E-ISSN:2456-3110

Review Article

Udavartini Yonivyapat

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

An approach towards Pain Management w.s.r. to Udavartini Yonivyapat

Totad C1*, Prasad N2, Utlaskar S3
DOI:10.21760/jaims.8.11.23

1* Channabasavva D Totad, Phd Scholar, Dept Of Kriya Shareera, Sri Sri College Of Ayurvedic Science Research Hospital Sri Sri University, Cuttack, Odisha, India.

2 Nagendra Prasad, Professor HOD, Dept of Kriya Shareera, Sri Sri College of Ayurvedic Science Research Hospital Sri Sri University, Cuttack, Odisha, India.

3 Santoshkumar B Utlaskar, PhD Scholar, Dept of Samhita Siddhanta Sanskrit, Sri Sri College of Ayurvedic Science Research Hospital Sri Sri University, Cuttack, Odisha, India.

In Ayurveda, diseases related to the female reproductive system i.e., gynaecological disorders are described under the caption of Yoni Vyapada. Women have been placed on an extreme worshiping place due to their power of ‘Janani’- creation. it is needed to give proper care and respect to women. God has blessed the female with the most valuable gift of motherhood.[1] The preparation of motherhood starts with puberty when Rajah-Pravriti i.e., menstruation begins.[2] and by the age of 16 it is fully completed after which she is capable of childbearing.[3] Udavarta Yonivyapada or painful menstruation is a common problem of the females in the reproductive age group & has got a detailed patho-physiology and treatment in the classical literature of Ayurveda.[4] “Arthave Sa Vimukthe Tu Tat Kshanam Labhate Sukham” mentioned by Acharya Charaka substantiate the close similarity of Udavarta with spasmodic dysmenorrhoea. Vegodavarthana leading to Pratiloma Gati of Apana Vata and Rajas is the pathology behind Udavartha Yonivyapath. So, treatment should aim at the relief of pain by normalising the direction of menstrual flow which in turn is by normalising the vitiated Apana Vayu. The present paper is aimed at incorporating all the references regarding Udavartha including Nidana Panchakas from Ayurvedic classics and to show the significance of Basti in normalizing the Apana Vata.

Keywords: Udavarta Yonivyapada, Uttarbasti, Kshobha Artava, Vatanulomaka, Menstruation, Dysmenorrhoea

Corresponding Author How to Cite this Article To Browse
Channabasavva D Totad, Phd Scholar, Dept Of Kriya Shareera, Sri Sri College Of Ayurvedic Science Research Hospital Sri Sri University, Cuttack, Odisha, India.
Email: 		Totad C, Prasad N, Utlaskar S, An approach towards Pain Management w.s.r. to Udavartini Yonivyapat. J Ayu Int Med Sci. 2023;8(11):148-152.
Available From
https://jaims.in/jaims/article/view/2888

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-08 2023-09-13 2023-09-18 2023-09-23 2023-10-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.96%

© 2023by Totad C, Prasad N, Utlaskar 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].

J Ayu Int Med Sci 2023;8(11)148
Channabasavva D. Totad et al. Approach towards Pain Management to Udavartini Yonivyapat

Introduction

In Ayurvedic classics gynaecological disorders have been described under the heading of Yoni Vyapat. All the classics have given the number of Yonivyapat as twenty.[5] One among them is Udavartini Yoni Vyapat. The main clinical feature is Rajah Kricchrata (painful menstruation). Udavartini Yoni Vyapada is one of them where in painful menstruation is the cardinal feature of the disease and the discomfort is relieved after establishment of menstruation, which may be foamy in appearance.[6] Udavartini being one of the Yonivyapat which occurs approximately 50% of menstruating women, and its reported prevalence has been highly variable (e.g., 45-95%) of women of reproductive age.

