E-ISSN:2456-3110

Review Article

Abnormal Uterine Bleeding

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 5 May
Publisherwww.maharshicharaka.in

An Ayurvedic approach in management of Asrigdara w.s.r. to Abnormal Uterine Bleeding

Joshi A.1*, Sharma R.2
DOI: http://dx.doi.org/10.21760/jaims.8.5.14

1* Apurva Joshi, Post Graduate Scholar, PG Department of Prasuti Tantra Evum Stri Roga, Dr. Sarvepalli Radhakrishnan Ayurved University, Jodhpur, Rajasthan, India.

2 Rashmi Sharma, Associate Professor, PG Department of Prasuti Tantra Evum Stri Roga, Dr. Sarvepalli Radhakrishnan Ayurved University, Jodhpur, Rajasthan, India.

Asrigdara is a disease in which manifestation of excessive bleeding per vaginum takes place it is considered as one of the commonest leading gynaecological problems. Ayurveda texts have described a variety of treatment options in the management of Asrigdara including Shodhana and Shamana Chikitsa. Out of them, the efficacy of “Shodhana Chikitsa” is having prime importance as it expels out the vitiated Dosha from the body. Vishesh Chikitsa according to Dosha is being described. In modern medicine haemostatic, analgesic and hormonal therapies are advised for abnormal uterine bleeding, which includes hormonal therapy, ant prostaglandins & antifibrinolytic agents. These have not proven their definitive efficacy in spite of high costs; their side effects have led to hormonal imbalances hence it is need of time to have an integrated and comprehensive therapeutic intervention in Ayurveda to prevent recurrence& would overcome the modern medicine limitations. Many herbal & Herbo-mineral preparations, Shodhan & Shaman Chikitsa are mentioned in Ayurveda to cure Raktapradar and related symptoms which can be used as per Anubandha Dosha and Lakshana.

Keywords: Asrigdara, Sodhana, Shamana, Vishesh Chikitsa

Corresponding Author How to Cite this Article To Browse
Apurva Joshi, Post Graduate Scholar, PG Department of Prasuti Tantra Evum Stri Roga, Dr. Sarvepalli Radhakrishnan Ayurved University, Jodhpur, Rajasthan, India.
Email: 		Apurva Joshi, Rashmi Sharma, An Ayurvedic approach in management of Asrigdara w.s.r. to Abnormal Uterine Bleeding. J Ayu Int Med Sci. 2023;8(5):83-89.
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https://jaims.in/jaims/article/view/2483

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-03-18 2023-03-21 2023-03-28 2023-04-04 2023-04-11
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2023by Apurva Joshi, Rashmi Sharmaand 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

Regular menstruation results from the balanced relationship between the endometrium and its regulating factors. In present time due to changing life style with food habits, incidence of excessive and irregular menstrual bleeding is increasing day by day because of which women need to take off from the work due to excessive bleeding as this excessive bleeding affects not just physical but also social, emotional and psychological well-being and quality of life.

Asrigdara is a disease in which manifestation of excessive bleeding per vaginum is there. Acharya Charaka described Asrigdara as a separate disease along with its management in Yonivyapad Chikitsa Adhyaya. Charaka also described it, as one of the Raktaja Vikara and also in Pitta Avrita Apana Vayu. Acharya Sushruta described it as a separate disease in Sharira Sthana in Shukra Shonita Shuddhi Sharira Adhyaya. Sushruta also mentioned Asrigdara under Pitta Samyukta Apana Vayu and in Rakta Doshaja Vikara. Ashtanga Sangraha described Raktayoni and mentioned Asrigdara and Pradara as its synonyms. Ashtanga Hridya described Raktayoni, but nothing is mentioned about Asrigdara or Pradara and hence it is explained under synonym of Rakta Pradara at some places.

The derivation of word “Asrigdara”, is derived from two words, Asrik- Menstrual Blood and Dara- Excessive excretion. Due to Pradirana (excessive excretion) of Raja (Menstrual Blood), it is named as Pradara, and because there is Dirana (excessive excretion) of Asrik (Menstrual Blood) hence it is known as Asrigdara. According to above definitions it can be said that, Excessive or prolonged bleeding occurring in menstrual or inter-menstrual period is called Asrigdara and Pradara is the synonym of Asrigdara.

