein there is a demand for water from the body. When we drink water, thirst pacifies. So we have to consider Trishna as excessive thirst or uncontrollable thirst.

Trishna, explained in Ayurvedic texts is a disease entity by itself. Trishna is also mentioned as a symptom of many other diseases. The clinical presentation of Trishna (other than normal thirst) can manifest in different forms:

Trishna as a Roga – As a disease:
This part will be dealt with in detail in this article along with its treatment

Trisna as a Purvarupa – As a premonitory symptom of a few diseases:

• Grahani
• Prameha
• Shitapitta
• Jwaramukta

Trishna as a Rupa / Lakshana – As a symptom of some diseases:

• Ajeerna – Vidagdhajeerna
• Apasmara (pittaja)
• Amlapitta (adhogata)
• Atisara (pittaja)
• Arochaka (pittaja)
• Alasaka (ajeerna)
• Arshas (pittaja)
• Anaha (amaja)
• Amavata (ativriddha)
• Amashayagata Vata
• Udara – Pittaja udara, Plehodara (pittaja), Yakrutodara (pittaj), Sannipatodara udara, Udavarta (aharaja)
• Kasa – Pittaja kasa, Kshataja kasa
• Kanthashundi (taluroga)
• Garahani – Pittaja grahani, Vataja grahani
• Gulma – Pittaja gulma, Raktaja gulma
• Chardi – Pittaja chardi, Tridoshaja chardi
• Jwara – Antarvega jwara, Abhichara jwara, Abhishapa jwara, Kapha-pittaja, Gambhira jwara, Pachyamana jwara, Pittaja jwara, Bahirvega jwara, Mamsagata jwara, Medogata jwara, Raktagata jwara, Vata-pittaja jwara, Visha-krita jwara, Sannipataja jwara
• Daha – Dhatukshayajanya daha, Pittja daha, Raktaja daha, Kshataja daha
• Dushta-stanya pana (balaroga) – Pitta dushta
• Nadi vrana (Pittaja)
• Paramada
• Parinama shula
• Pandu (Pittaja)
• Mutraghata (Kundalibhuta)
• Balagraha – Andha-putana, Putana
• Madatyaya (Pittaja)
• Masurika – Pittaja, Mamsagata masurika, Vataja masurika
• Murcha – Pittaja murcha, Vishaja murcha
• Medoroga
• Raktapurna koshta
• Vatarakta (Pittadhika)
• Vidradhi – Abhighataja vidradhi, Kloma vidradhi,
• Visha – Dushi visha, Manduka visha
• Visha-lipta shastra kshata
• Visarpa – Agni visarpa, Kardama visarpa, Pittaja visarpa
• Vishuchika (pipasa)
• Visphota – Pittaja visphota, Raktaja visphota, Vataja visphota, Sannipataja visphota
• Vrana – Pittaja vrana, Pittaja nadi-vrana
• Vrana shota (pachyamana)
• Shula (pittaja)
• Shota (pittaja)
• Shwasa (Tamaka)
• Sutika roga
• Swarabheda (medaja)
• Halimaka
• Hrudroga (pittaja)

Trishna as an Asadhya Lakshana – As a symptom indicating bad prognosis of some diseases:

• Atisara, Asrugdhara, Arshas
• Antar-vidradhi
• Udavarta
• Kamala
• Kushta, Vatarakta, Shotha (pipasa)
• Gulma, Grahani
• Chardi
• Jwara, Pandu
• Masurika
• Hikka (yamala)

Trishna as an Upadrava – As a complication of some diseases:

• Atisara, Arshas, Ashmari
• Asrugdhara, Amavata, Chardi
• Prameha (pittaja), Vatarakta, Raktapitta
• Vrana shotha (pipasa)

Trishna Vega Avarodha Janya Udavarta lakshana: (Signs and symptoms caused due to forcible suppression of thirst reflex / urge):
Thirst is a normal expression of the body for ‘want of water’

If we make it a habit of suppressing the impending reflex / urge of thirst manifested by the body while giving priorities to other works (in a long process) causes –