Charaka first describes Udavarta in Vataja Nanatmaja diseases also explained elaborately in Chikitsa Sthana. Udavarta derived from the word ut + avarta (upward direction) of Vayu. Rajah Kricchrata is one of the main clinical symptoms of Udavartini. Panchakarma therapy offers an effective treatment for Udavartini Yonivyapat along with Eka Moolokia Prayoga and Shamana Aushadi’s. As Vata is responsible for the occurrence of Pain in Udavartini, Basti is the best choice of treatment modality mentioned in classics.[7]

Aims and Objectives

The present paper is aimed at incorporating all the references regarding Udavartha including Nidana Panchakas from Ayurvedic classics and to show the significance of Basti in normalizing the Apana Vata.

Materials and Methods

Literature Search - search for the term ‘Udavarta’ in Brihatrayee and Lagutrayee and available commentaries along with online resources, Journals, was reviewed during this work.

Nidana

प्रवृद्धलिङ्गं पुरुषं याऽत्यर्थमुपसेवते |
रूक्षदुर्बलबाला या तस्या वायुः प्रकुप्यति ||सु.उ 38/03||
मिथ्याचारेण ताः स्त्रीणां प्रदुष्टेनार्तवेन च|
जायन्ते बीजदोषाच्च दैवाच्च शृणु ताः पृथक् ||च.चि 30/8||

The specific aetiologies are
1. Mithyaachara
2. Pradushta Artava
3. Beejadosha
4. Daiva[8]

1. Mithyahara

Hitaharas characterised by Guna Sampath of Ahara leads to formation of unvitiated Ahara Rasa, which further leads to the formation of Rasadhathu. Rasa Dhatu being the origin for Artava is an important factor causing gynaecological disorders.

  • Alpamatrasana and Anasana leads to Dhathukshaya and ill health which may result in anaemia, increased chances of infection, decreased pain threshold and increased chances of disease.
  • Atyadhika Ahara, Dushta Bhojana leads to Amotpatti. This infact can lead to various pathologies. Certain other factors along with Virudha Ahara can potentially cause the Utklesha Doshas to localise in Yoni.
  • Over intake of Ruksha substances and Katu, Tiktha, Kashaya Rasa. These Rasas are believed to be a propagating factor for Vata Dosha.

Mithya Vihara

Abnormal mode of life like suppression of natural urges, excessive coitus, and exercise, fear, sadness etc. will vitiate Vata. Sedentary life styles, stress and strain in daily life are risk factors for spasmodic dysmenorrhoea.

  • Vegadharana can disrupt the HPO axis leading to hypoestrogenism. Oestrogen deficiency leads to lack of menstruation and menstruation with difficulty leading to pain.
  • In some persons IUCD causes pain during menstruation which can be included under Apadravya Sevana as told in our classics.

2. Pradushtarthava

The word Artava refers to menstrual blood, ovum and ovarian hormones. Pradushtartava refers to the menstruation which is not having intermenstrual period of one month, and is associated with pain and burning sensation. Excreted blood is unctuous, very scanty, or excessive in amount, and the color does not resemble with that of Gunja, Laksha, Padma, or Shashaasrk.

3. Beejadosha

Hereditary factors of dysmenorrhoea can be considered under this. Depending on the degree of the defect in the abnormalities of Beeja, Beeja Bhaga (chromosome or gene) can


J Ayu Int Med Sci 2023;8(11)149
Channabasavva D. Totad et al. Approach towards Pain Management to Udavartini Yonivyapat

lead to abnormalities like absence or the defective formation of genital organs such as pinhole os (Suchimukhi), atresia of vagina, uterine hypoplasia, imperforated hymen etc.

Daiva

In the absence of apparent cause the disease developed by Purva Janmakritha Papa due to the curse of God.

