Posts Tagged ‘Pargamana’

CLINICAL PERSPECTIVE OF AVARANA


CLINICAL PERSPECTIVE OF AVARANA

Prof. Dr. S.N. Ojha
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Avaran

Lecture on Avaran

Shabda Vyutpati

‘Aa’ upasargapurvak

‘Vru’ dhatwatmak

‘Lyut’ pratayatmak

Shabdakalpadrum explains vyutpati of Avarana shabda from ‘Vru’ sanskirt dhatu which means valayita, vestita, ruddha and samvita

Nirukti

According to Ayurvediya shabdakosha the word avarana means avarodha gatinirodha ie. obstruction or resistance or friction to the normal gati of vata. Vata dosha is the gatyatmak dravya within the sharir. Hence its normal gati is hampered or vitiated thus vata becomes avrita.

          Shabdakoshkar says that balwan dosha due to its vitiation impedes the durbala dosha and hampers the normal gati of the avrita dosha.

Vaidyak Shabdasindhu says avaraka means achchhadaka while avrita means achchhadita.

Charak in context of madhumeha (C.Su. 17) has used the word avrita gati; Chakrapani explains it to be ruddhagati.

Dalhan commenting on the word avritamarga (Su.Sa.2) explains it to be pratibadha marga while Chakrapani commenting on the same word in ashtauninditiya adhyaya explains it to be avarudhagati.

In context of Kasa; Chakrapani says pratighat means avarana while in context of shotha says badhamarga means avritamarga.

Thus the word avarana can be understood as;

Achchhadan

Avaruddha gati

Sanga

Pidhan

Samvaran

Aakirya

Prachadana

Vestana

Valayana

Pravrita

Samvrita

To understand avarana firstly we need to understand the Gati-sidhant explained by our acharya.

GATI SIDDHANT:

          C.Chi. 28/4

Avyahatgati explains the normalcy of vata dosha and whenever vata dosha remains in prakritawasta the person lives a healthy life for hundred years.

Chakrapani commenting on the word avyahatgati has used 2 significant words aparityakta swamarga and anavritamarga.

Above, we have already discussed what do we mean by avritamarga; resistance to the normal gati of vayu. Whenever there is absence of resistance to a object, it moves in its own marga, srotas, dhamani etc. this is known as avyahat or prakrita gati.

Parityaktamarga means the sharir dravya is unable to maintain its swamarga. Vimarga is a synonymous word for parityaktamarga.

All the dosha have a normal shakha kostha gati which when maintained, dosha are able to maintain there normal function.

Vata dosha is raja guna dominated; it is the one which gives the initiating force (preraka) for the movement of all the other dosha. Hence its gati is very significant. If vata dosha gets avrita or vimargashrit, various disease proces begins within the body.

C.Chi.28/60

Causes of vata prakopa is either due to dhatu kshaya or due to marga avarana.

Pratibandha is the word used by Chakrapani in context of avarana. Vata has been explained to be sukshma-marganusari and preraka. Thus whenever movement of vayu through the suksma srotas is obstructed or the preraka karma is hampered the dravyabhuta vata dosha gets prakopita or vitiated.

Thus whenever avarana will take place it means it will hamper the following karma

-         Vikshepa

-         Samvahana

-         Parivahana

-         Chavan

-         Pargamana

-         Sravana

-         Visyandana

-         Ativedana, etc.

Charak in Vividhaashitapitiya adhyaya says that along with healthy food; jatharagni, anupahata dhatushma, anupahata srotas and anupahata vayu are responsible for healthy life.

Chakrapani says dhatu themselves are nutrient for the other dhatu and the urja of sharirdhatu depends upon anupahatadhatushma, dhatuposhak rasavahi vyanrupamarita and dhatuposhak rasavaha srotas

Anupahata dhatushma:-

Charak explains jatharagni is the one which gives bala to bhutagni and dhatwagni. For complete conversion agni is needed. Unless and until complete conversion of ahar into dhatuposhakansa does not take place they are not assimilated; such improperly converted dhatuposhakansa are called as the aparinamit dhatu or sama dhatu which offers resistance to the normal gati of vata dosha.

Hence, homeostasis in the content of dhatuposhakansa is brought about by the dhatushma it is therefore said to be responsible for dhatu urja.

Anupahata marita or dhatuposhak rasavahi vyanrupa vayu.

Amurta, subtle but dravyatmak vata existence in the sharir is understood by its vikshepana karma.

Charak in grahanidosha chikitsaadhyaya explain vyan vayu to be responsible for the continuous vikshepan of rasa raktadhi poshakansa.

Whenever sama dhatu are formed they disturb the normal gati of vata. The normal force required by the vayu for the transportation of dhatuposhakansa is unable to carry-out its normal function. The gati is restricted and the poshakansa is not made available to the dhatu thus leading to urja hanan of the dhatu. This explains the significance of dhatuvahi vyan vayu or marita in context of sharir dhatu urja.

Anupahata srotas

Sushrut says whenever ‘kha’ vaigunya is made available to vitiated dosha sanga takes place leading to the utpatti of vyadhi

Kha vikruti itself explains that the swaroop of aakash mahabhuta in that specific area is change ie apratighat guna of aakash is reducd and pratighat is increased. Pratighat develops sanga and apratighat contributes in prasarana or circulation. At definite extent pratighat is required across the srotas to provide the ahara rasa to surrounding part, but it is a non significant or negligible or non recordable, occurs at fastest rate and do not interfere with apratighatatva which maintains the constant condition or homeostasis.

One can understand the role of srotas in context of kapha, pitta, raktadi dhatujanya avarana but is their any role of srotas in context of parasparavarana?

Vatakalakaliya adhyaya gives the solution. Although vata being amurta, asanghata, anavastita dravya, how does its prakopa prashama takes place? Kankayan rishi says the rukshata, laghuta, sheetata, darunata adi lakshana are seen in the sharir viz srotas which leads to the prakopa of amurta vayu while dravya pradhan in snigdha adi guna act on sharir viz srotas and do the prashama of vata dosha.

