Lekhana garbhavyapad-psr

1,490 views

Published on

Clinical Evaluation Of Lekhana Procedure In Certain Conditions Of Streeroga & Garbhavyapad, Hosmath, VijayalKakshmi. S., Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,490
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
33
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Lekhana garbhavyapad-psr

  1. 1. AKNOWLEDGEMENT Completion of dissertation work is the hallmark in postgraduate studies. At this important junction ofmy life my head bows down with great humility in the feet of Almighty, without whose inspiration I wouldnot have been able to attain these stages in my life and whose affectionate touch was and always will be withme to triumph all the obstacles. I would like to thank my parents, Sri Pampanagouda. S. Patil and Smt Lalitha. P. Patil for theirconstant love and support, parent-in-laws, Vaidya. Sri Panchaxari. S. Hosmath and Vaidya. Smt Mahadevi.P. Hosmath for their kindness and encouragement. Thanks to my sisters for valuable help. Words are not enough to gratitude to my husband Dr. Sanjay. P. Hosmath for helping andencouraging me throughout the study. Many thanks to my children Siddarth and Ananya who were allowedme to concentrate on the work without troubling me. It is indeed my fortune to have carried out this dissertation work at S.D.M. college of Ayurveda,Udupi. In this regard, I would like to express my heartfelt gratitude to honourable Dr. D. Veerendra Hegde,Dharmadhikari, Shri kshetra Dharmasthala, and president of S.D.M. Society. I genuinely feel that any words of gratitude are inadequate to express my humble thanks to Dr.V.N.K.Usha, Professor & HOD Dept of Prasooti tantra & Streeroga S.D.M.College of Ayurveda & Hospital.It is my fortune to have her as my guide whose excellent guidance, moral support & kind words for each &every step during my course of study gave me a way to success for the dissertation & in future career also. I take this opportunity to thank my Co-guide Dr. Suchetha for all the expert advice & specificsuggestions during the course of my work. Without her, it would not have been what it ought to be. I express my heartfelt thanks to Dr. Mamatha K.V, Asst. Professor, for feeding me with precioustraining & constructive ideas, throughout my study period. My sincere gratitude & thanks to Dr. Ramadevi, Asst. Professor, Dept of Prasooti tantra &Streeroga, S.D.M.College of Ayurveda, Kuthpady, for her worthy suggestions. I also thanks to Dr. Vidya for her suggestions and help.
  2. 2. I render my thanks to Dr. V.N.Prasad, Principal SDMCA, Kuthpady for his invaluable support andguidance for the completion of the thesis. My deep sense of gratitude to Dr. Shrikant. U. Dean of P.G. Studies and Dr. Govind raju Co-Dean ofP.G. Stidies for their valuable guidance. I am thankful to Dr. Y.N.Shetty, Medical Superintendent and Mr. C.S.Hegde, Manager, S.D.MAyurvedic Hospital, Udupi, for providing all the facilities in the hospital for my study. I express my regards to Dr. Krishna bai and Dr. Veena Mayya for their help. I greatly indebted to Dr. Murulidhar Sharma, Dept of Shalya tantra, for his ablest guidance anddragging me to the path of success. I extend my regard to Mr. Harish Bhat, Liabrarian, S.D.M College of Ayurveda, Udupi for hisgenerous help during the course of my life. My genuine thanks to all my friends Dr. Shilpa, Dr. Sukanya, Dr. Sujatha, Dr. Shubha, Dr. Kavyafor always being there to my difficulties and render moral support. I also thanks to Miss. Rashmi and miss.Shruti for their support and encouragement to make myselffeel at home even in hostel. My deepest gratitude to the staff of Sampark Xerox for perfection of final product of my dissertation. I thank all those who have directly or indirectly contributed to the successful completion of this workstill, I apologize for errata and shortcomings. Dr. Vijayalakshmi.S.Hosmath
  3. 3. LIST OF ABBREVIATIONSSerial No Abbreviation 1 Su. Sa. Sushruta Samhita 2 A.Sa Astanga Sangraha 3 A.Hri. Astanga Hridaya 4 Gr Group 5 P/V Per vaginal 6 USG Ultra sonography 7 & And 8 % Percentage
  4. 4.          Dedicated To My Family
  5. 5. ABSTRACTTitle: “Clinical evaluation of lekhana procedure in certain conditions of streeroga &garbha vyapad”.Background: Lekhana karma is one of the Astavidha shastra karmas described inclassics and it is only one of its kind. It causes pattalikarana. It is better than chedana,bhedana etc procedures, because of little intervention to the tissues. The main instrumentwhich is used for Lekhana karma is Mandalagra shastra. The indications such asmamsonnati, mamsankura, arsha and granthi which are explained by Sushruta can beinterpreted in Streeroga, as in conditions like hyperplasia of endometrium. It is veryefficient therapeutic modality in shesha amagarbha chikitsa because of shodhana effect.Hence it has both diagnostic and therapeutic efficacy. The endeavor of the study is tostandardize the procedure as per changing era.Objective:   • Conceptual study of Lekhana vidhi & it’s indications in certain conditions of Stree roga & Garbha vyapad. • Analysis of Lekhana vidhi in different conditions of Stree roga & Garbha srava.Design and setting: It is a descriptive observational study. Randomly selected 50patients from OPD and IPD of S.D.M Ayurveda hospital, Kuthpady, Udupi, accordingto inclusive criteria were registered for the study.Methods: According to following groups, patients were diagnosed as A) Atyartava , i.e. Excessive bleeding during menstruation. B) Anartava, i.e. Secondary amenorrhoea. C) Garbha srava, i.e. Inevitable abortion D) Vandhyatva & other conditions of Stree roga.After diagnosing the particular condition, the incidence of Lekhana karma in differentindications was assessed on different parameters like time taken for the procedure,amount of collected endometrial material, complications and Samyak laxanas of theprocedure.
  6. 6. Results : • The patients who underwent Lekhana karma, were maximum in the Group of Garbha srava (48%), followed by patients of Atyartava (44%), Vandhyatva (6%) and Anartava (2%). • The efficacy of Lekhana karma was studied. The 52% of patients were cured, followed by 40% of patients were relieved and in 8% of patients no effect was seen.Conclusion:Lekhana karma is mainly recommended in cases of mamsonnati, mamsankura, granthi,arsha which usually clinically presented with Atyartava and also in cases of sheshaamagarbha. It is difficult to draw any conclusion regarding Anartava and Vandhyatvagroups, because of small sample size.Key words : Lekhana karma, Atyartava, Anartava, shesha amagarbha, Vandhyatva,Garbhavyapad, Mandalagra shastra.
