Changes

=== Importance of [[vata]] [[dosha]] in overall health and disease ===

=== Importance of [[vata]] [[dosha]] in overall health and disease ===

This text highlights the grandness of [[vata]] as a humor. [[Vata]] is equated to [[ayu]]. Life is sustained by [[vayu]] only. Even though [[ayu]] is previously defined as conglomeration of ''sharira'' (physical body), ''indriya'' (sensorium), ''satva'' (mind) and [[atma]] (soul), [Cha. Sa. [[Sutra Sthana]] 1/42] here it is mentioned equivalent to [[vayu]]. The sense organs, mind and soul in physical body are manifested through the functions of [[vayu]] only. The strength of the individual is also provided by [[vayu]]. These two usages of [[ayu]] and bala are later explained as, ''prana'' is life and ''udana'' is strength. (verse 3)

This text highlights the grandness of [[vata dosha]]. [[Vata]] is equated to [[ayu]]. Life is sustained by [[vayu]] only. Even though [[ayu]] is previously defined as conglomeration of [[sharira]] (physical body), [[indriya]] (sensorium), [[sattva]] (mind) and [[atma]] (soul). [Cha. Sa. [[Sutra Sthana]] 1/42] Here it is mentioned equivalent to [[vayu]]. The sense organs, mind and soul in physical body are manifested through the functions of [[vayu]] only. The strength of the individual is also provided by [[vayu]]. These two usages of [[ayu]] and bala are later explained as, ''prana'' is life and ''udana'' is strength. [verse 3]

[[Vata]] performs all its activity for a healthy long life subject to status of its three functions. They are ''akupita''(not increased, decreased or vitiated), ''sthanastha'' (located in its own place) and ''avyahatagati''(nothing is interfering with its movement or ''gati'').

[[Vata]] performs all its activity for a healthy long life subject to status of its three functions. They are ''akupita''(not increased, decreased or vitiated), ''sthanastha'' (located in its own place) and ''avyahatagati''(nothing is interfering with its movement or ''gati'').

=== Nature of [[vata]] ===

=== Nature of [[vata]] ===

[[Pitta]] and [[kapha]] are relatively compact and in corporeal form. On the contrary [[vata]] is incorporeal (''avayavasamghātarahita''). It can be termed as rarified in nature. The [[vata]] is ''anavasthita'' (unstable) too. These two properties are due to its composition formed by [[akasha]] and [[vayu]] predominantly<ref> Indu, Vagbhata, Sutra sthana Chap 20 Doshabhediya Verse 2, In: Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000.</ref>  which are incorporeal (''amurta''). ''Chalatva'' (mobility) and ''apratighata'' (unobstructability) are characteristics of [[vayu]] and [[akasha]] perceptible by the tactile sense organ[ Cha. Sa. [[Sharira Sthana]] 1/29-30]. The biological [[vata]] (which is present in the living being) is self originated (''svayambhu''), subtle (''sukshma'') and all pervasive (''sarvagata''). It is invisible (''avyakta'') but its activities are patent or manifest (''vyaktakarma'').<ref>Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 5. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>

[[Pitta]] and [[kapha]] are relatively compact and in corporeal form. On the contrary [[vata]] is incorporeal (''avayavasamghatarahita''). It can be termed as rarified in nature. The [[vata]] is ''anavasthita'' (unstable) too. These two properties are due to its composition formed by [[akasha]] and [[vayu]] predominantly<ref> Indu, Vagbhata, Sutra sthana Chap 20 Doshabhediya Verse 2, In: Sreekumari Amma (eds.) 1st ed. Trivandrum: Publication Division; Ayurveda College, 2000.</ref>  which are incorporeal (''amurta''). ''Chalatva'' (mobility) and ''apratighata'' (unobstructability) are characteristics of [[vayu]] and [[akasha]] perceptible by the tactile sense organ. [Cha. Sa. [[Sharira Sthana]] 1/29-30] The biological [[vata]] (which is present in the living being) is self originated (''svayambhu''), subtle (''sukshma'') and all pervasive (''sarvagata''). It is invisible (''avyakta'') but its activities are patent or manifest (''vyaktakarma'').<ref>Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 5. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>

Anavasthita (unstable) is due to chala property of [[vata]].  This continuous moving nature of [[vata]] is explained with other terminologies also like ''sheeghravata''(swift movement)[Cha. Sa. [[Vimana Sthana]] 8/98] , ''ashukari'' (instantaneous action), ''muhushchari'' (rhythmic movement).<ref>Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 9. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. It abounds in the fundamental quality of ''raja'' (the principle of cohesion and action). The predominance of ''raja'' is responsible for the instability of [[vata]]. The quality of ''chalatva'' is directional in nature, which is explained by the term ''gati''. [[Vata]] convenes all bodily activities by this important feature.

Anavasthita (unstable) is due to chala property of [[vata]].  This continuous moving nature of [[vata]] is explained with other terminologies also like ''sheeghravata''(swift movement)[Cha. Sa. [[Vimana Sthana]] 8/98], ''ashukari'' (instantaneous action), ''muhushchari'' (rhythmic movement).<ref>Dalhana, Sushruta. Nidana Sthana, Cha.1 Vatavyadhi Nidana Adhyaya verse 9. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref>. It abounds in the fundamental quality of ''raja'' (the principle of cohesion and action). The predominance of ''raja'' is responsible for the instability of [[vata]]. The quality of ''chalatva'' is directional in nature, which is explained by the term ''gati''. [[Vata]] convenes all bodily activities by this important feature.

Owing to its incorporeal nature and instability [[vata]] is ''anasadhya'' (inaccessible) also. The inaccessibility is characterized in regard to its functional and physical attributes but more relevant regarding the therapeutic aspect. Above explained cardinal features make [[vata]] achintya veerya (inconceivable prowess) and [[dosha]]nam neta (propeller of all functional elements in the body).[Cha. Sa. [[Sutra Sthana]] 1/8]

Owing to its incorporeal nature and instability [[vata]] is ''anasadhya'' (inaccessible) also. The inaccessibility is characterized in regard to its functional and physical attributes but more relevant regarding the therapeutic aspect. Above explained cardinal features make [[vata]] achintya veerya (inconceivable prowess) and [[dosha]]nam neta (propeller of all functional elements in the body).[Cha. Sa. [[Sutra Sthana]] 1/8]

Therefore, the biological energy produced by this ionic movement is the cause for ''sharira vayu'' and as per modern science too their concentration depends on ''ahara'' and ''vihara''.

Therefore, the biological energy produced by this ionic movement is the cause for ''sharira vayu'' and as per modern science too their concentration depends on ''ahara'' and ''vihara''.