Samprapti & Lakshana[9]

वेगोदावर्तनाद्योनिमुदावर्तयतेऽनिलः|
सा रुगार्ता रजः कृच्छ्रेणोदावृत्तं विमुञ्चति||२५||
आर्तवे सा विमुक्ते तु तत्क्षणं लभते सुखम् |
रजसो गमनादूर्ध्वं ज्ञेयोदावर्तिनी बुधैः|| च.चि.३०/२६||

Clinical features of Udawartha

RupaCharaka SamhitaSusrutha SamhitaAshtanga SamgrahaAshtanga HridayaMadhava Nidana
Krichrartava+++++
Artava Vimukhte Tatkshanam Sugham+----
Phenilatwam-++++
Vedana++--+
Yoni Prapidana--++-
Kapha Samsrishta Artava-----
Badhaartava--+--

Samprapti Ghataka

  • Dosha : Vata Pradhana Tridosha
  • Dhathu : Rasa, Rakta, Arthava
  • Upadhatu : Arthava
  • Agni : Jatharagni
  • Strotas : Rasa, Rakta, Arthavaha
  • Srotodusti : Sanga, Vimargagamana
  • Udbhava Sthana: Amapakwashaya
  • Rogamarga : Abhyantara
  • Vyakta Sthana: Garbhashaya

Differential diagnosis

In the description of Sthreerogas, pain associated with Yoni are seen in the following diseases

Terminologies describing pain in Sthreerogas

Samhita GranthasTerminology of painDiseases
Charaka SamhitaYoni Toda, SavedanaVatala Yoni Vyapad
SulaSannipatika Yoni Vyapad
SaartiPariplutha
SarujaVataja Asrigdhara
MandarujaKaphaja Asrigdhara
BrsaartiAntarmukhi
Susrutha SamhitaSula, Nistoda, PeedithaVataja Yoni Vyapad
TodaadikaSuchimukhi
Nitya VedanaViplutha
VagbhataRuk, TodamVataja Yoni Vyapad
Teevra RujamAntarmukhi

Pathophysiology of pain in Yonivyapad
Jaims_2888_01.jpg

Diagnosis

Udavarta Yoni Vyapath can be easily diagnosed from other conditions mimicking it by its specific characters like;

  • The pain strictly restricted to menstruation and usually patient feels relief following discharge of menstrual blood.
  • There will be no alterations in the amount of Artava, neither it will be excessive nor scanty.
  • There will be no local pathology like protuberance of mass, dryness, roughness or numbness of Yoni

Upadarava: Specific Upadravas are not mentioned for Udavartha and those mentioned in Yoni Rogas such as Pradara, Gulma, Arsa, Vandhyatha, Artavadosha etc. can be taken as its Upadrava.


J Ayu Int Med Sci 2023;8(11)150
Channabasavva D. Totad et al. Approach towards Pain Management to Udavartini Yonivyapat

Sadhyasadhyatha (Prognosis): Udavartha Yoni Vyapath is considered under Sadya category, as the disease is Ekadoshaja (Vataja).

Chikitsa

In case of Udavarta, Vataprakopa is the main reason and so the treatment should be directed to normalise the Vata. All Acharyas opine that, none of the Yonirogas occur without vitiation of Vata, and thus Vata is to be corrected first.

Jaims_2888_02.jpg

Mode of action of Basti

Since, Vata is responsible for the pain in Udaavartini, Basti is the main line of treatment mentioned in classics. Yoga Basti in the form of Kashaya and Anuvasana has local & systemic affects. Veerya of Kashaya Basti may get transported through Dhamanis, Sira, and Strotas to entire body. Makshika and Lavana does Kapha Chedana and Vilayana. Saindava by its Sookshma, Teekshna, and Vyavaya Guna reaches to minute channels of the body. Taila enters Strotas and removes the Sankocha (spasm) by the virtue of its Sookshma, Vyavayi and Vikasi Guna. Hence Basti relieves the Pain.

  • Basti stimulates the enteric nervous system and thus it influences CNS through ENS.
  • Basti Dravyas act on the inflammatory substances like prostaglandins and vasopressin.
  • Basti Dravyas excretes increased prostaglandins.

