Like this? Share it with your network

Share

Asrigdara virechan-rn

on

  • 1,440 views

A Critical Study On The Role Of Virechana In The Samprapti Vighatana Of Asrigdara W.S.R To DUB, ROOPA K.V., DEPARTMENT OF POST GRADUATE STUDIES IN ROGANIDANA, GOVERNMENT AYURVEDIC MEDICAL COLLEGE, ...

A Critical Study On The Role Of Virechana In The Samprapti Vighatana Of Asrigdara W.S.R To DUB, ROOPA K.V., DEPARTMENT OF POST GRADUATE STUDIES IN ROGANIDANA, GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI ROAD, BANGALORE

Statistics

Views

Total Views
1,440
Views on SlideShare
1,433
Embed Views
7

Actions

Likes
0
Downloads
27
Comments
0

1 Embed 7

http://www.slashdocs.com 7

Accessibility

Categories

Upload Details

Uploaded via

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Asrigdara virechan-rn Document Transcript

  • 1. “A Critical Study On The Role Of Virechana In The Samprapti Vighatana Of Asrigdara W.S.R To DUB”Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, for the partial fulfillment of Degree AYURVEDA VACHASPATHI M.D (ROGANIDANA) By Dr. ROOPA K.V. B.A.M.S. Under the guidance of Dr. K. PUSHPALATHA MD (Ayu) Ph.D Professor Department of Post Graduate Studies in Roganidana, Government Ayurvedic Medical College Bangalore DEPARTMENT OF POST GRADUATE STUDIES IN ROGANIDANA GOVERNMENT AYURVEDIC MEDICAL COLLEGE DHANWANTARI ROAD, BANGALORE – 560009 2010-2011 i
  • 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA DECLARATION BY THE CANDIDATEI hereby declare that this dissertation entitled “A critical study on the role ofvirechana in the Samprapti vighatana of Asrigdara w.s.r. to Dub” is a bonafideand genuine research work carried out by me under the guidance of Dr. K.Pushpalatha M.D. (Ayu), Phd Professor, Department of PG studies in Roganidana,Govt. Ayurvedic Medical College, Bangalore.Date: Signature of the candidatePlace: Dr. Roopa k.v i
  • 3. GOVERNMENT AYURVEDIC MEDICAL COLLEGE Department of P.G.Studies in Roganidana, Dhanwanthari Road, Bangalore –560 009 CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “A Critical Study On The RoleOf Virechana In The Samprapti Vighatana Of Asrigdara W.S.R. To DUB”Submitted By Dr Roopa K.V. for the degree of Ayurveda Vachaspati - MD(Roganidana) of the Rajiv Gandhi University of Health Sciences, Bangalore, is arecord of research work done by her under my guidance and supervision during theperiod of her study in our department. This dissertation has not previously formed thebasis for the award of any degree, diploma, associate ship, fellowship or other similartitles. I am recommending this dissertation for the above degree to the UniversityAssessment and approval. Guide Dr.K. Pushpalatha M.D. (Ayu)Date: ProfessorPlace: Dept of Postgraduate Studies inRoganidana GAM C, Bangalore. ii
  • 4. GOVERNMENT AYURVEDIC MEDICAL COLLEGE Department of P.G.Studies in Roganidana, Dhanwanthari Road, Bangalore –560 009 ENDORSEMENT BY THE HOD and PRINCIPAL This is to certify that the dissertation entitled “A Critical Study On The Role OfVirechana In The Samprapti Vighatana Of Asrigdara W.S.R. To DUB” is abonafide and genuine research work done by Dr. Roopa K.V. under the guidance ofDr. K.Pushpalatha M.D. (Ayu), Professor, Department of Postgraduate studies inRoganidana, Government Ayurvedic Medical College, Bangalore.Dr.R.K.Hibare M.D. (Ayu)Professor & HeadDept. of P.G. Studies in Roganidana, PrincipalGovt.Ayurvedic Medical College, Govt.Ayurvedic Medical College,Bangalore. Bangalore.Date: Date:Place: Place: iii
  • 5. COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Rajiv Gandhi University of Health Science,Karnataka shall have the rights to preserve, use and disseminate this dissertationin print or electronic format for academic/ research purpose.Date: Signature of the candidatePlace: Dr. Roopa K.V. © Rajiv Gandhi University of Health Sciences, Karnataka. iv
  • 6. ACKNOWLEDGEMENTAt this moment of submitting this dissertation in this Post Graduate study, my headbows down with great humility in the feet of Lord Dhanwantari, Lord Sai ram,LordGanesha without whose blessings , I would not have been able to attain these stages inmy life. I take this opportunity to acknowledge with holy passion and sinceregratitude, the unique guidance, enthusiasm and knowledge to me by my reverend andproficient guide Dr. Pushpalatha K. Head of the Department of Shareera Kriya,Govt Ayurvedic College Bangalore. I take this opportunity to express my sinceregratitude with due respect to Dr.R.K.Hibare our HOD Department of RoganidanaGovt Ayurvedic College Bangalore for his kind support and valuable suggestion.Dr.M.Ramesh Professor Department of Roganidana Govt Ayurvedic CollegeBangalore for his vigilant and valuable guidance, His deep and vast knowledge alongwith affectionate care has always encouraged me to persue right path in my work.I amvery much thankful to our Principal Dr.S.G.Mangalagi and Ex-PrincipalDr.Sreenivas H.T,who gave me a chance to complete this work successfully Andalso I thank Dr.L.N.Shenoy Dr.Anant Desai &Dr.Vijayalaxmi research officersNRHM for providing all sort of help to carry out this research study. I also thankDr.Ramesh M.S. Lecturer Department of Roganidana Govt Ayurvedic CollegeBangalore who helped me during the preparation of this work. At this Auspisciousoccasion of the completion of Dissertation, how can I forget my MaternalGrandmother Smt Venkatamma for her blessings, At this stage of my life I sincerelybow my head to them for cultivating basic virtues which has lead me to where I amnow that is my Parents Shri K.Venkatesh son of late R.B.Kempegowda and my v
  • 7. mother Smt Lakshmi Above all I am very much obliged to my brothersPrashanth,Dinesh,and chowdu and my sisters Nirmala, Mamatha & Poornima andto my Bhavas Ravi and Ramesh Without their basic support my entity would notbe fulfilled.Iam very kindful to my friends Vivek and Triveni who helped me incompleting this work successfully.I express my sincere thanks to all of my Colleagues Dr.Ranjitha, Dr.Praveen,Dr.Pranesh Dr.Basvaraj for their kind help and support,I am very thankful to myjuniors Doctors Dileep, , Pradeep, sachin, Nazima Radhika, and Jyothi for theirtimely help and support. and also I want to thank Dr.Manasa,Dr.Suma,Dr.Nishithafor their Suggestion and for right conduct for condensive research studies.I alsoexpress my thanks to Dr.Lancy D’ Souza who helped in completing my statisticswork, I also want to thank Mr.Raghavendra K.S. who helped me in completing myresearch work. I also express my warm thanks to hospital staff members for theirpositive approach and prompt co-operation. Medicinal research cannot be carried outwithout the enthusiastic attitude and due patience of the patient, I sincerely thanks toall my patients especially vani, nayana, anusuya etc who kindly allowed me to carryout the research studies on themselves. There are many who have contributed withtheir respective talent to compile this work to its present stage. I thank all of them.Date:Place: Bangalore Dr. Roopa k.v. vi
  • 8. ABBREVIATIONSAd: Arunadatta YR: YogaratnakaraAV: Atharva Veda VC: VachaspatyamAP: Agni Purana Vol:VolumeAS: Ashtanga Sangraha According to Sthana:AH: Ashtanga Hridaya Si: Siddhi SthanaApi: Ayurvedic Pharmacoepia of India Sha: Shareera SthanaBH: Bhela Samhita Pur: PurvardhaBP: Bhavaprakasha P.K: Poorva KhandaBR: Bhaishajya Ratnavali Su: Sutra SthanaCha: Charaka Samhita Vi: Vimana SthanaCh: Chikitsa Sthana DUB:Dysfunctional uterine bleedingCak: Chakrapani AUB:Abnormal uterine bleedingChu: Chaurasia, Human Anatomy MC:Menstrual cycleDal: Dalhana Hb: HemoglobinGay: Gayadasa FSH:Follicle stimulating hormoneHA: Harita Samhita LH:Leutinizing hormoneHM: Harsh Mohan’s pathology USG:Ultra sonographyHem: Hemadri DUB:Dysfunctional uterine bleedingKS: Kashyapa Samhita AUB:Abnormal uterine bleedingMN: Madhava Nidana PGE2 : Prostaglandin E2pg.no. Page Number PGF2a : Prostaglandin F2αSH: Sharangdhara Samhita PGI : ProstonoidsMN: Madhava Nidana IUCD:Intrauterine contraceptive devicesSKD: Shabda Kalpa Druma HSG:hystosalphingographySU: Sushrutha Samhita GnRH:Gonodotrophin releasing hormone viii
  • 9. ABSTRACTThe present study titled “A Critical study on the role of virechana in the sampraptivighatana of Asrigdara w.s.r to Dub.” is an attempt to evaluate the role of virechana inthe Samprapti vighatana of Asrigdara.the present study is based upon a reference fromkashyapa……..…………aÉpÉÉïzÉrÉÉxÉ×eÉÏ ÌuÉUåMü:| MüÉ.xÉÇ.ÍxÉ. 2/13 Meaning virechana is a line of treatment in uterine bleeding.Asrigdara indicate excess & irregular bleeding per vagina.the excessive bleeding hampers the social,personal,and professional life of the 21 st century of women,where in she tries to compete with men on equal terms.it is therefore imperative that these short coming which afflicts a fairly large percent of women is appropriately treated.The present study is carried out with the following objectives:-  Substantiation of the Principles of Samprapti in Asrigdara as is delineated in the Classical Texts through Clinical Trials.  To Validate the Role of Virechana as a form of Samprapti Vighatana in Asrigdara.  To study the effect of Pathya Aahara and Vihara in Samprapti Vighatana of Asrigdara.Study design:Present study comprised of 30 patients divided into 15 patients in each group.Patientsin Group A-were subjected to virechana along with pathya aahara and vihara,patientsin Group B-were placed on pathya ahaara and vihara only.the study was carried outfor a period of 30 days. ix
  • 10. Subjective parameters: Duration of bleeding, No.of clots passed per day.Objective parameters: Hbgrm %RESULT: The trial produced highly significant result among patients of Group Awith regard to duration of bleeding, no. of clots passed and in Hbgrm%, after trial incomparison to before trial.Similarly there was excellent relief among patients of groupA with regard to Dourbalya,angamarda,alasya,aruchi etc following trial.The data thus obtained among patients of group A & group B leads one to theinterpretation that the trial employed for patients of group A is much superior incomparison to group B.Key Words: Asrigdara, Virechana, Pathya ahara and Vihara, DUB x
  • 11. TABLE OF CONTENTSSL. NO CHAPTER PAGE NO 1. INTRODUCTION 1–3 2. OBJECTIVES 4 3. REVIEW OF LITERATURE a) Brief anatomy of female 5 – 20 reproductive system b) Normal and Abnormal uterine 21 – 40 bleeding c) Asrigdara-Disease review 41- 77 d) Drug review 78- 85 e) Virechana-Procedure review 86- 99 4. METHODOLOGY 100- 107 5. OBSERVATIONS & RESULTS 108-141 6. DISCUSSION 142- 155 7. CONCLUSION 156-157 8. SUMMARY 158-159 9. BIBLIOGRAPHY 160- 164 10. ANNEXURES 165-178 ix
  • 12. LIST OF TABLESSl.No Headings Page no. 1. Showing the etiology of AUB 45 2. Showing the classification of DUB 46 3. Showing the Causes of Ovulatory DUB 48 4. Showing the Lakshanas of Asrigdara according to different authors 62 5. Showing the Vishishta lakshanas of different types of authors 65 6. Showing the difference between Asrigdara & Adhoga raktapitta 69 7. Showing the difference between Asrigdara & Rakta yoni 70 8 Showing the difference between Vataja Asrigdara & Vataja 71 yonivyapad 9. Showing the difference between Pittaja Asrigdara & Pittaja 71 yonivyapad 10. Showing the difference b/w Kaphaja Asrigdara &Kaphaja 72 yonivyapad 11. Showing the Upadrava lakshanas acc to different authors 75 12. Showing the list of Apathya ahara and Vihaara 77 13. Showing the Properties of drugs in jeerakaadi choorna 79 14. Showing the Properties of drugs in Trivrith lehya 84 15. Showing the Samyak snigdha lakshanas 89 16. Showing the dosage of virechana acc to Sharangadhara 90 17. Showing the Aoushadha jeernaajeerna lakshana 91 18. Showing the virechana shuddhi vinimaya 92 19 Showing the samyak lakshanas of virechana karma 93 20. Showing the Ayoga lakshanas of virechana karma 93 21. Showing the Atiyoga lakshanas of virechana karma 94 22. Showing the ingredients with their quantities of drugs used in 103 Ghruta murchana 23. Distribution of patients based on Registration 108 24. Distribution of patients based on Age 109 25. Distribution of patients based on education 110 x
  • 13. 26. Distribution of patients based on Occupation 11027. Distribution of patients based on Socio economic ststus 11128. Distribution of patients based on Marital status 11229. Distribution of patients based on Religion 11230. Distribution of patients based on Family history 11331. Distribution of patients based on Drug history 11332. Distribution of patients based on Family Type 11433. Distribution of patients based on Chronicity 11534. Distribution of patients based on Age of menarche 11535. Distribution of patients based on Past menstrual history 11636. Distribution of patients based on Present menstrual history 11637 Distribution of patients based on Obstetric history 11738 Distribution of patients based on Contraceptive history 11839 Distribution of patients based on Diet 11940 Distribution of patients based on Dominant rasa 12041. Distribution of patients based on Dominant guna 12042. Distribution of patients based on Nature of work 12143. Distribution of patients based on Manasika avastha 12244. Distribution of patients based on Maithuna history 12245. Distribution of patients based on Shareera prakriti 12346. Distribution of patients based on Sara 12447. Distribution of patients based on Samhanana 12448. Distribution of patients based on Satva 12549. Distribution of patients based on Satmya 12550. Distribution of patients based on Abhyavarana shakti 12651. Distribution of patients based on Jarana shakti 12752. Distribution of patients based on Sleep 12753. Distribution of patients based on Akriti 12854. Distribution of patients based on Sroto Dusti 12855. Distribution of patients based on according to Nidana 12956. Distribution of patients based on Duration of bleeding 13157. Distribution of patients based on Passage of clots per vaginally 131 xi
  • 14. 58. Distribution of patients based on Associated symptoms 13259. Distribution of patients based on USG report 13260. Distribution of patients based on Per vaginal examination 13361. Observations of Samyak snehana lakshanas in Pts of Group A 13462. Observations of Vaigiki shuddhi lakshanas in Pts of Group A 13463. Observations of Anthikishuddhi lakshanas in Pts of Group A 13564. Observations of Laingiki shuddhi lakshanas in Pts of Group A 13565. Observations of Shuddhi lakshanas in Pts of Group A 13566. Effect of Virechana & Pathya ahaara vihaara on Asrigdara 13667. Effect of Virechana & Pathya ahaara vihaara (Group A) in Pts of 137 Asrigdara with regards to Associated complaints68. Effect of Pathya ahaara vihaara (Group B)on Asrigdara 13869. Effect of Pathya ahaara vihaara (Group B) in Pts of Asrigdara with 139 regards to Associated complaints70. Results of Group A & Group B- Comparative statistics 14071. Overall comparison of Group- A Group -B 141 xii
  • 15. LIST OF GRAPHSSl.No Headings Page no. 1. Distribution of patients based on Registration 109 2. Distribution of patients based on Age 109 3. Distribution of patients based on education 110 4. Distribution of patients based on Occupation 111 5. Distribution of patients based on Socio economic ststus 111 6. Distribution of patients based on Marital status 112 7. Distribution of patients based on Religion 112 8 Distribution of patients based on Family history 113 9. Distribution of patients based on Drug history 113 10. Distribution of patients based on Chronicity 115 11. Distribution of patients based on Age of menarche 116 12. Distribution of patients based on Past menstrual history 116 13. Distribution of patients based on Present menstrual history 117 14. Distribution of patients based on Obstetric history 118 15. Distribution of patients based on Contraceptive history 118 16. Distribution of patients based on Diet 119 17. Distribution of patients based on Dominant rasa 120 18. Distribution of patients based on Dominant guna 121 19 Distribution of patients based on Nature of work 122 20. Distribution of patients based on Manasika avastha 123 21. Distribution of patients based on Maithuna history 124 22. Distribution of patients based on Shareera prakriti 123 23. Distribution of patients based on Sara 124 24. Distribution of patients based on Samhanana 125 25. Distribution of patients based on Satva 126 26. Distribution of patients based on Satmya 127 xiii
  • 16. 27. Distribution of patients based on Abhyavarana shakti 12528. Distribution of patients based on Jarana shakti 12529. Distribution of patients based on Sleep 12930. Distribution of patients based on Akriti 12831. Distribution of patients based on Sroto Dusti 13032. Distribution of patients based on according to Nidana 13033. Distribution of patients based on Duration of bleeding 13034. Distribution of patients based on Passage of clots per vaginally 13135. Distribution of patients based on Associated symptoms 13236. Distribution of patients based on USG report 13337. Distribution of patients based on Per vaginal examination 13338. Showing the effect of Virechana & pathya aahara and vihaara 136 in Duration of bleeding39. Showing the effect of Virechana & pathya aahara & vihaara in 137 No. of clots passed per day40. Showing the percentage of relief in Associated symptoms 13841. Showing mean duration of bleeding in Group B 13842. Showing the mean of clots passed per day in Group B 14043. Showing the % of relief in associated symptoms in Group B 14344. Showing the % of improvement in both Groups 152 xiv
  • 17. LIST OF PLATESSl.No Headings Page no. 1. Normal uterine anatomy(cut section) 11 2. Layers of Uterus 14 3. The Phases of Menstruation 36 4. Murchita ghruta 85 5. Tila taila 85 6. Trivrith lehya 85 7. Jeerakaadi churna 85 xv
  • 18. Introduction INTRODUCTIONGender differentiation and discrimination in the 21st century have become a thing ofpast. Increasingly there is equality between male and female sexes in all aspects ofsocial and family life as well as in Professional life. Women are as good a decisionmakers as men are and they playing there are playing an increasingly important role inthe upkeep of social and family welfare. However in the changed social set up womenare unable to pay adequate attention to their own health. The increasing stress ofmodern life and to compete with men in all aspects of life, the women need to keepthoroughly in the pink of health.Apart from social and professional commitments a women is committed to her role aswife and mother. This added strain in her physical and psychological framework canprove deleterious unless proper care is taken weak link in this chain and the onewhich is most likely to get disturbed is the menstrual rhythm and the fertility.The word Artava denotes two meanings one of them is Antah Pushpa and another oneis Bahir Pushpa. Both Antah and Bahir Pushpa are interrelated. Bahir Pushpa isoutward manifestation of functional aspect of Antah Pushpa which is essential forconception. The present study deals with Bahir Pushpa that is manifestedmenstruation. Menstruation is the natural physical manifestation of the reproductivecycle occurring within the womens body.It is also called as monthly cycle because ofthe average intervals of 28days.Artava or menstrual blood is expelled from the uterus through the vagina rhythmicallyat regular intervals from menarche to menopause except during pregnancy. Thenormal range of menstrual cycle extends from 24-32days the duration of bleeding 1 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 19. Introductionnormally ranging from 4-6days and estimated blood loss is 20-60ml. The menstrualrhythm is a delicate chain reaction depending upon the patency of Hypothalamo-pituitary-ovarian- axis.Asrigdara indicates excessive and irregular bleeding per vagina.Asrigdara comprisesof all forms of excessive uterine bleeding, Dysfunctional uterine bleeding being oneof them.Dysfunctional Uterine Bleeding (DUB) is a State of Abnormal Uterine Bleeding WithOut any clinically detectable organic, systemic or iatrogenic cause. It affects about50% of menstruating women and has an incidence of about 10% amongst the newpatients attending the outpatient. Nearly 6% of women between the ages of 25-44years consult their GP’S for excessive menstrual loss every year, of which 35% ofthem are referred to hospitals and 60% will have a hysterectomy in the next 5 years.There is an elaborate description of Asrigdara both in Bhruhatrayees andlaghutrayees. Ayurveda describes in detail nidana, lakshana, prabheda and samprapthiof Asrigdara.The present study is designed to substantiate the theoretical aspects of nidana andsamprapthi of Asrigdara. Kashyapa has mentioned the use of virechana as a form oftreatment in asrigdara and in the present study the role of virechana as a form ofsamprapthi vighatana in asrigdara along with Pathya Aahaara and Vihaara is beinglooked into. 2 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 20. IntroductionReview of Previous Research Works Done:  1998 Joshi Seemi – Dysfunctional bleeding in relation to Dehaprakriti and its Management by Biofeedback procedures – Banaras  2004 Jamuna devi – Meaning of Asrigdara w.s.r to DUB With Ashoka yoga.- Puri  1998 Gupta anupama – Role Of certain indigenous drugs and uttara basti in pradara w.s.r to DUB.  1992 Sulochana – A study on Asrigdara with special reference to dysfunctional uterine bleeding.  1997 Manjusha M.Dixit. – Clinical and experimental study on Asrgdara. 3 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 21. Objectives OBJECTIVESObjectives of the Study:- The study is conducted with the following Objectives:  Substantiation of the Principles of Samprapthi in Asrigdara as is delineated in the Classical Texts through Clinical Trials.  To Validate the Role of Virechana as a form of Samprapthi Vighatana in Asrigdara.  To study the effect of Pathya Aahara and Vihaara in Samprapthi Vighatana of Asrigdara.Hypothesis:Null hypothesis H0: There is no significant role of virechana in samprapthi vighatanaof Asrigdara w.s.r to DUBAlternate hypothesisH1: There is a significant role of Virechana in the samprapthiVighatana of Asrigdara w.s.r to DUB 4 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 22. Anatomy Female Reproductive System BRIEF MENTION OF ANATOMY—FEMALE REPRODUCTIVE SYSTEMThe Menstrual phenomenon is one of the phenomena occurring in the females whichadd to the importance of females on the functional background. This is a very distinctphenomenon which is not present in the males; it not only distinguishes the femalesfrom the males but establishes the superiority of the females over males.zÉUÏUÌuÉcÉrÉÈ zÉUÏUÉåmÉMüÉUÉjÉïÍqÉwrÉiÉå |elÉÉiuÉÉ ÌWû zÉUÏUiÉiuÉÇ zÉUÏUÉåmÉMüÉUãwÉÑpÉÉuÉåwÉÑ elÉÉÉlÉqÉÑimɱiÉå | 1(Sha.6th 3rd shl) iÉxqÉÉcNûUÏUÌuÉcÉrÉqÉç mÉëzÉÇxÉÎliÉ MÑüzÉsÉÉ; ||This shloka is self explanatory, that Sharira Rachana and Kriya both are crucial intreatment as well as in Research work because without having proper knowledge ofPrakriti we cannot assess Vikriti. To know proper etiopathogenesis and managementof any disease the knowledge of Anatomy and Physiology of concerned organs is verynecessary.The anatomy of the Female Reproductive System is not clearly described inAyuvedic classics, but here and there a few scattered references are available.rÉÉåÌlÉ 3(Su. 35th 13shl),4(Su. 6th34 shl)The word "Yoni" in Ayurvedic classics refers to entire Reproductive system as well asindividual organs separately. With reference to Yoni, other few words are also foundin classics to denote the different parts of genital system. Bhagavistara, RaktapathaGarbhachidra,Garbhashaya , Apatyapatha , Madantpatra . 5 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 23. Anatomy Female Reproductive SystemurÉÑimÉÌ¨É (S.K.D)rÉÉæÌlÉÈ(Îx§É)rÉÉæÌiÉ xÉÇrÉÉåeÉrÉÌiÉÌiÉ |mÉrÉÉïrÉ:- Bhaga, Jal, Apatham, Janma-Vartma, Madanalaya, Adharam, Randhra.The word Yoni is derived from the Sanskrit root, "Yuj", (Amarkosha). "Yuj" means tojoin or to unite, which is suffixed by Ni to form the word YonixuÉÂmÉ:- 5(pu 3/31)“zÉÇZÉlÉÉprÉÉMüÌiÉrÉÉåïÌlÉx§ÉrÉÉuÉiÉÉï xÉÉ mÉëMüÐÌiÉïiÉÉ | çiÉxrÉÉxiÉ×iÉÏrÉå iuÉÉuÉiÉåï aÉpÉÉïzÉrrÉ mÉëÌiÉ̹iÉÉ |3(Sha.5th.43rdsl)According to Acharya Sushruta the shape of Yoni resembles with the "Shankh Nabhi"i.e. hollow portion of counch shell. Yoni has three avartas. The Garbhashaya isattached in third avarta.According to above description of Yoni, the Yoni refers toentire female genital organs. The "Avarta" of yoni resembles different parts of genitaltract. According to modern aspects also, similar type of descriptions are availablei.e. The vagina is a fibromusculo-membraneous sheath communicating the uterinecavity with the exterior at the vulva. It constitutes the excretory channel for theuterine secretion and menstrual blood. It is the organ of copulation and forms the birthcanal of parturition.The canal is directed upwards and backward forming an angel of450 with the horizontal in erect posture. The diameter of the canal is about 2.5 cm,being widest in the upper part and narrowest at its introitus. It has got an anterior, a 6 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 24. Anatomy Female Reproductive Systemposterior and two lateral walls. There are four fornices(clefts formed at the top ofvagina) – one anterior(shallow), one posterior (deeper)and two lateral.Structure:Layers from within outwards are:1) Mucous Coat2) Submucous Layer3) Muscular Layer4) Fibrous CoatEpithelium:The vaginal epithelium is under the action of sex hormones.at birth and upto 10- 14days,the epithelium is stratified squamous under the influence of maternal oestrogencirculating in the new born.upto prepuberty and in postmenopause ,the epitheliumbecomes thin,consisting of few layers only.from puberty till menopause the vaginalepithelium is stratified squamous and devoid of any glandaÉpÉÉïzÉrÉ :urÉÑimĘ́É:  aÉpÉïxrÉ AÉzÉrÉ: aÉpÉÉïzÉrÉ:  aÉpÉåï aÉpÉïaÉiÉÉ uÉÉ zÉcrÉiÉå 7 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 25. Anatomy Female Reproductive SystemThe word Garbhashaya is composed of two words i.e. Garbha and Ashaya. The wordAshaya means the place to rest. Thus the Garbhashaya means the space of the placewhere the Garbha lies or develops.mÉrÉÉïrÉ: (1) Kukshi (Ch. Sh. 4/5) (2) Garbhashaya (A.H.sh 1/8) (3) Vipul Srotas (Ka sh. 3/6(4) Dhara (Sh. pur. 5/10)xjÉÉlÉ  ÌmɨÉmÉYuÉÉzÉrÉrÉÉåqÉïkrÉå aÉpÉïzÉrrÉÉ rÉ§É aÉpÉïÎxiɸÌiÉGarbhashaya is situated in third avarta of yoni, behind the bladder, in betweenpittashaya and pakvashaya. In the context of situation of uterus the word "Pittashaya"should not beconsidered as gallbladder, rather it should be taken as small intestines the seat ofpittadhara kala. Pakvashaya refers to the place of digested food. i.e. large intestine.The uterus is above sigmoid colon, behind the urinary bladder and multiple coils ofsmall intestine rest upon uterus, which has been mentioned by Kashyapa. 