Lecture Note: Asrgdara – Concept to Practice- Ayurveda

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Asrgdara – Concept to Practice- Ayurveda

Transcript by
Dr. Varsha More

based on the lecture available at- Asrgdara – Concept to Practice- Ayurveda

Asrgdara Dhara” is a clinical condition mentioned in the gynaecological realm of disorders in the ‘Yonivyapad Chikitsita Adhyaya,’ Charaka Samhita, specifically in the 30th chapter of Chikitsasthana. In this chapter, it is described as ‘Raja Pradhiriyate Asmat Pradarasthena Sasmritaha,’ indicating the occurrence of Pradharana in the Raja, which is the Artav Rakta. Pradharana, defined as ‘Prakarshena Diryate, Chavyate,’ refers to the excessive expulsion or excretion of Aartav rupi Rakta, i.e., menstrual bleeding, leading to the condition known as Pradara.

The term ‘Asruk Diriyate, Chyavate, Yasmin iti Asruk Dara’ elucidates that ‘Asruk’ is a synonymous term in Ayurveda for Aarthav Rakta or Raja. If there is Chyavana or Deerana, meaning excessive spotting or bleeding per vagina, then the condition is termed Asruk Dara

Definition of Asrgdara:

In Ayurveda, it is described as a condition where Raja, the Artav Rakta, undergoes Pradharana. Pradharana is defined as ‘Prakarshena Diryate, Chyavate,’ signifying the excessive expulsion or excretion of Aartav rupi Rakta, which is menstrual bleeding. Asruk is a synonymous word in Ayurveda for Aarthav Rakta or Raja. If there is Chyavana or Deerana, referring to excessive spotting or bleeding per vagina, the condition is termed Asrugdara.

In summary, Asrgdara is a gynecological disorder characterized by the excessive expulsion of Aartav rupi Rakta, leading to Pradara.

Samanya Hetu evam Samprapti:

याऽत्यर्थं सेवते नारी लवणाम्लगुरूणि च|
कटून्यथ विदाहीनि स्निग्धानि पिशितानि च||
ग्राम्यौदकानि मेद्यानि कृशरां पायसं दधि  |
शुक्तमस्तुसुरादीनि भजन्त्याः कुपितोऽनिलः||
रक्तं [२] प्रमाणमुत्क्रम्य गर्भाशयगताः सिराः|
रजोवहाः समाश्रित्य रक्तमादाय तद्रजः||
यस्माद्विवर्धयत्याशु रसभावाद्विमानता |
(Ch. Chi 30/205,206,207)

The clinical pathology of Asrgdara can be understood by analyzing its Samprapati and the Hetus behind the Samprapati. A woman indulging in Ati Sevana of a particular Rasa dominance in the diet, such as Lavana, Amla, Katu, and Guru Ahara, along with excessive Snigdha Padartha that are Medura in nature and certain Dravyas producing Vidah in the Sharira, which are Guru in nature. This leads to Agnimandhya and the use of Pishita, Snigdha Pishita, such as Anupa Maamsa, Gramya, and Avudaka Maamsa Rasa. Ati Sevana, the use of Krishara (Kapha Prakopaka), and Payasa and Dadhi, which are Madhura Rasa Yukta and Abhisyandi in nature. The use of Amalibhuta Dravyas like Shukta, Mastu, and Sura in inappropriate quantities and durations for a longer period will lead to Agnimandhya, Pitta Dushti, Vidaha in Pitta, leading to Amalapitta-like Vikaras. Additionally, it produces Rasa Dushti by Agnimandhya. Thus, the text mentions that the Prakopa of Vata is occurring.

Now, how there is a Prakopa of Anila in the case of Nidanas like Snigdhaadi, Lavanaadi, and Amla Dravyas like Shukta, Mastu, is to be understood here. Vata gets Prakopita by two modalities: one is through Dhatukshaya. In a woman with Krisha Sharira and Vatala Prakriti, if there is indulgence in Vatakara Ahara, Vihara, and additional Nidanas mentioned here like Vegadharana, Rathri Jagarana, and other Vata Prakopaka Nidanas (Adhvagamana, Ativyayama, Ativyavaya, etc.), it leads to direct Vata Prakopa due to Dhatukshaya. So, Dhatukshaya Samprapati is Apatarpana Samprapati. On the other hand, if there is an Avarana Samprapati, the Samprapati mentioned here, like the use of Gramyaodakani, Medyani, Krisharam, Payasam, Dadhi, will supplement the Avarana due to the Vriddhi Kapha to the functionality of Apana Vata, regulating Aartha Vapravritti and Vyaana Vata, regulating the circulation of Ras Dhatu. Because of Avarana Samprapati, when the Vata gets aggravated, it leads to further processing of Samprapati like ‘Raktam Pramanam Utkramya Garbhasaya Gata Siraha,’ meaning the Rakta Pramana Utkramana is occurring. There is a quantitative increase in the Rakta Pramana or Aarthav Rakta. 4 Anjali is the Pramana of Aarthav Rakta. So, there is a quantitative enhancement in the quantity of Aarthav Rakta, which is getting collected in the Garbhasaya Gata Siraha.

