Vegavastha, Avegavastha Stages Of A Disease (Dormant and Active Stages)

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Vegavastha and Avegavastha are two stages of any given disease. For a physician it is very important to know these stages of the disease (just like other stages) and also the difference between these two stages.
Vega = bout, attack
Avega = A + Vega = no bout, no attack, attack free
Avastha = stage
Read – Formation Of Doshas In Avastha Paka

Vega avastha of a disease

Vegavastha means stage of attack. This is a stage in which the disease is active with its full blown signs and symptoms. In some disease it might occur in the form of episodic attack.

This happens when the dosha involved in the pathogenesis of the disease attains amalgamation (sammurchana) with the tissues involved in the pathogenesis of the disease. In other sense this stage of the disease occurs following the dosha dushya sammurchana i.e. amalgamation of dosha and tissue involved in the causation of disease. When this amalgamation occurs, the attack of the disease precipitates and when this happens, the signs and symptoms of the disease are found.
Read – Ayurvedic Treatment Strategies To Break The Pathogenesis

Importance

Ideal stage for treating a disease – Since the disease has presented itself in its full form in this stage, treating it would be easy.
Samprapti Vighatana (breaking the chain of pathogenesis) – Breaking the pathogenesis in Ayurveda means breaking the amalgamation of morbid dosha and tissue (dosha dushya sammurchana). This can be done only when we know the nature of the disease. Vegavastha is the best stage for the physician to understand the nature of the disease and break the chain of pathogenesis.
Vyadhi Pratyanika Chikitsa – Disease specific remedies mentioned and elaborated in the classics can be administered.
Lakshana Pratyanika Chikitsa (symptomatic treatment) – Predominant symptoms of a disease can be managed with ideal symptom specific remedies.
Dosha Pratyanika Chikitsa (dosha specific treatment) – In this stage the dosha specific treatment and medicines can be administered after figuring out which dosha or doshas are involved in the pathogenesis.
Pathya Apathya Yojana – In the presence of the disease it is easy to plan, advise and implement proper dietetic and lifestyle restrictions.
Upashaya Anupashaya (relieving and aggravating factors) – This is also a stage, wherein when the diagnosis cannot be done accurately, the physician would put the patient under trial and error of treatments and medicines in order to rule out certain diseases and come to a conclusive diagnosis. This would further pave the right path for administering right treatments. Thus it also helps in differential diagnosis of a disease.
Read – Shat Kriya Kala – ‘Stage-Wise Disease Management’

Avega Avastha of a disease

Avegavastha means stage in between the attacks of a disease. This is a stage in which the disease is not active. The disease has also not gone away. It has just taken a break. We can call it a disease interval. This break can be range from few days to few months.
This can happen in a single day also. Example, if the fever has a pattern wherein it comes once in the morning and once in the evening, the part of the day between these two fever attacks is avegavastha because there is no fever herein.

In avegavastha the disease will not present with its signs and symptoms. The time gap between the relief from a disease and its recurrence after a long time can also be considered as avegavastha. This happens when the amalgamation of dosha and tissue involved in the pathogenesis of a disease gets broken and the attack is aborted for time being. There is no disease and the signs and symptoms of the disease too have disappeared for a short duration until they surface in the next vegavastha. In spite of the disease being not manifested, this stage too is considered as ‘the stage of a disease’.

Linavastha – This is considered as ‘the hidden’ or ‘latent disease’. It has not totally gone away. It is opportunistic and will recur once there are ideal conditions for its manifestation. In this stage, the doshas remain increased and dormant and can produce an attack when the conditions get favorable to it. Such stages are observed to occur in diseases like tamaka shvasa (bronchial asthma), vishama jwara (irregular fevers), apasmara (epilepsy) etc.

Importance

Ideal stage to strengthen the tissues – Since the disease is not active during this stage; the weakened tissues shall be addressed. Medicines and measures to enhance the tissue strength shall be administered. When the tissue strength is increased it would efficiently combat with the invading doshas in future. This would prevent recurrences. As a result the vegas of the disease will not come and hence the patient may not experience the vegavastha.
Ideal stage to strengthen the srotas – Channels of the body are the mode of transportation of different tissues and the building blocks and nutrition needed for the formation and maintenance of tissues. These channels too may be contaminated by the doshas and damaged in the disease process. In avegavastha the physician should look towards enhancing the strength of the channels related to the tissues.
Ideal stage to enhance vyadhikshamatva (immunity) – This is an ideal stage in which the immunity of the patient needs to be enhanced by administering Rasayanas.
Ideal stage to prevent recurrences – When proper rejuvenating and immune-modulator treatments are given during avegavastha further relapse and recurrences shall be prevented effectively.
Ideal stage to administer shodhana – Cleansing therapies like purgation and emesis cannot be given when the disease is active i.e. when the signs and symptoms are evident. In fact any therapies of Panchakarma cannot be administered. Likewise oleation (internal administration of medicated fats) too are contraindicated. We have to wait for the disease to slope down and take a pause and enter the interval period i.e. avegavastha so as to administer these therapies. On the long run, these therapies when done in the interim will also provide long standing immunity as well as effectively help in preventing the relapses and recurrences.
Ideal stage to work out on health balance – This is a stage wherein the patient can work out on long term plans for hitting and maintaining the health balance by discussing and making blueprints for the same with the help of his or her physician.

