Asrgdara – Concept to Practice- Ayurveda
Part-2
Transcript by
Dr. Varsha More
based on the lecture available at- Asrgdara – Concept to Practice- Ayurveda
Vataja Asrgdara lakshana and chikitsa:
तिलचूर्णं दधिघृतं फाणितं शौकरी वसा ।
क्षौद्रेण संयुतं पेयं वातासृग्दरनाशनम्।।
वराहस्य रसो मेद्यः सकौलत्थोऽनिलाधिके।
शर्कराक्षौद्रयष्ट्याह्ननागरैर्वा युतं दधि।।
(च.सं.चि. 30/87-89)
The same Vata, which becomes aggravated due to factors such as dry and rough diet (ruksha ahara), harsh lifestyle (vihara), and exposure to dry and rough climates (ruksha advika ahara sevana), is responsible for causing Vataja Asrgdara. It is characterized by menstrual bleeding that is frothy, thin (tanu), rough (ruksha), and has a blackish, Krishna or Shyama varna (color). The bleeding may also exhibit an altered reddish hue. The discharge may occur with or without pain in the pelvic region and body aches. It is quickly and easily excreted without any issues and is discharged repeatedly in small quantities without clots. These are the clinical features of Vataja Asrgdara.
In addition to the aforesaid Dashamoola kwatha the chikitsa prayogas, in case of Vataja asrgdara, the classical references include the treatment usage of Tila Curna with curd, Ghee, Phanita, Sukara Vasa and honey. So, Dadhi is Abhishyandi, but at the same time, it is said to be Vatajit. Similarly, Tila churnam is said to be Taila yoni, and Taila is considered the best for krisha and sthula hita due to its Rasaposhaka and Rasavah srotho shodaka action, as per Bhava Mishra.
Therefore, Tila churnam, along with Dadhi and Ghrita, fanita, and shaukarivasa if available, then kshaudrena, is recommended. The decision to mix Tila churnam with Dadhi, to be further mixed with Ghrita, and combined with Fanita or Kshaudra is made based on the Anubhaddi Dosha in the case of Vata Asargdara.
- Mamsarasa of Varaha Medas with Kulattha Kwatha is beneficial.
- Curd mixed with Sarkara, Madhu, Yashtyahwa and Nagara: It is also said to be Pittashamaka, Agnideepaka, Vata Shamaka and nourishing
- Kalka of Rajadana and Kapittha leaves fried in ghee is beneficial: They are given in the form of dietary modifications so that the diet which is congenial to Vata Asargdara patient is achieved. Curna of Ela, Amsumati, Draksa, Usira, Tikta Rohini, Candana, Black Salt, Sariva and Lodhra (all in equal quantity) taken with curd.
Pittaja Asargdara lakshana and its Chikitsa:
अम्लोष्णलवणक्षारैः पित्तं प्रकुपितं यदा। पूर्ववत् प्रदर कुर्यात्..
पीतमत्युष्णमसितं तथा। नितान्तरक्त स्रवति मुहमहरथार्तिमत।।
दाहरागतृषामोहज्वरभ्रमसमायुतम्। असग्दर पैत्तिकं स्यात……।
(च.सं.चि. 30/214-216)
Menstrual pattern: Blue or yellow colour, blackish flow
- Characterized by sensation of heat
- expelled profusely (Brisha Vegi), repeatedly with pain.
- Systemic Features:Burning Sensation, Redness all over the body, Thirst, Mental Confusion
- Fever and Giddiness
Pitta becomes aggravated due to the mentioned nidanas in the above shloka, in addition to other Naidhanika samanya nidanas. Pitta prakopa will lead to Pittadushti, resulting in Pradara. The clinical pattern is as follows: Menstrual patterns include yellowish or blackish colored bleeding characterized by a sensation of heat in the pradesh, expelled profusely (Bhrishavegi), and repeatedly with pain. This is a classical feature of menstrual patterns in Pittaja Asargdara.
