An effort to analyze & differentiate ‘Avastha-pak’ and ‘Nishtha-pak’.

 

An effort to analyze & differentiate ‘Avastha-pak’ and ‘Nishtha-pak’

S. No.	Bhedakatva	Avastha-pak (Koshtha)	Nishtha-pak (Shakha & Marm-asthi-sandhi)
1.	Definition	No clear textual definition quoted but as per the context it may be…. “The sequential stages of digestion of ingested food in alimentary canal (Mahasrotas) is known as ‘Avasthas-pak’ where functional secretary state of Kapha & Pitta (Dosha-roopa) actively participating in co-ordination with Vatadosha resulting the formation of Dhaturoopa Doshas & ‘Aahar-kitta’ after the completion.” उक्तं हि तंत्रांतरे–“मधुरो ह्रुद्यादूर्ध्वं रसः कोष्ठे व्यवस्थितः (च. द.) अवस्थापाकात्‌ कफ-पित्तयोर्वृद्धिः (च.द.)	No clear textual definition quoted but as per the context it may be…. “The sequential stage of nutrition/formation of Rasadi saptadhatu, upadhatus & dhatu-malas etc in presence of Rasagni onward sapta-dhatwagnis. This takes place in Yakrita mainly and  various srotasa split all over the body.” विपाकस्तु रसमलविवेकसमकालो भिन्नकाल एवावस्थापाकैः सममिति न विरोधः (च.द.)
2.	Synonyms	Sthool-pak, Prapak, Pratham-pak	Sookshm-pak, Vipak , Gun-pak, (परिणामे गुणाढ्यत्वं विपाक इति सञ्ज्ञितम् ||५३||)  (R.Ni.)
3.	Importance	This is the most important 24X7 functional lifeline event in Alimentary Canal of human-body coordinated by various factors. As per Ayurveda Physiology, it is the base of Dosha-dhatu-mala-axis that lays the foundation of almost all basic principles of ‘Chikitya-purush’ like location of Doshas, Prakriti, Koshtha types, circadian cycle as per daily as well as seasonal changes etc.   उदीर्णपित्तेत्यादि मृदुकोष्ठस्वरूपकथनम्|  क्रूरकोष्ठस्य ग्रहणीगतो वायुर्गुडादीनां सरत्वं प्रतिबध्नाति, मृदुकोष्ठस्य हि ग्रहण्यां विरोधको वायुर्नास्ति, स्तम्भकोऽपि श्लेष्माऽल्पः, उद्भूतसरत्वगुणं च पित्तं प्रबलं; तेन गुडादिभिः सुखं विरेचनं भवतीति भावः||६५-६९||Ch. Su.-13)	This is the most important 24X7 functional circulatory lifeline through out the human-body including the all walls of the Alimentary canal, (only the hollow space of Alimentary canal is known as ‘Koshtha’ that a place of ‘Avastha-pak’ while the structural part must be taken as ‘Shakha’.) coordinated by various factors. As per Ayurveda Physiology, it is the base of Dosha-dhatu-mala-axis that lays the foundation of almost all basic principles of ‘Chikitya-purush’ like location of Saar, Samhanan, Praman etc. वृष्यादीनां प्रभावस्तु पुष्णाति बलमाशु हि||२०||(Ch.Chi.-15) अनुलोमोऽनिलः स्वास्थ्यं क्षुत्तृष्णोर्जो मनस्विता | लघुत्वमिन्द्रियो द्गार शुद्धि र्जीर्णौष धाकृतिः||२६|| क्लमोदाहोऽङ्गसदनं भ्रमो मूर्च्छा [१] शिरो रुजा| अरतिर्बल हानिश्च सावशेषौषधा कृतिः ||२७||(Ch.Si.-6)   यात्यधो दोषमादायपच्य मानं विरेचनम् | गुणोत्कर्षाद्व्रजत्यूर्ध्वम पक्वं वमनं पुनः ||३४|(Su.Chi.-33)
		Actually these two stages are almost inseparable or very very thin line in-between, because these are the base of each other. If Avastha-pak is not well then Nishtha-pak would also be affected sooner or later and vice versa. सम्यङ्मिथ्याविपक्वानि गुणं दोषं वा जनयन्ति |
4.	Types	3- Madhur-amla-katu	3- Madhur-amla-katu Tri-vidha-vipak (Chakrapani on Ch.Chi.-15/09-11)
5.	Agni	Action of Bhootagni & Jatharagni	Action of Dhatwagni mainly
		Proximal action	Remote action