• Kanta shosha – Dryness of the throat
• Asya shosha – Dryness of the mouth
• Shravana avarodha – Deafness
• Hridaya vyatha – Pain in the heart (cardiac area)

Trishna – 

• When it is an independent disease, Trishna has its own pathogenesis. It will manifest in 7 forms (explained below) and will have treatment specific to the types. They will generally be independent of other diseases but can give rise to many complications included death in very severe conditions.
• When Trishna is associated with other diseases (secondary Trishna) as enlisted above, it will go away if the main disease causing it is treated

Causes of Trishna

 Udakavaha Sroto Dushti:
According to Ayurvedic basics there are separate channels in our body for each dhatu (tissue or vital elements like water, stools, urine etc). They are called Srotas.

• Srotas are the channels which transport the dhatu’s or the essentials needed for the formation of the dhatu’s from one place to the other (nutrition, basic substances which form the matrix of the cells). Each srotas has a site of origin, path of distribution and a target cell or tissue or organ.

In this context we shall discuss about Udakavaha Srotas which are related to transportation of water to the needed cells and help in metabolism {Udaka = water}.

• Udakavaha Srotas (control mechanism of water metabolism) has its roots in Talu (palate) and Kloma (this is a controversial organ which has not been explained in precise context, it has been correlated with pancreas, pineal gland, adrenal glands or water regulating centers of the brain present above the palate).

When the Udakavaha srotas is contaminated it causes dryness in palate, lips, tongue and kloma and Pipasa (Trishna) i.e. thirst. When these symptoms prevail we should guess that Udakavaha Srotas has been diseased.

Treatment of Udakavaha Sroto Dushti – Treatment should be done on the basis of Trishna Roga Chikitsa (treatment line up of Trishna disease) – which I would be explaining in the coming passages.

• Kshobha – physical or mental irritation
• Bhaya – Fear
• Shrama – Exertion, Exhaustion
• Shoka – Grief
• Krodha – Anger
• Langhana – Fasting in excess
• Madhya – Excessive consumption of alcohol
• Kshara – Alkalis
• Amla – Sour food
• Lavana – Salty foods
• Katu – Spicy and pungent foods
• Ushna – Too hot foods and exposure to heat
• Ruksha Shushka anna – dry foods
• Dhatu kshaya – Depletion of body tissues
• Gadapakarsha – Being debilitated by a chronic illness
• Vamanadhyatiyogaat – Undergoing treatments like Vamana (therapeutic emesis) etc in excess
• Surya santapa – Excessive exposure to Sun
• Balasamkshaya – Decrease of bala (strength or immunity)
• Pittavivardhana – Foods and activities which bring about a pathological increase of Pitta

Pathogenesis

Due to the above said factors the Pitta and Vata get aggravated in the body. They in turn afflict the Soumya Dhatu’s (Tissues which are Kapha predominant or tissues having fluidity) and squeeze them out. They also dry up the Rasavahini’s (channels providing nutrition) of the root of the tongue, throat and palate. After doing so the deadly duo (vitiated Pitta and Vata) cause life threatening Trishna in the body. They both keep drying up whatever quantity of water that has been consumed. The afflicted person would like to drink water again and again but his thirst remains un-quenched even after drinking lot of water repeatedly. This Trishna is manifested in a severe form in those who have been debilitated due to chronic illness. Such Trishna is called Aupasargika Trihsna. They are thus manifested as a complication of some other underlying disease.

Pathogenesis according to Yoga Ratnakara:
Due to the above said factors, the Pitta accumulated in the upper portion of the body gets vitiated along with Vata,
The morbid pitta and vata later reach the Talu (Palate) of the person and afflicting it causes Trishna

Samanya Lakshana, Samprapti

Samnaya Lakshana – General (Common) symptoms of Trishna:

• The person afflicted by Trishna keeps drinking water but will never get satisfied
• After a short period he again wishes to consume water

Samprapti of Trisna (Pathogenesis)
Trishna is manifested when the ‘Udaka Vaha Srotas’ {channels related to the transportation of water or thirst regulating centres} is afflicted by the morbid Doshas