Thus srotas plays an important role in prevention of utpatti of any disease.

In nut shell we can conclude the above discussion as;

Paraspara Avaran

Vata dosha is the same everywhere but depending on karma and sthana we classify it into 5 types viz pran, udanadi.

All the 5 types interplay within themselves and maintain homeostasis for eg due to prayatna of udan assimilation function of pran vayu takes place; saman vayu later on absorb the ahar rasa from where it is transported throughout the sharir with help of vyan vayu. Excretion takes place with help of apana vayu. When they themselves hamper their own karma, utpatti of vatavyadhi takes place.

Acharya Vagbhat has given the dusti hetu and dusti lakshana of pranadi pancha prakar vayu.

Vatabheda Nidan Lakshana
Pranvayu RukshaVyayamaLanganaAtyahar

Abhighat

Adhwagaman

Vega udiran

Vega dharan

Chakshu adi indriyopaghataPinasaShwasaKasa

Hikka

Trishna

Udanvayu KshavathuUdgarChardi             Vega vidharanNidra

Ati guru padarth sevan

Ati bhara vahan

Ati rodhana

Ati hasya adi

Kanta udhwansaMano branshaChardiArochaka

Pinasa

Galagandha

Jatru-urdhwa Vikara

Vyanvayu Ati adhwaEkasthana asanaAti dhyanAti krida

Vishama chesta

Virodhi ahar sevan

Bhaya

Harsha

Vishada

PunstwahaniUtsahahaniBalabhransaChittotplawa

Jwara

Nistoda

Romaharsha

Angasudata

Kusta

Visarpa

Sarvanga vikara

Samanvayu Visham-aharAjirnaSheetaharSankirna Bhojana

Akalashayan

Akalajagaran

ShoolaGulmaGrahaniPakwa-aamashayaj Vyadhi
Apanavayu RukshaGuru annaVegavidharanAagat

Ativahan seva

Yanaatisevan

Aasana atisevan

Chakraman atisevan

Mutra pradoshaj vikarShukra pradoshaj vikarGudabhransaPakwashayagata Vyadhi

Vishesha sthan has been explained for each vayu prakar but at each cellular level we can understand their functional activity such as assimilation of pran vayu, excretion of apan vayu, circulation and transportation of vyan vayu agnisandukshan or digestion & metabolism stimulants of saman vayu and prayatna of udan vayu. The concept is important because in case of paraspara avarana some symptoms have been explained which are not specific to their sthan for eg in saman avrita apana hridroga has been explained. There is  interplay between gati of different vata prakar. In normal condition they help each other to carry out various function but when there gati gets vitiated due to above hetu the balwan vata prakar impedes the gati of other leading to paraspara avarana.

Chakrapani/ C.Chi. 28/205

Concept of avarana in case of mana

Mana has its utpatti from avyakta. Avyakta being trigunatmak by satkaryavad siddhant mana is also trigunatmak swaroop. While satva is understood as guna of mana, raja and tama are understood as manashika dosha.

Mahabhuta also have origin from triguna as explained by Sushruta in sharirsthan first adhyaya.

Aakash is satva bahul

Vayu is raja bahul

Agni is satva raja bahul

Aap is satva tamo bahul

Prithvi is tamo bahul

All the 3 viz satva, raja and tama in balance state help each other although they have opposite qualities.

Satva guna is gyan prakashak

Raja guna is pravriti mulak

Tama guna is apravriti mulak

Mana and Panchamahabhuta both have origin from trigunatmak prakriti hence ahar which is panchabhautik in swaroop has its impact on mana and mana which is trigunatmak has its impact on sharir which is panchabhautik in swaroop.

In Sharirik vyadhi we find manas dosha lakshana while in manasik vyadhi we find sharirik dosha lakshana for eg in udavarta vyadhi mano vikar may occur as upadrava swaroop while in unmada we may find chhardi, karsnya adi sharirik lakshana.

Activity of satva and tama depends on raja similar to sharirik dosha where vata is responsible for kapha and pitta activity. All the 3 have abhibhava between them which in prakritavastha helps to maintain homeostasis while in vikritavastha cause various manasika vikar.

Hence in context of mada, murchha, sanyasa apasmara and attatvabhinivesh avarana has been explained.

Concept of gatavata and avarana.

Dhatu can be classified into two types asthayi dhatu and sthayi dhatu. Asthayi dhatus are the ones which are dravaswaroop and undergoing conversion (parinam aapadyamananam) and they are being vikshepita from their mulasthan throughout the sharir (abhivahan) for the purpose of poshan of the sthayi dhatu. This parinaman and abhivahan prakriya takes place in marga which are known as srotas; hence marga is one of the synonym used for srotas alongwith sira, dhamani, rasayani, rasavahini, nadi, panthana, sharir chhidra, samvrita-asamvritani, sthan, aashaya, niketa, sharirdhatu avakasha.

Prakopita dosha have the capacity to further vitiate both sthanasta dhatu as well as margagata sharir dhatu.

          When prakopita vata vitiates the dhatu it is called as gata vata, means vata prakop with specific nidan occurs as initiative factor to interplay with specific dhatu or vitiated itself in specific sthan (Amashaya gata vata etc.). In this context specific nidan for each and every gata vata related diseases must be observed to clarify why vitiated vata goes to specific part of the body or to specific dhatu to develop kosthagata vata, raktagata vata etc. Here dhatu functions like dusya.

In case of avarana pitta, kapha, rakttadi dhatu play the role of dosha or initiative factor to hamper the gati of vata, which in turn lead to avaraka and avrita components of avaraka respectively.

Comparative study of dhatugata vata and avritavata

Raktagata vata

Raktavrita vata

Tivra rujaSantapaVaivarnyaKrushata

Aruchi

Arushim cha gatre

Bhuktashya stamba

Twak mansa antarjadaha & arti/vedanaRagayukta shothaMandala

                            

In raktagata vata, rakta dhatu gets vitiated by vata dosha leading to shoshan of rakta dhatu; thus raktadhatu is unable to carryout its normal function of jeevan,varnaprasadhan, mansa poshan etc. Vaivarnya is caused due to loss ofvarnaprasadhan karma, due to improper mansa poshan krishata is seen, tivra ruja is seen due to depletion of poshana (Ischaemic pain).

