E-ISSN:2456-3110

Case Report

Udavarta Yonivyapad

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August
Publisherwww.maharshicharaka.in

Effect of Marma Chikitsa in the management of Udavarta Yonivyapad (Primary Dysmenorrhea)

Jaiswal N1*, Marwaha R2, Bhalerao N3, Guru B4
DOI: http://dx.doi.org/10.21760/jaims.8.8.42

1* Niharika Jaiswal, Post Graduate Scholar, Department of Rachna Sharir, Pandit Khusilal Sharma Government Autonomous Ayurved College And Institute, Bhopal, Madhya Pradesh, India.

2 Rita Marwaha, HOD and Professor, Department of Rachna Sharir, Pandit Khusilal Sharma Government Autonomous Ayurved College and Institute, Bhopal, Madhya Pradesh, India.

3 Nisha Bhalerao, Reader, Department of Rachna Sharir, Pandit Khusilal Sharma Government Autonomous Ayurved College and Institute, Bhopal, Madhya Pradesh, India.

4 Basanti Guru, HOD and Professor, Department of Prasuti Tantra and Stri Roga, Pandit Khusilal Sharma Government Autonomous Ayurved College and Institute, Bhopal, Madhya Pradesh, India.

Marma Chikitsa is very useful in present era specially in pain management. While describing Sharir Rachna different Acharya has described about Marma and vital regions of the body. Marma Sthan is a confluence on body where two or more structures Mamsa, Sira, Snayu, Asthi or Sandhi. In human body many structures have Prana (Vital Power) these are known as Marma and Pranayatana. These Marma Sthan harmonize the nervous and endocrine system and normalize different pathology in the body through vital power itself, with proper stimulations/manipulation. This technique is known as Marma Chikitsa. Marma Chikitsa is an ancient Indian practice whose purpose is stimulations / manipulation of vital energy (Prana) in the body for enhancing the healing process. Marma’s knowledge helps the clinicians to regulate the flow of Prana through the coarse and subtle bodies in order to restore the patient’s health and serenity. All authorities of Ayurveda have described Udavarta Yoni Vyapad and it’s management. Dysmenorrhea means painful menstruation which can be corelated with Udavarta Yoni Vyapad. It occurs in 50% of post pubescent females. Dysmenorrhea literally means painful menstruation but a more realistic and practical definition includes case of painful menstruation of sufficient magnitude so as to incapacitate day to day activities. Primary Dysmenorrhea refers to menstrual pain without pelvic pathology. Udavarta Yoni Vyapad is characterized by painful menstruation. According to Charak, Rajas is pushed in upward direction by the aggravated Vayu due to obstruction in its normal flow (Anulomana Gati) in Pakwashya.

Keywords: Udavarta Yoni Vyapad, Marma Sthan, Prana, Primary Dysmenorrhea

Corresponding Author How to Cite this Article To Browse
Niharika Jaiswal, Post Graduate Scholar, Department of Rachna Sharir, Pandit Khusilal Sharma Government Autonomous Ayurved College And Institute, Bhopal, Madhya Pradesh, India.
Email: 		Jaiswal N, Marwaha R, Bhalerao N, Guru B, Effect of Marma Chikitsa in the management of Udavarta Yonivyapad (Primary Dysmenorrhea). J Ayu Int Med Sci. 2023;8(8):265-269.
Available From
https://jaims.in/jaims/article/view/2714

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-06-08 2023-06-14 2023-06-23 2023-07-04 2023-07-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by Jaiswal N, Marwaha R, Bhalerao N, Guru Band 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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Jaiswal N et al: Marma Chikitsa in Udavarta Yonivyapad (Primary Dysmenorrhea)

