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 Vatavyadhi (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).

Kapha (Shira –

Uroamashaya)

Pitta ( Amashaya –

Nabhiramashaya)

Vata ( Pakwashya and

downwards)

General Distribution Of Kapha – Pitta – Vata in Human

body

Subtypes and functions of VataVayu 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 ResponsesHeart Rate & BP Regulation

2. Udana Vayu umbilicus, thorax and trachea

speech, memory, energy, strength, complexion etc

Planning, Exceutivefunctions, 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- L2Spinal nervesPS – 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 NSConduction mechanisms

5. Apana Vayu located in testicles, urinary bladder, penis, umbilicus, thighs, inguinal region and anus

ejaculation, micturition, defecation, expulsion of menstrual blood and fetus.

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.

• 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.

Avruta(Vata)

Avaraka

Steps in Avarana

• सरे्वषे्वतेषु संसरं्ग पित्तादै्यरुिलक्षयेत् ||५८||

• र्वायोर्ाातुक्षयात् कोिो मार्गास्यार्वरणेन च (र्वा) |र्वातपित्तकफा देहे सर्वास्रोतोऽनुसाररणः ||५९||

• र्वायुरेर्व पह सूक्ष्मत्वाद््दर्वयोस्तत्रापु्यदीरणः [१] |कुपितस्तौ समुद्रू्य तत्र तत्र पक्षिन् र्गदान् ||६०||

• करोत्यारृ्वतमार्गात्वाद्रसादीशं्चोिशोषयेत् |६१|

• In all these disorders, the association of other dosha like pitta etc. is to beconsidered.

• The provocation of vata is either due to dhatukshaya, means diminution of tissueelements and/ or due to avarana means obstruction to its pathway. The vata,pitta and kapha, always circulate through all the body channels. The vata, owingto its subtle characteristics is really the impeller of the other two. When the vata isprovoked, it propels the other two doshas and dislodges them about here andthere, causing various diseases. Due to avarana (obstruction in its path), it furthercauses diminution of the body nutrient fluid and other body elements.

Avrita vata (conditions due to obstructed vata)

• पलङं्ग पित्तारृ्वते दाहसृ्तष्णा शूलं भ्रमस्तमः

• कट्वम्ललर्वणोषै्णश्च 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); heartburn on eating pungent, sour, salt and hot things and craving for cold things

• Possible pathology that can be correlated: Ischemia – Stroke, mesenteric

• Vascular Involvement

• शैत्यर्गौरर्वशूलापन कट्वाद्युिशयोऽपर्कम् ||६२||

• लङ्घनायासरूक्षोष्णकापमता च कफारृ्वते |

• 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.

• रक्तारृ्वते सदाहापतास्त्वङ्ांसान्तरजो भृशम् ||६३||

• Vata occluded by blood

• When it is occluded by the blood, there will be severe burning pain in the areabetween 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

• लङ्घनप्लर्वनात्यध्वव्यायामापतपर्वचेपितैः |कपिनाश्च पर्वर्वणााश्च पिडकाः श्वयथुस्तथा ||६४||

• हषाः पििीपलकानां च सञ्चार इर्व मांसरे्ग |चलः पिग्धो मृदुः शीतः शोफोऽङे्गष्वरुपचस्तथा ||६५||

• Vata occluded by mamsa

• In the flesh, it causes hard, discolored boils, and swellings, horripilation andtingling. Difficulty in physical activities like swimming, exercise

• Auto immune conditions of muscles, compartment syndrome, DMD?

• मेदसाऽऽरृ्वतमार्गात्वाद्वायुः कोषे्ठ पर्वशेषतः| चरन् सनु्धक्षयत्यपिमाहारं शोषयत्यपि||५||

• तस्मात् स शीघं्र जरयत्याहारं चापतकाङ्क्षपत| पर्वकारांश्चाशु्नते घोरान् कांपश्चत्कालव्यपतक्रमात्

Vata occluded by meda

• Due to the obstruction of body channels by medas, the movement of vata isspecially confined to koshtha (abdominal viscera) resulting in the stimulation ofdigestive power and absorption of food. Hence, the person digests food quickly andbecomes a voracious eater. By not following rules of taking meals at specific timesduring the day, he is afflicted by dreadful diseases.

• Obesity, Lipedema

• स्पशामस्थ्नाऽऽरृ्वते तूषं्ण िीडनं चापभनन्दपत ||६६||

• Vata occluded by asthi

• When the vata is occluded in the osseous tissue, the patient likes hot touch (localsudation) and pressing . He has splitting pain and feels as though his body is beingpricked with needles.

• Low back pain, Sciatica

• सम्भज्यते सीदपत च सूचीपभररर्व तुद्यते |मज्जारृ्वते पर्वनामःस्याजृ्जम्भणं िरररे्विनम् ||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), excessyawning, twisting and colicky pain. The patient gets relief on pressing with thehand (gentle massage).

• Spinal Cord injury, neurological illness, Hemiplegia, Parkinson’s disease

• शूलं तु िीड्यमाने च िापणभ्ां लभते सुखम् |शुक्रारे्वर्गोऽपतरे्वर्गो र्वा पनष्फलतं्व च शुक्ररे्ग ||६८||

• Vata occluded by shukra

• If the vata is occluded in semen, it results in ejaculation or premature ejaculationor sterility.

• Sexual Dysfunction, Leriche’s syndrome ( Erectile Dysfunction)

• भुके्त कुक्षौ च रुग्जीणे शाम्यत्यन्नारृ्वतेऽपनले |मूत्राप्ररृ्वपत्तराध्मानं बस्तौ मूत्रारृ्वतेऽपनले ||६९||

• Vata occluded by food

• If the vata is occluded by food, there will be pain in the stomach on ingestion offood 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 ofbladder.

• Multiple Sclerosis with Urine disturbances, Overactive/ Underactive bladder withneural involvement

• र्वचासोऽपतपर्वबन्धोऽर्ः से्व स्थथाने िररकृन्तपत |व्रजत्याशु जरां िेहो भुके्त 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 immediatelydigested (due to excess dryness in colon), after food intake the person suffers fromincreased distension of abdomen and owing to the pressure of the food ingestedthe patient passes dry feces with difficulty and after long delay. He is afflictedwith pain in the hips, groins and back; as the vata moves in a reverse directioncauses epigastric discomfort.

• Acquired mega colon as a sequale of different pathologies.

• सर्वार्ात्वारृ्वते र्वायौ श्रोपणर्वङ्क्षणिृष्ठरुक्||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, mamsarasa

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.