E-ISSN:2456-3110

Research Article

Management of Dysmenorrhea

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 2 February
Publisherwww.maharshicharaka.in

Clinical evaluation of Erand Tail Nabhi Puran in the management of Dysmenorrhea : Pilot Study

Shrirang Sawarde T1*, Suresh Deshmukh V2
DOI:10.21760/jaims.9.2.5

1* Trupti Shrirang Sawarde, Post Graduate Scholar, Dept of Stree Roga Prasuti Tantra, Shree Saptashrungi Ayurveda Mahavidyalaya and Hospital, Nashik, Maharashtra, India.

2 Varsha Suresh Deshmukh, Professor, Dept of Stree Roga Prasuti Tantra, Shree Saptashrungi Ayurveda Mahavidyalaya and Hospital, Nashik, Maharashtra, India.

Dysmenorrhea is defined as painful menstrual cramps of uterine origin which can be correlated with Udavartini Yonivyapad. It is very common gynecological disorder in females specially in reproductive age. Sometimes it also hampers women’s daily routine. Udavarta Yonivyapad is explained in Ayurveda as a Nanatmaja Vata Vyadhi by Charaka where there is abnormal movement of Vayu in Pakwashay with painful menses. There are different types of NSAIDS, OC pills, painkillers, etc. to give temporary relief from pain but it also has side effects on body if taken in excess amount. In Ayurveda lot of formulations are used for treatment of same. An attempt has been made through Ayurveda classics in regards to dysmenorrhea with Nabhi Puran using Eranda Taila.

Keywords: Dysmenorrhea, Nabhi Puran, Eranda Taila, Udavartini Yonivyapad

Corresponding Author How to Cite this Article To Browse
Trupti Shrirang Sawarde, Post Graduate Scholar, Dept of Stree Roga Prasuti Tantra, Shree Saptashrungi Ayurveda Mahavidyalaya and Hospital, Nashik, Maharashtra, India.
Email: 		Shrirang Sawarde T, Suresh Deshmukh V, Clinical evaluation of Erand Tail Nabhi Puran in the management of Dysmenorrhea : Pilot Study. J Ayu Int Med Sci. 2024;9(2):22-28.
Available From
https://jaims.in/jaims/article/view/2991

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-12-09 2023-12-19 2023-12-29 2024-01-09 2024-01-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.95

© 2024by Shrirang Sawarde T, Suresh Deshmukh Vand 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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Trupti Shrirang Sawarde et al. Clinical evaluation of Erand Tail Nabhi Puran in Dysmenorrhea

Introduction

Ayurveda is a science of life which focuses on preventive aspect rather than curative one. Ayurveda is an intricate and detailed science, which provides great insight into the cure of disease without causing any or minimal side effects.

Dysmenorrhea is painful menstrual cramps of uterine origin and one of the most common gynecological problems in young women, particularly among reproductive age.[1] It is characterized by painful menstruation severe enough to prevent from doing daily activities. It is classified according to its patho-physiology as primary dysmenorrhea and secondary dysmenorrhea.

1. Primary dysmenorrhea - Menstrual pain without pelvic pathology.

2. Secondary dysmenorrhea - Painful menses associated with an underlying pathology.

Clinical features of primary dysmenorrhea

a) Onset shortly after menarche within 6-24 months.

b) Usual duration of 48–72 hours, often starts before or just after the menses

c) Cramping or labor like pain, cyclic pattern, most severe during 1st day of menses and lasts till 72 hours.

d) Often unremarkable pelvic examination findings [2,3]

Udavarta Yonivyapad is explained in Ayurveda as a Nanatmaja Vata Vyadhi by Charaka where there is abnormal movement of Vayu in Pakwashaya. Udavartini Yonivyapad is characterized by painful menstruation i.e., kashtarva.[4] According to Charaka, Rajas is pushed in upward direction by the aggravated Apana Vayu, it fills the Yoni, causing pain and upward movement of Rajas. This Rajas is expelled with great difficulty.[5] Once the Rajas is expelled pain is relieved.

From all formulation Erand Tail is chose for Nabhi Puran for its Vaathar properties. Erand Tail Basti is mentioned as Chikitsa in Samhita for Yonivyapad but Nabhi Puran is chosen because of its easy administration. Nabhi Puran with Eranda Taila showed significant improvement in signs and symptoms of dysmenorrhea.