Other systemic features include a burning sensation all over the body, redness throughout the body, thirst, mental confusion, febrile illness, and giddiness. These are the lakshanas in Pittaja Asargdara.
The specific line of treatment for Pittaja Asrgdara includes all the aforementioned measures of the general line. In addition to these, the Raktapitta chikitsa sutra, specifically the Adhogat Raktapitta Chikitsa sutra, can be adopted. Raktarshas and Raktatisara chikitsa can also be employed. Aahar vihara sutra for abortion should be adopted that is Garbhasrava or Garbhapatha, Drakshadi kwatha, Darvyadi kashaya, Amruta shadanga paaniya, Mahatiktaka Ghrita for purgation that is snehpanottara shodhana, Tanduliyaka Moola with Madhu or with a Churna of Rasanjana with rice water that is Tandulodaka or Laksha choorna with Goat’s milk. Aja Dhugdha is indicated in Raktapitta. So Aja Dhugdha is a Rasayana and it is beneficial in case of Asargdhra chikitsa.
Pushyanug churna with madhu and Tandulodaka is highly beneficial. Lodra churna or Lodhra kwath along with the Pushyanug churna is also found to be clinically beneficial. Panchavalkala kshirapaka, Asoka valkala kshirapaka are also said to be or found to be beneficial in clinical practice.
Clinical features of Kaphaja Asargdara:
गुर्वादिभिर्हेतुभिश्च पूर्ववत् कुपितः कफः । प्रदरं कुरुते तस्य लक्षणं तत्त्वतः शृणु ।। पिच्छिलं पाण्डुवर्ण च गुरु स्निग्धं च शीतलम् । स्रवत्यसृक् श्लेष्मलं च घनं मन्दरुजाकरम् छरोचकहल्लासश्वासकाससमन्वितम्।(च.सं.चि. 30/216-219)
Key points :
Bleeding is characterised by: गैरिकोदकप्रतीकाशं, कोविदारपुष्प, चिरस्रावि, स्कन्दि, घनं, पिच्छिलं, तन्तुमत्
slimy, pale, heavy, unctuous, cold, mucoid, thick and is discharged with mild pain.
Associated with Vomiting, loss of appetite, nausea, Shwasa, Kasa
Some of the causative factors for Kapha Dushti are mentioned in the above shloka of Charak Siddhisthana. Kapha aggravated due to indulgence in Guruvadi (heavy) diet and regimen leads to Kaphaja Pradara. They also produce Agnimandya. Vitiated Kapha produces due to the indulgence in Guravadi ahara and viharas leading to Kaphaja Pradara, characterized by bleeding that is slimy in nature, pale red in color, and heavy. The patient feels heaviness in the lower abdomen, and during the flow, it is unctuous on touch, mucoid, slimy, cold without any hot discharges; then it is thick in consistency and discharged with mild pain. In addition, the colour may be pale red in nature, resembling red ochre mixed with water or the red flower of Kovidara. The nature of flow is slow ( Chirsravi , clotted in appearance(Skandi), heavy and thick in appearance( Ghana), Slimy and thready(Pichila, and Tantumat) in nature. These are the characteristic features by which we can diagnose Kaphaja Asarugdara. The associated complaints are excessive vomiting due to Rasadusthi, loss of appetite, Agnimandhya, Arochaka, that is not feeling Ruchi towards or a desire for having food.
Nausea ( Hrillasa ), breathlessness (Shwas), and coughing (Kasa) are associated with Kaphaja Asrgdara.
Kaphaja Asrugdara Samanya Chikitsa:
मौनिम्बगुडूच्याश्च रोहितस्यथ वा रसम्। कफप्रदरनाशाय पिबेद्धा मलयूरसम्।।
काकजंघामूलरसं मधुना सह भामिनी । सलोधचूर्णमापीय कफप्रदरकं जयेत्।।
(यो.र., प्रदररोग चि.)