  7. 7. CONTENTS TITLECHAPTER NO. PAGE NO 1 Introduction 1-2 2 Objectives 3 REVIEW OF LITERATURE 3.1 Historical review 4-5 3.2 Introduction of Lekhana karma 6-8 3 3.3 General description of Lekhana karma 9-14 3.4 Description of Lekhana karma in Streeroga & 15-20 Garbha vyapad 3.5 Modern Review 21-31 CLINICAL STUDY 4.1 Materials and methods 4 32-34 4.2 observations 35-65 Discussion 5 66-74 Summary and conclusion 6 75-77 Bibliography 7 78-90 Annexure 8 91-102
  8. 8. LIST OF TABLESSl No Table heading Page No 1 Distribution of patients according to Age 35 2 Distribution of patients according to Religion 36 3 Distribution according to Education 37 4 Distribution of patients according to Socio economic status 38 5 Distribution of patients according to occupation 39 6 Distribution of patients according to Region 40 7 Distribution of patients according to Diet 41 8 Distribution of patients according to sleeping pattern 42 9 Distribution of patients according to previous menstrual history 43 10 Distribution of patients according to Obstetric history 44 11 Distribution of patients according to previous surgical history 45 12 Distribution of patients according to Prakriti 46 13 Distribution of patients according to Samhanana 47 14 Distribution of patients according to Sara 48 15 Distribution of patients according to Satva 49 16 Distribution of patients according to Satmya 50 17 Distribution of patients according to Aharashakti 51 18 Distribution of patients according to Vyayama shakti 52 19 Incidence of Lekhana karma in 50 selected patients 53 20 Incidence of diagnosis of conditions on the basis of clinical features 54 in selected 50 patients.
  9. 9. 21 Incidence of total time taken for procedure in 50 patients 5522 Incidence of requirement of Vardhana karma before the procedure 5623 Incidence of P/V bleeding immediately after the procedure 5724 Incidence of pain in abdomen immediately after the procedure 5825 Incidence of amount of collected endometrial material obtained after 59 the procedure26 Incidence of injury after the procedure 6027 Incidence of infection after the procedure 6128 Incidence of P/V bleeding after 1 hour, after the procedure 6229 Incidence of pain in abdomen after 1 hour, after the procedure 6330 Incidence of surgical interventions after Lekhana procedure 6431 Incidence of final assessment of the procedure 65
  10. 10. LIST OF GRAPHSSl No List of Graphs Page No 1 Distribution of patients according to Age 35 2 Distribution of patients according to Religion 36 3 Distribution according to Education 37 4 Distribution of patients according to Socio economic status 38 5 Distribution of patients according to occupation 39 6 Distribution of patients according to Region 40 7 Distribution of patients according to Diet 41 8 Distribution of patients according to sleeping pattern 42 9 Distribution of patients according to previous menstrual history 43 10 Distribution of patients according to Obstetric history 44 11 Distribution of patients according to previous surgical history 45 12 Distribution of patients according to Prakriti 46 13 Distribution of patients according to Samhanana 47 14 Distribution of patients according to Sara 48 15 Distribution of patients according to Satva 49 16 Distribution of patients according to Satmya 50 17 Distribution of patients according to Aharashakti 51 18 Distribution of patients according to Vyayama shakti 52 19 Incidence of Lekhana karma in 50 selected patients 53
  11. 11. 20 Incidence of diagnosis of conditions on the basis of clinical features 54 in selected 50 patients21 Incidence of total time taken for procedure in 50 patients 5522 Incidence of requirement of Vardhana karma before the procedure 5623 Incidence of P/V bleeding immediately after the procedure 5724 Incidence of pain in abdomen immediately after the procedure 5825 Incidence of amount of collected endometrial material obtained after 59 the procedure26 Incidence of injury after the procedure 6027 Incidence of infection after the procedure 6128 Incidence of P/V bleeding after 1 hour, after the procedure 6229 Incidence of pain in abdomen after 1 hour, after the procedure 6330 Incidence of surgical interventions after Lekhana procedure 6431 Incidence of final assessment of the procedure 65
  12. 12. LIST OF FIGURESSerial No Figure Page no 1 Vrittamukha mandalagra shastra 10 2 Kshurakara mandalagra shastra 10 3 Karapatra 10 4 Prayatagra Vruddipatra 11 5 Anchitagra Vriddipatra 11 6 Dantalekhana shastra 11 7 Krpasavihitoshnisha shalaka yantra 99 8 Yonivranekshana yantra 99 9 Sarpaphanamukha yantra 100 10 Svastika yantra 100 11 Garbhashaya eshani 101 12 Shalaka yantra 101 13 Dvitala yantra 101 14 Vrittamukha mandalagra shastra 102 15 Kshurakara mandalagra shastra 102
  13. 13. Chapter 1  Introduction      INTRODUCTION Ayurveda is the system of medicine which serves ailing humanity. It is eternalbecause it has no beginning, it deals with such thing as are inherent in nature and suchmanifestations are eternal.“soayamaayurvedah shaashvato nirdishyate, anaaditvaat,svabhaavasamsiddalakshanatvaat, bhaavasvabhaavanityatvaachcha.” 1 Though the principles of Ayurveda are everlasting, their applications may differfrom time to time. Ayurveda is not only rich in medicine but is enriched in surgical fieldalso. Acharya Sushruta is a pioneer of surgery starting from the basic principles ofsurgery to the plastic surgery hence known as a Father of surgery. He explained all thenecessary details about instruments that are used till date, but are used in modified formin present era. Asthavidha shastra karmas which are explained by Acharya Sushruta,covers basic features of all surgical procedures. In the course of period due to so many social & political factors, Ayurveda hasfallen from its height of practice & remained as conceptual. Due to these factors thesurgical procedures of Sushruta disappeared from the mainstream of Ayurveda . Surgicaloperations such as the Nasa sandhana, couching for cataract, management ofMoodhagarbha, Asthibhagna chikitsa and many other procedures were not done bytraditional Vaidyas, but by illiterate practitioners who passed on their manual skill fromone generation to the next.2 What so ever we are implementing in contemporary surgicalpractice already exists in our samhitas. Lekhana karma is a distinctive technique which is one among the Ashtavidhashastra karmas & it has its own efficacy. It is one type of shodana therapy which is usedin failure of shamana chikitsa. It does the shodana of Garbhashaya in conditions ofArtavadusti & Yonivyapad. As it is teekshna chikitsa, it can be also implemented inGarbhasrava chikitsa. It is mainly indicated in vrana, vartmagata rogas etc. 1    
  14. 14. Chapter 1  Introduction      Present study explores the incidence of the various gynecological and obstetricpathologies which are indications of Lekhana karma. These pathological manifestationshave ill effect on the health and hamper reproductive capacity of the woman. If timelytreated with Lekhana karma, early diagnosis of the pathological conditions and avoidanceof surgical intervention like hysterectomy is possible. Hence Lekhana karma helps inrestorative effect of endometrium. Even in case of shesha amagarbha, teekhna upachara issignificant treatment for expulsion of remaining concepts. Hence Lekhana karma can beconsidered. The practical aspects of surgery were little focused in Ayurveda. Hence this studyhelps to prove facts and information present in classics. 2    