8 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 26. Anatomy Female Reproductive SystemAÉMüÉU“rÉjÉÉ UÉåÌWûiÉqÉixrÉxrÉ qÉÑZÉÇ pÉuÉÌiÉ ÂmÉiÉ:| 3(xÉÑ.zÉÉ.5/44) iÉixÉÇxjÉÉlÉÉÇ iÉjÉÉÂmÉÉÇ aÉpÉïzÉrrÉÉÇ ÌuÉSÒoÉÑïkÉÉ:”||Acharya Sushruta has mentioned the shape of Garbhashaya like the mouth of"Rohitfish" 3(zÉÉ.5th 44sl QûsWûhÉ)“ iÉiÉxÉçÇxjÉÉlÉÉÌiÉÌiÉ AsmÉqÉÑZÉÉqÉliÉçqÉïWûÉxÉÑÌwÉUÉÍqÉirÉjÉï:” ||According to Dalhana, Garbhashaya has a small opening and hollowspace inside.In"Ayurveda Dipika" commentary, commentator has mentioned the shape ofGarbhashaya as "Kshudratumbi phala" which is having its mouth down wards and itsshape is somewhat flattened .UTERUS:The uterus is a hollow pyriform muscular organ situated in the pelvis between thebladder in front and the rectum behind. It is the internal genital organ formenstruation,sperm Transport and capacitation, embryo embedding and child bearingin a Woman.Development of uterusUterus is developed by the fusion of the intermediate horizontal and the Adjoiningvertical part of the mullerian duct which begins at 7-8 wks and Complete at 12thweek. 9 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 27. Anatomy Female Reproductive System  Position: is one of the anteversion and snteflexion.the uterus usually inclines to the right(dextrorotation) so that the cervix is directed to the left(levorotation) and comes in close relation with the left ureter.  Shape: pyriform or pear shaped anteroposteriarly Flattened organ.  size : In nulliparous – 3” x 2” x 1” – l x b x t and In parous – measured more  weight : nulliparous – 45-50 gm Parous – 50-70 gm.  Parts: it is divided mainly into three parts. 1. Body or Corpus :  Fundus: upper 2/3 part lying above the plane of the tubal Attachment is known as the fundus uteri.  Cavity: which is triangular in shape, communicating into the lumens of the Fallopian tubes on either side 2. Cervix or Neck: It is divided in to two parts -  supra vaginal portion  Vaginal portion. 3. Isthmus: It is constricted part measuring about 0.5 cm situated between the body and the cervix. It is limited above by the anatomical internal os and below by the histological internal os. 10 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 28. Anatomy Female Reproductive System Fig.1 Normal uterine anatomy (cut section)Structure:The wall of the body consists of 3 layers from outside inwards without anysubmucous layer. The layers are as follows -1. Perimetrium (serous layer)2. Myometrium (muscle layer)3. Endometrium (mucous layer)1. Perimetrium:It is the outer most layer of uterine walls. Serous layer covers the fundus, the anteriorsurface of the body. The serous layer not covered lateral borders. 11 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 29. Anatomy Female Reproductive System2. Myometrium:It is formed by bundles of smooth muscle fibers separated by Fibrous tissue, throughwhich run the blood vessels, nerves and Lymphatics. The muscular is arranged inthree layers.1) Outer longitudinal layer2) Middle vascular layer3) Inner circular layer1) Longitudinal layer:This is a thin layer running hood like from before backwards Over the fundus andstops short at the internal os and does not Cover the sides of the uterus where bloodvessels enter. It Converges at the uterine cornu on each side of the uterus to beContinues at the fallopian and round ligament.2) Vascular layer:It forms the main bulk of the wall. The muscle fibers are Disposed as figure of eightaround the vessels and thus act as “physiological living ligatures” to the myometrialvessels during Their contractions.3) Circular layer:It is present at all levels but chiefly developed at tubal ostia And the internal os. 12 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 30. Anatomy Female Reproductive System3. Endometrium:It rests directly on the muscle without the intervening submucous Layer. Its thicknessis variable. It depends upon the phase of the menstrual cycle. During thepostmenstrual phase it is very thin, i.e. 1-3 mm. But during the pre-menstrual phase itis thick and mayMeasure 5-7 mm. In the pre-menstrual phase, when it is thick, it can beDivided into three layers.1) Compact layer2) Spongy layer3) Basal layer1) Compact layer:This is the most superficial layer of the endometrium. It is lined by columnarepithelium, and consists of thickly packed stromal cells and the ducts of the glands,which open on the surface of the Endometrium. This layer is more prominent duringthe pre-menstrual Period.2) Spongy layer:This is the middle layer of the endometrium. It consists of the Glands of endometriumand loosely packed stromal cells. Due to Loose packing of these elements, it is calledthe spongy layer.The glands are of the straight tubular type. The glandular Epitheliumis columnar. In the second half of the menstrual cycle the Glandular epithelium 13 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 31. Anatomy Female Reproductive Systemproduces secretions, which are rich in Glycogen. The compact and spongy layers areshed off during Menstruation.3) Basal layer:This is the deepest layer. It has one cell thickness, and it is not shed off duringmenstruation. The compact and spongy layers are formed by proliferation of thislayer. Cells of the basal layer rest on the myometrium, there being no sub-mucosa. Fig.2 showing the layers of uterusBlood supplyArterial supply: The blood supply is from the uterine artery one on each side. Theartery arises directly from the anterior division of the internal Iliac or in common withsuperior vesicle artery. The other sources are ovarian and vaginal arteries to which theuterine arteries anastomose. 14 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 32. Anatomy Female Reproductive SystemVenous drainage: The venous channels correspond to the arterial course and Draininto internal iliac veins.Nerves supply:Sympathetic components are from t 5 and t6 (motor) and t 10 to l1 Spinal segments(sensory). The somatic distribution of uterine pain is that area of the abdomensupplied by t10 to l1. The parasympathetic System is represented on either side by thepelvic nerve which Consists of both motor and sensory fibers from S2, S3, S4.oÉÏeÉaÉëÍjÉ“x§ÉÏhÉÉqÉÉuÉëÑirÉ ÌiɹÌiÉ TüsÉqÉliÉaÉïiÉÇ ÌWûiÉÉ:”|| 3(sha.5th.53) In Ayurvedic classics, no direct reference available regarding Beejavahini. 3(sha.7th.38sl)“ xÉåuÉlÉÏ zÉÑ¢üüWûUhÉÏ xÉëÉåiÉxÉÏ TüsÉrÉÉåaÉÑïSqÉç” ||In the Ashmari Chikitsaadhya, Acharya Sushruta has confined to avoid injury to eightvital parts among which "xÉëÉåiÉxÉÏ TüsÉrÉÉå" means two phalasrotasa indicative ofBeejagranthi. So, all the above references show the direct description about ovary andBeejagranthi, Phala, Antargataphala as synonyms of the ovary.OvaryThe ovaries are paired sex glands or gonads in female one on each side is a solid flatreniform Structure.  Size: 3.5 cm. In length, 1.5 cm in thickness  Weight: 5-10 gm. Each ovary consists- 15 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 33. Anatomy Female Reproductive System  Two ends : tubal and uterine  Two borders : meso-ovarian and free posterior  Two surfaces: medial and lateral.The ovaries are intraperitoneal structures. In nullipara, the Ovary lies in the ovarianfossa on the lateral pelvic wall. The ovary is attached to the posterior layer of thebroad ligament by the mesoovarium, to the lateral pelvic wall by theinfundibulopelvic ligament And to the uterus by the ovarian ligament.StructureThe ovary is covered by a single layer of cubical cell known as germinal epithelium.The substances of the gland consist of outer Cortex and inner medulla.Cortex:It consists of stromal cells which are thickened beneath the germinal epithelium tofrom tunica albuginea. During reproductive Period the cortex is studded withnumerous follicular structures, called the functional units of the ovary, in variousphases of their Development. These are related to sex hormone production andOvulation. The structure includes primordial follicles, maturing Follicles, graafianfollicles and corpus luteum. Atrasia of the Structures results in formation of atreticfollicles or corpus Albicans.Medulla:It consists of loose connective tissues, few unstrapped Muscles, bloodvessels and nerves. There are small collections of Cells called “hilum cells” which arehomologus to the interstitial Cells of the testes. 16 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 34. Anatomy Female Reproductive SystemBlood supply:Arterial supply is from the ovarian artery, a branch of the abdominalaorta, venous drainage is through pampiniform plexus, to Form the ovarian veinswhich drain into inferior vena cava on the Right side and left renal vein on the leftside.Lymphatics :Through the ovarian vessels drain into para-aortic lymph Nodes.Nerve supply:Sympathetic supply comes down along the ovarian artery from T 10 segment. Ovariesare sensitive to manual squeezing.oÉÏeÉuÉÉÌWûlÉÏ: In Ayurvedic classics, no direct reference available regarding Beejavahini.One Indirect reference available in Sushruta Sharirasthana 3(sha.9th 20sl)“AÉiÉïuÉWåû ²å iÉrÉÉåqÉÑïsÉqÉç aÉpÉÉïzÉrÉ AÉiÉïuÉuÉÉÌWûlrÉ¶É kÉqÉlrÉ:” |According to above description by acharya sushruta, they are two in number, theirroots in garbhashaya and artavavahi dhamanis. As the word artava has got twomeanings viz. The artava Shonita (menstrual blood) and the stri beeja (ovum), theartavavaha Srotasa can be meant for the blood vessels and capillaries of the Uterusand fallopian tubes. As per modern science, we can correlate the artavavaha Srotasawith fallopian tube, because tubes are also two in number, one on each sides of uterus. 17 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 35. Anatomy Female Reproductive SystemFallopian Tubes (Uterine Tubes / Oviducts):Development:The uterine tubes develop from the unfused parts of the paramesonephric ducts. Theoriginal points of invagination of the ducts into the coelomic epithelium remain as theabdominal openings of the tubes. Fimbrias are formed in this situation.General Description:The Uterine tubes are paired structures, measuring about 10 cm (4 inch) and aresituated in the medial three fourth of the upper free margin of the broad ligaments.Each tube has got two openings, one communicating with the lateral angle of theuterine cavity called "Uterine opening" and measures 1 mm in diameter, the other ison the lateral end of the tube, called pelvic opening or abdominal ostium andmeasures about 2 mm in diameter. PartsEach tube, consists (medial to lateral)) of the following parts.(1) Intramural or Interstitial - lying in the uterine wall and measures 1.25cm (1/2inch) in length and 1 mm in diameter.(2) Isthmus - almost straight and measures about 2.5 cm (1 inch) in length and 2.5mm in diameter.(3) Ampulla-Tortuous part and measures about 5 cm (2 inch) in length.(4) Infundibulum - Measures about 1.25 cm (1.2 inch) long with a maximumdiameter of 6 mm. The abdominal ostium is surrounded by a number of radiating 18 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 36. Anatomy Female Reproductive Systemfimbriae; one of these is longer than the rest and is attached to the outer pole of theovary called "Ovarian fimbria".Structures:It consists of three layers.(1) Serous - consists of peritoneum on all sides except along the line of attachment ofmesosalpinx.(2) Muscular - Arranged in two layers. Outer - longitudinal and Inner - circular(3) Mucous Membrane - is thrown into longitudinal folds. It is lined by columnarepithelium, partly ciliated others secretory non-ciliated and "Peg cells". There is nosubmucous layer or any glands. Changes occur in the tubal epithelium duringmenstrual cycle but are less pronounced and there is no shedding.Functions(1) Transport of gametes and(2) To facilitate fertilization and survival of zygote through its secretion 19 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 37. Anatomy Female Reproductive SystemVascular connections(1) Arterial supply (a) Uterine Artery (b) Ovarian artery(2) Venous supply (a) Pampiniform plexus (b) Ovarian veins(3) Nervous supply (a) uterine nerves (b) Ovarian nerves 20 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 38. Uterine bleeding Normal & Abnormal UTERINE BLEEDING – NORMAL AND ABNORMALAÉiÉïuÉÌlÉÂÌ£ü: (B.p.pur)1. UerÉiÉå AlÉålÉ rÉÉålrÉÉÌS CÌiÉ UeÉ:The substance which stains the Yoni or the Vagina is termed as Raja, its purity and impurityis to be tested by means of stained cloth (Amarkosh pp.210), since it stains the cloth also andas such it is termed as Raja. (B.p.pur)2. x§ÉÏkÉqÉï xÉÔcÉMüqÉÉiÉïuÉqÉç qÉsÉÂmÉÇ ÂÍkÉUçÇ UeÉ:According to Bhavaprakash, “qÉsÉÂmÉ ÂÍkÉU” which makes its appearance throughvagina every month i.e. menstrual blood, is called as Rajah. The presence of regularmenstruation indicates the starting of Reproductive life of a woman, which isindicated by Bhavaprakash as . x§ÉÏkÉqÉï .mÉËUpÉÉwÉ1. HiÉÉæ pÉuÉÇ AÉiÉïuÉqÉç x§ÉÏhÉÉÇ ÄrÉSmÉirÉqÉÉaÉÉïiÉç zÉѬqÉÏwÉiMÚüwhÉÇ 6(sha.1st1sl AÂhÉS¨É) ÌuÉaÉÇkÉÇ cÉ uÉÉrÉÑmÉëåËUiÉÇ sÉÉåÌWûiÉÇ mÉëuÉiÉïiÉå iÉSÉiÉïuÉqÉÑcrÉiÉåIn female, the periodical bloody discharged through vagina is by vayu. If it is pure, itis having blackish colour and specific odour, it Is known as artava.Commentatorarundutta gave detail composition of menstrual Blood with above mentioneddefinition. Thus, both words „artava‟ and „menstruation‟ convey same Meaning i.e.belonging or confirming to seasons or periods of time 6 ( sha .1/17) 2. qÉÉÍxÉ qÉÍxÉ UeÉ: x§ÉÏhÉÉqÉç UxÉeÉÇ xÉëuÉÌiÉ §ÉWûqÉ 21 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 39. Uterine bleeding Normal & Abnormal.Exclusively in female, the substance, which is formed from Rasadhatu as a part ofphysiology and comes out through the female genital tract every month for theduration of three days, is termed as Rajah.mÉrÉÉïrÉRajah, Artava, Asrika, Rudhira ,Rakta ,Shonita ,Lohita ,Pushpa ,BijaDifferent meanings of AÉiÉïuÉ :Mainly the meaning of the word artava is restricted to indicate the blood only butsometimes the term artava is meant for the stribeeja or ovum also.As per AcharyaCharaka – Purana raja for Bahirpushpa and Nava raja or Tanuraja or Beeja for theAntahpushpa.As per Acharya Kashyapa – Antahpushpa and Bahirpushpa words have been used forthe Artava.As per Chakrapani – Adjectives like Udbhoota, Prabhuta or Upchita for the menstrualblood, while Anudbhoota, Alpa, Tanu or Styanibhut for the ovum or the Antahpushpa.UeÉÉåmÉëuÉëÑÌ¨É MüÉsÉ ÌlÉuÉëÑÌ¨É MüÉsÉ 6 ( sha.1/7)1.uÉixÉÉUɲÉSzÉÉSÕkuÉåï rÉÉÌiÉ mÉÇcÉÉzÉiÉ: ¤ÉrÉqÉç | 3 (sha.14th 7sl)2.iÉSè uÉwÉÉïSè ²ÉSzÉSÕ²ïÇ rÉÉÌiÉ mÉÇlcÉÉzÉiÉ: ¤ÉrÉqÉç |3. iÉSè uÉwÉÉïSè ²ÉSzÉÉiÉç MüÉsÉå uÉiÉïqÉÉlÉqÉxÉ×Mçü mÉÑlÉ:| 3 (sha.3rd.11sl) eÉUÉmÉYuÉzÉUÏUÉhÉÉÇ rÉÉÌiÉ mÉÇhcÉÉzÉiÉ: ¤ÉrÉqÉç || 6 ( sha.1/21)4 .rÉÉåÍzÉiɶÉÉålɲÉSzÉÉiÉÏiÉ mÉÇlcÉÉzɲwÉÉïrÉÉ UeÉxiÉlrÉÉSrÉ CÌiÉ | 22 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 40. Uterine bleeding Normal & AbnormalAll Acharyas have mentioned twelve years as the age of menarche.There is nocontroversy regarding time of first Artava darshana.Acharya Kashyapa hasmentioned the age as sixteen years it may be the description of approximate age forconception. He further says, this age can be influenced by specific Ahara (dietetics)and Arogya (health). According to Arunadatta, these are the probable ages, there maybe slight variation in individual cases as menarche may come at eleven years similarlyage of menopause may also be delayed.All samhitas has mentioned the Artava nivrittikala as fifty years.Different forms of Artava :The Artava serves its function in three forms viz. 1. In the form of Dhatu 2. In the form of Upadhatu 3. In the form of Mala1) In the form of Dhatu:Acharya Bhavamishra has mentioned that the women have more Dhatus in number incompare to the males due to one more number of Ashaya (Garbhashaya) and artavabeing an essential factor for Garbhotpatti is called as the seventh dhatu in the femaleonly. When it serves the function of reproduction or progeny,placental formation andstanavriddhi during pregnancy, it is called as Dhatu rupa artava. Artava is consideredas an upadhatu.Upadhatu means those substances in the body which are theconstituents of body but having no qualities to generate like the dhatu. Here, theArtava has been described as the upadhatu of Rasadhatu by Acharya Charaka andAcharya Sushruta. But Sharangadhara, the seventh dhatu in the female only. When it 23 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 41. Uterine bleeding Normal & Abnormalserves the function of reproduction on progeny, placental formation and stanvriddhiduring pregnancy, it is called as Dhatu rupa artava.2) In the form of Upadhatu:Artava is considered as an Upadhatu. Upadhatu means those substances in the bodywhich are the constituents of body but having no qualities to generate like the Dhatu.Here, the Artava has been described as the Upadhatu of Rasadhatu by AcharyaCharaka and Acharya Sushruta. But, Acharya Sharangadhara, described Artava as anUpadhatu of Raktadhatu. Because the Artava performs only the Dharana and Poshanakarma for the female genital organs and foetus only.3) In the form of Mala:That from of artava occurs at a monthly interval through the female genital tract isnamed as Mala rupa artava due to the presence of some toxic substances in it. It‟sdischarge is supposed to clean the body of the females.Nature of Artava Shonita1.Varna(colour)1.aÉÑleÉÉTüsÉxÉuÉhÉïÇ cÉ mÉ©ÉsÉ£üMüxÉͳÉpÉqÉç | 1( 30th.226sl ) ClSìaÉÉåmÉMüxÉÇMüÉzÉqÉiÉïuÉÇ zÉÑS®qÉÉSÏzÉåiÉç ||2.zÉzÉÉxÉ×YmÉëÌiÉqÉÇ rÉiÉç iÉÑ rÉ²É sÉɤÉÉUxÉÉåmÉqÉqÉç | 3(sha.2 nd.17 sl ) iÉSÉiÉïuÉÇ mÉëzÉÇxÉÎliÉ rÉSè uÉÉxÉÉå lÉ ÌuÉUleÉrÉåiÉç ||The colour should resemble Gunjaphala ,Rakta Kamal ,Alaktaka ,IndragopaSashasrika ,Laksha rasa. In the modern text the menstrual flow is said to begin aspink in colour afterwards it turn into dark red. 24 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 42. Uterine bleeding Normal & Abnormal2. Gandha(Odour): 3( chi.14th 9sl) ÌuÉxÉëiÉÉ AÉqÉaÉÇÍkÉiuÉAcharya Sushruta says that the Rakta has visragandha due to prithvi mahabhuta, samecan be considered for Artava. Dalhana explains that this foul smell in menstrualblood is due to the fact that Artava has same properties as that of Pitta, thus smell likePitta. In menstrual blood, there is presence of mucous and nutritive substances likeglycogen, iron etc, so specific odour is found.3. Matra (Quantity): 6(sha 3rd 81sl) 1. cÉiuÉÉUÉå UeÉxÉ:Îx§ÉrÉÉ: 4 (sha.5th 98sl) 2. x§ÉÏhÉÉÇ UxÉeÉÉåSleÉsÉrɶÉiuÉÉUç:| 1(chi.30/225) 3. lÉæuÉÉÌiÉoÉWÒû: lÉÉirÉsmÉqÉÉiÉïuÉÇ zÉѬqÉÉÌSzÉåiÉç |According to Ashtanga Hridaya, it is four Anjali. Artava being a liquid is measured inAnjali pramana. Anjali pramana is measured by ones own Anjali. Due to variation ofDesha, Kala, Ahara, Vihara, Prakriti etc. quantity of menstrual blood also changes.Thus the quantity of blood which is normal for one lady may be abnormal for theother lady.According to Acharya Charaka, there is no fixed quantity of Artava. He says thatwhich is neither less nor more in amount and which is ideal for conception and doesnot cause any pathology during and after every cycle is the ideal amount.In Ayurveda, Anjali pramana of Artava srava seems to be much scientific becauseeach lady has different sizes of Anjali. Thus the amount of Artava srava is her ownAnjali pramana is better indicator of her health. If it increases or decreases than fourAnjali, that condition will be abnormal for her.Total loss of blood is difficult to 25 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 43. Uterine bleeding Normal & Abnormalestimate but normally 20-80 ml approximately with average of 35 ml is lost everymonth. Majority of the blood loss occurs during first 2 days.4.Artava Srava Kala (Duration) 6(sha.1st17sl)1.qÉÉÍxÉ qÉÍxÉ UeÉ: x§ÉÏhÉÉqÉç UxÉeÉÇ xÉëuÉÌiÉ §ÉWûqÉ |Artava Srava Kala means duration of menstrual bleeding. Artava Srava Kala varieswith individuals.Ayurvedic classics have different opinion regarding duration ofmenstruation. It describes three to five days and rarely up to seven days.Different opinions regarding Artava Srava Kala are as follows:- Charaka (Ch. Chi 30/226) → 5 Days Vagbhatta (A.S.Sh. 1/10, A.H. Sh.1/7) → 3 Days Harita and Bhel (Ha. Sh1/8, Bh. S.5/6) → 7 DaysAccording to above references minimum duration of Artava Srava Kala is 3 daysand maximum is 7 days. If Artava Srava Kala is less than 3 days and more than 7days it may be taken as abnormal. According to modern the menstrual cycle isgenerally of 28 days. Menstruation last for 3 to 7 days with average of 4 to 5 days.5.Swarupa (Characteristics) 3(su.14th 7sl)1.AÉiÉïuÉÇ zÉÉåÍhÉiÉÇ iuÉÉalÉårÉqÉç | 3(su.15th 5sl.)2. U£üsɤÉhÉqÉÉiÉïuÉÇ aÉpÉïM×üŠ | 3(sha.3rd.3sl)3. ......AÉiÉïuÉÉalÉårÉqÉç |According to Acharya Sushruta, Artava is Agneya, has characteristics of rakta,formsgarbha,and is also essential for life . 26 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 44. Uterine bleeding Normal & Abnormal 6. Composition of Menstrual BloodEach and every constitute of the body is of the combination of Panchamahabhutas.Similarly the composition of Artava is also Panchabhautik with the predominance ofPrithvi, Jala, and Teja mahabhutas. Vayu helps in its regular generation and flowwhereas Akasha mahabhuta gives it the necessary space and Laghuta.Menstrual discharge consists of dark altered blood mixed with mucous secretion fromcervical, vaginal secretion and endometrial debris, bacteria and leukocytes. Sometimes small shreds of necrotic tissues can be identified.Although menstrual blood ismainly fluid, small clots are noticed occasionally by 50% women. The normalmenstrual discharge does not clot and contains no prothrombin though rich incalcium. Its fibrinogen content is low and it is presumed that prothrombin isinactivated in the endometrium. It is suggested that the blood discharged from theendometrium during menses may clot inside the uterus. Subsequently an enzymecapable of proteolysis dissolves the clots.UeÉ ÌlÉqÉÉïhÉ : 3(su 14th 20sl) 1. UxÉÉiÉç xiÉlrÉqÉiÉïuÉ¶É | 1(chi.15th 17sl) 2. UxÉÉiÉç xiÉlrÉÇ iÉiÉÉå U£Çü | 6(sha.1st17sl) 3. qÉÉÍxÉ qÉÍxÉ UeÉ: x§ÉÏhÉÉqÉç UxÉeÉÇ xÉëuÉÌiÉ §rÉWÇû | 4. iÉjÉÉ UMüqÉåuÉ cÉ x§ÉÏhÉÉÇ qÉÉxÉå qÉÉxÉå aÉpÉïMüÉå¹É qÉlÉÑmÉëÉmrÉ §ÉrÉWÇû mÉëuÉiÉïqÉÉlÉqÉiÉïuÉÍqÉirÉÉWÒû:|| 4 (sha.1st.10sl)Different opinions regarding the formation of Artava:-(1) Formed from Rasa → Charaka, Sushruta, Vagbhatta II, Chakrapani, Dalhana. 27 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 45. Uterine bleeding Normal & Abnormal(2) Formed from Rakta → Vagbhatta I.Actually both these descriptions are identical because rakta either dhaturupa orartavarupa is always derived from rasa, thus it Appears that sushruta etc. Havementioned the earlier stage ofArtava formation while vagbhatta-i the later stage.chakrapani clarified that, during theprocess of formation the Artava is saumya due to influence of rasa, while at the timeof its Exertion due to specific changes it assumes agneya character. This Alteration isbrought due to change in character caused by Doshas in the same way as solidsubstance are changed into fume Due to action of fire, cane juice a vitiating factor ofkapha is Changed after fermentation into wine which vitiates all the three Doshas. Arunadatta has opined that, this artava is formed from aahara – rasa And not from rasa dhatu (A. H. Sha. 1/7) Acharya sharangadhara and Bhavaprakash mentioned artava as by product (upadhatu) of rakta. (Sha. Pu. Kha. 11/6) Chakrapani has clarified the process of artava as upadhaturupa with help of charaka opinion. According to acharya charaka, from the various kinds of food Ingested thereare formed assumable nutrient fluid called the prasada Bhaga and excretory matercalled the mala bhaga (Ch.Su. 28/5). Just after the completion of jatharagni andbhutagnivyapar, aahara Converts into Aahara rasa upon which rasadhatvagni acts andproduces two Main parts named as sthulabhaga and sukshma bhaga. Amongst themSthula bhaga is used as upadhatu i.e. Artava (ch. Chi. 15/16 – chakrapaniTika).Acharya sushruta while describing the formation of dhatu accepts Formation ofartava as dhaturupa along with shukra in female (Su. Su.14/10). 28 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 46. Uterine bleeding Normal & AbnormalRasa is successively transformed into each of the six remaining Fundamental tissuesof the body in continuation in shape of each Dhatu for the period of 3015 kala. Thusthe rasa is converted into Shukra or artava in woman in course of a month (Su. Su.14/14). Here if we conclude all opinions regarding formation of „artava‟ and interpretthem with modern gynaecological Endocrinology than we find some correlationbetween them. In classics raja or artava (menstrual blood) is said to be Formed from„rasa‟ or „rakta‟. This is actually description of two Stages of its formation, thehormone of hypothalamus to pituitary Then to ovary and ultimately to their targetorgan i.e. endometrium. This very process has been explained by chakrapani with thewords „avirbhave‟ (formation) and „tirobhava‟ (discharge) initially besidesNourishment to endocrine, glands as well as uterus and endometrium By „rasa‟. Thetransportation of hormones to target organs through „rasa‟ is essential here after theblood get accumulated in hair thin Branches of „artavavimochini‟ (uterine artery)which is discharged during menstruation. 29 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 47. Uterine bleeding Normal & AbnormalSchematic representation of ‘ARTAVA UTPATTI’ Ahara Process by Jatharagni Aahaara rasa Kittamsha Processed by Rasagni Prasadamsha Kittamsha Sukshma Sthula Rakta Poshaka Bhaga Rasadhatu Poshakabhaga Upadhatu Poshakabhaga(Artava,Stanya) Artava utpatti 30 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 48. Uterine bleeding Normal & AbnormalArtava ekatrikarana evam visarjana:1.