Understanding variants of abdominal distension from Ayurveda perspective

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Distension of the abdomen is explained in the name of ‘adhmana’ in Ayurveda texts. It is a vata vyadhi. There is another variant of adhmana which is called ‘pratyadhmana’.

While adhmana is a pure vataja condition, pratyadhmana is a vata condition associated with kapha. Adhmana begins from the colon whereas pratyadhmana has its origin from the stomach.

It is very essential to understand the differences between these two conditions so that proper treatment can be initiated.

Adhmana and Pratyadhmana are two different conditions which have been explained in brief in the context of Vata Vyadhi.

So, both these conditions are caused by aggravated vata, are special conditions caused by vata and hence qualify to be called as Vata Vyadhis. They are also variants of each other.

We find a small description about these conditions in a verse or two. The management too has not been specified in detail. But when we go through the description of these two conditions, we sense that we all would have experienced these conditions and the symptoms therein a few times in our lifetime. So, they are not uncommon conditions.

These conditions are not so severe that one would consider visiting the doctor to take medical opinion or undergo treatment through medicines or therapies as such. So, there are chances that one ignores these conditions or takes some home remedies or known over the counter medicines to combat the symptoms as and when they occur.

The real problem is when they run a long course and become chronic enough to disturb us. Therefore, understanding these conditions is very important.

In this article let us try to understand these variants, differential understanding and principles of management.

Adhmana and Pratyadhmana

Adhmana means distension. If not specified, adhmana means ‘distension of the abdomen’ caused by vata. It presents with distension of the abdomen.

Adhmana

साटोपमत्युग्ररुजमाध्मातमुदरं भृशम् ।।
आध्मानमिति जानीयाद्धोरं वातनिरोधजम् ।।८८ ।।

Adhmana is a condition caused by aggravated vata. It presents with severe distension of the abdomen.

Main Symptom – Severe distension of the abdomen is the main symptom of adhmana. The name of the disease itself is descriptive of its main symptom.

Associated symptoms –

– Atopa – gurgling sounds or noises in the abdomen

– Ati ugra rujam – severe pain in the abdomen / colic

Causes –

Any vata aggravating causes consumed for long periods of time, in the form of foods or activities which increase vata can cause adhmana, just like it causes other vata disorders. But a specific cause has been highlighted in the description of the disease. The cause is ‘vata nirodhajam’ i.e. habitual suppression of the urge to expel the fart or flatus. So, this condition is common in those people who forcibly stop the urge to expel the fart, when it occurs. This causes the fart and gases to be held back in the abdomen. This would aggravate vata and cause a condition called as ‘adhovata avarodhaja udavarta’ wherein the vata aggravated due to the forcible withholding of fart urge would move in upward direction and cause troublesome symptoms. This may not happen in those who hold the fart reflex once or twice or occasionally without their knowledge or as a point of compulsion, but will surely occur in those who are habituated to the same.

‘Adho vata nirodha’ can also be an effect of the disease. Gradually the colon will learn not to expel the flatus.

Adhmana is said to be in a dreadful condition and needs medical attention at the quickest.

Pratyadhmana

विमुक्तपार्श्वहृदयं तदेवामाशयोत्थितम् ।।
प्रत्याध्मानं विजानीयात् कफव्याकुलितानिलम् ।।८९ ।

As said, Pratyadhmana is a variant of Adhmana. Here also there is distension of the abdomen. Seeing its origin, we can consider it to be an ‘upper abdominal distension’.

Acharya Sushruta uses the words ‘tadeva’ which means ‘the same adhmana’, which clarifies that both are similar conditions manifest in slightly different ways.

Pathogenesis – When the same adhmana commences in the amashaya i.e. stomach, sparing the region of heart and flanks, it is called as Pratyadhmana. This condition is called vata in association with kapha.

Symptoms – The symptoms of pratyadhmana have not been specified but since ‘tadeva’ word has been used, we can infer the symptoms as –

– Atopa – gurgling sounds in the upper abdomen, in the region of stomach

– Ati ugra rujam – severe pain in the region of stomach i.e. upper abdomen

Differences between Adhmana and Pratyadhmana

Adhmana	Pratyadhmana
Distension occurs in the lower part of the abdomen, involving colon	Distension occurs in the upper part of the abdomen, involving stomach
Origin is pakvashaya – colon	Origin is amashaya – stomach
Caused by ‘only vata’	Caused by vata associated with kapha
Specific cause ‘vata nirodha’ has been mentioned	No specific causes have been highlighted
Sounds and pain are felt in the lower part of the abdomen	Sounds and pain are felt in the upper part of the abdomen
Kapha symptoms like heaviness of abdomen etc are not found	Though not described textually, kapha symptoms are found
Treatment shall be done on the lines of treating vata vyadhi chikitsa	Treatment shall be done on the lines of vata vyadhi chikitsa, giving importance to associated kapha

Treatment Principles of Adhmana and Pratyadhmana

आध्मानेत्वपतर्पणपाणितापदीपनचूर्णफलवर्तिक्रियापाचनीयदीपनीयबस्तिभिरुपाचरेत्;लङ्घनानन्तरंचान्नकालेधान्यकजीरकादिदीपनसिद्धान्यन्नानि।प्रत्याध्मानेछर्दनापतर्पणदीपनानिकुर्यात्।।२६।।

Nidana Parivarjanam

One should keep away from all those etiological factors which would cause increase of vata in the long run, mainly forcible withholding of ‘fart and defecation urges’.

Vata Vyadhi Chikitsa

General principles of treating ‘vata vyadhi’ shall be followed in treating these conditions.

Specific treatments

1. For Adhmana –

– Apatarpana – fasting, non-nutritive approaches

– Pani tapa – giving heat to the abdomen by warm hands / palms

– Dipana churna – herbal powders which would kindle digestive fire and enhance digestive capacity

– Phalavarti – suppositories

– Pachana – medicines to digest ama

– Vasti – enemas

Foods processed with dhāñyaka – coriander, jīraka – cumin seeds and such other carminative herbs should be served after the period of fasting.

2. For Pratyadhmana –