Introduction

Different Ayurved classics have dedicated a separate “Sthan” for the literature of Sharir Rachna. It is called “Sharir Sthan”. While describing Sharir Rachna different Acharya has described about Marma and vital regions of the body. Marma Sthan is a confluence on body where two or more structures Mamsa, Sira, Snayu, Asthi or Sandhi. Knowledge of Marma exists from ancient period of Vedas. Marma has been described in all described in all three great treatise- Charak Samhita, Sushrut Samhita and Ashtanga. According to Ayurveda, in human body many structures have Prana (Vital Power) these are known as Marma and Pranayatana.[1] Here Prana is nothing but source of Urja (energy). These Marma Sthana harmonize the nervous and endocrine system and normalize different pathology in the body through vital power itself, with proper stimulations/manipulation. This technique is known as Marma Chikitsa. Marma Chikitsa is an ancient Indian practice whose purpose is stimulations / manipulation of vital energy (Prana) in the body for enhancing the healing process. Marma Chikitsa is based on the action of 107 Marmas Sthana in the body to access the body and mind. Marma’s knowledge helps the clinicians to regulate the flow of Prana through the coarse and subtle bodies in order to restore the patient’s health and serenity. Aacharya Sushrut has mentioned that Marma knowledge is called Shalya Vishayardha.

Udavarta Yonivyapad and Dysmenorrhea

All authorities of Ayurveda have described Udavarta Yoni Vyapad and its management. Due to suppression of natural urges the aggravated Vayu (Apan Vayu) in reverse direction. This Vayu occupies Yoni. This vitiated Vata or Vayu causes pain during flow of menstruation as soon as the blood flows out, pain is relived that is immediately flowing the discharge of Raja. Since in this condition the Raja moves upward or in reverse direction hence, it is termed as Udavartini.

सफेनिलंउदवर्ता रज: कृच्छेण मुञ्चती ।

चतसृष्वपि चाद्यासु भवन्तयनिलवेदना ।। (सु.उ.त.38/9,11)

Aacharya Sushrut says that besides painful, frothy menstruation, there are other pain of Vata (body ache, general malaise etc).[2]


Dysmenorrhea: Dysmenorrhea means painful menstruation which can be correlated with Udavartini Yoni Vyapad of Charak or Udavarta Yoni Vyapad of Sushrut. Udavarta Yoni Vyapad is characterized by painful menstruation.[3] According to Charak, Raja is used in upward direction by the aggravated Vayu due to obstruction in its normal flow (Anulomana Gati) in Pakwashya. It occurs in 50% of post pubescent females. Dysmenorrhea literally means painful menstruation but a more realistic and practical definition includes case of painful menstruation of sufficient magnitude so as to incapacitate day to day activities.

  • It is of two types - Primary Dysmenorrhea refers to menstrual pain without pelvic pathology. Secondary Dysmenorrhea is defined as the painful menses associated with an underlying Pathology. Dysmenorrhea is the most common gynaecological problem among females which is mostly experienced by adolescent girls.[4]
  • A greater prevalence of Dysmenorrhea is generally observed in young women. Ranging from 67 to 90% for those age 17 to 24 years.

In Modern medical science, there is only symptomatic treatment of Primary Dysmenorrhea for examples - NSAID's groups, analgesics - Ibuprofen, COX -2 inhibitors, steroids and ultimately surgery. And long-term use of these drugs can lead to renal problems, hepatotoxicity, stomach ulcers and many more other problems or diseases and the adverse effect of NSAID’S is well known so to get out of these problems we need a non-medical approach for management.

Aim

Effect of Marma Chikitsa in the management of Udavarta Yonivyapad (Primary Dysmenorrhea)

Objectives

1. To review the literature and concept of Marma and Marma Chikitsa.

2. To explore in brief the surrounding underlying anatomical structures at the site of Indrabasti and Gulfa Marma.

3. To study the Udavarta Yoni Vyapad in detail in Ayurveda classics and Primary Dysmenorrhea in modern science.



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Marma[5]: Marma is defined as vital point of the body, the region in which there is a confluence of Mamsa, Sira, Snayu, Asthi and Sandhi. These are special points in human body and any injury to 20 points leads disability and if not treated properly may become fatal. The Marmas are made up of Soma, Maruta, Teja, Raja, Satwa, Tama, and Bhutatma. While describing Pranayatana, Acharya Charak mentioned 10 Pranayatana. They are- 2 Shankha, Marma Traya (Shir, Hridaya, Basti), Kantha, Rakta, Shukra, Oja and Guda. According to different classics of Ayurveda there are 107 Marma. Total numbers of “Marmas” are categorized depending upon the Rachna (structure involved), Shadanga (regional), Pramana (dimensional), Parinama (prognostic) and Sankhya (numerical).

