E-ISSN:2456-3110

Case Report

Vataja Yoni Vyapad

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 11 NOVEMBER
Publisherwww.maharshicharaka.in

Ayurvedic management of Vataja Yoni Vyapad - A Case StudyV. S. Madhumithaa et al. Ayurvedic management of Vataja Yoni Vyapad

V S Madhumithaa1*, Jana P2
DOI:10.21760/jaims.9.11.44

1* V S Madhumithaa, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Kalabyraveshwara Swamy Ayurveda Medical College and Research Centre, Bangaluru, Karnataka, India.

2 Papiya Jana, Professor, Department of Prasuti Tantra and Stree Roga, Sri Kalabyraveshwara Swamy Ayurveda Medical College and Research Centre, Bangaluru, Karnataka, India.

Vataja Yoni Vyapad is a disease condition of the female reproductive system that causes distressing menstrual symptoms and other complications such as prolapse of the reproductive organs, that severely affects the woman’s quality of life. Acharyas have mentioned a variety of oral medications and Sthanika Chikitsa that corrects the Dosha Dushti and imparts Bala to the Sthana that provide significant relief to the symptoms. In the present case study, a 34-year-old patient presented with premenstrual symptoms and severe dysmenorrhea and pain in the vaginal and vulval region. She was treated with oral medications and two cycles of Yoni Abhyanga Sweda and Veshavara Dharana after which her symptoms significantly reduced.

Keywords: Vataja Yoni Vyapad, Adenomyosis, Sthanika Chikitsa, Dysmenorrhea

Corresponding Author How to Cite this Article To Browse
V S Madhumithaa, Post Graduate Scholar, Department of Prasuti Tantra and Stree Roga, Sri Kalabyraveshwara Swamy Ayurveda Medical College and Research Centre, Bangaluru, Karnataka, India.
Email: 		V S Madhumithaa, Jana P, Ayurvedic management of Vataja Yoni Vyapad - A Case StudyV. S. Madhumithaa et al. Ayurvedic management of Vataja Yoni Vyapad. J Ayu Int Med Sci. 2024;9(11):303-308.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-10-13 2024-10-23 2024-10-03 2024-11-13 2024-11-21
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© 2024by V S Madhumithaa, Jana Pand 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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V. S. Madhumithaa et al. Ayurvedic management of Vataja Yoni Vyapad

Introduction

In Ayurveda, diseases related to the female reproductive system i.e., gynaecological disorders are described under the caption of Yoni Vyapad.[1] In Ayurveda, prolapse and adenomyosis are understood within the framework of Dosha imbalances, particularly of Vata Dosha, which governs movement and stability within the body. When there is imbalance of doshas in different levels of severity, Yonivyapad occur with the predominance of one of the Doshas. Adenomyosis and Pelvic organ prolapse are one of themost common complaints faced by women in the reproductive phase. Pelvic organ prolapse (POP) and adenomyosis are two prevalent gynecological disorders that significantly impact women's health, quality of life, and well-being. POP involves the descent of pelvic organs due to weakened pelvic floor structures, often resulting in symptoms such as discomfort, urinary incontinence, and bowel dysfunction, which impair daily activities and psychosocial health. Adenomyosis, a condition characterized by the invasion of endometrial tissue into the uterine muscle, causes chronic pelvic pain and heavy menstrual bleeding. Ayurvedic management focuses on balancing the doshas and strengthening the pelvic floor through diet, lifestyle modifications, and exclusive treatment modalities such as Sthanika Chikitsa.[2] Ayurveda aims to alleviate symptoms, enhance reproductive health, and improve overall vitality in women affected by prolapse and adenomyosis.

Case Report

A 34-year-old female patient was apparently normal 11 years ago, then post her marriage she developed irregularities of menstrual cycle and was diagnosed with PCOS by a gynecologist. After taking ayurvedic treatment, she had regular cycles and successfully conceived and delivered her first hold through elective C section. Two years ago, after 1 year post delivery of her second child she joined rigorous physical activities at the gym including weight lifting exercises after which she developed pain in lower abdomen lower back and legs about 10 days before her periods continuing throughout the period. It was constant aggravated by activity and subsided by rest, associated fatigue, giddiness, pain during intercourse and irritability present throughout starts 10 days before menstruation in the last 2 years.

Patient complains of discomfort in the vulval and vaginal region during strenuous activity in the last 6 months She approached an ayurvedic doctor in her hometown and underwent ayurvedic treatment (Details of which are unknown) after which she experienced weight loss but her other symptoms persisted. Then she came to SKAMCH & RC for further management.

