Udavarta in the Charaka Samhita: When Apana Turns Upward (Chikitsa Sthana 26)

इस लेख को हिंदी में पढ़ें: चरक संहिता में उदावर्त: जब अपान वायु ऊपर मुड़ती है (चिकित्सास्थान 26)

📖 27 min read · Charaka Samhita, Chikitsa Sthana 26.3–31, in Gabriel Van Loon's handbook, Volume II (printed pages 683–688)

What Is Udavarta? Apana Vayu Turned Upward

Udavarta is the classical name for a downward movement that has turned back. In Ayurveda, vata works in five forms, and one of them, apana, moves down and out: it carries wind, urine and stool out of the body. Chapter 26 of Charaka's Chikitsa Sthana, after four verses of introduction, begins with what happens when that wind is blocked in the lower bowel and goes the other way. The CSRTSDC English edition of the Charaka Samhita puts it in one line: Udavarta literally means upward and opposite frequent movement of vata dosha.

The passage is short. Verse 5 gives the causes, verses 6 to 9 the signs and what follows them, and verse 10 closes with a promise to explain the management. Most of what comes after, verses 11 to 25, is that management: procedures, powders, a medicated ghee and a cooked salt. This page reads the description and leaves the medicines in the book. It reads the verses in Gabriel Van Loon's Charaka Samhita: Handbook on Ayurveda, Volume II (printed pages 683 to 688), checks each line against the Sanskrit and the CSRTSDC English, and then sets them beside the Sushruta Samhita, which gives udavarta a chapter of its own.

The five forms of vata are set out on our page on the fifteen dosha subtypes in the Ashtanga Hridaya, and Charaka's main chapter on vata, Chikitsa Sthana 28, is read on our page on vatavyadhi and its two roads. Here we stay with one form of vata, at the moment it goes wrong.

Ud-Avarta: A Word for Turning Back Upward

The word has two parts. Ud means up. Avarta is a turning: the Monier-Williams Sanskrit dictionary gives turning, winding, turning round, revolving, and also whirl, gulf, whirlpool. An udavarta is a turning upward, the way river water turns back on itself behind a rock.

The same dictionary defines the medical word plainly: a class of diseases (marked by retention of the feces), disease of the bowels, iliac passion, citing Sushruta. "Iliac passion" is an old English medical name for a painful blockage of the bowel. Monier-Williams also lists a feminine form of the word for a different disorder of women, also cited from Sushruta. That word is not this chapter's, and we leave it there.

So the name carries its own picture. Something that should go down and out goes round and up instead. Charaka's verses do not stop to define the word. They describe how it starts and what it does, and the name says the rest.

Why the Trimarmiya Chapter Opens With Udavarta

Chapter 26 of the Chikitsa Sthana is called Trimarmiya Chikitsa, the chapter on the three marmas. Verses 3 and 4 name them: the bladder (basti), the heart (hridaya) and the head (shiras), chief among the hundred and seven marmas because prana rests in them. Van Loon gives the first with a query: basti ("kidney"[/bladder?]). Verse 4 ends with a call to listen: Hence in order to protect them listen about the management of great disorders in them O gentle one! Our page on trimarma, the three roots of the body, reads those verses and the chapter's closing note, so we do not repeat them here.

Then the very next verse turns to the bowel. Why open a chapter on the bladder, the heart and the head with a disorder of apana? The CSRTSDC editors answer in their introduction: Udavarta can be considered as cause for the diseases of three marma.

Our reading, flagged: the verses point the same way. Verse 6 places the pain first in the bladder and the heart (basti and hrit open its list), and the list in verse 9 reaches the head. All three marmas are touched within five verses. The chapter seems to begin with udavarta because udavarta, as Charaka tells it, travels to all three.

