E-ISSN:2456-3110

Review Article

Asrugdhara

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

Asrugdhara - A treatment approach through traditional Rasa Chikitsa and Ekamoolika Prayoga

Swaminath M.1, S Hiremath R.2*
DOI: http://dx.doi.org/10.21760/jaims.8.5.26

1 Meenu Swaminath, 3rd year Post Graduate Scholar, Department of Rasa shastra & Bhaishajya Kalpana, BM Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka, India.

2* R S Hiremath, Professor & HOD, Department of Rasa shastra & Bhaishajya Kalpana, BM Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka, India.

Introduction: To make the Ayurvedic physician more aware of menorrhagia and how they can serve a role in their patient’s care and education since women make up 60% of the population seeking ayurvedic natural care. In Ayurvedic classics, Menorrhagia is termed as Asrugdhara, means excessive discharge of blood per vaginum. Backache, pain in lower abdomen and weakness are also present in this disease. Materials & Method: A review of the ancient literature on menorrhagia was conducted. Items that were retrieved were synthesized and interpreted in order to give the best information to practise with easy way. Discussion: Most of the information available relative to menorrhagia is medically oriented. In this article included the role of Rasa preparations and easily available Ekamoolika Prayoga that can be practised in house hold level. Conclusion: Along with the proper knowledge of the disease and diagnosis, the ayurvedic treatment helps to cure the Asrugdhara in all age group of women. The patients have to be made aware the importance of following various regimen and easy traditional Ekamulika Prayogas to get the maximum result.

Keywords: Menstruation, Menorrhagia, Ayurveda, Asrugdhara, Traditional, Ekamoolika, Rasoushadhies

Corresponding Author How to Cite this Article To Browse
R S Hiremath, Professor & HOD, Department of Rasa shastra & Bhaishajya Kalpana, BM Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka, India.
Email: 		Meenu Swaminath, R S Hiremath, Asrugdhara - A treatment approach through traditional Rasa Chikitsa and Ekamoolika Prayoga. J Ayu Int Med Sci. 2023;8(5):159-164.
Available From
https://jaims.in/jaims/article/view/2424

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-27 2023-03-29 2023-04-05 2023-04-12 2023-04-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil 16%

© 2023by Meenu Swaminath, R S Hiremathand 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

Menstruation is the most important stage of a woman’s life. It is the starting celebration of youth and. but due to unhealthy life style, hormonal imbalance, young girls below 10 years also getting abnormal menstruation and bleeding. Disturbance of menstrual bleeding is a major problem for women for high percentage of gynaecological outpatient visits. It may be associated with physical and psychological factors. Menstruation is the cyclic discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. Age of onset of menstruation is known as Menarche (between 12-15 years of age). This is a cyclical process occurs due to the rise and fall of hormones.

The event occurs in menstrual cycle is the thickening of the endometrium of the uterus, and the growth of an ovum. The ovum is released around day fourteen in the cycle from an ovary. The thickened endometrium of the uterus provides nutrients to an embryo after implantation and if pregnancy does not occur, it is released and known as menstruation. Menstrual cycle is a coordinated effect of hypothalamus, pituitary, ovary and uterus. Alterations in anyone of these factors will cause failure of sexual maturation, absence of menarche and menstrual irregularities. Disturbance in the normal ovulatory cycle may lead to menstrual disturbance and also may cause infertility and abortion. Besides hormonal disturbance menstrual irregularity may also result from pathological conditions like fibromyoma uterus, adenomyosis and cervical lesions. Early treatment of these disorders would be helpful in prevention of anaemia infertility other complications and maintenance of good health by preventing heavy blood loss.

The commonest type of menstrual irregularity is menorrhagia. Menorrhagia is menstruation at a regular cyclical interval with excessive flow and duration; clinically, blood loss is in excess of 80 ml per cycle; or menses lasts longer than 7 days. the bleeding starts on schedule, but it is heavier than usual and may last longer than usual. it is one of the most common complaints in contemporary gynaecology. Asrugdhara is defined as excessive menstrual bleeding for prolonged duration and / or scanty intermenstrual bleeding for a shorter duration denoting the features of specific Dosha.[1]


Asrugdhara and Pradara are synonyms which include all types of bleeding disorders. Though various treatment modalities are available instant relief is needed to get rid of this condition. Rasoushadhies (herbo-mineral drugs) can be administered in smaller dosage, palatable, accessible in time. Rasoushadhies are recommended in minute doses/trace or ultra-trace amounts (Alpa/Swalpa Matra) and since these are inorganic in nature most often, they are tasteless hence not poses any problem of palatability or acceptability. Apart from this they are said to metabolise quickly and the metabolites after exerting their action however small the dose given, show a broad-spectrum activity also removed from body quickly. Ekamoolika Prayoga (single drug therapy) has been practising from long back. Along with the proper treatment protocol it is an add on therapy. Since Asrugdhara needed a quick result in treatment Ekamoolika Prayoga with herbal and mineral drugs giving excellent result has been comprised in this article.