“qÉÉxÉålÉÉåmÉÍcÉiÉÇ MüÉsÉå kÉqÉlÉÏqrÉÉÇ iÉSÉiÉïuÉqÉç | 3( sha.3rd 7sl) CwÉSè ¢ÑüwhÉÇ ÌuÉaÉlkÉ¶É uÉÉrÉÑrÉÉåïÌlÉqÉÑZÉÇlÉrÉåiÉç ” ||2. UeÉÉåuÉWûÉ ÍxÉUÉ rÉÎxqÉlÉç UeÉ: mÉëÌuÉxÉëÑeÉlrÉiÉ:| 7(khi. 99th 17sl ) mÉÑwmÉpÉÔiÉÇ ÌWû iÉSæuÉÉlqÉÉÍxÉ qÉÉÍxÉ mÉëuÉiÉïiÉå ||The blood collected for whole month by both (uterine vessels And their endometrialcapillaries) assuming ishat krishna varna and Specific gandha is brought downward toyonimukha for excretion. Acharya kashyapa believed that, the blood in adult femalesDuring their reproductive period enters into garbhakoshtha every Month. This is doneby the rajovaha shira present in the Garbhashaya which are the carrier of the artavaformed by the action Of artavagni upon the rakta. These shira fill the uterus everymonth And after the completion of one month the artava is expelled out by Them.Commentator vishvamitra has clarified the microscopic Appearance of vessels byusing the word „sukshma kesha‟.GiÉÑMüÉsÉ1. GiÉÑxiÉÑ ²ÉSzÉU§ÉÇ pÉuÉÌiÉ SعÉiÉïuÉ: | 3(sha.3rd 6sl) ASÛ¹ÉiÉïuÉÉSmrÉxiÉÏirÉåMåü pÉÉwÉliÉå | | 6(sha.1st 27sl)2. HiÉÑxiÉÑ ²ÉSzÉÌlÉzÉÉ...3. AiÉ FkuÉïqÉ×iÉѲÉïSzÉÉWÇû oÉëɽhÉÏhÉÉqÉç SzÉÉWÇû uÉæxrÉÉlÉÉÇ lÉuÉU§ÉÍqÉiÉUÉxÉÉqÉç |7(sha. 5th 5sl ) It is of 12 days according to other opinions it may be of 16 days.If yoni garbhashaya and artava are healthy it may be of entire month,sometimes rutukaala may come up without menstruation .dalhana has explained that in 12 31 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 49. Uterine bleeding Normal & Abnormal days duration the first 3 days and last 1 day of constriction of yoni out of 16 days duration are not counted.since the seeds(sperms) deposited during this period are likely to bear fruit(conception) hence it is termed as rutukaala Menstrual cycleThe normal reproductive years of the female (Except during pregnancy and lactation)are characterised by monthly rhythmical changes in the rates of secretion of thefemale hormones and corresponding physical changes in the ovaries and other sexualorgans. The rhythmical pattern is called "Female Reproductive Cycle" or"Menstrual Cycle."During the reproductive cycle, females normally experience a cyclical sequence ofchanges in the ovaries and uterus. Each cycle takes about a month and involves bothoogenesis and preparation of the uterus to receive a fertilized ovum. Thus, the generalterm Female Reproductive Cycle "encompasses the Ovarian and Uterine cycle andhormonal changes that regulate them.Artava or rutuchakra kala is described as one month and this Entire period is dividedin to three viz. 1. Raja srava kala: 3 to 5 days (menstruation) 2. Rutukala(proliferative phase Including ovulation) : 12 or 16 days 3. Rutu vyatitakala (post ovulatory phase or Secretory phase) : 9 or 13 daysAs per our science, the duration of artava chakra is one month (chandramasa - 28days) as per modern science, 28 ± 7 days have been accepted. 32 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 50. Uterine bleeding Normal & AbnormalMenstruationThe term menstruation is derived from latin „mensis‟ meaning month(lunar month)because the bleeding occurs roughly at intervals of 28 days.“Menstruation is the visible manifestation of cyclic physiologic uterine bleeding dueto shedding of the endometrium following invisible inteplay of hormones mainlythrough hypothalamo-pituitary-ovarian axis(HPO axis)”.During menstrual cycle,some major changes occur in the uterus,in addition ,changes occur also in the vagina,breast and other organs, side by side the maturation of follicle in the ovary(ovariancycle) continues.Periodic discharge of the bloody fluid from the uterus occurring at regular intervalsduring the life of a woman from the age of the puberty to menopause.Proliferative PhaseThe first day of bleeding is counted as the day of the menstrual cycle.in an averagecycle,the bleeding stops on about 4th day.from the day of stopping of the bleeding tillthe day of ovulation (which is usually on the 14th day of the menstrual cycle),theendometrium continuously proliferates and hence this phase is called the proliferativephase.Changes in Proliferative phase: 1. Uterus: a) Endometrium: It is thinnest after the cessation of menstrual bleeding because all the superficial layers have been cast off during the menstrual bleeding .the endometrium is little more than 1mm thick at this stage.as the 33 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 51. Uterine bleeding Normal & Abnormal proliferative stage progresses the glands in the endometrium grow in length,the blood vessels grow, just before ovulation ,the endometrium becomes about 5mm thick. b) Endocervical mucus: the secretion of the glands of the uterine cervix becomes very thin at the stage of ovulation to facilitate the entry of the sperms. c) Uterine muscles: the myometrial contractions become more powerful.this powerful contraction probably produces a suction action by which the spermatozoa are drawn inside the uterus. 2. Ovary: The uterine changes are due to the rising concentration of oestrogen. Because of the fact that the proliferative phase is associated with a growing (maturing) follicle in the ovary, this phase is also called as „follicular phase‟.Secretory phase:Within about three days after the ovulation, the corpus luteum is well developed,witha diameter of about 1cm and it is now secreting progesterone.the changes in thesecretory phase are due to the progesterone hence it is also called progesteronalphase. 1. Uterus a. Uterine glands become tortuous and filled with secretions.some exudating of secretion may occur from the vagina and called uterine milk. b. The arteries of the endometrium become coiled. 34 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 52. Uterine bleeding Normal & Abnormal c. Glycogen content of the endometrial epithelium increases d. The irritability of the myometrium decreases. 2. Ovary a. Corpus luteum is formed b. Granulosa cells are converted into lutein cells, unless pregnancy occurs the corpus luteum degenerates on 14th day. - Secretary phase is also called as luteal phase. 3. Bleeding Phase Changes in the uterus: At the end of the secretory phase,the spiral arteries of the endometrium undergo spasm,the cause of the spasm is not clear.as a result of the spasm portions of the endometrium are sloughed out together with the blood constituting the menstrual flow. Usually the superficial 2/3rd of the endometrial tissue is sloughed out,the basal 1/3rd remains. The blood undergoes clotting within the uterine cavity and within the cavity it is liquefied again.the blood which comes out per vagina in normal subjects,therefore does not clot.in some individual cases ovulation does not occur therefore there is no secretory phase of endometrium in these women.even then the bleeding occurs while the endometrium is still in proliferative phase .such menstruations are called „Anovular menstruation’ 35 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 53. Uterine bleeding Normal & Abnormal Fig No.3.Phases of MenstruationHormonal control of menstrual cycleAccording to modern gynaecology, gonadotrophins hormone And ovarian hormoneare responsible for menstruation.The secretion of gonadotrophins by the anteriorpituitary is in Turn controlled by a hypothalamic regulatory gonadotrophin Releasinghormone (gnrh).Ovarian hormones also control the production of Gonadotrophins bythe negative feedback mechanism. It is very necessary to know the basic function ofthese Hormones to evaluate the process of menstruation.GonadotrophinsThe following gonadotrophins are produced by the anterior Lobe of the pituitary.1) Follicle stimulating hormone (FSH)2) Luteinizing hormone (LH)3) Prolactin1) Follicle stimulating hormone (FSH) 36 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 54. Uterine bleeding Normal & AbnormalThis hormone is produced by the basophil cells of the anterior Pituitary. It acts on theprimordial follicles of the ovary and leads to Proliferation and growth of granulosacells and theca interna.Under the influence of this hormone, during each menstrual Cycle, one of theprimordial follicle is converted into graafian Follicle.2) Luteinizing hormone (LH):This hormone is also produced by the basophil cells of the Anterior pituitary. It actson the mature graafian follicle and leads To shedding of the ovum and conversiongraafian follicle into corpus Luteum.3) Prolactin (PRL):This hormone was also called, luteotrophic hormone (lth). It is produced by acidophilcells of the anterior pituitary. It is Responsible for the maintenance of corpus luteum.But its main actionIs on the active breasts where it maintains lactation.Ovarian steroidogenesisThe principal hormones secreted from the ovaries which are Responsible formenstruation are - oestrogen and progesterone.1) Oestrogen:The predominant sites of production are granulosa cells of the Follicle. Oestrogencauses proliferation of endometrial glands and Growth and compaction of the stroma.It restores the endometrium, Including its spiral arteries, after menstruation, but doesnot induce .The gland to secrete. An endometrium suddenly deprived of an Oestrogeninfluence breaks down and bleeds. 37 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 55. Uterine bleeding Normal & Abnormal2) Progesterone:The progesterone is secreted from the luteinised theca Granulosa cells of the corpusluteum.Progesterone increases the thickness of the endometrium by enlarging the glands andby rendering the stroma oedematous. It Promotes endometrial enzymatic activity,induces the glands, already Proliferated by oestrogen, to secrete and brings about thedecidual reaction in the stroma. ABNORMAL UTERINE BLEEDINGA normal menstrual period lasts from 2 to 7 days. The normal cycle patterns canrange from 21 to 35 days. When bleeding occurs that is not part of the regular cycle;periods are longer or heavier than normal; occurs between periods; time betweenperiods is longer than normal; or there is an absence of periods, this is calledabnormal or irregular uterine bleeding. There are various causes of abnormalbleeding, but the most common is a hormone imbalance.Menorrhagia (Hypermenorrhoea):Menorrhagia is defined as cyclic bleeding at normal intervals,the bleeding is eitherexcessive in amount (>80ml) or duration or both. The term menotaxis is often used todenote prolonged bleeding.Polymenorrhoea:Definition:Polymenorrhoea is defined as cyclic bleeding where the cycle is reducedto an arbitrary limit of less than 21 days and remains constant at that frequency cycleis associated with excessive and or prolonged bleeding. 38 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 56. Uterine bleeding Normal & AbnormalMetrorrhagia- Metrorrhagia is defined as irregular, acyclic bleeding from the uterus.Menometrorrhagia- Prolonged or excessive uterine bleeding occurring at irregular and more frequentthan normal intervals (the 2 above combined.)Intermenstrual bleeding commonly called "spotting". uterine bleeding of variable amounts occurring betweenregular menstrual periods.Oligomenorrhea - Uterine bleeding occurring at intervals of 35 days to six months.Amenorrhea - No uterine bleeding for 6 months or longer.Dysfunctional Uterine BleedingDysfunctional uterine bleeding (DUB), defined as abnormal uterine bleeding notcaused by pelvic pathology, medications, systemic disease or pregnancy, is the mostcommon cause of abnormal uterine bleeding but remains a diagnosis of exclusion.Classification of DUB : 39 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 57. Uterine bleeding Normal & AbnormalPrimary DUB – Due to primary dysfunction in the uterus, ovary, pitutary,hypothalamus, Higher centers.Secondary DUB – IUCD or administration of sex hormones Organic diseases outsidethe reproductive systemDUB can occur during the life span of a woman at any time from menarche;occasionally even after menopause. The etiological factors, investigatory proceduresand treatment modalities vary widely in the 3 major groups, namely Pubertal less than 20 years 5 – 15% Child bearing 20 to 40 years 40 – 55% Perimenopausal age more than 40 years 40 – 55% 40 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 58. Disease Review of Literature ASRIGDARAAsrigdara is a disease manifesting as excessive bleeding per vagina.This disease hasbeen known to mankind since the age of Vedas and puranas.Charaka explainedAsrigdara as a separate disease with its Management in yoni vyapat chikitsa. He hasalso explained it as one of the Rakta pradoshaja vikara and also under pittavruta apanavayu.Acharya sushruta explained it as a separate disease entity in Shukra shonitaadhyaya in sharirasthana. He also mentioned it under Pitta samyukta apana. He alsomentioned it in rakta pradoshaja vyadhi.Ashtanga sangraha explained raktayoni andsaid asrigdara and Pradara as its synonyms.Ashtanga hridaya described raktayoni, butnothing is mentioned about asrigdara or pradara. Yet it is explained under thesynonym of Rakta pradara in some places. HISTORICAL REVIEW OF ASRIGDARAVEDICA KALAA direct reference of Atirajapravartana is available in KaushikaSutra, where in ArmaKapalika or Sushka Panka Mrittika/fine mud has been suggested as internal remedy.Inthe Atharvaveda – Laksha is indicated for the treatment of Asrigdara. It is mentionedthat the children of Asrigdara patients have poor, health. The treatment Kilvikarana isalso indicated for the treatment of Asrigdara.PURANA KALAIn the Ramayana – it has been written that, Mandodari was suffering from Asrigdaraand Vaidya Sushena treated successfully with Lajuvanthi, Amla, Tenduka and bark ofAshoka. 41 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 59. Disease Review of LiteratureSAMHITA KALACharaka SamhitaVery elaborate description of Asrigdara is available. Almost all gynaecologicaldisorders characterized with dysmenorrhea, oligomenorrhea etc. are described underVimshati Yoni Vyapada.Sushruta SamhitaThough the description of Asrigdara is very short, he has included even normal scantybleeding coming in short inter-menstrual period under it. Artava Vriddhi with theirNidana, Lakshana and Chikitsa has been described.Kashyapa SamhitaKashyapa samhitha in siddhisthana mentions virechana as a form of treatment inasrigdhara. He said Asrigdara is one of the complications of Dushprajata.He hasexplained the use of Shatapushpa and Shatavarikalpam for menstrual disorders.Ashtanga SangrahaDetailed classification and clinical features of Asrigdara of Charaka Samhita,Artvavaha Srotasa, Marma of genital tract, Artavakshaya and Artava Vriddhi aregiven.Ashtanga HridayaEntire subject of Ashtanga Sangraha is described in summarized way.Madhava NidanaDescription of clinical features and complications etc. of Asrigdara or Pradara almostas in Sushruta.Vrinda MadhavaHe has explained treatment of Pradara, Yoni Vyapad and Sutika Roga. 42 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 60. Disease Review of LiteratureChikitsa KilasaPradara is said to be due to evil deeds (Karmaja) and is such not cured withmedicines. Yet certain recipes are prescribed for the treatment of Pradara. ASRIGDARAThe word „Asrigdara‟ is derived from two words, That is - Asrik – menstrual blood Dara – excessive excretionThe terms: Asrigdara is given by - Sushruta Pradara by - charaka Raktapradara by - sharangadharamÉËUpÉÉwÉ 8(61st.2 sl) 1. SÏrÉïiÉå crÉuÉiÉå rÉÎxqÉͳÉirÉxÉëÑaSUÇ | 1(chi.30th 209sl) 2. UeÉ: mÉëÌSrÉïiÉå rÉxqÉÉiÉç mÉëSUxiÉålÉ xÉ xqÉ×iÉ: | 3. mÉëÌSrÉïiÉå CÌiÉ mÉëSU: ÌuÉxiÉÉËUiÉÉå pÉuÉÌiÉ AxÉëÚaÉç ÌSrÉïiÉå rÉÎxqÉͳÉÌiÉ AxÉÚaSU.....cÉ.ÍcÉ-30/209It is the condition in which the rajorakta (menstrual blood) flows in abundant quantity.Charaka defined, due to pradirana (excessive Excretion) of raja (menstrual blood) it isnamed as “pradara” and since, there is dirana (excessive excretion) of asrik (menstrualblood) it is known as "Asrigdara". 43 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 61. Disease Review of LiteraturesɤÉhÉ: 1. “iÉSåuÉÉÌiÉmÉëxÉÇbÉålÉ mÉëuÉëѨÉqÉlÉëÑiÉÉuÉÌmÉ | AxÉëÑaSUÇ ÌuÉeÉÉlÉÏrÉÉSiÉÉåSlrÉSì£üsÉYzhÉÉiÉç || 3( sha.2nd18& 19th sl) 2. AxÉëÑaSUÉå pÉuÉåiÉç xÉuÉï: xÉÉ…qÉSï: xÉuÉåSlÉ: || Excessive and prolonged or prolonged blood loss during Menstruation or even scanty blood loss during inter-menstrual period is„Asrigdara‟.mÉrÉÉïrÉ:  Pradara, dara. Rakta pradara (Sharangadara samhita)  pradara, asrigdara, atiraja, raktapradara, raktayoni (Ashtanga sangraha)ABNORMAL UTERINE BLEEDING - IT’S ETIOPATHOGENESIS 35Menorrhagia is a symptom of some under lying pathology – organic orfunctional Organic Pelvic Systemic Endocrinal Blood dyscrasias Emotional upset Functional Due to disturbance of H-P-O endometrial axis 44 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 62. Disease Review of LiteratureTable No. 1. Showing the etiology of abnormal uterine bleeding 19 Pelvic pathology: Due to: Congestion, Increased surface area, Hyperplasia of endometrium Fibroid uterus Adenomyosis Pelvic endometriosis IUCD in-utero Chronic tubo ovarian mass Tubercular endometriosis (Early cases) Retroverted uterus (Due to congestion) Granulosa cell tumor of the ovary Systemic causes`11 Dysfunction – failure to conjugate – there by inactivates the oestrogens Congestive cardiac failure Severe hypertension Endocrinal Hypothyroidism Hyperthyroidism Blood dyscrasias Idiopathic thrombocytopenic purpura Leukemia Von Willebrands diseaseCommon causes of menorrhagia: DUB Fibroid Adenomyosis Chronic tubo-ovarian mass *The present study is on DUB 45 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 63. Disease Review of LiteratureTable No.2 Showing the classification of DUB 35 Classification of DUB: Primary DUB - due to primary dysfunction in the uterus, ovary, pitutary, hypothalamus, higher centers. Secondary DUB – IUCD or administration of sex hormones Organic disease outside the reproductive system *The proposed work is on primary DUBDysfunctional Uterine BleedingDefinitionDysfunctional uterine bleeding (DUB) is defined as a state of abnormal uterinebleeding without any clinically detectable organic, systemic, and iatrogenic cause.(Pelvic pathology e.g.tumour, inflammation or pregnancy is excluded).19The bleeding may be abnormal in frequency amount, duration or any combination ofthese.Currently many authors define DUB as a state of abnormal uterine bleedingfollowing anovulation due to dysfunction of hypothalamo-pituitary ovarian axis. DUBis a diagnosis of exclusion.Incidence: The prevalence varies widely but an incidence of 10% amongst newpatients attending the out-patient seems logical. in 40-60% of cases of excessivemenstrual bleeding 46 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 64. Disease Review of Literature PATHOPHYSIOLOGYThe current concept concludes that the abnormal bleeding is most likely due to localcauses in the endometrium there is some disturbance of the endometrial blood vesselsand capillaries and coagulation of blood in and around these vessels. these areprobably related to alteration in the ratio of endometrial prostaglandins which aredelicately balanced in haemostasis of menstruation. the endometrial abnormalitiesmay be primary or secondary to incoordination in the hypothalamo-pituitary ovarianaxis.it is thus more prevalent in extremes of reproductive period .The abnormalbleeding may be associated with or without ovulation and accordingly grouped into:Ovular bleeding and Anovular bleedingClassification of DUB: Dysfunctional uterine bleeding Ovulatory Dub AnovulatoryDub1. Ovulatory dysfunctional uterine bleeding This condition is characterized by excessive menstrual bleeding (usually veryheavy), usually at fairly regular intervals and with a pattern of daily menstrual losssimilar to normal menses, with ~90% of the flow occurring during the first 3 days.These women with menorrhagia and normal cycles show no abnormality of the H-P-O axis (Haynes, 1980). The under lying pathology is thought to be with pancrinecontrol of endometrial spiral arteries. There is altered ratio of different prostaglandinsproduced locally. There is an increase in PGE 2 and high ratio of PGE2: PGF2α –resulting in vasodilatation – abnormal bleeding. There is increased fibrinolysis andincreased plasminogen activator (TPA) in primary menorrhagia. Vasoactive substances like leukotrines, cytokines & endothelins areimplicated. 47 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 65. Disease Review of LiteratureOvulatory DUB with altered cycle length: It occurs due to endocrine imbalance. Short or long follicular phase results inpolymennorrheaTable No.3 Showing the Causes of ovulatory DUB 35 Endocrine abnormality & Type Typical bleeding pattern Endocrine histology Short cycle – short Polymenorrhea , menorrhagia proliferative phase, normal Normal endometrium Oligomenorrhea, menorrhagia ovulatory Long cycle – long proliferative phase, normal endometrium Insufficiency – short luteal Premenstrualspotting, Corpus phase, irregular or deficient menorrhagia luteum secretory endometriumabnormality Persistent (Halban‟s disease) irregular endometrial shedding Prolonged menstruation Insufficient follicles – short Polymenorrhea cycle, inadequate proliferative or atropic endometriumAnovulatory Persistent follicles/PCOD – Oligomenorrhea, metropathia prolonged cycle, proliferative hemorrhagica or hyperplastic endometriumPathology of Endometrium: Abnormalities of luteal phase (in ovulatory menorrhagia) Deficient progesterone Underdevelopment/Irregular ripening of endometrium Resistant corpus luteum Irregular shedding 48 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 66. Disease Review of LiteratureEndometrial hyperplasia: Most commonly observed abnormality in DUB Varies from slight exaggeration of proliferative phase to marked overgrowth – approaching adenocarcinoma.It is classified into 4 phases/types Simple hyperplasia – most common, has least malignant potential Complex hyperplasia Simple hyperplasia with atypia Complex hyperplasia with atypiaAtrophy of the endometrium: It is associated with the development of large dilated venules situated superficially under a thin endometrium Rupture of venules Post menopausal uterine bleedingProstaglandins and Menstruation:Prostaglandins are one of a group of hormone-like substances present in a widevariety of tissues and body fluids (including the uterus, brain, lungs, kidney,andsemen). Prostaglandins have many actions like they cause contraction of smoothmuscle like uterus, dilation of blood vessels ,and are mediators in the process ofinflammation.there are 9 classes of Prostaglandins(PGA-1),within which individualProstaglandins are denoted by numerals(PGE1).. 49 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 67. Disease Review of Literature PATHWAY OF PROSTAGLANDIN SYNTHESIS Phospholipids (in cell membranes) Phospholipase A2 (from cell ischaemia Cyclo-oxygenase TXA2 (Thromboxane PGF2α(vasoconstrictor) PGE2 (Vasodilator) PGI2 (prostacyclin) Endoperoxides PGD2PGF2α – vasoconstrictor & weakly platelet aggregatoryPGE2 – vasodilator & weakly platelet antiaggregatoryPGD2 – platelet aggregation inhibitorPGI2 – potent vasodilator & inhibitor of platelet aggregationTxA2 – potent vasoconstrictor & platelet aggregator{Prostaglandins are not stored in the tissues but are synthesized and released asrequired PGI2 – mainly formed in endothelial and vascular tissue. TxA2 – formed inplatelets}*All prostaglandins are rapidly metabolized & inactivated, are believed to act at theirsite of synthesis. 50 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 68. Disease Review of LiteratureNormal menstruation:In proliferative phase – the endometrium synthesizes equal amounts of PGF2 &PGE2 .During luteal phase, PGF2 synthesis increases, the ratio beingF2 : E2 = 2 : 1 PGF2 - synthesized in the endometrium Produces vasoconstriction of spiral arterioles Increased production of endoperxidase Deviated into the myometrium Produces PGI surge Diffuses back into the endometrium Vasodilatation MenstruationIn Anovulatory DUB, amounts of PGF2 & PGE2 found in persisting proliferativeendometrium are same. Absence of progesterone No increase in synthesis of PGF2 Decrease in PGF2 : PGE2 + increase in PGE2 Atrophic endometrium (deficient) Menorrhagia (also accounts for absence of uterine contraction & painless bleeding)In Ovulatory DUB, the order of prostaglandin is changed from PGF2 / PGE2 /PGD2 to PGE2 / PGD2 & PGF2 . 51 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 69. Disease Review of LiteratureCorpus luteum insufficiency : Inadequate development of corpus luteum Insufficient secretory changes Decrease in PGF2 : PGE2 ratio MenorrhagiaPersistent Corpus Luteum: Continued secretion of oestrogen & progesterone + absence of the normally sharp fall in oestrogen & progesterone secretion which precedes menstruation Inadequate release of phospholipids A2 Inadequate release of prostaglandins Irregular shedding of endometriumAnovulatory DubWithout ovulation the corpus luteum fails to form resulting in no progesteronesecretion. Unopposed estrogen allows the endometrium to proliferate and thicken.Theendometrium finally outgrows its blood supply and degenerates. The end result isbreakdown of the endometrial lining at different level. Insufficient follicular development Persistent ovarian follicle 52 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 70. Disease Review of Literature Insufficient follicular development Inadequate production of oestrogen & progesterone Inadequate proliferation of endometrium without any secretory changes Atrophic endometrium (deficient) Associated with large dialated sub endothelial vennules Menorrhagia Persistent ovarian follicleAdequate production of oestrogen, but no ovulation, corpus liteum fails to develop No progesterone reaction Continuous unopposed oestrogen secretion Continued proliferation of endometrium Benign hyperplasia / adenomatous hyperplasia When endometrium outgrows, its blood supply or there is decrease in oestrogen secretion MenstruationIntermittent vaginal bleeding is usually associated with low circulating oestrogenlevels resulting in break through bleeding due to prolonged anovulation leading topersistent desquamation. 53 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 71. Disease Review of Literature NIDANAAll the nidana of Asrigdara are grouped under four headings.1.AÉWûÉUeÉ ÌlÉSÉlÉ2. ÌuÉWûÉUeÉ ÌlÉSÉlÉ3. qÉÉlÉÍxÉMü ÌlÉSÉlÉ4. AlrÉÉ1. AÉWûÉUeÉ ÌlÉSÉlÉThe etiological factors related with dietary condition are known as Aaharaja nidana.In this class we can summarize the factors aggravating different dosha such as overindulgence of Ruksha, Sheeta etc. Diets which provokes vata; amla, ushna, tikshnaetc. which Provokes pitta & Guru, madhura, snigdha etc. which Provokes Kaphadosha.According to charaka:  rÉÉSirÉjÉïÇ xÉåuÉiÉå lÉÉUÏ sÉuÉhÉÉqsÉaÉÑÃÍhÉ cÉ | MüOÕûlrÉjÉ ÌuÉSÉWûÏÌlÉ ÎxlÉakÉÉÌlÉ pÉeÉlirÉÉ: MÑüÌmÉiÉÉåSÌlÉsÉ:|| aÉëÉqrÉÉæSMüÉÌlÉ qÉå±ÉÌlÉ M×üzÉUÉÇ mÉÉrÉxÉÇ SÍkÉ | zÉÑ£üqÉxiÉÑxÉÑUÉSÏÌlÉ pÉeÉlirÉÉ: MÑüÌmÉiÉÉåSåÌlÉsÉ: || cÉ.