E-ISSN:2456-3110

Review Article

Rajonivrutti

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 5 June
Publisherwww.maharshicharaka.in

Rajonivrutti Evum Rasayana

Kale T.1*, Gholap S.2
DOI:

1* Tapaswi R. Kale, Post Graduate Scholar, Dept. of Prasuti Tantra & Stri Roga, SMBT Ayurvedic Medical College and Hospital, Nasik, Maharashtra, India.

2 Sameer S. Gholap, PG Guide & Assistant Professor, Dept. of Prasuti Tantra & Stri Roga, SMBT Ayurvedic Medical College and Hospital, Nasik, Maharashtra, India.

Menarche, puberty, pregnancy, parturition, menopause are very important biological phases of female life. The term menopause is the used in the females who undergoes the hormonal change. This is the end of the reproductive stage in the women, during this phase menstruation and ovulation ceases. Similar hormonal changes occur in male too, that is termed as Andropause. About one third of life span has to be spent without menstruation. For so long period a woman cannot afford estrogen replacement especially because of its side effects and complications. That’s why we have to search for better and safer options. Here in this paper endocrine physiology and possible management through Ayurveda will be discussed in brief. At the same time scopes of Rasayana is also explored.

Keywords: Ayurveda, Rajonivrutti, Menopause, Rasayana, Rejuvenation

Corresponding Author How to Cite this Article To Browse
Tapaswi R. Kale, Post Graduate Scholar, Dept. of Prasuti Tantra & Stri Roga, SMBT Ayurvedic Medical College and Hospital, Nasik, Maharashtra, India.
Email: 		Tapaswi R. Kale, Sameer S. Gholap, Rajonivrutti Evum Rasayana. J Ayu Int Med Sci. 2022;7(5):108-114.
Available From
https://jaims.in/jaims/article/view/1816

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-04-28 2022-04-30 2022-05-07 2022-05-14 2022-05-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Tapaswi R. Kale, Sameer S. Gholapand 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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Introduction

Menopause is generally defined as the cessation of menses for period of 12 months or a period equivalent to three previous cycles or the time of cessation of ovarian function resulting in permanent amenorrhea.[1] During reproductive years, women are protected by female hormones, oestrogen and progesterone.

In menopausal women, an oestrogen deficient phase accelerates the aging process resulting in symptoms of menopause with decreasing life expectancy. Also, Regression of ovarian function occurs, causing depletion of primordial ovarian follicles resulting in symptoms of menopause with decreasing life expectancy. Also, Regression of ovarian function occurs, causing depletion of primordial ovarian follicles resulting in diminished oestradiol levels. These diminished hormonal levels lead to the various symptoms seen in menopausal phase which includes vasomotor symptoms like hot flushes, night sweats, headache, insomnia, dizziness, etc. Psychological symptoms include mood swings, anxiety, depression, irritability, etc. Other symptoms include loss of libido, dyspareunia, osteoporotic changes as well as cardiovascular changes.[2]

In Ayurveda the context of menopause is depicted as “Jara Pakwa Avastha” of body and Rajonivrutti. According to Acharya Sushruta and various other references, 50 years is mentioned as the age of Rajonivrutti.[3] Rajonivrutti Janya Laksana is a group of symptoms produced by degenerative changes in the body. Degenerative changes are explained in Ayurveda as Dhatukshaya Lakshana. Vata Dosha dominance is seen in the later stage of life. On other hand menopause is also associated with Vata Dosha dominance stage of life, therefore symptoms in menopausal phase like insomnia, anxiety, urinary symptoms, osteoporotic changes are due to dominance of Vata Dosha. Along with that Pitta Dosha symptoms like hot flushes, irritability, Gaining in body fat, particularly abdominal weight gain is Kapha Dosha etc. are seen, during this phase.

To overcome the degenerative process of the body tissue, Acharyas have described Rasayana Chikitsa. Rasayana includes drugs which promotes longevity and improve the quality of life. Thus, an effort is being made here, to study Rasayana

therapy, on Menopausal syndrome, conceptually, based on Available information in Ayurvedic texts and other contemporary resources.