6.	Area/ Location	Whole Mahasrotas(GIT) from mouth to anus. Madhur- Mouth, Oesophagus & Upper Stomach. Amla- Lower Stomach, Duedenum & Small intestine. Katu- Pakwashay (from cecum to anus. In short, ‘Avastha-pak’ is an intraluminal (In GIT only) essential event for the life.	Yakrita (Liver) & all Srotasa allied the whole body.   In short, ‘Nishtha-pak’ is an extra-luminal (Extra luminal) essential event for the life.
7.	Dosha Components	Pran Vayu- Shtheevan (Salivation) & Nigiran (Swallowing). Bodhak Kapha- Salive for lubrication & softening the food. Saman Vayu- Secrets & Regulates digestive enzymes & Bile. Kledak Kapha- Lubrication, softening & churning of the food. Pachak Pitta- Complete Digestion of the food. Vyan Vayu- Propel the Digested nutrients in the Nishthapak (systemic circulation). Apan Vayu- Excretion of Kitta (digestive waste)- Purish & Urine.	Sapta Dhatwagnis & Vyan-vayu- Action of Ras-raktagnis onward Dhatwagnis on Aahar-ras to convert it in various required Dhatus, Upadhatu, Dhatu-malas & Ojas etc. in co-ordination of Vyan vayu along with Pran-vayu.
8.	Srotas	Direct or baseline or constituting-Mahasrotas, Annavah, Purishvah, Mutravah, Udakvah Srotasas Indirect relation- Pranvah, Raktavah, Medovah Srotasas	Remaining all Srotasas
9.	Production/ Formation of Kitta/Mala	Purish(Stool), Mootra(Urine) after the completion of ‘Avastha-pak’. किट्टमन्नस्य विण्मूत्रं, (Ch.Chi.-15)	1.Ras-dhatu- Kapha (Malaroopa/Expectorant) 2.Rakta-dhatu- Pitta (Bile) 3.Mamsa-dhatu- Metabolic wastes found in Mouth, Nostrils, ears etc. 4.Medo-dhatu- Sweda (Sweat) 5.Asthi-dhatu- Kesha, Loma (Scalp & body Hairs) 6.Majja-dhatu- Akshi-twak-sneha (Eye gunk & Sebum) रसस्य तु कफोऽसृजः । पित्तं, मांसस्य खमला, मलः स्वेदस्तु मेदसः ॥१८॥ स्यात्किट्टं केशलोमास्थ्नो, मज्ज्ञः स्नेहोऽक्षिविट्त्वचाम् (Ch.Chi.-15)
10.	Dosha relevance & cycle	Kapha is secreted in first M.A.P. as per the capacity of individual constitution of the body to counter the Ushna, Teekshna, Vidahi etc Gunas present in diet /drugs if any. Pitta is secreted in second A.A.P. as per the capacity of individual constitution of the body to counter the Sheeta, Snigdh, Guru etc Gunas present in diet /drugs if any. These two stages purely regulated & coordinated by Pran-saman-vata. Actually these 2 stages (Madhur & Amla) are the based on the individual strength, prakriti, saar, samhanan ets where Dhaturoopa Doshas convert into Dosha/kriya-roopa Doshas to execute the most essential act for the life- The ‘Digestion’. K.A.P. as a Last stage generates the ‘Ushna-vayu’ because of presence of ‘Aagney-bhav’ in digested food that helps in ‘Sar-kitta-vibhajan’ & Vyan-vayu propel the Aahar-ras in the form of absoption and with this the completion of ‘Avastha-pak’ takes place. Further, the formation of Dhaturoopa Doshas takes place with Aahar-ras in next ‘Nishthapak’ & this cycle continue through out life.	It is totally different from A.P. After completion of ‘Avastha-pak, Aahar-ras enriched with Dhatu-roopa-doshas (enriched with essential nutrients) dominated by either Kapha, Pitta or Vata as per the Doshaja-dominance in diet  where ‘Sapta-dhatu-poshakansha’ utilized by ‘Saptadhatvagnis’ (known as ‘Vipak’) as per the ‘Dhatu-poshan-nyay’. Generally Aahar-ras calories should be high from the calories consumed by individual then the ‘Brimhan’ effect would be there if it is vice versa then ‘Karshan’ would be there, though there are many other factors responsible for that enlisted in Ch. Su.