Scientific Basis for Ayurvedic Therapies -37

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

20. Susruta, Susrutha Samhita, Part 1, 8th ed., commentary by Shastri, K.A., Chowkhamba Sanskrit

Sansthan, Chowkhamba, Varanasi, India, Samvat, 1993, Nidana sthanam 241, chap. 3.

21. Mindelzun, R.E. and Jeffrey, R.B., An enhanced helical CT for evaluating acute abdominal

pain — a little more cost, a lot more information, Radiology, 205, 43, 1997.

22. Davidson, S., Principles and Practices of Medicine, 16th ed., Christopher, R.W. and Bouchier,

I.A.D., Eds., Churchil Livingstone, Edinburgh, 1991, chap. 12.

23. Susruta, Susrutha Samhita, Part 1, 8th ed., commentary by Shastri, K.A., Chowkhamba Sanskrit

Sansthan, Chowkhamba, Varanasi, Samvat 1993, Sutra sthanam 227, chap. 33.

24. Susruta, Susrutha Samhita, Part 1, 8th ed., Commentary by Shastri, K., Ambikadatta,

Chowkhamba Sanskrit Sansthan, Chowkhamba, Varanasi, Samvat 1993, Chikitsa sthanam 41

chap. 7.

25. Agnivesa, Charaka Samhita, 3rd ed., Revised by Charaka and Dridhabala, with the Ayurvedia-

Deepika commentary of Chakrapanidatta, Trikamji, V.J. and Pandurang, S., Eds., Nirnaya

Sagar Press, Bombay, India, 1941, Siddi sthana 698, chap. 4.

26. Susruta, Susrutha Samhita, Part 1, 8th ed., commentary by Shastri, K.A., Chowkhamba Sanskrit

Sansthan, Chowkhamba, Varanasi, India, Samvat, 1993, Chikitsa sthanam 45 and 46, chap. 38.

27. Susruta, Susrutha Samhita, Part 1, 8th ed., commentary by Shastri, K.A., Chowkhamba Sanskrit

Sansthan, Chowkhamba, Varanasi, India, Samvat, 1993, Chikitsa sthana 41, chap. 7.

28. Susruta, Susrutha Samhita, Part 1, 8th ed., commentary by Shastri, K.A., Chowkhamba Sanskrit

Sansthan, Chowkhamba, Varanasi, India, Samvat, 1993, Chikitsa sthana 42, chap. 7.

29. Susruta, Susrutha Samhita, Part 1, 8th ed., commentary by Shastri, K.A., Chowkhamba Sanskrit

Sansthan, Chowkhamba, Varanasi, India, Samvat, 1993, Chikitsa sthana 42–44, chap. 7.

30. Cohen, E., Hofner, R., et al., Comparison of ketorolac and di-clofenac in the treatment of renal

colic, Eur. J. Clin. Pharmacol., 54, 455, 1998.

31. Govinda Das, Bhaishjya Ratnavali with Vidyotanai commentary, commentary by Shastri, K.A.,

Chowkhamba Sanskrit Sansthan, Chowkhamba, Varanasi, India, 1983, chap. 36, p. 506.

32. Yogaratnakar, Yogaratnakah, Shastri, S.S., Ed., Chowkhamba Sanskrit Santhana, Varnasi, India,

1939, p. 506.

33. Curhan, G.C. and Stampfer, M.J., Beverages, diet and prevention of kidney stones, Author's

reply, Am. J. Kidney Dis., 33, 398, 1999.

34. Kumar, A. et al., To evaluate the effect of Ayurvedic drugs (an herbo mineral combination of

Sveta parpati with Kulatha kwatha in the management of Mutrasmari), J. Res. Ayurveda Siddha,

16, 1–2, 1995.

35. Kumar, A. et al., To evaluate the effect of Palasa Kshara in the management of Mutrasmari,

J. Res. Ayurveda Siddha, 16, 1–2, 1995.

36. Sannd, B.N. et al., To evaluate the effect of Ayurvedic drugs Sveta parpati with Pasanabheda

and Gokshuru in the management of Mutrasmari (urolithiasis), J. Res. Ayurveda Siddha, 14,

3–4, 1993.

37. Gopakumara Pillai, R. et al., The core of the pseudostem of musa (kadali) in the treatment of

urinary stones, Ancient Sci. Life, 15, 1, 1995.

38. Kumar, N., To evaluate the therapeutic efficacy of different drug schedules in the management

of nephro-uretro calculi, Semin. Res. Ayurveda Siddha, CCRAS, New Delhi, India, 24, 20, 1995

(Eng.).

39. Misgar, M.S., Controlled trial in 100 cases with nephro-uretero-lithiasis by Cystone: an indigenous

drug and other advocated methods, Curr. Med. Pract., 26(11), 327, 1982.