• Mukhashosha – Dryness of the mouth
• Svarabheda – Hoarseness or loss of voice
• Bhrama – Giddiness
• Santapa – Rise in temperature
• Pralapa – Delirium
• Samstambha – Stiffness or catches in the body
• Talvoshtakantajihva Karkashatam – Roughness of palate, lips, throat and tongue
• Chittanasham – Mind disturbances
• Jihva nirgamana – Protrusion of the tongue
• Aruchi – Tastelessness
• Badhirya – Deafness
• Marma dooyanam – Pain in the vital parts
• Saadam – Weakness of the body parts

Types of Trishna

Trishna is of 7 types. They are:

• Vataja Trishna
• Pittaja Trishna
• Kaphaja / Shleshmaja Trishna
• Kshataja Trishna
• Kshayaja Trishna (due to degeneration, ageing etc)
• Amajanya Trishna
• Bhuktodbhava Trishna

Purvaroopa

Purvarupa of Trishna (Premonitory symptoms):

• Toda – Pricking sensation in the palate-lips and throat
• Daha – Burning sensation
• Santapa – Raise in temperature (especially in mouth)
• Moha – Altered consciousness
• Bhrama – Giddiness

These premonitory symptoms are seen in all the above said types of Trishna
They are seen just before Trishna is manifested

Types and symptoms

Vataja Thrishna Symptoms:

• Shushkasyata – Dryness of the mouth
• Shanka-shiro-toda – Pricking pain in the temples and head
• Srotorodha – feeling of block in all the channels of the body
• Virasam cha vaktram – Altered taste in the mouth
• Shitabhiradbhischa vivriddayati – Gets aggravated by drinking cold water or any cold related activities

Pittaja Thrushna Symptoms:

• Murcha – Loss of consciousness
• Anna vidwesha – Aversion to food
• Vilapa – Delerium
• Daha – Burning Sensation
• Raktaksha – Redness of eyes
• Pratata Shosha – Repeated dryness of the mouth
• Shitabhinanda – Wishes to drink cold water, wants cold comforts
• Mukha tikta – Bitterness of the mouth
• Paridhupanam – Feeling of fumes or steam getting eliminated from the body / mouth

Kaphaja / Shlaishmika Trishna Symptoms:

When Kapha gets vitiated, it causes Bashpa Avarodha (obstruction to the transportation of water and the escape of its smaller portion from the skin). The Kapha and Bashpa Avarodha afflict the Jataragni (metabolic fire or gut fire) and diminish it qualitatively and quantitatively. This causes the below said symptoms including thirst –

• Nidra – Excessive sleep
• Gurutvam – Heaviness of the body
• Madhurasyata – Sweetness / Sweet taste in the mouth
• Trishna – Thirst
• Shushyati cha atimatram – Excessive dryness of the mouth
• Kantopalepa – Feeling of abnormal coating in the mouth and throat
• Mukha Picchilam – Stickiness of the mouth
• Shita Jwara – Fever with cold and chills
• Arochaka – Tastelessness
• Gurugatrata – heaviness of the body
• Shakasu shoshatvam – Dryness of the limbs (emaciation)
• Avipaka – Indigestion
• Kankshati na cha ati ambhum – Doesn’t ask for water

Kshataja Trishna Symptoms:

• Ruk – Pain
• Shonita Nirgamana – Excessive bleeding

Note: This type of thirst leading to dry mouth takes place due to excessive bleeding to any cause. Here kshataja means due to injury. Thus we will primarily consider ‘bleeding due to injury’. Excessive bleeding has been mentioned in one of the causes leading to xerostomia (dry mouth) even in modern medicine

Kshayaja Trishna Symptoms:
This type of Trishna is caused due to Rasa Dhatu Kshaya (quantitative and qualitative depletion of the first tissue i.e. Rasa Dhatu formed from the nourishing fluids or nutritive juices in circulation – post digestion in the gut).

