A Cross Sectional Survey Study to find out the role of Avarana as a

diagnostic tool in General Practice with special reference to Madhumeha

Dr Ashish Tiwari*, Dr Ashish Reja**, Dr Pawankumar Godatwar***, Dr B K Sevatkar****
Abstract
Srotas and Avarana are essential factors of Samprapti of almost all the Nija roga.
Avarana is an underestimated and neglected aspect of Roga Samprapti. Therefore
a survey study was conducted to gather data about understanding of Avarana
w.s.r. to Madhumeha (Diabetes Mellitus).

A dully prepared questionnaire pro forma on Avarana have been proposed and
send it to 83 Ayurvedic doctors from NIA & across India to collect data.
Questionnaire included choices of different samprapti ghataka like Agni, Dosha,
Dushya, Srotasa, Ama, Avarana, Nidana and response against question “Is
Avarana an important samprapti ghataka in day to day practice?

On a small study of NIA it was found that 39.76% consultants included Avarana,
66.27% included dosha vighatana, 56.63% included dushya, 54.22% included
Agni 53.01% included Ama, 48.19% included srotasa and 36.15% included
nidana as a samprapti ghataka for diagnosing the disease in day to day practice.
Response against question Is Avarana an important samprapti ghataka in day to
day practice 62 (74.70%) consultants answered Yes, but Avarana the records
show that only 28 (33.74%) were using Avarana as an important samprapti
ghataka, 11 (13.25%) were seeing daily >10 patients in their OPD/IPD and 18
(21.69%) were unable to explain why Avarana should be an important samprapti
ghataka. Out of rest 21 (25.30%) answered No, 14 (16.87%) were unable to
explain their response & 7 (8.43%) cited difficulty in understanding Avarana in
diagnosis in day to day practice.

On an average it was found that 33.41% patients were consulted in OPD and
2.43% in IPD. Most of the consultants use only 7 samprapti ghataka for diagnosis
of diseases. 62 (74.70%) consultants answered ‘Yes’ in response to question (Is
Avarana an important samprapti ghataka in day to day practice?), but no
satisfactory explanation was given.

Keywords: Avarana, Madhumeha, Samprapti ghataka, Dosha vighatana.

Introduction
Srotas is marga and margavarodha implies
Avarana.1 There by implying that Srotas and
Avarana are essential factors of Samprapti of almost
all the Nija roga. Despite the all encompassing
importance of Srotas and Avarana in the formation
of Samprapti of almost all the Nija roga, Avarana is
an underestimated and neglected aspect of Roga
Samprapti. Therefore the present study proposes to
critically review the concept of Avarana.
In Ancient treatise we find a vivid description of the
disease solely attributed to metabolic derangement
along with genetic predisposition. Madhumeha is the
disease of metabolic derangement and genetic
predisposition related with each constituent of the
body.2 The meha word here mainly related with the
excretions through urine. The clinical entity in
which patient voids the urine having concordance
with Madhu i.e. of kashaya and madhura taste,

*
Lecturer, Shri Ganganagar College of Ayurvedic Science and Hospital, Shri Ganga Nagar, Rajasthan.
**
PG Scholar, Department of Roga Nidana Evam Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan.
***
Associate Prof. and HOD, Department of Roga Nidana Evam Vikriti Vigyana, National Institute of Ayurveda, Jaipur,
Rajasthan.
****
Assistant Professor, Department of Roga Nidana Evam Vikriti Vigyana, National Institute of Ayurveda, Jaipur, Rajasthan.
Correspondence to: Dr Ashish Tiwari, Shri Ganganagar College of Ayurvedic Science and Hospital, Shri Ganga Nagar,
Rajasthan. E-mail Id: ashishjptiwari@gmail.com

© ADR Journals 2015. All Rights Reserved.

Tiwari A et al. 8

ruksha (dry) texture and honey like colour. Body
acquires sweetness called madhumeha.3 It is having
more prevalence in the society. Sushruta
emphasized that Vyana and Apana vitiation causes
shukra dosha and Prameha.4 Madhumeha subtype
of Vataja Prameha5 due to involvement of vital
elements causes alarming health instability with
higher prevalence.
Vata is the conductor of healthy life and vitality
supporter of all the embodied beings and sustains
long life free of disorders. Sushruta emphasized that
Vyana and Apana vitiation causes shukra dosha and
Prameha. Vyana because of its potential to perform
the functions related to each and every body element
and Apana due to its potential related with excretion.
When we exploit Madhumeha we cannot denied the
credibility of Avarana in the pathogenesis. This
superior consideration of Sushruta proved to be
essential before profound treatment modality.
Aims and Objectives
Present study was done to conduct Survey to gather
data about the understanding of Avarana WSR to
Madhumeha (Diabetes Mellitus).
Materials and Methods
A Survey study was conducted at NIA and other
NIA camp sites. Survey was based about the
application of concept of “Avarana” in the Nidana
and Chikitsa at various institutes in India. For this
purpose a questionnaire was administered to faculty
from major Ayurvedic institutes to collect data about
the respective understanding and use of concept of
Avarana in that particular institute. To achieve this
aim, a questionnaire was devised as followed
(Appendix). Observations were calculated in the
form of percentage. Mean and SD for few
parameters were calculated.
Results
83 teachers from NIA & all over India were
subjected to a questionnaire to gather data on the
status of avarana in current practice w.s.r. to
madhumeha. 7 medical officers, 45 lecturers, 8
Assistant Professors, 17 Associate Professors, 3
Professors and 3 Head of the Departments
Participated in the study, out of whom, 43 were
general practitioners, 26 were specialists and remain
14 were doing both (General and Specialty)
practices in their OPDs (Table 1 & 2).