Verse 5: Kashaya, Tikta, Ushana and Ruksha

Chikitsa Sthana 26.5
kashaya-tiktoshana-ruksha-bhojyaih sandharanabhojana-maithunaish cha; pakvashaye kupyati ched apanah srotamsy adhogani bali sa ruddhva

In plain English: if apana is provoked in the pakvashaya by foods that are astringent (kashaya), bitter (tikta), pungent (ushana) and dry (ruksha), and by holding back urges, not eating and sex, then, being strong, it blocks the channels that run downward. Van Loon's English: If apana V in colon gets vitiated due to intake of astringent, bitter, pungent and rough food; suppression of urges, fasting and coitus, it creates obstruction in lower passages because of strength and causes retention of feces, flatus and urine and finally severe udavarta (upward movement of V). He writes V for vata throughout.

The four food words are qualities, not dishes. Three are tastes: astringent, bitter, pungent. The fourth, ruksha, means dry and rough, the opposite of oily. One word stands out. For pungent, Charaka does not use the usual taste name, katu. He writes ushana, which Monier-Williams gives as black pepper (and, in the feminine, long pepper). The pepper stands in for its whole taste. Sushruta, telling the same story, uses katu, as we will see.

Two raw green bananas, two bitter gourds, black peppercorns and dry roasted chana on a brass plate: astringent, bitter, pungent and dry, the four food qualities of verse 5.

Abhojana and Maithuna: Not Eating, and Sex

The second half of the cause list is about habits. The CSRTSDC English reads the three words as suppression of natural urges, starvation, and excess indulgence of sex; Van Loon has suppression of urges, fasting and coitus. Abhojana is simply not eating. The word "excess" in the CSRTSDC English has no word of its own in the Sanskrit line. The translators supply it, reading the verse as a warning against too much rather than against any.

Not eating sits oddly in a list that starts with food. Our reading, flagged: it may be one of the urges under another name. Hunger (kshudh) is among the urges that Charaka's Sutrasthana 7.3–4 says should never be held back, and Sushruta, as we will see, counts hunger held back as an udavarta of its own. If so, abhojana and sandharana overlap, and the verse names one habit twice: once as a missed meal, once as an urge refused.

An empty brass plate and bowl on a woven floor mat beside a low wooden seat: abhojana, not eating, one of the habits in verse 5.

Sandharana: Holding Back an Urge

Sandharana is the first of the three habits. Monier-Williams gives the sense holding in or back, checking, restraining, and cites Sushruta and Charaka for it. In the medical books it means holding back a natural urge (vega). Charaka's Sutrasthana 7.3–4 lists thirteen urges that should not be held, and our page on vegadharana, the thirteen urges never to suppress, walks through Vagbhata's version of that list.

What Chikitsa 26 adds is the end of the story. Sutrasthana 7.12 says what holding back wind does:

Sutrasthana 7.12, first half
सङ्गो विण्मूत्रवातानामाध्मानं वेदना क्लमः
sango vin-mutra-vatanam adhmanam vedana klamah

The CSRTSDC English: Retention of feces, urine and flatus, distension of abdomen, pain, fatigue and other abdominal diseases are caused due to suppression of urge to pass flatus. The first words are sango vin-mutra-vatanam, the holding of stool, urine and wind. Verse 6 of our chapter uses the same word for the same three: vin-maruta-mutra-sangam. The order changes, and the wind gets another name (maruta for vata), but the picture is one. Sutrasthana 7 stops at the holding. Chikitsa 26 says where it leads: kramad udavartam, in time, udavarta.

Our page on the three marmas counted sandharana and its cousins in eight places across Sutrasthana 17 and Siddhi Sthana 9. Chikitsa 26.5 adds one more, and here the habit is named as a cause of udavarta itself.

A shut wooden sluice gate between two stone posts across a field channel: sandharana, holding back.

Pakvashaya and Apana: Where Verse 5 Puts the Trouble

Verse 5 is exact about the place. The wind is provoked pakvashaye, in the pakvashaya, the seat of what has been digested: the lower bowel. Both English versions say "colon". And the wind is apana, which Monier-Williams describes as that of the five vital airs which goes downwards and out at the anus. The dictionary gives the word one more sense, in Latin: ventris crepitus, the wind itself.