Symptoms:

• Patient keeps drinking water throughout the day and night and is not at all satisfied even after drinking more and more water
• Some people call it ‘Sannipataja Trishna’ {Trishna manifested due to vitiation of all the 3 Doshas}

Amaja Trishna Symptoms:
This type of Trishna is caused due to excessive accumulation of Ama in the body.
Ama is an intermediate product of weak digestion process (sluggish metabolism at both gut and cellular level). This ama might accumulate at both cellular and gut level. Ama has a tendency to block all the transport systems of the body and cause cellular damage and cellular toxins.

Symptoms:
In this type, the symptoms of all the 3 – Vataja, Pittaja and Kaphaja Trishna will be manifested in mixed proportions. The other predominant symptoms are:

• Hrit-Shula – Pain in the heart / heart region
• Nishteevana – Spitting
• Sada – Laxity of body parts and weakness

Bhaktodbhava / Annaja Trishna:
Trishna or severe thirst leading to dry mouth is quickly manifested by consumption of the below said types of food:

• Snigdha Ahara – Oily food
• Amla Ahara – Sour Foods
• Lavana Ahara – Salty food, foods topped or added with more salt
• Guru Ahara – Heavy food (hard to digest)

Such type of Trishna caused or aggravated by food is called Bhaktodbhava or Annaja Trishna

Upasarga Trishna Symptoms:

• Deenasvara – feeble voice
• Pratamya – Feeling of darkness in front of the eyes
• Deenataa – Helplessness, feeling of weakness
• Mukha malinatva – feeling of a coating of dirt in the mouth
• Anana-gala-talu-hridaya shushkata – Dryness in the mouth, throat, palate and heart

When the Trishna is manifested with the above said symptoms it is called as Upasargaja Trishna

• Upasarga means infection or secondary manifestation of some primary disease

This Trishna is very dangerous. It dries up the body and is seriously troublesome. It creates a lot of complications also.

• Upasarga Trishna Prognosis:
  The Trishna with below said symptoms is said to have a bad prognosis (difficult to treat or impossible to treat):
• Jwara – Fever
• Moha – Loss of consciousness
• Kshaya – Depletion of tissues
• Kasa – Cough
• Shwasa – Difficulty to breathe / Dyspnoea
• Roga krusha– Person who has been emaciated or weakened due to the effect of some serious or chronic diseases
• Vamana – Severe and uncontrolled vomiting 

Prognosis

Trishna Asadhyata (Prognosis of Trishna):
The Trishna with the below said accompanying symptoms is said to have bad prognosis (impossible to treat, patient has death in waiting):

• Talu-oshta-kanta toda daha – Pricking pain and burning sensation in the palate, lips, throat
• Santapa – Rise in temperature
• Moha – Loss of consciousness
• Daha – Burning sensation
• Bhrama – Giddiness
• Vipralapa – Delirium

The patient having Trishna Roga should be denied treatment if he has the below said accompanying symptoms:

• Ksheena – Debility, tissue depletion
• Vibhinnam svaram – Change of voice
• Badhiram – Deafness
• Nirgata jihva – Tongue has come out of the mouth
• Trishna – Severe intolerable thirst

Complications

Complications of Trishna:
Jwara – Fever
Moha – Loss of consciousness
Kshaya – Depletion of tissues/consumption
Kasa – Cough
Shwasa – Dyspnoes / Breathlessness
Badhirya – Deafness
Bahirnirgata Jihva – Protruding tongue

Ayurvedic treatment

Vataja Trishna Treatment – 

• Vata alleviating food and drinks
• Consumption of madhura (sweet) and Sheeta (cold) food and drinks
• Milk and ghee processed with Jeevaneeya Gana (Jeevaneeya group of drugs)

Pittaja Trishna Treatment –
Udumbara Rasa – Juice of ripened fruit of Udumbara (Indian Fig Tree – Ficus Racemosa) mixed with sugar

• Laja Mantha – A refreshing drink prepared by churning the flour of Laja (parched rice, fried paddy, puffed grains) in milk.

