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|data1 = [[Chikitsa Sthana]] Chapter 28

|data1 = [[Chikitsa Sthana]] Chapter 28

|label2 = Preceding Chapter

|label2 = Preceding Chapter

|data2 = [[Urusthambha Chikitsa]]

|data2 = [[Urustambha Chikitsa]]

|label3= Succeeding Chapter

|label3= Succeeding Chapter

}}

}}

==([[Chikitsa Sthana]] Chapter 28, Chapter on disorders caused by ''vata dosha'')==

==[[Chikitsa Sthana]] Chapter 28, Chapter on disorders caused by ''vata dosha''==

=== Abstract ===

=== Abstract ===

[[Vatavyadhi Chikitsa]] deals with disorders particularly caused by ''vata dosha''. It is an important chapter as it encompasses a large spectrum of disorders especially concerned with neurological system, musculoskeletal system, reticulo-endothelial system and further pervades to all other systems in the body. The chapter highlights the five sub classifications of ''vata'', their habitat and functions. The etiological factors of ''vatavyadhi'' are enlisted and two major pathology viz, ''dhatukshaya'' and ''avarana'' are detailed. In ''dhatukshaya'', vitiated ''vata'' assumes the status of ''gatavata'' (increased movement of ''vata'') and occupies various sites leading to ''dhatugata'' (affecting tissues) ''vata, ashayagata'' (affecting various sites) ''vata'' and ''avayava'' (organs) ''gatavata''. ''Avarana'' (obstruction by covering) is a distinct pathology of ''vata'' in which the free mobility of ''vata'' is hampered. Accordingly, ''avarana'' may happen either due to two other ''dosha, dhatu'' (''rakta'', etc.) or ''mala'' (waste). ''Avarana'' may also happen in between two subtypes of ''vata'' as the direction of movement of various types of ''vata'' differ. This is called ''anyonyavarana''. The symptomatology, pathology and management strategies of ''avarana'' as well as ''gatavata'' are detailed in the chapter. The most common neurological disorders like ''pakshaghata'' (stroke), ''ardita'' (facial palsy), ''gridhrasi'' (sciatica), ''avabahuka'' (frozen shoulder), ''viswachi'' (cervico brachial neuralgia) etc. are described. Various formulations including medicated oils and ghee etc. are also included in the chapter. The chapter confirms the difficulty in curability of chronic ''vatavyadhi'' affecting debilitated individuals.  

[[Vatavyadhi Chikitsa]] deals with disorders particularly caused by ''vata dosha''. It is an important chapter as it encompasses a large spectrum of disorders especially concerned with neurological system, musculoskeletal system, reticulo-endothelial system and further pervades to all other systems in the body. The chapter highlights the five sub classifications of ''vata'', their habitat and functions. The etiological factors of ''vatavyadhi'' are enlisted and two major pathology viz, ''dhatukshaya'' and ''avarana'' are detailed. In ''dhatukshaya'', vitiated ''vata'' assumes the status of ''gatavata'' (increased movement of ''vata'') and occupies various sites leading to ''dhatugata'' (affecting tissues) ''vata, ashayagata'' (affecting various sites) ''vata'' and ''avayava'' (organs) ''gatavata''. ''Avarana'' (obstruction by covering) is a distinct pathology of ''vata'' in which the free mobility of ''vata'' is hampered. Accordingly, ''avarana'' may happen either due to two other ''dosha, dhatu'' (''rakta'', etc.) or ''mala'' (waste). ''Avarana'' may also happen in between two subtypes of ''vata'' as the direction of movement of various types of ''vata'' differ. This is called ''anyonyavarana''. The symptomatology, pathology and management strategies of ''avarana'' as well as ''gatavata'' are detailed in the chapter. The most common neurological disorders like ''pakshaghata'' (stroke), ''ardita'' (facial palsy), ''gridhrasi'' (sciatica), ''avabahuka'' (frozen shoulder), ''viswachi'' (cervico brachial neuralgia) etc. are described. Various formulations including medicated oils and ghee etc. are also included in the chapter. The chapter confirms the difficulty in curability of chronic ''vatavyadhi'' affecting debilitated individuals.  