Vagbhata's Ashtanga Hridaya gives apana its places in Sutrasthana 12.9:

Ashtanga Hridaya, Sutrasthana 12.9, first half
अपानोऽपानगः श्रोणिबस्तिमेढ्रोरुगोचरः
apano 'panagah shroni-basti-medhroru-gocharah

Apana sits at the lower opening and ranges over the hips, the bladder, the genitals and the thighs; the second half of the verse gives it the work of carrying things out of the body. So when Charaka says apana is provoked in the lower bowel and blocks the downward channels (srotamsi adhogani), he is describing a wind stopped at the very door it is meant to keep. His word for its force is bali, strong. Van Loon keeps it (because of strength); the CSRTSDC English turns it into excessively aggravates.

Kramat or Sadyah: Gradually in Charaka, at Once in Sushruta

Chikitsa Sthana 26.6, first half (as the CSRTSDC edition prints it, without word breaks)
करोतिविण्मारुतमूत्रसङ्गंक्रमादुदावर्तमतःसुघोरम्
karoti vin-maruta-mutra-sangam kramad udavartam atah sughoram

"It causes the holding of stool, wind and urine, and from that, kramat, the very dreadful udavarta." Kramat means in regular course, gradually, by degrees (Monier-Williams), and sughora is very fearful or terrible. Van Loon renders the word as "finally". The CSRTSDC English moves it onto the blockage: gradually obstructs the movement of stool, urine and the flatus causing udavarta, the serious trouble. Either way, Charaka's udavarta takes time.

Sushruta tells the same story in Uttara Tantra 55.37, and his clock runs the other way:

Sushruta Samhita, Uttara Tantra 55.37
वायुः कोष्ठानुगो रूक्षैः कषायकटुतिक्तकैः । भोजनैः कुपितः सद्य उदावर्तं करोति हि ॥
vayuh koshthanugo rukshaih kashaya-katu-tiktakaih; bhojanaih kupitah sadya udavartam karoti hi

"The wind of the abdomen, provoked by dry, astringent, pungent and bitter foods, makes udavarta sadyah." Sadyas is on the same day, in the very moment, and Kaviraj Kunja Lal Bhishagratna's English of 1916 keeps it: causes an immediate attack of Udávarta. The same four qualities, the same wind, the same result. Charaka says gradually. Sushruta says at once.

Our reading, flagged: the two clocks may not quarrel. Charaka's verse adds habits, holding back and not eating, which do their work over days. Sushruta's verse 37 is about food alone, a meal of the wrong kind. Neither text explains the difference, and we note it as we find it.

Basti, Hrit, Kukshi: Where Verse 6 Places the Pain

The second half of verse 6 maps the pain: rug basti-hrit-kukshy-udareshv abhikshnam sa-prishtha-parshveshv atidaruna syat. Pain comes again and again in the bladder, the heart, the flanks and the abdomen, and it is very sharp in the back and the sides. Van Loon: Because of this there starts intense and frequent pain in pelvis, cardiac region, sides and front of abdomen, back and sides of chest.

Look at the first word of the list. Three verses earlier Van Loon gave basti as a kidney with a query and a bladder in brackets; here the same word becomes "pelvis". The CSRTSDC English keeps urinary bladder in both places. Van Loon's handbook is a working translation, and his query marks are honest about his doubts. But a reader who follows only his English would not see that verse 6 names the first of the three marmas with the same word as verse 3.

Verse 7 goes on: adhmana, nausea (hrillasa), cutting pain (vikartika), pricking pain (toda), poor digestion (avipaka), a swelling of the bladder (basti-shotha), no passing of stool, lumps in the abdomen, and the wind going up. Two of those words repay a closer look.

Adhmana: A Word That Also Means a Bellows

Adhmana opens verse 7. It comes from a root meaning to blow, and Monier-Williams lists its senses in a row: blowing, inflation, puffing, then boasting, then a bellows, then intumescence, swelling of the body. An abdomen blown up like a bag of air is the picture behind the medical sense. Van Loon translates it tympanitis, an old medical word for an abdomen tight as a drum. The CSRTSDC English has flatulence. Bhishagratna, in Sushruta's chapter, writes Ádhmána (distension of the abodomen), misprint and all.