The continuous, controlled movement of the ions is responsible for cell activity which together at the level of cells contributes to tissue activity which together contributes to the organ, system and in turn whole body. (verse 4)

The continuous, controlled movement of the ions is responsible for cell activity which together at the level of cells contributes to tissue activity which together contributes to the organ, system and in turn whole body. [verse 4]

==== Types of [[vata]] [[dosha]] ====

==== Types of [[vata]] [[dosha]] ====

In Vedic literature, as a medical system, the important five types of [[vata]] are explained with their locations and functions. The word ''tantrayate'' is used to explain the functional quality of [[vata]] and ''sharira'' (physical body) is ''yantra'' for functioning of ''tantra''. The [[vata]] [[dosha]] on basis of its functions is classified into five types. They reside in the ''sharira'' at the level of ''sharira parmanu'' (cell) and also at gross level. Five types of [[vata]] work together in a synchronized manner for the normal functioning of the sharira ([[vayu]] tantrayantra dhara). (verse 5-11)

In Vedic literature, as a medical system, the important five types of [[vata]] are explained with their locations and functions. The word ''tantrayate'' is used to explain the functional quality of [[vata]] and ''sharira'' (physical body) is ''yantra'' for functioning of ''tantra''. The [[vata]] [[dosha]] on basis of its functions is classified into five types. They reside in the ''sharira'' at the level of ''sharira parmanu'' (cell) and also at gross level. Five types of [[vata]] work together in a synchronized manner for the normal functioning of the sharira ([[vayu]] tantrayantra dhara). [verse 5-11]

=== General etiological factors and basic pathogenesis of ''vata'' disorders ===

=== General etiological factors and basic pathogenesis of ''vata'' disorders ===

#which cause indirect [[vata]] vitiation.  

#which cause indirect [[vata]] vitiation.  

Day sleep (''divaswapna'') do not directly lead to vitiation of [[vata]]. However, it leads to formation of ''ama'' and cause [[vata]] vitiation indirectly by obstructing [[vata]]. ''Vegasandharana'' (suppression of natural urges) and ''marmabhighata'' (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of [[vata]] and diminution of [[dhatu]] and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of [[vata]]. The second pathology is by increase in [[dhatu]] leading to excessive filling in channels to cause their clogging and blocking [[vata]]. (verse 15-19)

Day sleep (''divaswapna'') do not directly lead to vitiation of [[vata]]. However, it leads to formation of ''ama'' and cause [[vata]] vitiation indirectly by obstructing [[vata]]. ''Vegasandharana'' (suppression of natural urges) and ''marmabhighata'' (trauma to vital organs) etc. are examples of direct vitiation. The pathogenesis is also bi-fold. The initial pathology is aggravation of [[vata]] and diminution of [[dhatu]] and vice versa. One augments the other. This ultimately causes emptiness in channels and rarity in tissues which gives more space for movements of [[vata]]. The second pathology is by increase in [[dhatu]] leading to excessive filling in channels to cause their clogging and blocking [[vata]]. [verse 15-19]

==== Premonitory signs and symptoms ====

==== Premonitory signs and symptoms ====

Clinical manifestations may not be apparent because of vague manifestation of symptoms (''Avyaktam lakshanam''). This occurs in two situations, either the pathogenesis is extremely slow or it is abrupt. In the initial case, it is unable to appreciate the prodromal symptoms and presenting complaints separately. If it is an abrupt pathology the clinical presentation immediately follows the prodromal symptoms without appreciable gap. (verse 19-20)

Clinical manifestations may not be apparent because of vague manifestation of symptoms (''Avyaktam lakshanam''). This occurs in two situations, either the pathogenesis is extremely slow or it is abrupt. In the initial case, it is unable to appreciate the prodromal symptoms and presenting complaints separately. If it is an abrupt pathology the clinical presentation immediately follows the prodromal symptoms without appreciable gap. [verse 19-20]

==== Clinical features ====

==== Clinical features ====

The clinical presentations vary according to the specificity of [[hetu]] (cause) and ''sthana'' (location). The treatment options also vary accordingly. For example if [[vata]] prakopa takes place due to ''ruksha vriddhi'' in ''pakvashaya'' it may lead to habitual constipation in which ''snigdha, ushna'' and ''tikshna aushadha'' like ''mishraka sneha'' may be a good treatment option.  

The clinical presentations vary according to the specificity of [[hetu]] (cause) and ''sthana'' (location). The treatment options also vary accordingly. For example if [[vata]] prakopa takes place due to ''ruksha vriddhi'' in ''pakvashaya'' it may lead to habitual constipation in which ''snigdha, ushna'' and ''tikshna aushadha'' like ''mishraka sneha'' may be a good treatment option.  

If the same [[vata]] gets vitiated in ''amashaya'' due to ''snigdha vriddhi'', it leads to gastro-esophageal reflux disease (GERD), ''ruksha ushna'' and ''tikshna'' like ''gomutra bhavita shaddharana'' is the ideal treatment option. ''Anuvasana'' is the ideal therapy in[[vata]] vitiated in ''pakwashaya'', whereas [[vamana]] is the best therapy in [[vata]] vitiated in ''amashaya''. (verse 20-24)

If the same [[vata]] gets vitiated in ''amashaya'' due to ''snigdha vriddhi'', it leads to gastro-esophageal reflux disease (GERD), ''ruksha ushna'' and ''tikshna'' like ''gomutra bhavita shaddharana'' is the ideal treatment option. ''Anuvasana'' is the ideal therapy in [[vata]] vitiated in ''pakwashaya'', whereas [[vamana]] is the best therapy in [[vata]] vitiated in ''amashaya''. [verse 20-24]

==== Three modes of pathogenesis of [[vata]] diseases ====

==== Three modes of pathogenesis of [[vata]] diseases ====

The three characteristics of [[vata]] vitiation viz. ''svatantra dushti'' (vitiation due to independent specific causes), gata [[vata]] (increased movement of [[vata]]) and ''avarana'' (obstruction to movement of [[vata]]). imply three possible modes of pathogenesis in [[vata]] diseases. These can be further analyzed as follows; due to the following three important properties of [[vata]], it is regarded entirely different from other [[dosha]][Cha. Sa. [[Sutra Sthana]] 12/3]

The three characteristics of [[vata]] vitiation viz. ''svatantra dushti'' (vitiation due to independent specific causes), gata [[vata]] (increased movement of [[vata]]) and ''avarana'' (obstruction to movement of [[vata]]). imply three possible modes of pathogenesis in [[vata]] diseases. These can be further analyzed as follows; due to the following three important properties of [[vata]], it is regarded entirely different from other [[dosha]][Cha. Sa. [[Sutra Sthana]] 12/3]

#''Asamghāta'' (Incorporeal)

#''Asamghata'' (Incorporeal)

#''Anavasthita'' (Unstable)

#''Anavasthita'' (Unstable)

#''Anāsādhya'' (Inaccessible)

#''Anasadhya'' (Inaccessible)

=== Pathogenesis of various conditions ===

=== Pathogenesis of various conditions ===

''Prakupita''(vitiated) [[dosha]] have the capacity to further vitiate both ''sthanastha dhatu'' (fixed tissue element) as well as ''margagata'' (circulating tissue elements) sharira [[dhatu]]. When prakupita [[vata]] vitiates the [[dhatu]], it is called as gata[[vata]]. In this condition, vitiated [[vata]] affects the specific site due to specific etiological factors. While designing treatment protocol, in this context specific etiological factors 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. In this condition, [[dhatu]] is ''dushya'' (getting vitiated).

''Prakupita''(vitiated) [[dosha]] have the capacity to further vitiate both ''sthanastha dhatu'' (fixed tissue element) as well as ''margagata'' (circulating tissue elements) sharira [[dhatu]]. When prakupita [[vata]] vitiates the [[dhatu]], it is called as gata[[vata]]. In this condition, vitiated [[vata]] affects the specific site due to specific etiological factors. While designing treatment protocol, in this context specific etiological factors 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. In this condition, [[dhatu]] is ''dushya'' (getting vitiated).

