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AIAPGET POINTS

1. Madira with Sauvarchala Lavana is prescribed for those suffering from Mutraja Udavarta. (Also Madya + Ela, Ksheera + Ela or Dhatri Swarasa with Jala). Ref – Su.Ut.55/22.
2. Mutraja Udavarta should be treated on the lines of Ashmari and Mutrakrchchra Chikitsa. (Su.Ut.55/26-27)
3. Snehana & Swedana are the treatments for Jrimbhaja and Ashruja Udavarta. Additionally, ASHRU MOKSHA (causing tears to flow out) is mentioned in Ashruja Udavarta treatment.
4. Treatment of Udgara Janya Udavarta includes – Snaihika Dhuma and Sura added with Sauvarchala and Bijapura Rasa.
5. Snigdha-Ushna-Alpa-Bhojana is the prescription of Kshut Janya Udavarta. Ref – Su.Ut.55/34
6. Srotas related to Vata, Mutra, Purisha, Asrk, Kapha and Meda are blocked in Annaja Udavarta.

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The 55th chapter of Uttaratantra of Sushruta Samhita is named as Udavarta Pratiședha. This chapter deals with Treatment of Upward movement of Vata.

अथात उदावर्तप्रतिषेधमध्यायं व्याख्यास्यामः ||१||
यथोवाच भगवान् धन्वन्तरिः ||२||

We will now expound Udavarta Pratisedha – treatment of diseases produced by suppression of urges of the body; as revealed by the venerable Dhañvañtari,

अधश्चोर्ध्वं च भावानां प्रवृत्तानां स्वभावतः |
न वेगान् धारयेत् प्राज्ञो वातादीनां जिजीविषुः ||३||

Vegas means the natural urges manifested in the body. They are manifested naturally when certain things are tending to move either in downward or upward directions. An intelligent person who is desirous of longevity of life should not suppress these naturally manifested urges.

Nirukti – definition

वातविण्मूत्रजृम्भाश्रुक्षवोद्गारवमीन्द्रियैः |
व्याहन्यमानैरुदितैरुदावर्तो निरुच्यते ||४||
क्षुत्तृष्णाश्वासनिद्राणामुदावर्तो विधारणात् |
तस्याभिधास्ये व्यासेन लक्षणं च चिकित्सितम् ||५||

Udavarta is the name given to the diseases which are manifested due to forcible suppression of the below mentioned vegas – naturally manifested urges.

They are, the urges of –

–        vata – flatus, fart,

–        vit – faeces,

–        mutra – urine,

–        jrmbha – yawn,

–        asru – tears,

–        ksavathu – sneeze,

–        udgara – belching,

–        vami – vomiting and

–        indriya – semen

–        kshut – hunger,

–        trsna – thirst,

–        svasa – respiration, rapid breathing caused by exertion and

–        nidra – sleep

Lakşana – clinical features

त्रयोदशविधश्चासौ भिन्न एतैस्तु कारणैः |
अपथ्यभोजनाच्चापि वक्ष्यते च तथाऽपरः ||६||

Now, I will describe the symptoms of udavarta and their treatment in detail. Based on different causes, udavarta is of thirteen kinds. One more kind of udavarta is produced by consuming unhealthy foods, which will also be described.

Below mentioned symptoms are produced by not releasing the tears (withholding tears) produced by either excessive joy or sorrow-

–        feeling of heaviness of the head,

–        diseases of the eyes and

–        severe rhinitis

Vataja Udavarta Lakshana 

आध्मानशूलौ हृदयोपरोधं शिरोरुजं श्वासमतीव हिक्काम् |
कासप्रतिश्यायगलग्रहांश्च बलासपित्तप्रसरं च घोरम् ||७||
कुर्यादपानोऽभिहतः स्वमार्गे हन्यात् पुरीषं मुखतः क्षिपेद्वा |८|

When Apana Vata is obstructed in its normal downward movement, it moves upward abnormally (Udavarta), causing bloating, abdominal pain, constipation, chest discomfort, headache, breathlessness, hiccups, cough, cold, and throat obstruction. It also leads to imbalance of doshas and, in severe cases, may even push contents upward toward the mouth, showing widespread systemic disturbance.