Marma Chikitsa: In Vedic science Chikitsa / Aushadha is divided into 4 parts. Atharvani, Angirasi, Daivi and Manushyaja. The basis of Marma Chikitsa can be considered as Angirasi Chikitsa. In Angirasi Chikitsa, Rasa refer to the executive element that controls and carries out various function of the body.

Indrabasti Marma

Anatomical Consideration

Locations and Numbers: Upper extremities-2 & lower extremities-2, total 4.

In the upper limbs: Indrabasti Marma is exactly located in the middle and anterior (front) part of the forearms between elbow and wrist (Madhyaprakostha).

Muscles, tendon involved: Flexor carpi radialis, Flexor digitorum superficialis, pronator teres, Flexor pollicis longus, Flexor digitorum profundus.

Nerve invoved: Medial antebrachial cutaneous and its branches.

Vessels: Median antebrachial vein, Ulnar vein, Ulnar artery and its branches.

In the lower limbs: Indrabasti Marma is exactly located in the middle of the leg (calf muscles) and in line of the Paarshni (calcaneum, lateral malleolus) of both legs.

Muscles, tendon involved: Gastrocenimius , Achillies tendon and Soleus

Nerve involved: Sural nerve, Tibial nerve (deep)

Vessels: Posterior tibial artery and vein.

Classification: Shakhagat Marma, Mamsa Marma, Kalantar Pranhar Marma & ½ Angula in Praman.[6]

Anatomical Consideration

Gulfa Marma: Gulfa Marma is one of the delicate and vital points of the body located in the foot, especially in the ankle joints.

Location: The Marma is located exactly at the junction of Pada (foot) and Jangha (leg).[6]

On the left side

Muscles, tendon involved: Flexor retinaculum medial ligament, flexor hallucis tendon, flexer digitorum longus tendon.

Nerve involved: Medial planter nerve on left side

Vessels involved: Post. Tibial artery and vein.

On the right side: Muscles, tendon involved: Sup. Peronieal retinaculum, lateral collateral ligament, fibularis longus tendon, fibularis brevis tendon.

Nerve involved: Sural nerve

Vessels involved: Fibular vein, small sephaneous vein, fibular artery and veins.

Marma Therapy: It is an art of treating 107 Marma (vital points) and rechannelise the Prana (vital force in the body). Touching a Marma point changes the body’s biochemistry and can unfold radical, alchemical change in one’s makeup.[7] Stimulation of these inner pharmacy pathway signals the body to produce exactly what it needs including hormones and neurochemicals that heal the body, mind and consciousness says Dr. Vasant Lad.

Case Description

A 22-year-old female patient consulted the outpatient department (OPD) at, Pt. Khushilal Sharma Govt. (Autonomous) Ayurveda College and Institute, Bhopal on 2nd November 2022 with the complaint of severe pain and cramping in the lower abdomen and vomiting during menstruation from last 1-2 years. She is unable to perform daily activities due to painful menstruation.

Past History

No relevant history found.

Physical Examination

Weight: 52kg


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Height: 160 cm

BMI: 21 kg/m2

Blood Pressure: 120/80 mmHg

Pulse rate: 74/minute

Pallor, Icterus, Cyanosis, Clubbing and Edema were absent,

Cardiovascular System (CVS): normal, Respiratory System (RS): clear no added sound.

Central Nervous System (CNS): consciousness & orientation, memory, and speech are normal, Reflexes in both upper and lower limbs were in the normal level and muscle power was elicited as 5/5 in all limbs.

Gynecology examination: Per Abdomen examination does not reveals any deformity.

