E-ISSN:2456-3110

Case Report

Asrigdara

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 7 July
Publisherwww.maharshicharaka.in

A Case Study in Asrigdara with Shodhana and Shamana Chikitsa

Joshi A.1*, Sharma R.2
DOI: http://dx.doi.org/10.21760/jaims.8.7.41

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 condition that physician to face in day-to-day practice. It is a common medical disease seen in women. Which can cause significant disturbances physically as well as mentally. Asrigdara characterized by excessive excretion of Asrik. Abnormal uterine bleeding includes both cyclic and noncyclic bleeding. Acharya Charaka has explained many causative factors for like Ati Lavana, Amla, Guru, Katu, Vidahi, Krushara, Payasa, Saktu, Mastu etc. aggravates Vata withholds Rakta, vitiated due to above mentioned reasons. Increases its amount reaching the Rajovaha Sira (uterine vessels) which further increases Rajas (menstrual blood). Normalizing the amount of flow and curing the associated symptoms are fundamental principles of treatment to be adopted. A married female patient of 31 years attended the OPD with the complaint of increased duration of menstruation associated with excessive flow with lower abdominal pain; pain was spasmodic in nature along with generalized weakness. With the aim to minimize the cyclic blood loss and regularize the cycle the Shodhana Chikitsa (detoxification) i.e., Virechana Karma and Shamana Chikita (palliative treatment) with Shalmali Ghrita. This therapy, helped to cure the heavy flow during menses and regularize the cycle.

Keywords: Asrigdara, Uterine vessels, Rajas, Shamana Chikita, Shodhana 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, A Case Study in Asrigdara with Shodhana and Shamana Chikitsa. J Ayu Int Med Sci. 2023;8(7):213-217.
Available From
https://jaims.in/jaims/article/view/2624

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-05-30 2023-06-01 2023-06-08 2023-06-15 2023-06-22
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 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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Joshi A et al: A Case Study in Asrigdara with Shodhana and Shamana Chikitsa

Introduction

A normal menstruating female denotes a healthy state of reproductive system. Abnormal uterine bleeding is a common condition affecting 14.25% of women reproductive age and may have significant impact on their physical, social, emotional and maternal quality of life.[1] Nearly 30% of all gynaecological outpatient attendants are of abnormal uterine bleeding.[2]

Acharya Sushruta mentions excessive flow and prolonged duration with or without menses mild menstrual bleeding (Dalhana elaborates excessive flow during menses, for prolonged duration, mild- menstrual bleeding which may be scanty and for short duration), different from normal features (i.e., devoid of qualities of Shudda Artava) and denotes features of specific Doshas involved is known as Asrigdara. All types of Asrigdara are associated with body ache and pain. Dalhana in another context mentions the clinical features of Asrigdara as burning sensation in lower portion of groin, pelvic region, back, renal angle, uterus and acute pain in uterus.[3]

Case Report

A 31-years old married woman visited the OPD of Department of Prasuti Tantra and Stri Roga at Dr. Sarvapalli Radhakrishnan Rajesthan Ayurved University, Jodhpur. She had complaints of heavy bleeding with lower abdominal pain, and pain was spasmodic in nature along with generalized weakness.

Past history: N/K/C/O DM/ HTN / Thyroid dysfunction.

Family history: No history of similar problem in any of the family members.

Personal history

Diet - vegetarian

Appetite - Good

Bowel - Once / day

Maturation - 4 to 5 times / day 1to 2 times / night

Sleep - Sound sleep

Menstrual and Obstetric history

Age of Menarche - 13 years

Menstrual cycle - 4 to 5 days / 28-30 days

2- 3 pads/day

Clots - present

Lower abdominal pain - present

L.M.P - 26/5/2023

On examination

Per abdomen: on palpation - soft, non-tender, no organomegaly

Chest, CVS - NAD

Gynaecological examination

1. On Inspection

Vulva-normal and healthy and on straining, no genital prolapse was observed.

Per speculum vaginal examination:

  • Vaginal walls - normal
  • White discharges - nil
  • Cervix - appearance - Normal
  • Mildly hypertrophied

On Palpation

Per Vaginal Digital examination

  • No labial swelling detected
  • No abnormality detected on palpation of vaginal walls
  • Cervix - firm in consistency, mobile, tenderness absent.

Bimanual examination

  • Uterus - anteverted, freely mobile, normal in size, firm in consistency
  • Bilateral Fornices - free, non-tender

After thorough check-up, patient was advised admission in IPD and the following investigations was done and under mentioned treatment was given:

Investigations (On 3/7/23)

CBC - Hb% - 9.2 gm %

ESR - 18mm fall

CT - 4.2 min

BT - 3.8 min


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RBS - 90 mg/dl

Urine (Routine and Microscopic) - P.C. : 0-1/HPF, E.C. : 0-1/HPF

USG - Uterus is normal size, Normal endometrial thickness of 7mm.

