E-ISSN:2456-3110

Case Report

Artava kshaya

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 3 April
Publisherwww.maharshicharaka.in

Effect of Kusumasanjanani Yoga in the management of Artava Kshaya (oligomenorrhoea) - A Case Report

NV G.1, Singh P.2*, Lamani A.3
DOI:

1 Gayathri Bhat NV, Professor, Department of Prasuti Tantra evam Stri Roga, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2* Priyanka Singh, Post Graduate Scholar, Department of Prasuti Tantra evam Stri Roga, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Ashok Lamani, Assistant Professor, Department of Prasuti Tantra evam Stri Roga, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

The most common gynecological problem in adolescent girls are menstrual disorders that can be amenorrhea or menorrhagia. After menarche, frequent ovulation is a physiological condition that can be triggered by the presence of oligomenorrhoea. This condition usually happens after a period of regular cycle. Artava Kshaya can be corelated with oligomenorrhoea or hypomenorrhea. Artava kshaya is explained by Acharya Sushruta and is characterized by Yathochitakala Adarshanam, Alpartva or Yoni vedana. Methodology: A case study of 19-year-old female patient with complaint of irregular menstruation since menarche associated with weight gain. Detail history with all physical examination and laboratory investigation were carried out. All the laboratory investigations were found normal but PCOD finding came in USG. Kusumasanjanani Yoga 10 ml thrice in a day has prescribed orally for 2 months. Patient was advised for follow up after 1st cycle. Result: patient had got her menstruation regularly with normal duration. Even after cessation of medicine she got her menstruation in 1 month.

Keywords: Artava kshaya, Kusumasanjanani Yoga, Oligomenorrhoea, Hypomenorrhea

Corresponding Author How to Cite this Article To Browse
Priyanka Singh, Post Graduate Scholar, Department of Prasuti Tantra evam Stri Roga, Shri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Gayathri Bhat NV, Priyanka Singh, Ashok Lamani, Effect of Kusumasanjanani Yoga in the management of Artava Kshaya (oligomenorrhoea) - A Case Report. J Ayu Int Med Sci. 2022;7(3):172-176.
Available From
https://jaims.in/jaims/article/view/1797

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-03-05 2022-03-07 2022-03-14 2022-03-21 2022-03-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Gayathri Bhat NV, Priyanka Singh, Ashok Lamaniand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Bhat G et al: Effect of Kusumasanjanani Yoga in the management of Artava Kshaya

Introduction

Menstruation is an essential physiological function of women during their reproductive age. According to classics normal menstruation is the indicator of healthy and normal reproductive organ in which intermenstrual period is one month, duration of blood flow is five to seven days (differ according to different opinion of acharyas), but not associated with pain and burning sensation. Due to increased physical and emotional stress in routine lifestyle of women alters the physiology of “Hypothalamus- Pitutary-Ovaraian axis”. This may lead to many gynecological disorders. According to ayurveda most of menstrual disorders have been described under the heading of Astha Artava Dushti, Asrigdara, Artavakshaya, Nastartava, and Yoni Vyapad.

In classics Artava Kshaya is not mentioned as a disease but described as a symptom of many gynecological disorders. Artava Kshaya Lakshana[1] has been described by Acharya Sushruta under “Dosha Dhatu Mala Kshaya Vriddhi Vignanam”. It is characterized by Yathochitakala Adarshanam (as delayed menstruation), Alpartva (Hypomenorrhea) or Yoni Vedana (Dysmenorrhea). Artava Kshaya has also been mentioned in Astha Artava Dushtis as Ksheena Artava.[2] Artava Kshaya is caused due to involvement of Vata and Kapha Dosha which leads to Margavrodha of Artava Vaha Strotasa which are also explained as the cause of Vandhyatava.

Artava Kshaya can be corelated with oligomenorrhoea[3] or hypomenorrhea.[4] Oligomenorrhoea is defined as menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency. Hypomenorrhea is defined as menstrual bleeding is unduly scanty and lasts for less than 2 days.

Prevalence of oligomenorrhea is increasing day by day making it to be the commonest gynecological disorders. Incidence of oligomenorrhoea in PCOD[5] is 87% which is highest among other menstrual irregularities in PCOD.

Rationality of Selection of Drug

As for Artava Kshaya it can be considered as Vata kaphaja Vikara since Vata is the one who provide the physiological function of the body.[6] Apana Vata is also responsible for the proper Nishkramana of Artava. The presence of the Avrodhaka Guna

in Kapha can also cause obstruction in the path of Artava Vaha Strotas, which contributes to the pathogenesis of Artava Kshaya. Pitta such as Pachaka Pitta can also contribute to the proper formation of Dhatus.