Marma therapy procedure

  • According to their anatomical location of Indrabasti and Gulfa Marma , every Marma Sthan will be stimulated by using thumb for 15-18 times on an average in single sitting.
  • A steady and moderate pressure will be applied slowly and gently.
  • Pressure will be increased gradually depending upon patient’s strength and tolerance.

Methodology

Initially moderate pressure was applied on Marma sites which is increased gradually.

Frequency: Twice a day.

Duration: 30 days

Follow-up: 15 days

Treatment Protocol

SNMarmaStimulation TimeSitting of Marma ChikitsaFrequencyTotal time
1.Indrabasti0.8secTwo times a day15-18 times30 days
2.Gulfa0.8secTwo times a day15-18 times30 days

Assessment

The assessment of the effect of treatment will be based on parameters of disease which will be recorded before and after treatment. The symptoms will be graded (0 - 3) on the basis of scoring system and Grading of Pain will be assessed using Visual Analogue Scale (VAS).

CriteriaGrading before Marma TherapyGrading after Marma Therapy
Severity of pain 3 1
Duration of pain 3 1
Radiation of pain 3 2
Cramping in the lower abdomen 3 2

Discussion

Marma points serve as channels connecting the physical body to the inner conscious and mind. By stimulation of Marma, Prana is channelized and pacifies the Vata Dosha. It enriches the aura or energy field of body and keeps the person energetic and healthy. According to pain gait theory by Marma Therapy, acute pain is stimulated which blocks the transfer of chronic pain, thus increasing the threshold of pain by stimulating the particular Marma. Aacharya Sushrut says that besides painful, frothy menstruation, there is other pain of Vata (bodyache, general malaise etc). Stimulation of Indravasti Marma can reverse the backflow of Vayu and relives the pain in Udavarta Voniyapad, It removes blocks in energy channels (Srotas), Pacifies Doshas bringing it to normal path (especially Vyanavayu which controls autonomic nervous system).[8] It creates physical, mental and emotional flexibility and creates an opportunity to experience powerful and dynamic transformation at physical, mental, emotional and spiritual level by building a positive link with the unconscious mind.

Conclusion

Marma Therapy is a promising fast acting, drug less, cost effective, less time consuming, easy to use and non-invasive alternative method for treatment of Dysmennorheoa vis Udavarta Yonivyapad. The results were quite encouraging without any side effects. This can be further evaluated on large number of patients to validate its effectiveness. Further pharmacological research studies are the need of the hour.

Reference

1. Sunil Kumar Joshi. Marma science and Principles of Marma therapy. New Delhi, Vani Publication. 2019.

2. Shastri Ambika Dutta. Sushrut Samhita, Ayurveda Tattva Sandipika. Chaukhambha Sanskrit Sansthan, Varanasi. Volume-1, 2012, Sharir Sthan, chapter 6.


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3. Pandit Kashinath Shastri, Gorakhnath Chaturvedi. Vidyotini Tika Charak Samhita. Choukhambha Bharti, Varanasi. Chikitsa Sthan chapter 30.

4. D. C. Dutta text book of Gynaecology including contraception edition 7th edited by Hiralal Konar Jaypee brothers medical publisher pvt. Ltd New Delhi 2016.

5. Sushruta: Sushruta Samhita, edited with Ayurvedatatvasandeepika Hindi commentary by Shastri Kaviraj Ambika Dutta. Varanasi India: Chaukhambha Sanskrit Sansthan; part-1; 2014; Shareera Sthana 6/3:71.

6. Shastri Ambika Dutta. Sushrut Samhita, Ayurveda Tattva Sandipika. Chaukhambha Sanskrit Sansthan, Varanasi. Volume-1, 2012, Sushrut Uttartantra, chap.38.

7. Frawley David, Ranade Subhash and Lele Avinash. Ayurveda and Marma therapy. Lotus Press. PO Box 325, Twin Lakes, WI 53181.2003

8. National Health Portal: Marma therapy. Available from www.nhp.gov. Accessed on 26/02/18.


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