Kashmaryadi Panakam:
{Panaka is a refreshing drink prepared in the form of sugared syrup processed with medicinal drugs}

The below said drugs are boiled in water –

• Gambhari fruit (Gmelina arborea)
• Rakta Chandana – Red Sandlawood (Pterocarpus santalinus)
• Usheera – Vetiveria zizanoides
• Padmakam – Prunus cerasoides
• Draksha – Vitis vinifera
• Madhuka – Glycyrrhiza glabra

The water boiled with the above said drugs is filtered added with sugar and consumed or the above said drugs are boiled with water and sugar so as to prepare syrup. The syrup is later diluted with water to required consistency and consumed.

Kaphaja Trishna Treatment:

• Tarpana (Refreshing drink)
• Vamana – Emesis with Saindhava Lavana (Rock salt) mixed water
• Avaleha – Herbal confection or jams prepared with Dadima (Pomegranate), Amlaphala (Tamarind) or with any other Kashaya Dravyas (drugs having astringent taste)
• Avaleha prepared from milk turmeric powder, honey and sugar

Kshataja Trishna Treatment:

• Treat the Kshata (injury or trauma) to begin with
• Mamsarasa pana – Meat soup
• Rakta pana – Blood to drink

Kshayaja Trishna Treatment:

• Milk mixed with water
• Meat soup mixed with honey
• Water mixed with honey

Amajanya Trishna Treatment:
Bilvadi Kwatha: Decoction prepared from Bilva (Aegle marmelos) and Vacha (Acorus calamus). This decoction is an appetite stimulant and digestant. It is also good in alleviating ama.

Bhukdodbhava Trishna Treatment:
Lekhana Kashayam – Decoction prepared with drugs which have a capacity to scrape excess kapha, ama and meda (fat) is given in Trishna manifested due to consumption of heavy foods.

• Gudodaka – Water boiled or processed with jaggery is given in Trishna manifested due to consumption of excess oily food

Paya pana: for debilitated and weak people having Trishna, lot of milk is given

Madhyaja Trishna:

• Acharya Charaka has also mentioned Madhyaja Trishna (Thirst caused due to consumption of excessive alcohol)
• When a person consumes excessive alcohol, the alcohol due to the influence of its hot, dry, deep penetrating and drying properties aggravates pitta and vayu. The vitiated Pitta and Vata squeezes out all the water of the body and causes Trishna

Madhyaja Trishna Treatment:

• The alcohol diluted with half the quantity of water and mixed with sour pomegranate juice, rock salt and other fragrant drugs should be given
• Give a cold water bath to the patient followed by diluted alcohol (as said above) and / or jaggery water

General line of treatment

Samanya Chikitsa Vidhi: (General line of treatment in all Trishna):
Aindra Jalam:

• Acharya Charaka advices to take Aindra Jala (rain water) mixed with honey. Since Aindra jala is not available all the time, Charaka advices one to take any water having the same qualities of Aindra Jala
• In the absence of Aindra Jala the water with below said qualities shall be taken:

Water available on the Earth, having Kashaya anurasa (astringent sub-taste), light in consistency, cold on touch, fragrant, having good taste and which doesn’t bring increase in Kapha

• Trinapanchamula Sadhita Jala: Water processed with Trinapanchamula(Kusha, Kasha, Ikshu, Shara, Darbha) group of drugs (roots of 5 grasses) mixed with sugar
• Laja Mantha: Refreshing drink prepared by churning the flour of Yava (barley) and honey in Aindra Jala

Yava Manda: Gruel prepared with Manda (Watery part of barley boiled with water) should be given mixed with honey and sugar.

Diet:

• Hot milk processed with honey and sugar
• Soup is extracted from the meat of Pigeon etc, fried in ghee and added with sugar and honey and consumed (salt or sour substances should not be added with meat soup

Avagaha:

• After rubbing the body of the patient afflicted with Trishna disease with Shatadhauta Ghrita (Medicated ghee processed for 100 times), he should be given tub bath with cold water. Later milk should be given for drinking.
• Yusha: Soup of green gram fried in ghee should be given to drink. This soup can also be used with rice.

