AVARAN & IT'S IMPORTANCE
AVRITA-VATA AND ITS IMPORTANCE IN CLINICAL PRACTICE
Prof.Gurdip Singh
D.Ay.M., Ph.D.
Director PG studies
SDM College of Ayurveda, Hassan
&
Dr. Mandip Kaur
M.D. (Ayu), Ph.D.
Lecturer in Kayachikitsa
Institute of postgraduate teaching and research in Ayurveda
Gujarat Ayurveda University, Jamnagar
Vata is a unique Dosha as it differs from other Dosha many ways, for example, Pitta and Kapha are Pangu and Vata regulates their functions. In the pathological state also it has double path of its vitiation i.e. its vitiation may occur by the depletion of Dhatu or by the obstruction of its path by the others. Before divulging on the Avarana aspects, first various pathological conditions of Vata are being discussed in brief.
Pathological Conditions of Vata
Sushruta has mentioned three pathological conditions of Vata viz. Kevala Vata, Dosha-Yukta Vata and Avrita Vata. (Sushruta.Chi.5: 29 Dal).
Shuddha (Kevala) Vata Disorders: The word Kevala refers to Dosha-Asamsrista i.e. pathological state of Vata without association of other Dosha (Sushruta.Chi.5: 29 Dal). The etiological factors of Vata are depletion in nature, due to that decrease in the body tissues occurs resulting in increase of Akasha (vacuum) and to fill this vacuum; Vata is increased leading to its Prakopa. In such condition the Hetu are of Vata, symptoms are of Vata and Upashaya and Anupashaya are of Vata. The treatment also consists of management of Vata only, though certain care has to be taken for the site also. By this path of pathogenesis, it may produce both Nanatmaja and Samanyaja types of its disorders. Its Nanatmaja type of diseases can be initiated and produced only by Vata and no other Dosha can produce it. On the other hand, its Samanyaja type of disorders can be initiated and produced by the other Dushya, which may be of Vata type only or may be due to Samsarga and Sannipata with other Dosha.
Dosha-Yukta Vata (Samsarga and Sannipata): Doshayukta Vata refers to association (Samyoga) with other Dosha, which is different to Avarana. It is a pathological state of Vata due to the association of Pitta or Kapha or both, which may be casued by the combined Hetu. Clinical manifestations of Vata as well as of the associated Dosha as Anubandha may be there. In that case, generally the primary Dosha i.e. Vata dominates in all the sphere of Hetu, symptoms and treatment. Generally, with the treatment of primary Dosha, the secondary Dosha or complication is also relieved provided a care is taken that the treatment is not antagonistic to the associated Dosha.
The Samsarga or Sannipata may occur in the simple way of Prakriti Sama Samaveta i.e. like physical mixture of Dosha, where the mixed symptoms of both the involved Dosha are manifested. On the other hand, when the combination of Dosha is in the form of Vikriti Vishama Samaveta then there may be some peculiar symptoms, which may not be belonging to either of the Dosha.
Gata Vata: Here first, Vata is vitiated by its own etiological factors, thereafter, following the specific path of its pathogenesis, when involves some specific site i.e. Dhatu, Upadhatu or Ashaya, then such condition is named as by adding adjective of that site (Dhatu or Ashaya) e.g. Pakvashaya Gata Vata or Rakta Gata Vata and so on (Charaka.Chi.28: 24-37).
Though the Vata is present all over the body, its Gata condition specifically indicates its abnormal localization at particular Dhatu or Ashaya. In this condition, the etiological factors are only of Vata and not of dual i.e.both Dosha and Dushya nature as observed in other similar conditions. For example in Vata Rakta, indulging of the patient in the etiological factors of both Vata and Rakta at a time, leads to provocation of both Vata and Rakta simultaneously, resulting in Vatarakta. While in Raktagata Vata, the patient indulges only in the causative factor of Vata and thus vitiated Vata by involving the Rakta produces the condition termed as Rakata Gata Vata.
Vijayarakshita while clarifying the difference between Vtarakta and Raktagata-Vata mentions that in the pathogenesis of Vatarakta both Dushta Vata and Dushta Rakta are involved. While in Rakta-Gata Vata the Dushta Vata affects Adushta Rakta to produce this condition (Vijayarakshita commentary on Madhava Nidana Raktapitta Nidanam).
The symptoms developed are of functional and organic or local and focal according to the chronicity, site of involvement etc. Pain is the common and chief complaint in all the conditions of Gatavata. However, nature of the pain varies according to the site of localization. For instance, agonizing pain associated with burning sensation is the symptom of Raktagata Vata, deep seated aching pain is the characteristic feature of Mamsa Gata Vata (Charaka.Chi.28: 31-32).
Avrita Vata
Term Avarana refers to, to cover, to mask or to obstruct. Here Gati is unique feature of Vata, whenever its Gati is disturbed due to Avarana then its vitiation occurs. This has been the central idea of Avritavata.
Avarana of Vata is a distinctive pathological condition, where obstruction to its Gati occurs due to the etiological factors other then its own, leading to its Prakopa resulting into various disorders of Avarana of Vata. The Avarana of Vata can be caused by the Dosha, Dhatu, Mala, Anna and Ama. Even any of sub-types of Vata may cause Avarana of each other, which is termed as Anyonya Avarana.
The substance, which obstructs the pathway of Vata, is termed as Avaraka. While Vata whose Avarana occurs is termed as Avariya or Avarita.