- 22 & 23) Again after food intake ‘Dhatu-roopa-doshas’ get the kriya/dosha-roopa-doshas generating ‘Avastha-pak’ onward. This cycle continued through out the life. As per the Doshaja-dominance in Aahar-ras, the ‘Vipak’ is classified as Madhur, Amla & Katu similar to ‘Avasthapak’.
11.	Active form of Tridosh- Saptadhatu mechanism	Mahasrotas (Alimentary canal) is the main natural site of the Dhaturoopa Tridosha- Urdhwa Aamashay for Kapha, Adho Aamashay Pitta & Pakwashaya for Vat-dosha. They do participate actively as a ‘Kriyatmak-doshaas’, may lead to ‘Chayadi’ 6 stages if ‘Avastha-pak’ gets interrupted or imbalanced with any Dosha specific or other Nidanas indulged if any.	Whole body except the hollow part of GI lumen is also secondary site of the Tridosha. Urah (Thorax), Shiro (Head), Griva (Neck), Parva (Joints), & Medas (Fat) are sites of Dhaturoopa-kapha, Swed (Sweat), Ras (Plasma), Lasika (Lymph) & Rudhir (Blood) are sites of Dhatu-roopa-pitta while Basti (Bladder), Purishadhan (Colon), Kati (Lumber), Sakthi (Thighs), Pad (Feet) & Asthi (Bones) are sites of Dhaturoopa-vat-dosha. (Ch.Su.20/8) When Doshas stay its specific sites in healthy state called ‘Dhatus’ maintaining the normal physiology & health, and these may act as ‘Kriya-roopa-doshas’ (Active metabolites) as per the requirement like Trauma, infection etc, then this process is called ‘Dosha-pak’ & if this exaggerates because of multiple potent pathological factors leading to tissue necrosis etc then it is known as ‘Dhatu-pak’ in Ayurveda terminology’
12.	Action of Ras-panchak	Mainly the action of ‘Ras (Taste)’, present in diet/drug is seen here in A.P. with some action of Guna (Attribute/quality), Virya (Potency) & Prabhav (Unique effect/Special action) too if any.	Mainly action of ‘Vipak’ (Post digestive effect) as per Doshaja-dominance present in Aahar-ras is seen with action of Prabhav too if any.
13.	13-A. Rog-marga	Koshtha/Aabhyantar Rog-marg कोष्ठः पुनरुच्यते महास्रोतः शरीर मध्यं महानिम्नमाम पक्वाशयश्चेति पर्याय शब्दैस्तन्त्रे, स रोगमार्ग आभ्यन्तरः ॥४८॥ (Ch.Su.-11)	Shakha/Bahya-rog-marg तत्र शाखा रक्तादयो धातवस्त्वक् च, स बाह्यो रोगमार्गः; (Ch.Su.-11)
		मर्माणि पुनर्बस्तिहृदयमूर्धादीनि, अस्थिसन्धयोऽस्थिसंयोगास्तत्रोपनिबद्धाश्च स्नायुकण्ड१राः, स मध्यमो रोगमार्गः; (Ch.Su.-11) It must not be understood that A.P. & N.P. don’t effect/affect Marma or Madhyam Rog-marg. Both does effect/affect all marmas including 3 main Marmas because these are structured/constituted by Dhatus (Specific tissues) so we can say that Action of ‘Nishtha-pak’ is more concerned. Actually this description of Rog-marg denotes the classification of the diseases as per its origination. Disturbance in A.P. & N.P. mainly involved in ‘Nija-vikaras.
	13-B. Rog-marga & Rogas (Anatomical distribution of diseases)	The classification of Anatomical distribution is unique in Ayurveda science that it superficial in comparison to multiple systemic approach mentioned in contemporary science and ‘Sroto-dushti’ etc concepts illustrated in Ayurveda because the ‘Alimentary -canal’, the site of ‘Agni’ has been given great priority and all management principles based on the GIT.