Hetu explained in vidhishonitiya adhyaya are responsible for quantitative increase of rakta dhatu which impedes the gati of vata dosha hence normal parivahan is hampered and stagnation takes place leading to sanga this is the reason why in rakta avritavata raga yukta shotha, mandala, local daha and vedana have been explained. It can be compared with urticaria or vasculitis wherein we find rashes, burning sensation, pain, wheel & flare like presentation.

Treatment

Considering treatment we see use of sheeta pradeha, virechan and raktamokshan as line of treatment in raktagata vata while we see vatarakta like treatment in raktavritavata, where in treatment is given to reduce the quantitative increase of rakta dhatu and also normalise the gati of vata dosha with the help of basti hence importance of basti chikitsa in vatarakta has been explained.

(Na Hi Bastisamam kinchit vataraktam chikitsitam) C.Chi. 29/88

Mansamedogata vata

Mansa avrita vata

Medo avrita Vata

Guru angaTudyate atyarthamDanda mustihatamShramika atyartham KathinaVivarna PidakaShothaHarsha

Pippilikanam cha

Sanchar

ChalaSnigdhaMriduSheeta sopha

Aruchi

Mansa meda dhatu have similar characteristic both being snigdha, guru, sthira guna pradhan which gets vitiated by ruksha, laghu and chala guna of vata leading to disorder called mansamedogata vata. Various myopathies can be included under mansamedogata vata specially Carnitine palmitoyltransferase deficiency in which severe pain with fatigueness is seen. Myasthenia gravis can also be considered in mansamedogata vata.

Mansa dhatu is formed when vayu, ambu, teja and rakta ushma together bring sthirata to the mansaposhakansa. Sthira, kathina are the gunas of mansa while lepana is the karma of mansa dhatu. Such mansa when opposes the gati of vata kathina pidaka and shotha is formed. Nodules and tumours are defined as the solid, raised and firm growth.

When ambu, snigdha guna along with the dhatushma acts on poshakansa a soft, snigdha meda dhatu is formed. When such medadhatu will obstruct the gati of vata dosha it leads to origin of snigdha, mridu, ambulatory shotha. Lipoma bullae can be understood in context of medasavritavata.

Mansa medas avritavata may also be a complication of prameha since mansa and meda are the avaraka along with kapha and pitta to develop avritavata in basti and in turn leading to madhumeha as in C.Su.17. It indicates when mansa and meda become more vitiated and cause more kleda genesis or become kledanvita, they lead to different micro and macro angiopathy related complication. Meda-avrita vata can be compared with Diabetic nephropathy.

Pippilikanam cha sanchar are the abnormal sensory positive phenomenon or it may be the late complication of microangiopathy.

Treatment

-         Virechan, niruha and shaman is the chikitsa sidhant for mansamedogata vata.

-         In case of mansa avrita vata swedan, abhyanga, mansarasa, kshira and sneha prayog have been explained which will regularize the gati of vata as well as create normal poshakansa.

-         Pramehagna, medogna and vatahara chikitsa have been explained for amavritavata or for adhyavata

Thus avaraka and avrita both are being treated.

Asthimajjagata vata

Asthyavrita vata

Majjavrita vata

AsthiparvabhedaSandhishool

Mansabalakshaya

aswapna

santata ruk

Ushna sparshaPidanan cha abhinandati

Sam-bhajyate

Sidhati (Depressed)

Suchivad vedana

VinamaJrimbha

Parivestana

Sholam tu pidyamane

Panibyam labhate saukhyam

Due to external injury or due to pressure the asthi majja dhatu gets deranged leading to pain mainly at ashti parva or at the level of joints. The pain is continuous and it may later on show periarticular muscular atrophy as its late complication. It can be collectively understood under osteoarthritis where in focal loss of articular hyaline cartilage is seen with simultaneous proliferation of new bone with remodelling of joint contour. (sclerosis).

In asthyaavrita vata asthikshaya is observed (decrease bone density) increasing the symptoms of pain along with chances of fracture. Eka sthana vridhi anya sthan kshaya is other sidhant which explain the concept of osteophytes Osteophytes may compress the nerves root causing tingling or suchivata vedana (entrapment or compressive neuropathy).

In majjavrita vata the majja dhatu impedes the gati of vata (nerve conduction) leading to the symptoms like vinama; pain etc. Diffuse bulging of cord may be considered as well spinal canal stenosis.

Treatment

In asthi majjagata vata bahya aabhyantar snehan are the line of treatment so lubrication is maintained at the joint and results in prakritisthapan of vata.

Mahasneha prayog has been explained in asthi majja avritavata.

Note that a common treatment is explained in both the avaran and gata vata clinically too we see that Compressive Neuropathy or compressive myelopathy occurs in both the condition.

Shukragata vata

Shukravrita vata

Kshipra munchati / badnatiVikriti janayed shukram

garbham cha

AvegaAtivega

Nisphalatwan


In shukragata vata shukra are formed but either the count is less or there is some anomaly with its structure. Hence along with early ejaculation there is also abnormality in the foetus. Anomalies caused by extra sex chromosomes or less sex chromosomes can be included under this group (Aneploidy or polyploidy).

In shukragata vata sperms are formed but the count may be reduced in viral Orchitis, TB, STD, Chemotherapy, Ionizing radiation and drugs in which testesterone levels remain normal. It may cause premature or delayed ejaculations and also may cause abnormality in the foetus.

In shukravrita vata immature sperms are formed which loose their forward movement activity. Ciliary dyskinesia (kartagener syndrome) can be included in this group. Since motility is reduced it leads to infertility. Y chromosomes microdeletions and POLG variants are increasingly recognised as a cause of azoospermia or oligospermia. Primary gonadal deficiency with low-testesterone and decreased spermatogenesis are the reason for infertility.

Patients with normal hormonal levels and low sperm count may be found in obstructive anomaly of vas deferens and epididymus.