ÍcÉ.30/205,206Madhava, bhavaprakash and yogaratnakar Viruddha bhojana Ati madya sevana Adhyashana Ajeerana 54 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 72. Disease Review of Literature2.ÌuÉWûÉUeÉ ÌlÉSÉlÉ Madhava, bhavaprakash & yogaratnakar Ati maithuna Ati yana Ati marga gamana Ati bharavahana Divaswapna3.qÉÉlÉÍxÉMü ÌlÉSÉlÉ Shoka (madhava)4.AlrÉ ÌlÉSÉlÉ Madhava, bhavaprakasha and yogaratnakara Garbhapata AbhighataAccording to Harita Samhita: In vandhya Ksheera Nadi vatena paripurita Ksheeram cha na bhavet She suffers from Artava adika srava 55 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 73. Disease Review of LiteratureAccording to Bhela Samhita: Shonita Reaches the Dustamarga PradaraEtiological factors according to dosha1) Vata dosha prakopaka hetu:A) Over intake of ruksha & kshariya substances:Ruksha is one of the properties of vatadosha. Therefore, over Intake of ruksha dravyahas a direct impact in aggravation of vata dosha.Kshariya substances act in karshanalike manner on the body and causes Dhatukshaya and thus provokes vata dosha. Thisaggravated vata dosha leadsto occurrence of asrigdara.B) Over indulgence of katu rasa (pungent taste):-The pungent taste is believed to be a prorogating factor of vata Dosha. Moreover, thediets with katu rasa have a katu vipaka and during this condition also vata is generated(ch. Chi. -15/11). In this way the exaggerated vata dosha creates Asrigdara.C) Excessive sexual intercourse (ati vyavaya):The tactile sensory organ situated in skin. This is counted as one of The seats of vatadosha. This is the most active during sexual Intercourse. So, due to its hyperactivityvata dosha is aggravated. In Newly wedded couples night awakening & dhatukshayaprovoke vata Dosha. In addition to this due to frequent sexual intercourses inSuccession the blood circulation in female genital parts increases and Due to this high 56 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 74. Disease Review of Literaturepressure of blood in this area, asrigdara may occur. The Western scientists have alsoaccepted this thought.D) Ati yanavarohana (too much riding):Too much riding on horse, camel, vehicles etc. Increase the Pressure of bloodpermanently and due to this, there will be an intra uterine hypertension also increasewhich may lead to Asrigdara. Besides these over exertion etc. Causes increase vatadosha helping in the spring up of asrigdara. Modern science also has considereddancing, over Exercise, cycling and hunting are main causes of Asrigdara.E) Ati shoka (depression):This is just an indication of deranged mental state. This kama, Krodha (anger), bhiti(fear), chinta (anxiety), etc. Are mental pulsations.These factors have an effect onnervous system which laterally results In Asrigdara by the vitiation of vata. Atichintana Vitiates manas Vitiates vata Inturn vitiates Apana Vayu Menstrual IrregularitiesAs told in modern parlance, schroder (1954) said that dub has Onset at times oflowered physical psychological resistance which Permits the assumption of endocrinedisorders between suprarenal and Thyroid. Emotional influence could be significantlyassociated with this Disease. Limbic system (emotional brain) is closely related toHypothalamus. 57 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 75. Disease Review of Literature Stress Affects Disturbs the h-p-o axis Hormonal imbalance Menstrual irregularitiesF) Ati karshana:If the food materials do not carry the needed quality and quantity of nutritionalsubstances, the stage of dhatukshaya engulf the patients. Due to this the Rukshaproperty of vata aggravates causing Asrigdara.G) Garbhapata (miscarriages or abortions):Miscarriage and abortion are believed to be reasons for Asrigdara. Normally after adelivery or abortion or miscarriage, the Uterus gains its normal position but if anyparts of the placenta or pieces of mucous membrane remain in it, they work asirritants for the uterus and do not let it gain its normal position which promotes theflow of Blood ceaselessly. Along with this the condition of dhatukshaya prevails Dueto excessive bleeding, causing Asrigdara.H) Abhighata (trauma):Among the extrinsic causative factors, this is greatly important. Trauma increases thepressure on uterus which vitiates the vata causing immediate vitiation of shonitaresulting in Asrigdara. 58 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 76. Disease Review of LiteratureAll the above mentioned causative factors are the aggravators of Vata dosha which iscounted as a main factor of this disease.2) Pitta prakopaka hetuA) Over intake of lavana & amla rasa:These two rasa work as appetizers and produce a liking for food.Even than their overindulgence especially lavana aggravates Pittadosha and by over use of sour substancespitta increases which Vitiates rakta. These both substances are of ushna viryaproperty, which also provokes pittadosha. Provoked pitta, due to being of same originVitiates rakta by samanyam vriddhi karanam and produces asrigdara.B) Intake of vidahi substances:The intake of acrid substances promotes the secretion of pitta and In the pachyamanastage of food augments pitta. This augmented vitiated Pitta vitiates rakta being of thesame origin causing the disease Asrigdara.C) Over intake of dadhi (curd) mastu-shukta-suradi:Curd and mastu are sour and ushna virya substances which Increase pitta due tocommon properties. Shukta is also considered to be of ushna virya and promotingrakta pitta. Thus the augmented Provocation of pitta and rakta lead to asrigdara. Theintake of alcoholic Substances i.e. Sura etc. Being of ushna, tikshna, sukshma,ashukari etc.Properties increase pitta. The new wine is considered as heavy as well asAcrid which increases pitta then artava gets vitiation and thus it becomes A causativefactor of Asrigdara. This theory has been accepted by modern Scientists also, as “overindulgence in food and alcoholic drink cause Asrigdara. 59 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 77. Disease Review of LiteratureD) Santapa:Due to the increased ushna property in santapa, pitta also Increases which vitiatesrakta and so as an after effect of many disease in which the temperature of the bodyincreases. Asrigdara is also generated due to this ushnata.3) Kapha prakopaka hetu a. Extra intake of guru (heavy) substances: Over intake of guru substances it augments kapha dosha. Heavy Substances are of downward going nature, helping the excretion of mala.The percentages of prithvi and jala mahabhuta are found more in such Substances. Apana vayu and vitiated kapha dosha increase the flow of Vitiated artava by affecting the uterus. Besides this the increase of Kapha enhances the endometrium and increasing the blood flow. b. Over intake of snigdha, krushara, payasa, audaka mamsa together,Medo vridhikara substances:All these substances are generally of guru guna. Snigdha and Guru guna augment thekapha dosha. The augmentation of kapha Gives rise to causation of asrigdara asdescribed earlier. c. Divaswapana :The main viharajanya cause in the increase of kapha is divaswapa.Our classics statethat it must not be done except during grishma rutu as it Increases kapha & pittadosha. d. Adhyashana – viruddhashana :The intake of food before the digestion of previously taken food is Known asadhyashana. The mixture of newly ingested food with improperly digested andabsorbed ahararasa of previously taken food Leads to the production of a very 60 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 78. Disease Review of Literaturepoisonous substance named „ama‟ which provokes all the three Doshas instantly. Thepoisonous effect of ama Falls on the reproductive organs increasing the activity ofbleeding and thus causing asrigdara. Viruddhashana means the intake of materialsopposite in samyoga, Virya, vipaka etc. Their simultaneous intake serves as thegenerator of Ama and endows the body with poisonous effect, which also falls on theReproductive organs creating asrigdara. POORVAROOPAThe phase of poorvaroopa of the Asrigdara is not mentioned in the Texts. Probablythere may not be any premonitory symptoms. LAKSHANA1. iÉSåuÉÉÌiÉmÉëxÉÇ…lÉ mÉëuÉÚ¨ÉqÉlÉ×iÉÉuÉÌmÉ | AxÉÚaSUÇ ÌuÉeÉÉlÉÏrÉÉSiÉÉåSlrÉSì£üsɤÉhÉÉiÉç | | AxÉÚaSUÉå pÉuÉåiÉç xÉuÉï: xÉÉ…qÉSï: xÉuÉåSlÉ: | | xÉÑ.xÉÇ.zÉÉ 2/18-192. AÌiÉmÉëxÉÉ…lÉÉlÉ×iÉÉuÉ×iÉÉæ uÉÉ iÉSåuÉÉxÉ×aSUÇ | mÉëSUÇ urÉÉmÉSÇ cÉ U£ürÉÉåÌlÉxÉÇelÉÉ sÉpÉiÉå || A.xÉÇ.zÉÉ.1/113.AxÉÚaSUÇ pÉuÉåiÉç xÉuÉïÇ xÉÉ….qÉSï xÉuÉåSlÉqÉç | | qÉÉ.ÌlÉ. 61/2*Atiprasangena – excess menstruation (Atimatra + Dirgakalanubandhi)*Pravruttam anrutavapi – alpa dirgakalanubandhi (menses even in intermenstrualperiod, scanty & associated for a long duration.)*Anyad rakta lakshanam – features different from normal menstruation i.e.,doshanubandhi 61 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 79. Disease Review of Literature Table No.4 Showing the Laxanas of Asrigdara According to different authorsSl. No. Lakshana Sushruta Vaghbhata Madhava Bhavaprakasha Charaka 1. Atipravrutti + + _ _ + 2. Anrutakaala + + _ _ _ Srava 3. Angamarda + + + + + 4. Vedana + + + + + VISHISHTA LAKSHANA: Vishishta lakshana are produced by particular dosha. 1. Vataja Asrigdara: TåüÌlÉsÉÇ iÉlÉÑ Â¤ÉÇ cÉ zrÉÉuÉÇ cÉÉÂhÉqÉåuÉ cÉ | ÌMÇüzÉÑMüÉåSMüxɃûÉzÉÇ xÉÂeÉÇ uÉÉSjÉlÉÏÂeÉqÉç || MüÌOûuÉQèû¤ÉhɾÒûimÉɵÉïmÉëѹ´ÉÉåÍhÉwÉÑ qÉÉËUiÉ: | 1(chi.30/212 & 213) MÑüÂiÉå uÉåSlÉÉÇ iÉÏuÉëÉqÉåiɲÉiÉÉiqÉMÇü ÌuÉSÒ: || In vataja asrigdara artava will be tanu, phenila, ruksha, shyava or Arunavarna or kimshukodaka samkasham, artavasrava may be saruja or Niruja. Along with these vedana will be felt in kati, vankshana, Hritpradesha, parshwa, prushta and in shroni. The presence or absence of pain may indicate that myometrial spasm May or may not be present but ache is constantly and severely present.Pain may be due to the spasm of myometrium and inflammation of Associated uterine ligaments and muscles of the back and pelvis.Artavasrava is saruja because of vitiated apana vayu and it is felt in kati,Shroni etc. Because these are the main fields of vayu.Sushruta and vagbhatta have added that this raja does not clot,Has a kashaya after taste, smells like iron and is cold. 62 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 80. Disease Review of Literature2. Pittaja Asrigdara:xÉlÉÏsÉqÉjÉuÉÉ mÉÏiÉqÉirÉÑwhÉqÉÍxÉiÉÇ iÉjÉÉ |ÌlÉiÉÉliÉU£Çü xaÉÉëuÉÌiÉ qÉÑWÒqÉÑïWûUjÉÉÌiÉïqÉiÉç || 1(chi.30/214 & 216)SÉWûUÉiÉÚwÉÉqÉÉåWûeuÉUpÉëqÉxÉqÉÉrÉÑiÉqÉç | AxÉÚaSUÇ mÉæ̨ÉMÇü xrÉÉiÉç.......||In pittaja asrigdara, the colour of artava will be neela, peeta or Asita, artava will beushna and srava is associated with ruja. Patient Suffers from daha, raga, trushna,moha, jwara and bhrama.Sushruta and vagbhatta-i add that the blood vitiated by pittaBecome blue, yellow, green, blackish or resembles the water mixed with Smoke orrasanjana or cow urine in colour, has musty or fishy smell,Being bitter (katu) in tasteis not liked by ants or flies, dose not Coagulate because it is hot, if put in waterspreads like moon-light means All of a sudden, evenly and all around.Thepredominant pitta afflicts the artava, hence all the properties Of pitta can beappreciated in the artava. It is difficult to explain the Discoloration of artava becausethis much variation in colour of Menstrual blood is not observed in practice. Ushnatais one of the Physical properties of pitta, when artava gets vitiated by pitta, it willProduce ushnata in the genital tract. As dravata and sara guna of pitta increases sodoes the menstrual Flow increases. Jwara is the indicative of pitta vruddhi. Pitta hasushna Property, due to ushna guna the santapa will increase.3. Kaphaja Asrigdara: ÌmÉÎcNûsÉÇ mÉÉhQÒûuÉhÉïÇ cÉ zÉÏiÉsÉqÉç | xÉëuÉirÉxÉÚMçü zsÉåwqÉsÉÇ cÉ bÉhÉÇ qÉlSÂeÉMüqÉç || 1(chi.30/217 & 219) NûkrÉÉïUÉåcÉMü¾ÒûssÉÉxɵÉÉxÉMüÉxÉxÉqÉÉÎluÉiÉqÉç ||In kaphaja asrigdara, the colour of artava is pandu and resembling the pulakatoya. Theartava is guru, snigdha, pichchhila and sheeta it Associates with certain bodily signs 63 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 81. Disease Review of Literatureand symptoms like chhardi, hrillasa, Arochaka, shwasa, kasa.Sushruta said that, theblood vitiated by kapha resembles water Mixed with red ochre, is unctuous, cold,thick and slimy, is excreted very slowly and gets clotted like a muscle. Vagbhattaaccepting the views of Sushruta has added that it is like flower of kovidara in colouror is pale,Gets clotted in the shape of fibers, flow stops at the opening of the Wound,is salty in taste and smells like fat.Sannipataja Asrigdara:U£üqÉÉaÉåïhÉ xÉ×eÉÌiÉ mÉëirÉlÉÏMüoÉsÉÇ MüTüqÉç |SÒaÉïlkÉÇ ÌmÉÎcNûsÉÇ mÉÏiÉÇ ÌuÉSakÉÇ ÌmɨÉiÉåeÉxÉÉ || 1(chi.30/223 & 224)uÉxÉÉÇ qÉåS¶É rÉÉuÉ̬.......................... cÉ.ÍcÉ.30/223-224In this type, the clinical features of all the three dosha are Present. When severely illand anemic woman consumes diet capable of aggravating all the three dosha, then herexcessively aggravated vayu Withholding kapha, which is already burnt due to fire ofpitta, is foul Smelling, slimy, yellow and has acquired opposite properties,dischargesIt through the vaginal passage, along with this it also discharges with Forcethe vasa and meda burnt with pitta, thus resembling ghrita, Marrow or muscle fat. Thewoman having such discharges continuously, Suffering from thirst, burning sensation,fever, anemia and weakness, is Incurable. Sushruta said that, blood vitiated withsannipata has the features of all the three dosha, resembles kanji in colour and foulsmells.Vagbhatta said that it is blue like bronze, dirty and foul smelling. 64 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 82. Disease Review of LiteratureTable No. 5 Showing the Visishta Laxanas of different types of AsrigdaraSl. Symptoms Vataja Pittaja Kaphaja SannipatajaNo. 1. Amount of AlpamMa Nitanta BahalamSu ---- flow raktamCh 2. Colour KimshukodakaCh, NilaCh, PanduCh Sarpimajja krshnaCh, peetaCh, vasopamaCh arunaMa,Ch krshnaA.Sa 3. Smell Loha gandhiA.Sam VisraCh, Vasa DurgandhaSu matsya gandhiA.Sa gandhaA.Sa 4. Consistency PhenilaCh, tanuCh, Snigdha Guru, picchilamCh rukshaCh picchilam, ghanamCh 5. Nature AskandiSu Askandi TantumatA.Sa BahuvegaCh Madhu (Clotting) Vranadwarav asadiA.Sa 6. Pain Saruja/nirujaCh Pittarti Mandarujaka ---- Madhu ramCh 7. Associated Kati Daha, raga, Chardi, Trisna, daha, symptoms vamkshanamCh, trishna, arochaka, jwara, ksheena hritparswa, moha, hrillasa, rakta, prishta, sroni- jwara, swasa, kasaCh durbalaCh shoola bramaCh 8. Temperatur SheetaA. Sa Atiushnam SheetalamCh ---- Ch e of discharge 9. Rasa KashayaA.Sa KatuA.Sa LavanaA.Sa ----10. Others Sashabda, Anrutavapi Anrutavapi ---- AnrutavapiCha Cha ChaDvidoshaja Asrigdara:Dvidoshaja lakshana of asrigdara is not seen to be mentioned in any of the classics.However, to understand this dvidoshaja lakshana, The lakshana mentioned invidhishonitiyam adhyayam of sushruta sutra And from siravyadha adhyaya ofashtanga sangraha can be applied to Understand the lakshana of each dosha. 65 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 83. Disease Review of Literature SAMPRAPTISamprapti is the process of the manifestation of the disease.Vagbhata definedSamprapti as the procedure in which the dosha get Vitiated and the way in which theymanifest the disease.it also called Samprapti Or jati or agati. A good understanding of it is very essential for early diagnosis, Prognosisand for adopting preventive and curative measures.U£ü mÉëqÉÉhÉqÉÑi¢üqrÉ aÉpÉÉïzÉrÉaÉiÉÉ: ÍxÉUÉ: |UeÉÉåuÉWûÉ: xÉqÉÉÍ´ÉirÉ U£üqÉÉSÉrÉ iÉSìeÉ:||rÉxqÉÉ̲uÉkÉïrÉirÉÉzÉÑ UxÉpÉÉuÉÉ̲qÉÉlÉiÉÉ | 1(chi.30/207 & 208)iÉxqÉÉSèxÉÚaSUÇ mÉëÉWÒûUåiɨÉl§ÉÌuÉzÉÉUSÉ: ||In the woman who partakes of the hetu enlisted earlier, her Aggravated vayu withholding the rakta being accompanied by rasa Vitiated due to the nidana sevana carriesit to the uterine vessels and Increases the amount of raja.uÉÚ¬ålÉ U£åülÉ rÉÉåeÉÌrÉiuÉÉ UeÉÉå ÌuÉuÉkÉïrÉÌiÉ........| cÉ¢ümÉÉhÉÏ OûÏMüÉ Nidana Ashrayaashra Sambanda Increases the Rasa Rakta Rakta pramana utkramya Garbhashayagata sira 66 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 84. Disease Review of LiteratureAcharya charaka has also enumerated Asrigdara amongst the Diseases of vitiatedrakta and pittavrita apana vayu. It can therefore be considered that vayu can also bevitiated only due to being covered by Pitta. The chala guna of vayu and sara guna anddrava guna of pitta Plays an important role in forming the basic samprapti ofAsrigdara.These are the essential factors for the profuse bleeding.The entire process of thedevelopment of the vyadhi can be summarized in the following words. Because ofvarious nidana sevana tridosha are get vitiated and Leads to “agnimandhya” whichleads to rasagni vaishamya and this again Leads vikrut rasa dhatu nirmana. Hence, theartava is upadhatu of rasa also get vitiated and rakta, due to its rasabhavata getsvitiated and Increases in amount by the pitta prakopaka nidana sevana, the sara andDrava guna of pitta being especially vitiated. This factors effect the Uterine vascularapparatus leading to uterine congestion and increasing Uterine circulation along ofthis pittavrutapana and its chala guna of Apana vayu leads to excessive and irregularbleeding which is term as “asrigdara”.Samprapti ghataka  Dosha : Tridosha  Dushya : rasa, rakta, artava  Agni : Jatharagnimandya  Ama:Amashayajanya ama  Srotasa : Artavavaha, rasavaha, raktavaha, mamsavaha  Srotodushti : Atipravritti  Adhisthana : Garbhashaya, Artavavaha srotasa  Sanchara sthana: Sarvashareera  Vyakta sthana : yonimukha 67 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 85. Disease Review of Literature SAMPRAPTI FORMATION OF THE DISEASE ASRIGDARA NIDANA Guru, Vidhahi, Krodha, Chinta Amla, Lavana, Diwswapna etc. Atimaithuna etc. Snigdha drava etc. Vitiation of Vitiation of Pitta Vitiation of Vata Kapha Agnimandata Vikruta Ahaara Rasa Pramana Vriddhi Rasagni Vaishamya Vikrut Rasa Dhatu Nirmana (Rasabhava Dwianta) ↑Rakta (due to rasabhavata get vitiated and Dravya guna increase in amount by Upadhatu rupa Pitta prakopaka Nidana sevan) Artava↑ UeÉÉåuÉWûÉ: xÉqÉÉÍ´ÉirÉ U£üqÉÉSÉrÉ iÉSìeÉ: affect the uterine vascular apparatus U£ü mÉëqÉÉhÉqÉÑiYëqrÉ aÉpÉÉïzÉrÉaÉiÉÉ: ÍxÉUÉ: Uterine congestion-increased uterinecirculation ApanaVayu Dushti Excessive and Prolonged bleeding Asrigdara 68 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 86. Disease Review of Literature VYAVACHEDAKA NIDANAAsrigdara is a disease in which profuse vaginal bleeding is found as A symptom.There are some other diseases also which have this symptom.So it is necessary todifferentiate Asrigdara from these diseases.1. Adhoga raktapittaTable: 6 showing the difference between Asrigdara & Adhoga raktapittaSl.No. ASRIGDARA ADHOGA RAKTAPITTA 1. Premonitory signs and symptoms are Not mentioned mentioned 2. Types according to doshaja condition Types acc. To marga-orifices 3. Specific time limitation is mentioned No specific time limitation i.e. Menarche to menopause 4. Primarily the discharge does not have Specific smell of the discharge a specific smell. Is present 5. Bleeding occurs due to the separation Bleeding does not occur due to of endometrium Separation of endometrium. 6. Only per vaginal bleeding is found Per rectal/urethral bleeding also can be found2. Asruja yoni vyapatAsruja is a condition wherein due to rakta pittakara nidana the Yonisthita rakta getsvitiated by pitta – resulting in atipravartam of Rakta even after achievement ofconception there is excessive bleeding per vaginum. Chakrapani commenting on this said – excessive bleeding leads to Abortion,therefore the woman remains without praja(AmÉëeÉÉ) ,Due to Excessive bleeding pervaginum it is referred to as U£ürÉÉåÌlÉ. 69 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 87. Disease Review of Literature3. Lohitakshara yoni vyapatThis condition is characterized by continuous or excessive Bleeding or oozing ortrickling of blood associated with other features of pitta – osha, chosha, jwara, daha,etc. The word kshara refers to Oozing or trickling.This kind of bleeding pattern isseen in small cervical polyps or Erosions which presents with intermittent scantybleeding. Due to Association of chronic inflammation with erosion, symptoms likeburning Sensation etc. Are present.Therefore this condition can be considered irregular bleeding Associated with erosionor polyp. It can be ruled out by clinical Examination, Pap smear and by d & c. 1. Asrigdara & Rakta yoni Table :7 Showing the difference between Asrigdara & Rakta yoni Sl. Asrigdara Rakta yoni No. 1. Different description of nidana No such different description Panchaka of asrigdara 2. Rajah-dushti yoni dushti 3. Mention of specific time limitation No such time limitation mention5 .Pittavruta apana vayuRajascha ativartanam is the feature associated with other Lakshana – haridra mutravarcha, tapa guda medrayaha. The concept of Aavarana is considered as apathological process towards the Development of the vyadhi, but not the vyadhi itself. 70 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 88. Disease Review of Literature6. Vatika Asrigdara and vataja yoni vyapada Table: 8 showing the Differnce between Vataja Asrigdara &Vataja yoni vyapadSl.No. Vatika asrigdara Vataja yoni vyapad1. No any local symptoms are Local symptoms are more Pronounced Aroused in yoni like like yoni stambha, Supti, karkasata, and stambha etc. pipilika vata Vedana.2. Menstrual discharges with Menstrual discharge is always Present the Pain or without pain. with pain.3. Severe pain is present in No any pain is present in the Vanksana, the kati, Shroni etc. Sites kati, pristha and shroni4. Line of treatment is mainly Line of treatment is mainly snehana Vatanulomana and And swedana. pittashamaka.7. Pitta asrigdara and Pittaja yoni vyapada andTable:9 showing the Differnce between Pittaja Asrigdara & Pittaja yoni vyapadSl.No Pittaja asrigdara Pittaja yoni vyapad 1. No yoni paka etc. Yoni daha, paka etc. Are present (local suppuration) 2. Very excessive menstrual blood Excessive menstrual blood Discharge Discharged 3. Repeated menstrual discharged is Repeated menstrual discharge is Not present. present 71 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 89. Disease Review of Literature8. Kaphaja Asrigdara and kaphaja yoni vyapadaTable: 10 Showing the Differnce between Kaphaja Asrigdara & Kaphaja yoni vyapadSl.no Kaphaja asrigdara Kaphaja yoni vyapad 1. Local symptoms like yoni kandu, Local symptoms are absent Yoni pichhilata etc. Are present 2. Chhardi, hrillasa, shwasa etc. Are Chhardi, hrillasa, shwasa etc. Are present. Absent 3. Menstrual discharge with pain Menstrual discharge without pain9. Raktarshas & RaktatisaraThese can be differentiated from Asrigdara by the marga through which it presents. 72 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 90. Disease Review of Literature SADHYA ASADHYATA1. Vataja Asrigdara2. Pittaja Asrigdara Sadhya3.Kaphaja Asrigdara4. Sannipataja Asrigdara is Asadhya.Signs-symptoms of sannipataja Asrigdara which is asadhya are:  The woman having continuous Bleeding,  Trushna  Daha  Jwara  Pandu and  DourbalyaHarita under the description of arista lakshana of artava says, when associatedwith…. Jwararta Fever Apoorne divase pushpa Rajasrava even before mapmuyat completion of rtu charka Sarena Continuous bleeding …..then that stree – na jeevet 73 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 91. Disease Review of Literature 1. The asadhya lakshana indicates the severity and chronicity of the disease. Chronicity of a disease weakness the body resistance and renders the disease incurable. 2. Loss of body resistance together with the weakness due to continuous and excessive loss of blood gives a bad prognosis to the disease. 3. Bhrama, murchha etc. Are due to cerebral hypoxia resulting from the reduced oxygen carrying capacity of blood. 4. Daurbalya is the result of raktakshaya. As the nutritional factor of blood gets impaired due to reduced blood volume and weakness or daurbalya results. 5. Trushna results from the rasakshaya i.e. the loss of fluids from the body. 6. Raga or Varna of the body is due to adequate quantity of blood in the body and excessive loss of blood from the body causes pallorpanduta. 7. The ushna guna of the vitiated pitta causes daha in asrigdara and pitta prakopa causes daha. Anaemic condition and vitamin b12 deficiency results in neuritis which expresses itself as daha. 8. Loss of blood causes vata prakopa and this prakupitta vata in turn results in vataja roga. 9. It can be thus seen that all the upadrava mentioned are due to tridosha prakopa and raktakshaya. 74 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 92. Disease Review of Literature UPADRAVA1. iÉxrÉÉÌiÉuÉרÉÉæ SÉåoÉïsrÉÇ pÉëqÉÉå qÉÔcNûÉãï iÉxiÉ×wÉÉ || 3(sha 2/19 & 20) SÉWû: mÉësÉÉmÉ: mÉÉhQÒûiuÉÇ iÉlSìÉ UÉåaÉÉ¶É uÉÉiÉeÉÉ:||2.zɵÉiÉç xÉëuÉliÉÏqÉÉxÉëÉuÉÇ iÉ×whÉÉSÉWûeuÉUÉÎluÉiÉÉqÉç | 8(61/5 & 6) ¤ÉÏhÉÉU£üÉÇ SÒoÉsÉÉÇ cÉ iÉÉqÉxÉÉkrÉÉÇ ÌuÉÌlÉÌSïzÉåiÉç |Table: 11 Showing the Upadrava lakshanas according to different authorsSl. Upadrava Charaka Sushruta Vaghbata MadhavaNo.1. Dourbalya _ + _ +2. Bhrama _ + _ +3. Murccha _ + _ +4. Trushna _ + _ +5. Daha _ + _ +6. Pralaapa _ + _ +7. Panduta _ + _ +8. Tandra _ + _ +9. Vata vyaadhi _ + _ _10. Shotha + _ + _11. Jwara _ _ _ +It appears that Sushruta Vagbhata and others have mentioned immediate complicationof excessive haemorrhage, while Charaka and Vaghbhata have mentioned delayedcomplication as due to chronic blood loss causing anaemia and then developingoedema. 75 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 93. Disease Review of Literature ARISTA LAKSHANAAmÉÔhÉãïÌSuÉxÉå lÉÉUÏ euÉUÉiÉÉï mÉÑwmÉqÉÉmlÉÑrÉÉiÉç | 9(dwi.4/37) xÉÉ lÉ eÉÏuÉålqÉWûÉmÉëÉelÉ rÉxrÉÉ ÌWû xÉÉUhÉÉã pÉuÉåiÉç ||Harita under the description of arista lakshana of artava says, when associatedwith…. Jwararta Fever Apoorne divase pushpa Rajasrava even before mapmuyat completion of rtu charka Sarena Continuous bleeding …..then that stree – na jeevet PATHYAPATHYAThe concept of the pathyapathya is the backbone of the principles of Ayurvedicmedication. It is followed both in normal day to day life as well as by the patientsduring illness. It was been stated that the person who always consumes pathyasevanado not require any medication, also those who never follows pathyasevana there is nouse of any medication to him(Pathyapathyavibhodhaka)PATHYA AAHARA AND VIHAARA:AAHAARA: 1. Shaali- shastika shaali 2. Shimbi daanya- mudga,masura,chanaka. 