Modern Aspect: Abnormal Uterine Bleeding (AUB) is the term currently used for alteration in menstruation resulting from increased amount, duration, or frequency. Terms such as dysfunctional uterine bleeding or menorrhagia were abandoned. Abnormal Uterine Bleeding has great importance for its incidence, and because it negatively affects physical, emotional, sexual and professional aspects of the lives of women, worsening their quality of life. In 2011, professionals from the International Federation of Gynecology and Obstetrics

(FIGO) proposed a classification for the disorders causing AUB that ease the understanding, assessment and treatment of this condition, and enabled comparisons among the data from the scientific literature. This scheme is known as PALM-COEIN, in which each letter indicates one of the etiologies of bleeding (uterine Polyp [P], Adenomyosis [A], Leiomyoma [L], precursor and Malignant lesions of the uterine body [M], Coagulopathies [C], Ovulatory dysfunction [O1, Endometrial dysfunction [E], Iatrogenic [I], and Not yet classified [N]. The PALM-COEIN system is applicable after excluding the pregnancy-related causes of bleeding.!

About 10-15% of women have to face episodes of abnormal uterine bleeding (AUB) at some time during the reproductive years of their lives. It is common during the extremes of reproductive life, following pregnancy and during lactation. It has been shown that 55.7% of adolescent's experience abnormal menstrual bleeding in the first year or so after the onset of menarche because of the immaturity of the hypothalamic-pituitary-ovarian axis leading to anovulatory cycles. It generally takes 18 months to 2 years for regular cycles to be established. It is not uncommon for a premenopausal woman to develop abnormal bleeding, and this is often due to anovulatory cycles in 80% cases.

Definition: AUB may be defined as any variation from the normal menstrual cycle, including alteration in its regularity, frequency of menses, duration of flow, and amount of blood loss. Up to one third of women will experience abnormal uterine bleeding in their life, with irregularities most commonly occurring at menarche, reproductive age and perimenopause. A normal menstrual cycle has a frequency of 24 to 38 days, lasts 7 to 9 days, with 5 to 80 ml of blood loss. Variations in any of these 4 parameters constitute AUB.

Clinical Features: These may be associated with small amount of irregular spotting to heavy vaginal bleeding. The frequency, regularity, duration, or volume will vary and may or may not be accompanied with excessive cramping, bleeding after menopause, bleeding or spotting after sex, bleeding or spotting between periods, periods lasts longer than 7 days, It takes the form of heavy regular or irregular cycles.


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Dysmenorrhea is invariably absent in anovulatory cycles. Excessive blood loss may lead to Anaemia. The pelvic findings by ultrasound scanning are normal except in ovarian tumour. It is important to rule out other causes of abnormal uterine bleeding before instituting hormonal therapy.

Associated Symptoms: Frequently accompanied by physical and nervous disturbances, exercise induced fatigue, fainting, increased heart rate, dyspnoea, palpitations and syncope. It is estimated that only 20% of women are completely free from discomfort or upset and that only 03% of young nulliparous do not experience premenstrual molimina of some kind. The degree of disturbance depends on the individual's outlook towards this physiological process, and on her determination not to allow it to interfere with her normal life.

jaims_2483_01.JPG

Nidana:  All the Nidana of Asrigdara are grouped under four headings-

1. Aaharaja Nidana

(a) Charaka Samhita - Lavana, Amla And Katu Rasa, Snigdha, Guru, Vidahi Gunas. Mamsa, Krishara, Payasa, Dadhi, Shukti, Mastu, Sura and Madya.

(b) Madhava, Bhavaprakash and Yogaratnakar- Viruddha Bhojana, Atimadya Sevan, Adhyashana and Ajeerna.

2. Viharaja Nidana: Madhava, Bhavaprakash and Yogaratnakar - Atimaithuna, Atiyana, Atimarga Gamana, Atibharvahana and

3. Mansika Nidana: Shoka (Madhava, Bhavaprakash and Yogaratnakar)

4. Others: Garbha Prapata & Abhighata

(Madhava, Bhavaprakash and Yogaratnakar) Vitiated Apatya Marga (Bhela Samhita) and Vata-Purita Ksheena Nadi (Harita Samhita)

Samprapti: According to Charaka, the aggravated Vayu, withholding the Rakta (blood) vitiated due to Nidana Sevana, increases its amount and then reaching Raja carrying vessels (branches of ovarian and uterine arteries) of the uterus, increases immediately the amount of Raja (Artava or menstrual blood), in other words, the increase in amount of Raja is due to its mixture with increased blood. This increase in menstrual blood is due to relative more increase of Rasa (plasma contents). Because of the increase in the amount of blood, the expert of this treatise named it Asrigdara. Since in this condition, excessive blood is discharged, hence it is also known as Pradara.