  15. 15. Chapter 2    Objectives   OBJECTIVE OF THE STUDY 1. Conceptual study of Lekhana vidhi & it’s indications in certain conditions of Stree roga & Garbha vyapad. 2. Analysis of Lekhana vidhi in different conditions of Stree roga & Garbha srava. 3    
  16. 16. Chapter 3.1                                                                                                  Historical Review    HISTORICAL REVIEW Ayurveda has historically made foundational contributions to the development ofthe branch of surgery. Surgery in ancient India was quite specialized and highlydeveloped. There were number of eminent surgeons who performed surgical procedureswith great skill and success and composed of great compendia on surgery recording theirvaluable experiences. Sushruta is called as the father of surgery and the first knownsurgeon in the world and even wrote a book and his practices reached the middle east andlater to the west.3 Sushrutha was also the first surgeon to advocate the practice ofoperations on inanimate objects such as watermelons, clay plots and reeds; thus predatingthe modern practice of the surgical workshop by half a millennium. There is wrong assumption that surgery waned and gradually came to a fall downdue to emphasis on non-violence by Jains and Buddists. On the contrary, Jain monkscarried with them a medicine chest which contained surgical instruments. Jivaka thecontemporary & devotee of Lord Buddha, was eminent surgeon who performedmiraculous cures by his surgical skill. The actual reason hindering the progress of surgeryin those times were want of anesthesia and lack of antiseptics, surgical operation on amanmade unconscious with wine along with physical pressure could not be expected togain popularity and continue for long.4 Change in thinking strategies regarding surgery and lack of facilities probablymade the surgical aspects infamous in India, later on the same concepts have came up indifferent countries and surgical practice has got flourished. One of them being curettage.Vedic period In Vedic period, references about miraculous performance in surgeries byAshvini kumaras are available. But there is no direct reference about Lekhana karma.Samhita kala – 4
  17. 17. Chapter 3.1                                                                                                  Historical Review    References regarding Lekhana karma are available in Bhruhatrayis. • Acharya Charaka has explained Lekhana karma while explaining vrana chikitsa in dvivraneeya chikitsa adhyaya.5 • Acharya Sushruta has explained Lekhana karma as it is one the of Astavidha shastrakarma6 and it is one of the pradhanakarmas of the shasthi upakramas which are explained in the vrana chikitsa7. He explained indications8 and procedure9 in detail. He has described the instruments which are used in Lekhana karma with the dimension of their sharp edges10, correct technique of holding11, method of using, merits12 and demerits13 etc. In Lekhyaroga pratishedhadhyaya, he enumerated the lekhana karma in vartma rogas with procedure14, indications15, samyak laxana16 and asamyak laxanas17. • Acharya Vagbhata explained the Lekhana karma mainly in netrarogas with procedure18, samyak laxanas and asamyak laxanas19. He has described detail description of shastras20 which are used in Lekhana karma. • In Bhavaprakasha, reference for Lekhana karma is directly not available, but indirect reference is available in Bhavamishra commentary while explaining vrana chikitsa.21 • In Bhela Samhita, reference about Lekhana karma is available in vrana chikitsa22.Modern - • The procedure, indications and complications of curettage is explained in all text books of Obstetrics and Gynecology. 5
  18. 18.   Chapter 3.2    Conceptual study  INTRODUCTION OF LEKHANA KARMA Nirukti23 – • Lekhya – sÉãZrÉÇ, ̧É, (ÍsÉZÉ+LrÉiÉ|) sÉãÎZÉiÉurÉqÉç sÉãZÉlÉÏrÉqÉç | CÌiÉ ÍsÉZÉkÉÉiÉÉã: MüqqÉïÍhÉ rÉmÉëirÉrÉãlÉ ÌlÉwmɳÉqÉç || (vÉoSMüsmÉSìÓqÉ) The word lekhya is derived from ‘likha’ dhatu & ‘ya’ pratyaya. • Lekhana – ÍsÉZÉç + srÉÑOè The word Lekhana derived from ‘likh’ dhatu and ‘kta’ pratyaya. Paribhasha24 – “Lekhanakarmakaree, pattaleekaranah”. The process of thinning is called as Lekhana karma. “Shastradigharshanena vranasya tanukaranam”. Lekhana karma means thinning of vrana by rubbing with instruments. “Upakramam shaslyatantre shastrena vilekhanam”. Lekhana is upakrama of shalyatantra. Related terms of the word Lekhana25 – ÍsÉZÉç – ÍsÉZÉÌiÉ, sÉãÎZÉiÉç, sÉãÎZÉiÉqÉç, ÍsÉÎZÉiÉqÉç, ÍsÉZrÉ To scratch, scrape, furrow, tear up(the ground) ÍsÉÎZÉiÉ – scraped, scratched, scarified, written 6
  19. 19.   Chapter 3.2    Conceptual study  sÉãZÉ – a line, stroke, a writing, manuscript sÉãZrÉ – to be scratched or scraped or scarified, to be written Introduction – Lekhana karma is one type shadvidha shastra karmas.26 Lekhana karma is one among the Ashtavidha shastra karmas.27 Lekhana karma is one of the procedure in surgical management of vrana.28 Lekhana karma is one important procedure in sixty upakramas of vrana.29 According to Dalhana, vartma can be considered as vrana vartma or netra vartma. So all the procedures which are carried on netra vartma, can be implied on vrana vartma also.30 • Lekhana karma as main procedure – It is one of the pradhana karma in shasthi upakramas of vrana chikitsa.31 It is the one type of asthavidha shastrakarmas. It is unique technique in some conditions like mamsonnati, mamsakandi etc.32 In vartmavabandi, klistha vartma, bahala vartma, pothaki, shyava vartma, kardama vartma, kumbhika vartma, vartma sharkara and utsanga vartma, it is the main procedure.33. • Lekhana karma as adjuvant therapy- In amarmaja apakva granthi Lekhana karma and kshara karma are as alternate procedures in paachana chikitsa.34 In kumbhika vartma, vartma sharkara and utsanga vartma, lekhana should be done after bhedana karma.35 In peedaka, bhedana followed by lekhana36 7
  20. 20.   Chapter 3.2    Conceptual study  In pilla chikitsa, after lekhana procedure, if not satisfied, the procedure should be repeated followed by application of jalouka.37 In nasa sandhana, Lekhana procedure following with other procedures.38 In alaji, bhedana, lekhana followed by dahana.39 In arbuda, chedana followed by lekhana. 40 In case of upanaha, bhedana followed by lekhana.41 In case of surgical treatment of linganasha, Lekhana karma is indicated with other procedures.42 8
  21. 21. Chapter 3.3    Conceptual study  GENERAL DESCRIPTION OF LEKHANA KARMA Indications of Lekhana karma – • General indications – Kilasa43 Kustha44 Mandala45 • Indications related with shalakya tantra – 4 types of rohini46 Upajihvika47 Dantavaidarbhya48 Vartma rogas49 Adhijihvika 50 Nasika sandhana51 Upanaha52 Linganasha 53 Dantasharkara54 • Indications related with shalya tantra and streeroga – Granthi55 Arsha 56 Mamsa kandi (alpa mamsankuras)57 Mansonnati 58 Vrana vartma59 Instruments used in lekhana karma – Mandalagra60 Karapatra61 Vruddipatra62 Dantalekhana shastra63 9
  22. 22. Chapter 3.3    Conceptual study Description of shastras – Mandalagra shastra – According to Acharya Sushruta, it is a round tipped instrument & six angula in length. According to Acharya Vagbhat, it has its edge in the shape of nail of index finger. Types - Acharya Dalhana explained 2 types of Mandalagra shastra as follows - 1. Vrittamukha – having circular tip. Fig No. 1 2. Kshurakaara – it resembles with shape of sickle. Fig No. 2 Karapatra – According to Acharya Dalhana, it looks like leaves of Kara which has rough edge. It is shape of fingers in hand. There are some differences among Acharyas regarding the length of this shastra. Acharya Sushruta has given its length as six angula while according to Dalhana its length as twelve angula. Fig No.3 10
