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Praveen B S / IJRAP 3(6), Nov – Dec 2012Review Article www.ijrap.net CLINICAL APPROACH TO AVARANA Praveen B S. Assistant Professor, Dept of PG Studies in Panchakarma, SDM College of Ayurveda & Hospital, Thanniruhalla, B M Road, Hassan, Karnataka, India Received on: 19/08/12 Revised on: 22/10/12 Accepted on: 06/11/12.Corresponding author E-mail: DOI: 10.7897/2277-4343.03612 Published by Moksha Publishing House. Website www.mokshaph.com All rights reserved. ABSTRACT Avarana is one of the most difficult concepts to understand, teach and incorporate in clinical practice. It is either least observed or goes unidentified due to lack of skill.

To understand and analyze the Avarana, meticulous knowledge of basic concepts of Ayurveda is essential. Panchakarma as well as other varieties of treatments has to be advocated based on the Avruta and Avaraka. Observation of the symptoms of the Avaraka and Avruta is mandatory to get succeed in the treatment. The treatment of Avarana should aim towards cleansing the Srotas with different medicaments which possess Anabhishyandhi, Snigdha, Kapha Pitta Aviruddham and Vatanulomana Dravya. Administration of Yapana Basti, Sramsana chikitsa and Rasayana Dravya may be considered after analyzing the Bala of patient. Though Panchakarma is not been considered as the treatment of choice in all varieties of Avarana, in specific Avarana it may be utilized with maximum benefits. The concept of Avarana is still relevant to present era.

Different clinical conditions present like Avarana, depending on the stage of the disease. Treatment of Avarana is easy, provided diagnosis is impeccable. Key words: Avarana, Avruta, Avaraka, Panchakarma, RasayanaINTRODUCTION Ayurveda believes in different pathology which sets in different Srotas to produce different diseases.

Whenever a favorable condition and situation arises, disease will manifest. It is elucidated that Ati Pravrutti, Sangha, Vimarga Gamana and Sira Granthi are different varieties of Sroto Dushthi which results in to diseases. Nanatmaja Vikara, Anubhanda, Gata Vata and Avarana are different pathologies explained in Ayurveda. Avarana is one of the most difficult concepts to understand, teach and incorporate in clinical practice. It is either least observed, diagnosed or goes unidentified due to lack of skill. To understand and analyze the Avarana, meticulous knowledge of basic concepts of Ayurveda is essential.

Misunderstandings on Avarana are many. It is assumed that each and every disease manifest due to Avarana and there is no difference between anubhanda and Avarana. In fact knowledge of Avarana plays an integral part in understanding the Samprapti of many diseases.

Famous saying in Ayurveda convey that, Samprapti Vighatana itself is the management of disease. So diagnosis plays an important part in treating Avarana. Panchakarma and Rasayana play an integral role in the management of Avarana. Panchakarma treatment modalities need to be selected very carefully as faulty selection leads to failure. Concept of Avarana Vata Vyadhi can manifest either due to Dhatu Kshaya or Avarana.1 Avarana literally means obstruction or to cover. Vata generally possesses the quality of Chala which is responsible for all its function. If Vata gets obstructed then, its function gets hampered and results in to Vata Vyadhi.

Many scattered references about Avarana are available in classics apart from Vata Vyadhi Chapter. Either Vruddhi or Kshaya of certain Dhatu can produce Avarana. Vata Rakta is an instance for the pathology inwhich Vriddhi of certain Dhatu produce Avarana.2 Dhatu Kshaya generally results in formation of Anyonya Avarana. It is not only the Vata which gets obstructed and results in diseases. Pitta also may get obstructed by Kapha and produce disorder like Shakhashrita Kamala.3 Ayurveda believes in Pancha Mahabhuta concepts as basic principle to understand the physiology as well as pathology. Tridosha theory is the simplified form of the same. Collaborated Vayu and Akasha are considered as Vata.