Samprapti Ghataka

  • Dosha - Vata-Pitta Pradhana,
  • Dushya - Rakta (Pradhana) and Artava, Rasa
  • Agni - Jathragnimandya
  • Adhishthana - Garbhashaya, Artavavahi Strotasa
  • Strotasa - Rakta Vahi, Artavavahi, Rasavahi
  • Sroto Dusti Prakara - Atipravritti
  • Roga Marga - Aabhyantara

Samanya Lakshanas

1. Raja Atipravruthi (Excessive bleeding)

2. Deerghakalanubandhi (Prolonged menstruation)

3. Intermenstrual bleeding

4. Along with or without Angamarda (body ache) and Vedana (pain)

Prakara

Vataja

Etiology: Ruksha Ahara Vihara and other Nidanas will cause vitiation of Vata along with Rakta, there is Sthanasanshraya in Garbhashaya Gata Sira and it will leads to Vataja Asrigdara.

Clinical Features

  • Phenila, Tanu, Ruksha Strava - Frothy and thin menstrual bleeding.
  • Shyava or Aruna Varna Strava - blackish or reddish bleeding.

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  • “Kimshukodaka- Samkasham”- Resembles of washing of Palasha Pushpa
  • Vedana will be felt in Kati, Vankshana, Hridaya Pradesha, Parshwa, Prishtha and in Shroni - Pain in back, groin including Iliac, sacral, cardiac regions.
  • Teevra Vedana - Pain is severe in nature

Pittaja

Etiology: Atyadhika Sevana of Amla, Ushna, Lavana and Kshara will cause vitiation of Pitta along with Rakta; there is Sthanasanshraya in GarbhashayagataSira and it will leads to Pittaja Asrigdara.

Clinical Features

  • Neela, Peeta, Asita Rakta Strava - Blue, yellow or Blackish coloured bleeding.
  • Atyushna Rakta Strava - Hot bleeding.
  • Nitya Rakta Strava - Almost continuous bleeding.
  • Muhur-Muhur Rakta Strava - Repeated bleeding per vagina.
  • Arti - pain.
  • Daha - Burning sensation.
  • Raga - Redness all over body.
  • Trishna - Thirst.
  • Moha - Mental confusion.
  • Jwara - Fever.
  • Bhrama - Giddiness

Kaphaja

Etiology: Guru Aahar and Vihara will cause vitiation of Kapha along with Rakta, there is Sthana-Sanshraya in GarbhashayaGataSira and it will leads to Kaphaja Asrigdara.

Clinical Features

  • Pichhila, Guru, Snigdha Rakta Strava - slimy, heavy, unctuous bleeding.
  • Pandu Varna Raktastrava - Pale coloured bleeding.
  • Sheetala Raktastrava - Cold bleeding.
  • Ghana, Manda Rujakara Raktastrava - Thick mucoid painful bleeding
  • Chhardi - vomiting
  • Arochaka - Anorexia,
  • Hrillasa - Nausea,
  • Swasa -Dyspnoea,
  • Kasa - Cough

Sannipataja

Sannipataja

Etiology: Sannipataja Asrigdara,Lakshanas of all the three Doshas are present. When Vyadhi Pidita and Rakta Kshaya Pidita Stree consumes Tridosha Prakopa Ahara and Vihara, then her AtikupitaVata with holding Kapha which is already Vidagdha, Durgandha Yukta, Pichhila, Pita Varna and having VipritaGuna due to TejaGuna of Pitta, discharges it through the Yoni along with Vasa and Majja.