		ज्वरातीसारच्छर्द्यलसकविसूचिकाकासश्वास हिक्कानाहोदरप्लीहादयो ऽन्तर्मार्गजाश्च विसर्प श्वयथुगुल्मार्शो विद्रध्यादयः कोष्ठानुसारिणो भवन्ति रोगाः ॥४९॥ (Ch.Su.-11/49)	तत्र, गण्डपिडकालज्यपचीचर्मकीलाधि मांसमषककुष्ठव्यङ्गादयोविकाराबहि र्मार्गजाश्चविसर्पश्वयथुगुल्मार्शोविद्रध्या दयःशाखानुसारिणो भवन्ति रोगाः; पक्ष वधग्रहापतानकार्दितशोषराजयक्ष्मास्थि सन्धिशूलगुदभ्रंशादयःशिरोहृद्बस्तिरोगा दयश्चमध्यममार्गानुसारिणो भवन्ति रोगाः;
14.	‘Sharir-kriya’ (Physiology) or ‘Vikriti’ (Pathology)	BASE OF PHYSIOLOGY AS WELL AS PATHOLOGY
		Both ‘Avastha’ & ‘Nishtha-pak’ are pure physiology & indicators of Life but also starting point of Pathology. Starting of all Nija-vikaras are absolutely depend on the imbalance of  ‘Avastha-pak’ first followed by ‘Nishtha-pak while other pattern like ‘Aagantuk’/‘Abhighataja’/‘Manas’ etc, chances are there to affect ‘Nishtha-pak’ first and later the ‘Avastha-pak’. Balanced & healthy functions of ‘Agni’ (Digestive-fire) is based on these two.(Ch.Chi.15) आयुर्वर्णो बलं स्वास्थ्यमुत्साहोपचयौ प्रभा । ओजस्तेजोऽग्नयः प्राणाश्चोक्तादेहाग्निहेतुकाः ॥३॥ शान्तेऽग्नौ म्रियते, युक्तेचिरंजीवत्यनामयः । रोगी स्याद्विकृते, मूलमग्निस्तस्मान्निरुच्यते ॥४॥
15.	Effect/affect of Seasons (Ritu)	Direct effect/affect is minimum but whatever the imbalance is experienced/observed in ‘Avastha-pak’ that is because of direct impact on ‘Nishtha-pak’.	Whole body is mainly affected by seasonal/environmental changes first then the modification of secretions of ‘Kriyatmak-doshas’ in GI takes place which is mainly responsible for ‘Chayadi-kram’ of Doshas. This will manifest the seasonal signs & symptoms in healthy individuals & modify the symptomatology in diseased according to the conditions of ‘Rog-rogi-ritu’.
16.	16-A. Naidanik affection	Direct affection by Aaharaja-nidanas (Dietary causative factors) first, later on pathology progresses to Nishtha-pak leading to ‘Shakha-dushti (tissue involvement as per ‘Koshtha to Shakhagamitva’ principles.	Viharaja & manas-nidanas (Regimen/physical activities & psychological causative factors) mainly affect ‘Nishtha-pak’ first, then followed by ‘Avastha-pak’.
	16-B. Role in almost all kind of manifestations of diseases	व्यायामादूष्मणस्तैक्ष्ण्याद्धितस्यानवचारणात् । को१ष्ठाच्छाखा मला यान्ति द्रुतत्वान्मारुतस्य च ॥३१॥ (Ch.Su.-28) Charakacharya state that almost all kind of disease manifestation take place when metabolic wastes (vitiated vat, pitta or kapha or Aam/Aam-visha or other entities get absorbed from imbalanced/disturbed ‘Avastha-pak’ (that’s takes place in GI lumen) to ‘Shakha’ (tissue level that is a place of ‘Nishtha-pak’). This physiological phenomenon is an essential in all living organism but may turn into pathology in presence of various causative factors. तत्रस्थाश्च विलम्बन्ते कदाचिन्न समीरिताः । नादेशकाले कुप्यन्ति भूयो हेतुप्रतीक्षिणः ॥३२॥ (Ch.Su.-28) Merely transportation of Doshas/malas from ‘Koshtha’ to ‘Shakha’ is not sufficient to manifest any disease because of ‘Vyadhi-kshamatva’ (Sharir-vriddhikar-bhav, Bal-vriddhikar-bhav Ch.Sha.-6/12-13) that resist but Doshas/malas unless not cleared/expelled from the body remains silently waiting for favourable condition to manifest the disease entity. Let’s take these 4 points one by one……