Aims and Objectives

1.To study, understand and compile Rajonivrutti Janya Lakshana from Ayurvedic classic texts.

2. To study menopausal symptoms according to modern science.

Methodology

Modern concept: Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity. It is the point of time when last and final menstruation occurs.

Endocrinal Changes[4]

First change in ovarian function is failure in ovulation or absent or deficient corpus luteum formation that’s why the first hormone to become deficient intermittently is progesterone. While reduction of plasma estradiol in premenopausal women stimulates negative feedback mechanism of the hypothalamus and pituitary causing raised follicle stimulating hormone (FSH) which is the most characteristic endocrinal change and the first detectable sign of approaching menopause. There are three phases of endocrinal changes at climacteric as follows:

Phase I: Hypothalamic Pituitary Hyperactivity

  • Starts 5 to 15 years before menopause
  • Compensatory for increased resistance of ovarian follicles and reduced follicular hormone secretion
  • Evidenced by elevated FSH and later luteinizing hormone (LH) associated with hot flushes. The pituitary become exhausted in late menopause.

Phase II: Ovulation and Corpus Luteum Failure

  • Anovulatory cycle and shortened luteal phase
  • Deficient progesterone and unopposed estrogen secretion may lead to abnormal uterine bleeding (AUB), endometrial hyperplasia.

Phase III: Ovarian Follicular Failure

  • Failure in follicular development leads to reduced estrogen.

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  • Ovarian stroma remains active along with adrenals produce androstenedione and testosterone. Estrogen produced by peripheral conversion.

Menopausal Symptoms

Apart from cessation of menstruation some of following symptoms may appear in different women:

1. Vasomotor symptoms- including hot flashes, night sweats, and flushing

2. Urogenital symptoms

3. Osteoporosis and fracture

4. Cardio-vascular disease

5. Cerebrovascular disease

6. Psychological changes

7. Skin and hair

8. Breast changes

9. Sexual dysfunction

10. Ophthalmic dysfunction

11. Dementia and cognitive decline.

Diagnosis of Menopause[5]

1. Cessation of menstruation for consecutive 12 month during climacteric.

2. Appearance of menopausal symptoms “hot flush “and “night sweat”.

3. Vaginal cytology - showing maturation index of at least 10/85 /5 (feature of low estrogen)

4. Serum estradiol; 40 mlU/ml (three value at weeks interval required)

Ayurvedic concept of Menopause

Human life span is grossly divided into 3 stages in literature, namely Balyavastha, Madhyamavastha and Vrudhvastha which are dominated by Kapha, Pitta, Vata respectively. Achaya Sushruta also classified Madhymavastha in 4 groups - Vrudhi, Yuwa, Dhatu Sampurnata, Kshaya. In all contexts of Ayurvedic literature the age for Rajonivrutti is stated around 50 years. Rajonivrutti is phase where women pass from Madhyamavastha to Vrudhavastha. Sushruta Acharya has explained that there is Shareera-Shaithilya (weaking of tissues) in

Vrudha-Avastha. This stage of life is dominated by Vatadosha, this affects the female body. The dominant Vata Dosha specially with Laghu and Ruksha Guna results in reduction in Dravata of Rasa Dhatu. This further leads to Dhatukshya starting from Rasa Dhatu, further respective Updhatu Kshaya takes place. Thus, leading to Artava Nasha (amenorrhea). The vitiated Vata Dosha also disturbs the other Sharira as well as Manas Dosha (Raja and Tama Dosha) leading to various psychological disturbances. Thus, according to Ayurveda, we can make a correlation between the different menopausal symptoms seen in the body.

Following are some probable causative factors for Rajonivrutti.

