Management of Asrigdara - A Case Report

Deepa M. Nelaguddad; V Anupama

Management of Asrigdara - A Case Report

M. Nelaguddad D.^1*, Anupama V.²

DOI:

^1* Deepa M. Nelaguddad, Final Year Post Graduate Scholar, Department of PG Studies in Streeroga Evam Prasootitantra, Sri Kalabyaraveshwara Swamy Ayurvedic Medical College and Research Centre, Bangalore, Karnataka, India.

² V Anupama, Professor & HOD, Department of PG Studies in Streeroga Evam Prasootitantra, Sri Kalabyaraveshwara Swamy Ayurvedic Medical College and Research Centre, Bangalore, Karnataka, India.

Pradara is a combination of excessive bleeding per vaginum, dysmenorrhoea and lowback ache. Vataja Pradara being a type of Pradara mainly includes Ati Rakta Pravrutti along with Shula in Kati, Vankshana, Prushta and Shroni. On the basis of clinical symptoms, Vataja Pradara mostly simulates with Adenomyosis which is a benign condition and one among the causes of chronic pelvic pain in multiparous woman. Incidence of Adenomyosis is 0.14% and prevalence is 2.00%. Here is a case study of 34 year old female presenting with severe pain during menstruation and excessive bleeding since 4-5 years and her USG report shows bulky uterus with focal adenomyosis. In contemporary science hysterectomy is the only way to treat this condition but with Vataja Pradara line of treatment including Shodhana, Shamana and Matra Basti patient got significant relief from pain and excessive bleeding along with the improved quality of life.

Keywords: Vataja Pradara, Adenomyosis, Shodhana, Shamana

Corresponding Author	How to Cite this Article	To Browse
Deepa M. Nelaguddad, Final Year Post Graduate Scholar, Department of PG Studies in Streeroga Evam Prasootitantra, Sri Kalabyaraveshwara Swamy Ayurvedic Medical College and Research Centre, Bangalore, Karnataka, India. Email:	Deepa M. Nelaguddad, V Anupama, Management of Asrigdara - A Case Report. J Ayu Int Med Sci. 2022;7(7):163-167. Available From https://www.jaims.in/jaims/article/view/1937

Introduction

Adenomyosis is a benign condition of the uterus defined by the presence of endometrial glands and stroma > 2.5 mm in depth in the myometrium and a variable degree of adjacent myometrial hyperplasia, causing globular and cystic enlargement of the myometrium, with some cysts filled with extravasated, hemolyzed red blood cells and siderophages.^[1]

Here is a case study of 34 year old female presenting with severe pain during menstruation and excessive bleeding since 4-5 years and her USG report shows bulky uterus with focal adenomyosis. In contemporary science hysterectomy is the only way to treat this condition but with Vataja Pradara line of treatment including Shodhana, Shamana and Matra Basti patient got significant relief from pain and excessive bleeding along with the improved quality of life.

Review of Literature

Excessive expulsion/excretion of Rajas is termed as Pradara.

General Aetiology and Pathogenesis

Excessive consumption of Lavana (salt), Amla (sour), Guru (heavy), Katu (pungent), Vidahi (producing burning sensation), unctuous substances meat of domestic, aquatic and fatty animals, curd, Sukta (vinegar), Mastu (curd water), wine etc. aggravates Vayu. The aggravated Vayu withholds Rakta vitiated due to the above mentioned reasons, increases its amount reaching the Rajovaha Sira which further increases the Rajas (menstrual blood)

Vataja Pradara: Due to Ruksha Ahara-Vihara the aggravated Vayu with holds Rakta and leads to Vataja Pradara.

Characteristics of menstrual blood in Vataja Pradara: Frothy, thin rough, blackish or reddish or washing of Palasha flower

Clinical features of Vataja Pradara: Severe pain in sacral, groin, cardiac region, flanks, back and pelvis.^[2]

Adenomyosis

Definition: Adenomyosis is a condition where there is ingrowth of the endometrium, both the glandular and stromal components, directly into the myometrium.

Causes: The cause of such ingrowth is not known. It may be related to repeated childbirths, vigorous curettage or excess of oestrogen which produces cystic glandular hyperplasia of the endometrium. In some, only the basal endometrium, while in others the functional zone as well invades the myometrium

Pathology: The growth and tissue reaction in the endometrium depend on the response of the ectopic endometrial tissues to the ovarian steroids. If the basal layer is only present, the tissue reaction is much less, as it is unresponsive to hormones. But, if the functional zone is present which is responsive to hormones, the tissue reaction surrounding the endometrium is marked. There is hyperplasia of the myometrium producing diffuse enlargement of the uterus, sometimes symmetrically but at times, more on the posterior wall. The growth may be localized or may invade a polyp.