Both ovaries are normal in size.

No free fluid seen in POD

Table 1: Menstrual History

  Previous cycle Present cycle
Duration 4-5 days 6-8 days
Interval 28-30 days 20- 25 days
Amount 2-3 pads/ day 5-6 pads / day
Colour Dark red Dark red
Odor Normal Normal
Consistency With clots With clots
Dysmenorrhea Mild pain Moderate pain

Dasha Vidha Pareeksha

  • Prakruti - Vata-Kapha
  • Vikruti - Pitta-Vata
  • Sara - Madhyama
  • Samhanana - Madhyama
  • Pramana - Dhairgya: 150 cms, Dehabhara: 62 kg
  • Satmya - Madhyama
  • Satva - Madhyama
  • Ahara Shakti - Abhyavarana Shakti: Madhyama, Jarana Shakti: Madhyama
  • Vyayama Shakti - Madhyama
  • Vaya - Youvana

General examination

Built - Moderate

Nourishment - Moderate

Temperature - 98.2° F

Respiratory rate - 22/min

Pulse rate - 68 bmp

Blood pressure - 110/70 mm of hg

Height - 150cms

Weight - 68 kg

Tongue - Uncoated

Systemic examination

CVS: S1 and S2 heard

CNS: Conscious and well oriented with date, time and place.

RS: Normal vesicular breathing, no added sounds.

P/A: Soft, Tenderness - present

Intervention

1. Shodhana Chikitsa (Detoxification) - Snehna and Swedana followed by Virechana Karma.

2. Shamana Chikitsa (Palliative management) - Shalmali Ghrita - 6ml twice in a day

The main aim of the treatment was to minimize the cyclic blood loss with regularization of cycle and to improve the general condition of the patient. So, the treatment was planned as Nidana Parivarjana, Shodhana Chikitisa (Detoxification) and Shamana Chikitsa (Palliative Treatment). After Virechana Karma, the Palliative treatment was given for one month with follow up advice every fortnightly in a month.

Patient was keenly observed for a period of two months with follow up every 15 days. The duration of menstrual cycle was reduced from 8- 10 days to 4-5 days without clots and she remained fully asymptomatic with regular menstrual cycle during this period.

Discussion

Ayurvedic management is a good alternative to Hormonal therapy as it has no side effects with minimal recurrence rate. Once, Shodhana is done there is less chance of recurrence of the disease. As, vitiation of Pitta Dosha is there in Raktapradra so, Virechana Karma was advocated according to the general condition of the patient. Moreover, Kashyapa has quoted that purgation cures menstrual bleeding.[4] Snehna (oleation) and Swedana (sudation) will help to change the cell permeability leading to expulsion of toxin material to outside the cell, which are membrane bound and toxins will come into circulation. Virechana drugs cause irritation of intestinal mucosa and does vasodilatation. Toxins which are present in gut lumen along with secretion of electrolyte and fluid from crypt of leperkuhn in distal lumen and colon will be expelled out through route.[5]


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Detoxification will lead to the better absorption of the drug through gut.

Trivrit Modak

Main ingredient of Trivrit Modak is Trivrit, it has predominantly has Madhura, Katu, Tikta, Kashaya Rasa, acts as Pittakaphahara and has Sukhavirechaka, Anulomana, Hridya Raktashodhaka, Amapachaka, Vedanasthapana etc. properties and are indicated in Hridroga, Raktavikara, Jwara, Pleeha-Yakruta Vyadhi etc.[6] The chemical constituents of Trivrit comprises of Turpethinic acids, α and β-turpethin, lupeol, b-sitosterol, botulin etc.[7] The laxative effect of Trivrit is mainly due to the presence of turpethin.[8] This fundamental constituent is believed to work on mysentric plexus and increase peristaltic movements in the body, thus acts as a laxative. Operculina turpethum exhibit analgesic, carminative, anti-inflammatory, antioxidant, hepato-protective, immunomodulatory and hydragogue activities.[9] The probable mode of action of Virechana with Trivrit can be understood by the dominant pharmacodynamics which helps in removing obstruction (Margavarodha) and eliminates the excess morbid toxic materials (Kledamsha) through Adhobhaga by the predominance of Jala and Prithvi Mahabhutas. Thereby it helps in pacifying Kapha and Pitta Doshas which altogether has its effect on Rakta due to Ashraya-Ashrayi Sambandha and regulates Vata Dosha by its Anulomana action and ultimately balances the Tridosha.