	16-C. Vyayam (Excessive physical activities or over exercise)	Decrease the ‘M.A.P.’ & increase in A. & K. A. if taken excessively. This phenomenon increases the absorption from GIT to compensate the energy requirement. If digestion process is not complete or ‘viruddhahar’ substances are there then intermediate indigested product entered in ‘Nishtha-pak’ leading to various disorders.	Increase in basic metabolism because of increased energy demand due to excessive physical activities so increase in ‘Nishtha-pak’ too that extract nutrition from A.P., if it is not sufficient then stored Dhatus utilizes. If indigested intermediate product enter here along with ‘Aahar-ras’ then possibility of manifestation of any sign or symptom or any disease there.
	16-D. Ushmanah Taikshnyat	Excessive power of digestive fire causes M.A.P. remarkedly leading to affection of N.P. too that results in generalized ‘Shleshma-guna-hani’ at tissue-leval (Dhatu-roopa). This leads to reactive partial ‘Vat-sanchay/prakopa’ too that may lead to various disorders.	Short M.A.P. lead to ‘Pitta-dominant ‘Aahar-ras’ along partial ‘Vat-sanchay/prakopa’ that results in generalized ‘Shleshma-guna-hani’ at tissue-leval (Dhatu-roopa). If ‘vyadhi-kshamatva’ is not appropriate then there are possibility of manifestation of any sign or symptom or any disease of ‘Paittika/vatapaittika’ nature there.
	16-E. Hitasyanava-charanat (Imbalanced/ unhealthy diet)	Incompatible or imbalanced or unhealthy or ‘Viruddhahar’ is most important causative factor mentioned for almost all kind of ailments. It first imbalances all 3 stages of A.P. as per doshaja dominance in presence of lack of nutritious factors etc.	Afterward it reaches to N.P. with ‘Aahar-ras’ and may lead to certain signs and symptoms if immune component is unable to counter.
	16-F. Drutatvat Marutasya	This is very broad causative mechanism applicable to almost all kind of pathogenesis, Vata-dosha being leader, responsible for all types of transportations in the body. Here in A.P., this mechanism come into force in presence of mentioned above factors along with condition of ‘Dhatukshaya’ etc. ‘Chala-guna’ may modify the sequence & timing ‘Avastha-pak’, Kapha or Pitta secretions, intestinal motility, increase or decrease the ‘Sar-kitta-vibhajan’, impact on absorption etc	Similar to ‘Avastha-pak’. Additionally, here ‘Aahar-ras’ will show the characters of Dominance of Dosha/Doshas/ Mala/ Malas/Aam etc that it obtained during ‘Avastha-pak’. Vatadi-doshas get ‘Sthan-samshraya’ ‘Shakha’/Dhatus initiated by leader ‘Vatadosha’.
		All ayurveda management principles given greatest priority to the ‘Tridosha’ and ‘Dosha-pratyanik-chikitsa’ has been applied every where whether the disease is caused by Vat, Pitta & Kapha or originated either from ‘Koshtha, ‘Shakha’ or ‘Marm-asthi-sandhi or concerned to ‘Manas’/Psyche etc. When we talk about the Doshas then their all functions are executed through ‘Avastha/Nishtha-pak’ always. So the transportation of the ‘Doshas’ from ‘Koshtha’ to ‘Shakha’ are always found in almost all kind of ‘Sampraptis’ in almost all kind of diseases.