Pureeshaja Udavarta: Suppression of urge of feces

आटोपशूलौ परिकर्तनं च सङ्गः पुरीषस्य तथोर्ध्ववातः ||८||
पुरीषमास्यादपि वा निरेति पुरीषवेगेऽभिहते नरस्य |९|

Suppressing the urge to pass stool disturbs Vata, causing abdominal gurgling, pain, cutting sensation, constipation, and upward movement of gas; in severe cases, it may even lead to reverse expulsion of fecal matter through the mouth.

Mootraja Udavarta: Suppression of urge of urine

मूत्रस्य वेगेऽभिहते नरस्तु कृच्छ्रेण मूत्रं कुरुतेऽल्पमल्पम् ||९||
मेढ्रे गुदे वङ्क्षणबस्तिमुष्कनाभिप्रदेशेष्वथवाऽपि मूर्ध्नि |
आनद्धबस्तिश्च भवन्ति तीव्राः शूलाश्च शूलैरिव भिन्नमूर्तेः ||१०||

Suppressing the urge to urinate causes difficulty in passing urine in small quantities, along with pain in the penis, anus, groin, bladder, testes, navel region, and even the head. It also leads to bladder distension and severe, piercing pain as if the body is being split by shoola.

Jrimbhaja Udavarta: Suppression of urge of yawning 

मन्यागलस्तम्भशिरोविकारा जृम्भोपघातात् पवनात्मकाः स्युः |
श्रोत्राननघ्राणविलोचनोत्था भवन्ति तीव्राश्च तथा विकाराः ||११||

Suppressing natural urges like yawning leads to Vata aggravation, causing stiffness of the neck and throat, headaches, and disorders affecting the ears, mouth, nose, and eyes, often becoming severe.

Ashruja udavarta: Suppression of urge of tears

आनन्दजं शोकसमुद्भवं वा नेत्रोदकं प्राप्तममुञ्चतो हि |
शिरोगुरुत्वं नयनामयाश्च भवन्ति तीव्राः सह पीनसेन ||१२||

Suppressing tears—whether from joy or sorrow—leads to heaviness in the head, eye disorders, and severe conditions like rhinitis (pinasa).

Kşavathu vegarodha: uppression of urge of sneeze

भवन्ति गाढं क्षवथोर्विघाताच्छिरोक्षिनासाश्रवणेषु रोगाः |
कण्ठास्यपूर्णत्वमतीव तोदः कूजश्च वायोरुत वाऽप्रवृत्तिः ||१३||

Below mentioned symptoms are manifested when the person forcibly suppresses the urge of sneeze –

–        severe diseases of head, eyes and ears,

–        feeling of fullness of the throat and mouth and severe pricking therein,

–        small sounds manifested from the throat or

–        obstruction to respiration

Udgara vegarodha: Suppression of urge of belching

उद्गारवेगेऽभिहते भवन्ति घोरा विकाराः पवनप्रसूताः |१४|

Many dreaded diseases of vata origin will arise when one suppresses the urge of belching.

Chardi vegarodha: Suppression of urge of vomiting

छर्देर्विघातेन भवेच्च कुष्ठं येनैव दोषेण विदग्धमन्नम् ||१४||

Kustha – leprosy and other skin disorders will be produced when the person suppresses the urge of vomiting. Kustha will be produced from the same dosha which gets aggravated by improper digestion of food.

Sukra vegarodha: Suppression of urge of semen

मूत्राशये पायुनि मुष्कयोश्च शोफो रुजो मूत्रविनिग्रहश्च |
शुक्राश्मरी तत्स्रवणं भवेद्वा ते ते विकारा विहते तु शुक्रे ||१५||