'''Keywords''': ''Aksepaka, Anyonyvarana, Apana, Ardita, Avabahuka, Avarana,'' Ayurveda, Convulsive disorders, ''Dhatukshaya,'' Facial palsy, ''Gatavata,'' General Line of treatment of ''Vatavyadhi, Gridhrasi,'' Neurological disorders, ''Paksaghata, Praana, Samana,'' Sciatica, Specific treatments of ''Vatavyadhi'', Stroke, ''Udana, Viswachi, Vyana.''

'''Keywords''': ''Akshepaka, Anyonyavarana, Apana, Ardita, Avabahuka, Avarana,'' Ayurveda, Convulsive disorders, ''Dhatukshaya,'' Facial palsy, ''Gatavata,'' General Line of treatment of ''Vatavyadhi, Gridhrasi,'' Neurological disorders, ''Pakshaghata, Prana, Samana,'' Sciatica, Specific treatments of ''Vatavyadhi'', Stroke, ''Udana, Vishwachi, Vyana.''

=== Introduction ===

=== Introduction ===

''Vata'' is the prime ''dosha''. Owing to its incorporeal nature and instability it is inaccessible in comparison to other two ''dosha''. The inaccessibility is characterized in regard to its functional and physical attributes but is more relevant regarding the therapeutic aspect. ''Vata'' is also explained as ''achintyaveerya'' (inconceivable prowess) and ''doshaanaam netah'' (propeller of all functional elements in the body).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

''Vata'' is the prime ''dosha''. Owing to its incorporeal nature and instability it is inaccessible in comparison to other two ''dosha''. The inaccessibility is characterized in regard to its functional and physical attributes but is more relevant regarding the therapeutic aspect. ''Vata'' is also explained as ''achintyaveerya'' (inconceivable prowess) and ''doshaanaam netah'' (propeller of all functional elements in the body).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/8; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

Before discussing the importance and implications of ''vata'', the references on ''vata'' and neurological elements in vedic literature is to be highlighted. In vedic science two terminologies namely ''prana'' and ''pranaja'' were used to denote nerve impulses. ''Prana'' is ''kriyashakti'' (power for action) and may be compared with motor impulse. ''Pranaja'' is also same as ''prana'' but conveys sensation of taste, smell, vision, sound, coitus, reproduction, pleasure and pain. It can be compared with sensory afferent impulse. Both ''prana'' and ''pranaja'' leave body at death. The entire neural axis is explained as ''sushumna'' (spinal cord) and it extends from the mid-perineum to inside of cranium runing through the middle of the spine to reach the cerebrum, twelve fingers breadth from nose. The shape of ''sushumna'' is compared with flower of ''datura alba'' with two dilatations at thoracic and lumbar areas. The cross section of spinal column is compared with the letter ''Aum'' in which grey matter and white matter is identified as ''chitrini'' (name for grey matter) and ''vajra'' (name for white matter). The neural net works are compared with ''luta tantu'' (spider web)<ref>B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)</ref>. Ten subtypes of ''vata'' are explained and ''dhananjaya'' (the tenth and last subtype) does not leave the body even after death. This is responsible for tissue transplantation after death. The description of ''shadchakra'' (six ''chakras'') is also very striking with latest functional modern neurology. The difference between vedic and ayurvedic neurology is that vedic science used it to attain higher level of consciousness through control of one’s nerve impulses. Ayurvedic science is meant for academic advancement or therapeutics. In Ayurveda it can be seen that practical utilization of vedic knowledge for therapeutic purpose by modification through experiments and experiences is done. Detailed descriptions of features of ''vata'' are available in various chapters of [[Charaka Samhita]] including [[Deerghanjiviteeya Adhyaya]], [[Vatakalakaliya Adhyaya]] and [[Rogabhishagjitiya Vimana]], etc. The pathology and therapeutic aspects of ''vata'' is explained in this chapter. There is no separate chapter for diseases of ''pitta'' and ''kapha dosha''. [[Vatavyadhi Chikitsa]] is an exclusive chapter dealing with ''vata janita vishesha vyadhi'' (diseases caused by vata vitiation). It is because of the supremacy of ''vata''. The chapter is kept just after [[Urusthambha Chikitsa]] since in that particular disease ''ama, kapha, meda,'' etc. are associated to cause ''vataprakopa'' and ''urustambha''. On application of strenuous ''rukshana chikitsa'' in ''urustambha, vataprakopa'' alone may also happen. Even though in ''nanatmaja'' (single ''dosha'') ''vatavyadhi'' the presence of other ''dosha'' can be traced, the disease cannot manifest without the vitiation of ''vata''.  