17.	17-A. Consideration in Chikitsa (Therapeutics or management)	When it is said ‘Dosha-pratyanik-chikitsa’ then it is always executed through ‘Avastha-pak’ first. All oral intake either diet or drug or any type of ‘Pathya’ first dealt by A.P. then followed by N.P. Here properties of ingested material converted into a form that can be utilized by the body & this may be called ‘Sharir-satmyikaran’ or biotransformation of diet.	When it is said ‘Vyadhi-pratyanik-chikitsa’ then the target is ‘Nishtha-pak’ usually, though it is also executed through ‘Avastha-pak’ (Sharir-satmyikaran or bio-transformation) always where Gunas (essence) of diet, drug etc. enters here to form or modify or correctify Dhatus/tissues dealing with ‘Dhatwagnis’.
		Charak Samhita Sharir-sthan- 6/16-17
	17-B. Panchakarma Procedures	All types of genuine main procedures are performed through the desired alteration in ‘Avastha-pak’ that include Deepan, Pachan, Snehan (internal), Swedan (Partial), Vaman, Virechan & Vasti.	All types of associated external Panchakarma procedures mainly exert the effect on ‘Nishtha-pak’ directly like all types of external Snehan-swedan, Nasya, Shiro- dhara-vasti, Agnikarma etc. These all procedures bypass the ‘Avastha-pak’
	17-C. Execution of ‘Shodhan-chikitsa’	As above	As above
		वृद्ध्या विष्यन्दनात् पाकात् स्रोतोमुखविशोधनात् । शाखा मुक्त्वा मलाः कोष्ठं यान्ति वायोश्च निग्रहात् ॥३३॥(Ch.Su.-28)
	17-D. Vriddhi (Increase or therapeutic aggravation)	It is a unique approach mentioned, practiced largely where stuck (Leena) metabolic waste or Dosha increased or aggravated in planned manner to bring back in in circulation. The process starts with A.P. with use of specific drug/diet/pathya useful specifically like ‘Pramathi’ diet or drug, also ends with excretion of ‘Leena-dosha’.	After A.P., planned increase or aggravation process takes place in N.P. where Leena-dosha gets dissolved & brought in circulation and later on again it is extracted in ‘Koshtha’ & expelled it out with specific purgative drugs or Virechan/ vasti-karma). Ex.- Planned purgation in ‘Kaamala’.
	17-E. Vishyandan (Liquification)	A.P. has hardly any role in this process specifically in ‘Panchakarma-procedures’ unless the used of ‘Swedopag’ (Drugs helpful to induce sudation in the body) drugs or diet/pathya. This step is executed in ‘Nishtha-pak’ primarily.	In mentioned above process in point no. 17-D, Vishyandan process also takes place. Additionally, swedan (sudation) process is mainly applied purposefully to induce ‘Vishyandan’/Liquification during chief Panchakarma procedures.
	17-F. Pakat	Again A.P. has hardly any role in this process because it takes place in ‘Shakha’ a place of  ececution ‘Nishtha-pak’ in presence of ‘Dhatwagnis’. But in the process of ‘Virechan-karma’ it is essential for the virechak-drug to be digested in ‘Avastha-pak’ while this is minimum in ‘Vaman-karma’. तद्द्रवैर्भिन्नसङ्घातं | (Ch.Chi-15) इयं चाल्प कर्मकता प्रभूतभेषजस्य दीप्तिकारण कोष्ठ व्याप्त्यादि प्रयोजनात् क्रियते, तेन न निष्प्रयोजना|(Ch. K.-12/48-49)	‘Vriddhi’, ‘Vishyandan’ & ‘Pak’ (completion of digestion/ maturation by chemical activities in the presence of Dhatwagni components with therapeutic aggravation & liquification) are multiple steps of one event that makes metabolic waste liable to bring back in circulation that to be excreted through the GIT. यात्यधो दोषमादाय पच्यमानं विरेचनम् | गुणोत्कर्षाद्व्रजत्यूर्ध्व मपक्वं वमनं पुनः ।(Su.Chi.-33) विपाक इति पाकः द्रव्याणां स्वरुप-रसयोः परावृत्तिः । सा च स्वरुपांत रत्वेन रसांतरत्वेन च परिणतिः तस्या विशेषो विपाकः । (Gangadhar)
