Charaka Samhita Chikitsa Sthana 28 (Vatavyadhi): Two Roads of Vata and the Eleven Coverings (Avarana)

इस लेख को हिंदी में पढ़ें: चरक चिकित्सा स्थान 28 (वातव्याधि): वात के दो रास्ते और 11 आवरण

📖 27 min read · Charaka Samhita, Chikitsa Sthana 28, verses 3–82, in Gabriel Van Loon's handbook (Volume II, printed pages 630–637), read beside Sushruta's Nidana Sthana 1

Charaka Chikitsa Sthana 28: The Vatavyadhi Chapter

If you came here looking for the Charaka Chikitsa 28th chapter, this is it: Chikitsa Sthana 28 of the Charaka Samhita, the Vatavyadhi Chikitsa, on the disorders of vata. It is easy to land on the wrong chapter 28, because the Samhita's first book, the Sutrasthana, has a chapter 28 too, and it is about something else entirely: how food becomes the body's tissues (we read it on our Sutrasthana 28 page). The Chikitsa Sthana is the book of measures, and its chapter 28 belongs to vata.

We read it in Gabriel Van Loon's Charaka Samhita: Handbook on Ayurveda, Volume II. Its eighth section, Specific Diseases, opens with this chapter on printed page 630, and the contents page gives it the title Paralysis etc. (Vatavyadhi). Van Loon does not translate verse by verse. He arranges each chapter as notes, charts and quotations, and closes each item with the verse numbers it comes from; his Ci28#58-59 is our Chikitsa Sthana 28.58–59. Printed pages 630 to 637 hold the diagnosis and the first measures, verses 3 to 82, and those pages are what this article reads.

The chapter's later lines on covering needed a second book. On printed page 650 Van Loon notes that Much information from this chapter has already been entered into book I, and points to the charts there: one on the last pages of his diagnosis section, with the signs of each of the five vayus covered by pitta or kapha (Volume I, pages 196 and 197), and others in his section on measures, one of which lists the vayus covering one another (page 293). We read both, with the closing lines on page 650. For a second voice we used Sushruta's account of the same wind in his Nidana Sthana 1, in Kaviraj Kunja Lal Bhishagratna's English translation.

Gati: Vata With Unimpeded Movement (Verses 3 to 12)

The chapter opens with praise: V is life, strength and sustainer of all creatures. V is the entire world, it is the master of all. The next line adds a condition: The person whose V is with unimpeded movements and in normal state lives long for 100 years devoid of disorders. That is Chikitsa Sthana 28.3–4.

Read the condition twice. Vata keeps a person alive on two terms: it must move without hindrance, and it must stay in its normal state. Almost everything in the first half of the chapter is about the ways those two terms fail.

Verses 5 to 10 divide vata into its five forms, prana, udana, samana, vyana and apana, each with its own seat and its own work. The handbook's summary keeps the theme of motion: V coordinates the body well while moving unimpededly in different places. Van Loon adds a bracket of his own: Each V sub-type is distinguished by location and action/ vector, function. A vector is a direction, and direction will matter later, when the chapter describes the aim of its measures as putting each vayu back on its own course.

We will not walk through the five here. Our page on the five pranas does that, Vagbhata's version is on our page on the fifteen forms of the three doshas, and Charaka's own long praise of vata is in Sutrasthana 12. One detail of this chapter's map matters below, so keep it in mind. Samana, the chart says, works in the channels carrying sweat, dosas and water (fluid) and seated beside the digestive fire provides strength to Agni. That line settles a puzzle further down.

Verses 11 and 12 then state the rule in both directions. In balance and in place, the five vayus perform their normal functions by which the body is sustained free from disorders. But If they move on wrong path or are unbalanced they afflict the body with disorders relating to their location and functions and take away life shortly. A wrong path, or an imbalance. The chapter's two roads can already be seen here, before it names them.