Past history: Medical History

  • K/C/O Hypothyroidism since 10 years - on medication
  • Tab Thyronorm 50 mcg 1 OD
  • N/K/C/O DM, HTN, Asthma, epilepsy

Surgical history

  • Previous 2 LSCS - 2016 AND 2019
  • Tubectomy in 2019

Occupational history: Housewife

Family history: All family members are said to be healthy No history of similar complaints in her family.

Menstrual history

Age of menarche - 14 yrs
Menstrual Cycle - Regular
Duration - 4-5 days
Interval - 28-30 days
D1 - 2-3pads (fully soaked)
D2 - 3 pads (fully soaked)
D3 - 3 pads (Partially soaked)
D4 - D7 - Spotting
Clots - present
Dysmenorrhea - Present – Congestive – starts 10 days before the menstrual cycle and continues till Day 6
Foul smell - Absent
LMP - 28/6/24
P.LMP - 28/5/24

Coital History

Frequency of coital act: 3-4 times in a month
Dyspareunia - Present
Burning sensation - Present

Obstetric History

P2L2A0D0
P1L1 - Female - 2016 - IUGR baby 1.2Kg - LSCS
P2L2 - Male - 2019 - LSCS
Tubectomy done in 2019


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Examination

General Examination

  • Built - Moderate
  • Nourishment - Moderately nourished
  • Pallor - Present in conjunctiva
  • Icterus - Absent
  • Cyanosis - Absent
  • Clubbing - Absent
  • Lymphadenopathy - Absent
  • Height - 162Cm
  • Weight - 83 kg
  • BMI - 30.9 kg/meter square
  • Pulse rate - 72/min
  • BP - 120/70mmhg
  • Respiratory rate - 18/min
  • Temperature - 97° Fahrenheit
  • Tongue - Not coated

Ashtasthana Pareeksha

Nadi: 76/min
Mootra: 4-5 times/day
Mala: regular, 1/day
Jihwa: Alipta
Shabdha: Prakrutha
Sparsha: Prakrutha
Drik: Prakrutha
Akruthi: Madyama

Dashavidha Pareeksha

Prakruti: Kaphavata
Vikruti:
Dosha: Vata Pradhana Tridoshas
Dushya: Rakta Mamsa
Desha: Sadharana
Bala: Madyama
Sara: Madyama
Samhanana: Madyama
Pramana: Madyama
Satmya: Madyama
Satva: Madyama
Ahara Shakti: Madyama
Jarana Shakti: Madyama
Vyayama Shakti: Madyama
Vaya: Madyama

Systemic Examination

1. Central Nervous System

Patient is conscious
Well oriented to time, place and person

2. Cardio Vascular System

Inspection: No distended vessels over neck or chest
Palpation: Apex beat palpable at 5th intercostal space
Percussion: Cardiac dullness present on left side
Auscultation: S1 S2 heard no added sounds

3. Respiratory System

Inspection
Shape of chest - Bilaterally Symmetrical
Movement - symmetrical
RR - 18 cycles/min

Palpation
Trachea - Centrally placed

Percussion
Resonant over the lung field except cardiac dullness
Auscultation - Bilateral NVBS heard

Gynecological Examination

Per Speculum & Per Vaginal Examination

  • Examination of vulva
  • Inspection
  • Pubic hair - Normal distribution
  • Clitoris - Normal
  • Labia majora - Normal
  • Labia minora - No abnormality detected
  • Discharge - Present

Inspection of Cervix

  • Size - Hypertrophied
  • External OS - Nulliparous
  • Uterine prolapse - Grade 2
  • Cervix has descended below the level of ischial spine approximately 1 cm
  • Upon wide opening the vaginal introitus, the cervix was visualised
  • Cough reflex - Positive - Mild cystocoele noted
  • Erosion - Absent
  • Discharge - present

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Palpation

  • Cervix position - Mid Posterior
  • Texture - Normal
  • No Palpable mass
  • Mobility - Mobile
  • Fornices - Free - Tenderness +
  • Bleed on touch - Absent

Per speculum examination

  • Inspection of vagina - Redness - Absent
  • Local lesion - Absent
  • Discharge - Present
  • Colour of discharge - White
  • Consistency of discharge - Slimy
  • Amount of discharge - Mild

Uterus

  • Position - Anteverted
  • Direction - Anti flexed
  • Size - Normal
  • Consistency - Firm
  • Mobility - Mobile
  • Tenderness - Absent