Koshthagata [[vata]]: [[Vata]] getting vitiated in the koshtha(alimentary tract) is explained as koshthagata [[vata]].

'''Koshthagata [[vata]]:'''

Gudagata [[vata]]: It can also be explained that gudagata [[vata]] and pakvashayagata [[vata]] are different clinical entities. In gudagata [[vata]], obstruction of stool, urine and flatus is observed, whereas in pakvashayagata [[vata]] there is painful defecation, micturition with ''antrakujana'' (gurgling sound), ''atopa'' (distension) and ''anaha'' (constipation). ''Ashma sarkara'' (urolith) is exclusively present in gudagata [[vata]] with pain and atrophy in calf muscles, thighs, sacram, feet and back. This can be compared with lumbo-sacral plexopathy. It may be understood as in case of ''pakvashaya gatavata'', proximal part of large intestine along with ascending, transverse and descending colon is involved; whereas in gudagata [[vata]], involvement of sigmoid colon, rectum, anus and their nerve supply.

[[Vata]] getting vitiated in the koshtha(alimentary tract) is explained as koshthagata [[vata]].  

'''Amashayagata [[vata]]''': This is a typical presentation of [[vata]] leaving its own site and vitiating other site. Here the local [[dosha]] is considered important because it is more virulent than the external [[dosha]] coming from other sites. The clinical entities originating from ''amashaya'' (stomach) are caused due to vitiated [[vata]] entering into ''amashaya''. It increases emptiness of stomach leading to indigestion or ''ama pradoshaja vikara'' like ''visuchika'' (diarrhea) etc.

'''Gudagata [[vata]]:'''  

'''Indriyagata [[vata]]''': Indriyagata [[vata]] is applicable to any sense organ. ''Indriya vadha'' may be interpreted as complete, partial or minimal loss of sensation. ''Shrotra''(ears) has specific importance among other ''indriya'', in which inherent [[dosha]] of ''shrotra'' is [[vata]] itself. So [[vata]] prakopa in ''shrotra'' is more impacting. It is worthy to remember the notion in vatakalakaleeya that [[vata]] is ''sarvendriyanam udyojaka'' (motivating factors for all sense organs).

It can also be explained that gudagata [[vata]] and pakvashayagata [[vata]] are different clinical entities. In gudagata [[vata]], obstruction of stool, urine and flatus is observed, whereas in pakvashayagata [[vata]] there is painful defecation, micturition with ''antrakujana'' (gurgling sound), ''atopa'' (distension) and ''anaha'' (constipation). ''Ashma sarkara'' (urolith) is exclusively present in gudagata [[vata]] with pain and atrophy in calf muscles, thighs, sacram, feet and back. This can be compared with lumbo-sacral plexopathy. It may be understood as in case of ''pakvashaya gatavata'', proximal part of large intestine along with ascending, transverse and descending colon is involved; whereas in gudagata [[vata]], involvement of sigmoid colon, rectum, anus and their nerve supply.

'''Twakgata [[vata]]''': ''Tvak'' (skin) is referred as somatic organ even though it is a sensory organ. ''Supti'' (numbness) and ''toda'' (pricking sensation) are not symptoms specific to ''tvakindriya.'' Here ''tvak'' represents [[rasa dhatu]]. Rasa does not have cellular pattern and hence not included in ''shakha''. The ''tvak'' is derivative of ''rasa'' and is included in ''shakha''. ''Tvakindriya gatavata'' should be understood under indriyagata[[vata]].

'''Amashayagata [[vata]]''':  

'''Siragata [[vata]]''': When [[vata]] afflicts ''sira'' (blood vessel) it may broaden or narrow the sirā. Widening may lead to ''shopha'' and narrowing may lead to ''shosha'' or vice versa as per the site of affliction. Two different conditions of vascular diseases i.e. aneurysym (''mahat'') and atherosclerosis / venous thrombosis (''tanu'') are examples.

This is a typical presentation of [[vata]] leaving its own site and vitiating other site. Here the local [[dosha]] is considered important because it is more virulent than the external [[dosha]] coming from other sites. The clinical entities originating from ''amashaya'' (stomach) are caused due to vitiated [[vata]] entering into ''amashaya''. It increases emptiness of stomach leading to indigestion or ''ama pradoshaja vikara'' like ''visuchika'' (diarrhea) etc.

'''Sandhigata [[vata]] (osteoarthritis)''': There is depletion of periarticular and articular tissue by vitiated [[vata]] in sandhigata [[vata]]/osteoarthritis, empty spaces are occupied by [[vata]] which is felt as crepitus on palpation. [[Vata]] also causes hypertrophic tissue in the form of osteophytes and causes painful flexion and extension movements. This is the characteristic feature of swelling in sandhigata [[vata]].

'''Indriyagata [[vata]]''':  

''Ardita'': ''Ardita'' is a disease of episodic origin. It may lead to facial paralysis or hemiplegia or both. In other classics ''ardita'' is explained as facial paralysis only. (verse 38-42)

Indriyagata [[vata]] is applicable to any sense organ. ''Indriya vadha'' may be interpreted as complete, partial or minimal loss of sensation. ''Shrotra''(ears) has specific importance among other ''indriya'', in which inherent [[dosha]] of ''shrotra'' is [[vata]] itself. So [[vata]] prakopa in ''shrotra'' is more impacting. It is worthy to remember the notion in vatakalakaleeya that [[vata]] is ''sarvendriyanam udyojaka'' (motivating factors for all sense organs).

''Antarayama'' (emprosthotonous) and ''bahirayama''(ophisthotonous): These diseases are tetany like conditions in which the body is sharply bent forward and backward respectively. (verse 43-48)

'''Twakgata [[vata]]''':  

''Hanugraha'': It is a lockjaw like condition that may be persistent or intermittent or recurrent due to vitiation of [[vata]] affecting the mandibular joint. (verse 49)

''Tvak'' (skin) is referred as somatic organ even though it is a sensory organ. ''Supti'' (numbness) and ''toda'' (pricking sensation) are not symptoms specific to ''tvakindriya.'' Here ''tvak'' represents [[rasa dhatu]]. Rasa does not have cellular pattern and hence not included in ''shakha''. The ''tvak'' is derivative of ''rasa'' and is included in ''shakha''. ''Tvakindriya gatavata'' should be understood under indriyagata[[vata]].

''Dandaka'':''Dandaka'' is a condition in which the muscles are hypertonic but without convulsions. When it further manifests as tonic clonic convulsions it is referred as ''danda akshepaka''. This condition is caused due to vitiation of [[vata]] simultaneously in muscle groups.  (verse 51)

'''Siragata [[vata]]''':

Episodic nature of various [[vata]] disorders: The disorders mentioned from ''ardita'' onwards are ''vegavana'' (episodic). All ''vegavana'' disorders have two phases, ''vega'' and ''vegantara''. ''Vegantara'' is the symptom free period and is considered as right time for medication. (verse 52)

When [[vata]] afflicts ''sira'' (blood vessel) it may broaden or narrow the sirā. Widening may lead to ''shopha'' and narrowing may lead to ''shosha'' or vice versa as per the site of affliction. Two different conditions of vascular diseases i.e. aneurysym (''mahat'') and atherosclerosis / venous thrombosis (''tanu'') are examples.