  23. 23. Chapter 3.3    Conceptual study  Vruddipatra – It resembles the barber’s knife in shape tapering to a sharp point at its tip for use in unnata and gambheera. Other one is opposite to this, it is having backward bend and a sharp edge outside. Prayatagra - Fig No. 4 Anchitagra - Fig No. 5 Dantalekhana shastra – It has four faces, each connected firmly with a band and one sharp edge, and is meant forscrapping the tarter on the teeth. Fig No. 6 11
  24. 24. Chapter 3.3    Conceptual study Shastra dhara in lekhana procedure64 – • sÉãZÉlÉÉlÉÉqÉkÉïqÉÉxÉÔUÏ The dhara of shastras which are used for Lekhana karma should be size of half lentil.Method of holding shastra in lekhana procedure – • Vruddipatra & Mandalagra should be held by the hand slightly raised up for the purpose of Lekhana karma & the procedure should be repeatedly.65 • For Lekhana karma, the shastra should be held carefully in between vrintaphala & the edge with index & middle fingers and the thumb.66Procedure- • According to Acharya Sushruta, in management of vrana shopha67 – Poorva karma- “Langhanadi virekaantam purvakarma vranasya cha” From langhana to virechana are considered to be poorvakarma of vrana chikitsa. Pradhana karma – ‘Paatanam ropanam chaiva pradhaanam karma tat smritam.’ From paatana to ropana are called as pradhaana karma. Pashchat karma- “Balavarnaagnikaaryam tu paschatkarma samaadishet” Impovement of bala, varna, agni to be considered in paschaat karma. • According to Acharya Sushruta as in Lekhya rogadhyaya68 – Poorva karma- snehana, vamana, virechana 12
  25. 25. Chapter 3.3    Conceptual study  Pradhana karma – Patient should lie down in supine position devoid of wind & sunrays. He should be held firmly. The vartma lifted with the left thumb & index finger. It should be everted & fomented carefully with a cloth dipped in warm water. The vartma should be cleaned with a swab & lekhana should be done with shastra or patra. Later on fomentation should be done after cessation of bleeding. Paschat karma – Apply the kalka of fine powder of manashila, kasisa, trikatu, rasanjana, saidhava mixed with madhu. Then sprinkle ghee after washing with the lepa with warm water & further managed like vrana. After 3days swedana, pidana should be done. • According to Astanga hridaya, in vartma roga chikitsa69 – Poorva karma – shodhana therapy Pradhana karma – The patient is made to lie in supine position in a place which is devoid of air. Svedana should be given to the vartma with warm water. The vartma held by the thumb & fingers of the left hand in such a way that it neither slips away nor makes any movement. Then with the Mandalagra shastra, an incision should be made horizontally, lekhana done by its own edge or leaves. The bleeding should be cleaned with phena or pichu. Paschat karma – after bleeding stops powder of saindava mixed with honey should be applied. After some time it should be washed with warm water, then applied ghee, a bolus of flour of yava mixed with honey & ghee should be applied. The vartma should be bandaged, above &below the ears. On the second day the bandage should be removed & parisheka should be given as described earlier. On the fourth day nasya should be done. On the fifth day the bandage should be removed. 13
  26. 26. Chapter 3.3    Conceptual study  Samyak lekhya vartma laxanas70- Asrugaasraavarahita (stoppage of bleeding), kandushopha vivarjitam (not associated with itching and inflammation), samam (the lesion should be even), nakhanibham (like colour of nail) Durlikhita vartma laxanas 71– Raktasraava , raga, shopha, parisraava, timira, the vartma becomes shyaava in colour, guru, sthabhdha , and associated with kandu, paaka 14
  27. 27. Chapter 3.4    Conceptual study  DESCRIPTION OF LEKHANA KARMA IN STREEROGA & GARBHA VYAPADChikitsa –“yaakriyaa vyadhiharanee saa chikitsa nigadhate” 72The measures or efforts, which destroys the disease is called as chikitsa.Shastra karma as a variety of shodana karma –“Samyak shodhayateeti samshodhanam; tadvidham –bahiraashrayamabhyantaraashrayam cha.Tatra bahiraashrayam shastrakshaaraagnipralepaadayah: abhyantaraashrayamchatushprakaaram – vamana, virechanam, asthaapanam, shonitamokshanam cha:anye tu shonitamokshanamityatra shirovirechanam manyate.”73The procedure which does the shodhana is called as samshodhana. Samshodhana chikitsais divided in to two types – bahiraashraya and abhyantaraashraya.Bahiraashraya is the application of shastra, kshaara, agni, pralepa etc.Abhyantaraashraya is again divided into 4 types – vamana, virechana, asthapana,raktamokshana. According to some other opinion that, instead of raktamokshana,shirovirechana can be considered. Any clinical condition if not treated by shamana (medical treatment) chikitsa,shodhana (surgery) chikitsa indicated after analysis of dosha, dhatu, rogibala androgabala. So in such conditions minor surgical procedures like Lekhana karma can beindicated in female genital tract.Indications –Indications in Streeroga - Atyartava – In this condition Lekhana karma can be implemented as Shodhana therapy. • Raktayoni – “……raktayonyaakhyaa srugati sruteh”74 Excessive bleeding per vagina is a main character of Raktayoni. 15
  28. 28. Chapter 3.4    Conceptual study  • Kunapa gandhi artava dusthi – “Kunapagandhyanalpam cha raktena”75 Kunapa gandhi artava dusthi is caused by vitiation of rakta. There is excessive amount of menstrual blood. “chakaaraachchonitavarnam pittavedanam cha, kunapam shavastasyeva gandho asyoti kunapaganghihi” According to Dalhana Acharya In this condition the bleeding resembles with fresh blood. It is associated with features of pitta and smell of dead body. • Asrigdara- “Tadevaatiprasangena pravruttamanrutaavapi Asrugdhsram vijaaneeyaadatoanyadraktalakshanaat Asrugdharo bhavet sarvah saangamardah savedanah.”76 According to Sushrutacharya, artava which is excessive in amount and is for prolonged period, occurs during intermenstrual period and is different from shudda artava lakshanas, is called as Asrigdara. Generalized body ache is a symptom of Asrigdara. “Rajah pradeeryate yasmaat pradarastena sa smrutah”77 According to Charakacharya, excessive excretion of menstrual blood is called as pradara. Types of Asrigdhara – Vataja asrigdhara78 – The artava which is vitiated by vata dosha is phenila, aruna, Krishna or shyava varnayukta, parusha, tanu, flows quickly, does not clot is called as vataja asrigdhara. Pittaja asrigdhara79 – In this condition the artava is neela, pita, harita or shyava in colour, visra, katu in taste is not liked by pipilika and makshika. Kaphaja asrigdhara80 – In this condition the artava is like gairikodaka, snigdha, bahala, pichchila, chirasravi and gets clotted like muscle. Sannipataja asrigdhara81 – In this condition the features of all doshas present and the artava resembles kanji in colour and is foul in smell. 16