Agni is considered as Pitta and Pritvi along with Jala is considered as Kapha. Vata Dosha is lightest among all, Pitta is lighter and Kapha is heavy by nature. Vata Possess Chala Guna, Pitta posseses Sara Guna and Kapha Possesses Sthira Guna. As Kapha is heavier as compared to other two, it naturally tends to obstruct Vata and Pitta.

Pitta is heavier than Vata due to its Drava Guna, it can obstruct Vata. So Vata is the only Dosha which tends to get obstructed easily most of the time. Different varieties of Vata move in different directions due to which a particular variety of Vata may get obstructed by each another. Prana and Udana naturally moves upwards, Samana moves in lateral direction, Apana moves downward and tendancy of Vyana is to move in all directions.

Though Prana and Udana as well as Samana and Apana work in coordination it may obstruct each other due to minor variation in path. The concept of Avarana can be well understood with some simple examples.

In a traffic signal if heavy vehicles are placed at front then, smaller vehicles get obstructed and can not move front. Whereas, a smaller vehicle like motor bike can move from far behind till front in smaller passages through available space but will get obstructed finally. Similar pathology can be understood in Anya Avarana. Where as in a traffic signal two or multiple vehicles moving in different directions 765Praveen B S / IJRAP 3(6), Nov – Dec 2012 violating traffic rules, lands in collision and ends in disaster. Similar pathogenesis occurs in Anyonya Avarana.

Anubhanda of a Dosha is mere collaborative effect of both Dosha where symptoms of both the Dosha are clearly evident. Where as, in an Avarana two or more entities obstruct each other and results in disease. For understanding the concept of Avarana it is mandatory to understand Avaraka and Avruta. When Dosha or Dhatu obstructs a particular Dosha then, it will give rise to increased signs and symptoms related to the function of that particular Dosha or Dhatu which has obstructed.4 The entity which get obstructed will show less signs and symptoms related to its normal functions.

For instance, If Pitta obstructs Vata then person will suffer with Daha, Trushna, Shula, Bhrama, Tama, Vidaha and Sheeta Kamata which are symptoms of Pitta and Karmahani is observed which is a Vata symptom.5 Commonly confronted Anya Avarana is Vidavruta Vata which is characterized by Vibhandha, Anaha, Shushka Vit Pravartana, Shroni Vankshana Prushtha Ruk, Viloma gati of Vata. This variety of Anya Avarana is easiest Avarana to understand.6 Different Dhatu or Mala can also obstruct specific variety of Vata. For instance, in Pittavruta Prana vata, Murcha, Daha, Bhrama, Shula, Vidaha, Sheeta Kamita and Chardhana are the presenting symptoms.7 In Kaphavruta Vyana either Gati Sanga or Adhika Gati or both may be observed.8 In Anyonya Avarana the symptoms and signs observed are related to two different varieties of Vata. For instance, in Pranavruta Vyana Vata, Sarvendriya Shunyatvam, Smruti Bala Kshayam are observed symptoms.9 So the permutation and combinations of the Avarana are many. Acharya have explained many Avarana and its signs and symptoms in detail. Further it is indicated that if unknown Avarana is suspected then, observation of signs and symptoms will give clue to the diagnosis of Avarana.

The increased signs and symptoms will suggest the Avaraka and decreased signs and symptoms suggest Avruta.10 Once the case is diagnosed then the treatment is predictable. Faulty treatments protocol may lead to failure. References are available regarding the Avarana as pathology in different disorders.

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Medasavruta Vata also known as Adhya Vata or Vatarakta is one such condition.11 Kaphadhika Vatarakta mimics the features of Medasavruta Vata. More over Urusthambha is also been considered as Medasavruta Vata.12 Pathogenesis of Kasa is also due the Avarana between Prana Vata and Udana Vata.13 Prameha is also another disorder in which Avarana is a variety of pathology apart from Dhatu Kshaya.14 Similarly many disorders are produced as a result of Avarana. More than one entity also can create Avarana to the other Dosha.

So identification of Avarana becomes very essential. In the pathogenesis of Avarana, Ati Pravrutti leads to Sangha and it in turn leads to Vimarga Gamana.