According to Chakrapani, the excessively increased strong Avaraka suppresses the normal actions of Avariya i.e. Vata. On the other hand, excessively increased Avaraka manifests its actions. Avarana of Vata in the form of obstruction to the functional channel of Vata leading to its Prakopa, hence at that stage its Prakopa symptoms are also manifested depending upon its site of function involved (Charaka Chi. 28: 216 Chakra.).
It is well known that Pitta, Kapha, Dhatu and Mala are considered as Pangu (inactive) and Vata is the motive force behind their actions. So, when they act as Avaraka, then they must be sufficiently strong to over power as well as to obstruct the functions and functional channels of Vata. Therefore, in the initial stage of the condition, as the Avaraka are strong and Vata is nearly in the normal state, so in the beginning, there will be decrease in the functions of Vata with increase in the function of Avaraka. Thereafter, when obstruction is complete, it leads to the Prakopa of Vata resulting in the manifestation of Vata vitiation symptoms as well as its disorder (Charaka.Chi.28: 215 Chakra.).
It is clear from the above that the Vata is initially in its normal state, but accumulation of Avaraka occurs. The accumulation of Avaraka can occur only when the patient indulges in the causative factors of that particular Avaraka. Hence, it may be deduced that in the condition of Avarana of Vata there will be no history of specific etiological factors of Vata though resulting condition is Vata disorders. On the other hand, the history of etiological factors of Avaraka will be available. Based on this, it can be inferred that here Vata disorders are produced without indulging in its own etiological factors.
Symptom complex in Avrita Vata:
Often the symptoms manifested are comprised of disturbed function of, the obstructing factor as well as the obstructed Vata. The symptoms produced are based on the principles of Rupahani (Karma Hani), Rupa Vriddhi (Karma Vriddhi) and Rupantara (Anya Karma)(Ashtanga Sam.Ni.16: 47) and which depend upon the intensity of the obstruction i.e. partial or complete; functional or organic; acute or chronic; transient or persistent etc. For instance, less strong obstruction of Vata will leads its provocation, where as the very powerful obstruction may make it weak and like wise.
The symptomatology of the Avarana depends up on the place wherever Dosha-Dushya Sammurchchharna has taken place. For instance, the symptom of Shula of Avrita Vata may occur in the different parts like head, ears, abdomen, back, depending upon the organ involved in the process of Avarana.
Similarly clinical manifestations are primarily depend on the direction of the movement of which is obstructed, anatomical limitation of particular Dosha or sub type of Vata which is involved in the pathogenesis, nature of obstruction i.e Dosha, Dathu, Mala (Ashtanga.Hri 16:32) etc. For example in Kaphavrita Prana Vata, the Prana is seated in Uttamanga (head) and its direction of movement is towards the centre (Nabhi) i.e.Urah and Kantha and it governs the functions like Anna Pravesha (deglutination), Sthivana (spitting), Ksavathu (sneezing), Udgara (eructation) etc (Ashtanga Hri.12: 4). If the direction of movement of Prana Vata is obstructed by Kapha in Urdva Amashaya then it leads to the pathological state i.e. movement in opposite direction resulting in disorders of deglutination, spitting, sneezing, eructation, vomiting & anorexia etc (Charaka.Chi.28: 222).
Is Avarana Independent or Dependent Phenomenon?
The various types of Avarana described in the texts are definitely independent clinical entities, because these conditions have definite set of symptomatology as well as have distinguished treatment. Further, there are many conditions like Sthaulya, Avrita Madhumeha, Urustambha, which occur through the pathogenesis of Avarana.
Moreover, Dalhana mentions that in Sthaulya many other types of Vata Vikara may occur as complications due to Avarana type of pathology. For example, Medavrita Vata in which Meda obstructs the Gati of Vata leads to the vitiation of Vata resulting in different Vata disorders (Vata Vikaram Ityatra Vatavikarah Medakrita Margavarana Nimitta Vatakopa Vikara Ityatra Sushruta Su.16: 38 Dal). In this way, it can be stated that Avarana may occur as independent disease as well as part of the pathogenesis of certain diseases. It may also help in understanding the pathogenesis of many conditions described in modern medicine as well as to decide their management on Ayuvedic lines.
Further, it has been mentioned that there may be innumerable Avarana disorders. It means the few conditions of Avarana mentioned in the texts are just examplory conditions and many other conditions of Avarana may be produced by involving different sites. For instance, the Kapha Avrita phenomenon occurs at different organs like stomach, head, heart etc resulting in the symptomatology pertaining to that particular organ. In this way by considering the findings of the modern medicine the diseases like cerebral thrombosis and embolism leading to hemiplegia, coronary thrombosis and embolism leading to myocardial infarction etc can be intrpreteted by the Avarana pathology of Ayurveda and accordingly their management may also be evolved purely based on Ayurvedic principles.
Charaka mentions the use of Rasayana drugs particularly Guggullu and Shilajatu in the management of Avarana (Charaka.Chi.28: 241). So the sphere of indications of these drugs may be widened to treat such conditions. In the case of myocardial infarction, the efficacy of Guggulu has already been established. The role of Shilajatu is well known in the Avrita madhumeha, Sthaulya etc and may also be established in other such conditions by scientific studies.