Aim and Objectives

1. To study in detail about Nabhi Puran and dysmenorrhea

2. To evaluate efficacy of Erand Taila Nabhipuran in dysmenorrhea

Materials and Methods

Study Population

A total of 10 females with diagnosed cases of primary dysmenorrhea, were enrolled from the OPD of Stree Roga & Prasuti Tantra, Shree Saptashrungi Ayurveda Mahavidyalaya and Hospital, Nashik.

Study Design

This was a pilot study conducted in Department of Stree Roga & Prasuti Tantra at Shree Saptashrungi Ayurveda Mahavidyalaya and Hospital, Nashik.

Drug Review

Earnd Tail is used in this study for Nabhi Puran.

Eranda - Ricinus communis, Euphorbiaceae

Rasa - Madhur; Guna - Guru Singdha; Virya - Ushna; Vipaka - Madhur; Karma - Vaathar, Vrushya, Aampachan.

Inclusion Criteria

a) Age group - 20 to 35 years

b) Dysmenorrhea without any pelvic pathology (Primary Dysmenorrhea)

c) Regular menstrual cycle

Exclusion Criteria

a) Secondary Dysmenorrhea

b) Age group below 20 and above 35 years excluded

c) Irregular menstrual cycle

d) Patient with venereal diseases

Mode of Action

A drug which has the property to bring about the Anuloma Gati of Vata helps in reliving the symptoms of primary dysmenorrhea. Eranda Taila has been mentioned in Bhaishajya Ratnavali 5/1290-91. The Vata is obstructed by Meda, Kapha, Pitta, or Rakta.


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Trupti Shrirang Sawarde et al. Clinical evaluation of Erand Tail Nabhi Puran in Dysmenorrhea

The reduction in painful menstruation attributed to Ushna Virya, Anulomana, Tridoshahara and Shothahara properties of Eranda. Due to its Srota Avarodhahara property, it removes the Sanga in Srotas and Dosha Shaman especially Vatahara property leads to reduction in pain during menses. The oil gets absorbed in pores of skin and act on deeply located Doshas.

Intervention - Nabhi Puran with Erand Taila was done

Mode of intervention

DrugErand Taila
KalpanaErand Taila Nabhipuran
Duration7 days prior to menses till days 5 of menses
Root of AdministrationExternal (Local) Nabhipuran
MatraAs per required

Assessment Criteria

SNSymptomsCriteriaGrade
1.Lower Abdomen Pain (VAS)No Lower Abdomen Pain (0)0
Mild Lower Abdomen Pain (1-3)1
Moderate Lower Abdomen Pain (4-6)2
Sever Lower Abdomen Pain (7-10)3
2.NauseaNo Nausea0
Mild Nausea1
Moderate Nausea2
Sever Nausea3
3.Period FatigueNo period fatigue0
Mild period fatigue1
Moderate period fatigue2
Sever period fatigue3

Age wise distribution

SNAge GroupsNo. of PatientsPercentage
1.16 – 24 yr.0220.00
2.25 – 33 yr.0770.00
3.34– 42 yr.0110.00
Total10100 %

Age wise distribution of 10 patients of Primary Dysmenorrhea.

Marital status wise distribution

SNMarital statusNo. of PatientsPercentage
1.Married0440.00
2.Unmarried0660.00
Total10100 %

Marital status wise distribution of 10 patients of Primary Dysmenorrhea.

Occupation

SNOccupationNo. of PatientsPercentage
1.Worker0110.00
2.Housewife0220.00
3.Receptionist0110.00
4.Student0660.00
Total10100 %

Occupation wise distribution of 10 patients of Primary Dysmenorrhea.

Education wise distribution

SNEducationNo. of PatientsPercentage
1.Illiterate0220.00
2.Literate0880.00
Total10100 %

Education wise distribution of 10 patients of Primary Dysmenorrhea

Prakruti wise distribution

SNPrakruti wise distributionNo. of PatientsPercentage
1.Vata0000.00
2.Pitta0000.00
3.Kapha0000.00
4.Vata-Pitta0330.00
5.Pitta-Kapha0220.00
6.Kapha-Vata0550.00
Total10100 %

Prakruti wise distribution of 10 patients of Primary Dysmenorrhea.