3. Phala: Adakiphala, 4. shaaka-patola 76 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 94. Disease Review of Literature 5. Mamsa(Non-veg)-Kapota,Paraavata 6. Ghruta mishritha yavaagu 7. Santhaanika(upper thick part of the of the boiled milk) Mixed with madhu and sharkara. 8. Navaneetha (new)+½ qty sugar+¼ qty of honey 9. Ksheerapaana 10. Mudga yusha 11. Amla rasa pradhana phalas like dadima 12. Laaja churna +Ghrutha+Madhu 13. Karjura VIHAARA: 1. vishraama 2. ushna jala avagaaha 3. sukha nidra APATHYA:Table: 12 Showing the list of Apathya ahara and VihaaraSl.No. Aahara Vihara 1. Intake of Ati mathra of lavana, Vyayaama amla,guru aahara 2. Intake of the Mamsa of gramya, oudaka Vyavaaya medya animals 3. Atiadhva Intake of shukta, masthu,sura 4. Intake of Katu,vidhaahi, and Aatapa sevana pishitha aahara 5. Intake in ati matra of Guru & snigdha Atisrama yuktakarya aahara. 77 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 95. Review of Literature Drug Review Drug reviewThe main aim and objective of the present clinical study To Validate the Role ofVirechana as a form of Samprapthi Vighatana in Asrigdara. Hence in this study,following medicines are used:They are as mentioned below: Jeerakaadi churna for Aamapaachana Murcchita ghruta for snehapaana Tila taila for Abhyanga Ushna jala for parisheka sweda Trivrith lehya for Virechana1. Jeerakadi churna 41(Ga.pgno 259)Ingredients: -1.Jeeraka, musta, patha, bilwa, dhanyaka ,sugandhabala, shatapushpa, dadima,kutaja,manjista, dhatakipushpa, shunti,maricha, pippali, ela, twak, patra, mocharasa,indrayava-equal parts2. Abhraka bhasma,tankana,shuddha parada,shuddha gandhaka –equal parts3. Jatiphala-quantity equal to all the drugs 78 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 96. Review of Literature Drug Review Table:13 Showing the properties of drugs in Jeerakadi choorna 41(Ga.pgno 259),Sl Drug Latin name Family Parts Chemical composition Rasa Guna Veerya Vipaka Doshagnata Karmukatano1 Jeeraka Cuminum Umbelliferr Seed Volatile oils like Katu Laghu Ushna Katu Vatakaphahara, Deepana, cyminum ae Pentosan, ruksha pacana, Thymine grahi, chakshushya,vrisya, medya,balya2 Musta Cyperus Cyperus Roots Fats,sugar,gum,starch, Katu Laghu Sheeta Katu Kaphapitta Deepana, rotundus albuminsalt & aromatic ,tikta ruksha shamaka pachana,grahi oil kashaya3 Patha Cissempelos Menisperma Root Berberine,deyameltin Katu Laghu Ushan Katu Vatakapha Balya,vishaghna pariera ceae teekshna shamaka4 Bilwa Aegle Rutaceae Apak Pectin,gum,marmelosin, Kashaya Laghu Ushna Katu Vatakaphaghna Grahi,balya,pachana marmelos wa Tannin tikta teekshna phala majja5 Dhanya Coriandrum Umbellifara Seeds, Jirenol,vebrinol,resin,ma Kashaya, Laghu Ushna Madhu Tridosha Mutrala, ka sativum e whole llic acid,alkaloids,resin tikta,katu, snigdha r shamaka avrishya, plant madhura. deepana, pachana, rochaka,grahi6 Sugand Pavonia Malvaceae Root Fragrant substance Laghu Sheeta Kaphapittaghn Deepana, ha bala octorate - - a pachana, vatanulomaka 79 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 97. Review of Literature Drug Review7. Shatapus Anethum Umbellifer Fruit,o Volatile fragrant Katu, Laghu Ushna Katu Kaphavatagh Deepana, hpa sowa ae il oil tikta teekshna, na medya ruksha8. Dadima Punica Punicaceae Fruits, Gallotanic acid Madhura, Laghu,snig Anush Mad Tridoshghna Tarpana,shukrala, granatum root, amla dha na hura grahi,medya9. Kutaja Holorrhena Apocynace Stem Conessine,kurchi Katu, Ruksha Sheeta Katu Kaphavatagh Deepana,grahi dysentrica ae bark ne kashaya na10 Manjista Rubia Rubiaceae Root Perfurin,garansin, Madhur, Guru Ushna Katu Kaphapittag Swaravarnakrita, cordifolia algerin tikta hna11 Dhataki Woodfordia Lythraceae Flowe Tannin,gum Katu,kash Laghu Sheeta Katu Kaphapittag Madakara floribunda rs, aya hna Leave s12 Shunthi Zingiber Zingiberac Rhizo Gingerin,resin,sh Katu Laghu Ushna Mad Kaphavatagh Ruchya,aamaghn officinale eae mes ogol hur na a,pachana, vrishya13 Maricha Piper nigrum Piperaceae Fruit Piperine Katu Ruksha,tee Ushna Katu Vatakaphagh Deepana,vrishya kshna na14 Pippali Piper longum Piperaceae Fruit Piperine,piperidi Katu Laghu,snig Anush Mad Kaphavatagh Pachana,deepana, ne hdha na hur na vrishya, medya15 Ela Elettaria Zingiberac Seeds Cineol,terpineol, Katu, Laghu , Sheeta Mad Tridoshghna Deepana.hridya,r cardamom eae Limonene Madhur Ruksha hur ochana 80 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 98. Review of Literature Drug Review16 Twak Cinnamum Lauraceae Twak Cinnamaldehyde, Katu,tikta Laghu , Ushna Katu Vatakaphagh Balya,shukrala,tri zeylanicum eugenol Ruksha na shahara ,teekshna17 Patram Cinnamom Lauraceae Patra Volatile oil Madhur Laghu,kinc Ushna Mad Kaphavatagh Ruchya,arsha,pin tamala hit hur na asahara teekshna18 Mochara Bombax Bombaceae Latex Catechutannic Madhur Grahi,snigh Sheeta Katu Kaphapittag Vrishya,aamahara sa malabaricum acid dha, hna19 Jatiphala Myristica Myristicace Seeds Nutmeg buffer, Tikta,katu Laghu Ushna Katu Kaphavatagh Grahi,swarya,dee fragrans ae myristic acid ,teekshna na pana, pachana20 Tankana Borax ----- -------- ---------------- Katu Ruksha,tee Ushna Katu ------------- Hridya,balya,deep - kshna,sara ana. 81 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 99. Review of Literature Drug Review2. Murcchita Ghrita :24,39Latin Name : Butyrum deparatuGana : Madhura Skandha (Cha.)Rasa : MadhuraVirya: sheetaGuna : Snigdha, GuruVipaka : KatuDoshaghnata : TridoshaghnaPhytochemical profile:Triglycerides, Diglycerides, Monoglycerides, Ketoacid Glyceride, free Fatty acid,Phospholipid sterols, Vitamin A, D, E & K.Pharmacological profile:It contains approximately 8% lower saturated fatty acids which makes it easily digestible.These are the most edible fat and which are not found in any other edible oil or fat. It alsocontains Vitamins, in which Vitamin A & E are antioxidants and are helpful in reducingketon bodies, helpful in preventing oxidative injury to growth at human body.Duringpreparation of Ghee, Protein casein is removed. Animal studies have shown that caseinelevates cholesterol. Ghee resists spoilage by microorganisms or chemical action.The melting point of Ghee is 350C which is less than the normal temperature of thehuman body. Its digestibility co-efficient or rate of absorption is 96% which is highest ofall oils & fats. Most Ayurvedic preparations are made with Ghee. Digestion, absorptionand delivery to a target organ system are crucial in obtaining the maximum benefit fromany formulation. Since active ingredients are mixed with Ghee, they are easily digestedand absorbed. Lipophilic nature of Ghee facilities entry of the formulation into the celland its delivery to the mitochondrium, microsome and nuclear membrane. In the processof evaluating the activities of natural compounds, it has been found by means of 82 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 100. Review of Literature Drug Reviewsophisticated research that when herbs are mixed with Ghee, their activity and utility ispotentiated many times.Actions and uses:It improves Smriti (memory), Varna (complexion), Buddhi (intelligence), Svara (voice),Kanti (personal beauty) and Oja. It removes toxic substance from the body.Ghrita has oneproperty Samskarasya anuvartanam i.e. there is no other such material which imbibes thequality to the extent that ghrita does. It is yogavahi, rasayana and Brimhana. So it carriesactive principles of the drugs to improve level of the body and increase the potency of thecompound drug.3. Tila Taila:33Rasa: Madhura.Anurasa: kashaya, tikta.Guna: guru, sukshma, snigdha sara vikasi, vishada.Virya: ushnaVipaka: madhuraDoshagnata: vata kapha shamaka.Karma: Agnideepaka, lekhana, balakaraka, deepaka, medhya, brimhanakaraka, etc.Uses: Seeds are laxative, emollient and demulcent, diuretic, nourishing, lactagogueand emmenagogue.Composition: Palmitic acid (9.1%), stearic acid (4.3%), arachidic acid (0.8%), oleicacid (45.4%), linoleic acid (40.4%). 83 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 101. Review of Literature Drug Review Table: 14 Showing the properties of drugs in Trivrit lehya 6(kal.2nd.9sl)Sl Drug Latin Family Part Chemical Rasa Guna Veer Vipak Doshagnata Karmukatano name s composition ya a1. Trivrit Operc Convolulac Roo Turpethin,liganin,v Tikta,katu Laghu,ruksha,tee Ushn Katu Kaphapittaghn Sukhavirechaka, ulina eae t olatile oil kshna a a Sarvarogahara turpet bark hum2. Sita - - - - Madhura Sheet Madh Vatapittahara Shukrakari,ruchya a ura3. Madhu - - - - Madhura,kas Laghu,ruksha Sheet Madh Kaphapittasha Grahi,lekhana, haya a ura maka Deepana,vrushya Varnya,medhya4. Ela Elettar Zingiberac See Cineol,terpineol, Katu, Laghu , Sheet Madh Tridoshghna Deepana.hridya,roc ia eae ds Limonene Madhura Ruksha a ura hana carda mom5. Twak Cinna Lauraceae Twa Cinnamaldehyde,e Katu,tikta Laghu , Ushn Katu Vatakaphaghn Balya,shukrala,tris mum k ugenol Ruksha ,teekshna a a hahara zeylan icum6. Patram Cinna Lauraceae Patr Volatile oil Madhura Laghu,kinchit Ushn Madh Kaphavataghn Ruchya,arsha,pinas mom a teekshna a ura a ahara tamala 84 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 102. Review of Literature Drug Review LIST OF MEDICINES USED FOR VIRECHANAPlate: 4 Jeerakaadi churna Plate: 5 Murcchita ghrutaPlate: 6 Tila taila Plate: 7 Trivrith lehya 85 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 103. Virechana Review of Literature VIRECHANANirukti and paribhashaVirechana is derived from the root –ËUcÉç kÉÉiÉÑ, ÌuÉ EmÉxÉaÉï,ÌlÉcÉç and srÉÑOèû mÉëirÉrÉ are also take part in the derivation.“ ÌuÉzÉåwÉålÉ UåcÉrÉiÉÏÌiÉ ” |skd It means “Mala Nissarana” i.e. elimination of malas through any of the routein the body. But in Ayurveda the word virechana is used for indication of only theelimination of malas through adhobhaga i.e. Guda (Anal route). Even in case ofNiruhavasti Malas are eliminated through Guda, but adhobhagaharana type ofshodhana is not produced here i.e. elimination of Aama and pakwashayagata malas.Certain specific terminology is used in Ayurveda to indicate the elimination of malasother than through Guda eg. Vamana, Shirovirechana. 1(kal.1st.4 )“iɧÉSÉåwÉWûUhÉÇ AkÉÉåpÉÉaÉqÉç ÌuÉUåcÉlÉqÉç xÉÇelÉMüqÉç |The act of expelling vitiated doshas (malas) through adhobhaga is known asVirechana. Here Chakrapani commented adhobhaga means “Guda”.“ÌuÉUåMüÉå qÉÑZÉmÉÏiÉqÉç aÉÑSqÉÉaÉåïlÉÉliÉ: xjÉåiÉxjÉ | SÉåzÉxrÉ ÌlÉUxÉÉUÉlÉqÉç ÌmɨÉxrÉ mÉUqÉÉæzÉSqÉç ||”Virechana is the process in which the orally administered drug can eliminate thevitiated doshas through adhomarga and it comprises special treatment for pittadosha. 86 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 104. Virechana Review of Literature“ÌuÉUåcÉlÉÇ ÌmɨÉWûUlÉqÉç ´Éå¹Ç |” 3(su.25/40)Virechana is a specially indicated in vitiation of pitta dosha,PARYAYAThe synonyms are Rechana Praskandana.Dictionary Meaning: Purgative, Cathartic, Evacuant and Aperient.VIRECHANA DRAVYASVirechana dravyas will have all the properties of vamana dravyas i.e. Ushna,Teekshna, Sukshma, Vyavayi, Vikashi. Vamana dravyas have Urdhvabhagahara gunawhere as Virechana dravys have Adhobhagahar guna. But, unlike vamana,theVirechana dravyas have predominance of prithvi and jala mahabuthas, which showspecific property of removing the doshas through adhobhaga. i.e. Guda marga.PROCEDURE OF VIRECHANAProcedure of Virechana can be classified under following three headings: - Purvakarma Pradhanakarma PaschatakarmaPurva karma: Sambhar sangraha Atura pariksha Atura siddhata Matra vinischaya 87 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 105. Virechana Review of LiteratureSambhar sangraha:The medicines and instruments useful for Snehana, Swedana, Virechana e.g. bed pan& measuring glasses and the treatment of Virechana vyapat must be collected prior tothe administration of Virechana therapy.Atura pariksha:  Examiniation of the patient for yogya ayogya.  Deciding the Virechana matra depending on the Dosha, Atura bala, Bheshaja, Kaala, Desha, Agni, Koshta, Shareera, Ahara, Satmya, Satwa, Prakriti, Vaya, Saama avastha and Vikara.  Deciding the type of Sneha and Virechana yoga by considering vyadhyanukulata and vyadhyanurupataAtura pariksha:  Examiniation of the patient are yogya ayogya.  Deciding the Virechana matra depending on the Dosha, Atura bala, Bheshaja, Kaala, Desha, Agni, Koshta, Shareera, Ahara, Satmya, Satwa, Prakriti, Vaya, Saama avastha and Vikara  Deciding the type of Sneha and Virechana yoga by considering vyadhyanukulata and vyadhyanurupataAtura siddhata: Prior to Virechana Karma the patients are administered with Deepana, Pachana, Snehana and Swedana procedures as a purvakarma  Pachana is administered in the condition of Ama, till the appearance of Nirama lakshanas  Snehapana is followed in arohana vidhi, till the appearance of samyak snigdha lakshanas, maximum duration will be 3 to 7 days. 88 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 106. Virechana Review of LiteratureSamyak Snigdha LakshanasTable:15 showing the Samyak Snigdha Lakshanas.Sl. Lakshanas Ch Su Va Sl. Lakshanas Ch Su Va01. Vatanulomana + - + 07. Anga laghavata - + -02. Agnideepti + + + 08. Twak snigdhata - + -03. Purisha snigdhata + + + 09. Adhomarga sneha srava - + -04. Asamhata varcha + + + 10. Klama - + +05. Gatra mardavata + + - 11. Shaithilya - + -06. Gatra snigdhata + + + 12. Snehodvega - - +xlÉåWûÉiÉç mÉëxMülSlÉÇ eÉliÉÑ: ÎiuÉUɧÉÉåmÉUÉiÉ ÌmÉoÉåiÉç |In case of Virechana, 3 days rest is given after Snehapana. During these daysAbhyanga, Swedana and Snigdha, Drava, Ushna bhojana, Mamsarasa, Odana,Amlarsa Phala is administered. i.e. The food must not produce kaphavruddhi“Manda Kapha” is the condition described for proper Virechana Karma.Matra vinischaya Matra of Virechana drug should be in such a quantity that the desired effect ofShodhana must be achieved without causing ayoga and atiyoga lakshanasTable:16 Showing the dosage of Virechana dravya according to sharangadhara. Kalpana Uttama Matra Madhyama Matra Heena Matra Kwatha 8 tolas 4 tolas 2 tolas Kalka, Choorna 4 tolas 2 tolas 1 tolas Modaka 89 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 107. Virechana Review of LiteratureNature of Koshta and VirechanaqÉëÑ̲ qÉÉ§É qÉëÑSÒ MüÉå¹ã cÉ qɱqÉ | MÚüUå iÉϤhÉlÉ qÉiÉ SìurÉæï qÉëÑSÒ qÉkrÉ qÉ iÉϤÉhÉMæü:|| 3(chi13/80)Acharya Sharangadhara opines that the dravya matra should be alpa, madhyama,uttama for the person of Mrudu, Madhyama and Krura Koshta respectively.Sushrutaalso opines the same.PRADHANA KARMA Pradhana karma starts with administration of virechana dravyas till the stoppageof virechana Vegas i.e. – 01. Virechana yoga sevana. 02. Atura paricharya and Nirikshana. 03. Vega nirnaya. 04. Observation of samyak yoga, ayoga and atiyoga lakshanas. 05. Virechana vyapat and Pratikara.Virechana yoga sevana:Before the administration of virechana yoga the physician must examine the patientsphysical and mental health once again. Patient must have digested, the food taken onprevious day and must have got sound sleep on the previous night.Time of administration of Virechana Yoga: 6( su.18/19)zsÉåwqÉ MüÉsÉå aÉiÉå elÉÉiuÉÉ MüÉå¹É xqrÉMçü ÌuÉUåcÉrÉÏiÉç |According to Vagbhata, the virechana Yoga should be administered just aftershlesmakala. It can be understood that time is so adjusted for virechana to be startedduring pittakala. Ushna or sheeta jala can be used as anupana in accordance withVirechana yoga. 90 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 108. Virechana Review of LiteratureAtura paricharya and Nirikshana:The vaidya must observe the lakshans of Jeernaushadha, Ajeernaushadha, Hrita doshalakshanas and vyapat.Aoushadha Jeernaajeerna LakshanaTable: 17 Showing Aoushadha jeernaajeerna lakshanas.Sl. Aushadha jeerna lakshana Aushadha ajeerna lakshana01. Vatanulomana Dourbalya02. Swasthya Daha03. Kshut Angasada04. Pipasa Bhrama05. Mana prasannata Moorchha06. Indriya prasannata07. Shuddha udgarIn case of ajeernaushadha lakshanas, the Virechana drugs are not be givenimmediately, as the drugs may produce severe purgation i.e. Atiyoga. But in somecases if the drug is digested, and there is no hrit dosha lakshanas, he should be givenfood, again virechana aushadhi administered on next day. Even then if the virechanadoes not occur then the patient must be given proper snehana swedana once again andthen Virechana oushadhi administered after 10 days.Apart from the above lakshanas the hrita dosha lakshanas also taken intoconsideration. In proper virechana there will be expulsion of mala, pitta and kaphaVata in sequence, “Kaphante Virechana” and appearance of daurbalyata and laghutaindicates that doshas have been properly eliminated. 91 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 109. Virechana Review of Literature If virechana persists even after manifestation of Hrita dosha lakshanas thenvamana should be performed. If the Virechana Vega does not occur theninstantaneously the ushna jala pana, and swedana performed on pani, pada and udara.Vega VinirnayaFor the purpose of observation of pravara, madhyama and avara shuddhi, Chakrapnihas given four types of criteria i.e. Laingiki, Antiki, Vaigiki and Maniki, butimportance should be given to Laingiki shuddhi.For vega vinirnaya the the first two-three malayukta Vegas are excluded thencounting is done till kaphantaTable:18 Showing the Virechana Shuddhi vinirnaya. Sl. Shuddhi Pravara Madhyama Avara Lakshana 01. Vaigiki 30 Vegas 20 Vegas 10 Vegas 02. Maniki 4 Prastha 3 Prastha 2 Prastha 03. Antaki Kaphante 04. Laingiki Samyak Virechana LakshanasObservation of samyak yoga, ayoga and atiyoga lakshanas: -Laingiki shuddhi lakshanas are given in the table. Thereafter the Ayoga and Atiyogalakshanas mentioned in the classics have been presented in tabular form. 92 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 110. Virechana Review of LiteratureTable:19 Showing the Samyak Lakshanas of Virechana karma. Sl. Virechana Samyak Lakshana Ch Su Va 01. Srotovishuddhi + - - 02. Indriya prasada + + - 03. Laghuta + + - 04. Agnideepiti + - - 05. Anamayatwa + - - 06. Kramat Vit, Pitta, Kapha and Vata Nissarana + + - 07. Vatanulomana - + - 08. Absence of Ayoga, Atiyoga lakshanas - - +Virechana Ayoga and Atiyoga LakshanasTable:20 Showing the Ayoga lakshanas of Virechana. Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va 01. Kapha 10. + + + Vata pratilomata + - - prakopa 02. Pitta prakopa + + + 11. Daha - + + 03. 12. Hridaya Vata prakopa + - - - + + ashuddhi 04. Agnimandya + + - 13. Kukshi ashuddhi - + + 05. Gourava + + - 14. Kandu - + + 06. Pratishyaya + - + 15. Vitsanga - + + 07. Tandra + - - 16. Mutrasanga - + - 08. Chhardi + - - 17. Pidaka - - + 09. Aruchi + + + 93 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 111. Virechana Review of LiteratureTable:21 Showing the Atiyoga lakshanas of Virechana. Sl. Lakshana Ch Su Va Sl. Lakshana Ch Su Va Kapha 01. + + - 12. Hikka + - - kshayaja vikara Pittakshayaja 02. + - - 13. Moorchha - - - vikara Vata kshayaja 03. + - - 14. Gudabhramsha - - - vikara 04. Supti + - - 15. Shoola - + - Kapha, Pitta rahita 05. Angamarda + - - 16. Sweta, lohita udaka - - + nissaranam Mamsa dhavanavat 06. Klama + - - 17. - - + Udakasrava 07. Vepathu + - - 18. Medakhandavat - - + 08. Nidra + - - 19. Trishna - - + 09. Dourbalya + - - 20. Bhrama - - + 10. Tamapravesh + - - 21. Netra Praveshanam - - + 11. Unmad + - - 22. Raktakshayaja vikara + - -Ahridya, durgandhita, adhika matra yukta virechana oushadhi and in kaphotkleshaajeernavastha the administered Virechana oushadha may produce vamana.Paschat Karma(A) Samsarjana Krama :After Samshodhana, Agnimandya occurs because the Doshas come to Amasaya(Jejjata), so peyadi Krama is recommended to increase the Agni gradually up to thenormal level, and make Tivra to digest Guru Anna too. 94 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 112. Virechana Review of LiteratureIn the Peyadi Krama Peya, Vilepi, Akrtyusa, Krtayusa, Akrtmamsarasa,Krtmamsarasa should be given for 3, 2 and 1. Annakala for Pradhana, Madhyama andAvara Suddhi patients respectively. (Ca. Si. 1.11).Susruta mentions Kulattha, Aadhaki, and Jangala Mamsarasa instead of Peyadi krama(Su.Ci. 33). Dalhana commenting on this clarifies that, in Ksina Kapha, Peya shouldbe given. Mamsarasa should be given to Vatapradhana patients having Diptagni. Ifsome Kapha dominance is there according to Dosa and Prakrti, then Kulathi Yushashould be given. The Peyadi Krama ends on 7th day in the Pradhana Suddhi patient.VIRECHANA OUSHADHA KARMUKATAAction of Virechana Karma can be divided in the following two ways.(1) Systemic - by which it brings down the morbid Dosas, particularly Pitta from thebody to Amasaya or Pakvasaya i.e. GIT.(2) Local evacuant: This is concerned with the evacuation of these Dosas in the formof Mala from the gut by Purgation.Both the actions and related factors are being described here in detail.1 ( K. 1/5).Virecana Yoga, gets absorbed and due to Virya. it reaches to the Hrdaya (Heart), thenthe Dhamanies (arteries) and thereafter it reaches to Sthula and Anu Srotas i.e. Macroand Microchannels of the body. 01. The Vyayayi Guna of drug is responsible for quick absorption. 02. The Vikasi Guna causes softening and loosening of the bond. 03. Due to Usna Guna, the Dosha Sanghata (compactness) is liquified (Visyandana). 95 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 113. Virechana Review of Literature 04. Action of Tiksna Guna is to break the Mala and Dosa in micro form. According to Dalhana it is responsible of quick excretion. 05. Due to Suksma Guna by reaching in micro channels, disintegrates endogenic toxins which are then excreted through microchannels (Anupravana Bhava).Due to Prabhava mainly and also due to Prthivi Jala Constitution finally Virecanaoccurs. This is the evacuant action.Classification of Laxative:These drugs are classified according to the intensity of action as mild, moderate,drastic, laxative effect suggest the eliminations of soft, formed stool without gripingand without much loss of water. In large doses, many laxatives promote catharsiswhich means purgation and the passage of more fluid stools.1) Drugs which accelerates the passage of food.a. Bulk Purgative: These work by one or more of the following actions.i. Non-metabolizingii. Retaining wateriii. Promoting peristalsis e.g. Plant gums like sterculina,Isabgole, etc.b. Faecal Softners: As dioctyl sodium sulphosuccinate.c. Osmotic purgativesi. Poorly absorbed solutes, which maintains an increased fluid volume.ii. Accelerate transfer to gut contents through small intestine to colon.iii. Large volume in colon results in purgation. 96 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 114. Virechana Review of Literatureiv. Saline purgative e.g. MgSO4 doubles the volume of faeces.d. Stimulant purgativei. Stimulates the mucosa of gutii. Irritate local reflexes e.g. castor oil.Castor oil is hydrolyzed in small intestine by lipase to give ricinoleic acid whichirritates and requires bile for hydrolysis.2) Drugs which increases GI motility  Local stimulant effect on motility  Acceleration of gastric emptying, but no effect on gastric secretion.Modern explanation of possible action of virechana karma: Ayurvedic shodhana karma are “physician induced mild inflammation” mainlyvamana and virechana drugs are quite irritant to the stomach and the intestinal mucosarespectively, to cause inflammation. Due to this the permeability of the membranechanges and those substances come out due to the changed permeability which cannotcome out in normal condition. The gross sign of inflammation are redness, heat,swelling and pain and loss of functions. These sign occurs due to the followingchanges at microscopic level. Hyperemia : It occurs due to capillary dilatation and arteriolar dilatation and mechanism. Exudation : Exudation is the increased passage of protein rich fluid through the vessel wall, in the intestinal tissue. The advantageous result of fluid increases is dilution of toxins. 97 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 115. Virechana Review of LiteratureSome chemical factors are also responsible which increase the permeability inresponse to acute inflammation.Vaso-active Amines:Mast cells, Histamine, Increase permeability Inflammation, Platelets, Serotonin.Vasoactive Polypeptide: These causes vasodilatation.Miscellaneous Agents: The other agents influencing vascular dilatation and increasingpermeability are –a) Lysosomal enzymes from polymorphsb) Prostaglandinsc) Globulin permeability factord) Lymph node permeability factore) Degradation products of DNA and RNA.f) Antigen – antibody complexes (Gorans – 1990)Some of the above factors may be responsible for the increase permeability of theintestinal mucosal in response to the inflammation caused by irritant Virechana Yoga.To further understand the action we should go through the mode of action certainmodern purgatives. In the modern medicine, purgatives are classified into thefollowing groups. 98 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 116. Virechana Review of Literature VIRECHANA IN ASRIGDARA1…………aÉpÉÉïzÉrÉÉxÉ×eÉÏ ÌuÉUåMü:| 7 (si 2/13) MüÉ.xÉÇ.ÍxÉ. 2/13 According to Kashyapa, Asrigdara Virechana should be given.2.Virechana has been indicated where in Charaka has suggested the use ofMahatiktaka Ghrita for Virechana in Pittaja type of Asrigdara.The predominant Doshabeing pitta, Virechana serves as the best Shodhana therapy.3. Virechana (Purgation) is beneficial for Artava rogas(1. Si. 2/13), 3( chi. 33/32), 49.Su. 27/9). 6(Su.18/9), 32(Sha utt. 4/9), 7(Ka.S. Si. 7/5) 99 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 117. Materials and Methods MATERIALS AND METHODSThe therapeutic measures, drugs and procedures of Ayurveda have remained inpractice since long period, on the basis of methodology prevalent in ancient times.This is the time that the Ayurvedic therapeutic approach is explained on rational lines.Clinical trial is a way of research and its best method to evaluate any drug or line oftreatment. This trial was carefully designed experiment with the aim of solvingunrewarding problems conducted on scientific lines. This study is a critical study where in the role of virechana in Sampraptivighatana of Asrigdara is studied.Source of data: For the present study Patients who fulfilled the inclusion criteriawhere randomly selected from O.P.D and I.P.D of S.J.I.I.M Hospital Bangalore.Diagnostic criteria:The patients with the cardinal symptoms of Asrigdara W.S.R toDUB With Normal Pelvic USG Study.Subjective criteria:- Increased(Abnormal) Amount of bleeding Increased(Abnormal) duration of bleeding Subjective symptoms like Angamarda, Dourbalya,Bhrama,Vedana,Shwasa kruchratha Objective criteria:- Hb gm % before and after treatment. Both subjective and objective signs and symptoms before and after treatment are recorded and analyzed statistically using Sudent ‘t’ test. 27 100 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 118. Materials and MethodsA) Inclusion Criteria:-  Patients aged between 22 - 44 yrs.  