Investigations

  • Hb - 9 gm/dl (11/3/24), 10.2mg/dl (17/07/24)
  • TSH - 0.24 µIU/ml (17/07/2024)
  • USG - Abdomen and Pelvis
  • Bulky uterus with altered echotexture
  • Partial loss of endo-myometrial texture
  • Features of Adenomyosis

Intervention

DateTreatmentObservation
11/03/2024 to 21/03/20241.  Changeryadi Ghrita - 1tsp bd with milk
2.  Guggulu Panchapala Churna - 1 tsp bd with water
3.  Tab Abra Loha 1- 0- 1 a/f
4.  Drakshamalaki Rasayana - 1 tsp BD for 10 days		White discharge +
Discomfort in vaginal region +
25/03/2024 to 30/03/2024Yoni Prakshalana with Panchavalkala Kashaya
Yoni Abhyanga with Changeryadi Ghrita
Yoni Sweda with Ksheera
Yoni Veshavara Dharana for 7 days
Followed by:
T. Mahadhanvantharam Vati 1 TID
T Coligo 1 TID with water for 7 days		Fatigue heaviness and giddiness reduced
White discharge reduced
Abdominal pain and premenstrual symptoms persist
LMP - 04/03/2024
15/04/2024Oral medications were continued for 1 month
Patient did not continue come for follow up due to personal reasons		Discomfort in vaginal and vulval region resolved
Abdominal pain and fatigue reduced by 50%
Pre-menstrual symptoms persist
10/05/20241.  Guggulu Panchapala Churna - 1 tsp BD with water
2.  Tab Abra Loha - 1- 0- 1 A/F
3.  Draksha Amalaki Rasayana - 1 tsp bd for 10 days
4.  Tab Brahmi Vati 1 TID
5.  Tab Laghusutashekara Rasa		Irritability and anxiety persist
Giddiness resolved
Fatigue persists
C/o burning sensation in abdomen and chest region after meals
LMP - 01/05/2024
Pain and premenstrual symptoms started only 4 days before cycle
11/05/2024 TO 23/05/20242nd cycle of treatment
Yoni Prakshalana with PVK + Tankana Bhasma
Yoni Abhyanga with Changeryadi Ghrita
Yoni Sweda with Ksheera
Yoni Veshavara Dharana for 4 days
Yoni Pichu with Changeryadi Ghrita for 3 days
Draksha Amalaki Rasayana
1 tsp BD for 10 days
Tab Brahmi vati 1 TID
Tab Laghusutashekara Rasa 1 TID
Cap Ksheerabala 101 avarthi 1-0- 1 a/f		Irritability and premenstrual symptoms reduced
Fatigue and low back pain persist
LMP - 01/05/2024
PV findings
Cervix - mid posterior
Located at 3 finger distance from the introitus
Fornices - free and non tender
02/07/20231.  Tab Abra loha 1- 0- 1 A/F
2.  Tab Brahmi Vati 1 TID
3.  Tab Laghusutashekara Rasa 1 TID
4.  Cap Ksheerabala 101 Avarthi 1-0- 1 A/F		Review for follow up
Lmp : 28/06/2024
Pre-menstrual symptoms resolved completely
Mild lower abdominal pain on the first day of menses

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Oral Medication

  • Changeryadi Ghrita - 1tsp BD with milk
  • Guggulu Panchapala Churna - 1 tsp BD with water
  • Tab Abhra Loha 1- 0- 1 A/F
  • Draksha Amalaki Rasayana - 1 tsp BD for 10 days
  • Tab Brahmi Vati 1 TID
  • Tab Laghusutashekara Rasa 1 TID

Sthanika Chikitsa - For 2 cycles

  • Yoni Prakshalana with Panchavalkala Kashaya
  • Yoni Abhyanga with Changeryadi Ghrita
  • Yoni Sweda with Ksheera
  • Yoni Veshavara Dharana for 7 days

Results

After 2 cycles of Sthanika Chikitsa and 4 months of oral medication, the patient found significant improvement, her Premenstrual symptoms resolved completely and only Mild lower abdominal pain on the first day of menses. Her PV findings were Cervix - mid posterior, Located at 3 finger distance from the introitus and Fornices - free and non- tender

Discussion

In Ayurvedic understanding of the presented case, the set of symptoms of exhibited by the patient are that of Vataja Yoni Vyapad. The major complaint by the woman is menstruation that is preceded and associated with severe pain. As told by Acharya Vagbhata, in the symptoms of Vataja Yoni Vyapad, severe pain in the back, groin, flanks and back region as well as displacement of uterus is seen.[3]

In the above presented case of Vataja Yoni Vyapad, the pathogenesis started with the unregulated lifestyle, improper food and exhaustive physical exercise undertaken by the patient post the delivery of her second child. That combined with the stressed mental condition, aggravated, Vata, caused Rasa and Artava Dushti to give rise to the following Samprapti.