Treatment

Harsha and annapan responsible to increase bala of shukra is given. Virechan is advice if the marga is obstructed followed by above treatment.

In shukravrita vata too virechan has been explained followed by shukra bala vridhikar ahar and aushada.

 

Annavrita Vata

Bhukte kuksho cha ruja

Jirne shamyati

Ahar when taken in excess the prokinetic movement is reduced and the ahar is not propelled forward leading to strech reflex. The pain of obstruction of hollow abdominal viscere is classically described as intermittent food related abdominal pain followed by remission is seen.

Treatment

Vaman, deepan, pachan and laghu bhojan are the line of treatment.

Vaman causes gastric emptying thus avaraka is removed and with deepan, pachan aushadhi digestive capacity as well as vata gati is maintained.

Laghu bhojan is an important pathya which is followed in annavritavata

Mutra-avrita vata

Mutra apravritati

Aadhmanam cha basto

These symptoms are seen in mutra vega dharan. Normal urine formation takes place but the patient does not evacuate it timely leads to the avarodha of vata gati. Vata is unable to contract the detrusor muscle thus there is mutra apravritati and inturn bladder distension. This condition may also arise in neurogenic bladder.

Atonic bladder – Micturition reflex contraction cannot occur if the sensory nerve fibres from the bladder to the spinal cord are destroyed, thereby preventing transmission of strech signals from the bladder. When this happens, a person loses bladder control, despite intact efferent fibers from the cord to the bladder and despite intact neurogenic connections within the brain. Instead of emptying periodically the bladder fills to capacity and overflows a few drops at a time through the urethra. This is called overflow incontinence. Crush injury is the common cause.

Treatment

Swedan between bladder and nabhi pradesh alongwith uttarbasti

Purishavrita vata

-         Ati vibandha

-         Parikartika

-         Sneha ansa shigra pachana

-         Bhojan jirnortar aadhman

-         Shuska shakrit visarjan

-         Shroni, vankshana prishtha ruja

-         Viloma vata.

Dietary fibres adsorb water and this increases the bulk of stools and helps reducing the tendency to constipation by encouraging bowel propulsive movements. Diet low in fibres content reduces the healthy bowel movements. Stools are formed but due to slow transit there is hard and pelty stool formation which finds it difficult to pass out.

Malavega dharan may also cause the above symptoms. In Diabetes mellitus whenever there is neurogenic involvement, peristalsis are reduced creating the above symptom. Spastic colon may also be considered.

Treatment

Erandataila

Swedan

Udavartanashak Chikitsa

Treatment is given first to soften the stools and increase the intestinal motility so painless anuloman takes place.

Pitta avrita vata

Kapha avrita vata

-         Daha-         Trishna

-         Shoola

-         Bhrama

-         Tama

-         Sheeta kamita

-         Katu, amla, lavan,

ushna vidaha karak

- Shaitya- Gaurav

- Shoola

- Langhan, aayas, ruksha, usna kamita

- Katu adi upashaya karak

Due to intake of pittakar hetu quantitative vridhi of pitta takes place. It starts accumulating and now opposes the gati of vata which is unable to get rid off the pitta dosha so pitta vridhi lakshana are observed. Symptoms like daha etc are observed. The symptoms can be compared with heat stroke where the failure of heat regulating mechanism takes place.Giddiness, syncope may be observed, heat cramps may occur due to loss of sodium, potassium, chlorides in the blood. Hyperthermia reduces blood flow to brain causing giddiness.

While in case of Kaphavrita vata effect of cold stress should be considered. Muscular weakness is observed along with hypothermia. Symptoms may also arise in morning hours of cold seasons and rainy season. Working in air-conditioned rooms for longer hours can also create such symptoms. Even in common cold without pyrexia such symptoms may be produced.

Treatment:

The treatment is classified depending upon the sthan where the avarana takes place. Alternate shit & ushna in pittavrita vata.

If vitiated kapha and vayu are in aamashaya, vaman has to be followed, virechan is directed if it is pakwashaya sthita.

If pitta is vitiated throughout sharir virechan is adviced.

If by swedan kapha or the pitta reaches pakwashaya basti is to be adviced.

Gomutra is added in basti if kapha is involved while kshirabasti is given if pitta is involved.

Dhumpan and nasya is advice if kapha takes ashraya in shira pradesh.

After the shaman of kapha and pitta vatahar chikitsa has to be followed.

 

Pitta avrita pran

-         Murchha

-         Daha

-         Bhrama

-         Shoola

-         Vidaha

-         Shit kamana

-         Vidagdha anna vaman

Pran vayu is said to be controller, it helps in assimilation of ahar etc.

In pittavrita pran there is quantitative increase of pitta and it opposes the gati of pran, hence ingested food is vomitted out and since the ahar is not completely digested it comes out in the vidagdha form, as pitta has increased there are symptoms of daha, vidaha, murchha, bhrama and sheet kamana

Whenever food is ingested it stimulates the pharyngeal sensory receptors which send the impulse to the swallowing centre from where the motor impulses are sent with the help of 5th, 9th, 10th, 12th, cranial nerves to the pharynx and upper esophagus similarly sensory signals that initiate vomitting originate mainly from the pharynx, esophagus, stomach and upper portion of small intestine. The impulse traverses by both vagal and sympathetic afferent  nerve fibres to the vomitting centre from where motor impulse that cause vomitting are transmitted by way of 5th, 7th, 9th, 10th & 12th cranial nerves to the upper GIT causing vomitting. Thus vomitting may be initiated by nervous signals arising in the brain. Stimulation of the floor of 4th ventricle called chemoreceptor trigger zone with the help of administration of certain drugs initiate vomitting. If the gastric contents are incompletely digested are vomited out with a burning sensation associated with abdominal pain, vertigo, etc. Viral encephalitis may also be considered which is associated with high grade fever, focal neurological signs and seizures. These emergencies are difficult to treat so as said by Charak that pitta and kapha avritapran are difficult to treat.