Below mentioned are the symptoms of suppression of urge of semen

(ejaculation) –

–        swelling and pain in the urinary bladder, rectum and scrotum,

–        non-elimination of urine,

–        formation and elimination of seminal stones

Kşud vegarodha: Suppression of urge of hunger

तन्द्राङ्गमर्दारुचिविभ्रमाः स्युः क्षुधोऽभिघातात् कृशता च दृष्टेः |१६|

Symptoms of suppressing the urge of hunger –

–        stupor,

–        body aches,

–        loss of taste / tastelessness,

–        giddiness and

–        dimness of vision

 Tṛṣṇā vegarodha: Suppression or urge of thirst

कण्ठास्यशोषः श्रवणावरोधस्तृष्णाभिघातद्धृदये व्यथा च ||१६||

By forcibly suppressing the urge of thirst, the below mentioned symptoms are produced –

–        dryness of throat and mouth,

–        hindrance to hearing and

–        discomfort in the heart

Ucchväsa vegarodha: Suppression of expiration

श्रान्तस्य निःश्वासविनिग्रहेण हृद्रोगमोहावथवाऽपि गुल्मः |१७|

When the urge for expiration on exertion is suppressed, the below mentioned symptoms are manifested –

–        diseases of heart

–        delusion / fainting or

–        abdominal tumour

Nidrā vegarodha: Suppression the urge of sleep

जृम्भाऽङ्गमर्दोऽङ्गशिरोक्षिजाड्यं निद्राभिघातादथवाऽपि तन्द्रा ||१७||

Below mentioned are the symptoms of forcibly suppression of sleep –

–        excessive yawns,

–        body aches,

–        More yawns, aches in the body, diseases of the body parts, head and eyes or even stupor will arise from suppression of sleep.

Cikitsā – treatment

तृष्णार्दितं परिक्लिष्टं क्षीणं शूलैरभिद्रुतम् |
शकृद्वमन्तं मतिमानुदावर्तिनमुत्सृजेत् ||१८||

Patient of udavarta suffering from the below mentioned symptoms should be rejected by the wise physician –

–        thirst,

–        debility,

–        emaciation,

–        pain in abdomen and

–        vomiting of faeces

सर्वेष्वेतेषु विधिवदुदावर्तेषु कृत्स्नशः |
वायोः क्रिया विधातव्याः स्वमार्गप्रतिपत्तये ||१९||
सामान्यतः पृथक्त्वेन क्रियां भूयो निबोध मे |२०|

The first approach and treatment in all kinds of udavarta should be to make vata move in its normal direction and in its own path. All vata balancing measures should be implemented in this direction. Now, the treatment for each variety shall be described by me separately.

आस्थापनं मारुतजे स्निग्धस्विन्ने विशिष्यते ||२०||
पुरीषजे तु कर्तव्यो विधिरानाहिको भवेत् |
सौवर्चलाढ्यां मदिरां मूत्रे त्वभिहते पिबेत् ||२१||
एलां वाऽप्यथ मद्येन क्षीरं वाऽपि पिबेन्नरं |
धात्रीफलानां स्वरसं सजलं वा पिबेत्त्र्यहम् ||२२||
रसमश्वपुरीषस्य गर्दभस्याथवा पिबेत् |
मांसोपदंशं मधु वा पिबेद्वा सीधु गौडिकम् ||२३||
भद्रदारु घनं मूर्वा हरिद्रा मधुकं तथा |
कोलप्रमाणानि पिबेदान्तरिक्षेण वारिणा ||२४||
दुःस्पर्शास्वरसं वाऽपि कषायं कुङ्कुमस्य च |
एर्वारुबीजं तोयेन पिबेद्वाऽलवणीकृतम् ||२५||
पञ्चमूलीशृतं क्षीरं द्राक्षारसमथापि वा |२६|

Oleation and sudation – are the main and preferable therapies that need to be done for diseases produced by suppression of flatus. Asthapana Vasti too should be done.

Treatments indicated for anaha i.e. flatulence (explained in uttara tantra chapter 56) should be administered for diseases produced by suppression of faeces.