Clinical features: Menorrhagia, irregular bleeding and often post-menopausal bleeding may occur, variable degrees of pelvic pain, suprapubic swelling.^[3]

Case Study

A female patient aged 34 years, who is N\K\C\O Diabetes mellitus, Hypertension and Thyroid dysfunction, attained menarche at 13 years of age and was apparently healthy. She got married at 22 years of age and had two abortions [spontaneous at 2 months and induced at 3 months respectively] at 23 years of age. At the age of 24 years she delivered a male baby vaginally and said to be apparently normal for next 2 to 3 years. Then she re-joined to her work.

After that she started noticing changes in her menstrual cycle where she started experiencing excessive bleeding during menstruation and pain abdomen associated with lower back pain since one and half years which was hampering her day today activities till the extent she could not get up from the bed.

Hence for the same complaints she used to take Analgesic injections for pain relief which was temporary.

For the same complaints she consulted many Gynaecologists and was prescribed with T. DNG 2 mg for 3 cycles. After completing this medicine the patient went for follow up and was having heavy menstrual flow, for which the Doctor prescribed T. Primolut N 5mg for 15 days.

Even after taking these medicines the patient did not find any relief. Hence, she consulted to Sri Kalabyaraveshwara Swamy Ayurvedic Medical College and Research Centre, Bangalore.

Clinical Findings

Per Abdomen

Inspection

Contour - Flat

Umbilicus - Centrally placed, Inverted

Palpation

Soft, Tenderness in supra pubic and right iliac fossa

No organomegaly observed

Percussion: Tympanic

Auscultation: Normal Bowel sounds heard

Gynaecological Examination

Pelvic Examination

Examination of Vulva

Inspection: Pubic Hair - Normal
Clitoris - Normal
Labia - Normal
Discharge - Nil

Palpation: No palpable mass observed

Per Vaginal Examination

Cervix

Texture - Soft
Mobility - Mobile
Movement - Painful
Bleeds on touch - Absent
Lateral Fornices - Free, Non tender
Posterior Fornix - Tenderness +

Uterus (Bimanual Examination)

Position - Anteverted
Direction - Anteflexed
Size - Normal
Consistency - Firm
Mobility - Mobile
Tenderness - Present

Treatment with Results

Days	Complaints	Treatment
Day 1	Excessive bleeding, low back ache, lower abdominal pain	a) Jeerakarishta + Abhayarishta 2 tsp each/BD/AF *1 Week
Day 8	Same complaints	a) Cap. Coligo 1 tablet/ TID/AF b) Chandraprabha Vati 1 tablet / BD/AF 1/OD/AF/*30 Days
Day 15		Pushpadhanva Rasa 1 tablet/BD/AF/ *1 month
Day 30	Abdomen pain reduced	a) Tab. Styplon 2 tablets/BD/AF b) Pushyanuga Churna 50 gm Godanti Bhasma 25gm Pravala Bhasma 25 gm Chandrakala Rasa 20 tablets Chandraprabhavati 20 tablets (1 tsp/TID/ with honey & Tandulodaka/AF) c) Mahayogaraja Guggulu 2 tablets / BD/ AF d) Cap. Coligo 1 tablet/ TID/ AF * 20 days
Day 45	Pain abdomen still persists	Matrabasti with Sahacharadi taila for 7 days
Day 60	Patient feeling better	Virechana Deepana

Discussion

Mode of action of Rajah Pravartini Vati

Main ingredients are Hingu, Kumari, Tankana and Kasisa. Hingu (Ferula asafetida Linn) has Shoolahara (colic pain reliever) and Vatanulomana (facilitates downward movement of Vata) property which helps in normalizing the function of Apanavata. Hingu has antiflatulent and digestive properties and counteracts spasmodic pain and may suppress the secretion of progesterone hormone.^[4]

Kumari (Aloe barbadensis Mill) has bitter taste and is purgative, improves digestion. The cathartic properties of aloes are attributed to the presence of a mixture of glycosides called ‘aloin’.^[5] Kumari also contains beta-sitesterol and has the anti-prostaglandin. Cathartic property of this relives the obstruction in pathways of Vayu and thereby relives spasm.

Hingu, Tankana, Kasisa are Artavajanana drugs. Kasisa helps in Rakta Dhatu Vriddhi, which improve the uterine blood circulation, Balya (strength promoting to uterine musculature). Tankana is Garbhashaya Sankochaka (improves the tonicity of uterine muscle) drug helps in normal harmonization during contraction.

