A conceptual view of Endometriosis through an Ayurveda Perspective

Neetu Singh; Rashmi Sharma

doi:http://dx.doi.org/10.21760/jaims.8.4.29

Endometriosis is one of the most mysterious and fascinating benign gynecological disorders defined by implantation of functioning endometrial tissue outside the uterine cavity. The prevalence is about 10 percent. However, prevalence is high amongst the infertile women (30–40%) as based on diagnostic laparoscopy and laparotomy. It is estrogen dependent condition hence increases due to high estrogen level in the body and regression occurs during pregnancy & after menopause. Women with endometriosis are usually confronted with one or both of the two major problems- pain and infertility. Pain includes dysmenorrhea, dyspareunia, and chronic pelvic pain. In Ayurvedic it can be correlate with Vataja Yonivyapada on the basis of two symptoms dysmenorrhea and chronic pelvic pain. It can be correlate with different Yonivyapada on the basis of other symptoms. Ayurvedic management can be done on the basis of Tridoshic theory in which Vata is responsible for displacement of endometrial cells from their original location in the uterus to places outside the uterine cavity. Pitta responsible for involvement of blood, hormones, and menstruation as well as the inflammatory nature of the disease. Kapha responsible for increasing buildup of cells and overgrowing much like a tumor. So treatment approach can be Ampachana & correction of Agni, Vaatanulomana, Mridu Virechana, Vatashamaka, Raktasravarodhaka, Granthihar and Lekhan Chikitsa, etc. Life style and diet modifications are also to be advocated as their role in the establishment of any disease cannot be ignored.

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Neetu Singh, Post Graduate Scholar, PG Department of Prasuti Tantra Evum Stri Roga, Dr. Sarvepalli Radhakrishnan Ayurved University, Jodhpur, Rajasthan, India.
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Neetu Singh, Rashmi Sharma, A conceptual view of Endometriosis through an Ayurveda Perspective. J Ayu Int Med Sci. 2023;8(4):173-176.
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2023-02-23

2023-02-25

2023-03-04

2023-03-11

2023-03-18

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Introduction

The most common sites are the ovaries, the cul-de-sac including the Uterosacral ligaments, peritoneum overlying the bladder, sigmoid colon, back of the uterus, intestinal coils and appendix.^[2] The exact cause is still not clear; however, several theories are explained like the implantation theory, metaplasia theory, lymphatic theory, and blood born spread theory, immune deficiency theory, and genetic theory and so on. The endometrium stroma and glands in the ectopic site has got the potentiality to undergo cyclical change. Proliferative changes are constantly evidenced, secretive changes are absent in ectopic endometrium. The periodical shed blood may remain encysted, the cyst becomes tense and ruptures. As the blood is irritant, there is dense tissue reaction surrounding the lesion with fibrosis. It produces adhesions and puckering of the peritoneum. There may be the formation of Chocolate Cyst. In spite of dense adhesion amongst the pelvic structure, fallopian tubes remain patent.^[3] Endometriosis is reported in the ovaries, uterine ligaments, recto vaginal septum, pelvic Peritoneum, laparotomy scars, vagina, umbilicus, hernia sacs, urinary tract, large and small intestine, appendix, umbilicus and rarely even in the pleura, diaphragm, arms, legs, kidneys etc. The clinical symptoms include nausea or vomiting and bloating, dysmenorrhea, dyspareunia, dysuria, dyschezia, lower abdominal pain, menorrhagia, irregular bleeding and chocolate cyst in later stages^[4] Although it is predominantly concluded that endometriosis has no cure or treatment. Ayurveda has detailed about the causes, factors that trigger endometriosis and therapies to recover from this condition.

Ayurvedic perspective of Endometriosis

In Ayurvedic it can be correlate with Vataja Yonivyapada on the basis of two symptoms dysmenorrhea and chronic pelvic pain.

It can be correlate with different Yonivyapada on the basis of other symptoms. Ayurvedic methods of diagnosis are not based on histological examinations rather on the clinical presentations. We can deduce that endometriosis is not a single entity from an Ayurvedic point of view. It can be compared with the following:

Endometriosis symptoms	Ayurvedic correlation
Chronic Pelvic pain	Vatika Yonivyapada
Menorrhagia	Rakta Yoni
Dysmenorrhea	Vatiki Yonivyapada or Udavarta Yonivyapada.
Dyspareunia	Paripluta Yonivyapada[5]
Infertility	Vandhya Yonivyapada,
Adhesions and Retroversion of uterus	Antarmukhi Yonivyapada.