  29. 29. Chapter 3.4    Conceptual study  Dwidoshaja asrigdhara82 – In this condition the features of both involved doshas are present. Anartava – In this condition Lekhana karma can be indicated as Shodhana chikitsa. • Arajaska83 – “Yonigarbhaashayastham chet pittam sandushayedasruk Saaarajaskaa mataa kaarshyavaivarnya jananeebhrusham” The pitta which is situated in yoni and garbhashaya, vitiates rakta, then the woman becomes more emaciated and discolored, is called as Arajaska. “Arajasketi anaartavaa” According to Chakrapani, anartava is a symptom of Arajaska. • Lohita kshaya – “........vaatapittaabhyaam ksheeyate rajah Sa daahakaarshyavaivarnya yasyaa saa lohitakshayaa”84 According to Astanga sangraha, when raja vitiated by vaata and pitta, the amount of raja becomes decreased. This condition is associated with daha(burning sensation), karshya(emaciation) and vaivarnya(discolouration). “ksheeyate raktamiti atipravrutyaa raktasya kshayah”85 In Madhukosha commentary excessive bleeding is the cause for raja kshaya. • Shushkaa – “Vegarodhaadrutou vaayurdushto vinmutrasangraham Karoti yoneh shosham cha shushkaakhyaa saativedanaa”86 According to Vagbhatacharya, when vaayu gets vitiated due to suppression of vegas during rutukala, produces retention of urine and feces, dryness in vagina. “Shushkaa nashtaartavaa kathitaa”87 According to Adhamalla, amenorrhoea is only symptom of Shushka yonivyapad. 17
  30. 30. Chapter 3.4    Conceptual study  Vandhyatva & other conditions – In all these conditions Lekhana karma explores the Garbhakostha for detection of Kshetra dusti and favors collection of artava to detect artava dusti. • Saprajaa – “saprajaa apeeti avandhyaa api satee katham chirena garbha vindati”88 Failure to get conception even after having previous uneventful pregnancy is termed as Saprajaa. • Aprajaa – “Yasyam labdheapi garbhe asrugatipravartate, saa taadrusharaktasrutyaa aprajaa bhavati, iyam cha raktayoniruchyate iti raktaatisrutyaiva 89 labhyate….” Unable to conceive due to excessive bleeding (menstrual irregularities) is called as Aprajaa. It is also called as Raktayoni. Indications in Garbhavyaapad - Garbhasrava - If pregnancy fails in the 1st trimester due to embryonic or fetal death or in incomplete spontaneous abortion or inevitable abortion or characterized by the absence of an embryo in the gestational sac, then these conditions have been managed with Lekhana karma. In all these conditions Lekhana karma explores and cleanses the Garbhashaya kostha. • Shesha amagarbha – “Aamagarbhasheshena hi punah punah shulamashajyet Tasmaateekshnairanavasheshayannupaacharet”90 The amagarbha which is expelled incompletely, it troubles the woman repeatedly. Hence this condition should be managed by teekshna upachara, till its complete expulsion. 18
  31. 31. Chapter 3.4    Conceptual study  • Asrujaa – “Raktapittakarairnaaryaa raktam pittena dushitam Atipravartate yonyaam labdhe garbhe api saasrujaa”91 Due to excessive consumption of ahara and vihara which aggravates the rakta and pitta, the rakta which is situated in reproductive organs, vitiated by dushita pitta, causes excessive bleeding per vagina. This bleeding may be present even after conception also. • Vaamini yonivyapad – “savaatamudigaredbeejam vaaminee rajasaa yutam”92 In this condition yoni excretes beeja with raja and vaata. “Beejam shukram Udgiret vamet Rajasaa yutam artavamishram” Beeja means shukra. The yoni which vomits shukra with artava.Procedure –Poorvakarma – • Preoperative assessment of the patient According to Acharya Sushruta, if patient is not assessed properly, not examined accurately and not elicited the clinical signs properly, all leads to improper treatment.93 • Position – Lekhana karma in Garbhashaya and Uttarabasti being the different modalities, involving in same organ “the uterus ( Garbhashaya)”. The procedure and principles described in Uttarabasti can be attributed to Lekhana karma as “Uttaanaayaah shayanaayaah samyak sankochya sakthinee”94 The woman should be in supine position with flexed thighs and elevated knees. 19
  32. 32. Chapter 3.4    Conceptual study  • Cleaning the parts was described in Lekhana karma of Vartma rogas, same can be employed “Tatah pramrujya plotena vartma shastrapadankitam”95 • Exposing the yonimukha with the help of Yoni vikshana yantra.96 • Stabilization of the garbhashaya mukha97 • Vardhana of the garbhashaya mukha, if it is constricted. “samvrutaam vardhayet punah”98Pradhana karma – • Lekhana karma should be samam likhet (uniformly), sulikhita (the lesions should be scraped well), niravasheshavat (completely) and vartmanaam tu pramaanena (with appropriate measure). “Samam likhet sulikhitam likhenniravasheshatah Vartmaanaam tu pramaanena samam shastrena nirlikhet”99 • The procedure should be according to the different conditions such as Samalekhanam avagaadhalekhanam -‘ sama lekhana’ means deep scraping Sulekhanam mridulekhanam - ‘sulekhana’ means mild scraping Niravasheshalekhanam nirlekhanam niravasheshalekhanamiti - 100 niravashesha lekhana’ means complete scrapingPaschat karma –Improvement of bala, varna, agni101 20
  33. 33. Chapter 3.5    Conceptual study  MODERN REVIEWIndications of curettage102 –Diagnostic – Infertility DUB Pathologic amenorrhoea Endometrial tuberculosis Endometrial carcinoma Postmenopausal bleedingTherapeutic - DUB Endometrial polyp Removal of IUCD Incomplete abortionCombined - DUB Endometrial polypDysfunctional uterine bleeding103 – It covers all forms of abnormal bleeding for which an organic cause cannot be found. This type of bleeding usually occurs at the extremes of reproductive age. It can be classified into two groups according to whether it is ovulatory or anovulatory. 1. Ovulatory bleeding –  It is mainly due to defect of corpus luteum which present in the following way- Irregular ripening of endometrium – It leads to inadequate bed for implantation. So patients present with DUB or infertility. 21
  34. 34. Chapter 3.5    Conceptual study  Causes – Failure of corpus luteum to develop, rapid regression of corpus luteum after development, failure of endometrium to respond due to decrease sensitivity to progesterone and hyperestrinism with normal corpus luteum. Histology – This condition is known as endometrium with irregular hormonal response. On microscopic examination, mixture of proliferative secretory endometrial glands or proliferative stroma & secretory glands are seen. Corpus luteum is normal. Irregular shedding of the endometrium – • Menstrual bleeding is prolonged, delayed & excessive • Stromal granulocytes of the endometrium fail to release their relaxin content & consequently the reticulum fibers supporting the stroma are not destroyed. • Shedding of endometrium is late & it occurs in large chunks causing membranous dysmenorrhoea. • Histology – Late secretory endometrium mixed with menstrual blood & early proliferative endometrium. Glands are frequently shrunken, stellate shaped & degenerated. They may show secretory activity or may regress. Stroma contains many stromal granulocytes & occasional neutrophils. Retarded luteal phase – Histology of endometrium lags behind dates by history. The criteria for diagnosis are that the delay should be at least by 3 days or more. In these cases corpus luteum is defective. 22
