Vatavyadhi Chikitsa: Difference between revisions

=== Management of ''avrita vata'' ===

In pittāvr̥ta vāta, hot and cold should be applied alternately.  Jīvanīya sarpi is also very brimhana. Brimhana is the ideal pacifying line of treatment for vāta and vātapitta.   

In kaphāvr̥ta vāta, rūkṣa is given importance. In association of kapha along with pitta in vātarōga, pitta should be given importance in management. It is because of the fact that pitta makes the disease process as ‘ashukāri’(instantaneous).  

In Kaphāvr̥ta vāta; tīkṣṇā sweda, niruha and vamana which reduces kapha is indicated followed by virechana intended for vāta anulomana and also useful for kapha.

Jirna/purāna sarpi (old ghee) which has kaphaghna quality has to be used; tila and sarṣapa which are kapha vātaghna are to be used. Warm drinks of yava, jāṇgala mānsa rasa which gives strength to the patient without increasing kapha are to be administered. (verse 183-188)

Kshara basti (gomūtrayukta basti) in case of kapha-vāta and ksheera basti in pitta-vāta is recommended. Raktāvr̥ta vāta is similar to uttāna-vātarakta and treatment is accordingly same. Rakta āvr̥ta vāta is one of the phases of vātarakta. Thus raktamokshan and basti cikitsā which is useful in vātarakta is also helpful in rakta āvr̥ta vāta.  

Prameha samprapti mentioned in Sutra sthana 17th chapter explains kapha, pitta, meda and mānsa which when increased causes āvarana of vāta. Therefore, pramehagna cikitsā is helpful in meda āvr̥ta vāta and also in mansāvr̥ta vāta. Hence in mansāvr̥ta vāta the pipilika iva sanchar (tingling sensation) reduces, if prameha is treated. Similarly, in obesity, medasāvr̥ta vāta (vata obstructed by excess meda) [Cha.Sa.[[Sutra Sthana]] 21/5] and meda and mānsa ativridhi [Cha.Sa.[[Sutra Sthana]] 21/9] is observed.  These conditions are best treated on the principles of management of prameha, sthaulya associated with vitiated vata. Therapeutic emesis to expel out the intoxicated food in stomach is advised in condition of annavrita vata ( vata obstructed by food). Pāchana and deepan helps in digestion and also pacifies vāta.

Hot foementation reduces urethral pressure. A study done by Shafik A.  showed that sitting in warm water helps in micturition which seems to be initiated by reflex internal urethral sphincter relaxation. A thermo sphincter reflex is likely to be involved.

Uttara basti effect is similar to catheterization. Further depending on the medicines used for uttara basti, tridōṣa shamāna can be done.  

The lines of treatment of raktagatavāta and raktvritavāta as well as śukragatavāta and shukrāvr̥ta vāta are one and the same irrespective difference in samprapti as gatavāta or āvr̥ta vāta. It is because of the fact that rakta and śukra are mobile and comparatively pervaded all over the body like vāta so gatavāta and āvr̥ta vāta are mutually complimentary here.  

Finally, the treatment strategies of anyasthānagata(in other sites) vata are explained. The importance is given to sthanastha dosha (in own sites).(189-199)

Movements of vata and concept of anyonyavarana:As discussed earlier avyāhatagati (free movement) is a cardinal feature of vāta to perform normally. In āvarana certain obstacles like dosha, dhātu or anna etc which are immobile, occupy the pathway of mobile vāta. It is not mandatory that such immobile articles only cause obstruction to vāta. If the individual sub types of vāta are considered prāna, udāna, vyāna, samāna and apāna are mobile and has some specific direction for their gati. For example, prāna has movement from murdha (head) to downwards. Udāna has movement from uras(chest) to upwards.  Vyāna moves upward downward and sidewards like rasa. Samāna moves around jatharāgni. Apāna move downwards from pakvāśaya. This can be further analysed as follows.  Udāna possess upward movement.  Likewise ‘apāna’ has downward direction.  Vyāna vāyu moves in horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana (circulation) is concerned.[19]Samāna is also having such qualities to equally distribute the nutrients through out the body.  Prāna has multi directional gati. So, the movements of individual subtypes of vāta are directional in nature. When these meet in opposite direction it makes anyonyāvarana. For example prāna and udāna meet opposite and interfere with mutual normal movements leads to difficulty in inspiration as well as expiration which is comparatively irreversible. This concept is called anyonyāvarana. It is of 20 types taking into account of 5 diiferent types making 4 particular combinations. Anyonyāvarana are comparatively difficult situations. (verses 199-206)

Anyonyāvarana is characterised by Svakarma hani or vriddhi (either increase or decrease in functions) which depends on the nature and site of anyonyāvarana (mutual covering). For example prānaāvr̥ta udāna may lead to difficulty in respiration, followed with cardiac symptoms, aphasia or dysarthria and some times upper respiratory symptoms. This presentation is comparatively acute in onset and. Here the functions of udāna are masked by prāna. But in  udānaāvr̥ta prāna the symptoms are loss of motor power, immunity and complexion leading to death. Here the functions of prāna are seriously hampered. This symptom may be acute or chronic in nature. When apāna got āvarana by udāna the normal peristalsis is hampared and anulomana is the line of treatment. In apāna āvarana to udāna increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.

Rehabilitation of vata: Prakr̥tisthāpanam means re-establishment in its own pathway (sva mārgaga)/ or in its own place (sva sthāna gamayed enam). Therefore for udāna vāyu, vamana etc. treatment should be administered to regulate the normal functional status of udāna vāyu. Apāna has adhogati, therefore anulomana chikitsā should be done, thereby regularizing the urdhva apāna bhava of Apāna vāyu. Shamāna should be line of treatment for samāna vāyu. Empowering digestive power should be done. Samāna being sited near agni, proper digestion and absorption of essential elements will be observed. Proper electrolyte balance will be maintained, thereby maintaining the pH of body fluids. As discussed previously vyāna has all the three gati i.e. urdhva, adho and madhya gati. Here the general line of treatment of anyonyāvarana is discussed. (verse 219-221)

Among various āvarana, the involvement of udāna and prāna are very important. As explained in the introductory comments, prāna is life and udāna is strength. These are very vital issues as far as āvarana is concerned. Improper management or avoidance of treatments may lead to permanant disabilities in Āvarana.  (verse 231-236)

Complications of āvarana:  

This includes hr̥drōga, vidradhi, plīhā, gulma, a'tīsāra. Hr̥drōga is a common complication of ill treated āvarana of prāna and udāna. Vidradhi and plīhā are caused by wrongly managed āvarana of vyāna. Gulma and atīsāra are common complications of āvarana of samāna and apāna.  

Srotoshodana is an important line of management in Āvarana. It ensures unobstructed movement of vāta. All abhishyandi(..) food causes srotorōdha (obstruction of channels). Yāpana Basti is ideal for all age group and safe to severe clinical presentations. It protects all marma points. As it is neither lekhana (..), nor brimhana, it is useful for managing vāta as well as āvaraka kapha or pitta. Guggulu rasāyana and shilajatu rasāyana is ideal for many clinical conditions of āvarana.