40. Baskar, R., Malini, M.L., et al., Effect of lupeol isolated from Crataeva nurvala stem bark against

free radical induced toxicity in experimental Urolithiasi, Fitoterapia, 67, 121, 1996.

41. Anand, R., Patnaik, G.K., et al., Antiurolithiatic activity of lupeol, the active constituent isolated

from Crateva nurvala, Phytotherapy Res., 8, 417, 1994.

42. Anand, R., Patnaik, G.K., et al., Effect of Crateva nurvala on calcium oxa-late Nephrolithiasis

and hyperoxaluria, paper presented in XXV Annual Conference of Indian Pharmacological

Society, Muzaffarpur, Dec. 6–8, 1992, Indian J. Pharmacol., 25, 12, 1993.

43. Anand, R. and Patnaik, G.K., Activity of certain fractions of Tribulus terrestris fruits against

experimentally induced urolithiasis in rats, Indian J. Exp. Biol., 32, 548, 1994.

44. Gupta, S.C. and Sharma, V.N., Some pharmacological observations on root bark of Bergenia

ligulata (Pakhan-bheda), paper presented at the sixth Annual conference of the Indian Pharmacological

Society, Hissar Dec. 30, 1973 to Jan. 1, 1974, Indian. J. Pharmacol., 6, 17, 1974.

32

Gynecological Diseases

Manjusha Vinjamury, Natesh Nagashayana, Sivarama P. Vinjamury, and Betsy B. Singh

32.1 Introduction

Women’s health is a topic of concern in the medical field, as women are an important

factor in the reproduction of healthy progeny. The environmental factors, fast-changing

lifestyles, and various addictions (drug abuse) as well as excess use of drugs (like steroids)

have endangered their health.

1

More than 4.5 million women (ages 18 to 50) report at least

one chronic gynecological condition each year.

2

It is estimated that 30 to 40% of women

have premenstrual syndrome (PMS) with symptoms severe enough to impair their daily

activities.

3

Infertility affected 6.1 million people in 1997 (about 10% of the reproductive

age population), up from 4.6 million in 1988.

4

Currently available therapies, which advocate greater use of antibiotics, steroids, or

surgery, may not be an ultimate answer for a woman’s ill health.

5,6

So, alternative systems

of medicine such as Ayurveda could be an option.

Streeroga

and

prasutitantra

(obstetrics

and gynecology) is one of the eight branches of Ayurveda.

7

Women’s disorders are

described as diseases of female genitalia (

Yonivyapad

).

8

Some people perceive

yoni

as

vagina, but that is just the literal meaning. The real meaning comprises the whole female

reproductive system.

Yoniyapad

consists of diseases of

yoni

and

stanaroga

(diseases of

breast). The major ailments described in conventional medicine such as amenorrhea,

dysmenorrhea, and menorrhagia come under this category and are discussed here along

with breast diseases. Uterine and breast cancers (

raktagulma

,

mamsarbuda

,

stanarbuda

) are

dealt with under a different category and are not the subject of this chapter. Etiopathogenensis,

diagnosis, prognosis, and treatment of all women’s diseases including pregnancy,

prenatal, postnatal health, and childcare are described in detail in this section.

8

This

chapter deals with the treatment and management of major gynecological disorders based

on clinical, laboratory, or pharmacological research.

Scientific Basis for Ayurvedic Therapies

32.2 Classification

There are 20 types of gynecological disorders (

yonirogas

).

8

1. Menorrhagia (

asruja

)

2. Amenorrhea (

arajaska

)

3. Vaginitis (

acharana

)

4. Excessive sexual indulgence

(

aticharana

)

5. Loss of libido (

prakcharana

)

6. Leukorrhea

(

upapluta

)

7. Sexually transmitted diseases (

paripluta

)

8. Dysmenorrhea (

udavartini

)

9

. Uterine polyp (

karnini

)

10. Bad obstetric history (

putraghni

)

11. Vaginal atrophy (

antarmukhi

)

12. Atrophy of uterus-congenital anomaly (

soochimukhi

)

13. Vaginal dryness

(

shushka

)

14. Small uterus (

vamini

)

15. Sterility (

shandhi

)

16. Prolapse of vaginal walls or uterus (

mahayoni

)

17.

Vataja

18.

Pittaja

19.

Kaphaja

20.

Sannipataja

These disorders are also considered predisposing factors of infertility. Traditionally, it

is believed that women suffering from these disorders cannot receive or hold semen

(

shukra

) and hence cannot conceive. Apart from these complaints, there are some separate

entities such as abnormal vaginal bleeding (

pradara

) and infertility (

vandhyatva

) that are

described in detail. Uterine fibroid, myoma, breast cancer, and endometriosis are categorized

under different headings like

gulma

,

arbuda,

etc. in the Ayurvedic classics and are

not listed under gynecological diseases.