Before discussing the importance and implications of ''vata'', the references on ''vata'' and neurological elements in vedic literature is to be highlighted. In vedic science two terminologies namely ''prana'' and ''pranaja'' were used to denote nerve impulses. ''Prana'' is ''kriyashakti'' (power for action) and may be compared with motor impulse. ''Pranaja'' is also same as ''prana'' but conveys sensation of taste, smell, vision, sound, coitus, reproduction, pleasure and pain. It can be compared with sensory afferent impulse. Both ''prana'' and ''pranaja'' leave body at death. The entire neural axis is explained as ''sushumna'' (spinal cord) and it extends from the mid-perineum to inside of cranium runing through the middle of the spine to reach the cerebrum, twelve fingers breadth from nose. The shape of ''sushumna'' is compared with flower of ''datura alba'' with two dilatations at thoracic and lumbar areas. The cross section of spinal column is compared with the letter ''Aum'' in which grey matter and white matter is identified as ''chitrini'' (name for grey matter) and ''vajra'' (name for white matter). The neural net works are compared with ''luta tantu'' (spider web)<ref>B C Joshy, Neurology in Ancient India – some evidences, Indian journal of History of science, 19(4):366-396(1984)</ref>. Ten subtypes of ''vata'' are explained and ''dhananjaya'' (the tenth and last subtype) does not leave the body even after death. This is responsible for tissue transplantation after death. The description of ''shadchakra'' (six ''chakras'') is also very striking with latest functional modern neurology. The difference between vedic and ayurvedic neurology is that vedic science used it to attain higher level of consciousness through control of one’s nerve impulses. Ayurvedic science is meant for academic advancement or therapeutics. In Ayurveda it can be seen that practical utilization of vedic knowledge for therapeutic purpose by modification through experiments and experiences is done. Detailed descriptions of features of ''vata'' are available in various chapters of [[Charak Samhita]] including [[Deerghanjiviteeya Adhyaya]], [[Vatakalakaliya Adhyaya]] and [[Rogabhishagjitiya Vimana]], etc. The pathology and therapeutic aspects of ''vata'' is explained in this chapter. There is no separate chapter for diseases of ''pitta'' and ''kapha dosha''. [[Vatavyadhi Chikitsa]] is an exclusive chapter dealing with ''vata janita vishesha vyadhi'' (diseases caused by vata vitiation). It is because of the supremacy of ''vata''. The chapter is kept just after [[Urusthambha Chikitsa]] since in that particular disease ''ama, kapha, meda,'' etc. are associated to cause ''vataprakopa'' and ''urustambha''. On application of strenuous ''rukshana chikitsa'' in ''urustambha, vataprakopa'' alone may also happen. Even though in ''nanatmaja'' (single ''dosha'') ''vatavyadhi'' the presence of other ''dosha'' can be traced, the disease cannot manifest without the vitiation of ''vata''.  