Nidana: Eighteen Causes in Verses 15 to 17, Sorted Two Ways

Nidana means cause. Van Loon prints Charaka's list of what disturbs vata as a single long sentence:

rough, cold, little and light food, excessive coitus and vigils, faulty therapeutic management, excessive elimination of impurity and blood, excessive movements such as leaping, jumping, wayfaring and physical exercise, wasting of dhatus, excessive emaciation due to anxiety, grief and illness, uncomfortable bed and seat/chair, anger, day-sleep, fear, suppression of urges, amadosa, injury, fasting, injury in vital parts, falling down from elephants, horses and other fast vehicles.

Counting the food as one cause and each kind of excess as one, that is eighteen causes, in no particular order. The chapter itself gives us a way to sort them, because some forty verses later it says that vata is disturbed either by the wasting of the tissues or by obstruction of its channels. Read each cause with that pair in mind and the list falls apart like this:

The sort is ours, not the text's. Day-sleep is the one we had to argue for. Charaka's Sutrasthana sets it against the night's waking in a single line, Night vigil [staying awake at night] is rough while day-sleep [sleeping in the daytime] is unctuous. (Sutrasthana 21.50), and a few verses earlier (21.44–45) it says that outside summer, sleeping by day disturbs kapha and pitta. Rough belongs with the drying causes; unctuous and kapha-making belongs with the ones that clog. So the night's waking and the day's sleep, both in the list, sit on opposite roads, a tidy result we did not go looking for.

Even with that argued case set aside, the shape is plain. Most of the causes empty or dry the body. A few block it. The rest strike vata directly, through a fall, a blow or a strong feeling. Amadosa, the sticky residue that the texts say forms when food is not digested, is the clearest of the blocking causes, and something very like it comes back in the covering chart.

A hard seat, a long road, an empty bowl: three of the eighteen causes Charaka lists in verses 15 to 17.

Samprapti and Purvarupa: Empty Channels and a Faint Return (Verses 18 to 24)

Samprapti is the course a disturbance takes. Verse 18 gives vata's course in one sentence: V, filling up the vacant channels in the body produces various disorders pertaining to the entire body or one of the parts. Wind moves into empty space. This is the first of the two roads, described before it has a name: the tissues waste, the channels empty, and vata fills them.

Verse 19 is about purvarupa, the early signs, which the handbook calls the unmanifested symptoms of these disorders. Then it adds a rule we did not expect: When the same are manifested they represent the own entity of disorders while their lightness (lessened severity) denotes the subsidence of the disorder. The same faint signs mean two opposite things, depending on when they appear. Faint before, they announce the disorder; faint after, they announce its going.

Verses 20 to 23 list the general signs of disturbed vata, mostly stiffness, contraction, drying, trembling and numbness in many parts of the body. We do not reproduce the list; like every list on this page, they are not a guide to symptoms. Verse 24 asks the obvious question, why one dosha makes so many different disorders, and answers it in one short line: Due to difference of cause and location. The Samhita's own sorting of such conditions by dosha is the subject of our page on Sutrasthana 20; verse 24 explains the variety without listing it.

Sthana: Fourteen Addresses (Verses 25 to 37)

Verses 25 to 37 describe disturbed vata by where it lodges (sthana, place). Van Loon's chart has fourteen rows: the bowels, the whole body (sarvanga), the anus (guda), the stomach (amashaya), the colon (pakvashaya), the sense organs (indriya), the skin (twak), the blood (rakta), muscle and fat together (mamsa and medas), marrow and bone together (majja and asthi), the reproductive tissue (shukra), the ligaments (snayu), the vessels (sira) and the joints (sandhi).

Two things in the chart deserve a second look. The first is the skin. Among the tissue rows, twak stands where the first tissue, rasa, would stand, and rasa itself never appears. That is not a quirk of this chart. In Charaka's account of the excellence of each tissue (sara), Vimana Sthana 8.103, the first excellence is also twak-sara, the excellence of the skin, and Van Loon flags it there with a note of his own: note the use of Twak vs. Rasa.

