E-ISSN:2456-3110

Research Article

Bhumyamalaki Churna

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 9 September
Publisherwww.maharshicharaka.in

The effect of Bhumyamalaki Churna and Kusha Mula Churna in the management of Asrigdara w.s.r. to Menorrhagia

Danappagoudara M1*, Patil S2
DOI:10.21760/jaims.8.9.6

1* Maheshwari Danappagoudara, Post Graduate Scholar, Department Of Prasuti Tantra And Stree Roga, Sri Sri College Of Ayurvedic Science And Research, Bengaluru, Karnataka, India.

2 Savita S Patil, Professor and HOD, Department of PG studies in Prasuti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

Background: Now a days in fast developing globalized era, the percentage of working women are more. Due to the busy schedule, she is unable to follow Paricharyas as mentioned in Samhitha, such as Rajaswala Paricharya, Sutika Paricharya. Due to which women are prone for menstrual disorders. One fifth of the women have the problem with heavy menstrual blood loss at some period of their reproductive life. One among them is Menorrhagia. Prolonged bleeding causes psychological upset like discomfort during work, lack of concentration, mental disturbance etc. Menorrhagia is defined as cyclic bleeding at normal interval; the bleeding is either excessive in amount (>80ml) or duration (>7days) or both. Menorrhagia is largely responsible for iron deficiency and iron deficiency anaemia, both of which have negative effect on women health. Acharyas explained both Shamana Chikitsa and Shodhana Chikitsa for Asrugdara. Among Shamana Chikitsa Bhumyamalaki Churna and Kusha Mula Churna are mentioned by Bhaishajya Ratnavali and Chakradatta respectively. Bhumyamalaki and Kusha Mula have Kashaya and Madhura Rasa, Shita Virya and Madhura Vipaka, does Pitta Shamana and Stambhana Karma. Both the drugs are easily available hence are opted for the study. Materials and methods: The present study was Randomised clinical study where 30 subjects diagnosed with Asrugdara was taken in 2 groups with 15 subjects in each group. Conclusion: Bhumyamalaki Churna is found to be more effective in managing the Asrugdara w.s.r. Menorrhagia.

Keywords: Asrigdara, Menorrhagia, Pradara, Rajaswala Paricharya, Sutika Paricharya

Corresponding Author How to Cite this Article To Browse
Maheshwari Danappagoudara, Post Graduate Scholar, Department Of Prasuti Tantra And Stree Roga, Sri Sri College Of Ayurvedic Science And Research, Bengaluru, Karnataka, India.
Email: 		Danappagoudara M, Patil S, The effect of Bhumyamalaki Churna and Kusha Mula Churna in the management of Asrigdara w.s.r. to Menorrhagia. J Ayu Int Med Sci. 2023;8(9):34-39.
Available From
https://jaims.in/jaims/article/view/2765

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-02 2023-08-09 2023-08-16 2023-08-23 2023-08-30
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.33

© 2023by Danappagoudara M, Patil Sand 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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Maheshwari D. et al. Effect of Bhumyamalaki Churna and Kusha Mula Churna in Asrigdara

Introduction

Menstrual cycle is a complex series of physiological changes that occurring in women on a monthly basis. The menstrual cycle is regulated by the endocrine system through the complex interaction of the HPO axis. The normal duration of bleeding is about five days and estimated blood loss is about 20 to 80 ml with an average of 35ml.[1]

The word ‘Menorrhagia’ is derived from the Greek words ‘Meno’ meaning uterus and ‘Rhegnunai’ meaning to burst forth. Menorrhagia which is defined as cyclic bleeding at normal intervals, the bleeding is either excessive in amount (>80ml) or duration (>7days) or both.[2] Globally its occurs in 9-14% of women between menarche to menopause, it is impacting quality of life and imposing financial burden.[3]

In Ayurveda, Menorrhagia can be correlated to the terminology called Asrugdara. Asrugdara / Rakta Pradara is one among the Rakta Pradoshaja Vikara.[4] It is characterized by Artava Ati Pravrutti, Deerga Kala Pravrutti, Anruta Kala Pravrutti, Daha in Adho

Vankshana Pradesha, Shroni, Prushta and Kukshi, Shoola in Garbhashaya Angamardha etc. It is Pitta Pradhana Tridoshaja Vyadhi.[5]

The treatment of menorrhagia is mainly consisting of hormonal therapy which in long term use may lead to side effects. Hence it becomes the need for time to find out an effective, non-hormonal remedy which is simple, easily available, cost effective and easy to administrate for the cure of Asrigdara. By Keeping all these in mind, this study had been designed to work out the clinical evaluation of effectiveness of Bhumyamalaki and Kusha in Asrigdara. This study is intended to know the effectiveness of a single drug administration in Asrigdara over the combined formulation.