  35. 35. Chapter 3.5    Conceptual study  Pre & post- menstrual bleeding –This may be seen in ovulatory cycles due to disorderly corpus luteum regression or irregular follicular response, respectively. Here bleeding is self limiting & requires no therapy. 2. Anovulatory bleeding – The endometrium remains fragile due to inadequate structural stromal support due to absence of progesterone. Thus with the withdrawal of estrogen, due to negative feedback action of FSH, the endometrial shedding continues for a longer time because of lack of compactness. Usually this condition is associated with endometrial hyperplasia. Endometrial hyperplasia104 – It is a hormone related, estradiol mediated condition and does not present in the absence of female gonads or without estrogen therapy. The endometrial hyperplasias are a heterogeneous group of proliferative disorders. • Classification – Endometrial hyperplasia – Simple Complex (adenomatous) Atypical endometrial hyperplasia – Simple Complex (adenomatous) • Etiology – o Obesity, diabetes and other metabolic disorders may enhance the extra gonadal estrogen production and the presence of high estrogen levels, especially of estradiol, as a result of the binding of the hormone to receptor sites in the nuclei of endometrial cells. 23
  36. 36. Chapter 3.5    Conceptual study  o Estrogen unopposed by progestin o Tamoxifen therapy • Macroscopic features – - Uterus may be enlarged - Opening it often shows an irregularly thickened pale tan endometrium, that may be polypoid - The increased thickness of the endometrium may be demonstrated by ultrasound. • Microscopic features –Histological features of simple hyperplasia –General – Diffuse changes throughout endometrium Increased gland: stroma ratio (greater than 1:1)Glands – Architectural features – Variation in size and shape Small to large and cystically dilated Minimal & focal crowding Minimal branching with infoldings & outpouchings No complex angularity Cellular features – Abundant & cellular epithelium Ciliated cell change common Pseudostratification Nuclear features – Oval & elongated No significant variation in size or shape Evenly dispersed chromatin Small, inconspicuous nucleoli Variable mitotic activityStroma – Abundant & cellular Small, oval cells with scanty cytoplasm 24
  37. 37. Chapter 3.5    Conceptual study  Mitotic activity in stroma Prominent superficial venules Inconspicuous spiral arteriolesHistological features of complex hyperplasia –General – Focal to extensive Greatly increased gland: stroma ratio (greater than 3:1)Glands – Architectural features – Marked variation in size & shape Marked crowding Branching with papillary infoldings & outpouchings Complex angularity Cellular features – Abundant & cellular epithelium Ciliated cell change (less than in simple hyperplasia) Squamous change Pseudostratification Nuclear features – Oval & elongated No significant variation in size or shape Evenly dispersed chromatin Small, inconspicuous nucleoli Variable mitotic activityStroma – Scanty & inconspicuous Dense & cellularAtypical hyperplasia –Histological features of simple atypical hyperplasia –General – architectural changes diffuse throughout endometrium Cellular changes focal to diffuse Increased gland: stroma ratio (greater than 1:1)Glands – Architectural features – Variation in size & shape 25
  38. 38. Chapter 3.5    Conceptual study  Small to large & cystically dilated Minimal & focal crowding Minimal branching with infoldings & outpouchings No complex angularity Cellular features – Abundant & cellular epithelium Ciliated cell change common Pseudo stratification Dense eosinophilia Nuclear features – Elliptical to round Variation in size & shape Hyperchromasia Nucleoli prominent, enlarged & irregular Coarse clumping of chromatin Variable mitotic activityStroma – Abundant & cellular Small, oval cells with scanty cytoplasm Mitotic activity in stroma Prominent superficial venules Inconspicuous spiral arteriolesHistological features of complex atypical hyperplasia –General – Focal to extensive Greatly increased gland: stroma ratio ( greater than 3:1)Glands – Architectural features – Marked variation in size & shape Marked crowding Branching with papillary infoldings & outpouchings Complex angularity Cellular features – Abundant & cellular epithelium Ciliated cell change (less than simple hyperplasia) Squamous change Pseudostrtification 26
  39. 39. Chapter 3.5    Conceptual study  Dense eosinophilia Nuclear features – Elliptical to round Variation in size & shape Hyperchromasia Nucleoli prominent Coarse clumping of chromatin Vesicular nucleus – hypochromasia Variable mitotic activityStroma – Scanty & inconspicuous Dense & cellularEndometrial carcinoma105 – Endometrial adenocarcinoma is common type of neoplasma of endometrium.Histologically, it arising from the endometrial glands, the glandular components of thetumor are somehow reminiscent of the normal proliferative endometrium. In moderatelydifferentiated endometrial adenocarcinomas the glandular pattern is present in 50-90% ofthe specimen with solid nest & sheets of tumor cells replacing the glands. These tumorsshowing pleomorphic nuclei with intranuclear clearing, coarse clumps of chromatin &multiple irregular nucleoli. Mitoses are numerous & atypical. Most cells have a highnucleus-cytoplasm ratio with very scanty basophilic cytoplasm. Anaplastic carcinomas ofthe endometrium show no glandular differentiation & a very marked degree of cellularanaplasia with the resemblance to endometrial tissue being difficult to ascertain.Endometrial polyps106 – Endometrial polyps are overgrowths of endometrial glands and stroma with blood vessels, sometimes also containing smooth muscle, which protrude into the uterine cavity. • Pathogenesis – A part of the thick endometrium projects into the cavity and attains a pedicle. It arises from the basal endometrium surrounded by the 27
  40. 40. Chapter 3.5    Conceptual study  functional zone. Multiple polyps are usually present in endometrial hyperplasia and are excluded from such a discrete polyp. • Naked eye appearance – A small polyp size of about 1-2 cm, looks reddish and feels soft. • Microscopically – the core contains stromal cells, glands and large thick walled vascular channels. The surface is lined by endometrium. The pedicle contains thin fibrous tissue with thin blood vessels.Chronic endometritis107 – Every case of acute endometritis might go on to chronic endometritis. It is a rare condition between the menarche and the menopause, because the regrowth of new surface endometrium during each menstrual cycle prevents the persistence of any infection which is not deep seated. Causes – Foreign bodies within the uterus Malignant disease of the uterus Infected polyps Retained products of conception With inflammatory cells including altered macrophages known as ‘foam cells’ After menopause Microscopic examination – As a diagnosis of chronic endometritis depends upon the presence of plasma cells with maximum accuracy.Tubercular endometritis108 – • Incidence – 60% endometrium involved 28
  41. 41. Chapter 3.5    Conceptual study  • Pathogenesis – The causative organism is Mycobacterium tuberculosis of human type It is almost always secondary to primary infection. • Pathology – The infection starts from the tubes either by lymphatic or by direct spread through continuity. Corneal ends are commonly affected due to their rich blood supply and their anatomical proximity to the tubes. The tubercle is situated in the basal layer of the endometrium only to come to the surface premenstrually. After the endometrium shed at each menstruation, reinfection occurs from the lesions in the basal layer or from the tubes. Endometrial ulceration may lead to adhesion or synechiae formation (Asherman’s syndrome ) Rarely infection spreads to the myometrium (2.5%) Microscopic examination – The principal histological feature of tubercular endometritis is the epitheloid cell granuloma. The epitheloid cell granuloma of tubercular endometritis contains a central collection of epitheloid cells with both Langhans & foreign body type gaint cells. There is usually a peripheral collar of lymphocytes. The gland may be functionally unaffected in tubercular endometrium. But they may show a poor response to ovarian hormones, as with non-specific endometritis. It is possible that this factor contributes to the infertility.Inevitable abortion109 –It is a clinical condition of abortion where continuation of pregnancy is impossible.Clinical features – 29