S.N. Designation No. of Consultants Percentage

1 Head of Department 3 3.61%
2 Professor 3 3.61%
3 Associate Prof./ Reader 17 20.48%
4 Assistant Professor 8 9.64%
5 Lecturer 45 54.22%
6 Medical Officer 7 8.43%
Table 1.Designation wise distribution of 83 ayurvedic consultants

S.N. Type of practice No. of Consultants Percentage

1 General practitioner 43 51.82%
2 Specialist 26 31.33%
3 Both type of practice 14 16.87%
Table 2.Type of practice wise distribution of 83 ayurvedic consultants

On an average 33.41% patients were counseled in admitted daily in IPDs (Table 3).
OPDs by the consultants, 2.43% patients were
S.N. Type of Patients registered Mean ± SD
1 OPD 33.41 ± 26.77
2 IPD 2.43 ± 2.92
Table 3.Average OPD & IPD Patients/ Sitting

On an small study of NIA it was found that the most
of the consultants were using only 7 samprapti
ghataka for diagnosing the diseases in day to day
practice, on the basis of that, only those 7 samprapti
ghataka were included as choices with optional
space for inclusion of other specific samprapti
ghataka. On an average it was found that 66.27%
consultants included dosha vighatana, 56.63%
included dushya, 54.22% included Agni, 53.01%
included Ama, 48.19% included srotasa and 39.76%
included Avarana in their battery of Samprapti
Ghataka while 36.15% opted for an approach of
direct Nidana (Table 4).

ISSN: 2394-6547 J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(2): 7-11.
9 Tiwari A et al.

S.N. Samprapti ghataka No. of Consultants Percentage

1 Agni 45 54.22%
2 Srotasa 40 48.19%
3 Dosha 55 66.27%
4 Dushya 47 56.63%
5 Ama 44 53.01%
6 Avarana 33 39.76%
7 Nidana 30 36.15%
Table 4.Choices of different Samprapti ghataka by consultants

Contrary to this observation of non-inclusion of
“avarana” in practice, the response to question no.-
VII (is Avarana an important samprapti ghataka in
day to day practice?), 62(74.70%) consultants
answered ‘Yes’, avarana should be an important
part of samprapti ghataka for diagnosis of any
disease in day to day practice, but the records show
that only 28(33.74%) were using avarana as an
important samprapti ghataka in day to day practice
(as they responded in the questionnaire). Out of
these, only 11(13.25%) were seeing daily >10
patients in their OPD’s/IPD’s of avarana janya
vikara and 18(21.69%) were unable to explain why
avarana should be an important samprapti ghataka
in day to day practice?
Out of the rest 21(25.30%) who answered ‘NO’ for
question no.-VII, 14(16.87%) were unable to explain
their response and 7(8.43%) cited difficulty in
understanding or no role of avarana in diagnosis in
day to day practice as their explanation (Table 5).

S.N. Answer No. & % of Consultants Cited Reason Not Cited reason
62 44 18
1 Yes
74.70% 53.01% 21.69%
21 7 14
2 No
25.30% 8.43% 16.87%
Table 5.Response against question “is Avarana an important samprapti ghataka in day to day practice?”