Clinical Features

  • Durgandha, Pichhila, Vidagdha Rakta Strava - bleeding with foul smelling, slimy, burnt with pitta.
  • Peeta Rakta Strava - Yellowish white discharge.
  • Sarpi, Majja, Vasa Rakta Strava - Bleeding resembling Ghrita, Vasa, Majja.
  • Vegasravi - Discharge with force.
  • Nirantara Strava - continuous bleeding.
  • Trishna - thirst
  • Daha - burning.
  • Jwara - fever

Sadhya-Asadhyata: Prognosis is deprived in the type of - Sannipataja Raktapradar.

  • Atyartav (Per Vaginum excessive bleeding).
  • Angamard (body ache), Daurabalya (generalized weakness), Trishna (thirst), Dah (generalized Burning sensation), Bhram (dizziness), Murcha (unconsciousness), Tandra (drowsiness), Jwara (fever) etc. These are all associated common symptoms. Less amount of blood in the body.
  • Raktanyunata (Anemia - Less amount of blood in the body).

Chikitsa Siddhanta: Ayurveda texts have described a variety of treatment options in the management of Asrigdara including Shodhana and Shamana Chikitsa. Out of them, the efficacy of “Shodhana Chikitsa” is having prime importance as it expels out the vitiated Dosha from the body.


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The general principles of treatment of Asrigdara are as follows

  • Nidana Parivarjana
  • Dosha Shodhana
  • Dosha Shamana
  • Raktasamgrahana - Rakta Shodhana - Rakta Sthapana
  • Use of Tikta Rasa (Deepana-Pachana)

1. Nidana Parivarjana: Nidana plays the prime role in the initiation of pathogenesis which proceeds towards the development of disease. Hence it is the chief principle of treatment in Ayurveda texts.

Excessive intake of salty, sour, heavy Katu (hot), Vidahi (producing burning sensation) and unctuous substances, meat of domestic, aquatic, Payasa, Sukta, Mastu & wine, are considered as Nidana and these should be avoided.

In context to maintain the normalcy of Rajah in any form or to avoid any kind of abnormality i.e., dysmenorrhoea, menorrhagia, oligomenorrhoea, the specific diet regimen is prescribed as Rajasvalacharya. As menstrual cycle is an effective monthly cleansing, thus it is necessary to support that cleansing process by doing Rajasvalacharya to rejuvenate the body, organs (uterus), Doshas and Agni.

Rajasvalacharya routine is a regimen of diet and work that a menstruating woman should adopt during first three days of cycle. It is as following:

A. Vihara: To avoid day sleeping, bathing, anointing, massaging, laughing, talking too much, combing and excessive exercises. Woman should sleep on bed made with Darbha over ground. Nasya, Vamana, Swedana are contraindicated during these three days etc.

B. Ahara: Eat Havishya (Sushruta) or Yavaka Anna with Paysa (Ashtanga Sangraha). In commentary Dalhana described Havishya as Shali rice with Ghrita and Yavaka as Yava (barley) with Ksheera.

Thus, this diet should be taken to get Karshana effect on female’s body and Koshtha Shodhana. As it can be assumed that this regimen is having a deleting and purificatory effect on the old endometrium, therefore giving the uterus a better environment to build up a healthy and proper endometrium from the fourth day.


2. Dosha Shodhana: Diseases treated with the Shodhana Chikitsa have negligible chance of recurrence because vitiated Doshas are totally expelled from the body. Those treated with Shamana Chikitsa are vulnerable for recurrence because subtle amount of vitiated Doshas left in the body which can get aggravated with the slightest opportunity.

A. Virechana: Virechana has been indicated. The predominant Dosha being Pitta, Virechana serves as the best Shodhana Acharya Charaka has suggested the use of Mahatikta Ghrita for Virechana in Pittaja Asrigdara.

B. Basti: Asrigdara Vyadhi occurs due to vitiation of Vata and Basti is said to be the best treatment for Vata Dosha. Classics have mentioned the use of Uttar Basti in Asrigdara. According to Vagbhatta, use of 2 or 3 Asthapana Basti followed by Uttar Basti is beneficial.

3. Dosha Shamana: Dosha which are increased brought down to normal by applying different methods of Shamana Chikitsa.

4. Rakta Samgrahana and Rakta Sthapana Dravya

This means the administration of drugs or other measures which causes Rakta Stambhana. In this disease excessive bleeding during menstrual and inter-menstrual period causes a condition of anaemia in the patient. Raktavardhaka Chikitsa is also necessary.