''Pakshaghata'': Three diseases namely ''pakshaghata''(hemiplegia), ''ekangaroga'' (monoplegia) and ''sarvangaroga'' (quadriplegia) are explained. In ''pakshaghata'' no painful symptoms are explained. ''Sira'' and ''snayu'' are considered as ''dushya'' in ''ekangaroga'' and ''sarvangaroga''. ''Sira'' is the ''upadhatu'' of [[rakta]] and ''snayu'' is the ''upadhatu'' of meda, therefore ''meda'' and ''rakta'' have vital role in pathogenesis of these diseases. (verse 53-55)

'''Sandhigata [[vata]] (osteoarthritis)''':

''Gridhrasi'': ''Gridhrasi'' is a ''snayugata'' (affecting tendon) ''roga''. The word ''gridhrasi'' is derived from ''ghridhra'', which means vulture, the typical gait of the disease is highlighted by the name.  The patient’s gait is changed like a vulture due to affected tendons by vitiated [[vata]].

There is depletion of periarticular and articular tissue by vitiated [[vata]] in sandhigata [[vata]]/osteoarthritis, empty spaces are occupied by [[vata]] which is felt as crepitus on palpation. [[Vata]] also causes hypertrophic tissue in the form of osteophytes and causes painful flexion and extension movements. This is the characteristic feature of swelling in sandhigata [[vata]].  

''Khalli'' is the term given to severe painful twisting conditions of tendons. (verse 56-57)

''Ardita'':

Nomenclature of diseases: All the [[vata]] disorders cannot be named or explained. They should be understood on the basis of site of affliction as well as nomenclature. (verse 58)

''Ardita'' is a disease of episodic origin. It may lead to facial paralysis or hemiplegia or both. In other classics ''ardita'' is explained as facial paralysis only. [verse 38-42]

Diagnosis of [[dhatu]]kshaya (degenerative pathology) and ''avarana'' (obstructive pathology) induced vitiation of [[vata]]: [[Vata]] can be vitiated due to [[dhatu]]kshaya and ''margavarana'' types of pathogenesis. [[Dhatu]]kshaya leads to depletion of tissues and more space for [[vata]] to move. This leads to gata[[vata]] phenomenon. ''Avarana'' of [[vata]] can be caused by other [[dosha]] or [[dhatu]]. So the differences between ''avarana'' and gata[[vata]] should be understood.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

'''Diagnosis of [[dhatu]]kshaya (degenerative pathology) and ''avarana'' (obstructive pathology) induced vitiation of [[vata]]:'''

 

[[Vata]] can be vitiated due to [[dhatu]]kshaya and ''margavarana'' types of pathogenesis. [[Dhatu]]kshaya leads to depletion of tissues and more space for [[vata]] to move. This leads to gata[[vata]] phenomenon. ''Avarana'' of [[vata]] can be caused by other [[dosha]] or [[dhatu]]. So the differences between ''avarana'' and gata[[vata]] should be understood.

The word, ''avarana'' means obstruction or resistance or friction to the normal ''gati'' of [[vata]]. Hence when its normal movement is hampered or vitiated, it becomes ''avrita'' and leads to different disorders. The gatatva and avritatva are entirely different phenomenon. Here an attempt is being made to differentiate the both physio-pathologies. [16]

The word, ''avarana'' means obstruction or resistance or friction to the normal ''gati'' of [[vata]]. Hence when its normal movement is hampered or vitiated, it becomes ''avrita'' and leads to different disorders. The gatatva and avritatva are entirely different phenomenon. Here an attempt is being made to differentiate the both physio-pathologies. [16]

#In ''avarana'', generally the vitiation of [[vata]] is passive. When vitiated [[dosha]] or any other thing obstructs the pathway of [[vata]], avarana happens. Normal state of [[vata]] gets vitiated as ''avarana'' progresses. The substance which obstructs the pathway of [[vata]] is called as ''avaraka'' and the [[dosha]] ([[vata]] in general or its components) affected by ''avarana'' is called as ''avariya'' or ''avrita''. Normally the ''avarana'' is caused by the etiological factors for the vitiation of ''avaraka''. Etiological factors for the vitiation of [[vata]] (''sva nidana'') will be absent. In case of gata[[vata]] the vitiation of [[vata]] will be active. Here its own etiological factors are operating in the vitiation of [[vata]] in the pathogenesis and the vitiated [[vata]] adopts specific pathway and abnormally localizes at particular sites.

#In ''avarana'', generally the vitiation of [[vata]] is passive. When vitiated [[dosha]] or any other thing obstructs the pathway of [[vata]], avarana happens. Normal state of [[vata]] gets vitiated as ''avarana'' progresses. The substance which obstructs the pathway of [[vata]] is called as ''avaraka'' and the [[dosha]] ([[vata]] in general or its components) affected by ''avarana'' is called as ''avariya'' or ''avrita''. Normally the ''avarana'' is caused by the etiological factors for the vitiation of ''avaraka''. Etiological factors for the vitiation of [[vata]] (''sva nidana'') will be absent. In case of gata[[vata]] the vitiation of [[vata]] will be active. Here its own etiological factors are operating in the vitiation of [[vata]] in the pathogenesis and the vitiated [[vata]] adopts specific pathway and abnormally localizes at particular sites.

#In the process of ''avarana chala'' property of [[vata]] is diminished due to obstruction. Other properties are not involved in the process of obstruction. But in case of ''gatatva'' the vitiation of [[vata]] takes place by involvement of other properties like ''ruksha, laghu, khara, vishada'' etc along with ''chala''.

#In the process of ''avarana chala'' property of [[vata]] is diminished due to obstruction. Other properties are not involved in the process of obstruction. But in case of ''gatatva'' the vitiation of [[vata]] takes place by involvement of other properties like ''ruksha, laghu, khara, vishada'' etc along with ''chala''.

#In ''avarana'' the ''gati'' of [[vata]] is obstructed partially or fully. Once gets obstructed the [[vata]] may simply get lodged there (''baddha marga, margarodha''), try to nullify the obstruction, may get covered by the obstructing substance (''avrita''), adopt an opposite direction (''pratiloma'') or alter the direction (''viloma''). The different terminologies have been used to denote ''avarana'' in different contexts according to the nature of ''avarana'' and the state of [[vata]] and ''marga'' (passage). In case of ''gatatva'' the ''gati'' of vitiated [[vata]] aggravated and starts moving abnormally leading to localization at particular sites.''Avarana'' is caused by ''purnata'' (filling) of other [[dosha]] in the ''srotas/marga'' (passage) of [[vata]]. In ''gatatva'' the ''srotas'' or sites of occupation of [[vata]] are ''rikta'' (unfilled or spacious) and the aggravated [[vata]] fills the ''srotas''/site.