Ayurvedic Pathogenesis: According to Ayurvedic physiology, Artava (the reproductive apparatus along with the menstrual blood and the ovum) is formed from the Rasa Dhatu (the first tissue formed after digestion and metabolism). When the food habits aren't the best, like an excessive indulgence is heavy, fried, oily, incompatible foods like fruits with milk, excessive junk food, non-vegetarian dominant or dairy dominant food, overeating, etc. Other contributing factors are sedentary lifestyle, habitual constipation, suppression of natural urges like urination and stools, excessive stress, environmental factors, and drug abuse leading to endotoxins or toxic metabolite formation in the Rasa Dhatu leads to improper nutrition as well as altered immune response in the reproductive system overall leading to excessive endometrial growth. These toxins termed as Ama in Ayurveda which cause Shrotorodha in the Artavahasrotasha leads to Vata Dosha Prakopa and Vatadosha Vimarggaman. Due to dysfunction in the normal movement of Vata Dosha (Apana Vata), there is a retrograde menstrual spill (reversed flow of menstrual blood) leads to these endometrial growths to implant in the other areas outside of the uterus.

Endometriosis - Imbalance of three Dosha’s
According to Ayurvedic classification, it is categorized under Tridosha imbalances under different circumstances. Overgrowth of cells is a Kapha imbalance. Since the location of the uterus and involvement of hormones as well as blood, it also indicates a Pitta imbalance. Since menstrual cycle involves movement it is also a Vata disorder. Imbalance of all three Doshas leads to endometriosis, more or less which indicates vitiation or lack of balance in Tridoshas. Tridosha role in endometriosis pathogenesis given in table below.

Doshas

Pathogenesis

Vata

The role of Vata is the displacement of endometrial cells from their original location in the uterus to places outside.

Pitta

Pitta problem because of the involvement of blood, hormones, and menstruation as well as the inflammatory nature of the disease

Kapha

Kapha problem due to the increasing buildup of cells and overgrowing much like a tumor

Mode of Treatment

Description

Ampachana & correction of Agni

Deepan-Pachan drug like Panchkol Churna, Ampachakvati, Chitrakadi Vati Agnitundi Vati, Sankh Vati, Vaishwanara Churna, Jirakadyarishta etc. can be used to promote Agni and for eleminatig Ama from Artavahasrotas i.e., removal of obstruction in the Srotas.

Vaatanulomana

Vatanulomak drug like Hingwastaka Vati, Hingwadi Churna, Avipattikara Churna, Abhayarista, Triphala Churna, Haritaki Churna, Trivrit Churna, etc. drugs which helps in decreasing Pratiloma Gati of vitiated Vata

Mridu Virechana

Mridu Virechana can be given to correct the Vatadosha Vimarggaman and to balance Pitta Dosha if there is any liver pathology involvement.

Vatashamaka

External oil massage with Vata pacifying oil like Bala Taila, Dhanwanthara Tailam, Sesame oil, etc. Yoga Basti procedure eliminate the Ama Doshas from body and balances the Vata Dosha. Drug formulation for Niruha Basti - (Dashmool Kwatha, Erandmuladi Kwatha etc.) and Anuvasana Basti - (Sahchar Taila Dashmool Taila etc.) can be given.

Raktasravarodhaka

Pradarantaka Rasa, Bolabaddha Rasa, Pradarari Rasa, Pushyanuga Choorna, Puskaraleha, Asokarishta, Lodhrasava, Patrangasava etc. which help in stopping bleeding and prevent formations of cyst.

Granthihar and Lekhan Chikitsa

Kanchnara Guggul having Antitumor activity. Varunadi Kashaya - Collection of Kapha removed by Bhedana Shigru leaf powder. Kumari - Bhedan, Kaphshamak and act on Liver. Manjishtha - Antitumor activity (Pitta Dosha) Gokshurdi Guggul - Anti tumour activity (if Kanchanar not work) Other drugs having antitumor activity like Sariva, Methika can be used.

Vednasthapan Drugs

Dashmoolarishta, Dashmool Kwatha, Ashokarishta, Maharashnadi Kashaya, Kumariasav, etc. can be used for pain relief.

Conclusion

The presence of endometrial-like tissue outside of the uterine cavity is referred to as endometriosis. It is a disease of theories.

Vitiation of Vata Dosha especially the Apana and Vyana Vata results in retrograde flow of menstruation and vascular spread of endometrial tissues. The ectopic implants of endometrium may get enlarged with subsequent menstrual cycles. Treatment approach with Ampachana & correction of Agni, Vaatanulomana, Mridu Virechana, Vatashamaka, Raktasravarodhaka, Granthihar and Lekhan Chikitsa, etc. with life style and diet modifications endometriosis can be treated.

Reference

1. DC Dutta’s text book of Gynecology including contraception edited by Hiralal Konar published by Jaypee Brothers Medical Publishers (P) Ltd, Seventh edition 2016. 22nd chapter pg 248.

2. Howkins and Bourne Shaw’s text book of Gynaecology edited by V.Padubidri and Shirish N. Daftary, Published by B.I. Churchill Livingstone Pvt Ltd, Eleventh edition 1994, 32nd chapter pg 526.

3. Endometriosis. Women’s health.gov. 13 February 2017. Retrieved 20 May 2017.

Review Article

Endometriosis

Journal of Ayurveda and Integrated Medical Sciences