The second is the pairing. Muscle shares a row with fat, and marrow with bone, the same pairs Charaka uses later when he gives a measure for each address (28.89–98). Our page on Sushruta's Chikitsa Sthana 4 compared that list with Sushruta's thirteen seats; the rows here are the other half of the same address book, the half that describes rather than prescribes. One row earns its image. When vata lodges in a joint, the chart describes a swelling like air-filled bladder to the touch.

Ardita to Khalli: Twelve Named Forms and Two Verdicts (Verses 38 to 57)

Next the chapter names particular forms. Van Loon's headings give eleven, and a twelfth is described without a heading: ardita, the face pulled to one side; manyastambha, stiffness of the sides of the neck; antarayama, the body bent forward, and bahirayama, bent backward like a bow; hanugraha, the jaw locked, open or shut; akshepaka, repeated convulsions; dandaka, the body stiff as a stick; the loss of movement in one side of the body, which Sushruta calls pakshaghata; ekanga and sarvanga, one limb or the whole body; gridhrasi, which starts at the hip and runs down the leg; and khalli, cramps in the foot, shank, thigh and wrist.

Two verdicts sit inside the list. Of dandaka the handbook says flatly: This is incurable. Then comes a rule for ardita etc., the forms just listed. When the attack passes, the person feels normal; if it persists, it brings its troubles with it, and The physician should not take up these cases. (verse 52). A physician of Charaka's school was expected to know which cases to decline as well as which to take.

One entry quietly anticipates the doctrine the chapter is about to state. Of gridhrasi, verse 56 says: These symptoms are of V but when the disorder is caused by V and K it is associated with drowsiness, heaviness and anorexia. Here, inside a single form, are vata alone and vata with kapha, told apart by what the second one adds. Then the list closes with an open door: The remaining disorders may be known from the symptoms according to location and name. The twelve are examples, not a catalogue. Sushruta's versions of several of them, with his conditions for accepting each case, are on our urustambha page.

Dhatu-Kshaya or Avarana: The Two Causes (Verses 58 and 59)

Then comes the line the whole chapter turns on. Above it Van Loon prints a banner: five asterisks, three exclamation marks, five asterisks. We looked through both volumes of the handbook for another like it and found none. Under the banner: Vitiation of V takes place due to either 1) wasting of Dhatus or 2) obstruction in Srotas. That is Chikitsa Sthana 28.58–59.

Two causes, and only two. The first is dhatu-kshaya, the wasting of the tissues. The second is the obstruction of the srotas, the body's channels, and its usual Sanskrit name is avarana, covering. Van Loon's word for it, in the chart that follows, is covered. Bhishagratna's Sushruta keeps the Sanskrit participle and translates it in a bracket: surcharged (Avrita).

The two read like opposites, and in a sense they are. On the first road the channels are empty and vata rushes into them, which is what verse 18 described. On the second the channels are blocked and vata cannot pass, which is what the causes amadosa and holding back the urges point to. One wind, two failures: too much room, or too little.

Two ways a channel fails: it runs dry, or something fills it. Verses 58 and 59 give vata the same two roads.

Why does the pair matter so much that an editor gave it asterisks? Because the two ask for opposite answers. An emptied channel needs filling; a blocked one needs opening, and filling a blocked channel only adds to the block. The chapter takes this up the moment it turns from knowing to doing, and we come back to it at the end of this page. Sushruta's Nidana Sthana 1, as far as we read it, never states the pair as a rule, but one of its prognoses sorts a form of vata into cases that line up with it. We read that passage under sadhya below.

Saukshmya: Vata Carries Pitta and Kapha (Verses 58 and 60)

Before the coverings, the handbook gives Charaka's account of how they come about, under the heading V mixed with K and P. First a warning to the physician: In all these disorders, association of P etc. should be observed. Then the reason:

V, P, and K move in all the channels of the body. Due to subtleness, V itself provokes the other 2 doshas. When aggravated it excites them and carrying them to different places produces different disorders due to obstruction in passage and dries up rasa etc. (the dhatus).