Swabhava[6]

Natural phenomenon are names under this heading. “Swabhava" as a causative factor in a generalized way. Nothing is eternal in universe and thus production of Rajah and then its declining nature is Swabhava. It can’t be explained by Karya-Karana Bhava. Thirst, hunger, sleep, aging and death are Swabhavik Vyadhis described by Sushrutachyara

Kala[7,8]

The "Vaya" is described on the basis of Kala. The characteristics of particular age or the changes taking place in different stages of age have to attribute to the Kala. Acharya Charaka beautifully explains that the same foetus after passing of sometime becomes child, young and old. Thus; it is clear that after a specific time, female body manifest "Rajonivritti" at the age of 50 years then process of aging starts.

Dhatukshay[9]

Leads to Vata vitiation. With advancing age, progressive vitiation of Vata due to its fundamental properties of Ruksha (Unctuousness), Chala (unstable), Laghu (light), Bahu (talkativeness), Shighra (quick) and Sheeta (cold), further precipitates the Soshana and Kshaya (involution and atrophy) of different Dhatu. This degeneration manifests as Indriya Kshaya (loss of this perceptive powers of sensory organs), Bala Kshaya (loss of strength) and Virya Kshaya (loss of reproductive strength). This may explain various symptoms of menopause related to degenerative changes in body such as urogenital atrophy, thinning of the membranes of the vulva, vagina, cervix,


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and also of the outer urinary tract, shrinking and loss in elasticity of all of the outer and inner genital areas and skin, breast atrophy, decreased libido, problems reaching orgasm and dyspareunia or painful intercourse.

Karma[10]: Ayurveda has considered Karma as a generalized factor for any activity. Karma is considered by two ways. First is Purvajanmakrita and other is, Aajanmakrita (Karma of this life). The prior is responsible for many things, because the science believes in the concept of Atma and Punarjanama. The later one has a direct relationship between Karana and Karya, which includes all the Pragyaparadhas for diseased condition and vice a versa.

Abhighata[11]

Acharya Sushruta has mentioned that the Viddhata of the roots of Artavavaha Srotas i.e., Garbhashaya and Aartavavhi Dhamanis (uterus and uterine or ovarian arteries) will lead to Artavanasha. This Viddhata may take place due to any direct or indirect trauma (Abhighata) to the Artavavaha Srotas, and will directly lead to Artavanasha and manifests as Akalaja Rajanivritti.

Vitiated Vata Dosha

"Vayu" as an active substance in the body, which is assumed to be a major factor behind initiation of every process. Vayu is responsible for Rajah Utpatti as well as its cyclic expulsion at every month. Hence, it can be considered as a causative factor for Rajah Nivritti also, and any vitiation of these factors may alter this process. Vitiated stage Vayu in the body is very well understood in the case of Rajonivritti. Factors like Vriddhavastha, generalized Dhatukshaya, generalized Rukshata and Shosha will lead Vatavriddhi. Hence, a vicious cycle will come into play and all the functions of Vata will be affected including Rajah Utpatti, which may be manifested as Rajaonivritti. In this way, Vayu is responsible for Rajonivritti.

Types of Rajonivritti

  • Kalaja Rajonivritti
  • Akalaja Rajonivritti

Lakshanas of Rajonivritti [12]

As there is no direct reference available regarding Lakshanas of Rajonivritti in the Ayurvedic classics, the clinical symptoms manifested

by the patients of Rajonivritti have to be considered and can be grouped under following Ayurvedic parameters.

Table 1: Rajonivrutti Lakshana classified as per Doshas.

