E-ISSN:2456-3110

Review Article

Stree Roga

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 4 April
Publisherwww.maharshicharaka.in

Role of Sthanik Chikitsa in Stree Roga

Choudhary M.1*, Rajpurohit D.2
DOI: http://dx.doi.org/10.21760/jaims.8.4.20

1* Malika Choudhary, Post Graduate Scholar, Department of Prasuti Tantra Evam Stree Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India.

2 Divya Rajpurohit, Post Graduate Scholar, Department of Prasuti Tantra Evam Stree Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India.

Healthy status of women is very much needed for society. In today's fast and competitive world, there is change in the lifestyle of women which leads to their physical and mental stress, women mostly gets affected by this environment and are prone to gynaecological problems. Womens always face very common gynaecological problems like white discharge, itching at vulva, foul smelling vaginal discharge, burning micturition etc. In such problems Sthanika Chikitsa has given excellent results and these local therapies should be practiced for admirable results in the above-mentioned gynaecological problems.

Keywords: Ayurveda, Sthanika Chikitsa, Stree Roga, Yonidhavan, Yonipichu, Yoni-Dhoopana, Yoni-Pariseka, Yoni Purana, Yoni-Lepana, Uttarbasti

Corresponding Author How to Cite this Article To Browse
Malika Choudhary, Post Graduate Scholar, Department of Prasuti Tantra Evam Stree Roga, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University, Jodhpur, Rajasthan, India.
Email: 		Malika Choudhary, Divya Rajpurohit, Role of Sthanik Chikitsa in Stree Roga. J Ayu Int Med Sci. 2023;8(4):116-121.
Available From
https://jaims.in/jaims/article/view/2265

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-02-23 2023-02-25 2023-03-04 2023-03-11 2023-03-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Malika Choudhary, Divya Rajpurohitand 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

Women’s health is the fulcrum not only for the healthy status for her family but rather to the whole society and to the nation. A girl must pass through different stages and several anatomical and physiological changes occur in her body to become a mature woman. There are many gynecological problems which usually occur in a female during her reproductive age. Most of the female related diseases belongs from the disturb functioning of genital tract. Diseases of women arise as a result of improper food and regimen. This results in the arrangement of three Doshas Vata, Pitta and Kapha. The most common symptoms of gynaecological disorders include pelvic pain, vaginal itching, vaginal discharge, abnormal vaginal bleeding. Depending upon the combination of the Doshas involved the diseases exhibit characteristic symptoms. Acharya has mentioned Chikitsa in two parts - Abhyantara Chikitsa and Sthanika Chikitsa. “Sthanika Chikitsa” means specific treatment given locally. Sthanika Chikitsa is beneficial when Sthanika Dosh-Dusti is more and it gives strength to respective Sthana. These local therapies have proved greatly beneficial in Stree Rogas if performed accurately. Although it is more of local treatment but their effect is systemic and capable of preventing complications of diseases consequently these are Para surgical because it doesn't involve the sharp instrument it helps to avoid impending major surgery consequently to diseases.

Materials and Methods

Our Acharyas very well know the mode of action of this Sthanika Chikitsa and describe the specific Sthanika Chikitsa according to different Yoni-Vyapad or vitiated Doshas.

These Sthanika Chikitsa (local therapies) are as follows.

  • Yoni Prakshalan
  • Yoni Pichu
  • Yoni Lepana
  • Yoni Poorana
  • Yoni Dhoopan
  • Yoni Varti
  • Uttar Basti


1. Yoni Prakshalana (Vaginal Douche)

Yoni Prakshalana is a procedure in which the vagina, vaginal passage, and mouth of uterus is washed with medicated decoction or other liquids. Dhawan means cleaning or purification of wound with water or other medicated material, Kwatha, Kshirapak, Siddha Jala, etc.

Sthana: Prathamavra Yoni (vagina)

Duration: 7 to 14 days after cessation of menses.

Position of patient during procedure: Dorsal lithotomy

Drugs used in the form of - Kwatha (Decoction), Oil, Kshirpaka (Medicated milk), Siddhjala (Medicated water).