	17-F. Sroto-mukh-vishodhanat	This is again a very broad terminology used frequently in Ayurveda management process. Here, regarding the A.P., all previous steps makes all microchannels able to excrete the metabolic wastes easily as well as smoothly without the causing any consequences.	Here also same event takes place as in A.P. but active microchannels are at tissue level & ‘Vriddhya’ etc steps makes them able so the dissolved & liquified metabolic wastes can enter in circulation to be excreted it out through GIT.
	17-G. Vayoshcha-nigrahat	All sequential steps are based on the normal desired/required movements of ‘Vayu’, if this is vitiated in any form either because if Kala (Season), Desha (Locality), Bal (Strength of the patient/drugs or severity of disease) etc. then chances of occurrence of  ‘Vyapad’  there in case of ‘Shodhan’ & under or nonachievement of desired results in ‘Shaman’-therapy. It is applicable in both ‘Avastha’ & ‘Nishtha-pak’.
18.	Consideration in ‘Shodhan-vyapad’.	Manifestations of all kinds of ‘Shodhan-vyapad’ are caused by pre-existing imbalance in ‘Avastha-pak’ mainly, that couldn’t have been normalized by instructed implementation of proper Panchakarma’s ‘Purvakarmas’.	It is not directly involved as A.P. but ‘Ati-yoga’ condition does affect it due to excessive ‘Sadyo-dhatu-kshaya’ with the possible affection of ‘Marmas’ too.
19.	Conclusion	It can be concluded that ‘Avastha-pak’ is an indicator of life & starting points of almost all kind of Doshaja, Dhatu-pradoshaja & Srotodushtija disorders as mentioned by Charakacharya in Ch.Chi.-15/45-49. Primarily ‘Avastha-pak’ is responsible for the biotransformation of the dietary substances so body can utilize it in ‘Nishtha-pak’	It can be concluded that ‘Nishtha-pak’ is a process in which body deals with bio transformed dietary substances & utilizes it as per the requirement either as energy or formation of 7 Dhatus, Upadhatus & Ojas etc. Both ‘Avastha-paks’ are dependent on each other and disturbance in either one will lead affection to other certainly gradually as per the causative factors.
		सर्व एव निजा विकारा नान्यत्र वातपित्तकफेभ्यो निर्वर्तन्ते, यथाहि- शकुनिः स१र्वं दिवसमपि परिपतन् स्वां च्छायां नातिवर्तते, तथा स्वधातुवैषम्यनिमित्ताः सर्वे विकारा वातपित्तकफान्नातिवर्तन्ते । वातपित्तश्लेष्मणां पुनः स्थानसंस्थान प्रकृतिविशेषान भिसमीक्ष्य२ तदात्मकानपि च सर्वविकारां स्तानेवोपदिशन्ति बुद्धिमन्तः ॥५॥ (Ch.Su.-20/5) All internal diseases originate solely due to the disturbance of vata, pitta, and kapha (Avastha-pak). Just as a bird cannot escape its own shadow no matter how long it flies during the day, similarly, no disease can manifest without the involvement of these three dosha and the imbalance of bodily tissues (dhatu) [Nishtha-pak]. Therefore, by carefully assessing the site of manifestation, signs and symptoms, and specific causes responsible for the vitiation of vata, pitta, and kapha in each case, a wise physician can accurately diagnose all diseases. ||5|