Materials and Methods

Ayurvedic formulations are classified into two groups i.e., Kashtha Aushadhi, only plant material is used in formulations and Rasa Aushadhi, predominantly metals and minerals are used in formulations. Rasa Shastra, an integral part of Ayurveda chiefly covers the entire field of inorganic pharmaceutical preparations (metallic and non-metallic compounds) of Ayurvedic Materia Medica. Different types of Kalpanas (formulations) like Kharliya Rasa, Bhasma, Pishti, Parpati, Potali, Kupipakva Rasayanas are made out of various minerals and organic poisons mentioned under various groups: Rasa, Maharasa, Uparasa, Sadharana Rasa, Ratna, Upratna, Visha, Upvisha. The manufacturing procedure of Rasa Aushadhies is very exhaustive and involves complicated steps like Shodhana (Cleaning), Bhavana (levigation), Mardana (trituration) and Marana (incineration) as internal administration of metals and minerals in unprocessed or misprocessed form can prove toxic. Rasa Aushadhies are appreciated as they are therapeutically effective in Alpa Matra (low dose). The Rasa Dravya swiftly undergo various Pharmacodynamics and Pharmacokinetics in our body called Samskara and have high efficacy. The herbomineral formulations possess longer shelf life due to their micronized preparation.[2]



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Nidana[3,4]

As per Modern Hormonal - Anovulation, Hypothyroidism
Mechanical - Cancer, Endometriosis, Endometritis
Clotting Abnormalities - Vitamin K Deficiency, circulating inhibitors of coagulation
As per Ayurveda Charaka Samhita - Excessive intake of salt, sour, heavy, hot, bitter food which produce burning sensation, unctuous substances, meat of domestic, aquatic and fatty animals, dish prepared with rice and pulses, rice cooked with milk, Curd, Sukta (Vinegar), Mastu (Curd water) and wine.
Sushruta Samhita - Pittavrita Apana Vayu
Ashtanga Sangraha - Increase in amount of blood (Ativridhi of Rakta).
Ashtanga Hridaya - Pittavrita Apana Vayu
Kashyapa Samhita - Pittavrita Apana Vata & Ativridhi of Rakta.
Madhava Nidana, Bhava Prakash, Yoga Ratnakara - Incompatible diet and wine, eating before the previous meal is digested, indigestion, abortion, excessive coitus, riding, walking, grief, emaciation, weight lifting, trauma and day time sleeping.
Harita Samhita - Milk carrying channels of infertile women are filled with Vata.

Pathogenesis

Intake of etiological factors

↓

Vata aggravated and Rakta vitiated

↓

Vitiated Rakta is increased in amount by aggravated Vata

↓

Increased Rakta reaches to Rajovaha Siras of uterus

↓

Increase in amount of Rajas immediately

↓

Excretion of excess amount of Rajas

↓

Asrugdhara or Pradara 

As per Ayurveda, Asrugdhara is divided into 4 types - Vataja, Pittaja, Kaphaja, Sannipataja. In the Samprapthi of Asrgdhara, Acharya Charaka specifically mentioned Pitta Pradhana Tridosha Dusti leading to Rakthavrddhi (increase in blood) due to Pittavruddhi by its Dravatva (liquidity) Guna along with Apana Vata Dusti leading to Rajo Vaha Sroto Dusti. The Vyana Vata Dusti causes alteration in the ratio of endometrial prostaglandins and disturbance in HPO axis, also the Pitta Dusti

cause disturbance in endometrial blood vessels and capillaries. Eventually these all factors cause excessive and prolonged bleeding leading to Asrgdhara.[5] There will be excessive flow and prolonged duration, with or without menses mid-menstrual bleeding. All types of Asrugdhara associated with body ache and pain.

