JEEVAK AYURVED MEDICAL COLLEGE HOSPITAL & RESEARCH CENTER�KAMLAPUR AKAUNI CHANDAULI U.P.

TOPIC – CONCEPT OF AVARANA CHIKITSA SUTRA & MANAGEMENT OF AVARANA

PRESENTED BY –

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MOHD. ARSHAD

RAVI KUMAR

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GUIDED BY –

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DR. GD GUPTA

DR. K.S GIRHEPUNJE

DR. ABHINAV SINGH

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AVARANA

Definition –

The word Avarana means to envelop, to mask, to obstruct, to cover or to overlap.

• In this type of pathogenesis, basically two types of pathological processes will occur, Avaraka and Avrita or Avarya.

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AVARAKA - The term Avaraka refers to the one which obstructs the passages.

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AVRITA - The term Avrita or Avarya refers to the one which is getting obstructed in the passages

Importance of the Avarana

In Ayurvedic medicine, the knowledge of the Avarana is as essential as the sam-nirama, decay-augmentation and samavastha of the doshas. Due to proper knowledge of the Avarana, the doctor never makes any mistake in treating them and is able to cure the disease quickly with his understanding.

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Characters of Avarana

When pathology of Avarana occurs in the body, two mechanisms happen in the body. These are occurring due to the difference in the functions of the abnormal Dosha. One Dosha is responsible for the enhancement of the function abnormally and another Dosha is responsible for the hampering of the function abnormally. The Dosha which enhances its functions is Avaraka and the one which decreases its functions is Avrita. In other words, it is the vitiated Vata responsible for the pathology of Aturana in the body.

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Pathophysiology of Avarana

Pathological mechanism of Avarana is of two folds - Dhatukshaya and Margavarana. In case of Dhatukshaya, there will be Saara Kshaya (reduced nutrition to the body). Where as in case of Margavarana, there will be obstruction to the flow of the Vata in the body.The person will be developing the gradual symptoms in case of vitiation of Vata Dosha due to Dhatu Kshaya mechanism of Avarana The person will show sudden symptoms in case of vitiation of Vata Dosha due to the mechanism of Margavarana of Avarana.Wherever we observe increased and decreased function of Vata Dosha, we can infer the ongoing pathological process of Avarana inside the body

Diagnosis of Avarana

Diagnosis of Avarana can be done by differentiating with Kshaya, Vriddhi, Gatavata with profound knowledge of Lakshana. It is done by exclusion and reasoning.

Exclusion by Nidana:

• Madhumeha - due to Avarana (Ca.Su. -17/78-79)
• Madhumeha - Kevala Vatajanya (Ca.Ni. -4/36)
• Though the disease is of Vata there is No causative factor of vitiation of Vata or Dhatu Kshaya
• History of indulgence of etiological factors of Avaraka can be appreciable

Clinical types of Avarana

1. Avarana of Sama Vata by Vriddha Dosha or Dushya
2. Avarana of Vriddha Vata by Sama Dosha or Dushya
3. Avarana of Vriddha Vata by Vriddha Dosha or Dushya

Exclusion by Lakshana

• In Kevalavatajanya Madhumeha, Mutra is Kashaya and Madhura Rasa and Pandu in colour
• In Avaranajanya Madhumeha, Dhatu Kshaya Lakshana are absent in initial stage of Prameha (Ca Su.-17/81)

Exclusion by Upashaya

• The condition of Avarana will not respond to Upashaya of Vata rather he feels Sukha with Upashaya of Avaraka.
• In Pittavrita Vata, Upashaya is Shita (exposure to cold) but not Ushna (exposure to heat).
• In Kaphavrita Vata, Upashaya is Katu etc and feels comfort on exposure to lightning activities and exertional activities. (Ca.Ci. -28/61-63)

Complications of Avarana

हृद्रोगो विद्रधिः प्लीहागुल्मोऽत्तीसार एव च।।

भवन्त्युपद्रवास्तेषामावृतानामुपेक्षणात्। Ca.C.- 28/236

It proper management of Avarana is not being followed, then that will lead to the manifestation of Hridroga , Vidradhi , Pliha , Gulma , Atisara.

Pittavrita Vata

Lakshana –

Daha (burning sensation), Trishna (thirst), Shula (pricking type of pain), Bhrama (giddiness), Tama (darkness in front of the eyes), Vidaha (burning sensation in epigastrium) by consuming Katu, Amla and Lavana Rasa (pungent, sour and salty) substances and Shita Prarthana (affinity towards cold substances)

Chikitsa –

Shitamushna Kriya (treatment leading to coldness and warmth of the body), consumption of Jivaniya Ghrita, Dhanva Mamsa consumption of Anupa Mansa), Yava (barley), Shali (rice), Yapana Kshira Basti (enema), Virechana (purgation), Panchamula Siddha Kshira

Kapha-vrita Vata

Lakshana –

Shaitya (coldness), Gaurava (heaviness), Shula (pricking type of pain), Katvadi Upashaya (getting comfort after consuming Katu etc substances) Langhanayasa (getting comfort after performing fasting and exertion) Ushnakamitva (affinity towards hot substances)

Chikitsa –

Svedana (fomentation), Niruha (a type of enema), Vamana (emesis), Virechana (purgation), Tila (sesamum seeds), Purana Ghrita (ghee kept for long duration), Sarshapa (mustard seeds)