Doshaja Vataja Pittaja Kaphaja
Shira Shula Hrud Spandandhikya Hasta Pada Supti Shabdasahishnuta Balakshyaya Adhmana Bhrama Katishula Sandhivedana Anidra/ Alpanidra Ushnanubhuti Daha Swedadhikya Ratrisweda Trisha Yonidaha Mutradaha   Hrud-Dravata Angmarda Raukshya Bhrama Shaithilya
Sharirika   Rasakshaya Shabdasahatva Hriddravatva Shula Shrama Shosha Trisha.
Rakta Kshaya Twaka Rukshata Sira Shaithilya.
Mamsa Kshaya Sphik-Gandadi Shushkata Toda Rukshata Glani. Sandhisphutana Sandhi Vedana Dhamani Shaithilya
Meda Kshaya Anga Rukshata Shrama Shosha Krushata.
Asthikshaya Asthitoda Danta-Nakha-Kesha-Roma (Rukshata /Shatana) Sandhishaithilya.
Majja Kshaya Asthi Saushirya Asthi toda Daurbalya Bhrama Tamodarshana Sandhi Shunyata.
Shukrakshaya Yoni vedana Shrama Daurbalya Panduta
Mansik Krodha, Shoka, Bhaya, Dwesha, Smriti Hras, Utsaha Hani, Dairya Hani, Shirah Shula Vishada, Chinta, Medhahras, Alpa Harsha and Priti Parakramahani

Fig. 1: Probable Samprapti of Rajonivritti.

Svabhava, Kala, Vayu, Jara, Karma

↓

Acts on Vata Pitta Kapha

↓

Sapta - Dhatukshaya

↓

Upadhatukshaya

↓

Aartavanasha

↓

Antaha Pushpakshaya + Bahyapushpakshay

↓

Rajonivritti


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Management: Before deciding upon a treatment, the physician should minutely examine and determine, Dushya (the Dhatu and Mala involved), Desha (the area of the body where disease is manifested, the living place of the patient), Bala (strength of the patient), Kala (season, how old is the disease, age of the person etc.), Anala (digestive power of the patient), Prakriti (Body constitution), Vayas (age of the patient and disease), Satva (mind, tolerance capacity of the patient), Satmya (The food and activities to which the patient is accustomed to), Ahara (food habits) and Avastha (stages of the diseases) of the patient and then only should decide the appropriate treatment.[13]

A unique concept of Ayurveda is Rasayana therapy, it is known to cause reversal of age and physiology.

Rasayana Chikitsa is mainly used for maintaining the health of healthy individuals although it can be used for diseased also.

These Rasayana cleans and activate the micro-circulatory channels i.e., Sroto Shuddhi leading to improved tissue health and their quality.[14]

Appropriate applications have potential to ward off problems related not only to aging and natural menopause but also in menopausal symptoms induced due to surgical, medical and other reasons.

Acts through mechanism of Rasa-Samvahan (circulation of nutrient juices), Dhatu, Agni and Srotas, it nourishes bodily tissues through micro- nutrition, thus helping in regeneration, revival and revitalization of Dhatu.

Table 2: Showing action of Rasayana Aushadhi at different levels in body. 

Acting at all levels of Rasa Draksha (Vitis vinifera Linn.), milk, Shatavari (Asparagus racemosus), Salparni (Desmodium gangeticum) etc. Enriching the nutritional value of the circulating plasma
At the level of Agni Pippali (Piper longum Linn.), Haritaki (Terminalia chebula), Citraka (Plumbago zylenica), Digestion and metabolism, digestion, absorption and metabolism, and has some anabolic effect.
At the level of Srotamsi Guggulu (Commiphora mukul), Pippali (Piper longum Linn.), Rasona (Allium cepa) The microcirculatory channels carrying nutrition to the tissues

Aushadha Rasayana: Some of the Rasayan Yoga (formulations) that may be helpful is Ashwagandha Rasayan, Hartitaki Rasayan, Amalki Rasayan, Pippali

Rasayan, Vidanga Rasayan, Shilajatu Rasayan, Triphala Rasayana, Vardhman Pippali Rasayana etc. They can be used in menopausal women for various indications.

Ahara Rasayana: Ahara is Dhatuposhak and Dhatu is responsible for the maintenance of compactness and strength, Dhatu reflects in the terms of Sara.[15]

Agnimandya, Ama generation and accumulation are major problems faced in menopause to conquer them diet becomes easier and more important.

Menopausal women should refrain from Vata vitiating food. Laghu (light) and Santarpaka (nutritive) diet is recommended. Packaged, processed, frozen, canned food and erratic food habits should be avoided.