  42. 42. Chapter 3.5    Conceptual study  • Symptoms and signs of pregnancy coincide with its duration. • Vaginal bleeding is excessive and may be accompanied with clots. • Colicky pain felt in suprapubic region radiating to the back. • The internal os of the cervix is dilated and products of conception may be felt through it.Incomplete abortion –Retention of a part of the products of conception inside the uterus is called as incompleteabortion.Clinical features – • History of expulsion of a fleshy mass per vagina • Continuation of pain in abdomen and vaginal bleeding • On examination, the uterus is less than the period of amenorrhoea. The cervix is opened and retained contents may be felt through it. • USG shows the retained contents.Missed abortion -When the fetus is dead and retained inside the uterus for a variable period, is called asmissed abortion. Carneous mole is a special variety of missed abortion in which the deadovum in early pregnancy is surrounded by clotted blood.Clinical features – • Symptoms of threatened abortion may or may not be developed. • Regression of pregnancy symptoms • A dark brown vaginal discharge may occur • The uterus is smaller in size • Cervix feels firm 30
  43. 43. Chapter 3.5    Conceptual study Findings in curettage in failed pregnancy110 – • There are 3 basic criteria which are reporting product of conception from abortions. 1) Confirmation of the pregnancy 2) Location of the pregnancy 3) To identify or exclude a serious disease process especially gestational trophoblastic disease. • In the majority of cases of 1st trimester abortions chronic villi are the only tissues of fetal origin identified. • The finding of a placental site trophoblastic reaction is important as it excludes that the pregnancy was ectopic in the fallopian tube & after aborting washed in to the uterus. • The gross appearance of the intrauterine contents from products as follows - The highest incidence of karyotypic abnormalities occurs in 9.4 wks of mean gestational age. Macroscopic features - Gelationous sacs that may be empty or contain a disorganized embryo or umbilical cord stump. Microscopic features - The villi are edematous. Some may show fibrosis & vascular obliteration. • Frequently the placenta is the only tissue available when examining the early concepts. 31
  44. 44. Chapter 3.5    Conceptual study Procedure of curettage111 – The patient should empty the bladder prior to operation. The procedure is done under general anesthesia or Diazepam sedation. The patient is placed in lithotomy position. Local antiseptic cleaning & draping done. Bimanual examination is performed. Posterior vaginal speculum is introduced inside the vagina. The anterior lip of the exposed cervix is grasped by multiple toothed vulsellum & pulled down near the vaginal introits. The uterine sound is introduced to confirm the position & to note the length of the uterine cavity. Cervical canal is then gradually dilated by the graduated metal cervical dilators. After the desired dilatation, the uterine cavity is curetted by an uterine curette either in clockwise or anticlockwise direction starting from the fundus down to internal os. The completion of the procedure should be confirmed by grating sound. Vulsellum & the speculum are removed. The curetted material is preserved in 10 per cent formal-saline (normal saline in suspected tubercular endometritis) labeled properly & sent for histological examination. Complications112 – Immediate complications are injury to the cervix, uterine perforation, injury to the gut, infection. Remote complications are cervical incompetence and uterine synechiae. 32
  45. 45. Chapter 4.1                                                                                                Materials And Methods     MATERIALS AND METHODSSource of data: About 50 patients under inclusive criteria of Lekhana karma were selected fromIPD & OPD of S. D. M Ayurveda Hospital Kuthpady, Udupi, were selected for the study. Method of collection of data: It is a descriptive study on different indications where the method of collectingthe data was by participant observation method. A minimum of 50 patients, diagnosed under inclusive criteria were taken for thestudy. The Lekhana vidhi was observed with results and the utility of Lekhana vidhi wasevaluated. A detailed proforma was prepared with all history taking, physical examinationwhich is explained in our classics & allied science to confirm the diagnosis. Inclusion criteria: • Patients between the ages of 18-50 years. • Patients who are married, • Patients who are diagnosed having, A) Atyartava , ie Excessive bleeding during menstruation. B) Anartava, ie Secondary amenorrhoea. C) Garbha srava, ie Inevitable abortion D) Vandhyatva & other conditions of Stree roga. Exclusion criteria: • Atyartava due to pittala yoni vyapad or tridoshaja yoni vyapad, ie acute infective state of reproductive system. • Endometriosis. • Fibroid uterus. 32    
  46. 46. Chapter 4.1                                                                                                Materials And Methods     • Unmarried. • Patients with systemic disorder like severe anemia, diabetes, hypertension, thyroid dysfunction. Intervention: After the diagnosis of particular condition of Streeroga & Garbha vyapad, theLekhana karma was observed. Later the patients were categorized in to 4 groups by theprocedure, which they underwent. Group “A” – The patients of Atyartava. Group “B” – The patients of Anartava. Group “C” – The patients of Garbha srava. Group “D”- The patients of Vandhyatva & any other conditions of Stree roga.Assessment criteria: • Incidence of Lekhana vidhi in different conditions of Streeroga & Garbha vyapad in 50 selected patients was assessed. • Reasons for implementing Lekhana vidhi in specific conditions of Streeroga & Garbha vyapad were assessed. • Effectivety & side effects of procedure in certain conditions of Stree roga & Garbha vyapad were assessed.Final assessment: The reason for Lekhana karma either therapeutic or investigated and the efficacyof treatment in curing disorders outcome assessed. The patients suffered from any othercomplications within 3 days & use of any alternative methods were assessed. 33    
  47. 47. Chapter 4.1                                                                                                Materials And Methods    Investigations:Blood examination: Hb% TC DC E.S.R RBSUrine examination: Sugar Albumin Microscopic USG (If necessary ) Urine Pregnancy Test (If necessary)  34    
  48. 48.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS  OBSERVATIONSDistribution of patients according to Age:Table No 1Age group Group A Group B Group C Group D Total %19-26 yrs 0 0 12 0 12 2427-34 yrs 2 0 10 2 14 2835-42 yrs 5 0 2 1 8 1643-50 yrs 15 1 0 0 16 32Graph no 1 35 30 25 19-26 yrs 20 27-34 yrs 15 35-42 yrs 10 43-50 yrs 5 0 Gr A Gr B Gr C Gr D Total %The study of age shows that maximum no. of patients 32% were found in the age groupof 43-50 years, followed by 28% patients in 27-34 years age group, 24% patients in 19-26 years age group & 16% patients in 35-42 years age group. 35
