Concept Of Avarana Pathology In Ayurveda

Concept of Avarana – Pathology in Ayurveda Chairperson Dr Kishore Kumar R Presenter : Dr Kamala Lakshmi GK Junior Resident Dept Of Integrative Medicine NIMHANS

The disturbance in the equilibrium between the tridosha causes a disease. Based on the the responsible dosha, the disease/ vyadhi can be named as Vata vyadhi (Diseases of Vata), Pittaja Vyadhi( Diseases of pitta) & Kaphaja Vyadhi (Diseases of Kapha). However the involvement of vata is seen in every disease whether negligible/not depending upon symptoms. Today we shall discuss on the concept of avarana, which is form of pathogenesis explained in the chapter of Vata Vyadhi( Diseases of vata).

General Distribution Of Kapha – Pitta – Vata in Human body Kapha (Shira – Uroamashaya) Pitta ( Amashaya – Nabhiramashaya) Vata ( Pakwashya and downwards)

Subtypes and functions of Vata Vayu Type Site Function Co relation 1. Prana Vayu vertex, thorax, trachea, tongue, mouth and nose spitting, sneezing, eructation, respiration, deglutition etc ANS reflexes Fight & Flight Responses Heart Rate & BP Regulation 2. Udana Vayu umbilicus, thorax and trachea speech, memory, energy, strength, complexion etc Planning, Exceutive functions, Speech, Impulse control, social & emotional behavior 3. Samana Vayu channels of sweat, digestive tract and lateral to the seat of agni (digestive enzymes (agni) Digestion Sympathetic – T 12- L2 Spinal nerves PS – Vagus N. ENS – Aurbachs’s & Meissner’s Plexus 4. Vyana Vayu All over the body gait, flexion, extension, etc movements, all the motor responses in the body Sensation & Ambulation of somatic NS Conduction mechanisms 5. Apana Vayu located in testicles, ejaculation, micturition, urinary bladder, penis, defecation, expulsion of umbilicus, thighs, inguinal menstrual blood and fetus. region and anus Push out / propogate activity of autonomic NS

Vata vyadhi (Charaka chikitsa 28th Chapter) Dhatu kshaya Avarana (Depletion of Dhatu) (Clouding of vata by other elements)

Avarana Avarana means ava-rodh gati nirodh i.e. obstruction to the normal gati of vata. Avaraka Avruta (Vata) The course of vata gets enclosed either by the other two doshas, any of the seven dhatus or the three malas result in Avarana. Components of Avarana Avaraka – That which covers Vata It can be the Doshas, Dhatus/ mala. Avruta – That which is covered/trapped Which is mostly Vata/ subtype of vata.

Steps in Avarana सर्वेष्वेतेषु संसर्गं र्वायोर्ाा तुक्षयात् र्वातपित्तकफा कोिो दे हे र्वायुरेर्व कुपितस्तौ पह समुद्र्ूय पित्ताद्यै रुिलक्षयेत् मार्गास्यार्वरणे न च �रणः ��णः तत्र तत्र पक्षिन् ��िशोषयेत् ६१ ५८ (र्वा) [१] र्गदान् ५९ ६०

In all these disorders, the association of other dosha like pitta etc. is to be considered. The provocation of vata is either due to dhatukshaya, means diminution of tissue elements and/ or due to avarana means obstruction to its pathway. The vata, pitta and kapha, always circulate through all the body channels. The vata, owing to its subtle characteristics is really the impeller of the other two. When the vata is provoked, it propels the other two doshas and dislodges them about here and there, causing various diseases. Due to avarana (obstruction in its path), it further causes diminution of the body nutrient fluid and other body elements.

Avrita vata (conditions due to obstructed vata) पलङ्गं पित्तार्वृते दाहस्तृष्णा शूलं भ्रमस्तमः �श्च पर्वदाहः शीतकापमता Vata occluded by pitta The symptoms of vata occluded by pitta are Daha(burning sensation), trishna (morbid thirst), shoola(pain), Bhrama(giddiness), tamah(darkness of vision); heart burn on eating pungent, sour, salt and hot things and craving for cold things Possible pathology that can be correlated: Ischemia – Stroke, mesenteric Vascular Involvement

�पन कट्वाद् युिशयोऽपर्कम् ६२ �णकापमता च कफार्वृते Vata occluded by kapha If the vata is occluded by kapha, there will be excess feeling of cold, heaviness, pain, pacification by pungent and similar other articles, need for fasting, exertion, less of unctuous and hot things CMBCD stage 1 &2 – Prediabetes Obesity Possible involvement of neurological and/ vascular involvement Stiffness, parasthesia, pain symptomatic cases.

रक्तार्वृते � सान्तरजो भृशम् ६३ Vata occluded by blood When it is occluded by the blood, there will be severe burning pain in the area between the skin and the flesh, along with edema and reddish tinge and around. Complex regional pain syndrome (CRPS) with / without nerve damage. Peripheral Arterial Diseases Peripheral neuropathies Mitchells disease

��ेपितैः कपिनाश्च पर्वर्वणाा श्च पिडकाः श्वयथुस्तथा ६४ हषाः पििीपलकानां च सञ्चार इर्व मां सर्गे चलः पिग्धो मृदुः शीतः �्तथा ६५ Vata occluded by mamsa In the flesh, it causes hard, discolored boils, and swellings, horripilation and tingling. Difficulty in physical activities like swimming, exercise Auto immune conditions of muscles, compartment syndrome, DMD?