Procedure: Patient advised to lie down in lithotomy position for procedure, sterile rubber catheter can be inserted into vagina and vagina is washed out with decoction. Vulva should be dried up with cotton after completion of procedure and procedure can be repeated as per requirements.

Indications

  • Yoni Strava - With Triphala Kwath, Karira, Dhava, Arka, Venu, Nimbi, Jambu, Jingini, and Sukta Kwath
  • Yoni Paicchilya - Rajavraksadi group of drugs.
  • Yoni Kleda, Dourgandhya - Aragvadhadi Gana Kwath.
  • Yoni Kandu - Guduchi, Triphala and Danti Kwath
  • Vatajaartvadushti - Sarala and Mudgaparni Kwath
  • Pittjaartvadushti - Gairika and Nimb Kwath
  • Kaphajartavadushti - Lodhra and Trikatu Kwath

Mode of action - The drugs used for Dhawana are antiseptic, have bactericidal action, wound healing property, alleviates pain. Drugs are absorbed through mucosa and blood circulation of vagina. Bactericidal actions of the drugs prevent bacterial growth and maintain the pH of vagina.

2. Yoni Pichu (tampons): Pichu or tampon is made up of cotton swab of size 2×3 cm (1 inch), wrapped with gauze piece and tied with long thread. It immersed in medicated it immersed in medicated Ghrita, Taila or Kashaya and placed in vagina. These preparations have two main functions Shodhana (purification) and Ropana (healing).


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Duration: 7-14 days after cessation of menses

Place: Pratham Avarta Yoni (Vaginal canal)

Pichu Dharana Kala: Aamutra Vega (Urge to urinate)

Position of patient during procedure: Dorsal lithotomy

Procedure: Ask the patient to pass urine before procedure and lie in supine position with knees flexed then Pichu soaked in medicated oil or liquid should be inserted into vagina with index finger of gloved hands. Thread of Pichu should remain outside the vagina so that Pichu can be removed easily.

Indications

  • Vataja Yoni Vyapad - Guduchyadi Tail Pichu,[4] Saindhavadi Tail,[5] Dashmoola Tail
  • Pittaj Yoni Vyapad - Ghrata Soaked Pichu, Pachavalkal Siddha Taila
  • Kaphaja Yoni Vyapad - Triphla Kashaya / Udumbara Kashay
  • Uppluta, Vipluta - Dhatkyadi Tail[6]
  • Uppluta, Vipluta, Vamin - Shallaki, Jingini, Jambu, Dhav & Panchvalkala Sidha Tail[7]
  • Putraghni Yonivyapada - Udumbar Siddha Taila
  • Garbhini - Madhur Aushadh Siddha Taila
  • Garbhastrava - Yashtimadhu Ghrita
  • Aparasang - Shatpushpa, Kushtha, Madanphal, Hingu Siddha Taila

Mode of action - Pichu helps in Shodhana Karma and thus removes slough. Oil used for Pichu strengthens the musculature of vaginal canal along with healing of wound.

3. Yonivarti (Vaginal suppository)

Varti is prolonged and long-lasting worthy can be used effectively in infections and also provides the opportunity to recreate the optimum vaginal health. Vartis (suppositories) which are made by mixing fine powder of drugs, adhesive drugs or binding agents. Varti should be prepared in a size of circumference of index finger and dried in shade. Prepared and well dried Vartis are wrapped in gauze piece and a thread is tied to it.

Duration: 2-3 hours


Size & shape: Tarjani Anguli Pramana (Index finger), Yavakara.[8]

Time duration: 1 Muhurta (48 min) or for short time period.[9]

Paschat Karma: Wash with luke warm water after 1 Muhurt (48 min.).[10]

Procedure: Expected part should be cleaned well then Oil smeared Varti should be inserted in such a way that the thread should remain outside. Up to retention period of urine Varti should be kept inside when patient felt urge of urine Varti should be removed and Yoni Dhawana with lukewarm water should be done.