Treatment is Ayurveda is based on the concept of destruction of the factors causing pathogenesis (Samprapti Vighatana). So, if we consider the Sampraptighataka in this case then it can be laid as follows:

  • Dosha: Vata (Apanavata), Kapha (Kledaka kaphda), Pitta (Pachaka Pitta)
  • Dushya: Rasa dhatu and Artavaupdhatu
  • Agni: Agni mandya
  • Strotas: Rasavaha and Artavavaha
  • Strodushti: Sanga
  • Adihsthana: Garbhaashya

Table 1: Showing Contents of Kusumasanjanani Yoga[7]

SN Drug Latin name Part used Rasa Guna Virya Vipaka Doshakarma
1. Japa Hibiscus rosa sinesis Flower Kahaya, Tikta Laghu, Rooksha Ushna Katu Kapha vatahara
2. Jyotishmati Celatrus paniculatus Leaves Katu, Tikta Tikshana Ushna Katu Kapha vatahara
3. Durva Cynodon dactylon Whole plant Madhura, Tikta, Kashya Laghu Sheeta Madhura Kapha pittahara

Preparation: Equal part of the above ingredients mentioned in the table are taken and grinded first, then Swarasa (juice) taken out of it. Equal to Swarasa, Kanji has taken and mixed in it. Required amount of sugar has been added in the above mixture for syrup preparation and heat till the accurate consistency of syrup.

So, the drug having Vata Kaphahara, Deepana, Pachana, Medhya, Vatanulomana, Artava Janan properties should be used to treat Artava Kshaya. Considering above and line of treatment of Artava Kshaya, Kusuma Sanjanani Yoga was selected and given to the patient for treatment.

Case Report

An unmarried female patient of 19 years of age came to OPD of Prasuti Tantra evum Stri Roga of SDM college of Ayurveda and


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Bhat G et al: Effect of Kusumasanjanani Yoga in the management of Artava Kshaya

Hospital, Hassan, Karnataka on 29 September 2021 with chief complaints of Irregular menstruation associated with weight gain since menarche.

Menstrual History

  • FMP: 12 Years
  • LMP: 19-7-2021
  • Previous LMP: 20-5-2021
  • Interval of cycles: 60 days
  • Duration of flow: 5 days
  • Amount: 3 pads/ day
  • Clots: Present
  • Foul smell: Absent
  • Pain: Absent

Past Medical History: No H/O thyroid dysfunction, DM, HTN or any other significant medical history was found.

Past Surgical History: No history of any general, gynaecological or any other surgery.

Family history: No significant family history was found in this case.

Personal history

  • Ahara: Mixed, Katu and lavana rasa dominant ahara
  • Vihara: Student, Prolonged sitting (atiasana)
  • Nidra: Reduced
  • Mala: Unaltered
  • Mutra: 6-7 times/ day, Pale yellow
  • Vyasana Sambandhi: Coffee 5-6 times/ day and Day sleep (Diva Swapana)

General Examination

  • Built: Moderate
  • Weight: 71.2 kg
  • Height: 162.56 cm
  • BMI: 26.9kg/m2
  • BP: 120/80mm of Hg
  • Pulse Rate: 76 /min
  • Respiratory Rate: 16/min
  • Tongue: Uncoated

Dashavidha Pareeksha

  • Prakruti: Vata Kaphaja
  • Vikruti: Kaphaja
  • Sara: Madhyama
  • Samhanna: Madhyama
  • Pramana: Pravara
  • Satmya: Sarvarasa
  • Satva: Madhyama
  • Ahara shakti: Madhyama
  • Vyama shakti: Madhyama
  • Vaya: Yuva

Systemic Examination

  • CVS: S1 and S2 were normal
  • CNS: Patient was well oriented and conscious
  • RS: Normal vesicular breathing

Examination of Reproductive System

  • External genitalia: well, developed, no abnormality detected
  • PS and PV not done as patient was unmarried
  • B/L breast: Symmetrical, no lump, no tenderness
  • B/L nipples: Normal, no discharge

Laboratory Investigations

  • Hb: 12.8 gm%
  • RBS: 83.9 mg/dl
  • T3: 110 ng/dl
  • T4:4 µg/dl
  • TSH: 1.76 µIU/ml

USG: B/L PCOD.

Diagnosis: Artava Kshaya (Oligomenorrhoea)

Treatment given: Kusumasanjanani Yoga[7]

Dose: 10ml

Frequency: Thrice a day

Time of administration: Abhakta (before food)

Pathya Apathya Advised: Patient was advised to take Mudga Yusha, Tila Laddu, Yava Daliya, Yava chapati, boiled vegetables, papaya. She was advised not to take spicy, oily, fast food, packed food and dairy items like curd, milk etc. She was asked to do Vyayama, Pranayamas and Yogas according to her body’s ability daily.