Nasya:

• Milk is processed with medicines having sweet or bitter taste, cold potency or with Jeevaneeya Gana group of drugs. From this ghee is extracted. This ghee is used for massage, intake and nasal instillation
• Nasya (nasal drops) with breast milk or camels milk mixed with sugar
• Nasya with sugarcane juice

Vamana with Magadhikodaka – If the thirst increases (and keeps increasing) and in the presence of accompanying Anaha (fullness of abdomen) – Vamana (vomiting) should be administered using water processed with Magadhi (Pippali – Piper longum)

• Viloma Vidhi – After emesis, Viloma Vidhi or procedures (medicines) to propel and eliminate the morbid Dosha’s in a downward direction
• Phala rasa: Juices of Dadima (Pomegranate), Amlavetasa (Garcinia pedunculata) and Matulunga (Citrus medica) should be given to pacify Trishna

Tapta jala: Water dipped with heated gold, silver, copper, mud balls, brick, sand and stones should be used (warm) to quench the thirst

Shita Hima: Cold water mixed with sugar and honey

Water processed with Srungataka (Trapa bispinosa), Kasheruka (Scirpus grossus), Padma beeja (Lotus seeds), Bisa (Nelumbo nucifera) and Ikshu (Sugarcane) – This formulation alleviates Kshayaja Trishna and Pittaja Trishna

Shitala Jala and Vamana:

• Cold water mixed with honey is given stomach full
• Following this Vamana (vomiting) is induced
• This alleviates Trishna

Madhuradi Shrita Ksheera:

• Milk processed with Madhura Dravyas (Drugs which are sweet ex. Draksha – Vitis vinifera), Jeevaniya Gana drugs, Sheeta Dravyas(drugs which have cold potency) and / or Tikta Dravyas (drugs with bitter taste) should be consumed after adding honey and sugar
• The same milk shall be used for Abhyanga (massage) and Seka (stream pouring over the body)
• Ghrita (ghee) processed with the same drugs should be used for Pana (consumption, intake), Abhyanga (massage) and Nasya (as nasal drops)

Jeerakadi Kwatha:
Kwatha (decoction) prepared from –

• Cumin seeds
• Ginger and
• Sauvarchala Lavana (black salt)

To this decoction – Madya (alcoholic preparation or fermented medicinal liquid) which is proved to strengthen the heart and also has good fragrance should be mixed in half the quantity of the Kwatha.
This compound should be given to pacify Trishna

Amradi Kashaya: Decoction prepared from Amra (Mangifera indica – Mango) and Jambu (Syzygium cumini) mixed with honey 

Gostanadi Rasa:
The below said should be mixed and given to pacify or alleviate Trishna –

• Juice of Draksha (Vitis vinifera)
• Milk
• Juice of Ikshu (Sugarcane juice)
• Madhuka Kashaya (Decoction of Glycyrrhiza glabra)
• Honey
• Juice of Utpala (Nymphaea alba)

Tapta Jala: A mixture of water, jaggery and curds dipped with heated Mud balls, Pieces of earthen pots and sand alleviates Trishna manifested after Vamana (vomiting)

• Gandusha (Gargles)
• Amradi Kashayam – Decoction prepared from Amra (Mango) and Jambu (Syzygium cumini) mixed with honey – used for both drinking purpose and for Gandusha. When using it for Gandusha, it should be made cold.
• Vrikshamla Kwatha Gandusha – Decoction of Vrikshamla (Garcinia cambogia / Garcinia Indica) mixed with milk, sugarcane juice, honey, juice of Draksha (Vitis vinifera), Saindhava Lavana (Rock salt) and water mixed with Jaggery

This gargle alleviates Talu Shosha (dryness of palate) and Trishna (thirst and dry mouth)

• Godugdha – Cow’s milk
• Ikshurasa – Sugarcane juice
• Gudodaka – Jaggery water
• Sitopalodaka – Sugared water
• Madhu – Honey
• Madhvika – Alcohol prepared from honey
• Matuluga rasa – Juice of Citrus medica