#In ''avarana'' the ''gati'' of [[vata]] is obstructed partially or fully. Once gets obstructed the [[vata]] may simply get lodged there (''baddha marga, margarodha''), try to nullify the obstruction, may get covered by the obstructing substance (''avrita''), adopt an opposite direction (''pratiloma'') or alter the direction (''viloma''). The different terminologies have been used to denote ''avarana'' in different contexts according to the nature of ''avarana'' and the state of [[vata]] and ''marga'' (passage). In case of ''gatatva'' the ''gati'' of vitiated [[vata]] aggravated and starts moving abnormally leading to localization at particular sites.''Avarana'' is caused by ''purnata'' (filling) of other [[dosha]] in the ''srotas/marga'' (passage) of [[vata]]. In ''gatatva'' the ''srotas'' or sites of occupation of [[vata]] are ''rikta'' (unfilled or spacious) and the aggravated [[vata]] fills the ''srotas''/site.

#In ''avarana'' of [[vata]], swakarma vriddhi (exaggerated activities) of ''avaraka'' (covering [[dosha]]) is manifested. The ''avrita'' (i.e. [[vata]]) will show ''swakarma hani'' (diminished activity). This is the general feature of ''avarana''. Here the excessively increased strong ''avaraka'' suppresses the normal action of ''avrita'' (i.e.[[vata]]). Therefore, when the obstruction is complete it may lead to the ''prakopa'' of [[vata]] resulting in the presentation of [[vata]] vitiated symptoms as well as its disorders[ Cha. Sa. [[Chikitsa Sthana]] 28/215, Chakrapani]. In case of ''gatatva'' the symptomatology will be predominantly of [[vata]] vitiation and pain is a common and chief complaint in all the conditions of ''gatatva''.

#In ''avarana'' of [[vata]], swakarma vriddhi (exaggerated activities) of ''avaraka'' (covering [[dosha]]) is manifested. The ''avrita'' (i.e. [[vata]]) will show ''swakarma hani'' (diminished activity). This is the general feature of ''avarana''. Here the excessively increased strong ''avaraka'' suppresses the normal action of ''avrita'' (i.e.[[vata]]). Therefore, when the obstruction is complete it may lead to the ''prakopa'' of [[vata]] resulting in the presentation of [[vata]] vitiated symptoms as well as its disorders[ Cha. Sa. [[Chikitsa Sthana]] 28/215, Chakrapani]. In case of ''gatatva'' the symptomatology will be predominantly of [[vata]] vitiation and pain is a common and chief complaint in all the conditions of ''gatatva''.

#Obstruction or covering of [[vata]] is possible by body components like [[dosha]] ([[pitta]] and [[kapha]]),tissues,food,  excretory products or mutual affliction of [[vata]] types. Gatatva of [[vata]] (affection) is happening in empty spaces or hollow cavities of tissues, their elements, organs and other body parts. In ''avarana'', the body component is in increased state causing fullness in respected channels, while in ''gatatva'' pathology, the body components are in depleted state casusing emptiness in the respected channels. Dhatugata [[vata]] will be presented with decreased quality of tissues associated with signs of vitiated [[vata]]. Obviously, exceptions are possible according to the complexities of process of ''avarana'' or ''gatatva''.

#Obstruction or covering of [[vata]] is possible by body components like [[dosha]] ([[pitta]] and [[kapha]]),tissues,food,  excretory products or mutual affliction of [[vata]] types. Gatatva of [[vata]] (affection) is happening in empty spaces or hollow cavities of tissues, their elements, organs and other body parts. In ''avarana'', the body component is in increased state causing fullness in respected channels, while in ''gatatva'' pathology, the body components are in depleted state casusing emptiness in the respected channels. Dhatugata [[vata]] will be presented with decreased quality of tissues associated with signs of vitiated [[vata]]. Obviously, exceptions are possible according to the complexities of process of ''avarana'' or ''gatatva''.

#In case of ''avarana'' of [[vata]], the ''avaraka'' is important for  treatment since vitiation of [[vata]] is passive. When ''avarana'' is removed vitiated [[vata]] gets pacified. But in cases of ''gatatva'', the vitiated [[vata]] has to be treated first along with correction of ''adhisthana''.

#In case of ''avarana'' of [[vata]], the ''avaraka'' is important for  treatment since vitiation of [[vata]] is passive. When ''avarana'' is removed vitiated [[vata]] gets pacified. But in cases of ''gatatva'', the vitiated [[vata]] has to be treated first along with correction of ''adhisthana''.

#Diagnosis of ''avarana'' is made with the help of ''upashaya–anupashaya'' (pacifying and aggravating factors) method. Diagnosis of ''gatatva'' is made according to the ''rupa'' (symptomatology).  

#Diagnosis of ''avarana'' is made with the help of ''upashaya–anupashaya'' (pacifying and aggravating factors) method. Diagnosis of ''gatatva'' is made according to the ''rupa'' (symptomatology).  

#Complications of ''avarana'' are explained in case of improper diagnosis and delayed treatment like ''hridroga, vidradhi, kamala'' etc. No known complication occur in ''gatatva''.

#Complications of ''avarana'' are explained in case of improper diagnosis and delayed treatment like ''hridroga, vidradhi, kamala'' etc. No known complication occur in ''gatatva''.

#''Avarana'' of [[vata]] may cause depletion of nutrition to [[dhatu]] ([[dhatu]]gata sama) leading to successive diminition of rasadi [[dhatu]](''rasadimscha upasosayet'').[Cha. sa. [[Sutra Sthana]] 28/61]  No such reference is available in case of ''gatatva''.  

#''Avarana'' of [[vata]] may cause depletion of nutrition to [[dhatu]] ([[dhatu]]gata sama) leading to successive diminition of rasadi [[dhatu]](''rasadimscha upasosayet'').[Cha. sa. [[Sutra Sthana]] 28/61]  No such reference is available in case of ''gatatva''.  

As ''avarana'' proceeds it may end up in [[dhatu]]kshaya as the ''avrita'' will block [[rasa dhatu]] which give nourishment. This is commonly observed. This is possible in many other disorders also. The best example is rajayakshma.  

As ''avarana'' proceeds it may end up in [[dhatu]]kshaya as the ''avrita'' will block [[rasa dhatu]] which give nourishment. This is commonly observed. This is possible in many other disorders also. The best example is rajayakshma.  

'''Prognosis''': Exclusive [[vata]] disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated [[vata]] affects vital parts. The therapeutic approaches should be cautious and extra efforts are essential for a better recovery. As the disease becomes chronic the curability rate drastically declines. The physical strength of the patient is also very important in determining prognosis. (verse 72-74)

'''Prognosis''':  

 

Exclusive [[vata]] disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated [[vata]] affects vital parts. The therapeutic approaches should be cautious and extra efforts are essential for a better recovery. As the disease becomes chronic the curability rate drastically declines. The physical strength of the patient is also very important in determining prognosis. [verse 72-74]

   

   

'''General principles of management''': The general line of management of ''vatavyadhi'' applies to absolute [[vata]] vitiation only. If there is any association or obstruction of other dosha in ''vatavyadhi'', the treatment will be different. ''Kevalam'' term indicates pathology of vitiation of exclusive [[vata]]. ''Nirupastambha'' is condition without any association of other [[dosha]]. This pathology shall be primarily treated with oleation therapy.