Saukshmya, subtleness, is the key word. Vata is the fine, mobile dosha, so it reaches where the others cannot, stirs them and carries them along. Now look at what the carrying does. It produces disorders due to obstruction in passage, and it dries up rasa etc. Both roads are in one sentence. The wind that carries the other two into the wrong place blocks itself with its own load, and dries the tissues on the way.

A wind carries whatever it picks up. Verse 60: being subtle, vata stirs pitta and kapha and carries them elsewhere.

The idea is older than this chapter in the Samhita's own order. In Sutrasthana 17.45–61, in a chart of what happens when one dosha is diminished and another increased, Charaka uses the same verbs. With kapha low and vata high, V Carries P; with pitta low and vata high, V Drags K. And when pitta or kapha rises, it can block the wind: P obstructs V, K obstructs V. Our page on Sutrasthana 17 walks through that chart's sixty-two combinations. Chikitsa Sthana 28 is where obstruction becomes a diagnosis of its own.

Avarana: The Eleven Coverings (Verses 61 to 71)

Then the chart the chapter is known for. Van Loon heads its first column Dosha or Dhatu covering V and fills eleven rows, Chikitsa Sthana 28.61–71. We give one or two signs from each row, never the whole row, and leave the reproductive row in the book:

Eleven rows: two doshas, six tissues, food, and two wastes. Five of the rows name something that eases or worsens the person; six do not.

Count the tissues and one is missing. The body has seven dhatus, from rasa, the first, to shukra, the last; the chart has six of them, and rasa has no row. We could not check a Sanskrit text for a rasa line, so we report the chart as Van Loon prints it and leave the question open. In the address chart of verses 25 to 37 the skin stood in rasa's place. Here neither appears.

The medas row carries a name: Medas causes adhyavata which is characterised by shifting, unctuous, soft and cold swelling in body parts along with anorexia. This is curable with difficulty. Our urustambha page followed that name, adhya-vata, through three different uses in two texts; here it is one row of eleven. The blood row has a long story of its own in vata-rakta, where vata and blood are bound together. And the food row looks like amadosa from the list of causes seen from the other side: food that has not moved on, sitting in vata's way. That reading is ours.

Upashaya: Reading a Covered Wind by What Eases It

Charaka names five means of knowing a disorder in Nidana Sthana 1.6–11: its cause (nidana), its early signs (purvarupa), its signs (linga), what suits the person (upashaya) and its course (samprapti). The handbook glosses upashaya as therapeutic suitability, the suitable use of drug, diet and behavior which are contrary to the cause and the disease. In plain words: what suits the person tells you what is wrong.

Five of the eleven covering rows use exactly that kind of evidence. The bone row is known by a liking for heat and kneading, the marrow row by aches that ease under the hands, the food row by trouble that comes with eating and goes when the stomach is empty. The two dosha rows go further, because they mirror each other. Pitta covering vata brings aggravation of burning sensation by the use of pungent, sour, salty and hot things and desire for cold. Kapha covering vata brings suitability of pungent, sour and salty and particular desire for fasting, exertion, rough and hot things. The same three tastes, pungent, sour and salty, appear in both rows. Under a cover of pitta they make things worse. Under a cover of kapha they suit.

Now set beside them what vata on its own asks for. In the handbook's summary of the measures that balance each dosha (Vimana Sthana 6.16), vata is balanced by what is unctuous, hot, sweet, sour and salty. Sour and salty suit the bare wind, but under a pitta cover they feed the cover; heat suits the wind, but a pitta cover wants cold. A covered wind and its cover want different things, which is why the coverings needed a chart of their own and could not simply be read as vata. Much later, the chapter's lines on the vayus covering one another end on a phrase that fits this bind exactly: hot and cold measures alternately (28.217–218). The fit is our observation; how a physician did any of it is a matter for the book, not for this page.