The word also ties the two Charaka chapters together. Sutrasthana 7.12, quoted above, puts adhmanam second, right after the holding of the three. Verse 7 of Chikitsa 26 puts it first. In both places it comes soon after the held-back wind. The dictionary's bellows is our picture, not Charaka's, but it fits: a bag of air with its mouth closed.

An old leather bellows on the floor of a cold, empty smithy. Monier-Williams lists 'a bellows' among the senses of adhmana.

Urdhvash cha Vayur Vihato Gude: The Line That Names the Turn

Chikitsa Sthana 26.7, second half (CSRTSDC, without word breaks)
वर्चोऽप्रवृत्तिर्जठरेचगण्डान्यूर्ध्वश्चवायुर्विहतोगुदेस्यात्
varco 'pravrittir jathare cha gandany urdhvash cha vayur vihato gude syat

"No passing of stool, lumps in the abdomen, and the wind, stopped at the anus, goes upward." This is the line that says outright what the name describes. Vihata is disturbed, impeded, even warded off, repelled (Monier-Williams), and gude says where: at the lower opening, apana's own door.

Both English versions keep the upward wind and lose the door. Van Loon has enlargement of mesenteric glands and upward movement of V; the CSRTSDC English has appearance of nodules in the abdomen, abnormal upward movement of vata. Neither says where the wind was stopped. Bhishagratna, translating Sushruta's matching line (Uttara Tantra 55.8), where the Sanskrit says only svamarge, in its own path, adds the place in brackets: The vital Apána-Váyu (at the anus) anyhow obstructed in its passage. The two Charaka translations also part ways on the lumps. "Mesenteric glands" is a modern anatomical guess; "nodules in the abdomen" stays with the word ganda.

Dry leaves lifted in a spiral by a gust in an empty courtyard: the wind of verse 7 that goes up instead of down.

Twenty-One Names, Then Many Others: Verses 8 to 10

Verse 8 begins with the stool itself. It comes with difficulty, dry and late (krichchhrena shushkasya chirat pravrittih), and the body turns hard, rough and cold (khara-ruksha-shita): dryness again, the quality the food list began with. Van Loon: stool is passed with difficulty, as dry and with delay, body becomes coarse, rough and cold.

Then come the consequences. From the second half of verse 8 to the end of verse 9, Charaka names twenty-one disorders in three long compounds. We counted them in the Sanskrit and in both English versions, and all three give twenty-one. Between them they reach from the bladder to the head: difficult urination (mutrakrichchhra) is the second name, and the head appears in shiro-abhitapa, which Van Loon reads as "headache" and the CSRTSDC English as burning sensation in head. We name only a few of the others: thirst (trishna), loss of taste for food (aruchi), cough (kasa) and a running nose (pratishyaya). Several of the rest are serious conditions, and a list of them, cut loose from a physician, would help nobody.

Verse 10 closes the list with a sweep: anye cha roga bahavo 'nilottha bhavanty udavarta-kritah sughorah, "and many other very dreadful disorders born of the wind are made by udavarta". Van Loon: Many other severe V disorders are caused by Udavarta. Sushruta ends his own list the same way, as the table further down shows.

Saumya and Agnivesha: The Teacher Speaks Twice

The Charaka Samhita is written as teaching, Atreya speaking to his pupil Agnivesha. In these few verses the teacher calls on his listener twice. Verse 4 ends shrinu saumya, "listen, gentle one", and verse 10 ends tac chrinu chagnivesha, "listen to that, Agnivesha". Van Loon keeps the first (O gentle one!) and drops the second. The CSRTSDC English keeps both: Treatment of these ailments will be described hereafter you may listen Agnivesha.

It is a small thing, but it shows the shape of the passage. Each call to listen comes just before a change of subject: the first before udavarta, the second before its management.