Agni wise distribution

SNAgni wise distributionNo. of PatientsPercentage
1.Tikshagni0110.00
2.Mandagni0660.00
3.Vishamagni0330.00
4.Samagni0000.00
Total10100%

Agni wise distribution of 10 patients of Primary Dysmenorrhea.

Koshta wise distribution

SNKoshta wise distributionNo. of PatientsPercentage
1.Krura0660.00
2.Madhya0110.00
3.Mrudu0330.00
Total10100 %

Koshtha wise distribution of 10 patients of Primary Dysmenorrhea.

Statistical Analysis

Subjective Parameters by Wilcoxon Singed Rank test


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Trupti Shrirang Sawarde et al. Clinical evaluation of Erand Tail Nabhi Puran in Dysmenorrhea

Lower Abdomen Pain (VAS)

BT/ATNMeanSDWPResult
BT102.7000.483-55P<0.001Significant
AT100.2000.422
Difference102.5000.527

Nausea

BT/ATNMeanSDWPResult
BT101.9000.738-55P<0.001Significant
AT100.3000.483
Difference101.6000.516

Menstruation Fatigue

BT/ATNMeanSDWPResult
BT102.3000.483-55P<0.001Significant
AT100.3000.483
Difference102.0000.816

Effect of therapy according to relief in Patients’ score

SNB.T.A.T.RelievedRelief in %
1.71685.71429
2.606100
3.72571.42857
4.808100
5.71685.71429
6.505100
7.71685.71429
8.81787.5
9.81787.5
10.61583.33333

Total Effect of therapy

SNImprovementNo of PatientsPercentage
1.Good Improvement
(75% - 40%)		10100.00 %
2.Moderate Improvement
(50% - 75%)		0000.00 %
3.Mild Improvement
(25% - 50%)		0000.00 %
4.Unchanged (No Improvement)
(0% - 25%)		0000.00 %
Total10100%

Effect of therapy according to relief in Symptoms’ score

SNSymptomsB.T.A.T.Relieved% Relief
1.Lower Abdomen Pain (VAS)27022592.59
2.Nausea19031684.21
3.Period Fatigue23032086.95
Overall result87.9166

Total effect of therapy:

SNClassPercentage of improvement
1.Good improvementTotal relief in cardinal symptoms - 75- 100%
2.Moderately improvement50% - 75%
3.Mild improvement25% – 50%
4.Poor improvementLess than 25%



Shows effect of therapy according to relief in symptoms score

SNImprovementSymptomsNo. of Symptoms
1.Good Improvement
(75% - 40%)		Lower Abdomen Pain (VAS), Nausea and Period Fatigue03
2.Moderate Improvement
(50% - 75%)		------00
3.Mild Improvement
(25% - 50%)		------00
4.Unchanged
(No Improvement)
(0% - 25%)		------00

Discussion

Age wise distribution

In the present study, maximum no. of patients i.e. 07 were from the age group 25-33 yrs. Followed by 02 in 16-24 yrs and 01 in 34-42 yrs.

Marital status wise distribution

In the present study, maximum no. of patients i.e. 06 was unmarried while remaining 04 was married.

Occupation

According Occupation wise distribution it was found that, maximum no. of patients i.e., 06 were students and followed by 02 were Housewife, 01 were worker and 01 were Receptionist.

Education wise Distribution

On the observation it was found that, no. of patients i.e., 08 were Illiterate while remaining 02 are literate.

Prakruti wise distribution

On the observation it was found that, maximum no. of patients i.e., 05 were in Kaphat Vataja Sharira Prakruti, 03 were Vata-Pttaja Sharira Prakruti and 02 were Pitta-Kaphaja Sharira Prakruti.

Agni wise distribution

On the observation it was found that, maximum no. of patients i.e., 06 were in Mandagni and 03 were Vishamagni and 01 was Tikshagni.

Koshta wise distribution

On the observation it was found that, maximum no. of patients i.e. 06 were in Krura Mrudu Koshta and 03 were Mrudu Koshta and 01 were Madhya Koshta.