Below mentioned recipes may be administered for three days, for drinking, in diseases produced by suppression of urine –

–        madira (wine) added with more quantity of sauvarcala or

–        wine added with ela – cardamom or milk or

–        juice of fresh dhatriphala diluted with water

One may also consume the below mentioned –

–        juice of fresh horse dung or donkey dung,

–        eatables prepared with meat added with honey or

–        drink sidhu prepared from jaggery

–        powders of one kola (5gm) each of bhadradaru, ghana, murva, haridra and madhuka with rain water or

–        fresh juice of dusparsa or

–        decoction of kumkuma or

–        seeds of ervaru macerated in water without adding salt or

–        milk cooked with laghu panchamula or

–        juice of draksa

योगांश्च वितरेदत्र पूर्वोक्तानश्मरीभिदः ||२६||
मूत्रकृच्छ्रक्रमं चापि कुर्यान्निरवशेषतः |
भूयो वक्ष्यामि योगान् यान् मूत्राघातोपशान्तये ||२७||

Treatments indicated in the below mentioned conditions shall be administered in diseases produced by suppression of urination, without omitting anything –

–        treatment indicated for asmari – urinary calculi – as explained in cikitsa sthana section, chapter 7 and

–        treatment of mutrakrchchra – dysuria – as explained in uttara sthana section, chapter 59

Now, I shall tell you about the formulae which mitigates mutraghata – obstruction of urination.

स्नैहैः स्वेदैरुदावर्तं जृम्भाजं समुपाचरेत् |
अश्रुमोक्षोऽश्रुजे कार्यः स्निग्धस्विन्नस्य देहिनः ||२८||

Oleation and sudation therapies are the best in treating udavarta caused due to suppression of yawning.

Below mentioned treatments should be done in udavarta caused due to suppression of tears –

–        oleation,

–        sudation and

–        cause tears to flow out

तीक्ष्णाञ्जनावपीडाभ्यां तीक्ष्णगन्धोपशिङ्घनैः |
वर्तिप्रयोगैरथवा क्षवसक्तिं प्रवर्तयेत् ||२९||
(तीक्ष्णौषधप्रधमनैरथवाऽऽदित्यरश्मिभिः||) |

Below mentioned are the best treatments for treatment of diseases caused due to suppression of sneezing –

–        strong collyriums,

–        strong avapida nasya (nasal drops),

–        inhaling of strong smells or

–        use of wicks or cigars (medicated) or

–        blowing powders of herbs which are penetrating in nature into the nostrils or

–        exposure to sun’s rays

उद्गारजे क्रमोपेतं स्नैहिकं धूममाचरेत् ||३०||
सुरां सौवर्चलवतीं बीजपूररसान्विताम् |३१|

Below mentioned treatments shall be done in diseases produced due to suppression of belching –

–        inhalation of lubricating smoke and

–        drinking sura (beer) added with sauvarcala lavana and juice of bijapura

छर्द्याघातं यथादोषं सम्यक् स्नेहादिभिर्जयेत् ||३१||
सक्षारलवणोपेतमभ्यङ्गं चात्र दापयेत् |३२|

Oleation and other therapies which are suitable for combating aggravation of doshas should be administered for treating udavarta produced by suppression of vomiting.

Abhyanga may also be done in this case. For this, oil mixed with yava ksara and saindhava lavana should be used.

बस्तिशुद्धिकरावापं चतुर्गुणजलं पयः ||३२||
आवारिनाशात् क्वथितं पीतवन्तं प्रकामतः |
रमयेयुः प्रिया नार्यः शुक्रोदावर्तिनं नरम् ||३३||

Powder of herbs which cleanse the urinary bladder is boiled with milk added with four times of water (water is four times that of milk). They are boiled until all the water evaporates and the contents are filtered. This recipe is beneficial in treating udavarta caused by suppression of semen. The patient should drink this milk as much as he desires. He may also have copulation with the woman he likes.

क्षुद्विघाते हितं स्निग्धमुष्णमल्पं च भोजनम् |३४|

Hot foods added with fats are beneficial in udavarta caused due to suppression of hunger. Such foods shall be taken in small quantities.

तृष्णाघाते पिबेन्मन्थं यवागूं वाऽपि शीतलाम् ||३४||
भोज्यो रसेन विश्रान्तः श्रमश्वासातुरो नरः |३५|

The person should drink mantha (groats) or yavagu (thick gruel) in a cold state, if he is suffering from udavarta caused due to suppression of thirst.