Classification of Avarana
The Avarana may be innumerable types (Ashtanga.Hri.Ni 16:30). Howevwe, 46 types of Avarana of Vata have been described in detail in the texts, which can be categorized under the following three major divisions:
(A) Murta Avarana: Kapa and Pitta Dosha, Dhatus, Mala and Anna are the Murta substances, which obstruct the path of Vata and this condition may be termed as a Murta Avarana. It may again be sub- divided into Doshavarita Vata-2, Doshavrita Panchabedha of Vata-10, Dhatvavrita Vata-6, Sarva Dhatvavrita Vata-1, Anna Avrita Vata-1, Malavrita Vata-1 and Mutravrita Vata-1 (Charaka.Chi.28: 61-7 & Ashtanga Sam.Ni 16:43).
(B) Amurta Avarana: When the sub-type of Vata impedes the function of each other, it may be termed as an Amurta or Anyonya Avarana. It is of 20 types in which symptom complex of 12 conditions are explained (Charaka.Chi.28: 199-216 & Ashtanga Sam.Ni 16: 44).
(C) Mishra Avrita Vata: When two or more factors are involved in the pathogenesis of Avarana, it is termed as a Mishra Avarana. Here permutation and combinations of Pitta and Kapha and sub-type of Vata result in innumerable numbers of pathologies of Avarana (Charaka.Chi.28: 233,Ashtanga. Sam.Ni.16: 48).
Avarana and Sama Dosha
Sama state of Dosha and Dushya is very important to produce Margavarana in the Srotas and Avayava. The Sama Dosha or Mala is capable of producing Srotosanga, which in turn obstruct the Gati of Vata. In this way, Ama may also help in producing the Avarana of Dosha and Dushya etc.indirectly.
Avarana-An Atypical clinical Presentation
The symptom complex produced by Avrana is always a diagnostic challenge. To identify the pricise cause and exact pathogenesis of Avarana requires a special diagnostic skill and expertise. Some time it misleads the physician because of its complex atypical presentations. Charaka cautions about its atypical presentation by mentioning that Vata obstructed by Meda and Kapha produces pain (Shula), numbness (Supti) and odema (Shvayathu). The physician ignorant of the condition of Avarana, thinking that Vata Prakopa is there, may prescribe unctuous enema, which may further deteriorate the conditions (Charaka Si.1: 57). All these references indicate towards its atypical presentation, which may lead to diagnostic error resulting in mismanagement too.
Diagnostic methods of Pathologies of Vata
Kshaya, Vriddhi and Gatatva conditions of Vata can be diagnosed easily with the help of symptomatology mentioned in the texts. However, Avarana requires a special diagnostic skill, because of its complex presentation. Sushruta mentions that the differential diagnosis between the conditions of pure Vata, Samsarga Vata and Avrita Vata can be made on the basis of their symptoms, by applying reasoning. Some times it may not be possible to diagnose the Avarana and Anyonya -Avarana straight forwardly and in that case it can be diagnosed with the help of the exclusion method with proper reasoning on the basis of its altered physiology (Sushruta Chi.5: 29).
Diagnosis of Avarana by Exclusion or Trial and Error Methods
Vagbhata mentions that some times it is very difficult to diagnose the condition of Avarana and in that case it requires repeated clinical examination and frequent administration of Upashaya (therapeutic test or trail and error method) before arriving to its proper clinical diagnosis (Ashtanga Hri.Ni.16: 55).
Exclusion by Nidana:
Though the resultant disorder in Avarana is exclusively of Vata, there is no history of indulgence in etiological factors of Vata i.e. pertaining to Dhatu Kshaya. On the contrary the history of indulgence in the etiological factors of Avaraka is available.
For instance, in Charaka Samhita two types of Madhumeha are described. Its one type is mentioned in Nidana Sthana, which is due to Dhatukshaya or Shuddha (pure) Vata, while the other is described in Sutra Sthana chapter seventeenth, which is due to Vata Avrita by Kapha, Pitta, Medas and Mamsa. The etiological factors of Madhumeha described in Nidana Sthana are that of Dhatu Kshaya, while the etiological factors described in the Sutra Sthana are of Avaraka i.e. of Kapha, Pitta etc. To make the point more clear the etiological factors of both of these varieties are being given here.
(A) Etiological Factors of Madhumeha due to Pure Vata: The habitual use of astringent, pungent, bitter, dry, light and cold articles; over indulgence in sexual act, exercise, emesis, purgation, enema and errhines; suppression of natural urges, fasting, trauma, sun-heat, worry, grief, depletion of blood, waking in the night and unwholesome postures of the body, lead to immediate provocation of Vata (Charaka Ni. 4:36).
(B) Etiological Factors of Madhumeha due to Avarana: By taking excess heavy, unctuous, sour, and salty articles; by using new cereals and drinks, by over indulgence in sleep, sedentary habits, by not undergoing seasonal purification, the Kapha, Pitta, Meda and Mamsa increases excessively leading to Madhumeha (Charaka Su. 17: 78-79).
It is obvious from the foregoing though the same disease i.e. Madhumeha is produced, the etiological factors are different in both the cases.
Exclusion by Samprapti :
In the case of the two types of Madhumeha under question, the Samprapti also differs. To clarify this point the pathogenesis of the two types of Madhumeha is being given here.
(a) Samprapti of Madhueha due to pure Vata: The provoked Vata by its Ruksha quality changes the natural sweet taste of Oja to the astringent taste and carries it in to Mutrashaya (urinary system) and results in Madhumeha. This type of Madhumeha caused by pure Vata is incurable owing to its severe nature and antagonism involved in the treatment (Charaka Ni. 4: 37-38).