Pittavrita and Kaphavrita: Ten Covered Vayus in Charaka and Sushruta

The eleven rows cover vata as a whole. Charaka then asks what happens when pitta or kapha covers each of the five vayus separately: ten cases. Van Loon moved this material into Volume I, a chart headed Signs of Vata Sub-types Covered by Kapha and Pitta on pages 196 and 197, where the vayu's column is headed Blocked Dosha. The chart gives no verse numbers, so we cite it by page.

Sushruta does the same ten in his Nidana Sthana 1. Before them he gives three general unions of vata, with pitta, with kapha and with blood (Bhishagratna's paragraphs 26 to 28): the same three that open Charaka's eleven, and there Sushruta stops. Then, in paragraphs 29 to 38, he takes the five vayus one by one, and in Bhishagratna's English each is surcharged with pitta or kapha. Here are the twenty descriptions side by side, cut down to their signs. The apana rows concern the downward functions, the reproductive ones among them, so for apana we give only the count.

We count a sign as shared when both editions name it in the same row, allowing near-synonyms such as fainting and loss of consciousness, or exhaustion and languor. Fifteen shared signs in all: eleven in the five pitta rows, four in the five kapha rows. Three kapha rows, prana, udana and apana, share none.

The two texts describe a wind covered by pitta in much the same way: heat, burning, sweating, fainting. About a wind covered by kapha they mostly part company, and one of the partings has a shape. Sushruta's signs for udana covered by kapha are a stoppage or absence of perspiration, appearance of goose-flesh on the skin, impaired digestion, coldness and numbness of the affected part. Four of those five are Charaka's signs for a different vayu, samana covered by kapha: absence of sweating, poor digestion, horripilation, excessive coldness of body parts. And in Charaka, the signs fit the seat. Remember where verse 5 put samana: in the channels that carry sweat, beside the digestive fire. A cover on samana that stops the sweat and dulls digestion is what Charaka's own map would lead you to expect. We cannot tell from two English editions whether the Sanskrit texts really differ here or whether a row has slipped in one of them.

Below his chart Van Loon adds two notes. One defines a mixture: Signs of P and K together indicates “mixed covering”. The other ranks the five: Covering of Prana and Udana by P or K is serious. Life is dependent on Prana, and strength is dependent on Udana. The chapter opened by calling vata life and strength. Here the two words come back, each given to one vayu.

Twenty Mutual Coverings: Eight Described, Twelve Left Open (Verses 199 to 218)

The last step is the subtlest: the vayus can cover one another. On printed page 650 the handbook gives the rule: Prana covers udana etc. and the latter also covers prana. Similarly all others udana etc. cover mutually. Thus there are 20 types of mutual covering of the 5 types of V in stage of aggravation. (Chikitsa Sthana 28.199–200). Five vayus, each able to cover any of the other four: five times four is twenty.

Then a count, Thus the 8 types of covering have been mentioned above broadly with symptoms and treatment for adding to the knowledge of the wise. (215–216), and an instruction for the rest: The physician should also diagnose the other 12 types of covering of V looking to their location and increase or decrease in functions. (217–218). Eight described, twelve left to the physician's judgment.

Van Loon's Volume I chart of the mutual coverings, on page 293, splits the twenty the other way. It prints twelve pairs with their signs, not eight, and so leaves eight undescribed. Every one of its twelve rows involves prana or vyana, and prana appears in eight of them. Eight and twelve make twenty either way; which eight Charaka meant, we cannot tell from an English handbook.

The rule for reading any of them is short: in the state of covering there occurs diminution or aggravation in normal function of these types of V. A covered vayu does too little of its own work, or too much. And the aim, as the Volume I chart puts it, is direction: Udana should be led upwards, apana should be directed downwards, samana should be brought back to the middle, vyana moved in all three directions, and prana protected most carefully. The chart's last line on the subject is the chapter's first idea run in reverse: Those V sub-types which are covered or moving in the wrong course should be brought back to their normal positions. Unimpeded movement was health. Putting each wind back on its own road is the goal.

Two more lines close the doctrine. Coverings that are missed continue for a year and neglected or managed improperly become incurable (235–237). And Charaka ends the subject by admitting how hard all of this is to see: As in Universe the movement of air, sun and moon is difficult to be known so is that of V, P and K in the body. (Chikitsa Sthana 28.246).