Discussion ghataka of any diagnosis or provisional diagnosis of

Acharya charaka has described the pathogenesis of
madhumeha that due to excess intake of heavy salty
and sour diet, avoidance of worry, exercise and
Sanshodhana Kapha and Pitta get provoke and
Vitiate Meda and Mamsa, which are present in
excess quantity. They cause obstruction to normal
pathways of Vata. These Vata get aggravated and
draws out Oja (Apara) from all parts of body and
carries it towards Basti resulting in Madhumeha.6
Pathogenesis of madhumeha is either by prakopa of
vata or by the Avarana described by Charaka: In
madhumeha caused by pure vata the patient passes
urine which is astringent and sweet in taste,
yellowish-white in color and is un-unctuous. All
these symptoms and signs are of vata only. In
madhumeha caused by avrtta vata, the patient shows
the symptoms of vata, pitta and kapha frequently
and the severity of the disease becomes diminished
for some time and becomes aggravated again. It
indicates the periodic and waxing waning nature of
clinical manifestation in Avarana.
Remarkably, the case record forms of the institutes
all over India as well as the OPD & IPD tickets and
personal notes of the consultants contained no
mention of the term “avarana” as samprapti
avarana in day to day practices.
Through a small questionnaire and survey find out
the status of Avarana in day to day practice from
NIA. The observations showed that only few
(39.76%) were included Avarana in their battery of
samprapti ghataka and maximum number of
consultants i.e. 66.27% included dosha vighatana in
their battery. While 58(69.88%) were able and
25(30.12%) were unable to cite the reason of answer
of question no.-VII (Is Avarana an important
samprapti ghataka in day to day practice?)”.
Conclusion
On an average it was found that 33.41% outdoor
patients and 2.43% indoor patients were diagnosed
on the basis of Avarana as a diagnostic tool of
madhumeha. Most of the consultants were using all
the Samprapti ghataka for diagnosis of diseases,
which has been asked in the questionnaire. 62
(74.70%) consultants answered ‘Yes’ in response to
question (is Avarana an important samprapti
ghataka in day to day practice?), but no satisfactory
explanation was given by them. Overall study
concluded that Avarana is very important factor in
the pathogenesis of madhumeha in general practice.
So it should be included as a diagnostic factor for

J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(2): 7-11. ISSN: 2394-6547
Tiwari A et al.
not only in madhumeha but also other chronic
diseases to give a better path for management of
diseases.
Acknowledgement
By the grace of Mr Bhagwana Dhanwantari, it is a
great feeling of pleasure, pride and happiness to
present this research article. I am very thankful to Dr
Surendra Kumar Sharma, Associate Professor, Dr
Sisir Kumar Mandal, Assistant Professor and Dr
Reetu Sharma, Lecturer of Department of Roga
Nidana Evam Vikriti Vigyana, National institute of
Ayurveda, Jaipur for their criticism and discussion
in preparing this article.
References
1. Yadavaji Trikamaji. Charaka samhita
Cakrapanidatta’s Ayurvedadipika commentary.
Chikitsa sthana 28/59. Varanasi: Caukhambha
Surbharti Prakashana, 2013: 619.
ISSN: 2394-6547 J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(2): 7-11.
10
2. Yadavaji Trikamaji. Sushruta samhita:
Dalhanacharya’s Nibandhasamgraha
commentary. Chikitsa sthana 11/3. Varanasi:
Caukhambha Surbharti Prakashana, 2012: 451.
3. Yadavaji Trikamaji. Charaka samhita
Cakrapanidatta’s Ayurvedadipika commentary.
Nidana sthana 4/44. Varanasi: Caukhambha
Surbharti Prakashana, 2013: 215.
4. Yadavaji Trikamaji. Sushruta samhitarya’s
Nibandhasamgraha commentary. Nidana sthana
1/20. Varanasi: Caukhambha Surbharti
Prakashana, 2012: 261.
5. Yadavaji Trikamaji. Charaka samhita
Cakrapanidatta’s Ayurvedadipika commentary.
Nidana sthana 4/39. Varanasi: Caukhambha
Surbharti Prakashana, 2013: 215.
6. Yadavaji Trikamaji. Charaka samhita
Cakrapanidatta’s Ayurvedadipika commentary.
Sutra sthana 17/78-80. Varanasi: Caukhambha
Surbharti Prakashana, 2013: 103.
11 Tiwari A et al.

APPENDIX

Survey on Samprapti Ghataka in Day to Day practice

1. Name of consultant: ……………………………………………………………....

2. Organization: …………………………………….………………………………..

3. Designation: …………………………………………………….…………………

4. Address: …………………………………………………………………………...

5. Contact/Mobile No: ……………………… Serial No.: ……………………..…..

Questionnaire:
I. How many days in a week you attend OPD:

1-2 times/ Week……........ 3-4 Times/Week……………. ≥5 Times/Week………..….

II. What kind of patients you attend in OPD: (If Speciality/Both please mention)

General ……………….... Specialty ………………….……………………………

III. On an average how many patients you attend to in one OPD session: (In
Numbers)…………….………..
IV. On an average how many patients are admitted under your care in one OPD session: (In
Numbers) ……………..………
V. What according to you are the major Samprapti Ghataka in influencing your diagnosis &
treatment? (One/More)
Agni Dosha Dushya Srotasa Ama Avarana Nidana
VI. The number of patients you have diagnosed with Avarana as a Samprapti Ghataka:
In last OPD….… In last one week…... In last one month…… In last one year……….…
VII. Is Avarana an important samprapti ghataka in day to day practice? - Yes/No……………
WHY?

Sign of Consultant

Survey Pro forma on Samprapti Ghataka in Day to Day practice

J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(2): 7-11. ISSN: 2394-6547