(b) Samprapti of Madhueha due to Avarana: The increased Kapha, Pitta, Medas and Mamsa by obstructing (Avarata) the Gati (movement) of Vata, which in turn carries Ojas into Basti (urinary tract) resulting into Madhumeha which is Krichchhra Sadhya (Charaka Su.17: 80)
Exclusion by Lakshana:
The symptoms of Dhatu Kshaya are not present in the condition of Avarana. This point will be clear, by analyzing the symptoms of the following two types of Madhumeha Viz. Madhumeha caused by pure Vata and Madhumeha caused by the Avarana described by Charaka:
(a). In Madhumeha caused by pure Vata the patient passes urine which is astringent and sweet in taste, yellowish-white in color and is ununctuous (Charaka Ni. 4: 44). All these symptoms and signs are of Vata only.
(b). In Madhumeha caused by Avarita Vata, the patient shows the symptoms of Vata, Pitta and Kapha frequently and the severity of the disease becomes diminished for some time and becomes aggravated again. It indicates the periodic and waxing waning nature of clinical manifestations in Avarana i.e.Sa Marutasya Pittasya Kaphasya Cha Muhurmuhuh, Darshayati Akritim Gatva Kshayam Apayayate Punaha (Charaka Su. 17: 81).
Exclusion by Upashaya:
Upashaya of Vata i.e. Avrita is not there, on the contrary Upashaya of
Avaraka is present. For example in Pittavrita Vata, the patient gets Vidaha from the Upashaya of Vata i.e.Amla, Lavana and Ushna. On the other hand, the patient shows the desire for cold things, which is Upashaya for Pitta. In Kaphavrita Vata there is Upashaya from Katu etc and patient shows desire for fast, exercise, Ruksha etc. things which are Upashaya for Kapha and Anupashaya for Vata (Charaka Chi. 28: 61).
Exclusion by Chikitsa:
Treatment of Vata is not effective. On the contrary, the treatment of Avaraka is effective. When Vata is occluded by Pitta, it leads to Vata Prakopa manifested by the symptom of colic (Shula). It may be the main symptom disturbing the patient very much. In addition other symptoms of Pitta like burning, thirst, giddiness and darkness before eyes may be there. Here to relive dominant symptom of Vata i.e. Shula, Pitta alleviating treatment should be undertaken as the basic pathology is due to the increased Pitta. Hence the administration of Vata alleviating treatment such as use of hot, sour and salt substances which are antagonist to Pitta may worsen the condition (Charaka Chi. 28:61).
If Vata is occluded by Kapha, it leads to Vata Prakopa manifested by the symptom of colic (Shula). It may be the main symptom disturbing the patient very much. In addition other symptoms of Kapha such as cold, heaviness, pronounced desire to pungent and similar other articles and craving for fasting, exertion and dry and hot things. Here to relive dominant symptom of Vata i.e. Shula, Kapha allivating treatment such as pungent, bitter etc articles should be used as the basic pathology is due to the increased Kapha though this therapy is antagonist to Vata (Charaka Chi. 28:62).
Prognosis of Avarana:
In Doshavarana type of pathologies, Avarana of Prana and Udana by Pitta and Kapha are more severe and difficult to treat (Gurutaram) because of their vital function in the body physiology i.e. to provide life (Jivana-Ayu.) and Strength (Bala).
Amongst the Dhatvavarana conditions, Medavrita Vata is comparatively more difficult to treat due to its complications and poor therapeutic response (Charaka.Chi.28: 233-234,Sushruta.Chi.5: 29, Ashtanga.Hri.Ni. 16:56,Ashtanga Sam.Ni.16: 29).
In Anyonya Avarana conditions Udanavrita Prana, the condition of occlusion of Prana by Udana leads to loss of all sensory and motor functions (Karma Kshaya), loss of vital essence (Oja Kshaya), loss of strength (Bala Kshaya) and complexion, and it may result even in death of the patient (Charaka.Chi.28: 208).
So depending on the type of Avarana and Avaraka prognosis of the Avarana pathology varies.
Similarly if the condition persists for one year, its management is delayed or improper, then it may land up in difficult to cure or incurable state. So early diagnosis and timely management make the good prognosis (Charaka.Chi.28: 235).
Complications of Avarna:
Improper diagnosis and delayed treatment of different Avarana conditions or of one year chronocity lead to complications like Hridroga (Hear disease) due to PranavritaUdana Vata, Vidradhi (Abscess), Gulma (localized enlargement of Abdomen) due to Vyanavrita Apana, Atisara (diarrhea) due to Apanavrita Vata, Agnisada (diminished digestive power) due to Kapavrita Samana.
Similarly, according to the site of involvement of different Sub-types of Vata, chronicity and severity of basic pathologies result in different complications. (Charaka.Chi.28: 207-211-212-227-238, Ashtanga.Hri.16: 58).
Avrita vata and Gata Vata:
Some of the important differentiating features of above conditions are:
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Avrita Vata Gata vata
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Vata vitiation is passive Vata vitiation is active
Avrita is more important Vata Dosha is more important
Phenomenon is more related to the Gati of Vata Phenomenon is related to other properties of Vata also
Vata vitiation is due to other Dosha Prakopaka Vata vitiation due to its own
Nidana Nidana
State of Dhatu Vriddhi State of Dhatu Kshaya
State of Doshapurna Srotas State of Rikta Srotas
Diagnosis with the help of Upashaya-Anupashaya Diagnosis with the help of Rupa
(Therapeutic test or trail and error method) (Straight forward diagnosis)
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In case of Raktagatavata according to therapeutic response towards blood letting, one has to decide the associated Avarana pathology and should be continued accordingly (Sushruta.Chi.4: 7 Dal)
Principles of Treatment of Avarana
General management:
(a) General principles of Vataopakrama may be applied with due care of obstruction to Vata and Srotas by Pitta and Kapha (Charaka.Chi.28: 75,183).