8

Neoplasms are not discussed in this chapter.

Even women’s diseases are a vast topic, which comprises various ailments of reproductive

organs and associated organs such as the endocrine system. It is not possible to describe

all of them because of the constraint of space and scope of this textbook. The major diseases

that affect a majority of the female population are discussed in this chapter.

32.3 Etiopathogenesis

According to Ayurveda, women who violate proper diet and lifestyle are more prone to

ill health.

9

Heavy, slimy, and excessive intake of sweet, acid, salty, sour, and incompatible

foods, lack of exercise, excessive sleep, laziness, daytime naps, and overeating are some

of the general causative factors of gynecological disorders.

10

Women’s diseases can also

occur due to external causes that are beyond one’s purview. One has to remember that

specific

dosa

-aggravating or -depleting factors (mentioned elsewhere in the textbook) could

also be contributory factors to gynecological diseases in addition to those mentioned

above. Essentially, all these factors cause an imbalance in the body tissues and organs and

make them prone to infections or internal pathology.

11

For any pathogenesis there are two

essential factors: structural and functional. The disease could originate from structural

changes and then bring about functional changes or vice versa. In this context, an increase

or deficiency (imbalance) of the three basic entities,

vata

,

pitta

, and

kapha

, lead to the

vitiation of the related structure or tissue of the genitourinary system.

11

As

dosas

become aggravated they develop pathogenesis in three different manners.

When

vata

is aggravated, it dries up the organ or tissues absorbing necessary unctuousness

and water in the tissue and makes the surface rough due to its innate rough (

rooksha

)

property. In an excited state, the

vata

becomes hypermotile (

chala

) and travels in all

directions. For example, this excited state of

vata

can expel the excretory products in excess,

like in menorrhagia, or move them upward and stop the normal expulsion that causes

pain in the local area (e.g., dysmenorrhea).

Apana

vayu

is the type of

vata

that is involved

basically in menstrual disorders.

Pitta

, in an aggravated state, also absorbs water and creates excess heat, burning sensation,

and inflammation in the organ. It also interferes with clotting because of its hot

and liquefying properties and may cause excess flow as in menorrhagia.

Kapha

, when out

of balance, obstructs the channels because of its slimy and heavy property. It disturbs

proper metabolism and stops or delays functions like ovulation and menstruation as in

amenorrhea. It can also produce heaviness, coldness, and sluggishness in the body as well

as in the local area. Some fungal infections in the vaginal area or vulval region may be

attributed to imbalance in

kapha

where itching (

kandu

) is the major symptom.

11

An imbalance of a single

dosa

or combination of

dosas

residing in the genitourinary

system may cause a gynecological disorder in women.

32.4 Clinical Features

There is no clear-cut description of clinical symptoms for all gynecological disorders in

Ayurveda. The symptoms are usually based on the affected

dosas

.

8

The characteristic

properties of each

dosa

reflected during an ailment are utilized by the physician for easy

diagnosis and treatment of the gynecological disorder.

32.5 Diagnosis and Prognosis

Diagnosis of gynecological disorders is also based on the same principles of Ayurveda

as are any other disease.

12

The history of the disease, its aggravating and relieving factors,

its predominant symptoms, and the patient’s personal and family history, pulse, tongue,

diet, and lifestyle are all taken into consideration to diagnose the type, subtype, and

stage of the specific gynecological ailment. Currently, Ayurvedic physicians in India are

also using the modern diagnostic procedures such as blood chemistries, hormonal

assays, x-ray, ultrasound, computered tomography scan, and magnetic resonance imaging

for proper diagnosis and staging of the disease.

32.6 Treatment

The Ayurvedic approach of treatment is always holistic and works at both psycho and

somatic levels. As most of the women’s diseases are psychosomatic, Ayurvedic therapy

has been often found to be effective in treating gynecological disorders. The first goal of

treatment is to relieve the symptoms and give comfort, which is followed by alleviation

or control of disease. The treatment comprises internal and external therapies.

7,8

Internally,

clearing the channels, correcting

dosa

imbalance, and improving internal environment of

the system is emphasized. Internal cleansing, if required, is usually done through

panchakarma

therapy. External modalities such as oleation (

snehana

), fomentation (

swedana

)

,

medicated enema (

basti

), and uterovesical douche (

uttara basti

) are also very effective in

women’s diseases and are usually combined with internal cleansing procedures.

13

However, they form the main treatment methods in some conditions. They help relieve

the obstructions, pacify aggravated

dosas

, and give symptomatic relief reducing pain and

tension. Compound formulas used for the treatment of gynecological diseases are listed

Usually this purification therapy is followed by the pacification by oral supplementation

of Ayurvedic herbs or herbal formulas.