Raktavrita Vata

Lakshan –

Daha (burning sensation), Arti (pain), pain in between Mamsa and Tvak, Saraga (redness) and Shvayathu (swelling)

Chikitsa –

Vatarakta line of treatment

Mamsa-vrita vata

Lakshan –

• Kathina (hard swelling), Vivarna (discolouration), Pidaka (boils) and Shvayathu (swelling), Harsha (horripulation) and Pipilika Iva Sanchara (sensation of movement of ants all over the body

Chikitsa –

• Sveda (fomentation), Abhyanga (massage), Rasa (consumption of Mamsarasa), Kshira (consumption of milk), Sneha (consumption of oil or ghee etc)

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Medasa-vrita Vata

Lakshan –

• Chala (unstable swelling), Snigdha (unctuousness), Mridu (soft swelling), Shita (cold in touch), Shophanga (swelling of body parts), Aruchi (tastelessness)

Chikitsa –

• Medohara Chikitsa (line of treatment of hyperlipidemia) and Prameha Chikitsa (line of treatment of excess passage of urine)

Asthi Avrita vata

Lakshan –

• Feeling comfortable while pressing and hot touch, Pidana and pricking type of pain

Chikitsa –

• Maha Sneha
• Ghreet
• Taila
• Vasa
• Majja

Majja-vrita vata

Lakshan –

• Vinama (forward bending), Jrimbhana (excessive yawning), Pariveshtana (sensation of covering of all over the body), Shula (pricking type of pain), feeling comfortable while pressing.

Chikitsa –

• Maha Sneha
• Ghreet
• Taila
• Vasa
• Majja

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Shukravrita Vata

Lakshan –

• Avega (absence of ejaculation) and Ativega (premature ejaculation) and Nisphalatva (absence of progeny)

Chikitsa –

• Consumption of Mahasneha
• Ghreet
• Taila
• Vasa
• Majja

Annavrita Vata

Lakshan –

• Shula (pricking type of pain) after the consumption of food and during Jirna Avastha

Chikitsa –

• Ullekhana (emesis), Pachana (digestion of food), Dipana (increasing the appetite) and Laghu Ahara (consumption of food which is light to digest)

Mutravrita Vata

Lakshan –

• Apravritti (reduced frequency of micturition) and Ati Adhmana (swelling observed in the supra pubic region)

Chikitsa –

• Svedana (fomentation therapy), Uttara Basti (administration of medicine through urethral or vaginal route)

Vid Avrita Vata

Lakshan –

• Vibandha (constipation), Parikrintati (discomfort), Anaha (distenstion of the abdomen), Shushka (hard stools), Dukha (discomfort while passing stools), Chirat Pidita (passage of stools with much dealy) while defaecation, pain in Shroni (pelvis), Vankshana (groin) and Prishtha (back), discomfort in Hridaya

Chikitsa –

• Eranda Taila, Snigdha and Udavarta Chikitsa (for example, consumption of Eranda Taila or castor oil which is having unctuous quality and is also useful in Udavarta)

Avarana Chikitsa sidhhanta or Chikitsa

• Treatment should be done keeping in mind both the Avaraka and Avrita
• The root cause of the Avarana is 'Vata dosha', so the treatment is also basically done for Vata dosha only, but to reach it, it is necessary to remove the Avarana first.
• In Avrita vata, treatment of Avaraka is done first and treatment of Vayu for the root is done later for which general principles, measures and medicine diet used in Vaat vyadhi treatment are arranged.
• In the Mishraavarana (pittakaphavrita) Pitta should be treated first and then Kapha.

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• In Pittavrita Vata, sheet and ushna activities should be used sequentially (Vyatyas Kram). Also use Jeevaniya Ghrita described in Vataraktrog Adhikar.
• Use barley, jangle mans, sharp sweating, niruh vasti, vomiting, defecation, Purana ghee, sesame seeds and mustard oil in Kaphavrit vata.
• If there is kapha in the stomach, perform emetic actions; if there is Kapha in the duodenum, perform purgation; if there is Pitta in the entire body, perform purgation.
• When the Kapha gets liquefied through sweating and settles in the duodenum or the aggravated Pitta produces its symptoms in the body, then remove the Kapha and Pitta through vasti.

• If there is Vata followed by Kapha, mix hot cow urine with Niruh Vasti. If there is Vayu combined with Pitta , Niruh Vasti with milk should be used to remove them.
• If vata has gone to the head region along with Kapha, then anti-headache methods like Dhumranasya etc. should be used.
• In case of Raktavrita Vata, treat it like 'Vatarakt' disease.

CONCLUSION

Concept of avarana can incorporate in every disease. We must assess each patient differently. Categorise the diseases into gatavata, avarana vata, ama vata, anubandha doshas etc in every case comes to us.

Avarana is a clinical condition where the dynamic equilibrium of vata is lost, either due to the impact of other doshas or due to untoward movement of any type of vata. The avarana is least observed diagnosed or goes unidentified due to lack of skills. To understand and analyse avarana meticulous knowledge of Ayurveda is essential. If we can trace out the exact avruta dosha and the aavaraka factor, it becomes easier to treat the case and the results become more encouraging.