E-ISSN:2456-3110

Review Article

Kashtartava

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Classical Review on Kashtartava

Mamgain N1*, Anupam A2
DOI:10.21760/jaims.9.8.31

1* Neha Mamgain, Assistant Professor, Dept of Prasuti Tantra and Stri Roga, Faculty of Ayurved Main Campus Uttarakhand Ayurved University Harrawala, Dehradun, Uttarakhand, India.

2 Akansha Anupam, Assistant Professor, Dept of Samhita Sanskrit and Siddhant, Main Campus Uttarakhand Ayurved University Harrawala, Dehradun, Uttarakhand, India.

Kashtartava (Dysmenorrhea) or painful menstruation is one of the leading causes for maximum absenteeism of females from school or workplace. Though it is not a serious problem but it definitely affects the quality of life and efficiency. In Ayurveda, gynecological disorders are described under Yonivyapad, Aartavadushti and Pradara. Few Yonivyapads resemble the clinical presentation of dysmenorrhea. Pradara refers to heavy or prolonged bleeding which may or may not be painful. The normal formation and expulsion of menstrual blood is the Karma of Apana Vayu. Therefore the basic line of treatment is pacifying of Vayu. It can be treated at OPD level with the use of oral medication of Panchakarma procedures.

Keywords: Kashtartava, Yonivyapad, Pradara, painful menstruation, Dysmenorrhea

Corresponding Author How to Cite this Article To Browse
Neha Mamgain, Assistant Professor, Dept of Prasuti Tantra and Stri Roga, Faculty of Ayurved Main Campus Uttarakhand Ayurved University Harrawala, Dehradun, Uttarakhand, India.
Email: 		Mamgain N, Anupam A, Classical Review on Kashtartava. J Ayu Int Med Sci. 2024;9(8):201-204.
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https://jaims.in/jaims/article/view/3424

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-12 2024-07-22 2024-08-02 2024-08-12 2024-08-23
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© 2024by Mamgain N, Anupam Aand 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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Introduction

Dysmenorrhoea refers to painful menstruation of magnitude sufficient so as to incapacitate day to day activities.[1] It may be primary or secondary, depending on absence or presence of any underlying pelvic pathology respectively.

In Ayurveda, gynecological disorders are described under Yonivyapad,[2] Aartavadushti[3] and Pradara.[4] Yonivyapads are 20 in number which can be classified according to the dominance of doshas. Further it can be divided into various categories as per the clinical presentation.

Table 1: Yonivyapad with clinical presentation[5]

YonivyapadDoshik dominanceClinical presentation
VatikiVata Menstrual disorder
PaittikiPittaMenstrual disorder
ShleshmikiKaphaAbnormal discharge
SannipatikiTridoshaMenstrual disorder
RaktayoniPittaAbortion
ArajaskaPittaMenstrual disorder
AcharanaVataRelated to sexual intercourse
AticharanaVataRelated to sexual intercourse
PrakcharanaVataRelated to sexual intercourse
UpaplutaVata KaphaPregnancy related
PariplutaVata PittaRelated to sexual intercourse
UdavartiniVataMenstrual disorder
KarniniVata KaphaPregnancy related
PutraghniVataRepeated abortion
AntarmukhiVataRelated to sexual intercourse
SuchimukhiVataCongenital
ShushkaVataCongenital
VaminiVata PittaAbnormal discharge or early abortion
AntarmukhiVataRelated to sexual intercourse
MahayoniVataRelated to sexual intercourse

Out of these Yonivyapads, Vattiki, Paitiki, Sannipatiki and Udavartini are disorders related to menstruation.

Vatiki Yonivyapad

Due to aggravated Vayu menstrual discharge is frothy, thin and ununctuous and is associated with sound and pain. This type of Yoniroga is also called as Vattika Pradara.[6] In this the blood resembles the juice of Kinshuk (Palasha) which may or may not be associated with pain. This type of dysmenorrhea causes excruciating pain in the waist, groins, cardiac region, side of chest, back and hips.

Paittiki Yonivyapad

Due to aggravated Pitta the menstrual discharge becomes blue, yellow or black in colour, in large quantity, hot and has offensive smell of a dead body. It is also called as Paittika Pradara.[7] In this type of dysmenorrhea it is frequently associated with pain. The patient suffers from burning sensation, redness, thirst, unconsciousness, fever and giddiness.

Sannipatiki Yonivyapad

Due to aggravation of all the three doshas, the menstrual discharge is white in colour and slimy. It is called as Sannipatiki Pradara.[8]

Udavartini Yonivyapad

Due to aggravation of Vata, the woman is afflicted with pain. She gets painful menstruation because of the tendency of the discharge to move in reverse direction. Immediately after the discharge of menstrual blood she gets relief from pain.[9]

Kaphaja Pradara

Chakrapani has mentioned Kaphaja Yonivyapad as Kaphaja Pradara. The symptoms of former are more similar to abnormal vaginal discharge but Kaphaja Pradara describes menstrual discharge as slimy, pale in colour, heavy unctuous, cold, mucus or dense. There is a dull pain and the woman suffers from vomiting, anorexia, nausea, dyspnoea and cough.[10]

Paripluta Yonivyapad

If a woman of Paittik constitution suppresses manifested urge for sneezing and eructation during sexual intercourse aggravated Vayu gets afflicted by Pitta, vitiating her gynecic organ. This causes inflammation, tenderness and pain in genital organs and discharge of bluish as well as yellowish blood. She suffers from pain in waist, groin and back and fever. Acharya Chakrapani states there is all around (Pari) affliction (Pluta) of her genital organs by Vayu and Pitta, ailment is called as Paripluta.[11]

Suchimukhi

This disease of the woman originates at the stage where she is as a fetus in her mother’s womb. The pregnant mother resorts to Vayu aggravating food and regimen which leads to morbidity in developing genital organs of fetus resulting in stenosis of the opening of latter’s genital organs.[12]


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Due to cervical stenosis there is obstruction to the normal expulsion of menstrual blood leading to Kashtartava.