14

Ayurveda also emphasizes preventive measures

using behavioral and dietary regimens to all gynecology patients, because both diet and

lifestyle play important roles in the etiopathogenesis of the disease. It helps maintain the

health and control the frequency and severity of the ailment. Ayurvedic treatment is

comprehensive because it encompasses cleansing (detoxifying), pacification, mental

health, diet, and behavioral therapy while treating gynecological disorders.

Specific details of seven gynecological disorders are described in detail below.

32.6.1 Amenorrhea

32.6.1.1 Etiopathogenesis

According to

Ayurveda, aggravated

vata

and

pitta

affect blood by drying-up menstrual

blood (

raja

), which ceases the regular flow of menses (

nashtartava

or ksheenartava).8 General

symptoms that are associated with this condition are emaciation and pallor. It suggests

the deficiency of blood or a severely anemic condition and weakness.

Conventional medicine indicates that amenorrhea is due to a wide range of causes that

include anatomic or structural and physiological or functional defects. It can be congenital

or develop at a certain age because of a particular change. There can be a defect from the

ovarian or uterine level to hypothalamus and pituitary level.15

32.6.1.1.1 Structural

Anatomically there are four major congenital anomalies: absence of uterus or some part

of the vagina, failure of the vagina to develop, imperforate hymen, or intrauterine synechiae.

All these consequently result in primary amenorrhea.

in Table 32.1.

32.6.1.1.2 Functional

Physiologically, after menarche, women have a menstrual flow every month because of

ovulation secondary to certain hormonal changes. The leutinizing hormone (LH) -releasing

hormone is the main hormone produced in hypothalamus that further releases the LH

TABLE 32.1

Compound Formulas for Gynecological Disorders

Formula Dosage

Gynecological Diseases in General

Ashokarishtom 15–20 ml two times/day after meals with equal water

Pushyanuga choornam 3–5 g two times/day with rice water

Kumaryasavam/kumari kalpa 15–20 ml two times/day after meals with equal water

Phalakalyanaka ghrita 5–10 two times/day with milk or warm water

Amenorrhea

Rajahpravartini vati 2 tablets two to three times/day with warm water or kumaryasavam

Nashtapushpantaka ras Same as above

Jeerakadyarishtom 15–20 ml two times/day after meals with equal water

Chandraprabha vati 2 tablets two or three times/day with warm water or kumaryasavam

Kumaryasavam 15–20 ml two times/day with equal water after meals

Dysmenorrhea

Rajahpravartini vati 2 tablets two or three times/day with warm water or kumaryasavam

Jeerakadyarishtom 15–20 ml two times/day after meals with equal water

Ashokarishtom Same as above

Dhanwantharam thailam For external application like massage

Kumaryasavam 15–20 ml two times/day with equal water

Menorrhagia

Pradarantaka rasa/loha 2 tablets two or three times/day with warm water or chandanasavam

Chandanasavam 15–20 ml two times/day after meals with equal water

Chandrakala ras 2 tablets two or three times/day with warm water or chandanasavam

Bolabaddha ras Same as above

Lodhrasavam 15–20 ml two times/day after meals with equal water

Leukorrhea

Pushyanuga choorna 3–5 g two times/days with rice water

Chandraprabha vati 2 tablets two or three times/day with warm water or chandanasavam

or ashokarishtam

Chandrakala ras 1–2 pills two times/day with warm water

Chandanasavam 15–20 ml two times/day after meals with equal water

Praval bhasma 120–240 mg two times/day with warm milk

PMS

Ashokarishtom 15–20 ml two times/day after meals with equal water

Kumaryasavam Same as above

Manasamitra vatakam 1 tablet one or two times/day

Ashwagandhadi choornam 3–5 g two times/day with rice water

Infertility

Phala ghrita 5 ml two times/day with milk or warm water

Satavari kalpa 5–10 g two times/day with warm milk

Kumaryasavam 15–20 ml two times/day after meals with equal water

Ashokarishtom Same as above

Jeevaniya rasayana 5–10 ml two times/day with milk or warm water

Menopausal Syndrome

Ashokarishtom 15–20 ml two times/day after meals with equal water

Shatavari kalpa 5–10 g two times/day with warm milk

Panchagavya ghrita 5–10 ml two times/day with milk or warm water

Kalyanaka ghrita Same as above

Chandanasavam 15–20 ml two times/day after meals with equal water

Chyavanaprasha 5–10 g with warm milk one time/day in the morning

and the follicular stimulating hormone (FSH). These hormones are responsible for the

process of ovulation and endometrial changes. There are also gonadotropins and estradiol

that stimulate ovarian functions. A defect of any of these glands at any level of hormone

production and at any age from puberty to menopause can cause amenorrhea.1,15

32.6.1.2 Clinical Features

Absence of menstrual cycle during the reproductive years is the clinical symptom according

to both Ayurveda and conventional medicine.