Aim

To evaluate whether the Bhumyamalaki Churna and Kusha Mula Churna have better effect in the management of Asrugdara w.s.r. to Menorrhagia.

Objective

1. To evaluate the efficacy of Bhumyamalaki Churna in the management of Asrugdara.

2. To evaluate the efficacy of Kusha Mula Churna in the management of Asrugdara.
3. To compare the efficacy of Bhumyamalaki Churna along with Kusha Mula Churna.
4. Efficacy was evaluated with PBAC score.

Study Design - A randomized open labelled comparative clinical study.

Selection of the subjects

The present study was carried out for the subjects from OPD & IPD, Dept. of Prasuti Tantra and Streeroga, SSCASR, Bengaluru.

Method of collection of data

Inclusion criteria

1. Subjects with the age between 18 to 45 years irrespective of their marital status.
2. Subjects with classical symptoms of Asrugdara i.e., Excessive and/or prolonged blood loss during menstruation.
3. Subjects with symptoms of Menorrhagia i.e., Bleeding more than 7 days and/or Excess in amount (>80ml).

Exclusion criteria

1. Structural abnormalities like Polyp, Fibroid uterus, Adenomyosis, Endometriosis, Malignancy etc.
2. Subjects with Pelvic inflammatory disease
3. Subjects with IUCD
4. Subjects with post-menopausal bleeding
5. Subjects with Pregnancy
6. Subjects with other systemic illness
7. Subjects with known case of bleeding disorders.

Consent: Written informed consent and voluntarily willing patients was taken for this study.

Materials and Methods

The present study was Randomised Clinical Study where 30 subjects diagnosed with Asrugdara was taken from OP and IP of Prasuti Tantra and Streeroga department of Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru.

Follow up

1st Follow up - 7th day of 1st cycle.

2nd Follow up - 7th day of 2nd cycle.



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Maheshwari D. et al. Effect of Bhumyamalaki Churna and Kusha Mula Churna in Asrigdara

Drug Review

Drugs Bhumymalaki[6] Kusha[7]
Botanical namePhyllanthus niruri sensce (Hook.f)Demostachya bipinnata (Stap.F)
FamilyPhyllanthaseaePoaceae
Rasa Tikta, Kashaya and Madhura Kashaya, Madhura
Guna Laghu, Ruksha  Laghu, Snigdha
Virya Sheeta Sheeta
Vipaka Madhura Madhura
Prabhava Kapha Pitta Shamaka Tridosha Shamaka
SynonymsBahu Patra, Tamalaki, Bahu Virya, Vrushya, Bhudhatri. Pavitra, Yagnanga, Samstara, Mahadarbha, Mahamula, Lavakusha
Useful partPanchanga Mula

Intervention method

Groups Drug Dosage Time of administrationDurationAnupana
Group ABhumyamalaki Churna6g/BDBefore FoodFrom 4th day of cycle for 3 days X 2cyclesTandulodaka
Group BKusha Mula Churna6g/BDBefore FoodFrom 4th day of cycle for 3 days X 2cyclesTandulodaka

Assessment Criteria

1. Subjective Criteria

Gradation Quantity of Bleeding Duration of Bleeding Lower Abdominal Pain Lower BackacheBodyache
0--No painNo painAbsent
13pads/pads3-5daysMild painMild painPresent
24pads/day5-7daysMod. PainMod. Pain-
35-6pads/day7-10daysSevere painSevere pain-
4>7pads/day>10days---

2. Objective Criteria

Hb gm% - Before treatment and After Treatment

Observation and Result

In the present study before starting the treatment, patients were observed for each assessment criteria’s for each group and recorded as well as investigations were done as per criteria of assessment. All the subjects were observed before and after the treatment.

Highly significant improvement in Amount of bleeding (p value <0.001) and Duration (p value <0.001) whereas Group B showed no significance for Amount of bleeding but highly significant for duration (p value <0.001).