�ात्वाद्वायुः कोष्ठे पर्वशेषतः चरन् �ारं शोषयत्यपि ५ तस्मात् स शीघ्रं जरयत्याहारं चापतकाङ्क्षपत पर्वकारां श्चाश्नु ते घोरान् कां �मात् Vata occluded by meda Due to the obstruction of body channels by medas, the movement of vata is specially confined to koshtha (abdominal viscera) resulting in the stimulation of digestive power and absorption of food. Hence, the person digests food quickly and becomes a voracious eater. By not following rules of taking meals at specific times during the day, he is afflicted by dreadful diseases. Obesity, Lipedema

�ृते तूष्णं िीडनं चापभनन्दपत ६६ Vata occluded by asthi When the vata is occluded in the osseous tissue, the patient likes hot touch (local sudation) and pressing . He has splitting pain and feels as though his body is being pricked with needles. Low back pain, Sciatica

सम्भज्यते सीदपत च सूचीपभररर्व तुद्यते मज्जार्वृते �्भणं िररर्वेिनम् ६७ Vata occluded by majja When the vata is occluded in the marrow, there will be curving of the body, /pandiculation (stretching and stiffening of the trunk and extremities), excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). Spinal Cord injury, neurological illness, Hemiplegia, Parkinson’s disease

शूलं तु िीड्यमाने च िापणभ्ां लभते सुखम् �र्वेर्गो र्वा पनष्फलत्वं च शुक्रर्गे ६८ Vata occluded by shukra If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. Sexual Dysfunction, Leriche’s syndrome ( Erectile Dysfunction)

भुक्ते कुक्षौ च रुग्जीणे �ेऽपनले �राध्मानं बस्तौ � ६९ Vata occluded by food If the vata is occluded by food, there will be pain in the stomach on ingestion of food and disappearance of pain after digestion. Intestinal Angina Vata occluded by urine If the vata is occluded by urine leads to urinary retention and distension of bladder. Multiple Sclerosis with Urine disturbances, Overactive/ Underactive bladder with neural involvement

�धोऽर्ः स्वे स्थथाने िररकृन्तपत व्रजत्याशु जरां िेहो भुक्ते चानह्यते नरः ७० Vata occluded by feces If the vata is occluded by the fecal matter; it leads to obstinate constipation, scissoring type pain in anal region, all unctuous matter ingested is immediately digested (due to excess dryness in colon), after food intake the person suffers from increased distension of abdomen and owing to the pressure of the food ingested the patient passes dry feces with difficulty and after long delay. He is afflicted with pain in the hips, groins and back; as the vata moves in a reverse direction causes epigastric discomfort. Acquired mega colon as a sequale of different pathologies.

�े र्वायौ �ष्ठरुक् ४१ पर्वलोमो मारुतोऽस्वस्थथं हृदयं िीड्यतेऽपत च (Ashtanga Hridaya Nidana sthana Chapter 16/42-43 shloka) Sarva Dhatu avruta Vata Involvement of all the dhatus reflects as Viloma maruta aswastha ( Restlessness), peeda & ruja (pain) all over the body. Aorto iliac occlusion, auto immune, neurodegenerative diseases.

Treatment of Avarana This general line of treatment is also recommended in conditions of association with morbidity of doshas, but especially when the body channels have been occluded by pitta and kapha in vata disorders. First target the Avaraka Dosha (The one which traps) Then the Avrutha dosha (the one that is trapped)

Type of Avarana Treatment 1. Pittavruta Vata Vyatyasa Chikitsa, Ksheerabasti, Virechana, Dhara, Grita, Ksheerapana and Ksheeranna Kalpana, mamsa rasa 2.Kaphavruta Vata Niruha Basti, Vamana, Virechana, Purana ghrita, Sesame , Mustard Oil, Barley diet, Sudation 3. Raktavruta Vata Virechana, Rakta Mokshana, Pittopakrama 4. Mamsavruta Vata sveda (sudation), abhyanga (oil massage), ingestion of meat soup, milk as food, sneha (oleation therapy) 5. Medavruta Vata Panchakarma as per the symptoms, rukshana (depletion therapy) 6. Asthimajjavruta Vata Tikta rasa yukta shodhana, Mahasneha (4 fat) administration 7. Shukravruta Vata Virechana, Harshana, shukra vardhana chikitsa

8. Annnavruta Vata administration of pachana (digestive), vamana (emesis), dipana (carminatives) & laghu (drugs & food which are easily digestible) are ideal 9.Mutravruta Vayu drugs which are mutrala (diuretic), sveda (sudation) & uttarbasti (Urethral douche) 10. Purishavruta Vayu drinking of eranda taila, basti (enema) & fats (medicated oil or ghee) which produce purgation 11. Sarvadhatu Avruta Vata Vata anulomana by basti/ virecana/ vamana followed by brimhana

Conclusion Avarana is a general pathophysiology explained in Ayurveda applicable in any disease. Clinical practice and research today understand some of the avarana types as ageing, pre disease conditions leading to diseases.

Raktavruta Vata Virechana, Rakta Mokshana, Pittopakrama 4. Mamsavruta Vata sveda (sudation), abhyanga (oil massage), ingestion of meat soup, milk as food, sneha (oleation therapy) 5. Medavruta Vata Panchakarma as per the symptoms, rukshana (depletion therapy) 6. Asthimajjavruta Vata Tikta rasa yukta shodhana, Mahasneha (4 fat) administration 7.