Changes

The term ‘artava’ has many meanings like ovum, menstruation and menstrual fluid or blood. It refers to normal physiological process of periodic per vaginal uterine bleeding, symbolizing the forthcoming fertile period. The term is also used to denote ‘ovum’ and functions of female reproductive hormones. [SAT-B.453]

The term ‘artava’ has many meanings like ovum, menstruation and menstrual fluid or blood. It refers to normal physiological process of periodic per vaginal uterine bleeding, symbolizing the forthcoming fertile period. The term is also used to denote ‘ovum’ and functions of female reproductive hormones. [SAT-B.453] <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>

This article describes normal physiological process of menstruation in Ayurveda and contemporary medical texts.The pathological morbidities related to menstruation are described in detail in a separate article on [[menstrual disorders]].  

This article describes normal physiological process of menstruation in Ayurveda and contemporary medical texts.The pathological morbidities related to menstruation are described in detail in a separate article on [[menstrual disorders]].  

== Etymology, derivation and synonyms==

 

|title = Contributors

 

|label1 = Section/Chapter/topic

 

 

 

|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

 

|label5 = Correspondence email

|data5 = carakasamhita@gmail.com

 

The term ‘‘artava’ literally means pertaining to/ dependent on/ accompanying the seasons or some particular period (ritu). The synonyms like artava, shonita, asrik, raja, rakta, lohita, rudhira, pushpa are used to denote menstruation and ovum. The references of each term denoting either menstrual blood or ovum are given in appendix 1.

|data7 =  [https://doi.org/10.47468/CSNE.2021.e01.s09.042 10.47468/CSNE.2021.e01.s09.042]

== Contextual meanings and importance==

== Contextual meanings and importance==

 

Following are the different contextual meanings indicating its physiological importance.

Following are the different contextual meanings indicating its physiological importance.

   

   

*It is also considered in the category of ‘dhatu’.[B.P.29/223]

*It is also considered in the category of ‘dhatu’.[B.P.29/223]

*The term artava is applied to denote the feminine genetic character.  At the time of conception, if the artava is dominant, it leads to female progeny. [Cha Sa [[Sharira Sthana]]  2/12-13] As per the recent researches, the sex of a baby is determined by its chromosome make-up at conception. The X chromosome dominance at conception determines female gender. An embryo with two X chromosomes becomes a girl. Further, the researchers have identified enhancers or regulators called SOX9 on DNA. The level of SOX9 determines development of sex organs in embryo.     

*The term artava is applied to denote the feminine genetic character.  At the time of conception, if the artava is dominant, it leads to female progeny. [Cha Sa [[Sharira Sthana]]  2/12-13] As per the recent researches, the sex of a baby is determined by its chromosome make-up at conception. The X chromosome dominance at conception determines female gender. An embryo with two X chromosomes becomes a girl. Further, the researchers have identified enhancers or regulators called SOX9 on DNA. The level of SOX9 determines development of sex organs in embryo.<ref>Brittany Croft, Thomas Ohnesorg, Jacky Hewitt, Josephine Bowles, Alexander Quinn, Jacqueline Tan, Vincent Corbin, Emanuele Pelosi, Jocelyn van den Bergen, Rajini Sreenivasan, Ingrid Knarston, Gorjana Robevska, Dung Chi Vu, John Hutson, Vincent Harley, Katie Ayers, Peter Koopman, Andrew Sinclair. Human sex reversal is caused by duplication or deletion of core enhancers upstream of SOX9. Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-018-07784-9 available from niversity of Melbourne. "Geneticists make new discovery about how a baby's sex is determined." ScienceDaily. ScienceDaily, 15 December 2018. www.sciencedaily.com/releases/2018/12/181215141333.htm cited on 17/01/2021 </ref>    

Ayurveda texts describe clinical observations during pregnancy that indicate female progeny are as mentioned below:  

Ayurveda texts describe clinical observations during pregnancy that indicate female progeny are as mentioned below:  

*The word Pushpa is analogous to blossoming of a flower seen in female reproductive organs during fertile period.   

*The word Pushpa is analogous to blossoming of a flower seen in female reproductive organs during fertile period.   