PBAC SCORE - P value <0.001, The results indicate almost equal therapeutic benefit in both the groups - with Group A exhibiting slightly better effect. But clinically Group A patients showed better results compared to Group B.

Statistical analysis of the assessment criteria

Parameter Group After 7th day of 1st cycleAfter 7th day of 2nd cycle
P valueESD ValueP valueESD value
Quantity of BleedingGroup A<0.0010.340.0020.2
Group B0.0020.20.0730.2
Duration of BleedingGroup A<0.0010.320.0170.2
Group B<0.0010.390.0050.2
PBAC ScoreGroup A<0.0010.38<0.0010.5
Group B<0.0010.41<0.0010.43
LowbackacheGroup A0.220.110.670.08
Group B0.120.140.350.12
Pain in Lower AbdomenGroup A0.0020.290.0170.25
Group B0.1300.130
Body AcheGroup A0.3600.360
Group B0.120.140.510.10
Clot Size Group A0.120.140.130.18
Group B0.1200.510
HaemoglobinGroup A--0.0050.1
Group B--0.210.1

Overall effect of the drug

Comparison between the group

1. Quantity of bleeding

Amount of blood loss at different points of time (Data: Median, 25th & 75th percentile)

Group 0th Day 7th Day of 1st Cycle 7th Day of 2nd Cycle Remark
Group A2.00(1.00-2.00)1.00 (0.00-1.00)@0.00 (0.00-1.00)@@P value <0.001, highly significant change with in both group with Wilcoxon Signed Rank Test.
Group B2.00(1.00-2.00)1.00 (0.00-1.00)@1.00 (0.00-1.00)

2. Duration of bleedin

Duration of blood loss at different points of time (Data: Median, 25th & 75th percentile)

Group 0th Day 7th Day of 1st Cycle 7th Day of 2nd Cycle Remark
Group A2.00 (1.00-2.00)1.00 (0.00-1.00)@1.00 (0.00-1.00)@@P value <0.001, highly significant change with in both group with Wilcoxon Signed Rank Test
Group B2.00 (1.00-2.00)1.00 (0.00-1.00)@1.00 (0.00-1.00)@

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Maheshwari D. et al. Effect of Bhumyamalaki Churna and Kusha Mula Churna in Asrigdara

3. PBAC Score

PBAC Score at different points of time (Data: Median, 25th& 75th percentile)

Group 0th Day 7th Day of 1st Cycle 7th Day of 2nd Cycle Remark
Group A252 (159.00-300.00)180.00 (110.00-250.00)@110.00 (98.00-204.00)@@P value <0.001, The results indicate almost equal therapeutic benefit in both the groups - with Group A exhibiting slightly better effect.
Group B251.00 (205.00-304.00)170.00 (104.00-228.00)@156.00 (94.00-210.00)@


Overall AssessmentGroup AGroup B
N%N %
Minor Improvement(Grade 1)213.33%960%
Moderate Improvement(Grade 2)426.66%426.66%
Marked Improvement(Grade 3)746.66%213.33%
Complete Improvement(Grade 4)213.33%00%
RemarksThough apparent difference existed between the group it did not reach statistically significant level (P-0.238)

Discussion

For a woman “Raja” is defining factor for her very existence. Shuddha Raja or Artava is one among the Garbha Sambhava Samagri and is most essential factors for the healthy progeny.

In our classics Raja is described as Upadhatu of Rasa and Rakta Dhatu. Upadhatu is nourished from Prasada Bhaga of Dhatu i.e., from that Sukshma Prasadaja Bhaga of Dhatu. Dhatwagni, Vayu and Srotas plays significant role in proper nourishment of Upadhatu. Vayu is responsible for conveyance of specific amounts of nutrients to a particular Upadhatu. ‘Srotas’ are the channels of transportations and transformation enabling this conveyance. “Parinama Apadhyamana Dhatu” travels through the Srotas, and; for this to happen Dhatwagni which is residing in that particular Srotas is an essential factor for transformation. Any vitiation of Vayu (Apana Vata) and Agni lead to Artava Dushti.

Rasa Dhatu is considered as Sowmya Dhatu, whereas Raja as Agneya. “Karya-Karana Siddhanta” is applicable here that is, “Parinama Vishesat Karana Visadarsam Karyam Bhavati” | Su.Su.4/7-Bhanumati.

During the process of formation of Artava is Sowmya

, due to the influence of Rasa, while at the time of its excretion due to specific changes it assumes Agneya character. We can also understand this change with the help of modern science.