If udavarta is caused due to suppression of ‘dyspnoea on exertion’, he should take rest and consume foods along with meat soup.

निद्राघाते पिबेत् क्षीरं स्वप्याच्चेष्टकथा नरः ||३५||

The person should drink milk and sleep well listening to his favourite stories when he is suffering from udavarta caused due to suppression of sleep.

आध्मानाद्येषु रोगेषु यथास्वं प्रयतेत हि |
यच्च यत्र भवेत्प्राप्तं तच्च तस्मिन् प्रयोजयेत् ||३६||

Suitable treatments should be done at the required / proper time when the patient has complications of udavarta such as flatulence etc.

Annaja udāvarta

वायुः कोष्ठानुगो रूक्षैः कषायकटुतिक्तकैः |
भोजनैः कुपितः सद्य उदावर्तं करोति हि ||३७||
वातमूत्रपुरीषासृक्कफमेदोवहानि वै |
स्रोतांस्युदावर्तयति पुरीषं चातिवर्तयेत् ||३८||
ततो हृद्बस्तिशूलार्तो गौरवारुचिपीडितः |
वातमूत्रपुरीषाणि कृच्छ्रेण कुरुते नरः ||३९||
श्वासकासप्रतिश्यायदाहमोहवमिज्वरान् |
तृष्णाहिक्काशिरोरोगमनःश्रवणविभ्रमान् ||४०||
लभते च बहूनन्यान् विकारान् वातकोपजान् |४१|

Ingestion of dry, astringent, pungent and bitter tasting foods, vata residing in the alimentary tract would get aggravated and produce udavarta. Consequently, the channels of flatus, urine, faeces, blood, kapha and medas (fat) get blocked.

In these patients, the below mentioned symptoms develop due to aggravation of vata –

–        pain in the heart and urinary bladder,

–        feeling of heaviness of the body,

–        anorexia,

–        elimination of flatus, urine and faeces with difficulty,

–        dyspnoea,

–        cough,

–        running in the nose,

–        burning sensation,

–        delusion (fainting),

–        vomiting,

–        fever,

–        thirst,

–        hiccup,

–        headaches,

–        disorders of the mind and ears and

–        many such diseases due to vata aggravation

तं तैललवणाभ्यक्तं स्निग्धं स्विन्नं निरूहयेत् ||४१||
दोषतो भिन्नवर्चस्कं भुक्तं चाप्यनुवासयेत् |
न चेच्छान्तिं व्रजत्येवमुदावर्तः सुदारुणः ||४२||
अथैनं बहुशः स्विन्नं युञ्ज्यात् स्नेहविरेचनैः |४३|

In such patients, oil mixed with saindhava lavana should be used to give bath.

Following this, oleation, sudation and enema therapies should be administered. Oil enema may be given after he takes food if he has broken stools.

If the disease does not subside in spite of administering these therapies or if udavarta is very powerful, the patient should be given with –

–        medicinal therapy many times and then should be administered with

–        oily purgatives

पाययेत त्रिवृत्पीलुयवानीरम्लपाचनैः ||४३||
हिङ्गुकुष्ठवचास्वर्जिविडङ्गं वा द्विरुत्तरम् |
योगावेतावुदावर्तं शूलं चानिलजं हतः ||४४||

Below mentioned two formulae would mitigate udavarta and cure abdominal pain caused by aggravated vata –

–        Trivrt, Pilu and Yavani mixed with sour gruel and

–        Digestive herbs or

–        Hingu, Kustha, Vaca, Svarji Ksara and Vidanga – each taken in double the quantity in its succeeding order should be taken along with sour gruel

देवदार्वग्निकौ कुष्ठं शुण्ठीं पथ्यां पलङ्कषाम् |
पौष्कराणि च मूलानि तोयस्यर्धाढके पचेत् ||४५||
पादावशिष्टं तत् पीतमुदावर्तमपोहति |४६|

Below mentioned ingredients are boiled in half adhaka (1.28kg) water, reduced to a quarter and their decoction is prepared –

–        devadaru,

–        agnika,

–        kustha,

–        sunthi,

–        pathya,

–        palankasa and

–        puskaramula

When consumed, this decoction relieves udavarta.