Shalmali Ghrita

The probable mode of action of Shalmali in the management of bleeding disorders can be explained by its action; done in previous clinical and experimental studies. The inhibitory effect of Bombax over cell growth may have regulatory effect in abnormal formation of layer of endometrium. Bombax malabaricum stem’s bark methanolic extract was found to exhibit a significant anti angiogenic activity on tube formation of Human Umbilical Venous Endothelial Cells (HUVEC).[10] Shedding of endometrial wall following each menstrual cycle require angiogenesis for endometrial repair and regeneration. Any disruption in above mentioned process leads to menorrhagia which is manifested as excessive bleeding. Excess uterine bleeding is evidenced to be caused by abnormal excessive angiogenesis.[11]

Santalum album possess anti-inflammatory and antiulcer activities evidence by significant inhibition in the carrageenan induced paw oedema, cotton pellet induced granuloma, as well as pylorus ligation induced ulcer. The in-vitro antioxidant and invivo analgesic and anti-inflammatory activities in mice were established for methanolic extracts of heartwood.[12]

The above activity of individual drug when work in combination in a compound along with fortification of Ghrita and change in properties of compound during its processing can be assumed to be helpful in healing the eruptions caused by the inflammatory causes of excessive bleeding and checking new growth and proliferation.

Conclusion

The probable mode of action of Shalmali in the management of bleeding disorders can be explained by its action; done in previous clinical and experimental studies. Flowers of Bombax ceiba have shown anti proliferative and antioxidant activity against Cancer cell lines, COR-L23, C32, A375, ACHN, and LNCaP cells. Here its effect on cell growth inhibition is for assessment of antitumor promoting activity about six novel sesquiterpenoids, two aromatic glycosides and several neolignans were identified from sandalwood heartwood chips, which were further evaluated for in-vitro Epstein-Barr virus early antigen (EBV-EA) activation in Raji cells. Later in vivo two-stage carcinogenesis assays were known to demonstrate its potent inhibitory effect on EBV-EA activation strong suppressive effect on two-stage.

Heavy menstrual bleeding poses undue mental stress and is sufficient enough to hamper physical activity of the woman. It can cause disruption in daily routine activities. Long term course of excessive heavy and prolong menstrual cycle can lead to life threatening condition. Untreated patients of HMB often suffer from severe anaemia and its consequences. Abnormal Uterine Bleeding directly affects quality of life of suffering women and has a significant impact on physical and mental health.

Thus, the above-mentioned findings under the discussion of the individual drugs could substantiate the inclusion of this formulation in the effective management of Asrigdara (Abnormal uterine bleeding) in Ayurveda system of medicine.


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References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc 4970656

2. Konar H, DC Dutta’s textbook of gynecology (7th ed.), 15th chapter, The health sciences publisher, 2005.pp.152.

3. Kapoor G, textbook of A comprehensive treatise on streeroga. 4th chapter, Chaukhambha Vishvabharati, Varanasi;2018.pp.69.

4. Vridha Jivaka, Kashyapa Samhita or Vridhajivakiya Tantra, revised by Vatsya with Sanskrit introduction by Nepal Rajaguru Pandit Hemraja Sharma with Ayurvedalankar Srisatyapala Bhisagacharya, Vidyotini Hindi Commentary and Hindi translation of Sanskrit Introduction, Chaukhambha Sanskrit Sansthan, reprint 2010, Sidhisthan- 2, p-150.

5. Mangal Gopesh, Sharma Om Prakash, Sharma R. S., Pharmokinetics of Vamana and Virechna karma, Journal of Ayurveda, Jan March-2011, P-67.

6. A.P. Deshpande, Subhash Ranade ed, Text book of DravaygunaVigyan (English), Part-2, A.R. Nandurkar, Proficient Publishing House 535, Shaniwar Peth, Pune; 2007. p.501.

7. Rastogi R, Mehrotra BN, Sinha S, Shrivastava M, Bhushan B. Compendium of Indian Medicinal Plants. Vol. 4. New Delhi, India; CDRI Lucknow & National Institute of Science Communication; 2002. p. 513.

8. Nadkarni KM, Nadkarni AK, editor. Indian Materia Medica. Vol. 1. Popular Prakasan: Bombay;2007. p. 691-4.

9. Mhaskar KS, Blatter E, Caius JF, Kirtikar KR, Basu’s BD. Illustrated Indian Medicinal Plants. Vol. 8. Delhi; Sri Satguru Publications; 2000. p. 2387-90.

10. You YJ, Nam NH, Kim Y, Bae KH, Ahn BZ. Anti angiogenic activity of lupeol from Bombax ceiba. Phytother Res 2003; 17: 341-4.

11. Le Couter, J.et al. Ogenic, Identification of an angiogenic mitogen selective for endocrine gland endothelium. Nature 412; 2001.p. 877-884.

12. Saneja A, Kaushik P, Kaushik D, Kumar S, Kumar D. Antioxidant, analgesic and anti-inflammatory activities of Santalum album Linn. Planta Medica 2009; 75: 102


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