Talk:Udavarta

Contributors
Section/Chapter/topic	Concepts & Practices/Udavarta
Authors	Dubey M.1,; Deole Y.S.2
Reviewer	Basisht G.3,
Editor	Basisht G.3
Affiliations	1Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India ; 2Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India; 3Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	dr.manish181@gmail.com, dryogeshdeole@gmail.com carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	November 03, 2023
DOI	--

Udavarta literally means the upward and repeated movements of vata. It is one of the important and commonly observed condition in clinical practice. It manifests with a number of clinical features which may lead to manifestation of other secondary diseases further. Udavarta is mentioned as one among the eighty diseases occurred primarily by the vitiated vata dosha (nanatmaja vata vyadhi). [Cha. Sa. Sutra Sthana 20/11] Udavarta (upward movement of vata) is very common now a days due to change in lifestyle of modern society. The change in dietary habits and due to hectic job schedule, suppression of natural urges (vegadharana) is also very common now a days. The two main cause of udavarta explained in classical texts are: suppression of natural urges (vegadharana) and faulty dietary habits (asatmya ahara sevana). Sushrut Samhita describes that suppression of natural urges (adharaniya vega) leads to manifestation of thirteen types of udavarta. Due to aggravating factors, vata dosha is aggravated, especially apana vata (one of the five subtypes of vata i.e., situated in the pelvic region) is affected. Generally, udavarta means upward movement of vata or apana vata, that results in retention of faeces, urine and flatus. However, the scope of udavarta extends to disturbance in normal functions of vata due to obstruction by metabolic wastes. This unique concept is not explained in any other contemporary sciences. So, understanding this concept and to provide better treatment for this disease is need of the society.

Nirukti (etymology)

The term udavarta is derived from Utt + Aavat i.e., “Ut + Ang + Vrut + Dhaya” to form word Udavarta. [ ] Udavarta is a Sanskrit word derived from 'Ut' verb root (dhatu) with 'Ang' and 'Vrut' preposition (upasarga), suffixed by ‘Dhaya’ pratyaya (suffix). “Ut” means upper side, (Urdhva) “Ang” means entirely and “Vrut” means to move (bhramana). Udavarta means upwards movement, to cause to go out, excrete, to secrete and to retain. Udavarta is a class of diseases marked by retention of the feces i.e., disease of the bowel so, in general urdhwa (upward direction) or pratiloma (moving in abnormal direction) movement of apana vata (one of the five subtypes of vata, situated in the pelvic region) is termed as udavarta.

Definition

‘Udavarta’ is that disease in which there is whirlpool movement (avartana) and upward movement (urdhva gamana) of vata is seen due to retention of vata, urine (mutra) and stool (purisha). The condition in which vata begins to move upwards is called as ‘udavarta’ and in this disease vata is the predominant dosha.

Etiopathogenesis

Intake of deficient quantity of food causes udavarta. [Cha. Sa. Vimana Sthana 2/7]
Intake of astringent, bitter, pungent and un-unctuous (dry) food and excessive fasting
Withholding natural urges (vegadharana)
Excessive indulgence in sexual activity. [Cha. Sa. Chikitsa Sthana 26/5-6]

Due to all above reasons the apana vata which resides in large intestine (pakvashaya) gets aggravated and further obstructs the downward movement of vata causing retention of movement of stool, urine and flatus. This leads to a dreadful disease named as udavarta. [Ca. Sa. Chikitsa Sthana 26/5-6]

Acharya Sushruta explained suppression of 13 urges leading to udavarta. [Su. Sa. Uttara Sthana 55/ 3-4] Thus, udavarta is caused by 2 main causes, one is suppression of natural urges and other one unwholesome eating. [Su. Sa. Uttara Sthana 55/ 6] Excess consumption of mudga (Phaseolus mungo), kodrava (Paspalum scrobiculatum Linn.), jurnahva (Sorghum vulgare/jowar), karira (Capparis decidua), chanaka (Cicer arietinum L.), etc. i.e., foods with property of dryness and causing constipation vitiate normal status of vata dosha in its own seat (large intestine). This vata becomes powerful and blocks the downward channels and produces severe obstruction in the movement of feces, flatus and urine leading to udavarta. [A. H. Nidana Sthana 7/46-52]