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Observation and Results

Results were observed before and after treatment taking medicines and also one cycle after cessation of medicine. Marked improvement was observed on the duration of menstrual flow, amount of blood loss and interval between two menstrual cycles which are as follows:

Table 2: Showing observation before and after treatment

SN Parameter BT AT FU
1. Duration of menstrual flow 5 days 5 days 5 days
2. Amount of blood loss 3 pads/day 2 pad/day 2 pads/day
3. Interval between two menstrual cycles 60 days 40 days 30 days

Discussion

Artava Kshaya is a common disorder that occurs due to Vata and Kapha Dosha. The vitiation of Vata leads to the Gati of Dhatu[8] being disrupted which in turn affects the movement of Dhatus. It is believed that Vata is the main etiological factor that leads to all gynaecological disorders.[9] It is also believed that Avrodhaka properties of Kapha Dosha will lead to the formation of Strotorodha. Kapha Prakopa Ahara Vihara by Kapha Prakruti Stree leads to vitiation of Kapha Dosha mainly which can cause Meda Vriddhi. This event can hamper the menstrual cycle which is described by Acharya Sushruta as Yadhochitakaladarshanam.

Kusumsanjanani Yoga is having Japa, Jyotishmati, Durva and Kanji in it. These drugs are having Artavajanana properties like Ushna Virya and Kaphavata Shamaka which are the main cause behind Artava Kshaya. Due to Ushna Virya and Agneyatwa properties of Jyotishmati[10] clears the Sroto Avarodha and increases the blood circulation in the Yoni and Garbhasaya, because of this there will be formation of healthy endometrium. Because of increased circulation the uterus gets proper nutrition and becomes healthier and thus the menstrual cycles become regularized, there will be increase in quantity of Artava as well as duration of bleeding also increases. Due to Kanji’s Ushna Guna and Ushna Veerya, it destroys the vitiated Vata or Kapha or Vata-Kapha, Kanji is antagonistic to Ama and Meda, removes the blocks in the cell and channels of transportation and nutrition. Due to Amla Rasa of Kanji it acts as Deepana and gets rid

of Ama and also corrects metabolism,[11] that helps to improve quality of Ahara Rasa and it leads to the Saptadhatu Poshana which will again helpful for Artava formation as Artava is Upadhatu of Rasadhatu.

Conclusion

Although Aratava Kshaya is not directly explained in classics it has been described as a symptom of Artava Vikaras in many texts. In classics treatment is mentioned to keep Doshas in equilibrium. It can be achieved by Samshodhana and Samshamana Chikitsa. Hence for the present study Shamana line of treatment was selected as the medicines are easily available, palatable and cost effective. Kusumasanjanani yoga was found to be effective in Artava Kshaya like it has improved the duration, interval, flow of menstruation.

Reference

1. Susrutha, Susrutha Samhita, Nibandhasangraha commentary of Sri Dalhanacarya edited by Vaidya Yadavji Trikamji Acharya, Published by Chaukhamba krishanadas academy, Varanasi, Edition- 2008, Sutra sthana, chapter- 15, pg- 70, pp -824.

2. Sushruta Samhita, by Kaviraj Dr. Ambika Dutt Shastri, Ayurvedatatvasandipika Hindi commentary published by Chaukhamba Sanskrit Samsthaan Varanasi, Sharirasthaan chapter 2, shloka no. 5

3. D.C. Dutta Text book of Gynaecology including contraception, New Central Book Agency Kolkata Edited by Hiralal Konar, Reprinted-2009 Edition-6th, 8th chapter, Menstruation, pg-79, pp-627.

4. D.C. Dutta Text book of Gynaecology including contraception, New Central Book Agency Kolkata Edited by Hiralal Konar, Reprinted-2009 Edition-6th ,8th chapter, Menstruation, pg-79, pp-627

5. Howkins & Bourn, Shaw’s Textbook of Gynaecology 16th edition, VG Padubidri, SN Daftar chapter no. 32.

6. Charak Samhita, Hindi commentary Vidhyotni, Chaukhamba Bharthi Academy, Varanasi, 2014, Sutra Sthana 12th chapter, Shloka no. 8. Pg. 246.

7. Dasji shri Govinda, Bhaishajya Ratnavali Volume-3, Chaukhamba Sanskrit Bhawan; Chapter-67, Page no. 364


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8. Charak Samhita, Hindi commentary Vidhyotni, Chaukhamba Bharthi Academy, Varanasi, 2014, Sutra Sthana 18th chapter, shloka no. 49. Pg. 375.

9. Charak Samhita, Hindi commentary Vidhyotni, Chaukhamba Bharthi Academy, Varanasi, 2014, Chikitsa Sthana 30th chapter, Shloka no. 115.

10. Monika Sharma, Sahu Subash, Gallery of Medicinal Plants, 45th Chapter pg. no. 285,286.

11. Dr Raghuram Y.S. MD. (Ayu) Dhanyamla Dhara, Kanjidhara: Benefits 2016/03/02/http://easyayurveda.com


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