Discussion

After analyzing of various types of conditions related to Kashtartava it is observed that it is due to predominance of Vata Dosha along with association of other doshas. Acharya Charaka also states that no gynecological disorder is possible without affliction of aggravated Vayu.[13] Out of the five Vayu, basically Apana Vayu is involved in elimination of menstrual blood.[14] Along with it, Vyana Vayu is also responsible for normal elimination of Asrik (menstrual blood).[15] Due to the vitiation of Vyana Vayu the normal Akunchana and Prasarana Kriya of Garbhashaya is affected which hampers the proper flow of menstrual blood leading to Kashtartava. So the treatment should be in accordance with focus on Vata Dosha.

The discomfort related to menstruation manifests only during the bleeding phase but the pathogenesis that produces it develops due to the vitiation of Vata arising due to faulty lifestyle throughout the month. The symptomatic relief can be achieved by oral administration of drugs and following the code of conduct during menstruation (Rajaswala Charya) as discussed in classics. But to avoid recurrence the basic underlying pathology needs to be addressed.

The first line of treatment is Nidana Parivarjan i.e., avoiding the cause which is Vata Dosha in this case. Secondly, Samprapti Vighatana has to be done using Shamana and Shodhana together. The vitiated Vata should be treated with drugs having Madhura, Amla and Lavana Rasa, Snigdha Guna and Ushna Virya and should be administered by means of oleation, fomentation, Asthapana and Anuvasana type of Basti, Nasya and Ahara. It could be given in the form of Abhyang (massage), Utsadana (unction), Parisheka (effusion).[16]

Kashtartava can be treated by both Shodhana and Shamana. Since the site of origin of this condition is Shroni which is the Sthana of Vata and also the Vyadhi is Vata Pradhan so the best option for Shodhana is Basti. Though all types of Basti can be administered but Matra Basti is advisable for this condition. The Matra Basti can be given with Tila Taila as Taila is the best Shamaka Sneha for Vata Dosha.[17]

Apart from this, Taila is also indicated for Yoni Vishodhana.[18] Matra Basti can be given with oil medicated with Vatashamaka drugs like Dashmula Taila, Mahanarayan Taila, Shatpushpa Taila, Sahacharadi Taila etc. The combination of Basti given with Vata Shamaka medicated oil gives a synergistic effect as Basti is the best treatment and Taila is the best medium for it.

The drugs having Madhura, Amla and Lavana Rasa, Snigdha Guna and Ushna Virya are capable of pacifying Vata.[19] The treatment of Avrita Apana Vayu involves the use of drugs having Agnideepaka, Grahi, Vatanulomana and Pakvashaya Shuddhikara properties.[20] Considering this pharmacodynamics, drugs like Rajahpravartini Vati, Hingwadi Vati, Kuberaksha Vati, Kanyalohadi Vati, Lashuna Vati, Dashmula Kwath, Rasnadi Kwath etc. can be used for symptomatic relief.

Conclusion

Kashtartava is a condition which manifests at the time of menstruation occurring basically due to affliction of Vata. Symptomatic relief can be given by administering oral medicines. But for the successful Samprapti Vighatana of underlying pathology and to avoid recurrence Shodhana should be planned.

References

1. Dutta D.C.Textbook of Gynecology. Seventh edition. New Delhi, Jaypee Brothers Medical Publishers(P) Ltd: 2016, Chapter- 14, pg-147.
2. Kushwaha H.S. Charak Samhita : Ayurved Dipika Ayushi commentary. Varanasi, Chaukhambha Orientalia:2012, Chi- 30, pg-800-804.
3. Kushwaha H.S. Charak Samhita : Ayurved Dipika Ayushi commentary. Varanasi, Chaukhambha Orientalia:2012,Chi- 30/212-218, pg-827.
4. Kushwaha H.S. Charak Samhita : Ayurved Dipika Ayushi commentary. Varanasi, Chaukhambha Orientalia:2012,Chi- 30/25,, pg-827.
5. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/39-40), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-139.
6. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/10), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-131.


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7. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/9-11), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-131.
8. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/15), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-132.
9. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/25-26), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-135.
10. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/218), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-183.
11. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/23-24), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-135.
12. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/31), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-137.
13. Sharma R.K; Das B: Charaka Samhita (C. Chi. 30/115), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-58.
14. Sharma R.K; Das B: Charaka Samhita (C. Chi. 28/10-11), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021,pg-21.
15. Dalhana; Sushruta Samhita: Nibandha Sangraha commentary (Su.Ni-1/17-18), Chaukhambha Orientalia, Varanasi, U.P, 2012, pg-260.
16. Sharma R.K; Das B: Charaka Samhita (C. Su 20/13), English translation (Vol-1) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2016, pg-367.
17. Sharma R.K; Das B: Charaka Samhita (C. Su 13/12), English translation (Vol-1) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2016, pg-246.
18. Sharma R.K; Das B: Charaka Samhita (C. Su 13/15), English translation (Vol-1) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2016, pg-248.
19. Tripathi R.D.: Ashtang Hridayam (Sutrasthana), (Su 13/3), Chaukhambha Sanskrit Pratishthan, Varanasi, U.P, Reprint 2016, pg-207.
20. Sharma R.K; Das B: Charaka Samhita (C. Chi. 28/243), English translation (Vol-5) Chaukhambha Sanskrit Series, Varanasi, U.P, India 2021, pg-84.


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