My approach why udaavarta is mentioned in Trimarmiya chikitsa adhyaaya of charak samhita
; It explains the treatment of diseases effecting three vital systems (cerebrovascular, cardiovascular and renovascular system) and not the organs themselves.
Brain, heart and kidney axis support each other in maintaining the homeostasis. Declining cardiac function is associated with a spectrum of compensatory mechanisms to preserve cardiovascular homoeostasis. Two of the major participants in the neurohormonal system that are intricately intertwined in order to achieve stability are (i) the Autonomic nervous system and (ii) the Renin–angiotensin–aldosterone system (RAAS). A reduction in cardiac output activates afferent stimuli from the baroreceptors to the central nervous system cardio-regulatory centres, which in turn leads to an activation of the sympathetic nervous pathway. Reduced renal perfusion, secondary to reduced forward flow activates the RAAS system via renin release. Importantly, renin facilitates the conversion of angiotensinogen to angiotensin I. Angiotensin-converting enzyme subsequently converts angiotensin I to angiotensin II. Although angiotensin II has a central effect on increasing sympathetic activity, it is also involved in sodium and water retention and has a systemic vasoconstrictive effect. It is noteworthy that these compensatory mechanisms are initially important to maintain cardiac outputbut over the long term are detrimental through their adverse impact on the structural adaptive response of the heart.Heightened sympathetic tone modulates heart rate, enhances AV conduction, as well as myocardial contractility, but when sustained over time it is associated with reduced cardiac sympathetic neuronal density and responsiveness. Sympathetic activation in turn increases the vasoconstrictor tone, accompanied by activation of the RAAS and the endothelin 1 and vasopressin system, which may be responsible for peripheral organ dysfunction and damage in the setting of congestive heart failure.
Thus a functional interrelationship is essential for homeostasis as well as disease condition. Diseases such as diabetes mellitus have an impact on all the three system and they in turn have impact on each other. Similarly, Acharya Charak observed Udavarta, a disease of gastrointestinal tract origin and dominated by vata doṣa to have impact on this trimarma. In other words, these Marma have to be protected especially from Anila (vāta), as vāta is the main cause for the aggravation of Pitta and Kapha and also is the cause of Prāna (Life force).
Vāta gets vitiated due to the vātaja aggravating factors and especially retaining or unnecessarily provoking the natural urges. Caraka in Vimānasthāna mentioned that diet if consumed without following the rules of proper dietary intake can lead to manifestation of disease by vitiating doṣa and deteriorating the healthy status of Dhātu.
The toxins retained due to retention of mala due to impaired apana can lead to various diseases. The impaired apana has first impact on agnito hamper the metabolism. The impaired metabolism leads to impaired gut microbiome and the latest research has shown that impaired gut microbiota can lead to various disorders, from heart disorders to psychological disorders which the Acharya have mentioned in verse 9-10.
It is generally observed that patient exaggerate pressure to evacuate the faecal matter which is not easily passed in case of udavarta. This increases the intra rectal pressure which can lead to arsha (piles), parikartika (fissure). The continuous increased pressure can further lead to bleeding leading to anaemia (pandu). As discussed in shwas adhyaya, pandu is cause of shwas (dyspnoea). Shwas has its impact on hridaya (heart) as it is seat of pranvahasrotas. Hridaya may also get involved due to pandu. Involvement of hridaya opens the gate for various disorders from brain to kidneys.Increased rectal pressure further leads to increased abdominal pressure which has been recorded as cause for TIA/ CVA in elderly individuals. Increased abdominal pressure has impact on movement of diaphragm which further increased the thoracic pressure. Restlessness attained due to improper evacuation of faeces increases the irritability and non attentiveness leading to psychological distress. Some Acharyas have accepted guda as a sthana of mana. (6-10)
It is also observed that due to impaired digestion and absorption, nutritional deficiency occurs especially folic acid etc which lead to increased homocystine levels, another cause for various serious diseases of three marma.
Therefore, one finds explanation of Udavarta which as a disease alone only has impact of abdominal discomfort but later on may be the basic pathogenic factor for various diseases related to three marma. Hence Caraka explained Udavarta as a disease of gastrointestinal tract prior to the explanation of diseases like mutrakrichra, hridroga and shiroroga.
Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..