''Vata'' as explained earlier is the biological force present in the body which recognizes and stimulates all the activities. Instability of ''vata'' makes it inaccessible. It is characterized by an increase in the ''chala'' (motion) property, which is favored and contributed by other properties also. The ''chala guna'' is directional in nature and termed as ''gati''. ''Gati'' is the distinct quality of ''vata'', very important on physiological and pathological aspects. The ''gati'' of individual components of ''vata'' is to be analyzed according to the intensity, direction and area; depending upon the particular function it is carrying out. When the ''gati'' is aggravated (''gatatva'') or obstructed (''avarana'') the functional normality’s of ''vata'' are impaired. The ''gati'' or ''gatatva'' have two implications, one subjected to activity (to move, carry out or reach-gata) and the second subjected to abode of activity (pathway). ''Gatatva'' is an essential part of any ''vataja samprapti'' (pathogenesis). ''Gatatva'' of ''vata'' is possible in ''dhatu, upadhatu, asaya'' (sites or hollow cavities of organs), ''avayava'' (part or organ), etc. Consumption of ''ahara'' of relatively higher ''kittansa'' (waste products) leads to diminution of ''dhatu'' and aggravation of ''vata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>. It leads to ''riktata'' (emptiness) and more ''avakasa'' (space) in ''dhatu'', makes the engorgement and hyper movement of aggravated ''vata'' in the site. ''Dhatugatavata'' and ''dhatuavrita vata'' are also distinct pathologies as in ''avarana'' the vitiation of ''vata'' is passive and the ''gati'' is obstructed.

''Vata'' as explained earlier is the biological force present in the body which recognizes and stimulates all the activities. Instability of ''vata'' makes it inaccessible. It is characterized by an increase in the ''chala'' (motion) property, which is favored and contributed by other properties also. The ''chala guna'' is directional in nature and termed as ''gati''. ''Gati'' is the distinct quality of ''vata'', very important on physiological and pathological aspects. The ''gati'' of individual components of ''vata'' is to be analyzed according to the intensity, direction and area; depending upon the particular function it is carrying out. When the ''gati'' is aggravated (''gatatva'') or obstructed (''avarana'') the functional normality’s of ''vata'' are impaired. The ''gati'' or ''gatatva'' have two implications, one subjected to activity (to move, carry out or reach-gata) and the second subjected to abode of activity (pathway). ''Gatatva'' is an essential part of any ''vataja samprapti'' (pathogenesis). ''Gatatva'' of ''vata'' is possible in ''dhatu, upadhatu, asaya'' (sites or hollow cavities of organs), ''avayava'' (part or organ), etc. Consumption of ''ahara'' of relatively higher ''kittansa'' (waste products) leads to diminution of ''dhatu'' and aggravation of ''vata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Sutrasthānam 28/4; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>. It leads to ''riktata'' (emptiness) and more ''avakasa'' (space) in ''dhatu'', makes the engorgement and hyper movement of aggravated ''vata'' in the site. ''Dhatugatavata'' and ''dhatuavrita vata'' are also distinct pathologies as in ''avarana'' the vitiation of ''vata'' is passive and the ''gati'' is obstructed.

==== Clinical features of vitiation of ''vata'' at different sites ====

==== Clinical features of vitiation of ''vata'' at different sites ====

===== ''Koshthashirta vata'' (vitiation at gastrointestinal tract) =====

===== ''Koshthashrita vata'' (vitiation at gastrointestinal tract) =====

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||  

तत्र कोष्ठाश्रिते दुष्टे निग्रहो मूत्रवर्चसोः ||२४||  

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē vātavyādhicikitśītāṁnāmāṣṭāviṁśō'dhyāyaḥ||28||  

ityagnivēśakr̥tē tantrē carakapratisaṁskr̥tē'prāptē dr̥ḍhabalasampūritē cikitsāsthānē vātavyādhicikitśītāṁnāmāṣṭāviṁśō'dhyāyaḥ||28||  

Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivesha and revised by Charaka, the twenty-eighth chapter entitled [[Vatavyadhi Chikitsa]] not being available, the same as restored by Dridhabala, is completed.[28]

Thus, in the section on ‘Therapeutics’, in the treatise compiled by Agnivesha and revised by Charak, the twenty-eighth chapter entitled [[Vatavyadhi Chikitsa]] not being available, the same as restored by Dridhabala, is completed.[28]

=== ''Tattva Vimarsha'' ===

=== ''Tattva Vimarsha'' ===

==== 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> Vagbhata Vridha, Astangasamgraham with Sasilekha Commentary Sutrasthāna20/2; 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<ref> Agnivesha, ''Charaka Samhita'' with Ayurveda Dipika commentary Shareerasthana; 1/29-30; Dr.Gangasahay pandey (eds.) 6th  ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000 </ref>. 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>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/5; Vd. Yadavji Trikamji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