  • Basti Dravya's act on Visceral afferent stimulation which result in activation of the Hypothalamo-pituitary adrenal axis and Autonomous nervous system.
  • It involves the release of neurotransmitters like serotonins, which normalizes the uterine contraction.
  • Basti makes - Vatanulomana & Normalizes the Apana Vata

Dravyas used in Basti

  • Snehana Karma with Trivrut Sneha.
  • Swedana Karma with Ksheera.
  • Dashamoola internally as well as Basti.
  • Anuvasana Basti by Trivrut Taila,
  • Anuvasana Basti by Nishotha Taila,
  • Upanaha made of paste of Barley, wheat, kinva, Kusta, Shatapushpa, Priyangu, Bala.

Shamana Aushadhi’s

  • Raja Pravartini Vati,
  • Kaseesadi Vati,
  • Maharasnadi Kashaya,
  • Sukumara Kashaya,
  • Jeerakadi Modakam,
  • Kumaryasava,
  • Sukumara Gritham,
  • Phala Gritham,
  • Hingu Twachadi Churna.
  • Danti Trivutyadi Churna
  • Agnimukha Churna,
  • Chandrabhaskara Rasa,

Conclusion

Vata is being the main causative factor, Raja Krichrata is one of the main symptom in Udavartini Yonivyapat. Yoga Basti & Uttara Basti have the significant role in normalizing the Vata along with Shamana Aushadhi’s. In present era the change in the life style, maintenance of proper Ahara, Vihara during Ritu Kala and Aushadhi Kala on proper time will cure the condition.



J Ayu Int Med Sci 2023;8(11)151
Channabasavva D. Totad et al. Approach towards Pain Management to Udavartini Yonivyapat

References

1. Manusmriti with Manuartha Muktavali Commentary of Kulluka Bhatta with Maniprabha Hindi Commentary by Pt. Haragovinda Shshtri; by Pt. Gopala Shashtri Nene.
Varanasi: Chaukhamba Surabharati Prakashana; 7th edition, 2001; 9/96:478.

2. Sushruta Samhita Nibandhasangraha Commentary, Sutra sthana 14/6, by Jadavji Trikamji Acharya. Varanasi: Chaukhamba Surabharati Prakashana; 1st edition, 1994; 59.

3. Sushruta Samhita Nibandhasangraha Commentary, Sharira sthana 10/53, by Jadavji Trikamji Acharya. Varanasi: Chaukhamba Surabharati Prakashana; 1st edition, reprint 1994; 392.

4. Charaka Samhita with Ayurveda-Dipika Commentary, Chikitsa sthana 30/25,26, by Jadavji Trikamji Acharya. Varanasi: Chaukhamba Surabharati Prakashana; 1st edition, reprint 2004; 635.

5. Charaka Samhita with Ayurveda-Dipika Commentary, Chikitsa sthana 30/7, by Jadavji Trikamji Acharya. Varanasi: Chaukhamba Surabharati Prakashana; 1st edition, reprint 2004; 634.

6. Sushruta Samhita of Sushruta with Nibandhasangraha Commentary, Sharira sthana 3/32, by Jadavji Trikamji Acharya. Varanasi: Chaukhamba Surabharati Prakashana; 1st edition, reprint 1994; 274.

7. Vagbhata. Ashtanga Hrdayam, English translation by Prof K R Srikanta Murty, Uttarasthana, Chapter 33, verse 33. Varanasi: Choukamba Krishnadas Academy; Reprint 2005; 311.

8. Agnivesa. Charaka Samhita, Text with English translation by Dr. RK Sharma and Bhagvan Dash, Chikitsa sthana; Yonivyapath cikitsa adhyaya, chapter 30, verse 8. Varanasi: Chaukambha Sanskrit Series; Reprint 2005; 130.

9. Agnivesa. Charaka Samhita, Text with English translation by Dr. RK Sharma and Bhagvan Dash, Chikitsa sthana; Yonivyapath cikitsa adhyaya: chapter 30, verse 26. Varanasi: Chaukambha Sanskrit Series; Reprint 2005; 135.


J Ayu Int Med Sci 2023;8(11)152