(b) The Avarana should be treated by measures, which are Anabhishyandi (non-obstructive), Snigdha (unctuous) and Sroto-Shudhi Karaka (depurative of body channels) (Charaka Chi.28: 239).
(c) In case, Vata is obstructed at all the places (Sarva Sthana Avarate), prompt (Ashu) measures, which are regulative of Vata and at the same time not antagonistic to Pitta and Kapha are beneficial (Charaka Chi. 28:239).
(d) In the condition of Pittavrita Vata, the treatment of Pitta, which is not antagonistic to Vata should be prescribed.In the condition of Kaphavrita Vata, the treatment of Kapha, which is Anulomana to Vata should be prescribed (Charaka Chi. 28:245).
(e) A vitiated Dosha attains great strength in its natural functional seat, hence it should be first subdued by suitable medications such as emesis, purgation, enema and sudation (Charaka Chi. 28:198).
(f) Sodhana therapy: Depending on the strength of the patients, Madhura Anuvasana or Yapana Basti and Mridu Srimsana should be administered (Charaka.Chi.28: 240)
(g) Rasyana therapy: All the palliative and preventive Rasayana drugs are useful for the prevention and treatment of Avrita induced disorder’s. Especially Shilajitu, Guggulu, Chawanaprasha and Bramha Rasayana are indicated after proper Sodhana (Charaka Chi. 28: 241-242).
Specific management:
According to specific pathologies of Doshavarana, Dushyavarana, and Mishravarana treatment modalities varies For example,altrnative administration of cold and hot therapeutics in case of Pittavrita Vata (Shitam Ushnam Tatha Kriyam Vyatyasat Karayat.Charaka.Chi.28: 184).
Anyonya Avarana
When one type of Vata obstructs the function of other types of Vata then it is known as Anyonya Avarana. For example, Prana Vata occludes Udana and other types of Vata and they too occlude the Prana. Udana and all other types of Vata may occlude each other in the same manner. Twenty such Avarana of the five types of provoked Vata may occur (Charaka Chi. 28: 99-201).
The question arises that Vata is Amurta then how one type of Vata can obstruct the channels of the other type? Arunadatta mentions that in Anyonya Avarana the strong i.e. excessively vitiated variety of Vata suppresses the weak type of Vata and thus produced functional derangement (Gati Bhangata), so it is also termed as Avarana.
Dalhana mentions that when Udana Vata, which is having movement in upward direction causes functional obstruction (Gati Nirodham) of the Prana or Apana Vayu having the movement in down ward direction, then Udana Vayu acts as Avaraka. Or when one stronger
Arundatta further mention that Vriddhi means the Vaikrita Karma of Avaraka Vata. On the other hand, Hani refers to the diminution in the function of the Avary-Vata. For example the Utasaha, Uchchvasa, Cheshta etc action of Prana are diminished while Vak-Pravritti, etc actions of Udana are increased then it is Udanavritta Prana (Ashtanga Hri. Ni.16: 52, Arunadatta).
Dalhana also mentioned that when the two Vata sub-types loses their normal course or direction of the movement then strong one suppress the weak and resulting in the condition Annyonnya Avrita (Dvayo MarutayoAbhimukhamAbhisarpato Balavato Durbalo-Abhibhutah Pratyavrita Sann Avrita Iti Ucchyatae-Sushruta Chi.5: 29 Dal).
Other view of Anyonya Avarana mentioned in pathogenesis of Vatarakta caused by the etiological factors of both Vata and Rakta is that, in the initial stage vitiated Vata obstruct the vitiated Rakta, later further viated Rakta inturn obstructs the Vata Dosha resulting in mutual obstruction of Vata and Rakta (Anyonyam Avarya Iti Raktena Vatam Vatena Cha raktam Avarya...Vataraktam (Charaka.Chi.29: 37 Chakra).
By their symptoms, the conditions of Avarana of mutual occlusion of the five types of Vata can be diagnosed. As per rule, there will occur either the increase or decrease of its actions as the particular type of Vata is affected. Charaka has described in detail only the following 12 types of Anyonya Avarana and remaining 8 other conditions of mutual occlusion of Vata may be understood or diagnosed on the basis of the seat of function of each type of Vata as well as increase or decrease of its functions (Charaka Chi. 28: 215).
Aruna Datta mentions that in Anyonya Avarana the strong i.e. excessively vitiated variety of Vata suppresses the weak type of Vata and thus produces functional derangement (Gati Bhangata), so it is also termed as Avarana.
Arundatta further mention that Vriddhi means the Vaikrita Karma of Avaraka of Vata. On the other hand, Hani refers to the diminution in the function of the Avary-Vata. For example the Utasaha, Uchchhvasa, Cheshta etc action of Prana are diminished while Vak-Pravritti, etc actions of Udana are increased then it is Udanavritta Prana (Ashtanga Hri. Ni.16: 52, Arunadatta).
By their symptoms, the conditions of Avarana of mutual occlusion of the five types of Vata can be diagnosed. As per rule, there will either the increase or decrease of its actions as the particular type of Vata is affected. Charaka has described in detail only the eight types of Anyonya Avarana. The remaining 12 other conditions of mutual occlusion of subtypes of Vata may be understood or diagnosed on the basis of the seat of function of each type of Vata as well as increase or decrease of their functions. They should be treated by means of massage, unctuous potion, enema and all other similar thearpies and by cold and hot measures alternatively (Charaka Chi. 28: 215-218).