After reaching the Garbhasaya Gata Siraha, the quantitative increase of the Aarthav Rakta leads to ‘Rajovaha Samashritya Raktamadaya Tadraja’. The Raja or the expulsive nature, the menstrual blood, takes up that excessive quantitative increase in the ‘Garbhasaya Gata Siraha’ and leads to congestion in the ‘Rajovaha Siraha’. So, Raktamadaya Tadraja Yasmad Rajaha Vivardhayati. There is a quantitative increase in the Pramana of Raja, that is, the Aartavrupi Rakta. ‘Aashu Vivardhayati’ means it is a spontaneous and quick acute phase in alteration of the quantity of the Aarthavsrava rupi Raktam. So, Rasabhava Vimanana or it is beyond the normal quantification of Rasadhatu or Aartav rupi Raktam. It leads to the excessive quantity of Aarthav rakta being collected in the Rajovaha Siraha. So, this is the Samprapati.

The next line says that it is about ‘Rajapradiyate tasmat Pradarasthena Sasmrta’. If we analyse this Samprapati and the Samprapati Ghatakas, the diet rich in Lavana, Amla, and Katu, when taken for a longer duration with Guru Guna (heavy to digest), Vidahi (Pitta Vardhaka), and Snigdha (oily in nature, Kapha Prakopaka), along with Dravyas like Anupa Mamsa and Medura Mamsata, dietary items like Krishara, Payasa, Dadhi, Shukta, Mastu, Sura aggravate Vata. In turn, it aggravates Pitta and Shleshma also. All the Tridoshas are involved with the dominance of Vata as the Pradhana doshas. Prakupita Vata withholds the Rakta, and it takes the Adhika Rakta into the Rajovaha sira and increases the Pramana of Rajas. Thus, the quantitative increase in the blood is termed as Asragdara, and excessive discharge of blood is termed as Pradara.

Nidanas:

In addition to the aforementioned Nidanas, Viruddha Bhojana, that is, the use of non-compatible food items either Virya Viruddha, Vipaka Viruddha, Sanyoga Viruddha, etc. Then Mady ati Sevana means excessive use of alcoholic beverages, Garbha Shatana, the use of abortifacients irrelevantly, Atimaithun, excessive sexual activity leading to pelvic congestion, Ati karshana, excessive exertion leading to Dhatukshaya or nutritional deficiency, Atimargamana, excessive traveling which is Vata Prakopaka, Abhigatha, which is Tridosha Prakopaka and Dhatu Dushthi Karaka, extrinsic injuries, Divashayana, day sleeping habits which are Kapha Prakopaka and Abhishyanti to the Srotas, and also Agnimandhyakara. Then Shoka, like psychological stress, worries, etc., is said to be additional causative factors by Madhavakara in the context of Asrgdhara.

The additional causative factors or the different types of Sampraptis mentioned in various classics of Ayurveda for Asrgdara are if Apana Vata gets avruta by Dushita Pitta, it produces Asurugdhara, as referenced in Vata Vikara. Harita Samhita, Prakran 8/10, says that a Nalliparous woman who has either not conceived or may be unmarried, then aggravated Vata, if she indulges in Vata Prakopaka Ahara Vihara, the Prakupita Vata occupies Kshiranadhi, which is non-functional in them, leading to excessive menstrual bleeding. Bhela also points out that if the Shonitha or the Arthavrakta or the Rakta Dhatu goes to the abnormal passage, then it is called Pradara (Bhel Samhita Sharir 5/6). In Ashtanga Sangraha, Sharira Vagbhata mentions that excessive bleeding during the menstrual phase or intermenstrual period is known as Asrgdara or Pradara, which is also termed as Rakta Yoni, wherein the only clinical feature mentioned is Rakta Yoni, Asrgati Shruti. So, Ati Shruti of Artavrakta without any other clinical features, without any other traceable pathologies, is mentioned as Asrgdara or Rakta Yoni, which is similar to the modern co-relatable point of dysfunctional uterine bleeding.