''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> Vagbhata Vridha, Astangasamgraham with Sasilekha Commentary Sutrasthāna20/2; 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<ref> Agnivesha, ''Charak Samhita'' with Ayurveda Dipika commentary Shareerasthana; 1/29-30; Dr.Gangasahay pandey (eds.) 6th  ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000 </ref>. 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>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/5; Vd. Yadavji Trikamji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004 </ref>

Anavasthita (unstable) is due to chala property of ''vata''.  This continuous moving nature of ''vata'' is explained with other terminologies also like ''sheeghravata''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 8/98; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref> (swift movement), ''ashukari'' (instantaneous action), ''muhushchari'' (rhythmic movement).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/9; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004</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''<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 8/98; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref> (swift movement), ''ashukari'' (instantaneous action), ''muhushchari'' (rhythmic movement).<ref>Sushruta. Sushrutasamhita with Nibandhasamgraha Commentary, Nidanasthānam 1/9; Vd. Yadavji Trikmji Ācharya (eds),Reprint, Choukhamba Krishnadas Academy, 2004</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.

#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 ''gatavata'' 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 ''gatavata'' 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.

#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.

*''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<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Chikitsasthana; 28/215; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000; Chakrapani on above</ref>. 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''.

5. In āvarana of vāta, swakarma vriddhi (exaggerated activities) of āvaraka (covering dosha) is manifested. The āvr̥ta (i.e. vāta) will show swakarma hāni (diminished activity). This is the general feature of āvarana. Here the excessively increased strong āvaraka suppresses the normal action of āvr̥ta (i.e. vāta). Therefore, when the obstruction is complete it may lead to the prakopa of vāta resulting in the presentation of vāta vitiated symptoms as well as its disorders14.

#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 gatatva the symptomatology will be predominantly of vāta vitiation and pain is a common and chief complaint in all the conditions of 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''.

6. 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 vāta (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. Dhātugata vāta will be presented with decreased quality of tissues associated with signs of vitiated vāta. Obviously, exceptions are possible according to the complexities of process of āvarana or gatatva.

#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).  

7. In case of āvarana of vāta, the āvaraka is important for  treatment since vitiation of vāta is passive. When āvarana is removed vitiated vāta gets pacified. But in cases of gatatva the vitiated vāta has to be treated first along with correction of adhisthāna.

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

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

#''Avarana'' of ''vata'' may cause depletion of nutrition to ''dhatu'' (''dhatugata sama'') leading to successive diminition of ''rasadi dhatu'' (''rasadimscha upasosayet'').<ref>Ibid 28/61</ref> No such reference is available in case of ''gatatva''.  

9. Complications of āvarana are explained in case of improper diagnosis and delayed treatment like hr̥drōga, vidradhi, kamala etc. No known complication occur in gatatva.

10. Āvarana of vāta may cause depletion of nutrition to dhātu (dhātugata sāma) leading to successive diminition of rasādi dhātu (rasādimsca upasosayet).15 No such reference is available in case of gatatva.

13. Successive diminuation of rasadi dhātu possible 14. None.

As āvarana proceeds it may end up in dhātukṣaya as the āvr̥ta will block rasadhātu which give nourishment. This is commonly observed. This is possible in many other disorders also. The best example is rajayakshma.

| Only ''chala'' property of ''vata'' is involved and it is diminished in the phenomenon

| ''Gati'' of ''vata'' is obstructed

| ''Gati'' of ''vata'' is aggravated

| ''Avarana'' by ''avayava''(body part) or ''ashaya''(organ) not possible

| ''Vata'' gets importance in treatment

Prognosis: Exclusive vata disorders are serious and have poor prognosis. The symptoms / diseases explained manifest when vitiated vāta 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 Vātavyādhi applies to absolute vāta vitiation only. If there is any association or obstruction of other dosha in Vātavyādhi, 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 vātaja disease the major gunavriddhi is rūkṣa which leads to riktatā in srotas and dhātu and more avakāsha (space) for vāta; Snēhana is essential and ideal. Various methods for snēhana are employed depending on avastha (stage), sthāna (site) and bala (strength) of the diseases and as well as patient.