 

==Panchabhautika constitution and properties: ==

==Panchabhautika constitution and properties: ==

 

Artava is ‘agneya’ which implies the predominance of teja mahabhuta.[Su.Sa Sutra Sthana 14/7] Other [[mahabhuta]] are present in minute form.[Su Sa. Sutra Sthana 3/3]

Artava is ‘agneya’ which implies the predominance of teja mahabhuta.[Su.Sa Sutra Sthana 14/7] Other [[mahabhuta]] are present in minute form.[Su Sa. Sutra Sthana 3/3]

The characters of ‘artava’ (ovum) are, it is less in quantity(alpa), in coagulated state(styanibhuta), is minute(sukshma) and is immobile (asanchari). [Su.Sa Sharira Sthana 2/36,Dalhana]  

The characters of ‘artava’ (ovum) are, it is less in quantity(alpa), in coagulated state(styanibhuta), is minute(sukshma) and is immobile (asanchari). [Su.Sa Sharira Sthana 2/36,Dalhana]  

 

==Formation ==

==Formation ==

 

Artava is a subordinate constituent (upadhatu) formed during metabolism of [[rasa dhatu]] [Cha.Sa.[[Chikitsa Sthana]] 15/17] and [[rakta dhatu]]. [Sharangadhara Sa. Purva khanda 5/16-17].  

Artava is a subordinate constituent (upadhatu) formed during metabolism of [[rasa dhatu]] [Cha.Sa.[[Chikitsa Sthana]] 15/17] and [[rakta dhatu]]. [Sharangadhara Sa. Purva khanda 5/16-17].  

The quantity of normal artava is four Anjali or 35 ml. [A. Hr. sharira sthana 3/81]

The quantity of normal artava is four Anjali or 35 ml. [A. Hr. sharira sthana 3/81]

One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person specific.  As per current understanding, the average volume of menstrual fluid during a monthly menstrual period is 35 ml with 10–80 ml considered typical.   

One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person specific.  As per current understanding, the average volume of menstrual fluid during a monthly menstrual period is 35 ml with 10–80 ml considered typical.<ref>Carlson KJ, Eisenstat SA, Ziporyn TD (2004). The new Harvard guide to women's health. Cambridge, Massachusetts: Harvard University Press. ISBN 0-674-01343-3 available from https://en.wikipedia.org/wiki/Menstruation#cite_note-isbn_0674013433-11 accessed on 12/01/2021 </ref>  

 

==Female reproductive system (artava vaha srotas)==

==Female reproductive system (artava vaha srotas)==

 

The channels of transformation and transportation of female reproductive constituents (artavavaha srotas) and menstrual blood originate from uterus(garbhashaya) and its vessels (artavavahi dhamani). Its injury leads to sterility, intolerance of copulation and loss of menstrual flow (amenorrhoea). [Su Sa Sharira Sthana  9/12]

The channels of transformation and transportation of female reproductive constituents (artavavaha srotas) and menstrual blood originate from uterus(garbhashaya) and its vessels (artavavahi dhamani). Its injury leads to sterility, intolerance of copulation and loss of menstrual flow (amenorrhoea). [Su Sa Sharira Sthana  9/12]

 

===Functions:===

===Functions:===

Artava is essential for the formation of embryo(garbha) and overall female reproductive health.

Artava is essential for the formation of embryo(garbha) and overall female reproductive health.

Menstrual fluid is reddish-brown, a slightly darker color than venous blood.  Various shades of red colored menstrual fluid are described with the similes of fruit of abrus precatorius (gunja fruit), red lotus flower(pinkish red), indragopaka insect(dark red) [Cha Sa [[Chikitsa Sthana]] 30/226] colour of rabbit blood or solution of lac. The blood does not stain cloth is considered as normal. [Su Sa Sharira  Sthana  2/17] It has typical odour [A. Hr. sharira sthana 1/22-23] or honey odour (madhugandha) [Ma. Ni. 61/7]  

Menstrual fluid is reddish-brown, a slightly darker color than venous blood.  Various shades of red colored menstrual fluid are described with the similes of fruit of abrus precatorius (gunja fruit), red lotus flower(pinkish red), indragopaka insect(dark red) [Cha Sa [[Chikitsa Sthana]] 30/226] colour of rabbit blood or solution of lac. The blood does not stain cloth is considered as normal. [Su Sa Sharira  Sthana  2/17] It has typical odour [A. Hr. sharira sthana 1/22-23] or honey odour (madhugandha) [Ma. Ni. 61/7]  

==Physiology of menstruation:==

This period is divided into three phases according to the physiological changes taking place in the body. The menstrual cycle is counted from first day of menstruation.

The following table 1 shows three phases of menstrual cycle and changes in female body.  

The following table 1 shows three phases of menstrual cycle and changes in female body.  