 

Kapha avrita pran

-         Kshthivan

-         Kshavathu

-         Udgar

-         Nishwas Uchhwas sangraha

-         Aruchi

-         Chhardi

Vridha kapha opposes the gati of controller pran hence nishwas uchaswas karma are hampered at the same time chhardi, ksthivan and kshavathu symptom increases in frequency.

Depression of respiratory centre in the medulla should be considered.

Abnormal ventilation may be considered as in case of COPD where in mucus plugs prevents the gases exchange. The mucus accumulated in nasal and throat cavity obstructs the gati of pran causing irritation, the afferent impulses passes to the medulla where the reflex of kshvathu and ksthivam is triggered the same impulse also stimulates the vomitting centre causing chhardi.

 

Pitta avrita udan

-         Murchha

-         Daha, Bhrama

-         Nabhi Ura daha

-         Klama

-         Ojo bhransa

Karma of udan vayu is to generate urja, it is vaka pravritai mulak, prayatna balavarnakarak along with srotas prinan, dhi dhriti smriti mano bodhana are the karma of udan.

The pitta which has increased quantitatively along with its tiksna, usnadi guna are responsible for avaran of udan vayu. Thus prayatna, bala, varna nasha take place similar to the ojo bhransa explained by Sushruta, body gets fatigue as there is reduced energy and burning sensation between nabhi and ura along with murchha, daha bhrama adi vridha pitta lakshana.

As ATP production is hampered (Urja hani) metabolism gets hampered leading to GERD (Gastro Eosophageal Reflux Disease) causing heart burn and associated symptoms like fatigueness vertigo etc.

 

Kapha avrita udan

-         Vaivarnya

-         Vaka, swar graha

-         Daurbalya

-         Guru gatrata

-         Aruchi

Sheeta, guru, manda guna yukta vridha kapha has qualities opposite of vata. Especially when vitiated kapha impedes udan vayu, vaka pravritati, bala,varna, utsaha are loss thus creating the above symptoms. Panini has explained swarotpati in which he says atma and budhi come together and they give prerna to the mana which further stimulates vayu and it moves upward through the thorax cavity and with the help of astasthan helps in shabdhotpathi.

Vayu prakar which is moving in thorax cavity in upward direction should be understood as udan. Kapha obstructs this particular gati causing vakswargraha, thus muscular movement in larynx mouth and respiratory system does not occur in succession causing dysarthria.

As ATP is unable to generate energy, daurbalya and gurugatrata symptoms are enhanced.

Pittavrita Saman Kapha avrita saman
AtiswedaTrishna

Daha

Murchha

Aruchi

Upaghata ushma

AswedaGatranam cha atisheetata

Agnimandya

Roma harsha

Pitta gives ashraya for agni while saman is said to be agni uttejak bhava. When avaran of saman takes place abhava of agni uttejana occurs but it takes with the help of pitta hence we have sarvadaihik symptoms of pittavridhi with ushma upaghat. Hence we see excessive sweating leading to trishna associated with daha murcha aruchi which are pittavridhi samanya lakshana.

Zollinger Ellison syndrome may be understood in this case wherein gastrinoma secretes large amount of gastrin which stimulate the parietal cells of stomach to secrete acid to their maximal capacity.

Increase aldosteronism may also be considered under pittaavrita saman.

In kapha avritasaman the sheeta, manda guru guna obstruct gati of saman. Thus agni uttejak abhavata is seen leading to agnimandya. Difference between the above too is the excessive drava gunatmak vridhi which prevents agnivridhi in case of pittavritasaman while incase of kaphavritasaman the enzymes are absent and there is no conversion of ATP.

Pitta avrita vyan Kapha avrita vyan
DahaSarvanga klama

Gatra vikshepa sanga

Santapa

Vedana

GurutaAsthi sandhi peeda

Gati sanga

Vyan vayu is responsible for all gati, prasarana, aakunchana, utshepa, avakshepa, nimesha unmesha adi kriya.

Whenever avarana of vyan vayu takes place sanga or restriction of sarvanga gatra occurs & daha, santapa are the samanya lakshana of vridha pitta while guruta adi are samanya lakshana of vridha kapha.

Inflammatory myopathies may be considered under pitta avritavyan. Systemic features like fever and fatigue are common. Other systemic autoimmune disease such as SLE (Systemic lupas erythomatosis) or vasculitis can also cause myositis. Polymyalgia rheumatica may also be considered where in muscular pain and stiffness is present. There is no true vasculitis but there is close association with giant cell arteritis, fatigueness, fever and depression.

In case of kapha avritavyan fibromyalgia may be considered. In this disorder there is no structural, inflammatory or endocrine abnormality. Marked fatigability, pain along with signs of osteoarthritis is also observed.

Pittavrita apan Kapha avrita apan
Haridra Mutra / VarchaSantapa Guda / Medra

Raja atidarshan

Bhinna, Aama, KaphaSansrista guru varcha

Kaphaj meha

The quantitatively increased pitta offers resistance to the gati of apan. Role of apan is dharana of the sharir. Mala bhag is excreted out with the help of apan vayu, raja pravartan, garbha nishkraman are also functions of apan.

The vridha pitta imparts its haridra peetavarnato mutra and purisha. Due to its ushna and tikshna guna santapa is felt at guda or medra sthana. Pitta is mala bhag of rakta and rakta helps in poshna of raja dhatu. Both pitta and raja have samana gunadharma hence pitta vridhi also leads to raja vridhi causing raja atidarshan.

This condition may be compared with infective inflammatory changes in urethra, anorectum and vagina.

HSV (Herpes simplex virus )  increases vaginal discharge along with vulval pain and dysuria. In trichomoniasis infection there is vulva and vaginal inflammation along with froathy yellow / green discharge. HSV and trichomoniasis may also be responsible for proctitis and urethritis.

The snigdha, guru, pichchhila, drava guna yukta kapha has its resemblance similar to meda and kleda does the bahudrava kapha when gets basti prabhava and along with meda and kleda reach the mutravaha srotas and get settle at glomerulus (Aasadya pratirudyate gatwa awatistate) leading to utpatti of kaphaj prameha.