Ahara Rasa or Rasa Dhatu is having nutritive substances like glucose, amino acids, fatty acids etc.

Some reproductive hormones like FSH and LH are made by protein. Steroidal hormones like oestrogen and progesterone are made by Cholesterol.

If Ahara Rasa or Rasa Dhatu is having all nutritive substances in proper quantity and quality, the body secretes the proper amount of hormones there by proper endometrial thickness and shedding. Any imbalance in these leads to Asrugdara.

Other than Asrugdhara certain Yoni Vyapat like Asrija, Rakta Yoni, Lohitakshara, Ekadoshaja Yonivyapat, Excessive bleeding during menstruation may be a disease, may be a symptom of other disease or may be a complication of a disease.

Probable action of the drugs

Mode of action of Bhumyamalaki on excessive bleeding:

Bhumyamalaki might affect Sara and Drava Guna of Pitta with the help of Ruksha, Laghu Guna and Kashaya Rasa. Sheeta Veerya possess Sthambana and Pittahara properties there by reduces the amount of bleeding.

Based on chemical constituents:

Controls bleeding by

  • The Action of progesterone hormone and maintains PgF2α & PgE ratio
  • It binds to the Lysine binding site on Plasminogen and prevents its combination with Fibrin like Epsilon Amino-caproic Acid (EACA).

Phenols & Lignans - Phylatralin, niretralin, niranthin acts as anti-inflammatory by inhibiting nutrophilic influx and cox 2 and cytokines via NF- Kappa B pathway.[8],[9]

Mode of action of Kusha on excessive bleeding

Madhura Rasa - It has action of Pitta Shamana.

Snigdha Guna and Sheeta Veerya possess Sthambana and Pittahara properties.


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Maheshwari D. et al. Effect of Bhumyamalaki Churna and Kusha Mula Churna in Asrigdara

As mentioned in Adhoga Rakta Pitta Chikitsa, Adhoga Rakta Pitta caused due to Ruksha, Ushan Guna can be treated with Snigdha Sheeta Guna.

  • Daucosterol or β sitosterol D- glucopyranoside acts on pathogens and controls infection.
  • Antioxidant activity of hydro methanolic root is potent scavenger of hydrogen peroxide radicals, helps in reducing the menorrhagia due to oxidative stress.[10]
  • Hydro methanolic extract of Kusha acts as an antispasmodic effect.

Mode of action of Tandulodaka

  • Tandulodaka is having Madhura, Kashaya Rasa, Sheeta Virya which is effectively does Rakta Sthambana Karma and Madhura Rasa nourishes Rasa Dhatu.
  • Vitamin B; normalize estrogen metabolism and Thiamine, improves endothelial activity of arteries there by controlling excessive bleeding.

Conclusion

The present study is a clinical study with pre-test and post-test design where 30 subjects diagnosed as Asrigdara were randomly assigned into 2 groups, Group A and Group B, comprising of 15 subjects in each group. Amount and duration of bleeding is improved significantly in both the groups but clinically, group A showed marked improvement in Amount of bleeding whereas Group B showed improvement in Duration of bleeding. Group A is having significant effect in reducing the lower abdominal pain during menstruation. 60% and 30% of clinical improvement could be observed in Group A and Group B respectively. Both groups having significant effect in reducing the low backache during menstruation, 33% and 62% of clinical improvement could be observed in Group A and Group B respectively. Reduction in clot size was significant within Group A compared to Group B. Group A is having significant effect within and between the group in haemoglobin levels. 66% showed mild and 20% showed moderate improvement in Hb% in Group A.

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8. Kiemer AK, Hartung T, Huber C, Vollmar AM. Phyllanthus amarus has anti- inflammatory potential by inhibition of iNOS, COX-2, and cytokines via the NF-κB pathway. Journal of Hepatology. 2003 Mar 1;38(3):289-97.

9. Joseph B, Raj SJ. An Overview: Pharmocognostic property of Phyllanthus amarus linn. International journal of Pharmacology.
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10. Vithalrao Bhimashya Khyade. Novel Sacrificial Medicinal Repositories Haf grass, Demostachya bipinnata(L.)and Cogan grass, Imperata
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11. Himamshi V. Role of Darvyadi Ghana Vati in the Management of Asrugdhara, MS [Dissertation]. Jamnagar, Gujarat Ayurveda University; 2006.


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