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
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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)
1 comments:
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