This condition can be compared with alimentary glycosuria, a rapid but transitory rise of blood glucose following a meal.The concentration exceeds the normal renal threshold; during this time glucose will be present in the urine.

Vridha kapha by its snigdha, pichchhil, aama swaroop, guna changes the consistency and physical appearance of the mala converting it into bhinna, aama, kapha sansrista guru varcha.

 

Prognosis of pitta and kapha avritavata prakar

-         Acharyas beleive  aavaran of pran and udan vayu by both kapha, pitta are a serious condition.

-         Anabhisyandhi, snigdha and srota shodhak dravyas should be selected.

-         Yapana basti with madhur rasa pradhan dravyas

-         Anuvasan basti

-         If patient is balwan mrudu anuloman is useful

-         Rasayan chikitsa to be followed

-         Shilajeet and guggulu should be administered along with milk

-         Chyavanprasa and abhayaamalaki rasayan should be given.

-         If apana vayu does the avarana then dipana grahi, vatanulomak and pakvashayashodhana dravyas should be selected.

-         In avarana due to pitta, therapy which alleviates pitta but does not work against vayu should be given.

-         If kapha does the avarana then therapies which reduce kapha and which do anuloma of vata should be selected.


Paraspara Avarana

Pran avrita Vyan

-         Sarva indriya soonyatwa

-         Smriti kshaya

-         Bala kshaya

Pran vayu acts like a controller. It is responsible for the aadana karma. Gyanendriya perceive their objects with the help of pranvayu.

Vyan vayu is responsible for gati or conduction. Hence vyan vayu plays a significant role in rasavikshepan. Conduction is not only related to cardiac cycle but all types of neural conduction should be considered.

Whenever the controller pran will restrict the gati of conducting vyan vayu the indriya will not be able to perceive its vishaya. It may happen in one indriya (homonymous) or in all indriya (heteronymous) together. If it happens in all indriya it can be compared with the vegetative stage or deep coma.

Rasarakta vikshepan is karma of vyan vayu. In case of eye; vascular disease related to retina / optic disc causes visual loss.

Alzheimers Disease may also be considered. Macroscopically, the brain is atrophic, particularly the cerebral cortex and hippocampus. Many different neurotransmitter abnormalities have been described in particularly impairment of cholinergic transmission through noradrenaline, 5 H-T, glutamate and substance P is also involved. Inability to retrieve information (smriti kshaya) is the symptom. Later apraxia, visuo spatial impairment and aphasia is seen.

Treatment – Urdhwa  jatrugata chikitsa.

 

Vyana avrita pran

Sweda atipravriti

Lomaharsha

Twak vikar

Supta gatrata

Sweda sravan is normal karma of vyan vayu thus whenever vyan gets vitiated it causes sweda atipravriti. It explains sympathetic overactivity or cholinergic effect. This may happen in anticholinergic side effects seen in poisoning. Sweat glands secrete large quantities of sweat when sympathetic nerves get stimulated. Visha is one of the hetu of vyan prakopa.

Perception is the function of pran vayu when it gets avrita its perception function is reduced. It is negative sensory feeling caused in disorders like diabetes mellitus

Excessive sweating may cause twakvikar due to dehydration.

Treatment

Sneha yukta virechan

Sneha helps to reduce vyan and virechan helps in bringing anuloma gati to pranvayu.

 

Pran avrita saman

-         Sharir jadatva

-         Gadgad

-         Mukata

Panini has explained that atma alongwith budhi activates the mana with the help of pran. Mana stimulates the kayagni with the help of saman vayu and gives prerna to vayu in upward direction which depending on ashtasthan produces various sounds. Thus vitiation of pran or saman leads to symptoms like gadgad and mukta.

Dysarthria, Mutism is associated with perisylvian region of left hemisphere. Posterior pole being Wernickes area and anterior pole of language is known as Brocas area. An essential function of this area is to transform neural word representation into their articulatory sequences so that words can be uttered in the form of spoken language. Both the poles are interconnected with each other and with additional perisylvian, temporal, prefrontal & posterior parietal regions making up a neural network subserving the various aspects of language function. Damage to any one of these components or to their interconnections can give rise to language disturbances (aphasia)

Treatment

Chatusprayoga sneha – gives bala to saman

yapana – gives bala to pran.

 

Udan avrita apan

Chardi

Shwas adi

In above condition we need to emphasize on gati of vata prakar. Udan has its urdhwagati while apan vayu has anuloma gati. In udan avrita apana; the later changes its gati and now becomes udan bhava aapana as commented by Chakrapani ‘Urdhwagati swabhava aapana’. Thus urdhwagati is increased causing symptoms like chardi, shwas etc.

Cigarette smoking often results in mucous gland enlargement and goblet cell hyperplasia. Goblet cell increase in number but in extent through the bronchial tree. Bronchi undergoes squamous metaplasia which disrrupts       mucociliary clearence leading to COPD.

Antiperistalsis means peristalsis up the digestive tract rather than downward. This may begin as far down in the intestinal tract as the ileum. It can push the contents upto duodenum and stomach leading to their over distention which becomes the exciting factor that initiates the actual vomiting act.

Treatment

Basti

Vata anulomak annapana

 

Apan avrita udan

-         Moha

-         Agnimandya

-         Atisar

Apan has it adogati and is responsible for kitta utsarjan while udan vayu is responsible for urja and has urdhwagati.

Apan when resist udan the udan vayu becomes apan bhava aapana. As udan vayu gets avrita urja or agni is reduced causing agnimandya. The increase kitta and reduced urja gives rise to moha and alpagni.

Uraemia may be understood in the above condition where the concentration of blood urea (kitta bhag) increases in blood.

Treatment

-         Vaman

-         Agnideepan

-         Grahi annapana

Agnideepan and vaman to increase bala of udan and normalize its urdhwagati and grahi annapana to compensate the vridha gati of apan.

 

Vyan avrita apan

-         Vaman

-         Aadman

-         Udawarta

-         Gulma

-         Arti

-         Parikartika

Apan vayu has to own anuloma gati and its role is to eliminate the faecal matter, urine etc.