Classification

The Bhedha or classification includes “Chaturvedam yasatastu vatadhe sannipatataha tam shleshma pitthanila sannipathe shatuprakaram pradaram vadanti.” So, why is Shleshma mentioned first? Because even in the presence of pain in the Shleshmaja Asrgdara, which is a deviation from the general default rule of the absence of pain in the Asrgdara, in the Shleshmaja Vikara. In brief, we can understand that Vataja, Pitthaja, Shleshmaja, and Sannipataja are the classifications of or Sankhya Samprapati of Asrgdara.

Samanya lakshana of Asrgdara

 तदेवातिप्रसङ्गेन प्रवृत्तमनृतावपि |
असृग्दरं विजानीयादतोऽन्यद्रक्तलक्षणात् [१] ||१८||
असृग्दरो भवेत् सर्वः साङ्गमर्दः सवेदनः
Su. Sha 2/18-19

  1. Excessive flow (in quantity)
  2. Prolonged duration
  3. Intermenstrual bleeding (Scanty or excessand for short duration)
  4. Devoid of qualities of Suddha Artava
  5. All types of Asrgdara are associated with bodyache and pain

The common clinical feature of Asrgdara is excessive bleeding or an abnormal flow in quantity. Additionally, it may manifest with prolonged duration, intermenstrual bleeding, either scanty or excessive for a shorter duration. In some cases, the bleeding may persist for an extended period, making it challenging to note the interval between two menstrual cycles. This continuous heavy bleeding is devoid of the qualities of Shuddha Artava.

Asrgdara lacks the characteristics of Shuddha Aarthava, such as staining clothes, association with pain, burning sensations, slimy or sticky consistency, and an abnormal odor. Unlike a regular menstrual flow, Asrgdara is not Masika, meaning it does not follow a monthly regimen or regularity. It does not follow a period of five days or three days; it could be of a duration that is less than 3 days or more than 7 days. These are some of the common clinical features. Also, all the Asrgdras, whether Vataja, Pittaja, Sleshmaja, or Sannipataja, are characterized by different types of body aches due to Vata prakopa and various types of pain.

‘Atiprasangena pravratham’ means a prolonged period or duration. ‘Anarutavapi pravratham’ means it is intermenstrual bleeding. The bleeding could be for a prolonged period. Also, intermenstrual bleeding can be observed.

Differential diagnosis:

The differential diagnosis includes distinguishing it from conditions with scanty bleeding or spotting per vagina, such as Lohitakshaya Yonivyapada, Ashta arthavadushti (Vataja arthavadushti, Pittaja arathavadushti, Sleshmajarathava dushti, or Samsargaj arathava dushti), and Pittavritta Apana Vata if there is an Avarana samprapati in the nidana as well as the lakshana. Raktarsha, Raktatisara, and Anubhandi Raktapravarti Dosha Marga should be elicited to rule out other potential causes. In cases of Adhogatha Raktapitta, where one or more channels are involved, the Rakta is dushita and it is not periodically onset and excessive in nature.

For Pittaja Yonivyapada, characteristics such as a burning sensation, Ashu pravrathi, muhur muhur pravrathi, and similar symptoms should be examined. Additionally, differentiation from Asruja Yoni vyapada is crucial, where conditions like ‘labdhe garbhe api’ are present. Identifying Raktapitta kara nidana can help trace differences from the classical features of Asrgdara.

Asrgdara Chikitsa:

In Ayurveda, every Chikitsa is based on certain sutras that apply to the overall condition, whether it is the causative factors for Vata, Pitta, Shleshma, or Sannipathija. Therefore, the general line of principles should be adopted as a fundamental aspect in every treatment modality. If it doesn’t work, we have to examine why it has not yielded results in the treatment process.

Shonita Sthapana:

The shloka from Charak Siddhisthana 30/86,87 indicates that if it is Jeevrakta shruti, then Shonitsthapana is indicated. Dravyas from Shonitsthapana Dashemani (Charak Sutrasthana 4) can be used to stop the bleeding. Raktsthapana is the line of treatment in the case of Raktayoni. Also, the type of color associated with bleeding (Asrugvarnanubandha) should be considered while treating the type of Dosha causing the pathology. It is advised to choose Raktastapak Aushadhi according to Dosha.