Clinical features

Frequent pain in the region of urinary bladder (basti), heart (hridaya), abdomen (udara) and excruciating or intense pain in the back of chest. Other symptoms are flatulence (adhmana), nausea (hrillasa), gripping type of pain in anus (vikartika), pricking (toda) type of pain in whole body, indigestion and inflammation of urinary bladder. Obstruction in passing stool less frequently and with difficulty and in less quantity, after long time and effort. Upward movement of flatus occurs because of obstruction in channels (srotasa), increased roughness, dryness and coldness in the body. [Cha. Sa. Chikitsa Sthana 26/6-7]

Udavarta janya vikara

If not treated early, udavarta leads to other secondary complications as follows:

Fever (jwara), dysuria (mutrakricchhra), dysentery (pravahika), heart disease (hridroga), diseases due to malfunctioning of duodenum (grihani dosha), vomiting (chhardi), blindness, deafness, burning sensation in the head, affliction of abdomen by vata (vatodara), tumors (asthila), psychological diseases (mano vikara), disorders of excessive thirst (trishna roga), an ailment characterized by bleeding from different parts of the body (raktapitta), aruchi (anorexia), phantom tumor (gulma), cough (kasa), dyspnoea (shwasa), chronic rhinitis (pratishyaya), facial paralysis (ardita), diseases of the flanks including lower respiratory tract disorders (parshva roga) and such other serious diseases caused by aggravation of vata. [Cha. Sa. Chikitsa Sthana 26/8-9]

Udavarta as a causative factor (nidana) of other diseases

Udavarta is the etiological factor of abdominal swelling caused by intestinal obstruction (baddhagudodara) [Cha. Sa. Chikitsa Sthana 13/39]
Udavarta is the cause for abdominal swelling afflicted by spleen (plihodara). [Cha. Sa. Chikitsa Sthana 13/75]
Udavarta is the cause for respiratory diseases including bronchial asthma (pratamaka shwasa-type of tamaka shwasa) characterized by fever, syncope and other such symptoms which are relieved by cold measures. [Cha. Sa. Chikitsa Sthana 17/63]
Udavarta caused by suppression of the urge of urination is causative factor of condition where severe painful distension of abdomen below umbilicus is present along with obstruction of downward movement of urine (mutrajathara- a type of mutraghata i.e., retention of urine). [Su. Sa. Uttara Sthana 58/13]
Vidvighata (type of mutraghata i.e., retention of urine): In debilitated person due to loss of fat, udavarta brings small amount of feces into the channels of urine (bladder and urethra) resulting in patients voiding of urine having odour of feces is termed as vidvighata. [A. H. Nidana Sthana 9/33-34]
Hemorrhoids (arsha): Udavarta is the chief complication in hemorrhoids (durnama/arsha). This udavarta may occur in person who has predominance of vata dosha in alimentary tract (koshtha) even without piles.
Vatodara: Udavarta is one of the causative factors of abdominal swelling afflicted by vata dosha (vatodara). [Cha. Sa. Chikitsa Sthana 13/23]
Hiccups (hikka) & dyspnoea (shwasa): Udavarta is the one of the etiological factors for causation of conditions such as hiccups (hikka) and dyspnoea (shwasa).