Patients who are having the cardinal and associated symptoms of Asrigdara w.s.r to DUB.B) Exclusion Criteria:  Excessive bleeding due to Polyps, Erosions, Carcinoma, Fibroids, Endometritis etc.  Post menopausal bleeding.  Bleeding due to Miscarriage, Inevitable abortions.  History of bleeding other than from Uterus.  Patients with Cardio vascular Diseases, Renal Diseases or Hematological Diseases are excluded.  Coagulation disorders  Thyroid abnormalitiesResearch design: After the diagnosis of Asrigdara W.S.R. DUB based on the above parameters, the selected patients were subjected for the study. Sample size and grouping: A minimum sample of 30 patients with disease Asrigdara W.S.R. DUB were selected for the study, and randomly distributed into 2 groups of 15 patients. 1. GROUP A – Patients in this group are subjected to virechana procedure with Pathya aahara and vihaara. 101 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 119. Materials and Methods 2. GROUP B – Patients in this group are kept as control group on Pathya aahara and vihaaraSTUDY DESIGN:Total Study duration: 30 daysGroup A: The patients were given 3grms of Jeerakaadi Churna bid till niramalakshanas. After aamapaachana,followed by snehapaana is done with MurcchitaGhruta till samyak lakshana appears ,it is followed by Bahya snehana with tila tailafollowed by parisheka sweda for 3 days on the 3rd day of bahya snehana and parishekasweda with ushna jala Trivrith lehya about 30grms is given on empty stomachbetween 9.30-10 am .After this samsarjana karma is followed depending on shuddhilakshanas,this should be followed by Pathya Aahaara and Vihaara.Group B: The patients in this group are given Pathya aahara and should followVihaara as listed below for a month.PREPARATION OF THE DRUGS:Jeerakadi Churna: The ingredients are Jeeraka, musta, patha, bilwa, dhanyaka,etc.which is taken from NKCA Pharmacy was given to patients.Murchita Ghrita : Murchita Ghrita is prepared using the following ingredientsusing the below procedure. 102 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 120. Materials and MethodsGhrita Murchana: 24Table:22 showing the ingredients with their quantities of drugs used in GhritaMurchanaINGREDIENTS QUANTITY INGREDIENTS QUANTITYPathya 1 pala Rajani 1 palaDhatri 1 pala Matulungasvaras 1 palaVibhitaki 1 pala Ghrita 1 prasthaJalada 1 pala Jala 4 prasthaMethod of preparation: The above mentioned drugs were made in to coarse powder,Than kalka was made out of it by adding water in little quantity.Later this kalka and the mentioned quantity of water was added to this followed by Goghrita and processed for paka till it attained Ghrita siddha lakshanas.Later vessel was taken out from the fire and prepared Ghrita was filtered.Such murchita Ghrita does not possess any Amatva & it has its own specific colour and odour.Trivrit lehya:Trivrit lehya was purchased from market, of Nagarjuna pharmacy for virechanakarma. 103 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 121. Materials and MethodsMETHODOLOGY OF STUDY:The patients who fulfilled the inclusion criteria were subjected for routineHaematological examination like Hbgm%, TC, DC and Ultra sonography.Before commencement of the treatment an informed consent was taken from thepatients, and the patients were evaluated for both subjective and objective parameters.GYNAECOLOGICAL EXAMINATION: PV Examination Procedure:  Interrogation & consent  Washing the hands thoroughly  Wear a glove  Position patient in dorsal position-Knees to chest, heels together and legs apart.  Inspection of external genitalia  Insert 1-2 fingers into the vagina  Place the other hand on the lower abdomenNOTE:(1) Uterus : Position : AVAF / RVRF /Deviated Size : Normal / Bulky / Small Mobility : FM / IM / Fixed / Tender(2) Cervix : Consistency : H/S/N Growth: Yes/No(3) Fornices : Ant. : Fused / Tender / Normal Post: Fused / Tender / Normal Lat.: Fused / Tender / Normal 104 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 122. Materials and MethodsMETHOD OF ADMINISTRATION OF VIRECHANA TO GROUP A:Purvakarma: The patients were administered Jeerakadi choorna internally in a dose of 3gms twice daily with 1 glass of warm water, half an hour before food, the treatment was given till the nirama lakshanas were observed After aamapaachana with Jeerakaadi churna the patients was given hrasi hrasi matra(30ml) of murcchita ghruta on empty stomach and the patient is asked to take warm water in between. No food should be taken till the patient feels hungry depending on how much time the patient has taken to digest the test dose we should calculate the amount of sneha which can be given for the patient the dose can be divided and can be given to the patient till the appearance of samyak snigda laxanas like vaataanulomana,deeptaagni,etc for 3,5 or 7 days .After samyak snigda laxanax the patient is given bahya snehana with tila taila followed by parisheka sweda with hot water for 3 days. Pradhana karma: On the 3rd day of abhyanga and parisheka sweda at about 9.30am the patient is given 30grms of trivrith lehya On empty stomach ,during each vega the patient is advised to take small quantity of warm water. Pashchath karma: the patient is advised to follow samsarjana karma (manda,peyaadi ) for 3,5 or 7 days depending on the avara,madhyama,and pravara shuddhi lakshanas.Pathyaapathya Aahara and Vihara (for both Group A and Group B) Aahaara: 1. Use of Shaali- shastika shaali in the routine food. 2. Shimbi daanya- mudga(hesaru),masura,chanaka. 105 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 123. Materials and Methods 3. Phala: Adakiphala, 4. shaaka-patola 5. Mamsa(Non-veg)-Kapota,Paraavata 6. Ghruta mishritha yavaagu 7. Santhaanika(upper thick part of the of the boiled milk) Mixed with madhu and sharkara twice in a day. 8. Navaneetha (new) +½ qty sugar+¼ qty of honey twice in a day 9. Ksheerapaana twice in a day 10. Mudga yusha once a day 11. Amla rasa pradhana phalas like pomogranite,orange etc fruits 12.Intake of Laaja churna +Ghrutha and Madhu twice in a day. 13. Karjura 3 to 4 per day Vihaara: 1. vishraama 2. ushna jala avagaaha 3. sukha nidraAPATHYA: Aahara Vihara  Intake of Ati mathra of lavana,  Vyayaama amla,guru aahara  Intake of the Mamsa of gramya,  Vyavaaya oudaka medya animals  Intake of shukta, masthu,sura  Atiadhva  Intake of Katu,vidhaahi,snigdha and  .Aatapa sevana pishitha aahara  Atisrama yuktakarya 106 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 124. Materials and MethodsFollow up study: Patients were assessed after 2 MonthsASSESSMENT CRITERIA Assessment of Subjective Criteria: 1. Duration of Bleeding < 5 days Nil 5 to 7 days Mild 7 to 8 days Moderate >8 days Severe 2. Size and No. of clots passed per day 1 or 2 Small clots Nil 2 or 4 Large clots Moderate Multiple Large clots Severe Assessment of Objective Criteria: 3. Hbgm% variations < 12 – Nil 10 - 12 – Mild 8 - 10 – Moderate > 8 -- SevereCRITERIA FOR ASSESSMENT OF TOTAL RESPONSE OF THE STUDY:Effect of virechana on Asrigdara is assessed employing Student‘t’ test. The significance of virechana is classified as:- 1. Highly Significant – when P<0.001 2. Highly Significant – when P<0.01 3. Just Significant - When P<0.05 4. Insignificant – when P>0.05 107 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 125. Observations and Results OBSERVATIONSA total of 43 patients were screened for the study, among these 43 patients 9 patientsdid not complete the study due to various reasons. A total of 34 patients wereregistered for the present study.16 patients were registered in group A, 1 patient dropped out in the middle, while 17patients were registered in Group B, and 2 patients dropped out in the middle. Thedata of 3 patients who dropped out of the study have not been included here.All the patients were examined before and after the treatment and data recordedaccording to the case sheet format given in the appendix. Changes in both thesubjective and objective parameters were recorded.The data recorded are presented here under the following heading:–I. Demographic dataII. Data related to the diseaseIII. Data related to the responseDEMOGRAPHIC DATATABLE: 23 DISTRIBUTION OF PATIENTS BASED ON REGISTRATIONRegistered No. of Patients Total %Pts wise GROUP A GROUP BDistributionRegistered 16 17 33 100Completed 15 15 30 90.9LAMA 1 2 3 9.09 108 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 126. Observations and Results GRAPH NO. 1 HPARG .ON 1 Registered Patients Registered Completed LAMA 100% 0% Group Group Total A B A Total of 16 patients were registered in group A, Amongst them 15 Patients completed the treatment and 01 left against medical advice.In group B, 15 patients completed the treatment while 02 patients Left against medical advice. Hence a total number of patients were recorded for the present study, Observation of patients and results obtained there upon given below. TABLE: 24 DISTRIBUTION OF PATIENTS BASED ON AGE GRAPH:2Age wise No. of Patients Total %Distribution GROUP A GROUP B Age wise distribution 20-25yrs 2 2 4 13.3 Group A Group B Total 26-30yrs 3 2 5 16.7 30-35yrs 5 4 9 30 36-40yrs 2 3 5 16.7 4 5 9 5 7 41-45yrs 3 4 7 23.3 2 2 4 3 4 2 3 5 2 3 It was found that Highest number of patients i.e. 30% belonged to Age group of 30 - 35 years, followed by 23.3% Belonging to age group of 41-45 yrs ,16.7% belonging to age group of 36 – 40yrs ,26 – 30 yrs .and 13.3% belonging to 20 – 25 years. 109 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 127. Observations and ResultsTABLE: 25 DISTRIBUTION OF PATIENTS BASED ON EDUCATIONEducation No. of Patients Total %wise GROUP A GROUP BDistribution Illiterate 1 2 3 10 Primary 5 3 8 26.7High School 2 1 3 10 Graduate 7 9 16 53.3 GRAPH NO.3 Education wise distribution Group A Group B Total 16 3 8 2 3 9 3 1 5 1 7 2 Illiterate Primary High School GraduateAmongst 30 patients, Highest no. i.e. 53.3.7% patients were Graduates, 26.7 % werehaving primary education, about 10% were having Education at high school level andIlliterates.TABLE: 26 DISTRIBUTION OF PATIENTS BASED ON OCCUPATIONOccupation No. of Patients Total %wise GROUP A GROUP BDistributionHouse wife 9 13 22 73.3 Labour 3 1 4 13.3 Service 3 1 4 13.3 110 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 128. Observations and ResultsGRAPH NO.4 Occupation wise distribution House wife Labour Service 25 23 20 15 13 10 10 3 3 4 4 5 1 1 0 Group A Group B TotalOn considering the nature of occupation, it was found that Highest i.e. 73.3% patientswere housewives, while 13.3% were both service people, and labourers.TABLE:27 DISTRIBUTION OF PATIENTS BASED ON SOCIO ECONOMIC STATUSSocio No. of Patients Total %economicstatus wise GROUP A GROUP BDistributionPoor 1 2 3 10Lower middle 3 2 5 16.7classMiddle class 10 10 20 66.7Rich 1 1 2 6.7GRAPH NO.5 Group A Socio economic status Group B 20 Total 20 15 10 10 10 5 4 3 2 5 2 2 1 1 2 0 Poor Lower Middle class Rich middle class 111 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 129. Observations and ResultsTable shows that Highest i.e. 66.7% patients were belonging to Middle class, 16.7%were from lower middle class and 16.6% were belonging to Poor society, and 6.7%were rich.TABLE:28 DISTRIBUTION OF PATIENTS BASED ON MARITAL STATUSMarital No. of Patients Total %status wise GROUP A GROUP BDistribution Married 12 14 26 86.7 Unmarried 3 1 4 13.3 Widow 0 0 0 0 Divorcee 0 0 0 0 GRAPH NO.6 Marital Status Group A Group B Total 26 14 4 12 1 0 0 0 3 0It is clear from table that highest numbers of patients i.e. 86.7% were married while13.3% were unmarried.TABLE: 29 DISTRIBUTION OF PATIENTS BASED ON RELIGIONReligion No. of Patients Total %wise GROUP A GROUP BDistribution Hindu 15 13 28 93.3 Muslim 0 2 2 6.7 112 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 130. Observations and Results GRAPH NO.7 Hindu Muslim Religion 50 16 13 29 0 Group A Group B Total It is evident from the above table that Highest i.e. 93.3% patients were Hindu followed by 6.7% of Muslim. TABLE30 DISTRIBUTION OF PATIENTS BASED ON FAMILY HISTORY GRAPH NO.8Family No. of Patients Total %History wiseDistribution GROUP A GROUP B Family history Positive 1 2 3 10 15 13 28 50 1 Negative 14 13 27 90 2 3 0 Group Group A Total B Positive Negative In this series, Highest i.e. 90% patients had negative family history while remaining 10% patients had positive family history. TABLE: 31 DISTRIBUTION OF PATIENTS BASED ON DRUG HISTORY Drug history No. of Patients Total % wise GROUP A GROUP B Distribution Hormonal 12 10 22 73.3 Non-Hormonal 3 5 8 26.7 113 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 131. Observations and ResultsGRAPH NO.9 Hormonal Non-Hormonal Drug history 50 3 5 13 10 23 8 0 Group A Group B TotalIn this series, Highest i.e. 73.3% patients werehaving a history of taking hormoneswhile 26.7% were not taking hormones.TABLE: 32 DISTRIBUTION OF PATIENTS BASED ON FAMILY TYPE No. of Patients Total % Family GROUP A GROUP B Type wise Distribution Nuclear 12 13 25 83.3 Joint 3 2 5 16.7GRAPH NO.10 Family type Nuclear Joint 50 13 3 26 5 13 2 0 Group A Group B TotalIn this series, Highest i.e. 83.3% patients were from nuclear families while 16.7%were from joint families. 114 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 132. Observations and Results DATA RELATED TO DISEASETABLE: 33 DISTRIBUTION OF PATIENTS BASED ON CHRONICITYChronicity No. of Patients Total %wise GROUP A GROUP BDistribution2-6mnths 4 6 10 33.36-12mnths 2 2 4 13.31-2yrs 8 6 14 46.72-3yrs 1 1 2 6.7Above 3yrs 0 0 0 0GRAPH NO.11 20 Chronicity 0 Group A Group B TotalThis table and highlights the distribution of patients based on chronicity, whichIndicates that Highest number of the patients i.e. 46.7% were having 1-2 yrschronicity, 33.3% were having 2 - 6months chronicity, 13.3% were having 6 – 12months, 6.7% were having 2-3 years chronicity.TABLE: 34 DISTRIBUTION OF PATIENTS BASED ON AGE OF MENARCHEAge of No. of Patients Total %menarche GROUP A GROUP BwiseDistribution11-12yrs 4 3 7 23.313-14yrs 11 10 21 70Above 14yrs 0 2 2 6.7 115 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 133. Observations and Results GRAPH: 12 Total no. Age of Menarche of Pts Total % 100 50 0 11-12yrs 13-14yrs Above 14yrsIt is evident from the above table that Highest i.e. 70% patients Had age of menarchebetween the age of 13 – 14 years, while 23.3% patients had at 11-12 years and 6.7%had at above 14years.TABLE: 35 DISTRIBUTION OF PATIENTS BASED ON PAST MENSTRUAL HISTORYPast menstrual history No. of Patients Total %wise Distribution GROUP A GROUP BRegularity Regular 15 15 30 100 Irregular 0 0 0 0Amount of Average 10 11 21 70Blood loss Heavy 0 0 0 0 Scanty 5 4 9 30Table shows that maximum number of patients 30 (100%) had regular cycle and 21Patients (70%) had Average amount of blood loss and 9 patients (30%) had scantyblood loss.TABLE: 36 DISTRIBUTION OF PATIENTS BASED ON PRESENT MENSTRUAL HISTORYPresent menstrual No. of Patients Total %history wise GROUP A GROUP BDistributionRegularity Regular 0 0 0 0 Irregular 15 15 30 100Amount of Average 0 0 0 0Blood loss Heavy 15 15 30 100 Scanty 0 0 0 0 116 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 134. Observations and ResultsGRAPH NO.13 Present Menstrual History Group A Group B Total 100% 50% 0% Irregula Average Scanty Regular Heavy rAll the patients 30 (100%) had Irregular cycle, and all the patients (100%) had heavymenstrual blood loss.Present menstrual No. of Patients Total %history wise GROUP A GROUP BDistributionCharacter of Blackish 0 2 2 6.7blood loss red with liquid With 15 14 29 96.7 clotsFoul Present 4 3 7 23.3smelling Absent 11 12 23 76.7Bleeding with clots for 29 patients (96.7%) and 3 patients (10%) had blackish reddischarge .7 patients (23.3%). had foul smelling and 12 patients (76.7%) had no foulsmelling discharge.TABLE: 37 DISTRIBUTION OF PATIENTS BASED ON OBSTETRIC HISTORY No. of PatientsObstetric history Total % GROUP A GROUP B Nil 1 2 3 11.1Parity Primipara 4 5 9 33.3 Multipara 8 7 15 55.6 0 4 3 7 23.3 1 3 3 6 22.2Abortion 2 5 6 11 40.7 >=3 1 2 3 11.1 117 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 135. Observations and ResultsGRAPH:14 15 9 Obstetric History 3 7 11 6 Nil 3 Primipara Multipara 0 1 2 >=3 Parity AbortionHighest numbers of patients i.e. 15 (55.66%) were multiparous,While 9 patients(33.3%) were primipara and only 3 patients (11.1%) had no Obstetric history.Highest numbers of patients i.e. 40.7% had history of 2 Abortion, while 22.2% hadone abortion history, 23.3% had no history of Abortion,11.1% had history of abortionof >=3.TABLE: 38 DISTRIBUTION OF PATIENTS BASED ON CONTRACEPTIVE HISTORYContraceptive history No. of Patients Total % GROUP A GROUP BNot using 2 3 5 18.5Tubectomy 3 2 5 18.5Lap.tubectomy 3 2 5 18.5OCP 5 7 12 44.4GRAPH:15 20 Contraceptive History 5 5 12 5 0 Tot… 118 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 136. Observations and ResultsContraceptive history reveals that majority of the Patients i.e. 44.4% were using OCPwhile each of 18.5% had tubal ligation,tubectomy and 18.5% were not using anycontraceptives.TABLE: 39 DISTRIBUTION OF PATIENTS BASED ON DIETDiet wise history No. of Patients Total % GROUP A GROUP BNatureof Shakha 2 3 5 16.6diet Mishra 13 12 25 83.3Dietic Samashana 2 3 5 16.7habits Vishamashana 9 8 17 56.7 Adyashana 4 3 7 23.3 Anashana 0 1 1 3.3Appetite Poor 6 4 10 33.3 Moderate 8 9 17 56.7 Good 2 2 4 13.3GRAPH:NO 16 90 83.3 80 70 56.7 56.7 Total no 60 of 50 40 33.3 Patients 25 23.3 Total % 30 16.6 16.7 17 17 20 10 13.3 5 5 7 3.3 4 10 1 0 Vishamashana Anashana Shakha Moderate Mishra Samashana Good Poor Adyashanatable shows that 83.3% patients Were having Mixed type of diet while rest of the16.6% patients were taking vegetarian type of diet.Majority of the patients i.e. 56.7%were having Vishamashana type of Dietetic habit, followed by 23.3% were havingAdhyashana and only 3.3% were having anashana dietetic habit.56.7% patients hadmoderate appetite while 33.3% patients were having Poor appetite and 13.3 werehaving very good appetite. 119 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 137. Observations and ResultsTABLE: 40 DISTRIBUTION OF PATIENTS BASAED ON DOMINANT RASADominant Rasa No. of Patients Total % GROUP A GROUP BMadhura 10 10 20 66.7Amla 8 9 17 56.7Lavana 9 9 18 60Katu 12 11 23 76.7Tikta 5 4 9 30Kashaya 6 8 14 46.7GRAPH NO: 17 Total No.of Patients 50 20 17 18 23 0 9 14 Madhura Amla Lavana Katu Tikta KashayaIt is evident from the table that Highest no. patients of this series i.e.76.7% were ofkatu rasa dominant in taste, 66.7% Madhura rasa, 60% lavana rasa, 56.7% Amla rasa,46.7% kashaya rasa and 30% tikta rasa in dominancy in their Daily diet.TABLE: 41 DISTRIBUTION OF PATIENTS BASED ON DOMINANT GUNADominant Guna No. of Patients Total % GROUP A GROUP BGuru 8 6 14 46.7Laghu 5 5 10 33.3Snigdha 3 5 8 26.7Sheeta 5 6 11 36.7Ushna 8 9 17 56.7Manda 3 2 5 16.7Tikshna 7 8 15 48.4 120 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 138. Observations and ResultsGRAPH NO: 18 Total no of Pts Total % 46.7 33.3 26.7 36.7 56.7 16.7 48.4 14 10 8 11 17 5 15In this series Highest no.of Patients i.e. 56.7% were taking diet dominant in Ushnaguna 48.4% were taking diet dominated Tikshna guna, 46.7% were taking guruguna,36.7% Sheeta guna, 33.3% Laghu guna ,26.7% were having diet dominated insnigdha guna,16.7% were having diet Dominant in Manda guna routinely.TABLE: 42 DISTRIBUTION OF PATIENTS BASED ON NATURE OF WORKNature of work No. of Patients Total % GROUP A GROUP BPhysical Sedentary 7 5 12 40 Heavy 8 10 18 60Mental Relaxed 5 7 12 40 Stressed out 10 8 18 60GRAPH NO: 19 Total no.of Patients Total % 40 60 40 60 12 18 12 18 Sedentary Heavy Sedentary Heavy Physical MentalThe Table shows that Highest no. of about 60% of the Patients had reported to haveheavy physical work while remained 40% had sedentary work.40% patients werereported to be relaxed mentally and rest of the patients i.e. 60% were stressed outmentally. 121 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 139. Observations and ResultsTABLE: 43 DISTRIBUTION OF PATIENTS BASED ON MANASIKA AVASTHAManasika avastha No. of Patients Total % GROUP A GROUP BBhaya 3 2 5 16.7Chinta 6 5 11 36.7Shoka 9 9 18 60Krodha 4 7 11 36.7GRAPH NO: 20 Total no.of Pts Total % 60 16.7 36.7 20 36.7 5 11 18 6 11 Bhaya Chinta Shoka Krodha KopaFrom the above mentioned data of the present series, it shows that Highest60%patients found shoka as manasika nidana, 36.7% Patients have both Chinta andkrodha, 16.7% had bhaya as found as their manasika nidana.TABLE:44 DISTRIBUTION OF PATIENTS BASED ON MAITHUNA HISTORYMaithuna history No. of Patients Total % GROUP A GROUP B1 to 2 times/week 6 7 13 48.12 to 3 times/week 3 3 6 22.23 to 4 times /week 0 0 0 0 122 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 140. Observations and ResultsGRAPH:21 Maithuna History Total no.of Pts Total % 48.1 22.2 13 0 6 0 1 to 2 times/week 2 to 3 times/week 3 to 4 times /weekThe above table reveals that 48.1% patients had history of coitus i.e. 1– 2 time/week,while 22.2% patients were having a history of coitus i.e. 2 – 3 time/week.TABLE:45 DISTRIBUTION OF PATIENTS BASED ON SHAREERA PRAKRITIShareera prakriti No. of Patients Total % GROUP A GROUP BVata-Pitta 9 8 17 56.7Vata-Kapha 5 5 10 33.3Pitta-Kapha 1 2 3 10GRAPH:NO 22 Shareera Prakriti Total no.of Patients 17 10 3 Vata-Pitta Vata-Kapha Pitta-KaphaAbove table highlights that Highest no. i.e. 56.7% patients had vata-pitta Prakriti,33.3% had vata-kapha prakriti and 10% patients had Pitta-kapha Prakriti. 123 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 141. Observations and ResultsTABLE: 46 DISTRIBUTIONS OF PATIENTS BASED ON SARASara wise No. of Patients Total % GROUP A GROUP BPravara 0 1 1 3.3Madhyama 12 11 23 76.7Avara 3 3 6 20Graph No.23 Total no.of Patients 23 6 1 Pravara Madhyama AvaraThe table shows that Highesti.e.76.7% patients Were of madhyama sara,and 20%patients were of Avara and 3.3% patients were having Pravara sara.TABLE: 47 DISTRIBUTION OF PATIENTS BASED ON SAMHANANASamhanana No. of Patients Total %wise GROUP A GROUP BPravara 3 2 5 16.7Madhyama 11 10 21 70Avara 2 3 5 16.7GRAPH:NO 24 21 5 5 Pravara Madhyama Avara 124 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 142. Observations and ResultsThe table shows that highest i.e.70% patients were of madhyama samhanana and16.7% patients were both of Avara and Pravara samhanana.TABLE: 48 DISTRIBUTION OF PATIENTS BASED ON SATVASatva wise No. of Patients Total % GROUP A GROUP BPravara 1 0 1 3.3Madhyama 9 8 17 56.7Avara 6 7 13 43.3GRAPH NO: 25 17 13 1 Pravara Madhyama AvaraThe table shows that Highest i.e.56.7% patients Were of madhyama Satva and43.3%patients were both of Avara Satva and 3.3% were having Pravara Satva.TABLE: 49 SATMYA WISE DISTRIBUTION OF PATIENTSSatmya wise No. of Patients Total % GROUP A GROUP BPravara 5 3 8 26.7Madhyama 8 6 14 46.7Avara 3 6 9 29.0 125 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 143. Observations and Results GRAPH NO: 26 14 8 9 Pravara Madhyama Avara The table shows that Highest i.e.46.7% patients were of madhyama Satmya 29% patients were of Avara Satmya and 26.7% were having Pravara Satmya. TABLE: 50 DISTRIBUTION OF PATIENTS BASED ON ABHYAVAHARANA SHAKTI GRAPH NO: 27Abyavaharana No. of Patients Total %shakti GROUP A GROUP BPravara 4 5 9 30 16 9Madhyama 9 7 16 53.3 6Avara 3 3 6 20 Pravara Madhyama Avara The table shows suggests that Highest i.e. 53.3% patients were of madhyama Abhyavaharana shakti, 30% patients were having Pravara Abyavaharana shakti ,and 20% were having Avara Abhyavaharana shakti. 126 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 144. Observations and Results TABLE: 51 DISTRIBUTION OF PATIENTS BASED ON JARANA SHAKTI GRAPH NO: 28 Jarana Shakti No. of Patients Total % GROUP A GROUP B Jarana Shakti Pravara 1 2 3 10 Madhyama 9 8 17 56.7 17 11 Avara 6 5 11 36.7 3 Pravara Madhyama Avara The Table shows , that Highest i.e. 56.7% patients were of madhyama Jarana shakti, 36.7% patients were having Avara Abyavaharana shakti ,and 10% were having Avara Jarana shakti. TABLE: 52 DISTRIBUTION OF PATIENTS BASED ON SLEEP GRAPH NO: 29Sleep No. of Patients Total %wise GROUP A GROUP B Sleep PatternSound 6 5 11 36.7 11 11 9 10Disturbed 4 7 11 36.7Irregular 6 3 9 30Day sleep 4 6 10 33.3 The Table shows that Highest i.e. 36.7% patients were having both Disturbed and sound sleep Pattern, 33.3% were having Day sleep and 30% were having Irregular sleep Pattern. 