The treatment principle for Rakta Yoni should be adopted based on dosha predominance. Additionally, if the intention is to address the acute bleeding phase or after Rakta Sthapana, Basti can be considered. Asthapana, Anuvasana, Matra, or Uttar Basti may be employed. Uttar Basti and Matra Basti are contraindicated, except in Aatyaika Avastha of Asragdara, where Uttar Basti is indicated. In this case, Uttar Basti need not be administered intrauterine; it can be introduced through the urethral passage or the vaginal canal. Continuous spotting is considered Asragdara in Ayurveda. Although Matra Basti is generally contraindicated in bleeding disorders, in the case of Aatyaika avastha or Asrgdara, Matra Basti has been found to be highly beneficial. By the third dose of Matra Basti, bleeding spontaneously gets arrested, even in the presence of Avarana lakshana or Dhatu kshaya laksana due to Pakvashaya Gatha Vata Vriddhi.

Pichha Basti is also said to be beneficial for Pradhara. Virechanam,specifically ‘Sneha Panottara Virechanam,’ is beneficial, and Garbhashaya Asruji Virekaha is attributed to Kashyapa. Vamana is recommended as Adho Gatha Rakta Pitta Chikitsa, and ‘Pratimarga Harana Chikitsa’ is found to be highly beneficial for patients with Aamashaya Gatha Kapha Vikara, Rasapradoshaja vikara, Pandu Roga associated with Asragdara, as well as Polycystic ovarian diseases leading to Asragdara-like symptoms, obesity, and hormonal disturbances. In these conditions Urdhwa Jatru Gatha Kapha Vikara, Anubhandi along with Shwasa Kaasadi Vikara along with Asrgdara

During my early practice period, I encountered a case involving a 35-year-old patient with complaints of bleeding per vagina coinciding with exacerbations of bronchial asthma. In this scenario, Vamana was administered, and the patient experienced relief from both Asrgdara and Shwasa Kaasadi Vikara. This treatment approach with Vamana proved beneficial even in cases of excessive bleeding in the adolescent age group when a diagnosis aligns with PCOS. Immediate Vamana, even without Sneha Pana (Sadhya Vamana or Ulle Khana), was found to be effective. Depending on the dosha, Yashtimadhu Siddha Jala, Draksha Mrudita Jala, Triphala Kashaya, etc., or Vacha Siddha Jala, Kevala Saindhava Lavana Mishrita Ushna Jala can be given for Sadhya Vamana. Repeated Sadhya Vamana was observed to promptly arrest bleeding. Following Vamana, Nasya, both Shodhana and Shamana, as well as Brahmana Nasyas, were beneficial in regularizing the HPO axis.

Samanya Chikitsa Sutra:

For the general treatment approach in young women with congenial diets and fewer complications, Adho Gath Raktapitta Chikitsa can be applied. Additionally, Raktatisara Chikitsa, Raktasthambana Chikitsa, and Raktasangrahana Chikitsa may be given. Sthambana involves Sandhanam, Skandanam, Pachanam, and Dahanam modalities, while Raktasangrahana uses Grahi dravya like Kutaja. The combination of Kutaja, with its Deepan Pachan, Ushna properties, helps in reducing congestion in arterioles, leading to the arrest of excessive bleeding. Drugs like Ashoka, which tone up uterine musculature, aid in Raktasangrahana action through VataShamana. Additionally, Raktaja Arsha Chikitsa can be adopted, and Yoni Vyapad Chikitsa Sutras, including Asurja Yoni Vapad, Apraja Yoni Vapad, Raktayoni, Vatajaadi Yoni Vapad Chikitsa, and Guhya Rogokta Chikitsa Sutras, may be applied. Garbha Srava and Garbhapata Chikitsa can also be considered, provided Shalya Bhuta Garbha is removed through Shalya Karma.

Following this, Asurja and Asrgdara Chikitsa should be managed according to the Suthika Paricharya, where “Maasatulyam Dinaniyevam Peyadi Patitekramaha” is emphasized. This means that Suthika Paricharya, done for 10 months in the natural state, should be followed for 10 days. For a 3rd-month abortion or GarbhaSrava, the regimen should be followed for 3 days. This approach reflects the art of Ayurveda.