In this avaran vyan opposes the gati of apan thus anuloman does not take place. Features resemble adovega dharan vyadhi like aadman, udawarta, gulma and vedana. When the person stresses while passing motions the hard stools cause painful condition called the fissure.

G.I. has its own intrinsic set of nerves known as intramural plexus or the intestinal enteric nervous system located on the walls of gut. Both parasympathetic and sympathetic stimulation originating in the brain can affect gastro intestinal activity mainly by increasing or decreasing specific actions in the gastrointestinal intramural plexuses. Strong sympathetic stimulation inhibits peristalsis and increases the tone of sphinctures. Net results in slow propulsion of food through tract sometimes decrease the secretion as well even to the extent of constipation. As the peristalsis are reduced the food remains in stomach or early part of small intestine which send the strech impulse to vomitting centre causing the vomitting.

Treatment

-         Snigdha anuloman

 

Saman avrita apan

-         Grahani

-         Parshwa / Hridgada

-         Aamashaya shoola

Saman vayu helps in agni sandukshan also it has role in anna dharan, pachan, vivechan and taking kitta downward.

Saman vayu is agni-samipasta vata prakar. Grahani avayava helps in apakwa ahar dharan and pakwa ahar is pushed forward in parshwabhag. In saman avrita apan vridha saman does not help in dharan of apakwa ahar. Grahani vyadhi is so called because grahani is unable to do dharan of ahar. As apakwa ahar moves forward parshwa shool begins.

Due to vitiated saman the number of intermediate metabolites increases and it obstruct gati of apan causing ischemia causing hridroga.

 

Treatment

Agnideepak ghrita

 

 

 

Pran avrita udan

-         Shirograha

-         Pratishaya

-         Nishwas Uchshwas sangraha

-         Hridroga

-         Mukhashosha

Role of udan vayu is to give urja, bala, increase prayatna, srotas preenan etc. They get hampered when pran does avaran over udan vayu. The pran vayu has adhogati while udan vayu has urdhwagati does mismatching takes place leading to sangraha of nishwas and uchshwas.

Failure of control over the immune system leads to autoimmune disorder. The above condition can be seen in rheumatic heart disease and also in allergic rhinitis.

Treatment

Aashwasan chikitsa

 

Udan avrita pran

Karma Nasha

Oja Nasha

Bala Nasha

VarnaNasha

Mrityu

Bala,varna, oja, prayatna depend on Udan vayu while controller and assimilator is pran vayu.

In udan avrita pran the pran gati is restricted does perceiverance and control is lost while udan vayu being prakopita oja,varna, bala nasha is seen.

The above symptoms are seen in terminally ill patient in which fatigueness and weakness is commonly seen associated with psychological symptoms like hopelessness, meaninglessness, confusion, delirium which are similar to oja nasha.

Underlying various disorders reduce the energy store. It occurs due to disease induced factors such as TNF, cytokines and from secondary factors such as cachexia, dehydration, anemia, infection hypothyroidism and DKA. Changes in muscle enzymes also plays an important role. RAS system may get involve later on causing semicoma followed by coma and lastly death.

Treatment

-        Shanaihi Sheetavarina Shinched

-        Ashswashan

-         Sukham cha upapadayet

 

Apan avrita vyan

Purisha                 Atipravriti

Mutra                             Atipravriti

Retasa                   Atipravriti

Karma of apan vayu is nissaran of purisha, mutra, artava and shukra at a specific interval.

Apan when gets vridha and restricts the gati of vyan the utsarga vriti of avaraka is seen. Thus atipravriti of purisha, mutra and retasa is seen.

There is interplay between gati of apan with gati of vyan. The srijan karma and gati karma of apan vayu vitiates vyan vayu which becomes avrita and thus rasa vikshepan karma is reduced.

Diarrhoea causes dehydration leading to reduced ventricular filling pressure. Modulation comes into play causing increase heart rate and peripheral vasoconstriction but if the dehydration continues the cardiac output is reduced thus leading to reduced rasa vikshepan causing hypovolaemic shock

Treatment

Sangrahan

Saman avrita vyan

-         Murcha

-         Tandra

-         Pralapa

-         Angaawasad

-         Agnimandyata

-         Oja kshaya

-         Sharir bala kshaya

Many systemic metabolic abnormalities cause altered sensorium by interrupting the delivery of energy substrates. Almost all instance of diminished alertness can be traced to widespread abnormalities of the cerebral hemisphere or to reduced activity of a special thalamocortical alerting system termed the reticular activating system (RAS). Suppression of RAS and cerebral function can take place incase of metabolic dearrangement such as hypoglycaemia or hepatic failure leading to stage of reduced comprehension, coherence and capacity to reason. Irrelevant talk, lack of appreciation of spatial relation of self or external environment (agnosia) may also occur.

Treatment

Vyayam

Laghu bhojan

 

Udan avrita vyan

-         Stabdata

-         Alpaagnita

-         Asweda

-         Chestahani

-         Nirmilan

Vyan vayu is responsible for gati, vikshepan, sweda sravan nimesha, unmesha etc. but whenever it gets avrita swa karma hani occurs and if it gets avrita by udan the one responsible for bala, prayatna, urja causes symptoms like stabdhata, alpagni, asweda, chestahani and nirmilan.

Continuous generalized electrical discharges of the cortex are associated with coma even in the absence of epileptic motor activity. The self limited coma that follows seizures termed the postictal state may be due to exhaustion of energy resources or effects of locally toxic molecules that are byproduct of seizures.

Treatment

-         Alpa and Laghu bhojan

Anukta Avaran

Vyan avrita udan

Vyan is associated with gati and prakshepan while udan is associated with bala prayatna & urja. Vikrut vyan has impaired gati which when impedes udan will reduce the bala, prayatna adi karma of udan.

Sympathetic fibres originate in the hypothalamus, pass down the brain stem and cervical spinal cord to emerge at T1, return back up to the eye in association with the internal carotid artery and supply the dilator pupillae. Lesion in the sympathetic pathway cause Horner’s syndrome. The reason may be central (at the level of Hypothalamus / brain stem) or at the periphery (at the level of lung apex, carotid artery) or may be idiopathic.