Generally Udana should be regulated upwards and the Apana downwards. The Samana should be pacified and the Vyana should be treated by all these three measures. Prana should be maintained with due care in comparision to other types of Vata, because life depends on the proper maintanace of it in its habitat. Thus the various typesof Vata which are occluded or misdirected (Vimargaman) should be established in their normal habitat (Charaka Chi. 28: 219-220).
Management: They should be treated by means of massage, unctuous potion, enema and all other similar therapies and by cold and hot measures alternatively i.e.Vyatyasa Chikitsa (Charaka Chi. 28:218).
Generally Udana should be regulated upwards and the Apana downwards. The Samana should be pacified and the Vyana should be treated by all these three measures. Prana should be maintained with due care in comparison to other types of Vata, because life depends on the proper maintenance of it in its habitat. Thus the various types of Vata which are occluded or misdirected (Vimargaman) should be established in their normal habitat (Charaka Chi. 28: 219-220).
Neurological consideration of Avrita Vata:
Applied neuro-physiology of Vata:
Applied physiological aspect of Vata and five subtypes is very important to understand the Avrita Vata in relation to neurophysiology and its clinical presentations.
Prana, Udana and Vyana Vata play a major role in the neurological functions of the body, in which Prana and Udana act as a central governing factor and Vyana along with Samana &Apana in peripheral governing factors.
Prana Vayu: Located in the Utamanga (head) which controls the function of Manas (Buddhi and Chitta Drik) and Hridaya intern co-ordinate the vital function of the body viz Nishvasa (respiration), Stivana (spitting), Ksavatu (Sneezing) etc (Ashtanga Hri.12: 4). It is also called as Pranavalambana, which refers to Pranadhara Hridaya Avalambana i.e. primary controller of Hridya, a seat of life (Prana) that carries all the vital functions of the body (Sushruta Ni.1: 13 Ganga). Thus, Prana is central controller of all the motor activities of body.
Udana Vayu: Located in the Chest region and activates Manas to carry out its own (Svartha) higher functions like Chinta (thinking), Smriti (memory) and other sensory functions (Bahya vishayartha) like perception of five types of sensations. It is the coordinator of Speech, memory, strength etc (Ashtanga Hri.Su.12: 5, Sushruta Ni.1: 14).
Vyana: Located mainly in heart and also whole body, important peripheral controller of both sensory and motor functions It governs all the different motor activities i.e.Gati (movement-gait), Apakshepana (downward movement) Utkeshapana (upward movement), Nimesha and Unmesha (blinking of eyes) etc (Ashtanga Hri.Su 12:17). It also controls the circulation of Rasa, Rakta and Sveda in the body (Sushruta.Ni 1:17-18).
Samana Vayu: Located in the Agni Sthana and in the channels of Sveda (sweat) & Ambu (intra & extra cellular fluid) major peripheral controller of Upper GIT functions like motility, digestion and metabolism, Sweating etc (. Charaka.Chi.28: eight, Ashtanga Hri.Su.12: 6).
Apana Vayu: Located mainly in the lower GIT and Genito-urinary system which controls the visceral functions (Reflex) like Micturition, defecation, ejaculation and fetal expulsion (Ashtanga.Hr.Su.12: 7).
Any sort of either functional or organic; trasient or persistent obstruction to pathway i.e. direction of Vata and its sub-types leads to different neurological manifestations according to the site of pathology.
Some of the most common clinical conditions in neurology practice related to the Avrita Vata are as follows and it requires special attention for the prompt diagnosis and successful management.
Neurological Manifestation of Avritavata with Dominance of Motor Dysfunctions:
Kaphavrita Udana Vata
When Udana is occluded with Kapha, it leads to difficulty in speech and voice (Vaksvara Griha), heaviness of body (Guru Gatrata), debility (Daurbalya), discoloration (Vaivarnya) and anorexia (Charaka Chi. 28: 224).
Kaphavrita Vyana Vata
In the condition of occlusion of Vyana by Kapha there may be severe restriction of movement (Gati Sanga/Chesta Stamba), Vakgraha (Difficulty in speech), heaviness in the body (Guruta Sarva Gatranam), severe loss of motor power (Skalitam Cha Gatau Brisham), pain and stiffness in all the bones and joints (Sarva Sandhi Asthi Ruja/Stamba), etc. (Charaka Chi. 28:228, Ashtanga Sam.Ni.16: 42,Sushruta Ni.1: 39).
Pittavrita Vyana Vata
In the condition of occlusion of Vyana by Pitta there will be exhaustion (Sarvanga Klama), loss of the movement of limbs or loss of movement and tremor (Gati Vikshepa Sanga) accompanied with temperature (Santapa), pain (Vedana) and burning sensation (Daha) all over the body (Charaka Chi. 28:227& Ashtanaga.Hri.16: 43).
Udanavrita Vyana
The condition of occlusion of Vyana by Udana leads to rigidity (Stabdata), loss of movement (Chesta Hani) and winking (Nimilanam), anhidrosis (Alpa Sweda) and poor digestion (Alpa Agni), Wholesome, measured and light diet should be prescribed to manage this condition (Charaka Chi.28: 214).