Indications

  • Kaphaja Yonivyapada - Yava, Saindhav and Arkaksheer Varti
  • Karnini Yonivyapada - Kustha, Pippali, Arka, Rock Salt and Aja Mootra
  • Anartava - Ikshvaku, Danti, Madanphala, Kinva, Yavashooka, and Snuhiksheera
  • Yoni Paichhilya - Kasis, Triphala, Sphatika, Samnga, Lajjalu, Amrasthi, Dhatakipushpa
  • Vipluta Yonivyapada - Bile of Cow or Fish or Kinva Mixed with

4. Yoni Lepana (Vaginal Painting): The finely powdered is mixed with water or medicated liquid and paste with uniform consistency is made, and applied at affected area locally.

Type: Pradeh, Pralep, Aalep.

Timing: Until the Lepa dries.

Position of patient during procedure: Dorsal lithotomy

Procedure: Affected part should be cleaned and fresh prepared Lepa applied over affected part uniformly. Immediately after drying, Lepa should be removed as it may irritate the skin and can cause rashes or itching

Indications

  • Yoni Arsha - With powder of Tuttha, Gairika, Lodhra, Ela, Rasanjana, Harenu, Pushpakasis, salt mixed with honey.
  • Vivrutta Yonivyapada - With powder of Palashbeeja and Udambarphala mixed with Tila Taila and honey [11]

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Mode of action - Drug which use in Lepana have Kashaya Tikta Rasa so their actions are anti-inflammatory, antiulcer, anti-helminthic, astringent, slough of dead cell, improve blood circulation and promote new growth also provide strengthening. It helps in relieving pain and burning use with Sheeta Dravya.

5. Yoni Poorana (vaginal packing): Yoni Poorana means vaginal packing in which vagina covered/filled with pastes, oils and powdered medicine. Pastes (Kalkas) used mainly for this purpose for the management of inflammatory and infectious conditions.

Site: Prathamavart Yoni.

Time: after cessation of menses for 7 -14 days.

Position of patient during procedure: Dorsal lithotomy

Duration: Aamutra Vega (Urge to urinate).

Indications

  • Mahayoni - with fat of bear, crab or cock medicated with Madhura group of drugs
  • Prasansini Yoni - with Vesawara (minced meat or oleo mixed with drug)

Mode of action - Drug used for Mahayoni are fat of animals Acharya Charaka says that ''Sarvada Sarvabhavana Samanyam Vrriddhi Karnam'' so this theory prove that animal fat nourishes or helps in new tissue growth and strengthen pelvic musculature and also specify animal fat for Bhrista Yoni (uterovaginal prolapse).

6. Yoni Dhoopana (Fumigation of vagina with medicated smoke)

Yoni Dhoopana means fumigation of vaginal region with medicated smoke. Fumigation is done on wound, a part of the body or on the whole body depending on the need. Fumigation is the exposure till the action of smoke or of fumes of any kind as a means of disinfection or eradication. Yoni Dhoopana is also used for local disinfection of genital organs.

Site: Prathamavrta Yoni

Time limit: 10-15 min.

Procedure: A chair having hole in the middle is used and patient is asked to sit on this chair after voiding the urine, the Dhoopana Dravya are lit in Dhoopana apparatus which is placed

just below the chair, the smoke coming from Dhoopana drugs must reach up to external genitalia.

Indications

  • Yoni Kandu - Haridra and Brahati Dhoopana
  • Shweta Pradara - Dhoopana by Saral, Guggul, Yava, Ghrata
  • Garbh Sanga - Dhoopana by Sarp Nirmok and Katuk Alabu
  • Apra Sang - Dhoopana with Bhoj Patra, Kachmani, Katuk Alabu, Krit Vedhana, Sarsap
  • Sutika Paricharya - Dhoopana with Kushtha, Guggulu, Agar, Ghrita

Mode of action - Dhoopana increase vaginal temperature so increase blood supply & this rise temperature soothing affect which helpful in pain relief. Dhoopana also has drying effect; which causes reducing vaginal discharge & antimicrobial action thus helping in prevention infection. Drugs used in Garbhasang & Aprasang indicating its oxytocic action.

7. Uttar Basti: Uttar Basti is an important para surgical procedure among the 60 Karma as told by Acharya Sushruta, Acharya Charak and Vagbhatta has mentioned Basti as Ardha Chikitsa. Basti chikitsa is best for Vata Dosha. ''Uttarena Margena Va Diyate Va Shreshtham Api Uttarbasti'' (Ch.Si.9) Insertion of medicated oil decoction into Uttarmarga i.e., true the passage located above or in front part of anus that is vagina or urethra is known as Uttar Basti.