Sushruta's Thirteen Kinds of Udavarta (Uttara Tantra 55)

Sushruta gives udavarta a chapter of its own, the fifty-fifth of his Uttara Tantra, Udavarta Pratishedha. It opens with the rule in verse 3:

Sushruta Samhita, Uttara Tantra 55.3
अधश्चोर्ध्वं च भावानां प्रवृत्तानां स्वभावतः । न वेगान् धारयेत् प्राज्ञो वातादीनां जिजीविषुः ॥
adhash chordhvam cha bhavanam pravrittanam svabhavatah; na vegan dharayet prajno vatadinam jijivishuh

Bhishagratna's English: A wise man valuing his life shall never repress any natural urging of his body, whether upward or downward, e. g. that of Váyu, etc. Then Sushruta defines the disorder by its causes. It is called udavarta when an urge that has come is held back, and he names the urges: wind, stool, urine, yawning, tears, sneezing, belching, vomiting and semen (verse 4), then hunger, thirst, breath and sleep (verse 5). Verse 6 gives the count:

Uttara Tantra 55.6
त्रयोदशविधश्चासौ भिन्न एतैस्तु कारणैः । अपथ्यभोजनाच्चापि वक्ष्यते च तथाऽपरः ॥
trayodasha-vidhash chasau bhinna etais tu karanaih; apathya-bhojanach chapi vakshyate cha tatha 'parah

In Bhishagratna's words: It is of thirteen different types and are brought about through the aforesaid causes, over and above the one incidental to the habitual use of unwholesome food and drink (Apathyaja). Thirteen kinds, one for each urge held back, and one more from the wrong food. That last kind is the closest to the one Charaka describes.

The thirteen urges are the same thirteen that Charaka lists in Sutrasthana 7.3–4, under different names in places:

Six of the thirteen carry the same name in both lists. The other seven differ in the word, not the thing; sneezing differs only in its form, kshava against kshavathu.

Udavarta Types According to Charaka

People search for the types of udavarta according to Charaka, and the honest answer is that Charaka does not give a count. We searched the CSRTSDC text of Sutrasthana 7, the chapter on the urges, and the word udavarta does not appear in it, in English or in Sanskrit; each held urge there gets its own short list of results. Chikitsa 26 describes one udavarta, the one of apana in the lower bowel, and gives its causes in a single verse.

The CSRTSDC editors do write, in their introduction to Chikitsa 26: There are thirteen types of udavarta based upon suppression of natural urges described in Naveganadharaniya Adhyaya. That sentence joins the two books, laying Sushruta's count over Charaka's list of urges. It is a fair reading, but the number is Sushruta's.

One Paragraph in Two Books: Charaka 26.5–10 and Sushruta 55.37–41

Put Charaka's verses beside Sushruta's account of the food-born kind, verses 37 to 41, and they read like two copies of one paragraph.

The last row is the closest. Charaka has anye cha roga bahavo 'nilottha. Sushruta, in verse 41:

Uttara Tantra 55.41, first half
लभते च बहूनन्यान् विकारान् वातकोपजान्
labhate cha bahun anyan vikaran vata-kopajan

"And he gets many other disorders born of the wind's anger." Bhishagratna ends the passage with the words pre-eminently mark the deranged action of the bodily Váyu. Two authors and the same closing gesture: a list, and then the admission that the list could go on.

The match goes beyond description. Both chapters also share one of their medicines, a powder built on a doubling rule (dviruttara, each part twice the one before), with small differences in what goes in. We do not give it. Which book had it first, or whether both took it from an older one, we cannot say.

Anaha Born of Ama: Verse 26

After the management, one more verse of description. Verse 26 turns to anaha that comes from ama, matter left undigested:

Chikitsa Sthana 26.26, first half
hrit-stambha-murdhamaya-gauravabhyam udgara-sangena sa-pinasena

It is known by stiffness at the heart, trouble and heaviness in the head, belching held back, and a running nose (pinasa). The second half of the verse turns to management, which we leave out.