Udavarta as symptoms (lakshana) in following diseases

Vataja plihodara (vata predominant plihodara i.e., abdominal swelling afflicted by splenomegaly) [Cha. Sa. Chikitsa Sthana 13/38]
Vatodara (abdominal swelling afflicted by vata dosha) [Cha. Sa. Chikitsa Sthana 13/25]
Vataja gulma (vata predominant gulma/ phantom tumor) [Cha. Sa. Chikitsa Sthana 5/10]
Sahaja arsha (congenital hemorrhoids) [Cha. Sa. Chikitsa Sthana 14/8]
Vataja arsha (vata predominant hemorrhoids) [Cha. Sa. Chikitsa Sthana 14/11]
Vyana avruta apana (type of avarana (occlusion) where vyana vata obstructs the flow of apana vata) [Cha. Sa. Chikitsa Sthana 28/211]
Basti marma viddha (injury to bladder) [Cha. Sa. Siddhi Sthana 9/6]

Types of Udavarta

Udavarta is of 6 types which occur by suppression of natural urges viz., apana vata nirodhaja (suppression of flatus), mutra vega nirodhaja (suppression of urine), purisha vega nirodhaja (suppression of faeces), shukra vega nirodhaja (suppression of ejaculation of semen), chhardi vega nirodhaja (suppression of vomiting) and kshavathu vega nirodhaja (suppression of sneezing). [Cha. Sa. Sutra Sthana 18/3]

As per Sushruta Samhita, there are 13 types of suppression of natural urges (vegadharana) namely flatus, faeces, urine, yawning, flow of tears, sneezing, eructation, vomiting, ejaculation of semen, hunger, thirst, breath and sleep. [Su. Sa. Uttara Sthana 55/ 3-4] Suppression of these vega (urges) gives rise to their respective type of udavarta and manifest their respective symptoms which are as follows;

Asadhyata [incurable stage of diseases]

Udavarta with symptoms of excessive thirst, excessively depressed, emaciated, suffering from pain and vomiting of fecal matter is difficult to manage or incurable.[Su. Sa. Uttara Sthana 55/ 17-18]

Treatment

Treatment principles for udavarta i.e., palliative therapy (shamana) or purification (shodhana) etc., can be selected based on stages of the disease and as well as on the condition of the patient. The treatment guidelines explained in Charaka Samhita are as follows: [Cha. Sa. Chikitsa Sthana 26/11]

The patient suffering from udavarta should be given massage with hot oil described for the treatment of fever presented with cold extremities (sheeta jwara). Then fomentation therapy should be administered for the detachment of the adhered dosha in the tissue cells. This should be followed by the administration of suppository (varti), un-unctuous enema (niruha basti) and unctuous type of purgative (snigdha virechana). The patient should be given food which helps in the normal downward movement (anulomana) of apana vata.

A) Unction therapy (snehana):

Udavarta is produced due to aggravation of vata and sneha (lipids) is the best treatment for pacification of vata vata (shamana). Therefore, unction therapy (snehana) is indicated in udavarta.

B) Fomentation therapy (swedana):

After massage with oil, fomentation therapy should be administered for the detachment of the adhered dosha in the tissue cells.

C) Suppository (varti):

A suppository having the thickness of the thumb is to be prepared with drugs like Shyama Trivrita (Operculina turpethum), Vidanga (Embeila ribes), Kampillaka (Mallotus philippensis) etc., which should be triturated with gomutra (cow’s urine) or arka (Calotropis gigantea) latex (kshira) and made in to form of suppository (phala varti) by adding jaggery. This suppository should be inserted through anus for the downward movement of apana vata to relieve retention of stool, flatus and urine caused by udavarta.

D) Palliative therapy (shamana):

Shamana includes administration of internal medication such as dviruttara- hingvadi churna, hinguvachadi churna given with warm water as an anupana (co-administers with medicine) for correcting the upward movement of vata.

E) Purification therapy (shodhana):

When the disease is chronic and relief is not observed even by adopting above measures, then purification (shodhana) by non-unctuous enema (niruha basti) or purgation (virechana) is advised.

F) Pathya ahara kalpana (wholesome diet):

Intake of wholesome diet (pathya ahara) which helps in normal downward movement (anulomana) of apana vata whereas, intake of unwholesome diet (apathya ahara) should be avoided for better recovery. Generally, in all types of udavarta all measures for controlling vata should be adopted in order to restore it to its normal channels (srotasa). [Su. Sa. Uttara Sthana 55/ 19]