{| class="wikitable" |}

{| class="wikitable" |}

|-

|-

!Cycle Days!! 1-5  6-14 || 15-28

|Cycle Days|| 1-5  || 6-14 || 15-28

|-

|-

!Endometrial cycle !!Menstrual Phase ||Proliferative Phase || Secretory Phase

|Endometrial cycle ||Menstrual Phase ||Proliferative Phase || Secretory Phase

|-

|-

!Ovarian cycle !!Early follicular || Late follicular || Luteal

|Ovarian cycle ||Early follicular || Late follicular || Luteal

|-

|-

!Estrogen/Progesterone dominance !! Low|| Estrogen||Progesterone

|Estrogen/Progesterone dominance || Low|| Estrogen||Progesterone

|-

|-

!Gonadotropins FSH*/LH**!! Low ||FSH|| LH

|Gonadotropins FSH*/LH**|| Low ||FSH|| LH

|}

|}

*Follicle Stimulating Hormone **Luteinizing Hormone

* *Follicle Stimulating Hormone **Luteinizing Hormone

The menstruating woman should observe chastity, avoid day time sleep, anointing, massaging, vigorous exercise, excess laughing and talking etc. The diet shall be light to digest with food items like rice, barley with small quantity of ghee and milk. [A. Hr.Sharira Sthana 1/25]   

 

The menstruating woman should observe chastity, avoid day time sleep, anointing, massaging, vigorous exercise, excess laughing and talking etc. The diet shall be light to digest with food items like rice, barley with small quantity of ghee and milk. [A. Hr. Sharira Sthana 1/25]  Apana vata dosha is responsible for normal menstruation. Abovementioned activities can vitiate vata dosha leading to disorders. Hence, moderate lifestyle and diet regimen is advised to help normal physiological process of menstruation.

Apana vata dosha is responsible for normal menstruation. Abovementioned activities can vitiate vata dosha leading to disorders.  

 

Hence, moderate lifestyle and diet regimen is advised to help normal physiological process of menstruation.

==Current researches ==

==Current researches ==

• The endometrium functions as a complex multicellular structure that involves interactions of immune, endocrine and vascular systems. The strict regulation of this tissue to allow cyclical ‘injury’ and ‘repair’ at menstruation results in a remarkable physiological response that allows pregnancy to occur.  

• Overall, 1753 genes were differentially expressed in one or more comparisons related to menstrual breakdown and repair. Significant canonical pathways, gene clusters and upstream regulators enriched during menstrual bleeding included those associated with immune cell trafficking, inflammation, cell cycle regulation, extracellular remodeling and the complement and coagulation cascade.  

*The endometrium functions as a complex multicellular structure that involves interactions of immune, endocrine and vascular systems. The strict regulation of this tissue to allow cyclical ‘injury’ and ‘repair’ at menstruation results in a remarkable physiological response that allows pregnancy to occur.<ref>Maybin JA, Critchley HO. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update. 2015;21(6):748‐761. doi:10.1093/humupd/dmv038</ref>

• A non-invasive sampling method is developed by collecting menstrual blood and filtering endometrial tissue. In combination with advanced experimental technology, the sample of menstrual endometrium is studied further for researches on endometriosis, endometrial lesions or other menstruation-related diseases.  

 

• A study investigated the effects of donor age and passage number on the biological characteristics of menstrual blood-derived stem cells (MenSCs) by comparing MenSCs derived from donors with three different age ranges and after different passage times. Continuous passage, flat cloning, cell proliferation assays, flow cytometric phenotyping and whole human genome microarray were performed to systematically analyse the relationship between the self-renewal ability of MenSCs as well as their potential to maintain their stem cell characteristics and to resist aging. The results demonstrated that the immune phenotypes and in vitro cultural characteristics of MenSCs did not change significantly with the progression of aging.  

*Overall, 1753 genes were differentially expressed in one or more comparisons related to menstrual breakdown and repair. Significant canonical pathways, gene clusters and upstream regulators enriched during menstrual bleeding included those associated with immune cell trafficking, inflammation, cell cycle regulation, extracellular remodeling and the complement and coagulation cascade.<ref>Paiva P, Lockhart MG, Girling JE, et al. Identification of genes differentially expressed in menstrual breakdown and repair. Mol Hum Reprod. 2016;22(12):898‐912. doi:10.1093/molehr/gaw060</ref>

• Some studies have shown the evidences regarding the feeling like craving for certain type of food articles like chocolate in women during the menstrual phase.  