Rakta Skandhana Upaya:

Rakta Skandhana Upaya involves Sandhana using Kashaya rasa and Stambhana, Skandana using Hima dravya or Sheeta sparshadi dravya orally, Pachana through Kshara application like Paniyakshara Prayoga, and Dahana through cauterization. While direct cauterization is not indicated in Asrgdara, Shonita Stapana Dravyas can be used in Sandhana and Skandana modes of administration. Nidana Parivarjana is the recommended line of treatment, with Samshodhana followed by Shamana using Vata Pitta Shamaka, Amapachana, Hridya, Grahi dravya, Shulahara, Stambhana, and Anulomana. The inclusion of Hridya as a treatment line in Rakta Skandhana is crucial due to the influence of mental factors such as Shokadi Tapta Avasta and Rasadi Chintyanamchati Chintana. Addressing the patient’s mental state is essential, and psychological support and counselling are vital components to help overcome Asurgdhara Vikara.

Samanya Chikitsas:

Samanya Chikitsas, which are done in the case of Asrgdara, include Dashamula Kshrapaka. It is Vata Shamaka and Vata Shleshma Shamaka and can be given as Kshirapaka or kwath. Dashamula Kshirapaka is mentioned as Vata Rakta Rujapaham. ‘Dashamula Shrutam Kshiram Sadhyashula Nivaranam’. So, even in Angamardadi Vikara of Asrgdara, Dashamula Siddha Kshirapaka can be used.

Drakshadi kwatha is mentioned in Jwara Chikitsa and Rakta Pitta Chikitsa Prakarna in Ashtanga Hridaya, wherein Draksha madhuaka Madhooka Lodhra is used. This yoga is indicated with Jati Kusuma Vasita and is to be given along with Jati Pushpa as a prakshepa, indicating its use in Asrgdara as well.

Nasya (inhalation), Abhyanga (massage with Shata Pushpa Taila, Ksheera Bala taila), Durva Swarasapana or Nasya, Niruha Basti (Rasnadi, Chandanadi, Kushadi, Lodhradi Gana), Mustadi Rajayapana Basti, Anuvasana with Madhuakadi Taila or Jeevaniya Varga Sadhita Ghrita or Taila, Uttara Basti with Chandanadi Taila, Panchatikta Ghrita, Sukumara Ghrita (containing Erenda Tail as an ingredient), Pichu with Phala Ghrita, Dadimadhi Ghrita, Panchatikta Ghrita, Prakshanana with Panchavalkal Kwath, Abhayaarishta, Dashamula Haritaki Avaleha sevana – all these are beneficial in the case of Asrgdara in practice.

Some Aushadha Kalpanas in Asrgdara include Panchavidha Kashaya Kalpana like Swarasa, Durva Swarasa, Samanga Samula, Kalkas such as Tanduliya moola Kalka, Lajjalu Moola Kalka, Apamarga Moola Kalka, Churna of Gairika, Amalaka, Lodhra, Pushyanuga, Sarasaji Makarandadi, with appropriate Anupanas, and Kashayas of Mustamritadi Kashaya, Musalli Khadiraadi Kashaya, Shatavariyadi Kashaya, Maharasnadi Kwata, Darvyadi Kwatha, Shonita Stapana, Gana dravya Siddha Kwatha.Hima or Sheetha Kashaya or Phanta Kashaya include Drakshadi Kwatha, Dhanyaka Jeerak.

Vati: Candraprabha Vati, Kamadugha Vati, Kamadugha Mukta Vati, Gokshuradi Guggulu
Rasa: Shonitargala Rasa, Pradararipu Rasa, Pradarantaka Louha, Bola Parpati, Candrakala Rasa.
Ksheerapaka: Ashoka Valkala, Arjuna Twak, Musta, Kutaja Twak, Lodhra, Panchavalakala Ksheera Paka
Avaleha: Dashamoola, Chyavanaprasha, Kushmanda, Khandamalaka, Kevalamalaka, Shatavari Guda, Dashamoola Haritaki, Sukumara avaleha, Manibhadra Guda, Kutajastaka Avaleha.
Asava-Arishta: Ashokarishta, Patrangasava, Lodhrasava. Draksharishta. Abhayarishta, Kutajarishta.
Ghrita: Shatavari Grita, Ksheerabala Avartita 101,41,7

Sukumara Grita, Phala Ghrita, PanchaTiktaka Ghrita

  • Dadimadi Grita, Kalyanaka, Sheeta Kalyanaka, Brahmi Ghrita
  • Taila: Mahanarayana Taila, Shatapushpa Taila, Triphaladya Taila. Dashamoola Taila

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.

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