32.6.1.3 Diagnosis and Prognosis

Diagnosis of amenorrhea is very complicated and requires a series of investigations and

physical examinations. To reach a perfect diagnosis, a step-by-step evaluation is necessary

from vaginal or uterine level to the hypothalamus. To detect the anatomical anomalies, a

pelvic ultrasound or examination under anesthesia may be required in adolescent girls.

The hormonal levels can be investigated to help determine the exact cause. Prognosis of

amenorrhea is good. It is not a life-threatening disease and can be treated successfully in

many cases.15

32.6.1.4 Treatment

According to Ayurvedic treatment, the major objective is to alleviate vata in amenorrhea.

The therapy is composed of three stages: (1) cleansing therapy, (2) palliative therapy, and

(3) advising a dietary regimen.

32.6.1.4.1 Cleansing Therapy (Shodhana)

Vasti (medicated enema), one of the detoxification procedures (panchakarma), is the vata

alleviation treatment. Vata-pacifying herbs such as castor, sesame oil, meat soups, and

milk can be used for the enema treatment.8

32.6.1.4.2 Palliative Therapy (Shamana)

This therapy works on two principles: one is to control vata and pitta and the other is to

improve tissue status. In amenorrhea, blood is deficient, so supplements like iron (loha)

and Suvarna makshika give good results in weak or anemic women. Where there is a

hormonal imbalance, herbs like Aloe vera, ashwagandha, and black kohosh are more useful.

Ultakambal (Abroma augusta), vamsha (Bambusa arundinacea), and shana (Crotolaria junecea)

are the herbs described for inducing menstruation (artavajanana). Black pepper (Piper

nigrum), long pepper (Piper longum), garlic (Allium sativum), ginger (Zingiber officinale),

sesame (Sesamum indicum), and papaya (Carica papaya) are some of the stimulating herbs

proved effective to induce menstruation. Rajapravartini vati, Nashtapushpantaka rasa, and

Chandraprabha vati are some of the effective formulas to treat amenorrhea.14

Conventional treatment includes the induction of ovulation as the main goal of therapy.

It is done with the help of the drugs such as bromocriptine, clomiphene citrate, and

steroids. Some patients who are hypoestrogenic can be treated with progesterone and

estrogen in combination.15

32.6.1.4.3 Dietary and Behavioral Regimen

Cold and heavy food, oily deep-fried food, and frozen food tend to increase the vata dosa

in the body in general and might accumulate in the uteri of women suffering with

amenorrhea; such foods also block the free flow of menstrual blood.10 Foods such as

potatoes and peas produce gas and constipation and need to be avoided. A sedentary

lifestyle aggravates the disease. Light exercises such as yogasanas or walking are recommended.

32.6.2 Dysmenorrhea

Dysmenorrhea is a painful period or menstrual cramps. It is the most common complaint

among all gynecological disorders. Because most women have some discomfort during

the period, it is considered natural. It is named dysmenorrhea only when the pain is too

severe and disturbs a woman’s routine, and it is relieved only with medication.15

32.6.2.1 Etiopathogenesis

Ayurvedic literature attributes dysmenorrhea to the above-mentioned general causes as

well as suppression of natural urges (sneezing, coughing, micturition, defecation, etc).

These factors provoke Apana vata and disturb its natural route of a downward direction

and start moving it in reverse or an upward direction. The change in direction of the vata

dosa alters the menstrual blood flow. This results in painful and scanty menstruation. When

the flow is proper without any obstruction, pain is relieved.10

In conventional medicine, the prostaglandin theory is currently more accepted as the

causal explanation for dysmenorrhea, although endometriosis or adhesions can also cause

dysmenorrhea. It is believed that women with dysmenorrhea have much higher concentrations

of prostaglandin.15

32.6.2.2 Clinical Features

The symptoms are cramping and spasmodic pain in the lower abdomen which may spread

over to the gluteal region, thighs, and lower back. Generalized pelvic tenderness is usually

present. Nausea, diarrhea, or constipation and headaches are the other common symptoms.

Vomiting or fainting may occur in some cases.3,15

32.6.2.3 Diagnosis and Prognosis

Because the pain and discomfort is subjective, diagnosis relies upon the proper history. It

is also important to differentiate the primary diagnosis from the secondary one. For

example, an underlying cause like endometriosis may create confusion or be missed.

Prognosis of dysmenorrhea is good. It can be treated successfully with Ayurvedic single

herbs or formulations in addition to making diet and lifestyle changes.15

32.6.2.4 Treatment

Ayurvedic treatment emphasizes sweating, cleansing douches, and medicated enemas.