'''General principles of management''':  

 

The general line of management of ''vatavyadhi'' applies to absolute [[vata]] vitiation only. If there is any association or obstruction of other dosha in ''vatavyadhi'', the treatment will be different. ''Kevalam'' term indicates pathology of vitiation of exclusive [[vata]]. ''Nirupastambha'' is condition without any association of other [[dosha]]. This pathology shall be primarily treated with oleation therapy.

    

    

As in exclusive [[vata]]ja disease the major ''gunavriddhi'' is ''ruksha'' which leads to ''riktata'' in ''srotas'' and [[dhatu]] and more ''avakasha'' (space) for [[vata]]; [[snehana]] is essential and ideal. Various methods for [[snehana]] are employed depending on ''avastha'' (stage), ''sthana'' (site) and ''bala'' (strength) of the diseases and as well as patient.

As in exclusive [[vata]]ja disease the major ''gunavriddhi'' is ''ruksha'' which leads to ''riktata'' in ''srotas'' and [[dhatu]] and more ''avakasha'' (space) for [[vata]]; [[snehana]] is essential and ideal. Various methods for [[snehana]] are employed depending on ''avastha'' (stage), ''sthana'' (site) and ''bala'' (strength) of the diseases and as well as patient.

Following [[snehana]], [[swedana]] is also mandatory. Here the ''ushna guna'' (hot property) operates to control ''sheeta'' (cold).  Repeated [[snehana]] and [[swedana]] imparts high grade of flexibility.  

Following [[snehana]], [[swedana]] is also mandatory. Here the ''ushna guna'' (hot property) operates to control ''sheeta'' (cold).  Repeated [[snehana]] and [[swedana]] imparts high grade of flexibility.  

''Sneha'' is a good medium to control [[vata]] as well as [[vata]]-[[pitta]]. Generally, this line of treatment can be counted as a part of [[brimhana]]. (verse 75-83)

''Sneha'' is a good medium to control [[vata]] as well as [[vata]]-[[pitta]]. Generally, this line of treatment can be counted as a part of [[brimhana]]. [verse 75-83]

Repeated [[snehana]] and [[swedana]] therapies can control [[vata]] well. However, ''samshodhana'' (purification) therapies are executed to remove the residual [[dosha]]. As ''shodhana'' has a definite chance for causation of [[vata]] prakopa, the approach should be cautious, so ''mridu samshodana'' (mild purification) is done. Sneha [[virechana]] is done by ''tilwaka ghrita'' or ''eranda taila'', etc. ''Eranda taila'' is very effective in treating [[vata]] prakopa due to ''udavarta''. If [[virechana]] is not possible, ''anulomana'' diet should be adviced. If the patient is extremely weak niruha is better option. Even after ''shodhana''; recurrent application of [[snehana]] and [[swedana]] are essential.(verse 83-88)

Repeated [[snehana]] and [[swedana]] therapies can control [[vata]] well. However, ''samshodhana'' (purification) therapies are executed to remove the residual [[dosha]]. As ''shodhana'' has a definite chance for causation of [[vata]] prakopa, the approach should be cautious, so ''mridu samshodana'' (mild purification) is done. Sneha [[virechana]] is done by ''tilwaka ghrita'' or ''eranda taila'', etc. ''Eranda taila'' is very effective in treating [[vata]] prakopa due to ''udavarta''. If [[virechana]] is not possible, ''anulomana'' diet should be adviced. If the patient is extremely weak niruha is better option. Even after ''shodhana''; recurrent application of [[snehana]] and [[swedana]] are essential.[verse 83-88]

==== Management of [[vata]] at different sites ====

==== Management of [[vata]] at different sites ====

Treatment of disorders of [[vata]], when located in different sites, habitat (''sthana'') is more important in comparison to the invaded (''agantu'') [[dosha]] e.g in koshthagata [[vata]], koshtha is given preference in treatment, and so ''kshara'' is used which helps in digestion ([[pachana]]). But when [[vata]] is located in ''pakvashaya'' or ''guda'' which is [[vata]]sthana, udavartahara treatment is selected, which includes [[vata]] anulomana, [[basti]], varti'' etc. In amashayagata [[vata]], shodhana in the form of [[vamana]] is done.  

Treatment of disorders of [[vata]], when located in different sites, habitat (''sthana'') is more important in comparison to the invaded (''agantu'') [[dosha]] e.g in koshthagata [[vata]], koshtha is given preference in treatment, and so ''kshara'' is used which helps in digestion ([[pachana]]). But when [[vata]] is located in ''pakvashaya'' or ''guda'' which is [[vata]]sthana, udavartahara treatment is selected, which includes [[vata]] anulomana, [[basti]], varti'' etc. In amashayagata [[vata]], shodhana in the form of [[vamana]] is done.  

=== Management of ''ardita'' (facial palsy) ===

=== Management of ''ardita'' (facial palsy) ===

The line of treatment of ''ardita'' aims at ''mastishkya'' (brain), therefore, [[nasya]] is indicated. [[Nasya]] is explained to be the direct entrance to the cranial vault. [[Nasya]] may be ''shodhana, shamana'' or [[brimhana]] as the case may be. But there is an opinion that since the word ''navana'' is used, it means snaihika [[nasya]]. ''Murdhni taila'' is absolutely meant for treatment in head region and is of four types viz. ''abhyanga'' ( head massage), ''seka'' (pouring liquid on head), ''pichu'' ( therapeutic unctuous swab on head) and ''shirobasti''. ''Tarpana'' (nourishment therapy) is ''akshitarpana'' (nourishing eyes) and ''shrotratarpana'' (nourishing ears). ''Nadisweda'' is very specific in ''ardita'' and ''ksheeradhooma'' (medicated fumes of milk).

The line of treatment of ''ardita'' aims at ''mastishkya'' (brain), therefore, [[nasya]] is indicated. [[Nasya]] is explained to be the direct entrance to the cranial vault. [[Nasya]] may be ''shodhana, shamana'' or [[brimhana]] as the case may be. But there is an opinion that since the word ''navana'' is used, it means snaihika [[nasya]]. ''Murdhni taila'' is absolutely meant for treatment in head region and is of four types viz. ''abhyanga'' ( head massage), ''seka'' (pouring liquid on head), ''pichu'' ( therapeutic unctuous swab on head) and ''shirobasti''. ''Tarpana'' (nourishment therapy) is ''akshitarpana'' (nourishing eyes) and ''shrotratarpana'' (nourishing ears). ''Nadisweda'' is very specific in ''ardita'' and ''ksheeradhooma'' (medicated fumes of milk).