Air, sun and moon: verse 246's picture of how hard the three doshas are to follow inside the body.

Sadhya and Asadhya: Depth, and Sushruta's Order of the Two Roads

Prognosis in this chapter is a matter of depth. Some forms, verses 72 to 74 say, are curable with difficulty or incurable due to deepness of their location, and even these should be treated if they are new, free from complications and in strong patients. The list that follows ends on the forms located in majja and asthi, as our Sushruta Chikitsa Sthana 4 page noted. The deepest of them are seated in the tissues, and the tissues are the first road.

Sushruta is more explicit. In his Nidana Sthana 1 (Bhishagratna's paragraph 55) he gives the prognosis for pakshaghata, the loss of movement in one side of the body, as three cases. Brought about by vata alone, it can be cured only with the greatest care and difficulty. Brought about by vata in conjunction with the deranged Pittam or Kapham, it proves amenable to medicine (Sadhya). And It becomes incurable when caused through the waste of the root principles (Dhatu) of the body.

Put that beside Charaka's two roads and an order appears, if Sushruta's vata in conjunction with pitta or kapha is read as Charaka's covered vata, which is our reading, not his. Of the three cases, the covered one is the most hopeful and the wasted one the least, with vata alone in between. Sushruta is speaking of one form only, and Charaka draws no such ranking himself. But where either text gives a verdict, the road of wasting is the hard one. A prognosis in an old text is not a prognosis for anyone today.

Kevala Vata: The Chapter's First Question (Verses 75 to 83)

When the chapter turns from knowing to doing, the two roads decide where it begins. Van Loon heads the first passage In the case that V is alone and uncovered (verses 75–82) and the next In the case that V is accompanied by excess impurity (verses 83–88). Vata alone, kevala, is met with oiling and warming. Where an excess of impurity keeps that from working, the next passage clears the impurity first and only then returns to the oil. The same wind gets its steps in two different orders, chosen by the road it took.

The first passage has one image, and it is the chapter's picture of what it expected from oil and warmth: After massage and fomentation even a crooked or stiffened limb can be bent gradually as desired like a piece of dry wood. Dry wood will bend if it is oiled and heated, slowly and with patience. These are a physician's measures in an old text, nothing anyone should imitate; the line is here for its picture, and for what it shows about the chapter's confidence.

Dry wood bends with oil and heat: the chapter's own picture of what it expected from oiling and warming, not a promise.

What follows on printed pages 638 to 650 is measures and preparations, and we leave it in the book.

What This Page Withholds, and Why

Indian law lists paralysis, lockjaw, fits and disorders of the nervous system among the conditions for which medicines may not be advertised, and a page on a shop's website should not read like an advertisement for one. So this page keeps to the chapter's ideas and its arguments, and withholds everything that could be read as a medicine or a measure to try:

• every preparation, ingredient, quantity and procedure in the chapter, including all of printed pages 638 to 650;
• the measures given in the Volume I charts for each covering;
• the reproductive row of the eleven coverings, the details of both apana rows, and the chapter's lines about conception;
• the full lists of signs, which we have cut to a word or two a row.

Nothing on this page should be read as a sign to look for in yourself, or as a measure to try.

What We Could Not Settle

• Whether the Sanskrit of verses 61 to 71 has a rasa row. Van Loon's chart has none.
• Which eight mutual coverings verse 215 counts as described. Van Loon's chart prints twelve.
• Why Sushruta's signs for udana covered by kapha are Charaka's signs for samana covered by kapha: a real difference between the texts, or a row that slipped.
• Whether Van Loon's word "suitability" in the kapha row renders upashaya. We matched the English words; the handbook does not say.
• Bhishagratna notes a different reading, "loss of taste", in Sushruta's row for prana covered by kapha. It would give that row one sign in common with Charaka's.
• The sorting of the eighteen causes into the two roads is ours, and so is the reading of day-sleep.

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