Time of administration - Ritukala (after menstrual bleeding stops / from 6th to 13th day of menstrual cycle)

Procedure: The patient is advised in dorsal lithotomy position. Cleaning with antiseptic solution done, cervix visualized with cusco’s bivalve speculum, the IUI (Intrauterine insemination) cannula connected with 5 ml syringe and filled with Medicated Ghrita / oil and very slowly the medicated oil or Ghrita inserted in uterine cavity.

Indication

1. Yonivyapada Chikitsa

  • Udavarta & Vatala - Traivritasneha
  • Arajaska & Putraghni - Ghrita medicated with the Kwath of Kashmari & Kutaja

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  • Aparasang - Sidharathakadi Taila

Tubal disorders

  • Tubal block - If block is due to adhesions Kshartaila Uttarbasti is beneficial
  • Hydro-salphinx - Nirgundi Taila, Yashtimadhu Taila, Til Taila are used to manage this inflammatory condition.

3. Endometrial condition - Sneha prepared from Bruhana Dravyas helps in improving endometrial thickness.

4. Cervical erosion - Triphala Ghrita, Shatavari Ghrita, Phala Ghrita are the commonly used.

5. Vandhytva - Phala Ghrita, Shatpushpa Taila, Lashuna Taila, Shatpak Taila, Bala Taila, Narayana Taila [12]

Contraindications: Cervical cancer, virginity vesico vaginal fistula hypersensitivity disorder.

Discussion

So, the probable mode of action of Sthanika Chikitsa

Prakshalan means cleansing, their all drug have cleansing, bactericidal and healing property.

Pichu provides muscle strength, stretchability & tissues nourishment, Yoni Purana is advised for where the whole vaginal epithelium affected and required large amount drug and prevent the uterus to descent from its position.

Yoni Lepana provides more surface area for absorption of drug, better increase bio-avability of drug due to semisolid consistency efficacy of Lepana relates to both inherent potency and the ability of drug to penetrate the dipper tissue.

Varti for cleansing pH maintains, Dhoopana for disinfection.

Uttar Basti for nourish endometrium, stimulate essential cervical secretion, remove obstruction. So, all these local therapies having above these property and rich blood supply in posterior fornix Sthanika Chikitsa effective in Yoni Vyapada and other Stree Roga.

Drug absorbed easily through vaginal route due highly permeable vaginal mucosa and rich blood supply on posterior fornix which clear by intravaginal drug delivery system.

Conclusion

Sthanika Chikitsa are cheap, safe, effective and with no adverse effect. Helps to treat various Yoni Rogas including Yoni Kleda, Yoni Strava, Yoni Paicchilya and Yoni Arsha. Different procedure needs different drug forms like Kwatha, Taila, Ghrita, Dhoom etc. Sthanika Chikitsa holds its own importance and show tremendous results when applied with proper indications, strict aseptic precaution and extreme carefulness.

References

1. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/115, edited by Pt.Kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.858.

2. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/61, edited by Pt. Kasinatha Sastri Dr. Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.849.

3. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/124, edited by Pt. kasinatha Sastri Dr. Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.856.

4. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/59, edited by Pt.Kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.849.

5. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/58, edited by Pt.Kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.849.

6. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter-30/78-81, edited by Pt. Kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.852.

7. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/61, edited by Pt. Kasinatha Sastri Dr. Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.849.


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8. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/72, edited by Pt.Kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.851.

9. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/71 edited by Pt.kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.851.

10. Agnivesa, Caraka, Drdhabala, Caraka Samhita, Vidyotini, Chikitsa Sthana chapter -30/71 edited by Pt.Kasinatha Sastri Dr.Gorakha Natha Chaturvedi, Chaukhambha Bharti academy, Varanasi, page no.851.

11. Sharangadgar Samhita, Acharya Sharangadhar, Jivwanaprad Hindi commentary, Dr Shailaja Srivastava, reprint edition:2015, Chaukhambha Orientalia Varanasi, Uttara Khanda, chapter 11/ 110, page 445

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