Classification

Types Causes Discharge Local Symptom Systemic Symptom External Treatment Internal Treatment Complication & Prognosis
Vataja Consuming Ruksha Dravyas (dry food items) Frothy, watery, with or without pain, reddish, resembles Kimsuka (Butea monosperma)   - Pain in lower back, pelvic, chest region Anuvasana Vasti (oil enema) with warm Bala Thaila, Uttara Vasthi (vaginal douche) with Pancha Valkala Kashaya Ghrita prepared with Nagakeshara (Mesua ferrae), Sunthi (Zingiber offinale), Bola Parpati, Loha Parpati with butter/honey/butter milk Vatala Yoni Vyapat (uterine disorders due to Vata), Pandu (aneamia) Kastha Sadhya (difficult to cure)
Pittaja Consuming Amla (sour), Lavana (salt), Kshara (alkali, Ushna (hot) Bluish, yellow blackish Burning sensation, inflammation Thirst, fever, giddiness Uttara Vasthi (vaginal douche) with Pancha Valkala Kashaya Ashoka (Saraca indica), Mocha Rasa (Salmalia malabarica), Pravala (Coral), Makshika (copper Pyrite), Shatavari (Asparagus racemosus), Sutasekhara Rasa, Chandrakala Rasa, Ashok arista, Ushirasava, Sarivadyasava Asrija yoni (type of uterine disease), Pandu, Raktarbud, Kastha Sadhya (difficult to cure)
Kaphaja Consuming Guru (heavy)   Sticky, white in colour, thick clotted Mild pain Vomiting, nausea, dyspnoea, lethargy, heaviness Uttara vasthi (vaginal douche) with Pancha Valkala Kashaya / Sphatika Jala Lodhra (Symplocos racemosa), Shubhra Bhasma, Shankha Bhasma, Gairika (haematite), Laksha (Laccifer lacca), Puga (Areca catechu), Kamala (Nelumbo nucifera), Goat’s milk Upapluta Yoni Vyapat (type of uterine disease), Kastha Sadhya (difficult to cure)
Sannipata Asatmya (unwholesome), Viruddha (incompatible), Praklinna Ahara (too soft food), Madya (alcohol), exhaustion of mind and body With kapha, sticky, foul smelling, with Vasa (marrow) and Meda (fat), profuse discharge Inflammation, severe pain, burning sensation Fever, emaciation, anaemia, diarrhoea, pain Uttara vasthi (vaginal douche)  with Chandana thaila Symptomatic treatment Rakta Gulma (type of uterine disease), Asadhya (incurable)  

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Treatment Procedure

  • Vata Raktaja Yoni Vyapat Chikitsa
  • Adhogata or Yoni Gata Raktapitta Chikitsa
  • Raktatisara Cikitsa/ Rakta Stambhana Cikitsa/ Samana Chikitsa
  • Kashaya-Tikta Rasa Aushadhies/ Sita Virya Aushadhies
  • Yoni Visesha Cikitsa / Garbhasaya Balya & Vatanulomana Aushadhies / Rakta Pushtikara Aushadhies (on recovery phase).
  • Sandhana, Skandana, Pachana and Dahana Chikitsa have to be adopted.

Treatment Modalities[6,7]

  • Avagaha (Sita Virya Kashaya/ cold water/ Triphala Kashaya/ Pancavalkala Kashaya)
  • Adhōnabhi Picu Yoni Picu Dharana - Usiradi Kalka with Ghrta (Usira, Utpala Nala, Candana, Nalpamara / Satadhouta Ghrta)
  • Yoni Purana / Yoni Dhara - (Stanya Dhara, Kshira Dhāra)
  • Yoni Abhyanga (recovery stage)
  • Takradhara
  • Kshira Vasti / Asthapana Vasti-Lodhrādi Gana Vasti / Mustadi Yapana Vasti / Anuvāsana Vasti Satapushpa Taila / Madhukadi Anuvasana Vasti / Narayaṇa Taila.

Bahya Prayoga: Uttaramukhi situated Vyaghranakhi Mula grown in a Pavitra Sthana, uprooted during Uttaraphalguni Nakshatra and tied in Kati Pradesha cures Rakta Pradara.

Vishista Yoga: Pradaradi Louha, Pradaranthaka Rasa, Sarasijadi Churna, Nishoshiradi Thaila Abhyanga (massage)

Ghrta: Sita Kalyanaka, Modakatvakeladi, Padagairikadi, Varahyadi, Asokaghrta, Mashalakshaghrta

Kashaya: Nalikeraprasunadi, Vatsadanyadi, Khadirasheetadi, Musalikhadiradi.

Bhasma / Pisthi: Akika Pishți, Annabhedi Sindūra, Gairika Bhasma, Jaharmohara Pishti, Kanta Bhasma, Mouktika Bhasma, Pravala Bhasma / Pishti, Rajatha Bhasma, Sphatika Bhasma, Swarnamakshika Bhasma.


Rasa / Dhatu / Loha preparations

Bola Parpati, Bolabaddha Rasa, Chandrakala Rasa, Dhatri Louha, Kamadudha Rasa, Pradarantaka Louha, Pradarantaka Rasa, Vasanthakusumakara Rasa, Bola Parpati, Sarvangasundara Rasa, Pradarari Rasa, Pradarari Lauha, Pradarantaka Lauha, Lakshmana Lauha, Pradaripu Rasa, Bola Pisthi, Ratnaprabha Vatika, Shilajatu Vatika, Chandra Prabha Vatika.