मूलकं शुष्कमार्द्रं च वर्षाभूः पञ्चमूलकम् ||४६||
आरेवतफलं चाप्सु पक्त्वा तेन घृतं पचेत् |
तत् पीयमानं शास्त्युग्रमुदावर्तमशेषतः ||४७||

Below mentioned ingredients are boiled in water and their decoction prepared –

–        dry mulaka,

–        ardraka,

–        varsabhu,

–        herbs belonging to brhat pancamula group,

–        fruit of arevata

Medicated ghee is prepared with this decoction. When consumed, this ghee would mitigate even powerful cases of udavarta.

वचामतिविषां कुष्ठं यवक्षारं हरीतकीम् |
कृष्णां निर्दहनीं चापि पिबेदुष्णेन वारिणा ||४८||

Nice powder of the below mentioned ingredients should be prepared –

–        Vaca,

–        Ativisa,

–        Kustha,

–        Yavaksara,

–        Haritaki,

–        Krishna and

–        Nirdahani

This powder should be consumed mixed with warm water.

इक्ष्वाकुमूलं मदनं विशल्यातिविषे वचाम् |
कुष्ठं किण्वाग्निकौ चैव पिबेत्तुल्यानि पूर्ववत् ||४९||
मूत्रेण देवदार्वग्नित्रिफलाबृहतीः पिबेत् |५०|

Powder of the below mentioned ingredients shall be prepared –

–        root of iksvaku,

–        madonna,

–        visalia,

–        ativisa,

–        vaca,

–        kustha,

–        kinva and

–        agnika

It should be consumed mixed with hot water as said earlier.

Likewise, powder of below mentioned ingredients shall be consumed with gomutra (urine of cow) –

–        Devadaru,

–        Agni,

–        Triphala and

–        Brhati

यवप्रस्थं फलैः सार्धं कण्टकार्या जलाढके ||५०||
पक्त्वाऽर्धप्रस्थशेषं तु पिबेद्धिङ्गुसमन्वितम् |५१|

One prastha (640 gm) of Yava and Kanntakari (together) should be taken and boiled in one adhaka (2.56 kg) of water and reduced to half prastha (320 gm) so as to prepare its decoction. This decoction should be consumed with Hingu – asafetida.

मदनालाबुबीजानि पिप्पलीं सनिदिग्धिकाम् ||५१||
सञ्चूर्ण्य प्रधमेन्नाड्या विशत्येतद्यथा गुदम् |५२|

Nice powder of the below mentioned seeds should be prepared –

–        Madana,

–        Alabu,

–        Pippali and

–        Nidagdhika

This powder should be blown into the rectum through a tube.

चूर्णं निकुम्भकम्पिल्लश्यामेक्ष्वाक्वग्निकोद्भवम् ||५२||
कृतवेधनमागध्योर्लवणानां च साधयेत् |
गवां मूत्रेण ता वर्तीः कारयेत्तु गुदानुगाः |
सद्यः शर्मकरावेतौ योगावमृतसम्मतौ ||५३||

Powder of the below mentioned ingredients should be prepared –

–        Nikumbha,

–        Kampilla,

–        Syama,

–        Iksvaku and

–        Agnika

This powder may be macerated with cow’s urine and made into a wick (rectal suppository).

Wicks of Krtavedana, Magadhi and Saindhava Lavana etc. may also be prepared in the similar way (macerating them with cow’s urine).

When introduced into the rectum, these wicks would bestow immediate relief.

These two formulae are similar to nectar for the patients of udavarta.

इति सुश्रुतसंहितायामुत्तरतन्त्रान्तर्गते कायचिकित्सातेन्त्रे उदावर्तप्रतिषेधो नाम
(सप्तदशोऽध्यायः, आदितः) पञ्चपञ्चाशत्तमोऽध्यायः ||५५||

Thus ends the fifty-fifth chapter by name ‘Udāvarta Pratiședha’ inUttara Sthana of Susruta Samhita.