Abhayarishta: Haritaki is the main ingredient which possesses Kashaya Rasa, Laghu Ruksha Guna, Ushna Veerya and Madhura Vipaka. It is attributed for properties like Vata-Pitta Shamaka, Rakta Stambhaka, Rasayana, Garbhashaya - Shaithilyahara and Anulomana. It is mentioned as Pathya in all Yonirogas so that it maintains Prakrtavastha of Apana Vata.^[6]

Pushpadhanwa Rasa: It contains ingredients like Triphala, Arka, Ardraka, Vata, Haridra, Ashwattha, Dhattura, Shalmali, Nagavalli, Shuddha Gandhaka, Manashila, Naga Bhasma, Vanga Bhasma, Abhraka Bhasma, Tila Taila, Takra etc. The ingredients are mainly having Madhura, Tikta, Kashaya, Katu Rasa, Sheeta Veerya, Madhura Vipaka, Laghu Guna. Most of the drugs are attributed to the properties like Rasayana, Vrishya, Balya, Vata-Kapha Shamaka Karma. Dhattura, Nagavalli have shown the effective anti-angiogeni, anti-cancerous and metastatic activities. Most of the ingredients have shown the anti-cancerous and anti-proliferative activities.^[7]

Pushyanuga Churna: It is a well known formulation for the treatment of Pradara. Most of the drugs like Jambu, Rakta Chandana, Kutaja, Dhataki, Manjishta, Lodhra etc. act as Sthambhana because of Kashaya Rasa and Sheeta Veerya. Lodhra being a main ingredient contains loturine alkaloid in large quantity and spinosteral which are proven for anti-inflammatory activity. Some research studies claim that Lodhra might influence the endometrial prostaglandin apparatus, thereby acting effectively in the control of dysfunctional uterine bleeding.^[8]

Matra Basti with Sahacharadi Taila: Once Pakwashayagata Doshas get cleared, Vayu attains normalcy and Basti Chikitsa makes the vitiated Apanavata to move in a downward direction. It has the action upto the Nabhi Pradesha, Kati, Parshwa and Kukshi, thus pacifying the symptoms of Vataja Pradara. Sahacharadi Taila contains Sahachara, Ksheera and Tila. It has Ushna Virya and acts as Vata-Kapha Dosha Hara.

Virechana: According to Kashyapa, Asrigdara should be treated by Virechana. The predominant Dosha in Asrigdara being Pitta and also Raktadushti, Virechana serves as the best Shodhana therapy. According to Bhela, Virechana is useful in all types of Asrigdara. Apanavruta Pitta is one of the main cause leading to Asrigdara and Virechana helps to pacify the Apanavayu.

The present case was taken with an intension of highlighting the management of Asrigdara through Ayurveda and avoiding Hysterectomy in such an young age of 34 years. With the help of this approach, the patient’s quality of life improved wherein till the extent that she has improved from being bedridden during menstruation up to the stage of doing all her day today activities on her own, after completion of treatment patient had stopped the medications, inspite of her recent USG report which showed persistence of Adenomyosis.

Conclusion

Pradara is a common dominating disorder seen in society. Vataja Pradara being a type of Pradara mainly includes Ati Rakta Pravrutti along with Shula in Kati, Vankshana, Prushta and Shroni. On the basis of clinical symptoms, Vataja Pradara can be compared with Adenomyosis which is a benign condition. A 34 year old female had severe pain during menstruation and excessive bleeding since 4-5 years with USG report showing bulky uterus with focal adenomyosis. Patient was treated with Vataja Pradara line of treatment including Shodhana, Shamana and Matra Basti. Patient got significant relief from pain and excessive bleeding along with the improved quality of life.

Reference

1. Naftalin J, Hoo H et al. 2016 Association between ultrasound features of adenomyosis and severity of menstrual pain. Ultrasound Obstet Gynecol 47: 779-783

2. Agnivesha, Charaka, Dridhbala, Charaka Samhita, Chikitsa sthana, Yonivyapad chikitsa, 30/225, elaborated Vidyotini Hindi Commentary by Pt. Kashinatha Shastri and Dr.Gorakha Natha Chaturvedi, Part-2 Chaukhamba Bharti Academy, Varanasi, 2009; Pp. 870.

3. D C Dutta, Textbook of Gynaecology including contraception, edited by Hiralal konar, ed 5; New centrak book agency

4. Anonymous, The Wealth of India, Vol 3:D1, NISCAIR, New Delhi, 2009, Pp126

5. Anonymous, The Wealth of India, Vol 1A, revised edition, NISCAIR, New Delhi, 2010, Pp191-193

6. Dr Brahmanand Tripathi; Sharangadhara Samhita, Chaukhamba Surbharti Prakashan, Varanasi, Ed: Reprint 2011, purva khanda ch-4/3

7. Dash MK, Joshi N, Goutam DNS, New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian cancer : A review JOA XIII-3, 2019; 117-113

8. Devi K P, Clinical evaluation of Pushyanuga Choorna and Lodhrasava in Rakta Pradara (DUB), IJTK vol 6(3), July 2007, pp. 429-431

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-06-25	2022-06-27	2022-07-04	2022-07-11	2022-07-17
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	18%

Case Report

Asrigdara

Journal of Ayurveda and Integrated Medical Sciences