Sparsha dravyas

• Sparsha Dravya: (Things which need to be touched to get relieved from Trishna)
• The head, chest and face of the patient afflicted with Trishna is touched with a cloth dipped in Mastu (Supernatant layer of curds or Curd water) and Kanji / Aranala (fermented liquid) {sponging}
• Patient is given Kamalamani hara (garland of lotus flowers or gems) to wear in the neck like an ornament
• Embracing a beautiful woman wearing a silk dress dipped in sandal water and whose breasts, hands and body has been anointed with sandalwood paste
• Thinking about or hearing stories about – lakes, forests, pond, rivers found in Himalaya, lotus, cold breeze, moon rays etc

Lepa – Application of herbal pastes:
Dadimadi Lepa –
The paste prepared from the following when applied on the head, alleviates Trishna (thirst) and Daha (burning sensation):

• Dadima – Pomegranate
• Badara – Ziziphus mauritiana – Indian Jujube
• Lodhra – Symplocos racemosa
• Kapitta – Limonia acidissima
• Beejapura – Citrus medica (Citron fruit)

Kushtadi Vati:
Tablets prepared from the below said should be used for sucking (as lozenges) to alleviate Trishna –

• Kushta – Saussurea lappa
• Musta – Cyperus rotundus
• Vata praroha – Shoots of Ficus Benghalensis
• Yashtimadhu – Glycyrrhiza glabra
• Honey

Dhanyaka Kwatha:

• Decoction of Dhanyaka (Coriandrum sativum) mixed with honey and sugar
• This decoction is very useful in Upasargaja Trishna (thirst which is a complication of some other disease or infections)

Chaga mamsarasa:
Goat Meat soup is cooled and mixed with ghee, honey and sugar alleviates Trishna, Daha (burning sensation), Murcha (fainting), Vamana (vomiting) and Madatyaya (alcoholic intoxication)

Wholesome diet

Pathya in Trishna (Good foods):

• Shastika Shali – Rice which is grown in 60 days
• Peya and Vilepi – Gruel’s
• Lajasaktu – Flour of Parched rice or puffed grains
• Annamanda – Water part of cooked rice (rice filtrate)
• Sharkara – Sugar
• Yusha (Soup) prepared from bhrista mudga (fried green grams), masura (Lens culinaris) and Chanaka (Cicer arietinum)
• Rambhapushpam – Plantain flower
• Kushmanda – Ash gourd
• Upodika – Basella alba
• Kharjura – dates
• Dadima – Pomegranate
• Amalaki – Emblica officinalis
• Beejapura – Citrus medica
• Gavam paya – Cow milk
• Jambeeram – Citrus medica
• Karamarda – Carissa carandas

Unwholesome diet

Apathya in Trishna (Bad foods for Trishna):

• Guru Ahara – Heavy foods
• Amla Ahara – Sour foods
• Lavana Ahara – Salty foods
• Kashaya Ahara – Astringent foods
• Trikatu – Powder of 3 pungent drugs (Piper longum, Piper nigrum and Zingiber officinale)
• Dushtajala – Contaminated water
• Teekshna Ahara – Irritating foods

Ayurvedic formulations, herbs

Some important formulations for Trishna:
(Click to know more about them)

• Dhanyakadi Hima
• Kharjuradi Mantha
• Shadanga Paneeya
• Kamadugha Rasa
• Chandrakala Rasa

Ayurvedic herbs used in the treatment of Trishna:

• Kharjura – Phoenix dactylifera (Dates)
• Draksha – Vitis vinifera
• Usheera – Vetiveria zizanoides
• Chandana – Santalum album (Sandal wood)
• Amalaki – Emblica officinalis (Indian gooseberry)
• Matulunga – Citrus medica
• Kashmarya – Gmelina arborea
• Dadima – Punica granatum (Pomegranate)
• Dhanyaka – Coriandrum sativum (coriander)
• Rambhapushpam – Plantain flower
• Kushmanda – Benincasa hispida (Ash gourd)
• Upodika – Basella alba
• Beejapura – Citrus medica
• Jambeeram – Citrus medica
• Karamarda – Carissa carandas
• Jambu – Syzygium cumini
• Amra – Mangifera indica (Mango)
• Kusha – Desmostachya bipinnata
• Kasha – Saccharum spontaneum
• Ikshu – Saccharum officinarum (Sugarcane)
• Shara – Saccharum munja
• Darbha – Imperata cylindrical

Note: The final 5 drugs Kusha to Darbha are called as Trina Panchamula (5 grass roots). They are useful as a group. They can also be used individually for getting rid of Trishna.