Importance Of Vyadhi Avastha

Vyadhi avastha means stage of a disease. They are stages of manifestation of disease or those of a manifested disease. Any given disease is in ‘one or the other stage of its manifestation’. Every disease will have its own pathogenesis. During the process of pathogenesis of a disease many stages are formed. These stages may vary from disease to disease. For a physician it is not only important to understand a disease and its pathogenesis but it is equally important to understand in which stage a given disease is in.

Importance

The physician should have a comprehensive knowledge of not only a disease but also its stages. This will help in –

1. Diagnosis of diseases
2. Determination of strength of the disease and the diseased
3. Determination of immunity of the person
4. Planning and administration of stage-wise treatment (treatment varies for different stages of a disease)
5. Giving advices regarding diet, daily activities and behavior
6. Deciding the prognosis of the disease
   Read – How To Make Prognosis Of Disease According To Ayurveda?

Therefore the physician, patient and attendants must keenly observe the changes occurring in the disease at different points of its course. The treatment choices should be planned in accordance to the stages of the disease. The changes which occur in a disease produce different stages of a disease. These changes take place with respect to the contributory factors responsible for the same which include – dosha, dushya, agnimandhya, ama and srotorodha.

1. Certain symptoms are specific for a given specific disease. These symptoms are not dependent on the stages of the disease.

Example – obstruction of sweating, rise in temperature etc are specific symptoms of fever and do not belong to any ‘stage of fever’. These symptoms will generally manifest in all fevers. apart from this, the other symptoms are either dependent on dosha dushti (quantity of aggravation of doshas) or vyadhi avastha (stages of fever). For a physician it is very much essential to differentiate the symptoms occurring due to contamination of doshas from those occurring due to ‘different stages of a disease’ so as to arrive at a correct diagnosis of the disease and also for implementation of treatment in a comprehensive way.

The symptoms of kapha disease and amavastha of a disease resemble each other. The symptoms of pitta disease and pachyamana avastha of a disease have closer resemblance. Here a comprehensive knowledge of the symptoms occurring due to different stages of a disease helps the physician to differentiate between both these conditions.
Example – heaviness of the parts of the body, salivation, vomiting sensation and drowsiness are the symptoms common in amavastha of fever and kaphaja fever. But the symptoms like indigestion, sluggish digestive power, excessive urination are the specific symptoms of sama jwara (fever associated with ama) which are absent in kaphaja fever. This is the key for differentiating between these two conditions.
Read – Ayurveda Lifestyle and Diet For Fever – 45 Important Things

2. If the treatment for any disease is given after properly understanding different stages of the dosha i.e. increase, decrease and balance, the condition of the body and digestive fire, the mental state of the patient and stages of the disease, the physician will attain fourfold success.

3. Treatment plans should be changed in accordance to the changes in the stages of the disease.
Example – Langhana i.e. lightening therapies are recommended in acute fevers. On the other hand oral consumption of ghee or medicated ghee is recommended in chronic stage of fever. Stambhana i.e. constipating treatments are the best in treating diarrhea but the same treatments should not be administered in diarrhea associated with ama. Lack of knowledge of stages of disease may lead to administration of erroneous treatments and medicines by the physician. Such treatments would lead to manifestation of many complications including deformities and death.

4. If the medicines and dietetic protocols are administered without the knowledge of specific stage of the disease they produce greater vitiation of doshas.

5. A proper knowledge of stages of diseases is helpful in preventing the development of severe stage of the disease. Example – pain in the heart is the early stage of hrdroga – heart disease. If this stage is treated properly we can possibly prevent the occurrence of heart disorders.

6. The knowledge of various stages of the diseases is also helpful in determining the prognosis of the disease. Antarvegi jwara (stage wherein the symptoms of fever are predominantly manifested inside the body) indicates difficult prognosis of the fever. On the other hand bahirvegi avastha (stage of fever wherein the symptoms are manifested externally) suggests good prognosis of fever i.e. fever can be easily treated. The benign type of tumor is easily curable while its malignant type is incurable. The dhatugata avastha i.e. stage in which the disease is lodged deep inside the deeper tissues such as bones, bone marrow and semen is incurable in nature.
Read – Upadrava: Complications of diseases, Definition, Examples

To sum up
Therefore a wise physician shall consider the different stages of a fever before administering any treatment since different stages demand specific interventions which are not applicable for the other stages of the same disease. This can be done on the basis of a comprehensive knowledge of disease pathogenesis and also the different stages of the disease. This also forms the basis for success in clinical practice as far as the physician is considered.
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