Oil therapy, including massage, is used to relieve any obstructions in the passage, relieve

any spasms, facilitate free movement of vata in the proper direction, and enhance a proper

menstrual flow. Gentle massage with sesame oil, dhanwanthara thailam, narayan thailam, or

kottamchukkadi thailam is advised over the lower abdomen, pelvic region, and thighs.

Sweating methods and fomentation remove the toxins and also relieve muscular spasms

and tenderness. A medicated enema with a mixture of oil, milk, herbal paste, and decoction

or tea also pacifies vata and reduces any flatulence, removes obstruction of fecal matter,

and relieves the tension in the pelvic cavity. These three therapies together help relieve

pain and discomfort in the pelvic region.7,8

32.6.2.4.1 Palliative Therapy

Pootikaranja (Caesalpinia bonducella) is a very effective herb for improving menstrual flow

and relieving abdominal pain. It also checks nausea and vomiting along with clove or

black pepper. Bol, or myrrh (Commiphora myrrh), is another effective drug used in this

disease.14

The first aim of the conventional treatment is to relieve pain and discomfort. Analgesics

such as codeine or parenteral medication in severe pain will serve the purpose. If the

causative factor is prostaglandin as is currently hypothesized, antiprostaglandins (e.g.,

ibuprofen) are generally very effective. Cyclic administration of oral contraceptives in the

lowest dosage is useful in many cases, especially if the patient cannot tolerate antiprostaglandins.

In some cases of severe pain, medication does not help. When the underlying

cause is endometriosis or adhesions, surgical treatment is recommended.15

32.6.2.4.2 Dietary and Behavioral Regimen

Hot, slightly oily, and light food containing digestive herbs such as ginger, pepper, clove,

and cinnamon is advised. Light exercises, such as like walking or yogasanas, are beneficial.

32.6.3 Menorrhagia

Excessively heavy bleeding or prolonged periods are considered as menorrhagia. It is

categorized under abnormal uterine bleeding.15

32.6.3.1 Etiopathogenesis

According to Ayurveda, the aggravated pitta vitiates blood (rakta) and causes overflow

through yoni. This is named asruja yoni.8

In modern medicine, submucous myomas, complications of pregnancy, adenomyosis,

endometrial hyperplasias, or malignant tumors are some of the causes. It is very difficult

to determine the exact cause, and there may be more than one diagnosis present. Metrorrhagia

(bleeding any time in-between the period), polymenorrhea (too frequent menstruation),

and menometrorrhagia (frequent and intermediate bleeding) are other types of

abnormal excess bleeding. Dysfunctional uterine bleeding is one more type that is without

any pathologic cause; it is due to only hormonal imbalance. In this disorder, the

endometrium outgrows its blood supply because of estrogen stimulation, breaks down,

and sheds in an irregular manner.15

32.6.3.2 Clinical Features

The symptoms differ according to type. There are four types of pradara; three types

are caused by a single dosa (vata, pitta, and kapha) and the fourth one is known as

sannipataja.

1. Vataja pradara — Menstrual discharge is painful, frothy, thin, rough, dark, and

graying or light red. The associated symptoms are intense pain in pelvic region,

thighs, back, and sides of the chest.7,8

2. Pittaja pradara — This type of pradara is characterized by a dark red a with

yellowish or bluish tinge; hot, continuous flow that is associated with a burning

sensation; and redness in the local area. Excess thirst, vertigo, and fever are the

general symptoms.

3. Kaphaja pradara — In this condition, menstrual discharge will be slimy, pale, thick,

heavy, and unctuous with dull pain. General features are nausea, vomiting, anorexia,

cough, and dyspnea.

4. Sannipatika pradara — Sannipatika refers to all three dosas, hence there will be a

variety of severe symptoms. Examples include slimy, dark-red blood; hot, yellowish

discharge; or discharge containing body fat or marrow. Flow will be continuous,

resulting in extreme weakness and anemia. Thirst, a burning sensation, and

fever are some of the general symptoms. They indicate that deep tissues in the

body are involved. Therefore, one can infer the prognosis is worst.3,10

According to conventional medicine, the main symptom is heavy bleeding with clots

and gushing. Many times it is prolonged more than 7 days. Usually it leads to anemia

due to excessive blood loss. Severe weakness, pallor, cramps, and palpitations are usually

associated with excess bleeding.15

32.6.3.3 Diagnosis and Prognosis

The number of sanitary napkins soaking per hour with passage of clots or prolonged

periods more than 7 days is the salient feature used to make such a diagnosis. Diagnosis

requires proper history, physical examinations to detect abdominal masses and so on,

endometrial biopsy to rule out malignancy, ultrasonography, and hysterescopy to confirm

the diagnosis and obtain a clear picture.15,16

32.6.3.4 Treatment

The external therapy includes the following:

1. A continuous thin flow of medicated oil (dhara), milk, or buttermilk on forehead

or lower abdomen

2. Fomentation (seka)

3. Simple oil application (abhyanga)

4. A local application of drugs with cotton ball as a plug (pichu)

These external treatments are done to alleviate pain, stop the excess blood flow, and relax

the patient. Internally Saraca indica, Terminalia arjuna, Indian sarsaparila, Santalum album,

and A. vera are commonly used herbs. Lodhrasavam, chandanasavam, kumaryasavam, ashokarishtom,

chandrakala vati, bolabaddha ras, and pradarantak ras are some of the most commonly

used formulas.14

Takradhara (a continuous flow of buttermilk processed with Cyperus rotundus and Emblica

officinalis is called a Takradhara)17 was found effective in menorrhagia in a 10-day pilot

study conducted in Maharashtra, India. Uterovaginal administration (uttarabasti) of a

formulation named kashmarya-kutaja ghrita was found very effective in menorrhagia in a

study conducted at Government Ayurveda College, Trivandrum, India. The duration of

the study is not available.18

Pushyanuga churnam was found highly significant in menorrhagia at Government

Ayurveda College, Trivandrum, India. In an animal study, the same formulation showed

positive effects on endometrium, such as atrophy of hyperplastic endometrium. The

investigators’ details are not available. In a study conducted at Government Ayurveda

College, Trivandrum,19 ashokarishtam and musalikhadiradi kwatha, two multiherbal formulas,

have been shown to be highly effective in normalizing the menstrual cycle as well as

reducing associated symptoms such as palpitation, weakness, and myalgia. Kutajashtaka

lehyam, a classical formula, was also found to be very effective in menorrhagia and dysfunctional

uterine bleeding in a study with little details.20

A multiherbal formula containing Saraca indica, A. vera, Cyperus rotundus, etc. produced

significant results in oligomenorrhea. Approximately 25% of women conceived during the

study. This suggests that the formula may be significantly effective in helping infertility

disorders.21

According to conventional medicine, conservative therapy is advised; when bleeding is

not acute and life threatening, a hormonal therapy (e.g., oral contraceptives) can control

the disease. If the cause is myoma or adenoma, the new growths are excised to save the

uterus in childbearing age. Otherwise, a hysterectomy is the preferred treatment.15

32.6.3.4.1 Dietary and Behavioral Regimen

Women should avoid foods that are fried, greasy, spicy, and sour. Indian spices such as

coriander, turmeric, mint, and anise seeds are recommended. Hot spices, garlic, ginger,

and chilies and hot beverages such tea, coffee, and alcohol should be avoided. Green

vegetables including zucchini, squash, cucumber, pumpkin, Indian gooseberry, and dates

and soups of legumes and vegetables are recommended, as these have a cooling effect.

Women should add fresh fruits (except citrus) and dairy products such as milk, fresh

cottage cheese, and ghee (butter oil) to the diet. Pulses and grains are also very beneficial.

Coconut water, barley water, and buttermilk are also good. Excessive stress and strain

need to be avoided. Maintaining proper hygiene of the genital organs is of primary

importance. A proper bowel movement everyday is also considered important. Relaxation

of the mind is very important for menorrhagia as in any other disease.3,8,12

32.6.4 Leukorrhea

32.6.4.1 Etiopathogenesis

Leukorrhea is also called as sweta pradara in Ayurveda. This disease is caused by the

imbalance of vata and kapha dosa. The production and transportation of fluids by the

urogenital organs becomes disturbed and leads to leukorrhea.8,10

In conventional medicine, an abnormal vaginal discharge that is watery, cloudy, or white;

thick or thin in consistency; and malodorous or odorless is a condition known as leukorrhea.

When it is thin, clear, mucuslike, odorless, and not subsequently increased in

quantity, it is considered normal. It is generally secreted before menstruation, due to sexual

excitement, or due to emotional stress. Fungal, bacterial, and viral infections change the

environment in the vagina and make it alkaline. An alkaline environment results in

production of vaginal discharge. Foreign bodies also cause vaginal infections and discharge.

There are several other causes that also cause this type of discharge (e.g., worms

or ulcers).15

32.6.4.2 Clinical Features

According to Ayurveda, the main symptoms are a pale or white discharge from the vagina

that is usually painful and thick or thin in consistency.

Western medicine attributes specific symptoms to specific causative agents. The discharge

may be malodorous or show a change in color with fever if it is due to bacterial

infections. In viral infections, discharge may be profuse and the cervix tender. In fungal

infections, vulvar pruritis followed by burning urination and itching are the principal

symptoms. Along with the profuse vaginal discharge, there may be symptoms like weakness,

lower backache, leg pain, etc.15

32.6.4.3 Diagnosis and Prognosis

Diagnosis is dependent upon a proper history and pelvic examination. In addition, a pap

smear is done to identify any pathogens and also to rule out any displasia. Prognosis is

often very good except in the case of a malignancy of the cervix.15

32.6.4.4 Treatment

Ayurvedic treatment emphasizes the use of vaginal douches (uttarbasti or yonidhavana).