127 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 145. Observations and ResultsTABLE: 53 DISTRIBUTION OF PATIENTS BASED ON AKRITIAkriti wise No. of Patients Total % GROUP A GROUP BSthula 6 5 11 36.7Madhyama 5 5 10 33.3Krusha 4 5 10 30GRAPH NO: 30 11 10 9 Sthula Madhyama KrushaThe table shows that Highest i.e. 36.7% patients were having Sthula akriti, and 33.3%were having Madhyama and 30 % were having Krusha akriti. SROTASA PARIKSHATABLE: 54 DISTRIBUTION OF PATIENTS BASED ON SROTO DUSTISroto dusti No. of Patients Total %wise GROUP A GROUP BAnnavaha 8 4 12 40Rasavaha 11 7 18 60Raktavaha 7 6 13 43.3Artavavaha 15 15 30 100 128 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 146. Observations and ResultsGRAPH: 31 100 100 60 40 43.3 50 0The table show that Highest i.e. 100% patients were having involvement of Artavavahasrotus, 60% were having the involvement of Rasavaha srotus ,43.3% were having theinvolvement of Raktavaha srotus,Remaining 40% were having the involvement of Annavahasrotus. CAUSATIVE FACTORSTABLE: 55 DISTRIBUTION OF PATIENTS ACCORDING TO NIDANACausative No. of Patients Total %factors GROUP A GROUP BLavana 9 9 18 60Guru 8 6 14 46.7Katu 12 11 23 76.7Vidahi 5 3 8 26.7Snigdha 3 5 8 26.7Viruddha 8 5 13 43.3Dahi 4 3 7 23.3Adyashana 4 3 7 23.3Atimaithuna 3 3 6 22.2Garbhapata 9 11 20 74Shoka 9 9 18 60Diwaswapna 4 6 10 33.3 129 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 147. Observations and ResultsGRAPH: 32 90 76.7 74 80 70 Total no 60 60 60 of 46.7 43.3 Patients 50 40 33.3 Total % 23 26.7 26.7 23.3 23.3 22.2 20 30 18 18 20 14 13 8 8 7 7 10 10 6 0The above table shows that Highest no. i.e. 76.7% patients were having dominatedtaste for katu rasa, 74% of patients were having a history of garbhapata, 60%Patients reported to having shoka,and 60% Patients reported to having dominatedtaste for Lavana rasa,46.7% patients were having guru guna diet ,43.3% Patientswere having a habit of Viruddha ahaara,33.3% patients were havingdivaswapna,26.7% of patients both were having the intake of vidahi Anna andSnigdha ahaara, 23.3% patients each were having Dahi intake and , 23.3% patientseach were having Adhyashana, 22.2% patients were having history of Atimaithuna astheir causative factors.TABLE: 56 DISTRIBUTION OF PATIENTS BASED ON DURATION OF BLEEDINGDuration of menstrual No. of Patients Total %bleeding wise GROUP A GROUP BDistribution< 5days 0 0 0 05-7 days 2 6 8 26.77-8days 6 4 10 33.3>9days 7 5 12 40 130 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 148. Observations and ResultsGRAPH NO: 33 Duration of bleeding 15 12 8 10 10 5 0 0 < 5days 5-7 days 7-8days >9daysHighest12patients (40%) had bleeding duration of >9days, While 10 patients (33.3%)had bleeding duration of 7 – 8 days, where as 8 Patients (26.7%) were having ableeding duration of about 5-7days.TABLE; 57 DISTRIBUTION OF PATIENTS BASED ON PASSAGE OF CLOTS PERVAGINALLYPassage of clots Per No. of Patients Total %vaginally GROUP A GROUP BNil 0 0 0 01 or 2 large clots 4 6 10 33.3Multiple large clots 11 9 20 66.7GRAPH NO: 34 Total No. of Patients 100% 90% 80% 70% 60% 50% 10 20 40% 30% 20% 10% 0% 0 0 Nil 1 or 2 small 1 or 2 large Multiple clots clots large clotsHighest10 patients (33.3%) had Passage of large clots about 1 - 2, 20 patients (66.7%)had passage of Multiple large clots. 131 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 149. Observations and ResultsTABLE: 58 DISTRIBUTION OF PATIENTS BASED ON ASSOCIATED SYMPTOMSAssociated symptoms No. of Patients Total % GROUP A GROUP BDourbalya 14 12 26 86.7Angamarda 13 8 21 70Alasya 7 8 15 48.4Bhrama 3 5 8 26.7Vedana 6 7 13 43.3Shabdaasahishnutaa 5 8 13 43.3Aruchi 5 7 12 40GRAPH NO: 35 Associated Symptoms 30 26 25 21 20 15 13 13 15 12 8 10 5 0The above mentioned data of the present series shows that Highest numbers ofpatients i.e. 86.7% had daurbalyata, followed by 70% Had Angamarda, 48.4% hadAlasya, 43.3% had Vedana and Shabdaasahishnutaa, 40% had Aruchi, 26.7% hadBhrama.TABLE: 59 DISTRIBUTION OF PATIENTS BASED ON USG REPORTUSG Report No. of Patients Total %wise GROUP A GROUP BNormal 13 12 25 83.3Bulky 2 2 4 13.3Ovary cyst 0 1 1 3.3 132 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 150. Observations and ResultsGRAPH:36 25 Total no.of pts 4 1 Normal Bulky Ovary cystThe table shows that Highest no. i.e. 83.3% patients were having normal USG. while13.3% patients had bulky uterus and 3.3% patients had ovarian cyst in USG report.TABLE: 60 DISTRIBUTION OF PATIENTS BASED ON PER VAGINAL EXAMINATIONPer vaginal examination No. of Patients Total % GROUP A GROUP BUterus AVAF 5 7 12 44.4Position RVRF 8 7 15 51.9Uterus Size Normal 11 12 23 85.2 Bulky 2 2 4 14.8Cervix Hard 0 0 0 0 Soft 2 4 6 22.2 Normal 11 10 21 77.8Fornices NAD 8 8 16 59.3 Tenderness 5 6 11 40.7GRAPH NO: 37 25 23 21 20 16 15 15 12 11 10 6 Total 4 no.of 5 0 Pts 0 Tenderness Normal Normal RVRF Soft Bulky Hard AVAF NAD 133 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 151. Observations and ResultsIn gynaecological P/V examination , 15 Patients (51.9%) were having the Uterus inRetrovertedretroflexed position followed by 44.4% (12 patients) were havingAntiverted Antiflexed uterus.In 23 patients (85.2%) had normal size of uterus, while 4patients (14.8%) had bulky uterus.In P/V Examination of cervix, consistency of cervixwas observed Normal in 14 patients (66.66%) while in 6 patients (22.2%) cervix wasObservedto be Soft. In 16 patients (59.3%) fornices were observed Normal, while in11 Patients (40.7%) fornices were tender.TABLE: 61 OBSERVATION OF SAMYAK SNEHANA LAKSHANAS IN GROUP ALAKSHANAS NO OF PATIENTS % Vataanulomana 10 66.7 Deeptaagni 15 100 Snigdavarcha 11 73.3 Asamhata varcha 15 100 Mardavata 10 66.7 Snigdaangata 11 73.3The table shows each of the lakshana deepthaagni,and asamhata varcha was found100% ,snigdhavarcha and snigdaangata was found 73.3%,vataanulomana andmardavata was found 66.7%.TABLE: 62 OBSERVATION OF VAIGIKI SUDDHI IN PATIENTS OF GROUP ALAKSHANAS NO OF PATIENTS %Uttama 21-30 3 20Madhyama (11-20) 9 60Hina upto 10 3 20The above table shows that uttama vaigika shuddhi was found 20% ,Madhyama in60%,Hina in 20%. 134 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 152. Observations and ResultsTABLE: 63 OBSERVATION OF ANTIKI SHUDDHI IN PATIENTS OF GROUP ALAKSHANAS NO OF PATIENTS %Kaphanthe 12 80Pittante 3 20Kaphanthe was found in 80% of the patients,Pittanthe in 20%TABLE: 64 OBSERVATION OF LAINGIKI SUDDHI IN PATIENTS OF GROUP ALAKSHANAS NO OF PATIENTS %Srotovishuddhi 15 100Indriya prasada 10 66.7Laguta 12 80Agnivriddhi 15 100Kramat Vit, Pitta Kapha 12 80AgamanaVatanulomana 10 66.7100% in srotovishuddhi and agnivriddhi,and 80% was found in laghuta and Kramatvit,pitta,kapha agamana ,66.7% in indriya prasada,and vattanulomana.TABLE: 65 DISTRIBUTION ACCORDING TO SHUDDHI LAXSHANAS IN PATIENTS OFGROUP ALAKSHANAS NO OF PATIENTS %Pravara 3 20Madhyama 9 60Avara 3 2060% had madhyama shuddhi, 20% each of avara and pravara shuddhi was found. 135 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 153. Observations and Results RESULTS The effect of the therapy was analyzed statistically by calculating the mean, standard deviation, standard error, t and p values by using Paired t test applied for Group A and Group B. Following results were obtained through statistical analysis:- GROUP A TABLE: 66 EFFECT OF VIRECHANA AND PATHYA AAHARA AND VIHARA ON ASRIGDARAChief complaints Mean X % S.D S.E ‘t’ ‘P’ Significance B.T A.TDuration of 2.33 0.33 2 86 1.41 0.36 5.5 <0.001 Highlybleeding significantNo.of Clots passed 1.73 0.47 1.26 73 0.57 0.147 8.6 <0.001 Highlyper day significantHbgrm % 1.8 1.4 0.4 22 0.49 0.124 3.2 <0.01 Highly Significant GRAPH: NO 38 SHOWING THE EFFECT OF VIRECHANA ON DURATION OF BLEEDING IN PTS OF GROUP A Duration of bleeding 2.5 2.33 Mean duration of 2 bleeding 1.5 1 Group A 0.5 0.33 0 Before After 136 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 154. Observations and ResultsGRAPH: 39 SHOWING THE EFFECT OF VIRECHANA AND PATHYA AHARA ANDVIHARA ON NO. OF CLOTS PASSED PER VAGINALLY IN PTS OF GROUP A 2 1.73 1.5 Mean of clots passed per 1 Group A day 0.5 0.47 0 Before AfterComparision of the data obtained before and after treatment among patients of GroupA when statistically analysed shows t value for Duration of bleeding (Group A ) At5.5 ,The P value at <0.001 this indicates highly significant towards to treatment.The tvalue for No.of clots passed per day is 8.6,the P value is <0.001,which is also againhighly significant towards the treatment. t value for Hbgrm% is 3.2, The P value is<0.01,which is also highly significant.TABLE: 67 EFFECT OF VIRECHANA AND PATHYA AHARA AND VIHARA (GROUP A)IN PATIENTS OF ASRIGDARA WITH REGARD TO ASSOCIATED COMPLAINTSASSOCIATED NO.OF PATIENTS NO.OF PATIENTS % OFSYMPTOMS WITH GOT RELIEF RELIEF COMPLAINTSDourbalya 14 13 92.85Angamarda 13 13 100Alasya 7 5 71.42Bhrama 3 3 100Vedana 6 3 50Shabdaasahishnutaa 5 5 100Aruchi 5 5 100 137 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 155. Observations and Results GRAPH: 40 SHOWING THE PERCENTAGE OF RELIEF IN ASSOCIATED SYMPTOMS 120 100 100 100 100 100 92.85 80 71.42 % of pts 60 50 got… 40 20 0 The above mentioned data shows that Highest numbers of patients i.e. 100% got relief in Angamarda, Bhrama,Shabdaasahishnutaa,and Aruchi , 92.85% had got relief in daurbalyata, and 71.42% in Alasya ,50% in Katishoola. GROUP B Table: 68 Effect of Pathya Aahara and Vihara (Group B) in patients of AsrigdaraChief complaints Mean X % S.D S.E ‘T’ ‘P’ Significance B.T A.TDuration of 1.93 1.7 0.27 14 0.44 0.11 2.3 <0.05 SignificantbleedingNo.of Clots 1.6 1.6 0 0 0 0 0 - Notpassed Significantper dayHb Grm % 1.8 1.73 0.07 3.7 0.25 0.065 1.07 >0.05 Not significant GRAPH:41 SHOWING MEAN DURATION OF BLEEDING IN GROUP B 2 Mean value of duration 1.9 1.93 of bleeding 1.8 Group B 1.7 1.66 1.6 1.5 Before After 138 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 156. Observations and ResultsGRAPH: NO 42 SHOWING THE MEAN OF CLOTS PASSED PER DAY IN GROUP B No.of clots Passed per day 2 Mean of clots passed per 1.5 1.6 1.6 1 day GROUP B 0.5 0 Before AfterComparision of the data obtained before and after treatment among patients of GroupB when statistically analysed shows t value for Duration of bleeding (Group B ) At2.3,The P value at <0.05 this indicates significant towards to treatment. The t valuefor No.of clots passed per day is 0, the P value is- , which shows it is insignificanttowards the treatment.t value for Hbgrm% is 1.07, The P value is >0.05,which is alsonot significant. ASSOCIATED COMPLAINTSTABLE:69 EFFECT OF PATHYA AHARA AND VIHARA(GROUP B) ON ASSOCIATEDCOMPLAINTS IN PATIENTS OF ASRIGDARAASSOCIATED NO. OF PATIENTS NO.OF % OFSYMPTOMS WITH COMPLAINTS PATIENTS GOT RELIEF RELIEFDourbalya 12 0 0Angamarda 8 0 0Alasya 8 0 0Bhrama 5 0 0Vedana 7 0 0Shabdaasahishnutaa 8 0 0Aruchi 7 1 14.2 139 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 157. Observations and ResultsGRAPH:43 SHOWING THE % OF RELIEF IN ASSOCIATED SYMPTOMS - GROUP B Total No. of Patients got relief % of Relief 14.2 00 00 0 0 00 00 00 1The above table shows there is 0% relief in all associated symptoms and only 14.5%relief is found in Aruchi after pathya ahara and Vihaara in Group BTable: 70 RESULTS OF GROUP A AND GROUP B - COMPARATIVE STATISTICSParameters A B X S.D S.E ‘t’ ‘P’ SignificanceDuration of 0.33 1.66 1.33 0.662 0.120 11 <0.001 Highlybleeding significantNo. of Clots 0.46 1.6 1.13 0.389 0.071 15.93 <0.001 Highlypassed significantper dayHb Grm % 1.4 1.73 0.33 0.47 0.085 15.64 <0.001 Highly significantComparative statistics pertaining to results of Group A and Group B obtained asshown in table Indicates that the response seen in the pts of Trial group A is highlysignificant (P>0.001) in comparision to patients of controlled Group B.The symptomof Duration of bleeding in Patients of Group A Showed highly Significant relief(P>0.001) in comparision to patients of Group B, Simillarly No of Clots Passed showshighly significant response(P>0.001) in Group A patients when compared withpatients of GroupB, Simillarly in Hbgrm% shows highly significantresponse(P>0.001) in Group A patients when compared with Patients of Group B 140 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 158. Observations and ResultsTable no: 71 Overall Comparison of Group A and BNo of Pts Mean- A Mean-B SD SE ‘ t’ P X 30 0.4 1.67 1.27 0.584 0.106 11.98 <0.001The data obtained before and after treatment in Patients of Group A when comparedto similar data obtained from patients of Group B indicates that the response seen inthe pts of Trial group A is highly significant (P<0.001) in comparison to patients ofcontrolled Group B. 141 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 159. Discussion DISCUSSION DISCUSSIO Observations ‘perse’ do not help one in reaching a comprehensive conclusion, N if the conclusion is to be logical & appropriate a thorough discussion of all the aspects of data obtained in observation is essential. The discussion takes care of different dimensions of the problem that was analysed, & the data obtained. In short discussion provides a different dimension to the problem. In the present study the role of virechana in Asrigdara has been studied in 2 groups of patients Trial & control group. The data obtained during these trials is opened to discussion. A critical discussion regarding the observations on the role of virechana along with pathya Aahara & vihara,& only with Pathya Aahara & vihara is presented as follows: Data obtained pertaining to the age group of the patients (Table no.24) shows that highest number of patients i.e. 30% belonged to age group of 30-35 years, followed by 23.3% patients of 41-45yrs, & 16.7% each of 26-30 years & 36- 40yrs of Age group, 13.3% belonged to 20-25years of age group. This shows that Asrigdara can be encountered in any age group starting from the menarche to climacteric period. Asrigdara is found predominantly in the Reproductive age than the post menarcheal age. During reproductive phase of life family burdens, children & Personal worries are higher. The stress thus produced can affect the menstrual cycle & cause Asrigdara. 142 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 160. Discussion Data obtained pertaining to the Education of the patients (Table no.25) shows that highest no. of the patients were educated & were Graduates i.e.32%, followed by 26.7% with Primary Education. This only indicates that educated people are more Conscious towards their health. Data obtained pertaining to the Occupation of the patients (Table no.26) shows that highest no. of the patients were house wives 86.7 %. They are more prone to emotional stress because they don’t have any Extra activity to engage their mind. Psychological state may affect the artava utpatti. However, further study is required to come to an exact conclusion. Data obtained pertaining to the Socio-econo.mis status of the patients (Table no.27) shows that highest no. of the patients were from middle Class 66.7% followed by lower middle class 16.7%. It may be presumed that people of middle class & lower middle class are not having Proper diet & hygienic environment. So the chances of malnutrition are higher in the lower middle & middle class than the ladies of other classes. Middle & lower middle class people belong to the Lower strata of the econo.mic ladder .Therefore they undergo lot of Stress in many phases of day to day life. The stress itself is a Cause for many disorders. Though it is not based on reason to say that the problem of Asrigdara is seen only in middle & lower middle Class but as the study has been carried out in government hospital, Incidence of such patients are higher. Data obtained pertaining to the marital status of patients (Table no.28) shows that highest number of patients 86.7% were married, While 13.3% patients were unmarried. This indicates that this disorder is more observed in married patients.This may be due to frequent coitus, use of Iucd & increased number 143 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 161. Discussion of parity which leads to bulky uterus. Some married women who had psychological & economical stress & family disturbances after marriage may present with ‘Asrigdara’. Data obtained pertaining to the religion of the patients (Table no.29) shows that highest number of patients 93.3% was from Hindu Community. This may not be due to any particular reason, but because of Hindu dominated population in the area from where the patients were selected. Data obtained pertaining to the Family history of the patients (Table no.30) shows that highest number of patients i.e. 90% had negative family History while 10% had positive family history of excessive bleeding. This suggests that Asrigdara runs in the family atleast in certain percentage of women. Data obtained pertaining to the Drug history of the patients (Table no.31) shows that highest number of patients i.e.73.3% had positive drug (Hormonal) History, 26.7% patients had negative drug (hormonal) history. This indicates that, patients had given first preference to allopathic treatment to get immediate relief. Data obtained pertaining to the Chronicity of the patients (Table no.33) shows that highest number of patients i.e. 46.7% had a Chronicity of more than 1-2 years, 33.3% of patients had reported Chronicity of 2-6 months .13.3% had chronicity of 6 -12 Months, 6.7% had a chronicity of more than 2-3yrs. which suggests that this problem needs active treatment for alleviation. Data obtained pertaining to the Onset of menarche of the patients (Table no.34) shows that highest number of patients i.e.70% had age of Menarche between 13 to 14 years, while 23.3% had between 11 to 12 years & 6.7% patients had at above 14 years Normally menarcheal age is between 13 to 14 144 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 162. Discussion years. Hence it is logical that Patients of this menarcheal age group are more in number. No relationcan be established between age of menarche & Asrigdara. Data obtained pertaining to the Family history of the patients (Table no.35) shows that highest number of patients i.e.100 % patients had regular cycle, 70% patients had average amount of blood loss, & 30% had scanty blood loss. This indicates that before the manifestation of disease, most of the patients had normal menstrual History. Data obtained pertaining to the present menstrual history of the patients (Table no.36) shows that highest number of patients i.e,100% had irregular cycle, 100% had heavy blood loss, 96.7% had bleeding with clots & 23.3% had foul smelling this indicates disease condition. Data obtained pertaining to the Obstetric history of the patients (Table no.37) shows that highest number of patients i.e.55.6% suffering from Asrigdara were multipara,the least 11.1% had no children, This indicates that Multiparity is a predisposing factor for Asrigdara. Highest numbers of patients i.e. 40.7% had history of 2 Abortion, while 22.2% had one abortion history, 23.3% had no. history of Abortion,11.1% had history of abortion for >=3,these findings correlate well with the fact that multiparas usually have bulky uterus resulting in Asrigdara & more the number of abortions has greater the possibility of Asrigdara. Uterine congestion is more common in multiparous women. Data obtained pertaining to the Contraceptive history of the patients (Table no.38) shows that highest number of patients i.e. 44.4% was using OCP type of contraceptives, the percentage of patients making use of tubal ligation, tubectomy & those using no.ne of the protective methods are an equal 145 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 163. Discussion percentage of 18.5% .This correlates well with the use of contraceptives among general population. Data obtained pertaining to the diet history of the patients (Table no.39) shows that highest incidence of Asrigdara was recorded among the patients of mishraahara(83.3%) this possibly points that no.n-vegetarians particularly aquatic animals like fishes promote Asrigdara as described in classics.the table also shows that 56.7% of patients had vishamaasana which again has been implicated as a cause for Asrigdara.As regarding appetite 56.7% of the patients had moderate appetite,patients with good appetite comprised only of 13.3% of the patients with Asrigdara,this again shows that agni which is balanced prevents the causation of Asrigdara. Data obtained pertaining to the distribution based on dominant rasa shows that patients (Table no.40) consuming katu rasa had the highest incidence of Asrigdara (76.7%) followed by those consuming madhura rasa yukta aahara(66.7%),& lavana aahara(60%) These rasas are responsible for vitiation of rakta & pitta, these correlates well with the nidana of Asrigdara where it is stated that lavana,amla,guru,& katu ahara promotes Asrigdara. Data obtained pertaining to the distribution based on dominant guna shows that patients (Table no.41) who consumed ushna aahara form the highest number(56.7%) followed by tikshna aahara (48.4%) of patients, Guru guna (46.7%) in diet. This again substantiates the nidana of Asrigdara as mentioned by charaka. Data obtained pertaining to the distribution based on Nature of work (Table no.42) indicates that 60% of the patients had heavy physical work which again 146 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 164. Discussion as been mentioned as the causes for asrigdara, mental factor recorded indicate that 60% of the patients were stressed out which is also a nidana for Asrigdara. Data obtained pertaining to the distribution based on Manasika avastha of the patients (Table no.43) shows that highest incidence of Asrigdara was recorded among patients with shoka(60%) & then followed by krodha(36.7%) & chinta(36.7%),from this we can infer that negative emotions also play a dominant role in causation of Asrigdara. It alters the hypothalamo-pituitary- ovarian axis & thus produces some Irregularities in the menstrual cycle. Data obtained pertaining to the distribution based on Maithuna history (Co- habitation) the highest (Table no.44) i.e.48.1% is recorded among the patients co-habiting 1-2 times a week, followed by 22.2% co-habiting 2-3 times/week. Data obtained pertaining to the distribution based on Shareera prakriti indicates that the highest i.e.( 56.7%) of patients (Table no.45) were of vata- pitta prakriti,followed by 33.3% of vata-kapha ,this correlates well with the classical dictum that the vata is the root cause of all streeroga & in association with pitta causes Asrigdara. Data obtained pertaining to the distribution based on Sara of the patients indicates that high incidence of Asrigdara was recorded among patients(table no.46) of madhyama sara(76.7%) & the least with pravara sara(3.3%) this again indicates that pravara sara prevents the causation of asrigdara to some extent however it may be also be interpreted in general population that no. of patients with pravara sara are also less. Data obtained pertaining to the distribution based on Samhanana & Satmva of the patients(Table no.47 & 48) indicates that highest incidence of the 147 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 165. Discussion patients i.e. 70% had Madhyama samhanana & 46.7% Madhyama satmya,this again shows distribution of samhanana & satva in general population. Data obtained pertaining to the distribution based on Satva of the patients (table no.49) indicates that Highest no. Of the patients i.e. 56.7% in the present study had Madhyama & 43.3% had avara satva. These factors are important causes of Psychological disorder including ‘asrigdara’. Data obtained pertaining to the distribution based on abhyavarahana shakti & jarana shakti of the patients shows that the highest incidence seen in patients with madhyama abhyavarahana shakti(53.3%) & Jaranashakti(56.7%). Agnim&hya & Agnivaishamya are thus found to Influence the development of asrigdara considerably. Data obtained pertaining to the distribution based on Akriti of the patients shows that patients Sthula,madhyama, & krushaa Aakara are equally susceptiple to Asrigdara. Data obtained pertaining to the distribution based on Sleep pattern indicates that high percentage of Asrigdara is seen among patients with disturbed ,irregular,day sleep.patients with sound sleep formed36.7% of those with Asrigdara,this again indicates the importance of sleep in the prevention of Asrigdara. Data obtained pertaining to the distribution based on Sroto dusti indicates that the highest percentage of patients were those with affliction in Artavaha srotus(100%) & rasavaha srotus(60%) .this correlates well with the theory that Artava has its origin from rasa dusti at the level of rasa can cause Artava dosha. 148 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 166. Discussion Data obtained pertaining to the distribution based on Nidana of the patients shows that highest incidence of Asrigdara was recorded among Aharaja nidana like Lavana 60%, Amla 56.7%, Katu 76.7%, guru,Snigdha,& Viruddha aahara 46.7% ,26.7%,43.3% respectively, Adhyashana 23.3%,Dahi 23.3%,& Vidahi 26.7%. Viharaja nidana: Atishrama 60%,Diwaswapna 33.3% Manasika nidana: Shoka 60%,Krodha 36.7%,Chinta 36.7%, are tend to provoke Vata Dosha & Raja Dosha. Anya nidana: Garbhapata 74% - these correlates well with nidana mentioned by charaka. Data obtained pertaining to the distribution based on Duration of bleeding(table no.56) shows that a total of 12(40%) patients had a duration of bleeding of more than 9 days, the least no.of 8(26.7%) patients had a duration of bleeding5-7days. This possibly indicates that patients come to a physician for a treatment only when the duration become uncontrollable & the discomfort become unbearable. Data obtained pertaining to the distribution based on Clots passed per vaginally (table no.57) indicate that highest 66.7% patients had passage of large multiple clots. There were no. patients with absent of clots this again indicates the no.rmal tendency to approach a physician only when the disease becomes severely disturbing to the patient.Passage of large clots indicates increased bleeding Data obtained pertaining to the distribution based on associated symptoms (table no.58) indicate that highest i.e. 86.7%has dourbalya as their complaint,followed by Angamarda(70%),alasya( 48.4%), Aruchi(40%), 149 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 167. Discussion Bhrama(26.7%), Shabdaasahishnuta(43.3%) & Vedana(43.3%).This again indicates that only when the patient is severely incapacitated by dourbalya,vedana etc,they approach the physician. Data obtained pertaining to the distribution based on Per vaginal examination (table no.60) indicate that the highest number i.e.85.2% of the patients had no.rmal size of uterus.The incidence was equal in AVAF,& RVRF uterus. Cervix was no.rmal in majority of patients & fornices were tender only in 40% of patients .this data indicates that they cannot be taken as diagno.stic feature of Asrigdara. Data obtained pertaining to the distribution based on assessment of samyak snehana (table no.61, 62, 63, 64, 65). The Murcchita ghruta was given for internal snehana prior to Virecana. The average quantity of this ghruta consumed in days was 240ml per patient.Among the symptoms of Samyak Snehapana, Asamhata Varca was reported by all the patients on all the days of Snehapana. The Snigdha Varca was reported by 100% patients in later days of Snehana.The other main symptoms Vatanulomana (69.4%) & Snigdhatvak (40%) Thusall the patients showed Samyaka Snehana Laksanas. Data obtained pertaining to the distribution based on assessment of samyak virechana (table no.62,63,64,65) The Virecana Yoga administered to The patients in this series produced on an average 11.6 drava mala. Kaphanta Suddhi was noticed in 80% patients while Pittanta in 20%. patients.In the present study among the symptoms of Samyaka Virecana, Sroto Visuddhi was 150 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 168. Discussion observed in 100% patients, followed by Laghuta & Kramat Vit, Pitta Kapha Agamana each reported in 80% patients. Agnivrddhi was reported by 100% patients while Indriya Prasada was reported by 66.7% patients. Vatanuloma was reported by 66.7% patients. In this series, 60% patients had Madhyama Suddhi & 20% Patients had Avara Suddhi & 20% patients had Uttama Suddhi.RESULTS: In the present study the patients were divided into two groups. The Assessment of the results was made by adopting the st&ard methods of Scoring the signs & symptoms. Results were observed on cardinal Symptoms, associated complaints & hematological investigations.EFFECT OF THERAPY ON CARDINAL SYMPTOMS OF ASRIGDARA 1.DURATION OF BLOOD LOSS: Group-A (Virechana with pathya Aahara & vihara) showed 86% Relief in the duration of bleeding while Patients of group- B (Pathya Aahara & vihara) showed 14% relief. Statistical analysis of patients of Group A gave highly significant result on the Duration of blood loss. 2.NO. OF CLOTS PASSED PER VAGINA: In patients of Group-A 73% result was found, In patients of Group-B showed 0% result,The result was highly significant among patients of Group – A. 3. EFFECT OF THERAPY ON HEAMOGLOBIN GRAM PERCENTAGE: Hbgrm% level increased 22% & the result was significant among patients of Group-A while Insignificant result was found among patients of in Group-B. 151 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 169. Discussion 4. Effect of virechana on associated complaints:  In Daurbalya 92.85% relief was observed in patients of Group-A & 0% in patients of Group-B.  