Treatment for dry mouth problem:
Principles – 

• Successful treatment is difficult and often unsatisfactory
• Treatment of dry mouth depends on the cause
• The cause should be identified. If the cause is correctable it can be corrected or removed
• Treatment is symptomatic and aims at preventing tooth decay through improving oral hygiene
• If dry mouth is caused by hypo-salivation which is secondary to any underlying chronic disease, dry mouth is considered permanent (or progressive)
• Dry mouth products – These products contain a variety of agents such as lubricants that may help treat your dry mouth

The product range includes toothpaste, mouthwash, gums and topical agents

• Antibiotic and anti-fungal drugs – To treat any infection
• Treating an underlying condition such as Sjogren’s syndrome or Diabetes mellitus with appropriate medication

Talk to a doctor: 

• If you think that dry mouth is caused by certain medication intimate it to the doctor. The doctor may adjust the dose or switch over to another drug that doesn’t cause dry mouth
• The doctor may also prescribe an oral rinse to restore mouth moisture
• If that doesn’t help, the doctor may prescribe medications that boost saliva production

Modern management

Modern Management of salivary gland dysfunction (SGD) involves the use of:
Salivary substitutes: include –

• Water
• Artificial saliva (mucin based, carboxy-methyl cellulose based) and
• Other substances (milk, vegetable oil)

They improve xerostomia but not other problems associated with SGD

Saliva stimulants:

• Organic acids (ascorbic acid, malic acid)
• Chewing gum
• Parasymathomimetic drugs (choline esters ex. Pilocarpine hydrochloride, cholinesterase inhibitors)
• Other substances (sugar free mints, nicotinamide)

They may improve xerostomia symptoms and other problems associated with SGD. Patients find them more effective than substitutes.

• Sialogogue – A drug or substance that increases the rate of salivary flow

History:
Xerostomia is used as a test to detect lies. It relies on emotional inhibition of salivary secretions to indicate possible incrimination

Studies:

• Limited evidences were found to show that oxygenated glycerol tri-ester spray was more effective than electrolyte sprays
• Sugar free chewing gum increases saliva production but there is no strong evidence that it improves symptoms
• There was a lack of strong evidence to show that intraoral devices and integrated mouth-care systems may be effective in reducing symptoms of SGD
• There was limited evidence to support the use of pilocarpine in the treatment of radiation induced SGD. Pilocarpine is not always successful in improving symptoms of xerostomia

References:
http://www.top10homeremedies.com/home-remedies/home-remedies-dry-mouth.html/3
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dry-mouth-syndrome
http://www.webmd.com/oral-health/guide/dental-health-dry-mouth
https://en.wikipedia.org/wiki/Xerostomia

Some more tips to finish…
Do not eat anything when you are thirsty…the body just wants you to spare some time and supply water to it

Likewise, don’t drink water when you are hungry…your body’s fire wants some fuel in the form of food and giving water at that time will put off the fire

Both are dangerous with constant practise…

Ayurveda tells that ‘There is nothing bigger than eating when hungry, drinking water when thirsty and sleeping when you feel sleepy’

Amidst all the treatment which has been described elaborately for Trishna, the best treatment or medicine will still be ‘WATER’ 

So let us keep it simple ‘Just sip some water and keep chill’

Epidemiology:
Prevalence –
About 20% in general population
Up to 30% in women
Up to 50% in elderly

• You have the best remedies in Ayurveda for ‘Dry Mouth’ but don’t forget to consult an Expert Ayurveda Doctor for an opinion before starting on with anything because your ‘Dry Mouth’ can be much bigger and dangerous than just being DRY…