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Trupti Shrirang Sawarde et al. Clinical evaluation of Erand Tail Nabhi Puran in Dysmenorrhea

Statistical Analysis

Statistical analysis between BT and AT by Wilcoxon Signed Rank Test in Subjective Parameters

SNSymptomsWPSignificance
1.Lower Abdomen Pain (VAS)-55P<0.001Significant
2.Nausea-55P<0.001Significant
3.Period Fatigue-55P<0.001Significant

Wilcoxon Ranked Sign test was applied observe whether the difference between BT and AT score is significant or not.

H0: Erand Taila Nabhipuran is not effective to reduce symptoms in Udavartini Yonivyapad (Dysmenorrhea).

H1: Erand Taila Nabhipuran is effective to reduce symptoms in Udavartini Yonivyapad (Dysmenorrhea).

In the case of all symptoms Lower Abdomen Pain (VAS), Nausea and Period Fatigue the test has shown highly significant difference between BT and AT symptom scores. H1 is accepted and H0 is rejected here. It was hence concluded that Erand Taila Nabhipuran is effective to reduce Lower Abdomen Pain (VAS), Nausea and Period Fatigue symptoms in Udavartini Yonivyapad (Dysmenorrhea).

SymptomMeanSDWP value
Lower Abdomen Pain (VAS)2.5000.527-55P<0.001
Nausea1.6000.516-55P<0.001
Menstruation Fatigue2.0000.816-55P<0.001

Total effect of the therapy

1. The total effect of therapy is evaluated by taking relief in percentage of each patient. Out of 10 patients Good improvement was seen in 10 patients.

2. By using Erand Taila Nabhipuran on Udavartini Yonivyapad (Dysmenorrhea) symptoms as Lower Abdomen Pain (VAS), Nausea and Period Fatigue were got the 75 % to 100 % relief.

3. As for Lower Abdomen Pain (VAS) symptom in Study group shown the 92.59 % relief followed by 21 % for Nausea and 86.95 % for Period Fatigue for symptom of all 10 patients of Udavartini Yonivyapad (Dysmenorrhea).

4. Udavartini Yonivyapad is Vaat Vyadhi and can be treated rightly with help of Vaathar Nabhi is Sthan of Apan Vayu. In Udavartini Yonivyapad, it is Apan Vayu

that is vitiated causing pain during menses. Erand Tail causing Shaman of Apan Vayu with its Vaathar Properties followed by pain relief.

5. It was also observed the menses were smooth without any discomfort and approximately occurred on Day 28 of the cycle. Eranda Taila contain constituents like tannin, saponin etc. The role of tanin and saponin in analgesic and anti-inflammatory activities were proven.[6] Rukshahara, Shophahara, Apanavatanulomana and Deepen properties of Eranda Taila can be considered for reducing pain.[7]

Conclusion

Nabhi Puran with Eranda Taila showed significant improvement in signs and symptoms of Dysmenorrhea. Dysmenorrhea which can be treated by using principles of Vatiki Yoniroga Chikitsa. Vatika Yoniroga Chikitsa includes Snehan, Swedan, Basti along with Shaman Aushadhi which can alleviate Vata and gives relief from pain. The total effect of therapy is evaluated by taking relief in percentage of each patient. Out of 10 patients Good improvement was seen in 10 patients. By using Erand Taila Nabhipuran on Udavartini Yonivyapad (Dysmenorrhea) symptoms as Lower Abdomen Pain (VAS), Nausea and Period Fatigue were got the 75 % to 100 % relief. As for Lower Abdomen Pain (VAS) symptom in Study group shown the 92.59 % relief followed by 84.21 % for Nausea and 86.95 % for Period Fatigue for symptom of all 10 patients of Udavartini Yonivyapad (Dysmenorrhea). Nabhi Puran is a cost effective, safe and effective procedure in any pain during menses. Based on the outcome of the study we can adopt Nabhi Puran in the management of Primary Dysmenorrhea. The present study was conducted with limited time, limited facilities and limited number of patients. A study of larger group of patients may help to comprehend the mode of action of the trial drug.

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5. Shastri K, Chaturvedi G. Upadhyay Y, Sastri RD, Pandey G, editors. Charaka Samhita. Chowkhamba Sanskrit Series. (a)Chikitsa sthana. (843).1998;2:25–3. (b) Cha.Chi 30/110-1 p. 847.

6. Castor Oil: Are There Health Benefits Pros and Cons, Nutrition, and More [Internet]. [cited 2022 Mar 31].

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