In Angamarda 100% relief was observed in patients of Group-A & 0% in Patients of Group-B  In Bhrama 100% relief was observed in patients of Group A and 0% relief in patients of Group -B.  In Alasya 71.42% relief was observed in patients of Group-A & 0 % relief in patients of Group-B.  In Aruchi 100 % relief was observed in patients of Group-A & 14.2% in patients of Group-B.  In vedana 50% relief was observed in patients of Group-A & 0% in patients of Group-B  In Shabdaasahishnutaa 100% relief was observed in patients of Group- A,0% in patients of GroupBGRAPH:44 SHOWING THE PERCENTAGE OF IMPROVEMENT IN BOTH GROUPS Duration of 1 86% bleeding 73% 0.8 No of clots 0.6 Passed per vaginally 0.4 22% improvement 14% in Hbgrm% 0.2 3.70% 0% 0 Group A Group B 152 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 170. DiscussionOverall effect of therapy: When data obtained in patients of Group A was statistically compared with the data of patients of Group B, Response in patients of Group A i.e. with Virechana & pathya aahara & vihara is found to be more effective than in patients of Group-B i.e. with pathya aahara & vihara.Role of virechana in samprapthi vighatana of Asrigdara w.s.r to Dub: Acharya charaka has mentioned that all drugs carry out their actions due to their five properties viz. Rasa, guna, virya, vipaka & karma.Jeerakaadi churna is having laghu guna, ushna veerya,katu vipaka & with deepana & paachaneeya karmas does agnideepana. Trivrith lehya is having Tikta rasa, Tikta rasa has the property of deepana, pachana,Raktaprasadana, dahaprashamana, shoshana of mala, mutra, pitta, kapha.(ch. Su. – 26)SAMPRAPTHI VIGHATANA – AN INSIGHT INTO DRAVYA KAARMUKATADoshaVata: ushna virya helps in vata shamana.Pitta & kapha: virechana procedure does Piitta-kaphashamana.Dushya: Laghu & ruksha guna of trivrith lehya help in srotoshodhana. Virechana does sthirata of rasa & raktaadi dhatus, thus reducing blood flow & formation of clots it also eliminates foul smelling.Agni: Jeerakadi churna causes deepana & pachana since it consists of katu rasa,ushna virya & katu vipaka. This process increases the jataragni and dhatwagni and helps in bringing the vitiated doshas to normal form. Virechana reduces uterine congestion, & thus may help in reducing the flow, it is just a Hypothesis further research is needed to prove this concept. 153 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 171. Discussion SCHEMATIC DIAGRAM OF ‘SAMPRAPTHI AND ‘SAMPRAPTHI VIGHATANA’ OF ASRIGDARA BY ‘VIRECHANA’ NIDANA Anya Aharaja Viharaja Manasika Tikta.katu,ushna veerya Agnimaandya Deepaneeya & paachaneeya Agnideepana karmas of jeerakaadi churna .Vikruta Ahaara Rasa Pramana Vriddhi stops formation Corrects the rasagni Tiktarasa,laghu& Rasagni Vaishamya rukshaguna,rakta shodana activityof trivrith lehya Vikruta Rasa Dhatu Nirmana (Rasabhava Dwianta) Prakruta rasa dhatu nirmana ApanaVayu Dushti Shamana of apana vata by vataanuloma Excessive & Prolonged bleeding Lakshanopashamana Asrigdara 154 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 172. DiscussionThe above schematic representation of samprapthi and samprapthi vighatana ofAsrigdara shows that the nidanas of Asrigdara namely ofAaharaja,Vihaaraja,Manasika Anya nidana causes agnimaandya, and result in thequantitative increase of vikruta aahara rasa.The jeerakaadi churna because of the katu,ushna,deepana,pachana karmasameliorates agnimaandya and helps in Normalising the quantity of aahara rasa atthis stage.It corrects the rasagni prevents the formation of vikruta aahara dhatu.The use of trivrith lehya acts as vataanulomaka and prevents the dushti of apanavaayu.when agnimandyata is eliminated ,rasagni is normalised and functionalaspects of Asrigdara is restored to normalcy and excessive and prolonged bleedingseen in Asrigdara is eliminated. 155 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 173. Conclusion CONCLUSIONConclusions of a clinical study is the final result of painstaking effort of selection ofpatients,their systematic classification,collection of data,tabulation of data,statisticalanalysis of data,logical interpretation of the statistically analysed result.In the present study 30 patients have been listed out divided them into 2 groups-GroupA and Group B.Patients in Group A-Trial group,were administered with Virechanaand pathya aahara and vihaara and patients in Group B-Control group were kept onpathya aahara and vihaara.The data recorded on the observations and results:-  It can be concluded that the highest incidence of Asrigdara is seen among the patients of 30-39yrs, most of them on mixed diet.  It can also be concluded that stress is an important causative factor in causing Asrigdara since 60% of the patients were under mental stress.  Again it can also be concluded that Asrigdara is more common among married women, since 86.7% of patients were married in this study.  From the signs and symptoms recorded in the present study Asrigdara can be favourably compared with Dysfunctional uterine bleeding.  Statistical analysis of the data obtained leads to the conclusion that Virechana along with pathya aahara vihaara is highly effective in Samprapti vighatana of Asrigdara.  It can also be concluded that Pathya aahara and vihaara(Group-B) alone doesn’t produce results comparable to Pathya aahara vihaara along with virechana(Group-B). 156 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 174. Conclusion It can therefore be concluded that ‘Pathya Aahara and vihaara along with virechana has a significant role to play in the Samprapti vighatana of Asrigdara’. The study has to be done on a larger sample for further exploration. 157 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 175. Summary SUMMARYThis dissertation work entitled “A Critical study on the role of Virechana in thesamprapthi vighatana of Asrigdara w.s.r to DUB” consists of 7 chapters namelyIntroduction, Review of Literature, Methodology, Observations and Results,Discussion, conclusion and Summary.  1st Chapter – Deals with introduction where in brief account of need and scope for the study and the rationality behind selecting the disease and objectives of the study.  2nd Chapter – is sub-divided into 5 sub chapters - Brief Anatomy of female Reproductive system, Normal and Abnormal uterine bleeding, Asrigdara- Disease review,Drug review,Virechana-Procedure review. Brief Anatomy of female Reproductive system:-Description of Anatomy of female reproductive system both in ayurveda and modern is explained briefly. Normal and Abnormal uterine bleeding: - Description of Physiology and Pathology of Uterine bleeding. Asrigdara Disease review:- Etymology,Definition,Nidana,Lakshana,Bheda, Samprapthi, Sadyaasadyata, Arishta lakshana is explained. Drugreview:- In this Botanical name,family,rasa,guna,veerya,vipaka, Doshagnatha,Rogagnathaa and karma of Tila taila along with all ingredients of Jeerakaadi churna,Murchita ghruta,Trivrith lehya is explained. 158 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 176. Summary Virechana-Procedure review:- Etymology,Definition,hina,ati,Ayoga and Samyak yoga lakshanas and Virechana in Asrigdara is explained. 3rd Chapter – Deals with material and methods, the study design, source of data and parameters for assessment. 4th Chapter - The clinical study, observations made on study, the results of the data drawn after the study are expressed in diagrams and the comparison between the groups are made statistically. 5th Chapter- Discussion of observations made during the study along with the probable mode of action of the drugs is discussed. 6th Chapter - lastly the conclusion drawn out of the clinical study and 7th Chapter –explains summary of the entire work . 159 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 177. Bibliography BIBLIOGRAPHY1. Agnivesha; Charaka Samhita; redacted by Charaka and Dridhabala with Ayurveda Dipika commentary by Chakrapanidatta; edited by Vaidya Yadavji Trikamji Acharya, 4th edition, 2001; Published by Chaukhambha Surabharati Prakashana, Varanasi, Uttar Pradesh.2. Agnivesha; Charaka Samhita; redacted by Charaka and Dridhabala with Ayurveda Dipika commentary by Chakrapanidatta; English translation edition 1997; by Ramkaran Sharma and Vaidya Bhagwan Dash; Chaukhambha Sanskrit Series Office, Varanasi, Uttar Pradesh.3. Sushruta; Sushruta Samhita; redacted by Nagarjuna; with commentaries Nibandha Sangraha of Dalhana and Nyayachandrika of Gayadasa; Vaidya Yadavji Trikamji Acharya, Narayan Rama Acharya, Kavyatirtha; Reprint edition, 1998, Krishnadas Academy, Varanasi, Uttar Pradesh4. Vagbhatacharya; Ashtanga Sangraha with Hindi Vyakhya by Kaviraj Tridev Gupta; Reprint Edition, 1993; Krishnadas Academy, Varanasi, Uttar Pradesh.5. Bhavamishra; Bhavaprakasha with Vidyotini Hindi Tika by Bhishakratna Shri Bramhashankara Shastri and Shri Roopalal Vaishya; 8th edition, 1997, Chaukhambha Sanskrit Bhavan, Varanasi, Uttar Pradesh.6. Vagbhatacharya; Ashtanga Hridaya with Commentaries Sarvangasundara of Arunadatta and Ayurveda Rasayana of Hemadri; edited by Pandit Bhishakacharya, Hari Shastri Paradkar, Akola, 8th edition, 2000, Chaukhambha Orientalia, Varanasi, Uttar Pradesh.7. Vrddhajivaka .Kasyapa Samhita or Vriddhajivakiya tantra preached by Maharshi Marica Kasyapa; redacted by Vatsya,edited translated and commentary by 160 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 178. Bibliography prof(km.)P.V.Tewari,published by choukambha Vishwabharati; Reprint: year 20028. Madhavakara; Madhava Nidanam with Madhukosha Vyakhya by Vijayarakshita and Srikanthadatta, Vidyotini Tika by Ayurvedacharya Shri Sudarshana Shastri; 29th edition1999, Chaukhambha Sanskrit Sansthan, Varanasi, Uttar Pradesh.9. Harita. Harita Samhita – with Hari Hindi Commentary, edited in Hindi by Hariprasad Tripathi, 1st ed. Varanasi: Chowkhambha Krishadas Academ200510. Anonymous; Yogaratnakara, with Vidyotini Hindi Commentary by Vaidya Lakshmipati Shastri, 7th edition, 1999, Chaukhambha Sanskrit Sansthan, Varanasi, Uttar Pradesh.11. Askel S, Jones G, Etiology & Treatment of Dysfunctional Uterine Bleeding, Obstetrics & Gynaecology, 1974, 44,112. Ayurvediya Prasuti tantra evam stree roga, Part I, Prof. (Km.) Premvati Tewari, Chukambha Orientalia Varanasi13. Ayurvediya Prasuti tantra evam stree roga, Part II, Prof. (Km.) Premvati Tewari, Chukambha Orientalia Varanasi14. Chatterjee C. C., Menstruation, Human Physiology, 10 th Edition, Vol II, Medical Allied Agency, 1988, 4.15. Chatterjee C.C.; Human Physiology, 11th edition 1998, Medical Allied Agency, Calcutta.16. Database Information on Pharmacological activities & clinical reports, FRLHT, Anandnagar, Bangalore17. Dewhurt Textbook of Obstetrics & Gynaecology for post graduates, 5th Edition, Charles R. Whitfield. 161 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 179. Bibliography18. Dhanvantari; Dhanvantari Nighantu; Commentary by Jharkhande Ojha & Umapati Mishra; 11th edition 1996, Published by Chaukhambha Surabharati Prakashana, Varanasi, Uttar Pradesh.19. Dutta D. C., Text Book of Gynaecology, Edited by Hiralal Konar, 5th edition, New Central Book Agency (P) ltd., Calcutta.20. Shaws Text Book of Gynaecology, 12th Edition, Edited by V. G. Padubidri, B. I. Churchill Livingstone, New Delhi.21. Jeffcoate’s principles of gynaecology intrtnational edition 5th Edition. 200122. Guyton A. C., Hall E. J., Female Reproductive System, Textbook of Medical Physiology, 10th Edition, Harcourt Asia W. B., Saunders, 200, 929-933.23. Guyton A. C. and Hall J. E.; Textbook of Medical Physiology, 10 th edition 2001, Harcourt Publishers International Company and W. B. Saunders Company24. Hiremath Shobha; Textbook of Bhaishajya Kalpana; 1 st edition, 2000, IBH Prakashana, Bangalore.25. Shastri Joshi on behalf of Maharashtra Rajya Sahitya and Sanskrit Mandal, Mumbai, Maharashtra.26. Kaiyadeva; Kaiyadeva Nighantu, edited by Priyavrat Sharma and Guru Prasad Sharma; 1st edition 1979, Chaukhambha Orientalia, Varanasi, Uttar Pradesh.27. Mahajan B. K.; Methods in Biostatistics, 6th Edition, Jaypee Brothers,New delhi, India.28. Mukhopadhyaya Girinath; History of Indian Medicine, 2 nd edition, 1974, Oriental Books Represent Corporation, New Delhi.29. Nadkarni K. M. and A. K. Nadkarni; Indian Materia Medica, Revised 3 rd edition, Popular Prakashan, Mumbai, Maharashtra. 162 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 180. Bibliography30. Pandit Narahari; Raja Nighantu, Dravyaprakashika Hindi Vyakhya by Indradev Tripathi, 11th edition 1998, Krishnadas Academy, Oriental Publishers and Distributors, Varanasi, Uttar Pradesh.31. Satoskar, Bhandarkar, Ainapure; Pharmacology and Pharmacotherapeutics, 7 th edition, 2001, Popular Prakashana, Mumbai, Maharashtra.32. Sharangadhara; Sharangadhara Samhita Madhyama Khanda, English Translated 3rd edition, 1997 by Ayurved Vidvan Prof. K. R. Shrikantha Moorty, Chaukhambha Orientalia, Varanasi, Uttar Pradesh.33. Sharma P.V.; Dravyaguna Vijnana, 1998, Chaukhambha Amarabharati Prakashana, Varanasi, Uttar Pradesh.34. Sharma Priyavrat, Ayurved Ka Vaijnanik Itihasa, 2nd edition, 1981, Chaukhambha Orientalia, Varanasi, Uttar Pradesh.35. DUB: Current thoughts on medical management, Obs. & Gynae., Vol IV, No. 10, Oct. 1999.36. Singh E. J., Baccanini I. M., Zuspan F. F., Levels of prostaglandins F2α & E2 in human endometrium during the menstrual cycle, American Journal of Obst. & Gynae., 1975, 121, 1003.37. Stud J., Menorrhagia Progress in Obstetrics & gynaecology, S. Churchill Livingstone Longman Crp., Co, 1985, 293-308.38. Sushruta Samhita’ with English translation of text and Dalhana’s commentary along with critical notes by Dr. P. V. Sharma, First edition; Varanasi; Chaukhambha Bharati Academy; 1999.39. The Wealth of India; Publications and Information Directorate, CSTR, New Delhi. 163 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 181. Bibliography40. Tripathi Indradev; Chakradatta of Shri Chakrapanidatta with Vidyaprabha hindi Commentary, 3rd edition 1997, Chaukhambha Sanskrit Bhavan Varanasi, Uttar Pradesh.41. Bhaishajya rathnavali:Sri govindadasa sena virachita,venimadava ashwini kumara shastri,chowkambha Publications.42. Tripathi K. D.; Essentials of Medical pharmacology, 4 th edition, 1999, Jaypee Brothers Medical Publishers Pvt. Ltd., New Delhi.43. Vaishyavarya Shaligrama; Nighantu Ratnakara of Shaligrama Nighantu; 1999 edition, M/s Khemraj Krishnadas Shrikateshwara Press, Mumbai, Maharashtra.44. Dravyaguna vijnana by Dr. Gyanendra pandey, chaukhamba Prakashan, varanasi.45. Dravyaguna vijnana (vol. II), prof. P. V. Sharma, chaukhamba Bharti academy, varanasi, 2001 Websites: 1. WWW.BUPA.CO.UK/HEALTH_INFORMATION 2. http://www.womenshealthchannel.com/dub/index.shtml 3. WWW.WOMENS-HEALTH.CO.UK 4. http://WWW.Cnn.Com/HEALTH/Library/DS/00394html 5. http://www.panchkarma.co.in/VIRECHAN.aspx 164 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 182. Annexure PROFORMA FOR M.D. (AYU.) RESEARCH WORK DEPARTMENT OF P.G. STUDIES IN ROGA NIDANA GOVT AYURVEDA MEDICAL COLLEGE BANGALORETitle : ―A Critical Study On The Role Of Virechana In The SamprapthiVighatana Of Asrigdara W.S.R. To Dub.‖Guide : Dr.K. PushpalathaScholar : Dr. Roopa K.VSpeciality : RoganidanaYear : 2008-2011 1. Pt noPARTICULARS OF THE PATIENT: 2. Group 3. O.P.D.no *Name of the patient: 4. I.P.D.no Fathers /Husbands Name: Age: Address: D.O.A. : D.O.D. : Phone No: Religion: H/M/S/C/Other Education: UE/P/HS/G/P.G. Occupation: Student/Labour / Service / Housewife Income: Dependent / Independent Socio Economic Status: P / LM / M/ UM /R Marital Status: UM / M /W / D Family: Nuclear / Joint Members: Adult Children 165 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 183. Annexure Habitat: Rural / Urban / Slum 1. HISTORY: (A) PRADHANA VEDANA (Chief Complaints with duration) (B) ASSOCIATED COMPLAINTS WITH DURATION2. VARTAMANA VEDANA VRITTANTA (History of associated illness)3. PURVA VEDANA VRITTANTA (History of Past illness)4. CHIKITSA VRITTANTA (Treatment History)5. KULA VRITTANTA (Family History) 166 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 184. Annexure6. VAYAKTIKA VRITTANTA (Personal History) Aahara Shakha/Mishraharaa Bhojan Kala (Dietetic Samshana/Vishamasana/Adhyashana/Anashana Habits) Pradhana Rasa Sevana M/A/L/K/T/Ka Pradhana Guna Sevana G/L/Sni/Ruk/She/Ush/Tik Agni Manda / Sama / Tikshna / Vishma Koshta Mrudu / Madhyama / Krura VihaaraVyayama Less / Moderate / Excessive / Not at all Regular / IrregularVyavayaNidra Sound / Disturbed / Insomnia ----- Hours Day/NightVyasana Smoking/alcohol/both Tobacco/or any7. RAJO VRITTANTA (Menstrual History) Age of Menarche: Past Menstrual cycle: 167 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 185. AnnexureMenstrual History :SL.NO B/T A/T 1. Regularity *Regular *Irregular 2. Amount of blood loss *Average *Heavy *Scanty 3. Duration 4. Character of blood loss *Darkish red with liquid *Bright red or black with clots 5. Character of pain *Spasmodic *Dull 6. Foul smelling *Associated(P) *Absent(A)8. PRASAVA VRITTANTA (Obstetric History) GPALD Nature of Delivery: Last Delivery:9. CONTRACEPTIVE HISTORY: Yes / No Methods of Contraception Temporary – OCP / Condom / IUCD Permanent – T / L10. PHYSICAL EXAMINATION: General Examination Height Pallor Weight Tempt Pulse /min Respiration /min Built Lean / Med / Obese B.P mm of hg 168 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 186. Annexure Ashtasthana Pariksha:Nadi /minMala Prakrita/VibandhaMutra Frequency : ----times / day - --times / nightJihva Liptata/AliptataShabda CVS-Vishesha ./ Avishesha RS - Vishesha ./ AvisheshaSparsha P/A-Soft/Tender,Ushna / Sheeta / Samashitoshna / Ruksha/ Kara / MruduDrika Prakrita/VikritaAkriti Krisha / Madhyama / SthulaDashavidha Pariksha: Prakriti – Sharirika V / P / K/ VP / PK / KV / VPK -Manasika S/R/T Sara P/M/A Satva P/M/A Samhanana P/M/A Satmya P/M/A Pramana U / M / Hina Desha A/ J / S Kala H / S / Va / G / V / Sh Vayamshakti P/M/A Abhyavarana Shakti P/M/A Jarana Shakti P/M/A 169 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 187. AnnexureSROTASAM PARIKSHA:ANNAVAHASROTAS B /T A /T RAKTAVAHASROTAS B /T A/TChhardi AmlaprartanaAruchi SheetaprartanaAvipaka Twak rukshaAnannabilasa Twak parushyaAtisaara Twak sputanaMalaavarodha ShirashaitilyaRASAVAHASROTUS ARTAVAHASROTUSShrama AlpartavaGlani KastartavaHritpida Ati artava pravruttiTrishna MaithunaasahishnutvamShabdaasahishnutvaKampaShoshaRuksha11.VISHESHA PARIKSHA:Gynaecological Examination: P/V Examination: (1) Uterus : Position : AVAF / RVRF / Deviated Size : Normal / Bulky / Small Mobility : FM / IM / Fixed / Tender (2) Cervix : Consistency : H/S/N Growth: Yes/No (3) Fornices : Ant. : Fused / Tender / Normal Post : Fused / Tender / Normal Lat. : Fused / Tender / Normal 170 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 188. Annexure12.Vikrititaha Pareekshaa) Nidana : Aharaja Viharaja Manasika Anyab) Samprapthic) Samprapthi ghataka Dosha : Dushya : Srotas : Srotodusti prakara : Udbhava sthana : Sanchara sthana : Adhisthana : Rogamarga : Vyakta sthana :d) Poorva Roopae) Roopaf) Upashayag) Anupashayah) Sapeksha Nidanai) Vyadhi Vinishchayaj) SadhyasadhyataPrayoga Shaleeya Pareeksha B /T A /T1. Hb % USG (pelvis):2. T.C3. D.C –N-- L-- M-- B-- E—4. PCV-- 171 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 189. Annexure13.SAMPRAPTI VIGHATANA:VIRECHANA KARMA: Type Of No Of Days Karma1. Deepana And Till Niraama Lakshanas Pachana With Jeerakaadi Churna 3grms Bid2. Snehapaana Days 1 2 3 4 5 6 7 With Murcchita Ghruta QUANTITY3. Abhyanga 3 Days (Tila Taila) And Parisheka Sweda(Hot water)4. Virechana With Mathra: ------ Trivrith Lehya Anupaana: --------- Kaala:-------- Shuddhi Lakshana: Anthiki: ------------ Vegiki:-----Maaniki:---- Laingiki: --------- --------------------------------------------------------------------------- -----------------------5. Samsarjana Annakaala KarmaPATHYA AAHARA AND VIHAARA:AAHAARA: 1. Shaali- shastika shaali in the daily usage 2. Shimbi daanya- mudga(hesaru),masura,chanaka 3. Phala: Adakiphala, 4. shaaka-patola 5. Mamsa(Non-veg)- 6. Ghruta mishritha yavaagu once in a day 7. Santhaanika(upper thick part of the of the boiled milk) Mixed with madhu and sharkara.twice a week 172 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 190. Annexure 8. Navaneetha(new)+½ qty sugar+¼ qty of honey 9. Ksheerapaana twice in a day 10. Mudga yusha once in 2 days 11. Amla rasa pradhana phalas like dadima 12. Laaja churna +Ghrutha+Madhu once in a day 13. Karjura 3 or 4 per day VIHAARA: 1.vishraama 2.ushna jala avagaaha 3. sukha nidraAPATHYA: Aahara Vihara Intake of Ati mathra of lavana, Vyayaama amla,guru aahara Intake of the Mamsa of gramya, Vyavaaya oudaka medya animals Atiadhva Intake of shukta, masthu,sura Intake of Katu,vidhaahi,snigdha and .Aatapa sevana pishitha aahara Atisrama yuktakaryaFOLLOW UP STUDY: Patients were assessed after 2 Months 173 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 191. Annexure14. CRITERIA FOR ASSESSMENTASSESSMENT CRITERIAAssessment of Subjective Criteria:1. Duration of Bleeding < 5 days 0 Nil 5 to 7 days 1 Mild 7 to 8 days 2 Moderate >8 days 3 Severe 2. Size and No. of clots passed per day 1 or 2 Small clots 0 Nil 2 or 4 Large clots 1 Moderate Multiple Large clots 2 SevereAssessment of Objective Criteria: 3. Hbgm% variations < 12 – 0 Nil 10 - 12 – 1 Mild 8 - 10 – 2 Moderate > 8 -- 3 Severe 174 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 192. AnnexureCRITERIA FOR ASSESSMENT OF TOTAL RESPONSE OF THE STUDY:Effect of virechana on Asrigdara is assessed employing Student ‗t‘ test.The significance of virechana is classified as: 1. Highly Significant – when ‗P‘ value is less than 0.001 (P<0.001) 2. Highly Significant – when ‗P‘ value is less than 0.01 (P<0.01) 3. Just Significant - When ‗P‘ value is less than 0.05(P<0.05) 4. Insignificant – when ‗P‘ value is greater than 0.05(P>0.05)Signature of the Researcher Signature of the Guide 175 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 193. Annexure INFORMED CONSENT FORM I ..................………………... hereby willingly agree to participate in thisexperimental study. I affirm that there has been no compulsion or monetaryinducement in my agreeing to be volunteer for this study, which I do on my free will.I have been explained the general purpose of the experiment. I am convinced that it isfor the benefit of science and mankind. I understand that the risk involved is very less.I agree to undergo following investigations.1. Radiological examination2. Blood investigations I also agree to remain under observation for long period. I can apt out the study at any time.Signature of the investigator Signature of the VolunteerSignature of the Guide 176 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 194. AnnexureDO`S AND DON’T`S (Patient Reference Sheet)SNEHAPAANA:DO`S1. Snehapaana must be taken on empty stomach.2. After snehapaana at every half an hr hot water should be consumed.3 light and easily digestible foods should be taken after belching is cleared ofmedicine smell.4. Patient is asked to have curry or sambhar made up of moong dal /green gram withrice.5.beans,carrot,ridge guard, bitter guard,rice,rava,ragi,wheat,garlic,onion,curry leaves.DONT`S1. Intake of spicy and oily food stuffs.2.avoid journey,curds,cold foods,butter milk,tea,coffee,milk,day sleep,headbath,exercise,exposure to cold wind,rain,sunlight etc.3. one should not take morning and afternoon dose of internal medicine.4. Curds, potatoes, greenpeas, channa, avarekaalu, nonveg,egg.CAUTIONThere are possibilities of getting headache,uneasiness,heaviness of head duringdigestion of medicine. Hence the patient is advised not to worry, if more troublecontact doctor. 177 Dept of PG Studies in Roganidana G.A.M.C B’lore-09
  • 195. AnnexureVIRECHANA KARMA:DO`S1.After snehapaana there is a gap of three days during which pt will be undergoingfull body massage and steam.2.During this period pt is advised to take rasam,chapaathi, playa.3.On forth day virechana oushadi must be taken in b/w 9.30-10.30am which inducesloose stools.4. During this period one should increase the intake of hot water at every passage ofthe stool‘5.Once the stools are stopped then at the gap of 1½hrs,ganji must be consumed madeup of rava with more watery portion.6.Hypertension and Diabetes medicine should be taken missing the morning andafternoon dose of other internal medicine.7.After virechana patient should follow the strict diet regimen advised by the doctor.DON’T`S1.One should avoid intake of sweets,vada,oily foods stuffs etc.,during the gap of 3days after snehapaana.2.Tea, coffee,day sleep,non veg,journey,cold wines,head bath,milk,butter milk,curdsetc., 178 Dept of PG Studies in Roganidana G.A.M.C B’lore-09