5. Use of Tikta Rasa is advised with following purposes:

  • It pacifies the Pitta Dosha.
  • Agni Deepana- Dosha Pachana (To improve metabolism).
  • Rakta-Samgrahana (As a coagulant)
  • Tikta Rasa has Lekhana Karma

A brief review of some drugs in Asrigdara

1. For Asthapana Basti

Drugs

  • Chandanaadi Niruha Basti
  • Rasnaadi Kalpa
  • Kushadi Asthapana
  • Mustadi Yapana Basti
  • Lodhradi Asthapana

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2. For Anuvasana Basti

Drugs: Madhukadi Taila Shatapushpa Taila

3. Internal Medicines

Drugs

  • Kashayas
  • Darvyadi Kwatha
  • Dhataki and Pugi Kusuma
  • Pradarhar Kashya, Vasadi Kashya,
  • Pathyamalakyadi Kashya,
  • Vasa Kashya

4. Kalka and churnas

Drugs

  • Tanduleeyaka Moola Kalka with Madhu and Tandulambu .
  • Rasanjana and Laksha Choorna with Aja Ksheera
  • Bala Moola with milk
  • Pushyanuga Choorna with Madhu and Tandulodaka

5. Ksheera Prayoga

Drugs: Ashoka Valkala Kwatha Siddha Ksheera

6. Modaka

Drugs

  • Alabu Phala Modaka
  • Malaya Phala Modaka

7. Avaleha

Drugs

  • KhandaKushmandavaleha
  • Jeerakavaleha
  • Kutajshtakleha

8. Ghrita

Drugs

  • Shalmali Ghrita
  • Sheeta Kalyanaka Ghrita
  • Shatavari Ghrita
  • Mahatikta Ghrita

9. Rasaushadhi

Drugs

  • Pradararipu Rasa
  • Bolaparpati

10. Gutikas

Drugs: Gokshuradi Guggulu

11. Asava and Arishta

Drugs

  • Ashokarishta
  • Patrangasava

Discussion

In Ayurvedic classics, all gynecological disorders comes under a big heading ‘Yonivyapada’. Asrigdara is very severe and life-threatening disease which may be fatal to the patient if not treated properly and timely. Complications of Asrigdara includes weakness, giddiness, mental confusion, feeling of darkness, dyspnoea, thirst, burning sensation, delirium, anaemia, drowsiness, convulsion and other disorders due Vata vitiation because of excessive bleeding per vaginum. Prophylaxis of asrigdara is possible only due the avoidance of all etiological factors causing Raktapradara. The drugs and formulations used in treatment of Asrigdara are mainly rich in Kashaya rasa and Tikta rasa because both of these rasas have the property of astringent i.e., Stambhana Guna in Ayurveda and thus due to astringent property, bleeding will be checked. Then next aim of treatment should be rising of blood i.e., haemoglobin level in body and for that, Raktasthapana drugs should be used. Maharshi Kashyapa has described use of purgation (Virechana) in treatment of Asrigdara because Virechana is most appropriate and superior therapy among Panchkarma for Pitta Dosha and Rakta Dosha have quality identical to Pitta Dosha, hence Virechana therapy will be also effective to treat the disease originated due to vitiation of Rakta Dosha.

Conclusion

Asrigdara is prolonged and excessive menstrual bleeding or intermenstrual bleeding along with pain and bodyache. Aggravated Vayu, withholding the Rakta (blood) vitiated due to Nidana Sevana, increases its amount and then reaching Raja carrying vessels (branches of ovarian and uterine arteries) of the uterus, increases immediately the amount of Raja (Menstrual blood). After reviewing different research articles and Ayurvedic classics, the general principles of treatment of bleeding per vaginum are - Eradication of the cause, Dosha Shodhana, Dosha Shamana, Rakta-Sthapana & Rakta Sangrahana and Use of Tikta Rasa, these


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help in regulating the excessive menstrual flow, promotes the strength of the reproductive tract and by means of Shodhana Chikitsa i.e., Virechana is help in resolving vitiation of Rakta and Pitta Dosha and Basti improves the Asrigdara by its specific action on Vata. After the reviewing the aspect of Raktapradar or Asrigdara as per Ayurveda which intends to intervene and proves that the entities discussed in the article are safer, reliable and effective therapies.

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