Vyan avrita udan can also be considered in paroxysmal tachycardia. Abnormalities in different portions of the heart including the atria, the Purkinje system, or the ventricles, can occasionally cause rapid rhythmical discharge of impulses that spread in directions throughout the heart. This is believed to be caused most frequently by re-entrant circus movement feedback pathways that set up local repeated self re-excitation.

The above process occurs unless considerable ischemic damage and may lead to ventricular fibrillation. Thus there is never a coordinate contraction of all the ventricular muscle at once which is required for cardiac pumping. Patient may complaint of palpitation or symptoms such as dizziness, dyspnoea, fatiguebility ie. Bala, prayatna are reduced.

Apan avrita saman

Apan is responsible for srijan karma. Vikrita Apan increases the nishkraman prakriya. Increase Hustration reflex causes excessive propulsion movement. Excess motility causes reduced absorption. The body in unable to reabsorb bicarbonate ions i.e. saman karma is reduced.

Loss of bicarbonate causes rise of H+. Body compensates the process by increased ventilation. The PaCO2 is reduced secondarily by hyperventilation which mitigates the rise in H+. Leading to metabolic acidosis

Diarrhea associated with passage of more than 200g of stool with urgency of defaecation and faecal incontinence. This may lead to malabsorption leading to hypoalbuminaemia, hypocalcaemia & vitamin D deficiency, hypomagnesaemia, phosphate , zinc and weight loss.

Pran avrita Apan

Pran vayu function is associated with controlling system of the body, as said by Nyayachandrikakar. Pran vayu helps in assimilation and maintain homeostasis

Apan is responsible for elimination. Considering pakvashaya it may be compared with srijan of purisha mutra etc. at cellular level considering removal of cellular products within the cell.

In this particular condition of pran avrita apan the vikrita pran obstructs the gati of apan and it is unable to release the cellular products. This can be understood in condition of Brainstem lesion where in the control over CO2 expiration is lost. Depletion of CO2 expiration leads to increase in concentration of CO2 in blood resulting in respiratory failure of Type II origin ie severe respiratory acidosis.

A simple sleep apnoea / hypopnoea syndrome may also be considered.

Udan avrita Saman

In this particular condition as udan vikriti takes place anabolism increase reducing the catabolism. This is observed in Hypothyroidism where in weight gain is seen with decreased appetite.

Leptin is secreted by adipose cells and acts primarily through the Hypothalamus. Its level of production provides an index of adipose energy stores. High leptin levels decrease food intake and increase energy expenditure. TheOBgene is present in humans and expressed in fats. The obesity in these individuals begin shortly after birth, is severe and is accompainied by neuroendocrine abnormalities. Role of central hypothyroidism has been understood in mouse model.

Another condition may be considered where increased acetylcholine stimulates increased ATP (­urja) which further increases excessive secretion of fluids and electrolytes in addition to normal viscid alkaline mucus which further increases gastrointestinal activity causing reduced absorption (annashoshan, vivechan karma) leading to malabsorption diarrhea.

 Vyan avrita saman

There is interplay between gati of vyan with gati of saman. Therefore when rasa vikshepan karma of vyan related to saman vayu is vitiated, the later becomes avrita and in turn annapachan, vivechan and munchan karma of saman are inhibited or decreased.

Sympathetic nerves have dual action in some cases. It increases secretion but if parasympathetic is already causing copious secretion sympathetic usually reduces the secretion mainly by vasoconstriction reducing the blood supply.

Although ENS (enteric nervous system) can function autonomously; ANS connects ENS centrally. When ANS activity is increased it has its impact on gastrointestinal tract.

Sympathetic overstimulation causes vasoconstriction which reduces secretion of gastric juices and pancreas exocrine secretion. Their insufficiency can cause malabsorption syndrome in which predominant feature is steatorrhoea, deficiency of fat soluble vitamins, protein and carbohydrate deficiency related features.

As compensatory mechanism vasodilatation in skin leads to excessive sweating and skin related features.

Saman avrita Pran

Role of saman along with agnideepan is to help in pachan and sara kitta vibhajan. Thus along with pitta, saman plays its major role in metabolism. If saman gets prakopit sara kitta vibhajan does not takes place properly and kitta bhaga gets upashoshit along with sara bhaga. Thus kitta munchan prakriya does not take place. This condition may be noted in metabolic acidosis, hypercalcemia and uraemia. The kitta bhaga now alters the gati of pran or in other words neuronal excitability. It may show symptoms like confusion seizures, coma and death. It may also depressed the respiratory centre causing hyperventilation or Kussmaul breathing.

 

Saman avrita Udan

The same kitta bhag depending on sthan obstructs the gati of udan. The bala, prayatna, urja adi karma are reduced.

Conditions can be observed in hepatic coma where in increase levels of ammonia (kitta bhag) interfere with cerebral energy metabolism and with Na+, K+, ATPase pump. Number and size of astrocytes are increased. They alter the nerve cell function and causes symptoms of fatiguebility, altered sensorium and coma. (prayatna nasha)

Similarly Hyperthyroidism may also be considered. Saman is said to be Agnibala pradha, it leads to increase in catabolism. Energy gets exhausted with increase catabolism reducing the bala prayatna which is the role of udan vayu as seen in thyrotoxicosis.

Apan avrita pran

Interplay exists between apan the eliminator and pran the controller of the body system. Mismatching between apan and pran karma leads to various disorders. If the srijan karma and gati of apan related to adan karma of pran gets vitiated the pran vayu gets avrita and in turn causing shwas, confusion, coma and death.

Loss of Na+, Cl-, H+ and extra cellular fluid depletion occurs in excessive administration of diuretics or in congenital chlorodiarrhoea. It leads to increase concentration of plasma HCO3 which leads to condition such as apathy, confusion and drowsiness.

In anxiety induced hyperventilation excessive loss of CO2 takes place. PaCO2 and H+ falls. The low PaCO2 results in reduced renal Na+/H+ exchange due to which patient feels short of oxygen.

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