=== Importance of site of affliction in treatment ===

=== Importance of site of affliction in treatment ===

The specificity of treatment depends on the site of affliction and the associated morbid tissues. For example masthishkya is very specific for ardita, pakshaghata, indriyagatavata etc. Even though [[vamana]] is [[kapha]]hara, it is exclusively indicated in āmashayagata vāta taking into account of site of affliction. (verse 104)

 

[[Brimhana]] treatment of [[vata]] vitiation: The treatment of exclusive [[vata]] vitiation (without involvement of other [[dosha]]) is [[brimhana]]. If associated [[dosha]] is present, they shall be treated first. (verse 105)

The specificity of treatment depends on the site of affliction and the associated morbid tissues. For example masthishkya is very specific for ardita, pakshaghata, indriyagatavata etc. Even though [[vamana]] is [[kapha]]hara, it is exclusively indicated in āmashayagata vāta taking into account of site of affliction. [verse 104]

Bala is excellent for lone vitiated [[vata]]. The head of goat is indicated on the basis of the principle ‘samanyam vridhikaranam’(like increases like). These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha (stiffness) and samghata (conglomeration). Upanaha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. (verse 106-108)

 

Avagaha (immersion) sweda:

[[Brimhana]] treatment of [[vata]] vitiation: The treatment of exclusive [[vata]] vitiation (without involvement of other [[dosha]]) is [[brimhana]]. If associated [[dosha]] is present, they shall be treated first. [verse 105]

Avagāha is typically indicated in apana vaigunya (defects due to apana [[vata]] vitiation), it is a type of drava sweda (liquid fomentation). Nādisweda is also an excellent option for all types of vātarōga. Poultices (upanāha) of different types  provide self generated heat to cause swedana. It is by virtue of various dhanya (cereals) and kinwa (yeast) available in it.  (verse 109-118)

 

Different formulations:

Bala is excellent for lone vitiated [[vata]]. The head of goat is indicated on the basis of the principle ‘samanyam vridhikaranam’(like increases like). These also explain the awareness of utilization of brain of goat in degenerative brain lesions. Lavana relieves stambha (stiffness) and samghata (conglomeration). Upanaha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. [verse 106-108]

Different medicated ghrita,taila, vasa, majja and maha sneha ( combination of all four sneha) are indicated for various conditions in the form of oral ingestion, inhalation, enema and external application etc. Maha sneha is guru (heavy to digest) and ultimately indicated in disorders like convulsions, tremor etc. (verse 119-136)

 

Pinyaka taila is a preparation in which ruksha [[guna]] is imparted to taila and is highly useful in [[kapha]] associated [[Vata]]vyadhi. (verse 136-137)

=== Avagaha (immersion) sweda ===

Importance of oil in treatment of [[vata]]: By virtue of vyavayi [[guna]] (pervading/diffusive), it reaches the different interior parts of the body without any metabolic changes. By processing taila can adopt any type of qualitative changes.  The drugs are potentiated by repeated processing in its own media. Drugs like ksheerbalā (101 āvartita), dhanwatharam (21 āvartita) etc. are worth mentioning here. This approach of samskāra makes snēha as sukshma snēha (with better bio-availability and penetration) .(verse 181-182)

 

Avagaha is typically indicated in apana vaigunya (defects due to apana [[vata]] vitiation), it is a type of drava sweda (liquid fomentation). Nādisweda is also an excellent option for all types of vātarōga. Poultices (upanāha) of different types  provide self generated heat to cause swedana. It is by virtue of various dhanya (cereals) and kinwa (yeast) available in it.  [verse 109-118]

 

=== Different formulations===

 

Different medicated ghrita, taila, vasa, majja and maha sneha ( combination of all four sneha) are indicated for various conditions in the form of oral ingestion, inhalation, enema and external application etc. Maha sneha is guru (heavy to digest) and ultimately indicated in disorders like convulsions, tremor etc. [verse 119-136]

 

Pinyaka taila is a preparation in which ruksha [[guna]] is imparted to taila and is highly useful in [[kapha]] associated [[Vata]]vyadhi. [verse 136-137]

 

=== Importance of oil in treatment of [[vata]]===

 

By virtue of vyavayi [[guna]] (pervading/diffusive), it reaches the different interior parts of the body without any metabolic changes. By processing taila can adopt any type of qualitative changes.  The drugs are potentiated by repeated processing in its own media. Drugs like ksheerbalā (101 āvartita), dhanwatharam (21 āvartita) etc. are worth mentioning here. This approach of samskāra makes snēha as sukshma snēha (with better bio-availability and penetration) .[verse 181-182]

 

=== Management of avrita [[vata]] ===

=== Management of avrita [[vata]] ===

In [[pitta]]vr̥ta [[vata]], hot and cold should be applied alternately.  Jīvanīya sarpi is also very [[brimhana]]. [[Brimhana]] is the ideal pacifying line of treatment for [[vata]] and [[vata]]-[[pitta]].   

In [[pitta]]vr̥ta [[vata]], hot and cold should be applied alternately.  Jīvanīya sarpi is also very [[brimhana]]. [[Brimhana]] is the ideal pacifying line of treatment for [[vata]] and [[vata]]-[[pitta]].   

In [[kapha]]vr̥ta [[vata]], ruksha is given importance. In association of [[kapha]] along with [[pitta]] in [[vata]]roga, [[pitta]] should be given importance in management. It is because of the fact that [[pitta]] makes the disease process as ‘ashukāri’(instantaneous).  

 

In [[Kapha]]vr̥ta [[vata]]; tīkṣṇā sweda, niruha and [[vamana]] which reduces [[kapha]] is indicated followed by [[virechana]] intended for [[vata]] anulomana and also useful for [[kapha]].

In [[kapha]]vr̥ta [[vata]], ruksha is given importance. In association of [[kapha]] along with [[pitta]] in [[vata]]roga, [[pitta]] should be given importance in management. It is because of the fact that [[pitta]] makes the disease process as ‘ashukari’(instantaneous).  

Jirna/purāna sarpi (old ghee) which has [[kapha]]ghna quality has to be used; tila and sarshapa which are [[kapha]] [[vata]]ghna 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)

 

In [[Kapha]]vritta [[vata]]; tīkṣṇā sweda, niruha and [[vamana]] which reduces [[kapha]] is indicated followed by [[virechana]] intended for [[vata]] anulomana and also useful for [[kapha]].

 

Jirna/purāna sarpi (old ghee) which has [[kapha]]ghna quality has to be used; tila and sarshapa which are [[kapha]] [[vata]]ghna 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]]-[[vata]] and ksheera [[basti]] in [[pitta]]-[[vata]] is recommended. [[Rakta]]vruta [[vata]] is similar to uttana-vatarakta and treatment is accordingly same. [[Rakta]] avruta [[vata]] is one of the phases of vatarakta. Thus [[raktamokshana]] and basti cikitsā which is useful in vātarakta is also helpful in rakta avruta [[vata]].  

Kshara [[basti]] (gomūtrayukta [[basti]]) in case of [[kapha]]-[[vata]] and ksheera [[basti]] in [[pitta]]-[[vata]] is recommended. [[Rakta]]vruta [[vata]] is similar to uttana-vatarakta and treatment is accordingly same. [[Rakta]] avruta [[vata]] is one of the phases of vatarakta. Thus [[raktamokshana]] and basti cikitsā which is useful in vātarakta is also helpful in rakta avruta [[vata]].  

Prameha samprapti mentioned in Sutra sthana 17th chapter explains [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]] which when increased causes avarana of [[vata]]. Therefore, pramehagna cikitsa is helpful in meda avruta [[vata]] and also in mamsavruta [[vata]]. Hence in mamsavruta [[vata]] the pipilika iva sanchara (tingling sensation) reduces, if prameha is treated. Similarly, in obesity, medasavruta [[vata]] ([[vata]] obstructed by excess meda) [Cha.Sa.[[Sutra Sthana]] 21/5] and meda and mamsa 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). [[Pachana]] and [[deepana]] helps in digestion and also pacifies [[vata]].