'''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)

Following snēhana, swedana is also mandatory. Here the ushṇā  guna (hot property) operates to control śītā (cold).  Repeated snēhana and swedana imparts high grade of flexibility.  

Snēha is a good medium to control vāta as well as vāta-pitta. Generally, this line of treatment can be counted as a part of brimhana. (verse 75-83)

'''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.

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

Management of vata at different sites:

As in exclusive ''vataja'' 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.

Treatment of disorders of vāta, when located in different sites, habitat (sthāna) is more important in comparison to the invaded (āgantu) dosha e.g in kōṣṭhagata vāta, kōṣṭha is given preference in treatment, and so kshara is used which helps in digestion (pāchana). But when vāta is located in pakvāśaya or guda which is vātasthāna, udāvartahara treatment is selected, which includes vāta anulomana, basti, varti etc. In āmashayagata vāta, shodhana in the form of vamana is done.  

 

Hridya anna (favourite food) is typically indicated in tvakgata vāta because, rūkṣatā in tvak is a result of rasakṣaya caused by overworrying.17

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.  

Bahya snēhana in the form of abhyanga or dharā etc are very effective in asthi and majjāgata vāta. Ābhyantara snēhana replenishes meda dhātu and subsequently asthi and meda. It is worthy to note the utility of tikta ghrita in asthikṣaya.   

 

In śukrakṣaya (depletion of shukra), harshana (pleasure) and vrishya annapāna (aphorodisiac diet) is very useful. 18

''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)

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, shamāna or brimhana as the case may be. But there is opinion that since the word nāvana (..) is used, it means snaihika nasya. Mūrdhni 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). Poultice prepared from flesh of marshy animals is used for brimhana in atrophy of muscles. Vamana is indicated in ardita, when it is associated with śōpha and raktamokshana is indicated when associated with dāha (burning) and raga (redness).

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)  

In Pakṣāghāta, swedana, fomentation mixed with unctuous material and virechana or purgation therapy with unctuous substance is indicated. Virechana is the line of treatment in pakṣāghāta and outweighs basti which is said to be ideal for vātakopa. Pakṣāghāta may be understood as a concealed urdhwaga raktapitta (bleeding from upper orifices of body) in which the only and effective choice is adho-shodhana (purgation). Gr̥dhrasī is a tendon and ligament disorder and shastra, kshara, agnikarma are the main line of treatment. Therefore sirāvyadha (blood letting) and dāhakarma (cauterization) is advised. Basti is also a good choice since pakvāśayagata vāta leads to kateegraha and gr̥dhrasī.  

 

Agnikarma and sirāvyadha are the two line of treatment which are useful in acute phase to relieve the pain in gr̥dhrasī and also in khalli. Agnikarma relieves muscle spasm thereby reducing pain whereas, sirāvyadha may be helpful by reducing the blood stasis. Improved circulation removes cytokines and other inflammatory factors thereby reducing pain. (99-103)

===== Management of ''vata'' at different sites =====

Agni karma :  Agnikarma is a para surgical procedure in which a metallic thin pointed rod called shalaka is heated. Then the hot shalaka is touched to specific points of pain for relieving. It is commonly used as efficient pain reducing therapy in musculoskeletal disorders.  

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 ''vatasthana, udavartahara'' treatment is selected, which includes ''vata anulomana, basti, varti'' etc. In ''amashayagata vata, shodhana'' in the form of ''vamana'' is done.  

Importance of site of affliction in treatment:

 

''Hridaya anna'' (favourite food) is typically indicated in ''tvakgata vata'' because, rūkṣatā in tvak is a result of rasakṣaya caused by overworrying.<ref>Agnivesha, Carakasamhita wtih Ayurveda Dipika commentry Vimanasthāna; 5/13; Dr.Gangasahay pandey (eds.) 6th ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2000.</ref>

 

''Bahya snehana'' in the form of ''abhyanga'' or ''dhara'', etc are very effective in ''asthi'' and ''majjagata vata''. ''Abhyantara snehana'' replenishes ''meda dhatu'' and subsequently ''asthi'' and ''meda''. It is worthy to note the utility of ''tikta ghrita'' in ''asthikshaya''.  