 

 Simply the modification or alteration of ‘Avastha/Nishtha-pak’ may be understood with following table where expansion, interchange & shrinkage have been tried to present in simple systemic manner which would be helpful especially for undergraduate students.

S. No.	Bhedakatva	Avastha-pak (Koshtha)	Nishtha-pak (Shakha & Marm-asthi-sandhi)
1.	‘Madhur-avastha-pak’- Increased/expanded/ Exaggerated.	This will lead to manifestation of 20 Kaphaja-disorders through GIT. ‘Koshthastha’ (GIT) features will be visible first. Examples- ‘Apakti’ (indigestion), ‘Sheetagnita’ (loss of appetite) ‘Shleshmodgiran’ (cough reflux), ‘Mukhamadhurya/  srava (Sweet taste in mouth & Hypersalivation etc.)	Afterward ‘Shakhagat/Marma’ features get manifested with the involvement of ‘Nishtha-pak’ (‘Dhatwagnis’). Examples- ‘Tandra-nidra’ (Drowsiness, sleep), ‘Atisthoulya’ (Obesity), ‘Guru-gatrata’ (Heaviness in body) ‘Dhamani-pratichaya’ (Arterio-atherosclerosis) etc
		Charak-sutra-sthan- 20/17
2.	‘Amla-avastha-pak’- Increased/expanded/ Exaggerated.	This will lead to manifestation of 40 ‘Pittaja-disorders through GIT. ‘Koshthastha’ (GIT) features will be visible first. Examples- ‘Amlak/Dhoomak’ (Hyperacidity), ‘Daah/Vidaah’ (Burning0sensation), ‘Antardaha’ (Heartburn), ‘Pooti-mukhata’ (Helitosis), ‘Tikta-asyata’ (Bitter tasteness) etc.	Afterward ‘Shakhagat/Marma’ features get manifested with the involvement of ‘Nishtha-pak’ (‘Dhatwagnis’). Examples- Atisweda (Hyper-hidrosis), Raktakotha/visphota (Blisters), Raktapitta (Bleeding), Kaamala (Jaundice), Akshipak (inflammation in eyes) etc
		Charak-sutra-sthan- 20/15
3.	‘Katu-avastha-pak’- Increased/expanded/ Exaggerated.	This will lead to manifestation of 80 Kaphaja-disorders through GIT. ‘Koshthastha’ (GIT) features will be visible first. Examples- ‘Vid-bheda’ (Loose motion), Kashay-asyata (Astringent tasteness), Udavarta (Belching), Arasagyata (Tasteless ness), Gudabhransha (Rectal-prolepse), Udaraveshta (Colic pain Abdomen) etc.	Afterward‘Shakhagat/Marma’ features get manifested with the involvement of ‘Nishtha-pak’ (‘Dhatwagnis’). Here, the manifestation would take place through either ‘Dhatu-kshaya’ or ‘Margavarodha’ as instructed. Examples- ‘Gridhrasi’ (Sciatica), Hriddrava (Palpitation), Pakshavadha (Hemiplegia), ‘Ardita’ (Facial paralysis), ‘Shpro-ruk’ (Headache, Prishthagraha (Stiff back) etc
		Charak-sutra-sthan- 20/11
4.	Interchanges in ‘Avastha-pak’ in disease phenomenon	When 1 or 2 A.P. expands then it will reduce/shrink another 1 or 2 A.P. as per the capacity of its own or body. M.A.P., if this expand then Kapha dosha will dominate and chances are there to diminish Amla Avastha pak along with affection to K.A.P. because of Sheeta/cool Guna of Kapha. Here Guna dominance is key. Similarly if A.A.P. expands then M.A.P. may shrink & K.A.P. may be affected with Shleshma-kshaya. Same principle is applicable to K.A.P. Extended M.A.P. may reach the area of K.A.P. & may lead to symptom like indigestion, diarrhoea etc. while affection to K.A.P. may lead to dysentery etc. Extension of A.A.P. may be upward reducing the M.A.P. and developing the Amlapitta, Mukhapak,  G.E.R.D., oesophagitis etc while downward progression may lead to Ulcerative Colitis, Chrone’s disease like IBD etc. K.A.P. always dominate in the condition of Dhatukshaya leading to ‘Pratiloma-vat’ that may be taken as reverse peristalsis leading to constipation, colic-pain, Gulm, Abdominal distension etc many varied ailments including neurological disorders.	N.P. has not such event because there is not a locality wise step by step sequential stages here, as seen in A.P. & the dominant fine Dosha or Doshas will enter here with ‘Aahar-ras’ & changes are not visible so early as seen in A.P., because Dhatus have capacity to maintain homeostasis (Vyadhi-kshamatva). Constant indulgence of Dosha specific Nidanas will lead to affection in A.P. first, then after N.P. will generate specific signs & symptoms. Extreme Madhur vipak will lead to Hyperlipidemia/ dyslipidemia, hyperglycemia etc, Amal vipak may lead to metabolic acidosis or alkalosis while excessive katu vipak may lead to weight loss, neurological or deficiency disorders in the presence of ‘Dhati-kshaya’. As mentioned in point no. 1., 2. & 3. All Dhatwagni (Endocrine) disorders are accounted into Nishtha-pak.
5.	Conclusion	Basically the Concept of ‘Shat-kriyakal’, ‘Rituchakraja’ or ‘Vayo-aho-ratri-bhuktanaam te antya-madhyadiga Kramat etc all Dosha-chaya-prakopa & prasham’ get executed through ‘Avastha-pak’ initially and later on ‘Nishtha-pak’.

 

Presented by

Prof. Surendra A. Soni

M.D., Ph.D (Kayachikitsa)

H.O.D.

P.G. Dept. of Kayachikitsa

Govt. Akhandanand Ayurved College,

Bhadra, Ahmedabad, Gujarat, India.

email: kayachikitsagau@gmail.com

Reviewed & edited (DG) by

Prof. S. N. Lungare

M.D., Ph.D (DG)

H.O.D.

Dept. Of Dravyaguna 

PMT's Ayurved College,

Shevgaon, Dist. Ahilyanagar

Maharashtra, India. 

Email - drsnlungare@gmail.com