The word anaha gets four readings. Van Loon: Diagnosis of Anaha (hardness of bowels) as caused by Ama: should be known from cardiac stiffness, heaviness in head and abdomen, retention of eructation and catarrh. The CSRTSDC English places it in the upper abdomen. Monier-Williams gives epistasis, suppression of urine first and constipation second. Hard bowels, the upper abdomen, held urine, held stool: four readings for one word.

Our reading, flagged: Van Loon's "heaviness in head and abdomen" has one place too many. The compound names the heart and the head (hrit, murdha) and has no word for the abdomen; the CSRTSDC English, diseases of head and heaviness, stays closer to it. And notice what this verse does not say. Udavarta sends the wind upward. In anaha from ama even the upward road is shut, since belching is held back too. It is a fullness that stops, not a wind that turns.

Ity Udavarta-Chikitsa: The Bracket and the Closing Line

In the CSRTSDC edition, verse 26 is followed by five verses in round brackets, 27 to 31, on one more medicine and when it may be given. Then comes a closing line:

After Chikitsa Sthana 26.31
इत्युदावर्तचिकित्सा
ity udavarta-chikitsa

Thus ends the treatment of udavarta, in the CSRTSDC English. By the text's own marker, the udavarta section runs from verse 5 to verse 31, and anaha belongs inside it. Our reading of the chapter stops at that line; the next verse begins the eight kinds of difficult urination.

Van Loon's handbook does not have the bracketed verses. After the anaha verse it goes straight to the urinary section, and the numbering shows it. He labels the first urinary verse Ci26#27, where the CSRTSDC edition numbers the same lines 32. From there on, his verse numbers mostly run five behind. Round brackets in a printed Sanskrit edition often mark lines the editors doubt, and the five verses may be a later addition that some manuscripts carry and others do not. We cannot settle that from the editions we have. What we can say is practical: anyone matching Van Loon's numbers to a Sanskrit edition of this chapter has to add five from the urinary verses on.

Three Englishes for One Chapter

Every reading on this page went through at least two English versions, and they rarely agree word for word. Here are the places in our passage where Van Loon and the CSRTSDC English part ways:

Van Loon's handbook moves fast and writes vata, pitta and kapha as V, P and K; it is built to be used. The CSRTSDC English stays nearer the words and glosses them as it goes. Bhishagratna, a century earlier, worked on Sushruta and put what he added in brackets. None of them is wrong to choose, but each choice shows. Reading them together, with the Sanskrit open beside them, is the only way we know to see what a verse itself says.

What This Page Leaves in the Book

Of the twenty-nine verses from 3 to 31, eight and a half describe and twenty and a half give management: verses 11 to 25, the second half of 26, and the bracketed 27 to 31. That is a lot to leave out, so here is what it is, in outline only. The management starts with oiling and sweating and moves through suppositories (varti), powders blown in through a pipe, sharp enemas, a diet built on barley, purging for a case that drags on, powders taken with warm water, a medicated ghee, and a salt cooked in a sealed clay pot. The bracketed verses add one more medicine.

We give no ingredients, amounts or methods. These are procedures from a physician's manual, written for a physician's hands, and several of them can do real harm in the wrong ones. If the old account of udavarta sounds like something you are living with, the next step is a doctor, not a page of Sanskrit. That is a question for a doctor who knows you.

Reading Udavarta Today

What should a reader today take from verses 5 to 10? Not a diagnosis, and not a plan. The verses are an old physician's account of how wind, held back, was thought to turn and travel, written in a system of ideas (apana, vata, srotas, marma) that modern medicine does not use. We know of no modern study that tests what these verses claim, and we make no claim either way.

What lasts is the attention. Charaka looked at an everyday habit, holding back, and followed it through the body to the three marmas. Sushruta built a whole chapter on the same idea and counted the ways it can happen. The advice that the body's urges are better not fought runs through the classical texts, and most people have heard some version of it from a grandparent. Read it here as history. For anything you feel in your own body, ask someone who can examine you.

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