  49. 49.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Religion:Table No 2 Religion Group A Group B Group C Group D Total %Hindu 18 1 17 3 39 78Muslim 3 0 5 0 8 16Christian 2 0 1 0 3 6Graph no 2 80 70 60 50 Hindu 40 Muslim 30 Christian 20 10 0 Gr A Gr B Gr C Gr D Total %The study of religion shows that maximum no. of patients 78% were Hindus, followed by16% patients were Muslims & 6% patients belong to Christian. 36
  50. 50.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS  Distribution according to Education – Table No 3 Education Group A Group B Group C Group D Total %Uneducated (U.E) 8 0 0 0 8 16Primary (P) 8 1 7 0 16 32Secondary (S) 4 0 9 1 14 28Higher 1 0 8 16secondary(HS) 7 0Graduate (G) 1 0 0 2 3 6Post graduate (PG) 0 0 1 0 1 2 Graph no 3 35 30 25 U.E P 20 S 15 H.S 10 G P.G 5 0 Gr A Gr B Gr C Gr D Total % The study of education shows that maximum no. of patients 32% were primary educated, followed by 28% patients were secondary educated, 16% uneducated, 16% higher secondary educated, 6% patients were graduated and 2% patients were post graduated. 37
  51. 51.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Socio economic status:Table No 4 Socio economic Group A Group B Group C Group D Total % statusLower (L) 0 0 0 0 0 0Lower middle 17 1 14 1 33 66(L.M)Upper middle 7 2 8 0 17 34(U.M)Upper (U) 0 0 0 0 0 0Graph no 4 70 60 50 L 40 L.M 30 U.M 20 U 10 0 Gr A Gr B Gr C Gr D Total %The study of socio-economic status shows maximum no. of patients 66% were found inlower middle class and 34% patients were in upper middle class. 38
  52. 52.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to occupation:Table No 5Occupation Group A Group B Group C Group D Total %House wife 13 0 22 1 36 72Working 9 1 2 2 14 28Graph no 5 80 70 60 50 40 house wife 30 working 20 10 0 Gr A Gr B Gr C Gr D Total %The study shows maximum no. of patients 72% were house wives, and 28% patients wereworking. 39
  53. 53.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Region :Table No 6 Region Group A Group B Group C Group D Total % Urban 9 0 2 1 12 24 Rural 13 1 22 2 38 76Graph no 6 80 70 60 50 40 Urban 30 Rural 20 10 0 Gr A Gr B Gr C Gr D Total %The study shows that majority of patients 76% were from rural area and 24% patientsfrom urban. 40
  54. 54.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Diet:Table No 7 Diet Group A Group B Group C Group D Total %Vegetarian 5 0 9 2 16 32Mixed 17 1 15 1 34 68Graph no 7 70 60 50 40 Vegetarian 30 Mixed 20 10 0 Gr A Gr B Gr C Gr D Total %The study of diet shows that maximum no. of patients 68% were mixed diet and 32%patients were vegetarians. 41
  55. 55.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS  Distribution of patients according to sleeping pattern: Table No 8 Sleeping pattern Group A Group B Group C Group D Total %Sound 13 0 21 3 37 74Disturbed 9 1 1 0 11 22 Graph no 8 80 70 60 50 40 Sound 30 Disturbed 20 10 0 Gr A Gr B Gr C Gr D Total % The study of sleeping pattern shows that maximum no. of patients 74% were having sound sleep, followed by 22% patients were having disturbed sleep. 42
  56. 56.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS  Distribution of patients according to previous menstrual history: Table No 9 Menstrual history Group A Group B Group C Group D Total %regular 6 1 22 2 31 62Irregular 16 0 2 1 19 38 Graph no 9 70 60 50 40 Regular 30 Irregular 20 10 0 Gr A Gr B Gr C Gr D Total % The study of previous menstrual history shows that maximum no. of patients 62% were having regular menstrual periods and 38% patients were having irregular menstrual periods. 43
  57. 57.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Obstetric history:Table No 10Obstetric history Group A Group B Group C Group D Total %Nullipara 0 0 0 3 3 6Primi 0 0 15 0 15 30Multi 22 1 9 0 32 64Graph no 10 35 30 25 20 Nullipara 15 Primi Multi 10 5 0 Gr A Gr B Gr C Gr D Total %The study of obstetric history shows that the maximum no. of patients 64% were multigravidae, 30% patients were primi gravidae and 6% patients were nullipara. 44
  58. 58.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to previous surgical history:Table No 11 Previous surgical Group C Group D Group A Group B Total % historyCurettage 2 0 6 1 9 18LSCS 0 0 2 0 2 4Tubectomy 15 0 0 0 15 30Any other 0 0 0 0 0 0Nothing specific 5 1 16 2 24 48Graph no 11 50 45 40 35 Curettage 30 LSCS 25 Tubectomy 20 Any other 15 Nothing specific 10 5 0 Gr A Gr B Gr C Gr D Total %The present study shows maximum number of patients 48% had no previous surgicalhistory followed by 30% patients were tubectomized, 18% patients previously underwentcurettage and 4% patients had history of LSCS. 45
  59. 59.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Prakriti :Table No 12Prakriti Group A Group B Group C Group D Total %Vata-kapha 4 0 7 0 11 22Vata-pitta 8 1 13 3 25 50Pitta-kapha 10 0 4 0 14 28Graph no 12 50 45 40 35 30 Vata-kapha 25 Vata-pitta 20 Pitta-kapha 15 10 5 0 Gr A Gr B Gr C Gr D Total %The present study shows that maximum patients 50% were of vata-pitta prakriti, followedby 28% patients were of pitta-kapha and 22% patients were of vata-kapha prakruti. 46
  60. 60.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Samhanana :Table No 13Samhanana Group A Group B Group C Group D Total %Pravara 5 0 1 0 6 12Madyama 14 0 19 3 36 72Avara 3 1 4 0 8 16Graph no 13 80 70 60 50 Pravara 40 Madyama 30 Avara 20 10 0 Gr A Gr B Gr C Gr D Total %The present study shows maximum number of patients 72% were of madyamasamhanana, followed by 16% patients were of avara samhanana and 12% patients were ofpravara samhanana. 47
  61. 61.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Sara:Table No 14Sara Group A Group B Group C Group D Total %Twak 0 0 0 0 0 0Rakta 0 0 0 0 0 0Mamsa 6 0 7 1 14 28meda 10 0 3 2 15 30asthi 6 1 14 0 21 42majja 0 0 0 0 0 0shukra 0 0 0 0 0 0Satva 0 0 0 0 0 0Graph no 14 45 40 Twak 35 Rakta 30 Mamsa 25 Meda 20 Asthi 15 Majja 10 Shukra 5 Satva 0 Gr A Gr B Gr C Gr D Total %The incidence of sara shows that maximum number of patients 42% were asthisara,followed by 30% patients were meda sara and 28% patients were mamsa sara. 48
  62. 62.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Satva :Table No 15Satva Group A Group B Group C Group D Total %Pravara 1 0 0 0 1 2Madyama 19 0 20 3 42 84Avara 2 1 4 0 7 14Graph no 15 90 80 70 60 50 Pravara 40 Madyama 30 Avara 20 10 0 Gr A Gr B Gr C Gr D Total %The present study shows that maximum number of patients 84% were of madyama satva,followed by 14% patients were avara satva and 2% patients were pravara satva. 49
  63. 63.                                                                                    Chapter 4.2                                                                                             OBSERVATIONS Distribution of patients according to Satmya :Table No 16Satmya Group A Group B Group C Group D Total %Pravara 1 0 0 0 1 2Madyama 19 0 20 3 42 84Avara 2 1 4 0 7 14Graph no 16 90 80 70 60 50 Pravara 40 Madyama 30 Avara 20 10 0 Gr A Gr B Gr C Gr D Total %The present study shows that maximum number of patients 84% were of madyamasatmya, followed by avara satmya 14% and pravara satmya 2%. 50

×