Achara Rasayana[16]

Achara Rasayana (social and personal code of conduct) is unique concept of socio-moral and behavioural therapy which is preventive in nature. It is a non-pharmacological approach by which one can acquire the Rasayana effect. It broadly includes personal and social behaviour and Sattvika Ahara.

  • One should maintain inner peace, maintain cleanliness of body and mind, do Japa, control his senses, and give up exhaustive exercises and practice to be free from Ahamkara (ego).
  • About social behaviour it has been said that one should always speak truth, do not show anger, have sympathetic behaviours to others, remain conscious about the change of body and environment etc.
  • State of mind such as greed, hate, and dullness cause Doshic imbalances and lead to a state of Vikriti (diseases).
  • From the options presented, evaluation based on Rogi-Roga Pariksha (examination of the patient as an individual irrespective of his disease and examination of the disease entity/disease state) specific drug and therapeutics can be selected as per individual needs.

Discussion

Dhatu Kshaya, Vaat vitiation, Kaala, Vaya all factors manifests to transition in menopausal phase, which may pass uneventful in most women.


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At the Dosha level, this involves transition from Pitta dominant phase to Vata dominant phase of life; while aging and natural menopause are different processes but the consequences of each are similar.

To prevent or to reduce the symptoms Vayahsthapan, Vajikar, Balya, Rasayana, Vata-Pitta pacifying drugs provide a vast range of options. For research purpose principles and philosophy of Ayurveda must be kept under consideration.

A condition such as surgical menopause or premature menopause occurring due to genetic or medical reasons, where menopause occurs before the age of 40 years and is not a part of natural aging process, requires the need to distinguish between chronological age and endocrinal change.

Assessment using elaborate methodology of Rogi Roga Pariksha and deciding therapeutics based on Ayurveda. Beyond HRT, Ayurveda for Menopause and Associated Aging Problems, International suggested treatment modalities can be used without any untoward effects for these individuals also. Further, women having menopausal symptoms are led to believe that estrogen decline must be replaced and medical intervention is needed. In majority of such women, the depletion of estrogen which occurs during menopause does not need to be replaced; estrogen is only required for women who have significant menopausal symptoms due to deficiency of the hormones. Understanding age related changes and Dosha involvement at individual level a timely intervention may help such individuals and prevent symptoms also.

Conclusion

Ayurveda and modern medicine have basic epistemological differences. Ayurvedic wisdom and logic is more health-oriented than disease-oriented. Started during midlife as component of preventive health care, management of menopausal symptoms based on Ayurvedic principals can not only reduce the menopausal symptoms but can also effectively address the aging and allied problems. It can improve the quality of life as well as life expectancy of aging female population. It provides wide range of treatment options in the form of single herbs, formulations, therapeutic procedures and life style modifications, which can be utilized as per individual needs. Single drugs given under

Jeevaneeya, Vayahstapan and Balya Mahakashaya, formulations and Rasayan Yoga, Ghrita Yoga and Achara Rasayana, Aahar Rasayana opens new avenues for scientific researches. Although menopausal syndrome does not find mention in Ayurvedic literature, todays growing population of suffering female prompts us to look for effective and safer alternatives. It is not possible to name each and every disease; it is the responsibility of the physician to identify the nature, sign and symptoms of presenting ailment and treat it accordingly.

Reference

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2. Ash Monga, Stephen Dobbs, Gynaecology By Ten Teachers, 19th edition, 2011; 167

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11. Dr. Anant Ram Sharma, Sushrut samhita with Sushrutavimarshini hindi commentary, Choukhamba Surbharati prakashan, Varanasi, First editon, 2001; sha.9/2.

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14. K. K. Dwivedi, M. Paul, P.B. Behere and R.H. Singh. The concept of Aging in Ayurveda Ancient Science of Life, Vol No. XIV Nos. 3 and 4, January – April 1993, Pages 377 – 387

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