Pranavrita Samana
The condition of occlusion of Samana by Prana leads difficulty or slurring of speech or muteness (Jada-Gadgada-Mukata). All the four modes of Sneha therapy and Yapana Basti are indicated for this condition (Charaka Chi.28: 204).
Neurological Manifestation with Dominance of Sensory Dysfunctions:
Vyanavrita Prana Vata
The condition of occlusion of Prana by Vyana leads to and numbness of limbs (Supta Gatrata), excessive perspiration (Ati Sveda) horripilation (Loma Harsha), and tropic changes in the skin (Tvagdosha). Its treatment is unctuous purgation (Sheha Virechana)(Charaka Chi. 28:203).
Kaphavrita Samana Vata
The occlusion of Samana by Kapha leads to excessive coldness of the limbs (Gatranam Ati Shitata), anhidrosis (Asveda), horripilation (Loma Harsha) and diminished digestive power (Vanhimandya) (Charaka Chi. 28: 227).
Neurological manifestation with intellectual, motor and sensory dysfunctions:
Pranavrita Vyana Vata
The condition of occlusion of Vyana by Prana leads to loss of memory (Smriti Ksaya) loss of intellectual, motor & sensory functions (Sarva Indriya Shunyatvam) and strength (Bala Ksaya). Its treatment is the same as that of the diseases occurring supra-clavicular region (Urdvajatruga Karma) i.e. Nasya, Shirobasti, Shirodhara etc (Charaka Chi. 28: 202).
Udanavrita Prana
The condition of occlusion of Prana by Udana leads to loss of all motor and sensory functions (Karma Kshaya), loss of strength (Bala Kshaya) and complexion (Varna Kshaya), loss of vital essence (Oja Kshaya), and it may result even in death of the patient (Mrityurapi). This condition should be treated by gradual effusion with cold water (Shanai Shitavarina Sinchayata) and assurance (Ashvasana) and such other measures which may help in restoring the health (Charaka Chi. 28:208).
Neurological Manifestation with Dominent altered Conscious with Motor Dysfunctions:
Samanavrita Vyana
The occlusion of Vyana by Samana leads to manifestations of altered sensorial like fainting (Murcha), drowsiness (Tandra), delirium (Pralapa) and weakness in the limbs (Angasada), loss of strength (BalaKshaya). It is also associated with diminished digestion (Agni Kshaya) and vital essence (Ojo Kshaya). In this condition exercise and light diet are indicated (Charaka Chi. 28: 213).
Here an attempt has been made to understand the unique concepet of Avarana of Vata by analyzing the textual references from different angles. It is hoped that these views will form the basis for better understanding the many other phenomena described in Ayurveda like Ashyapkarsha. The understanding of applied aspect of Avarana is very important for the diagnosis as well as Ayurvedic management of many diseases described in modern medicine, specially where they have got little to offer in their diagnosis and management.
Rakta-Avrita Vata
If Vata is occluded by Rakta, it leads to Vata Prakopa manifested by the symptom of
edema (Shopha) with reddish tinge. It may be the main symptom disturbing the patient
very much. In addition other symptoms of Parkopa of Rakta
like severe burning pain in the area between skin and flesh and rashes are also found (Charaka Chi. 28:63).
Mamsa-Avrita Vata
If Vata is occluded with Mamsa, it leads to Vata Prakopa manifested by the symptom of edema (Shopha). It may be the main symptom disturbing the patient very much. In addition other symptoms of Mamsa like appearance of hard pigmented papules, horripillation and parasethesia/fornication (Charaka Chi. 28:64).
Medasa-Avrita Vata
If Vata is occluded with Medas, it leads to Vata Prakopa manifested by
the symptom of oedema (Shopa)of soft ,cold and shifting in nature and anorexia (Charaka Chi. 28:65).
Asthna-Avrita Vata
If Vata is occluded with Asthi, it leads to Vata Prakopa manifested by
the symptom of pain of spliting and pricking in nature, exhaustion and patient is desire for pressing with warm hand (Charaka Chi. 28:66).
Majja-Avrita Vata
If Vata is occluded with Majja, it leads to Vata Prakopa manifested by
the symptom bending of the body, colic, yawning and gridle pain.Paient feel relief on pressing with hand (Charaka Chi. 28:67).
Shukra-Avrita Vata
If Vata is occluded with Shukra, it leads to either anejaculation or early
ejaculation of semen and infertility(Charaka Chi. 28:68).
Anna-Avrita Vata
If Vata is occluded with food (Anna), it leads to pain in the abdomen on ingestion of food and disappearance of pain at the end of digestion (Charaka Chi. 28:69).
Mutra-Avrita Vata
If Vata is occluded with urine (Mutra), it leads to retention of urine and distension of the bladder (Charaka Chi. 28:69).
Purisha-Avrita Vata
If Vata is occluded with feces (Purisha), it leads to absolute retention of feces in rectum and colons with griping pain, the unctuous substances are immediately digested and the distension of abdomen occurs on ingestion of food. The owing to the pressure of food taken, patient passes dry feces with difficulty and after long delay. The patient suffers from pain in hips, groins and back and the Vata moves in a reverse direction (mis-peristalsis) and uneasiness in the cardiac region (Charaka Chi. 28:70-71).
Pittavrita Prana Vata
When Prana Vata is occluded by Pitta, it leads to its Prakopa manifested by the symptom of colic (Shula). It may be the main symptom disturbing the patient very much. In addition other symptoms of Pitta like burning sensation, giddiness, fainting, burning epigastrium and vomiting of undigested food and craving for cold things (Charaka Chi. 28:221).