- Curna of Nimba and Guduchi with wine should be used.
- Swarasa of any one of the drugs i.e. Nimba, Guduchi, Rohitaka or Malayu with wine is beneficial.
- Swarasa of Kakajangha with Lodhra Curna and honey cures Kaphaja Asrgdara.
In addition to these Abhaya Aristha, Asokaristha, Kumariasav cures the Kaphaja Asragdara. In addition to these Abhayarishta, Ashokarishta, Kumaryasava, Patrangasava, and Lodhrasava. So these combination are also beneficial in case of Kaphaj Asrgdara.
Clinical features of Sannipataj Asaragdara:
त्रिलिङ्गसंयुतं विद्यनैकावस्थमसृग्दरम्।। नारी त्वतिपरिक्लिष्टा यदा प्रक्षीणशोणिता। सर्वहेतुसमाचारादतिवृद्धस्तदाऽनिलः ।।
रक्तमार्गेण सृजति प्रत्यनीकबलं कफम्। दुर्गन्धं पिच्छिलं पीतं विदग्धं पित्ततेजसा।।
वसां मेदश्च यावद्धि समुपादाय वेगवान्। सृजत्यपत्यमार्गेण सर्पिर्मज्जवसोपमम्।।
शश्चत् स्त्रवत्यथास्त्रावं तृष्णादाहज्वरान्विताम्। क्षीणरक्तां दुर्बलां च तामसाध्यां विवर्जयेत्।।
(च.सं.चि. 30/220-224)
All the Tridosha Lakshanas may be present. When a severely ill and anaemic woman indulges in a diet and regimen capable of appreciating all the Tridosha, the excessively aggravated Vata, withholding the Kaphaja, exhibits symptoms like foul-smelling discharge, etc. It will resemble Durgandham, Pichilam, Pitham, Vidaham, Pita tejasam, and Vasa medascha. It resembles Sarpi Majjavasopamam and Shashvat sravati, meaning continuous flow of Artav Rakta for a prolonged period associated with excessive thirst (Trishna). Here is pathological Trishna, which is Aupasargika Trishna, Daha, and Jwaryukta. Then Kshina Raktaam Durbalaam; if the woman is Kshina Rakta, that is Rakta Kshay lakshanas, Rasa Rakta Kshaya lakshanas are observed. If she is having Dhatu Bala kshay, that is Durbala, Agni Bala Kshay, that is Durbala, and Kshina Mamsa Balata, then it is said to be Asadhya and should be contraindicated for treatment, or the patient is to be taken for critical care.
The Sannipat Asrgdara is characterized by all the lakshanas of Tridosha, Kanjikabha means Kanjika-like. Then Visheshato Durgandhi, that which is foul-smelling in nature, Majja Prakasham, that it is Tantumant and Ghana, and it is Majja-like in appearance, Hartala Varnam, that is yellowish-green in color. Kunapam, that which is foul-smelling because of the pyometra-like conditions, and the discharge from the vagina is foul-smelling with a yellowish flow resembling that of Ghee, honey, Majja, or Vassa.
Sadhya Asadhyatvam:
Sadhya Asadhyatvam of Sannipathari Asrgdara is said to be Asadhya, whereas the previous eka Doshaja is said to be Sadhya.
रसाञ्जनं तण्डुलकस्य मूलं क्षौद्रान्वितं तण्डुलतोयपीतम्। असृग्दरं सर्वभवं निहन्ति….. ॥ (भा.प्र.चि. 68/13) पश्यामलकबिभीतकविश्वौषधदारुरजनीनामा सक्षौद्रलोधचूर्णक्वाथो हन्त्येष सर्वजं प्रदरम्।।रसाञ्जनं…..निहन्तिा (भा.प्र., यो.र., प्रदररोग चि.)