In the present case, the patient presented with clinical complaints of adenomyosis and uterine prolapse. Hence Vatahara line of treatment was chosen.

jaims_3794_00.JPG

  • Guggulu Panchapala Churna[4] - explained in Sahasryayoga Churna Prakarana contains Guggulu, Triphala and Pippali that acts as Vatahara, Gulmahara, Deepana-Pachana and Strotoshodhana. This formulation subsides the Vata Dosha and clears the Vikara in the Artavavaha Strotas.
  • Abra Loha - In the properties of Abhraka Bhasma, it is explained as Deepana and Deha Shakti Vivardhana. Abraka Bhasma with Loha acts as Panduhara and reduces the
  • Brahmi Vati[5] - The patient often experienced sleep disturbances because of Prakupita Vata and Brahmi being a Medhya Dravya helps to calm and mind and improve sleep quality.
  • Sthanika Chikitsa - The variety of treatments addressed to cleanse and impart strength to the region are collectively known as Sthanika Chikitsa.[6]
  • In this condition, the Yoni was thoroughly washed with Panchavalkala Kashaya that being Kashaya Rasa Yukta clears the white discharge followed by Yoni abhyanga, Swedana and Veshavara dharana. Veshavara is a ball of Mamsa prepared in the form of Pichu along with Dadima, Trikatu Churna, Ghrita and kept inside the vagina indicated in Prasramsini Yoni Vyapad /Genital prolapse.[7] Weakness of supports of the uterus is one of thecauses of uterine prolapse. The Veshavara Pinda imparts strength to the region and helps in reduction and reduce the reoccurrence of prolapse.

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  • Apart from this, Mamsa acts as Vatahara as Brimhana and Balya action subsides Vata as explained by Acharya Vagbhata.[8]

Conclusion

Vataja Yoni Vyapad often cause severe discomfort to women in the form of Dysmenorrhea, pain in the vaginal region, dyspareunia which disturb both her physical and mental health. Many times in such cases, surgery and pain medications are advised as the methods adopted. However, alternative system of medicine such as Ayurvedic treatment modalities provide significant relief to the patients in improving quality of life through Sthanika Chikitsa and Shamana Aushadhis.

References

1. Agnivesa, Caraka Samhita, Sri Chakrapanidatta, Vaidya Yadavji Trikamji Acharya, Charakasamhita: Chikitsa sthana, Chapter Yonivyapathchikitsadhayaya, Verse: 5 Ayurveda Dipika commentary. Published by ChaukhambaKrishnadasAcademy, Varanasi, 2010

2. Vriddha Vagbhata, Indu commentary, Ashtanga Sangraha, Uttara sthana, Guhyarogapratishedha adhyaya, Verse 53, Published by Chaukambha Orientalia, Varanasi

3. Vriddha Vagbhata, Indu commentary, Ashtanga Sangraha, Uttara sthana, Guhyarogavijyaniya adhyaya, Verse 33, Published by Chaukambha Orientalia, Varanasi

4. Nishteswar K, Vidyanath R. Sahasrayogam: Text with English Translation. Varanasi: Chowkhamba Sanskrit Series Office; Churna Prakarana: Page 201

5. Ayurveda Sara Sangraha. Gutika Vati Prakarana. 2nd ed. Varanasi: Krishnadas Ayurveda Series; 2015. p. 456

6. Vriddha Vagbhata, Indu commentary, Ashtanga Sangraha, Uttara sthana, Guhyarogapratishedha adhyaya, Verse 53, Published by Chaukambha Orientalia, Varanasi

7. Sushrutha, Dalhana, Gayadasa, Sushruta Samhita: Uttaratantra, Chapter Yonivyapadpratishedha adhyaya, Verse 28, Nibandha sangaraha commentary. Published by ChaukambhaOrientalia, Varanasi, 2019:

8. Vagbhata. Ashtanga Hridaya, Sutrasthana. Translated by Srikantha Murthy KR. Doshadivijyaneeya Adhyaya Verse 292nd ed. Varanasi: Chowkhamba Krishnadas Academy; 2009:

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