Swarasa / Ksheera Paka / Ekamulika Prayoga

  • Amrta (Tinospora cordifolia) Satwa with honey.
  • Ashoka Puspha (Saraca indica) - for chewing
  • Ashokavalkala (Saraca indica) Siddha Kshira (milk).
  • Dhathri (Emblica officinalis) Swarasa with honey.
  • Mukkutti (Biophytum sensitivum) Samula Swarasa in milk or butter.
  • Patmakesara (Nelumbo nucifera) Swarasa with sugar.
  • Satavari Swarasa (Asparagus racemosus) / Bhumyamlaki (Phyllanthus niruri) / Sahachara (Strobilanthes ciliates) with milk or honey.
  • Tenginpukula (Cocus nucifera) Swarasa with sugar/Tila Taila.
  • Vasa (Adhatoda Vasica) Swarasa with honey.
  • Vaţa Pusha (Ficus benghalensis) / Japapuspha Mukula (Hibiscus rosa sinensis - stamen) Siddha Kshira
  • Gomaya Rasa (cow dung expressed juice) with Tila Taila.
  • Gairika (red ochre) with Ksheera (milk).

Sonita Sthapaka Mahagana Kashaya (Styptic group of drugs decoction)
Madhu (honey), Madhuka (Glycyrrhiza glabra), Nagakeshara (Mesua Ferrea), Rudhira (Crocus sativa) Mocha Rasa (Salmalia malabarica), Mrit Kapala (earthern pot pieces), Lodhra (Symplocos racemosa), Gairika (Red ochre), Priyangu (Callicarpa macrophylla), Sarkara (sugar candy), Laja (fried paddy).

Discussion

In the pathogenesis of Asrugdhara – Chala (moving) Guna of Vata Dosha, Sara (mobility) and Drava (liquidity) Guna (quality) of Pitta Dosha increase the amount of blood.


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Hence these drugs might affect the Sara (mobility) and Drava (liquidity) Guna of Pitta Dosha with the help of Ruksha (dry), Laghu (light) Guna of Tikta (bitter) Rasa (taste) and Kashaya (astringent) Rasa. By Tikta Rasa (bitter taste) Dravya - Pitta Shamaka (reduce), Vatanulomaka (downward regulation), Raktasthapaka (styptic), Raktasangrahi (collection), Rakta Prasadaka (purifying) and Dosha Pachana (humours properly digested). By Kashaya Rasa (astringent taste) Dravya - Rakta Shodhana (cleaning), Rakta Stambhana (retaining) and Sandhaniya (regrowing). By Sheeta Virya (cold potency) Dravya - Rakta Stambhana (retaining), Pitta Samana (reduce Pitta), Daha Prashamana (reducing burning sensation). By Katu Vipaka (pungent secondary taste) - Srotoshodhana (clearing channels), Amapachana (digestion of undigested food), Sothahara (reduce inflammation). Kashaya Rasa (astringent taste), calcium ions medicines and cold preparations are effective for coagulation of the blood and vasoconstrictor.

Conclusion

Various treatment modalities like hormonal therapy, antiprostaglandis and antifibrinolytic agents are available in modern medicine for bleeding disorders. Many side effects have been observed, because of these medications, including hormonal imbalance. Since Asrugdhara is an immediate treatment needed disease, by the efficacy, easy action, minimum dosage Rasoushadhies give excellent result rather than herbal medications. There are effective formulae in Ayurveda which are non-hormonal and without side effects. Ekamoolika Prayogas and Rasoushadhies help to cure this disease as fast as possible without any side effect. Ayurvedic herbs having tannins, flavonoids, rich iron content, vitamin A, B, C, K help in curing the disease in the tissue level and grosser level. Even the diets rich in these help in the management of this disease. Even by its holistic approach to maintain the hormonal imbalance effecting mentally controlled by practicing mild Yogas like Shalabhasana, Pranayama and proper counselling.

Reference

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2. Priya B, Aggarwal K, Barwal V. Rasa dravya and their use in the management of life style diseases: an ayurveda perspective. wjpmr, 2018,4(2), 61-63.

3. Devi G, Streeroga vijnana-made easy, Delhi, Chaukhamba Sanskriti Pratishthan,2016:66-91.

4. Mishra A, Shelare R, An ayurvedic and contemporary overview of heavy menstrual bleeding: A conceptual approach; International Journal of Clinical Obstetrics and Gynaecology 2019; 3(5): 237-242.

5. Kapoorchand H, A comprehensive treatise on Streeroga, Varanasi, Chaukhamba Vishvabharati, Reprint 2020 :60-110.

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