   

In ''shukrakshaya'' (depletion of ''shukra''), ''harshana'' (pleasure) and ''vrishya annapana'' (aphorodisiac diet) is very useful. <ref>Vagbhata, Astangahrdayam; Shareerasthānam 5/67; BhishagĀcharya Harisastri Paradikara Vaidya (eds.) 9th ed. Varanasi: Chaukhambha Orientalia; 2005. P798</ref>

 

==== 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).

 

Poultice prepared from flesh of marshy animals is used for ''brimhana'' in atrophy of muscles. ''Vamana'' is indicated in ''ardita'', when it is associated with ''shopha'' and ''raktamokshana'' is indicated when associated with ''daha'' (burning) and ''raga'' (redness).

 

In ''pakshaghata, swedana,'' fomentation mixed with unctuous material and ''virechana'' or purgation therapy with unctuous substance is indicated. ''Virechana'' is the line of treatment in ''pakshaghata'' and outweighs ''basti'' which is said to be ideal for ''vatakopa''. ''Pakshaghata'' may be understood as a concealed ''urdhwaga raktapitta'' (bleeding from upper orifices of body) in which the only and effective choice is ''adho-shodhana'' (purgation). ''Gridhrasi'' is a tendon and ligament disorder and ''shastra, kshara,'' and ''agnikarma'' are the main line of treatment. Therefore ''siravyadha'' (blood letting) and ''dahakarma'' (cauterization) is advised. ''Basti'' is also a good choice since ''pakvashayagata vata'' leads to ''kateegraha'' and ''gridhrasi''.  

 

''Agnikarma'' and ''siravyadha'' are the two line of treatment which are useful in acute phase to relieve the pain in ''gridhrasi'' and also in ''khalli''. ''Agnikarma'' relieves muscle spasm thereby reducing pain whereas ''siravyadha'' may be helpful by reducing the blood stasis. Improved circulation removes cytokines and other inflammatory factors thereby reducing pain. (99-103)

 

''Agnikarma'' is a para surgical procedure in which a metallic thin pointed rod called ''shalaka'' is heated and applied to specific points of pain for relief. It is commonly used as efficient pain reducing therapy in musculoskeletal disorders.

 

==== 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, pakṣāghāta, indriyagatavāta etc. Even though vamana is kaphahara, it is exclusively indicated in āmashayagata vāta taking into account of site of affliction. (verse 104)

The specificity of treatment depends on the site of affliction and the associated morbid tissues. For example masthishkya is very specific for ardita, pakṣāghāta, indriyagatavāta etc. Even though vamana is kaphahara, 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 vāta vitiation (without involvement of other dosha) is brimhana. If associated dosha is present, they shall be treated first. (verse 105)

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

Balā is excellent for lone vitiated vāta. The head of goat is indicated on the basis of the principle ‘sāmānyam vridhikārānam’(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). Upanāha is also prepared with such well fomented flesh and added with different oils, salts etc. Such upanāha are brimhana. (verse 106-108)

Balā is excellent for lone vitiated vāta. The head of goat is indicated on the basis of the principle ‘sāmānyam vridhikārānam’(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). Upanāha 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:

Avagaha (immersion) sweda:

Pinyaka taila is a preparation in which rūkṣa guna is imparted to taila and is highly useful in kapha associated Vātavyādhi. (verse 136-137)

Pinyaka taila is a preparation in which rūkṣa guna is imparted to taila and is highly useful in kapha associated Vātavyādhi. (verse 136-137)

Importance of oil in treatment of vata: By virtue of vyavāyi 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)

Importance of oil in treatment of vata: By virtue of vyavāyi 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:

 

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.   

==== 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, 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.

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.

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.

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.

=== Reference ===

=== Related Chapter ===

 

=== References ===

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