Introduction

Udavarta is a unique concept explained in Ayurveda which portraits itself as a disease or as Nidana or sometimes plays a major role in Samprapti of a disease. In Udavarta, the normal Gati of Vata Dosha is being obstructed. The obstruction can be due to any of the thirteen Vega Dharana mentioned in the classics or due to excessive consumption of Kashaya, Tikta, Ushna, Ruksha Bhojana, or Abhojan ^[1] (not taking food at all). In the present case, the patient was not taking food at appropriate time and was doing fasting most of the time. The foods she consumed included most of Ruksha Dravyas. Habituated by these routines, she gradually developed Udavarta which presented as severe constipation which in turn caused the acidity and abdominal fullness. For these complaints, she was taking allopathy medications which gave only relief to the acidity and not constipation. Unsatisfied by those treatment protocols she approached our hospital for a permanent relief of her condition. The multidimensional approach of Ayurveda provides a promising pathway for managing such chronic conditions with permanent solution.

Case Report

A 32-year-old female patient with an alleged history of severe constipation for 9 years along with burning sensation over chest and neck region, sour belching, nausea, occasional vomiting, feeling of heaviness in the abdomen, occasional rumbling and severe pain in the abdomen was presented to the hospital. The patient had severe burning sensation over chest and neck region when the duration of non-passage of stool increases more than 4 - 5 days. The Bristol stool form scale (BSFS) revealed the constipation to be of type 1 (very constipated) and constipation assessment scale (CAS) showed the score to be 14. She was advised with oral medications at first followed by 11 days admission in the hospital.

Examination

On examination, the patient was anxious; tongue was coated; appetite was poor; micturition was regular and bowel movement was irregular and constipated. The patient was in Madhyama Avasta, with Vata Pitta Prakriti, with Madhyama Samhanana (medium body built), Madhyama Sara (medium purest body tissue),

Results

The patient was assessed with Bristol stool form scale (BSFS) (Table 3) and constipation assessment scale (CAS) (Table 4) before and after therapy. Improvement was found in the scores of these scales (Table 5) evaluated after oral medication followed by 11 days IP treatment. Complete recovery from constipation, sour belching, nausea, occasional vomiting, burning sensation over chest and neck region, feeling of heaviness in the abdomen, occasional rumbling and severe pain in the abdomen was achieved which helped in improving her quality of life.

Discussion

Udavarta is a most common clinical condition that can be presented as a disease or Nidana or Samprati. It is characterized by the reverse movement of Vata, arises due to factors such as Vegadharana (suppression of natural urges) and improper dietary practices. This pathophysiology leads to obstruction in the Adhogami Srotas, resulting in varied symptoms like abdominal pain, distension, nausea, flatulence, and retention of stool and urine.^[4] If left untreated, Udavarta can contribute to chronic systemic complications and the progression of other diseases. In the present case, a structured Ayurvedic approach was employed to address the vitiation of Vata and associated symptoms. The therapeutic strategy combined internal medications with external therapies to achieve significant relief.

Internal medications such as Aamapachan Vati and Gandharvahastadi Kashayam played a pivotal role in correcting the digestive imbalance and Gati of Vata. Aamapachan Vati facilitated the digestion by removing Ama, thereby improving Agni and clearing Srotodushti.^[5] Gandharvahastadi Kashayam not only relieved constipation but also addressed Vata imbalance and enhanced appetite, making it highly beneficial for the patient.^[6]

Erabdabrishta Haritaki (EBH) was instrumental in facilitating the downward movement (Anulomana) of Vata^[7], while Sootasekhar Rasa effectively managed symptoms of acidity, such as sour belching and burning sensations.^[8] Abhayarishta was incorporated as it helps in managing Chardi, correcting the Gati of Vayu as well as increasing the Agni.^[9]

By the time of discharge, there was a significant improvement, as evidenced by a marked reduction in the Bristol Stool Form Scale (BSFS) and Constipation Assessment Scale (CAS) scores. The patient reported complete relief from symptoms such as a burning sensation in the neck and chest, abdominal fullness, occasional abdominal pain, abdominal rumbling, and chronic constipation. Upon discharge, the patient expressed full satisfaction with the outcomes of the treatment.

Table 1: Timeline of Internal Medication

Table 2: Timeline of External Intervention

Table 3: Bristol stool form scale

Table 4: Constipation Assessment Scale