Kaphavrita Prana Vata
In the condition of occlusion of Prana by Kapha leads to impediment of inspiration and expiration, eructation, salivation, sneezing and anorexia and vomiting (Charaka Chi. 28 : 222).
Pittavrita Udana Vata
The condition of occlusion of Udana with Pitta leads to exhaustion, loss of vital essence (Ojobhramsha), asthenia, fainting, burning in umblical and chest regions (Charaka Chi. 28:223)
Kaphavrita Udana Vata
When Udana is occluded with Kapha, it leads to difficulty (Graha) in speech and voice, discoloration, debility, heaviness of body and anorexia (Charaka Chi. 28 :224)
Pittavrita Samana Vata
The occlusion of Samana with Pitta causes hyperhidrosis, thirst, burning, fainting, anorexia and loss of body heat (Charaka Chi. 28 :225)
Kaphavrita Samana Vata
The occlusion of Samana by Kapha leads to poor digestive power, anhidrosis horripilation and excessive coldness of the limbs (Charaka Chi. 28: 226)
Pittavrita Vyana Vata
In the condition of occlusion of Vyana by Pitta there will be exhaustion, loss of the movement of limbs accompanied with temperature, pain and burning sensation all over the body, (Charaka Chi. 28:227)
Kaphavrita Vyana Vata
In the condition of occlusion of Vyana by Kapha there may be pain in all the bones and joints, severe restriction of movement and heaviness in the body (Charaka Chi. 28:228)
Pittavrita Apana Vata
In case of the occlusion of pathways of Apana by Pitta, there may be yellow discoloration of urine and feces, sensation of heat in the anus and phallus and excessive flow of mensus in case of women (Charaka Chi.28: 29)
Kaphavrita Apana Vata
The occlusion of the chennels of Apana with Kapha leads to passing of heavy and loose stool mixed with undigested matter and mucus and urine also mixed with mucus (Charaka Chi. 28:230).
Pranavrita Vyana Vata
The condition of occlusion of Vyana by Prana leads to loss of function of all the sense-organs and lossof memory and strength.Its treatment is the same as that of the diseases occuring supra-clavicular region (Charaka Chi. 28:202).
Vyanavrita Prana Vata
The condition of occlusion of Prana by Vyana leads to excessive perspiration, horripilation, skin disorders and numbness of limbs.Its treatment is unctous purgation(Charaka Chi. 28 :203).
Pranavrita Samana
The condition of occlusion of Samana by Prana leads difficulty or sluring of speech or muteness. All the four modes of Sneha therapy and Yapana Basti are indicated for this condition (Charaka Chi. 28:204).
Samanavrita Apana
The condition of occlusion of Apana by Samana leads to disorders of Grahani, Parshva and Hridaya and pain in the epigastrium. The ghee medicated with digestive drugs is indicated in its treatment (Charaka Chi. 28:205).
Pranavrita Udana
The condition of occlusion of Udana by Prana leads stiffness in the head, coryza, impediment of inspiration and expiration, cardiac disorders and dryness of mouth. The regimen prescribed for the treatment of supra-clvicular diseases and reassuration is indicated in this condition (Charaka Chi. 28:206-207).
Udanavrita Prana
The condition of occlusion of Prana by Udana leads to loss of functions, loss of vital essence (Oja), strength and complexion, and it may result even in death of the patient. This condition should be treated by gradual effusion with cold water and assurance and such other measures which may help in restoring the health (Charaka Chi. 28:
Udanavrita Apana
The condition of occlusion of Apana by Udana leads to vomiting, dyspnoea and other similar disoders. It should be treated by Basti and diet articles which are regulatory of Vata (Charaka Chi. 28: 209).
Apanavrita Udana
The condition of occlusion of Udana occurs by Apana leads to delusion impaired digestion and diarrhoea. Therapeutic emesis and diet which is digestive stimulant and astringent are prescribed for its treatment (Charaka Chi. 28: 210). While giving the example Aruna datta mentions that in this condition that strong Udana causes vomiting, dyspnea, cough etc. while due to weak Apana, there is diminished digestion and diarrhea.
Vyanavrita Apana
The condition of occlusion of Apana by Vyana leads to vomiting, distension of abdomen, misperistalsis, Gulma, colic and griping pain. For this condition Anulomana with unctous drugs are indicated (Charaka Chi. 28: 211).
Apanavrita Vyana
The condition of occlusion of Vyana occurs by Apana leads to excessive elimination of feces, urine and semen. For this condition Grahi (astringent) therapy is indicated (Charaka Chi. 28: 212).
Samanavrita Vyana
The condition of occlusion of Vyana by Samana leads to fainting, drowsiness, delirium, asthenia of the limbs, diminished digestion, strength and vital essence (Oja). In this condition exercise and light diet are indicated (Charaka Chi. 28: 213).
Udanavrita Vyana
The condition of occlusion of Vyana by Udana leads to rigidity, poor digestion, anhidrosis, loss of movement and winking. Wholesome, measured and light diet should be prescribed to manage this condition (Charaka Chi. 28: 214).
Here an attempt has been made to understand the Ayurvedic concept of Avarana from the different points of view. It is to be emphasized here that the diagnosis of Avarana conditions can be made by an expert/specialist even on the first visit of the patient. But the general practioners have to put little more efforts, require practice and patience, and by acquiring tha experience they can also diagnose and mange the various conditions of Avarana properly on the basis of the principles of management given therein.