Prameha samprapti mentioned in Sutra sthana 17th chapter explains [[kapha]], [[pitta]], [[meda dhatu]] and [[mamsa dhatu]] which when increased causes avarana of [[vata]]. Therefore, pramehagna cikitsa is helpful in meda avruta [[vata]] and also in mamsavruta [[vata]]. Hence in mamsavruta [[vata]] the pipilika iva sanchara (tingling sensation) reduces, if prameha is treated. Similarly, in obesity, medasavruta [[vata]] ([[vata]] obstructed by excess meda) [Cha.Sa.[[Sutra Sthana]] 21/5] and meda and mamsa 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). [[Pachana]] and [[deepana]] helps in digestion and also pacifies [[vata]].

Hot fomentation 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.

Hot fomentation 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, tri[[dosha]] shamana can be done.  

 

Uttara basti effect is similar to catheterization. Further depending on the medicines used for uttara basti, tri[[dosha]] shamana can be done.

The lines of treatment of [[rakta]]gata [[vata]] and raktvrita [[vata]] as well as [[shukra]]gata [[vata]] and shukrāavruta [[vata]] are one and the same irrespective difference in samprapti as gata [[vata]] or avruta [[vata]]. It is because of the fact that [[rakta]] and [[shukra]] are mobile and comparatively pervaded all over the body like [[vata]] so gata[[vata]] and avruta [[vata]] are mutually complimentary here.  

The lines of treatment of [[rakta]]gata [[vata]] and raktvrita [[vata]] as well as [[shukra]]gata [[vata]] and shukrāavruta [[vata]] are one and the same irrespective difference in samprapti as gata [[vata]] or avruta [[vata]]. It is because of the fact that [[rakta]] and [[shukra]] are mobile and comparatively pervaded all over the body like [[vata]] so gata[[vata]] and avruta [[vata]] are mutually complimentary here.  

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

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

Movements of [[vata]] and concept of anyonyavarana:As discussed earlier avyahatagati (free movement) is a cardinal feature of [[vata]] to perform normally. In [[avarana]] certain obstacles like [[dosha]], [[dhatu]] or anna etc which are immobile, occupy the pathway of mobile [[vata]. It is not mandatory that such immobile articles only cause obstruction to [[vata]]. If the individual sub types of [[vata]] are considered prana, udana, vyana, samana and apana are mobile and has some specific direction for their gati. For example, prana has movement from murdha (head) to downwards. Udana has movement from uras(chest) to upwards.  Vyana moves upward downward and sidewards like rasa. Samana moves around jatharagni. Apana move downwards from pakvashaya. This can be further analysed as follows.  Udana possess upward movement.  Likewise ‘apana’  has downward direction.  Vyana [[vayu]] 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.  Prana 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)

 

Anyonya avarana 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 prana avruta udana 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 prana. But in  udana avruta prana the symptoms are loss of motor power, immunity and complexion leading to death. Here the functions of prana are seriously hampered. This symptom may be acute or chronic in nature. When apana got avarana by udana the normal peristalsis is hampared and anulomana is the line of treatment. In apana avarana to udana increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.

Movements of [[vata]] and concept of anyonyavarana:As discussed earlier avyahatagati (free movement) is a cardinal feature of [[vata]] to perform normally. In [[avarana]] certain obstacles like [[dosha]], [[dhatu]] or anna etc which are immobile, occupy the pathway of mobile [[vata]. It is not mandatory that such immobile articles only cause obstruction to [[vata]]. If the individual sub types of [[vata]] are considered prana, udana, vyana, samana and apana are mobile and has some specific direction for their gati. For example, prana has movement from murdha (head) to downwards. Udana has movement from uras(chest) to upwards.  Vyana moves upward downward and sidewards like rasa. Samana moves around jatharagni. Apana move downwards from pakvashaya. This can be further analysed as follows.  Udana possess upward movement.  Likewise ‘apana’  has downward direction.  Vyana [[vayu]] moves in horizontal direction (vyāpanat vyāna uccyate) along with upward and downward directions as rasa samvahana (circulation) is concerned.[19]Samana is also having such qualities to equally distribute the nutrients through out the body.  Prana has multi directional gati. So, the movements of individual subtypes of vāta are directional in nature. When these meet in opposite direction it makes anyonyavarana. 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 different types making 4 particular combinations. Anyonyāvarana are comparatively difficult situations. [verses 199-206]

Rehabilitation of [[vata]]: Prakrutisthapanam means re-establishment in its own pathway (sva margaga)/ or in its own place (sva sthana gamayed enam). Therefore for udana [[vayu]], [[vamana]] etc. treatment should be administered to regulate the normal functional status of udana [[vayu]]. Apana has adhogati, therefore anulomana chikitsā should be done, thereby regularizing the urdhva apana bhava of Apana [[vayu]]. Shamana should be line of treatment for samana [[vayu]]. Empowering digestive power should be done. Samana 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 anyonyavarana is discussed. (verse 219-221)

 

Importance of udana and prana vata:

Anyonya avarana is characterized by Svakarma hani or vriddhi (either increase or decrease in functions) which depends on the nature and site of anyonyāvarana (mutual covering). For example prana avruta udana 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 prana. But in  udana avruta prana the symptoms are loss of motor power, immunity and complexion leading to death. Here the functions of prana are seriously hampered. This symptom may be acute or chronic in nature. When apana got avarana by udana the normal peristalsis is hampared and anulomana is the line of treatment. In apana avarana to udana increased bowel motility can be seen grāhi is the line of treatment which should be adopted here.

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

 

Complications of Avarana:

=== Rehabilitation of [[vata]]===

 

Prakrutisthapanam means re-establishment in its own pathway (sva margaga)/ or in its own place (sva sthana gamayed enam). Therefore for udana [[vayu]], [[vamana]] etc. treatment should be administered to regulate the normal functional status of udana [[vayu]]. Apana has adhogati, therefore anulomana chikitsā should be done, thereby regularizing the urdhva apana bhava of Apana [[vayu]]. Shamana should be line of treatment for samana [[vayu]]. Empowering digestive power should be done. Samana 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 anyonyavarana is discussed. [verse 219-221]

 

===Importance of udana and prana vata===

 

Among various avarana, the involvement of udana and prana are very important. As explained in the introductory comments, prana is life and udana is strength. These are very vital issues as far as avarana is concerned. Improper management or avoidance of treatments may lead to permanant disabilities in avarana.  [verse 231-236]

 

=== Complications of Avarana===

This includes hrudroga, vidradhi, plīhā, gulma, atisara. Hrudroga is a common complication of ill treated avarana of prana and udana. Vidradhi and pliha are caused by wrongly managed avarana of vyana. Gulma and atisara are common complications of avarana of samana and apana.  

This includes hrudroga, vidradhi, plīhā, gulma, atisara. Hrudroga is a common complication of ill treated avarana of prana and udana. Vidradhi and pliha are caused by wrongly managed avarana of vyana. Gulma and atisara are common complications of avarana of samana and apana.  

=== Related Chapter ===

 

=== Related chapter ===

 

* [[Vatakalakaliya Adhyaya]]

* [[Vatakalakaliya Adhyaya]]