 

• Ayurveda emphasizes the importance of diet and life-style for maintaining the proper menstrual health. Dysmenorrhea, premenstrual syndrome (PMS), and menstrual irregularities are directly associated with dietary habits and physical activities. Diet, characterized by a high consumption of sugars, salty snacks, sweets and desserts, tea and coffee, salt, fruit juices and added fat (labeled as “snacks” pattern), is associated with an increased risk of dysmenorrhea among young women.  

*A non-invasive sampling method is developed by collecting menstrual blood and filtering endometrial tissue. In combination with advanced experimental technology, the sample of menstrual endometrium is studied further for researches on endometriosis, endometrial lesions or other menstruation-related diseases.<ref>Shu S et al, Investigation on endometrium from menstrual blood as a source of non-invasive tissue, Zhonghua Fu Chan Ke Za Zhi. 2019;54(8):527‐533. doi:10.3760/cma.j.issn.0529-567x.2019.08.005.</ref>

• In a study, it is observed that smoking is associated with increased risk of reporting psychological and behavioral symptoms in premenstrual syndrome. High calorie/fat/sugar/salt foods intake is associated with increased risk of reporting physical symptoms. Fruit consumption shows decreased risk of reporting behavioral symptoms.  

 

*A study investigated the effects of donor age and passage number on the biological characteristics of menstrual blood-derived stem cells (MenSCs) by comparing MenSCs derived from donors with three different age ranges and after different passage times. Continuous passage, flat cloning, cell proliferation assays, flow cytometric phenotyping and whole human genome microarray were performed to systematically analyse the relationship between the self-renewal ability of MenSCs as well as their potential to maintain their stem cell characteristics and to resist aging. The results demonstrated that the immune phenotypes and in vitro cultural characteristics of MenSCs did not change significantly with the progression of aging.<ref>Chen J, Du X, Chen Q, Xiang C. Effects of donors' age and passage number on the biological characteristics of menstrual blood-derived stem cells. Int J Clin Exp Pathol. 2015;8(11):14584‐14595. Published 2015 Nov 1.</ref>

 

*Some studies have shown the evidences regarding the feeling like craving for certain type of food articles like chocolate in women during the menstrual phase.<ref>Hormes JM, Niemiec MA. Does culture create craving? Evidence from the case of menstrual chocolate craving. PLoS One. 2017;12(7):e0181445. Published 2017 Jul 19. doi:10.1371/journal.pone.0181445</ref>

 

*Ayurveda emphasizes the importance of diet and life-style for maintaining the proper menstrual health. Dysmenorrhea, premenstrual syndrome (PMS), and menstrual irregularities are directly associated with dietary habits and physical activities. Diet, characterized by a high consumption of sugars, salty snacks, sweets and desserts, tea and coffee, salt, fruit juices and added fat (labeled as “snacks” pattern), is associated with an increased risk of dysmenorrhea among young women.<ref>Najafi, N., Khalkhali, H., Moghaddam Tabrizi, F. et al. Major dietary patterns in relation to menstrual pain: a nested case control study. BMC Women's Health 18, 69 (2018). https://doi.org/10.1186/s12905-018-0558-4</ref>

 

*In a study, it is observed that smoking is associated with increased risk of reporting psychological and behavioral symptoms in premenstrual syndrome. High calorie/fat/sugar/salt foods intake is associated with increased risk of reporting physical symptoms. Fruit consumption shows decreased risk of reporting behavioral symptoms.<ref>Hashim MS, Obaideen AA, Jahrami HA, et al. Premenstrual Syndrome Is Associated with Dietary and Lifestyle Behaviors among University Students: A Cross-Sectional Study from Sharjah, UAE. Nutrients. 2019;11(8):1939. Published 2019 Aug 17. doi:10.3390/nu11081939</ref>

===List of thesis done===

===List of thesis done===

1. Shinde Vaishali S.(2004) : A study on the concept of Upadhatu in Samhitas with applied aspect to Artava-Dushti. Samhita, department of basic principles , IPGT & RA .Jamnagar

1. Shinde Vaishali S.(2004) : A study on the concept of Upadhatu in Samhitas with applied aspect to Artava-Dushti. Samhita, department of basic principles , IPGT & RA .Jamnagar

==More information ==

==More information ==

[[Grahani Chikitsa]]  

[[Grahani Chikitsa]]  

[[ Yonivyapat Chikitsa]]  

[[ Yonivyapat Chikitsa]]  

References

 

 

==References==