These douches are intended to treat the uterus, fallopian tubes, and the external vagina.

They act as local antibiotics, clear the blockages in the channel pathway, and pacify

dosas.8 The herbs used for douches are Santalum album (chandana), Azadiracta indica (neem),

Tinospora cordifolia (guduchi), Saraca indica (ashoka), Terminalia arjuna (Arjuna), etc. Internally,

ginger, cinnamon, fenugreek, gooseberry (Emblica officinalis), Terminalia chebula,

and Hemidesmus indicus are the popular herbs. Pushyanuga choorna, Chandraprabha vati,

Chandrakala ras, Chandanasavam, loha, and praval bhasma are some of the effective formulas.

14

Conventional medicine treatment includes cleaning the genitalia, maintaining dryness,

avoiding tight clothing, and occasionally douching. Infections can be treated with antibiotic

drugs. In some cases, surgical intervention is necessary to eradicate infections.15

32.6.4.4.1 Dietary Regimen

Food should be simple, easily digestible, and taken at regular intervals. Excessive amounts

of puddings, garlic, onion, pickles, potatoes, sour foods, and excessive fried and greasy

foods are not recommended. Rice water (water collected after washing the raw rice) is a

very useful remedy in this disease.14

32.6.5 Infertility

In Ayurveda, if the breasts, ovaries, and uterus are not well developed and the patient

cannot ovulate, then it is considered primary infertility (shandi yoni).8,10 Women with this

condition cannot conceive due to a genetic defect. The monthly cycle may or may not be

regular in such women. Decreased fertility (vandhyatva), which is also primary infertility,

can be treated. Secondary infertility is known as kakavandhya according to Ayurveda.7,8

32.6.5.1 Etiopathogenesis

There are four major causes for primary infertility: systemic (dosadhatu mediated), congenital

(beejadosa), vaginal and organic defects (yonivyapat), and idiopathic (daiva).3,10

Conventionally, infertility is attributed equally to both factors, male and female. In the

female factor, congenital and acquired structural abnormalities, ovulatory defects, and a

hormonal imbalance should be investigated. The psychological factor is a very important

precipitating factor and needs to be considered.15

32.6.5.2 Clinical Features

No specific symptoms are seen in infertile patients that can differentiate them from other

women who have not had problems conceiving. Infertility is defined as a failure to

conceive after a year of regular intercourse without using any contraceptives. The infertility

can be primary or secondary. Primary infertility refers to those who have never

conceived. Secondary infertility applies to those who have conceived in the past. Although

both partners are equally important in the act, there is more evidence of infertility due to

abnormalities in the female reproductive system. The abnormality may be structural (e.g.,

developmental anomalies) or functional (e.g., hormonal imbalance). There are many diseases

of various systems as underlying causative factors. Infertility is different than sterility.

Sterility implies an intrinsic inability to conceive.15 It resembles the concept of shandhi

yoni in Ayurveda.

32.6.5.3 Diagnosis and Prognosis

History, pelvic examination, ultrasonography (USG), hysterosalpingogram, diagnostic laparoscopy,

and blood examination are some of the investigations necessary to reach a proper

diagnosis. Prognosis is dependent upon the cause. It is usually difficult to treat with total

success in every patient.15

32.6.5.4 Treatment

Ayurvedic treatment differs according to etiopathogenesis. When infertility is due to

congenital or idiopathic causes, it cannot be treated. It is clearly mentioned in the classical

texts that when a woman has any local defect, she cannot conceive. Those disorders should

be treated first and her menstrual cycle should be regular. Cleansing therapies are carried

out using herbs and formulas that have a penetrating capacity (e.g., Triphala/Trikatu kwatha,

kshara taila).8 These therapies are advised to unblock the channels and make the tracts

patent. Some uterine tonics and ovulation inducing herbs or formulas should be administered

as a palliative therapy. The jeevaniya gana, rasayana, and vajikarana group of formulations

not only enhance strength and vigor, but improve the internal environment of the

reproductive system. Formulas such as ashokarishta, phala ghrita, and shatavari kalpa give

excellent results. Amalaki, guduchi, bala, and ashwagandha are some of the uterine and

ovarian tonics which promote fertility.1,14

Conventional treatment is offered at various levels. If infertility is due to anovulation,

then using clomiphene citrate alone or in combination with some steroids or human

gonadotrophins will be the best choice. In case of endometriosis or adhesions, surgical

intervention is necessary. If cervical mucus is inadequate, it should be improved or introduced.

 

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)