Rasanjana with Tandulodaka Moola, Tandulaka Moola with Kshaudra, is said to be beneficial if taken along with Tandulodaka in Sannipat Asrgdara. the combination of Pathya, Amalaki, Vibhitaki, Shunti, Daru, Haridra mixed with Madhu, and Lodra Churna is also said to be beneficial.
Pathya, Amalaki kwatha, is also said to be beneficial, and research studies have been conducted on this in Sannipataj Asrgdara. Though there is no direct mentioning of Dvidoshaja asrgdara, a combination of the Lakshana of both the Doshas, we have to consider as Dvidosha Lakshana. Patra Kalka, which is fried with ghee of Rajadhana and Kapittha, is said to be beneficial in Pitha Vataja Asrgdara. So, this is one of the cross-references that we come across in Sannipat, Samsargaja asrgdara Chikitsa, basing on the Doshaprakopa Lakshana in Charaka Samhita Chikitsa sthana.
Prognosis:
शाश्वत् स्रवन्तीमास्त्रावं तृष्णादाहज्वरान्विताम्। क्षीणरक्तां दुर्बलां च तामसाध्यां विनिर्दिशेत्।
(मा.नि. 61/5-6)
Sannipataja Asrgdara as bad prognostic sign and incurable. Upadrava in Sannipataja Asrigdara:Eka Doshaja type is said to be Sadhya, whereas Tridoshaja or Sannipataja is said to be Asadhya. Sannipataja Asrgdara, having a bad prognostic sign, is said to be incurable. The Upadravayukta Sannipataja Asrgdara or Doshaja Asrgdara also comes under Asadhya Lakshana, like continuous bleeding, pathological thirst, excessive burning sensation, associated with febrile illness, associated with anemia and its clinical features, associated with Durbala, that is a Balakshaya of Agni, Balakshaya of Mamsa, Balakshaya of Rasadhi-Dhathus, and also Manasika Balakshaya. So, this is said to be an immunocompromised condition due to excessive bleeding disorder, which may be because of some underlying pathology. This will lead to Asadhyatva in Asrgdara. The Arishta Lakshana of Artava related to can be considered as Asadhya Lakshana of Ashrigdhara wherein when the clinical features like bleeding before the onset of the actual next menstrual cycle, that is intermenstrual bleeding, occur along with fever and continuous bleeding, the woman may not survive. So, this is one of the Asadhya Lakshanas and Arishta Lakshanas told in the context of Asrgdara Pradoshaja conditions like Asrgdara.
Updrava in Sannipataja Asrgdara
- Continuous bleeding
- Thirst
- Burning Sensation
- Fever
- Anaemia
- Weakness
अपूर्णेदिवसे नारी ज्वरात पुष्पमाप्नुयात्। सा न जीवेन्महाप्राज्ञ यस्या हि सारणो भवेत्।।
(हा.सं.दि. 4/37)
Arista Lakshana of Artava which can be considered as Asadhya Laksanas of Asrgdara
When the clinical features like bleeding before the onset of the next menstrual cycle (inter-menstrual bleed), fever, continuous bleeding are present, the woman may not survive.
Pathya:
Aja Ksheera, Go Ksheera, Shastika Shali, Mudga, Godhuma, Ghrita, Patola Shaka, Jangala Mamsa Rasa, Madhu,Suddhajala, Saindhava, Draksha, Amalaka, Dadima,Haritaki, Amalaki, Lashuna, Samyak Nidra, Samamatra Ashana
Apathya
Vega Dharana, Vega Udeerana, Ratrijagarana,Diwaswapna Katu, Rooksha, Amla, Guru, Vidahi, Abhishyandi Bhojana, Viruddhashana, Vishamashana, Anashana, Anupamamsa,Ativyayama, Ativyavaya, Atiadhwagamana, Atiyana,Atichinta, Krodha, Shoka, Bhay, Rakta Pittakara Nidana Raktarsha Hetu.
