Changes

== Examination of patients ==

== Examination of patients ==

=== Observation (darshana) ===

=== Observation (darshana) ===

On examining the patient, the general health status should be the prime concern. In case of clinical conditions like scanty bleeding or amenorrhea, the patient may be emaciated(krusha) and there may be discoloration of skin (vaivarnya) or pallor which is mentioned as the clinical features of a disorder of reproductive tract namely “arajaska yoni vyapad” [Cha.Sa.Chikitsa Sthana 30/17]. The same presentation is found in heavy menstrual bleeding also.

On examining the patient, the general health status should be the prime concern. In case of clinical conditions like scanty bleeding or amenorrhea, the patient may be emaciated(krusha) and there may be discoloration of skin (vaivarnya) or pallor which is mentioned as the clinical features of a disorder of reproductive tract namely “arajaska yoni vyapad” [Cha.Sa.Chikitsa Sthana 30/17]. The same presentation is found in heavy menstrual bleeding also.

In case of primary amenorrhoea, development of secondary sexual characters should be noted. For example, the breast development is absent or less in conditions called “ shushka revati”[Ka. Sa. Kalpa Sthana 6/31] and “shandhi yoni vyapad”. [Cha.Sa. ChikitsaSthana 30/35]

 

In case of primary amenorrhoea, development of secondary sexual characters should be noted. For example, the breast development is absent or less in conditions called “ shushka revati”[Ka. Sa. Kalpa Sthana 6/31] and “shandhi yoni vyapad”. [Cha.Sa. ChikitsaSthana 30/35]

 

The features like obesity, enlargement of thyroid gland, excessive androgenic hair growth, etc. which give a clue regarding the metabolic and endocrinal disorders like poly cystic ovary syndrome(PCOS), thyroid dysfunction, hyperprolactinemia etc. leading to menstrual irregularities also should be observed.  

The features like obesity, enlargement of thyroid gland, excessive androgenic hair growth, etc. which give a clue regarding the metabolic and endocrinal disorders like poly cystic ovary syndrome(PCOS), thyroid dysfunction, hyperprolactinemia etc. leading to menstrual irregularities also should be observed.  

The similar descriptions of diagnostic features due to hyperandrogenism and insulin resistance found in case of PCOS are mentioned in the disorder called “pushpaghni jataharini”. [Ka. Sa. Kalpa Sthana 6/33]

The similar descriptions of diagnostic features due to hyperandrogenism and insulin resistance found in case of PCOS are mentioned in the disorder called “pushpaghni jataharini”. [Ka. Sa. Kalpa Sthana 6/33]

The color index for normal menstrual blood (artava) is available in the text books of Ayurveda.  It is mentioned as different shades of red having resemblance with the followings.

The color index for normal menstrual blood (artava) is available in the text books of Ayurveda.  It is mentioned as different shades of red having resemblance with the followings.

• the color of fruit of Abrusprecatorius(gunja)[Cha. Sa. Chikitsa Sthana 30/226]

• the color of fruit of Abrusprecatorius(gunja)[Cha. Sa. Chikitsa Sthana 30/226]

• the color of red lotus flower[Cha. Sa. ChikitsaSthana 30/ 226]

• the color of red lotus flower[Cha. Sa. ChikitsaSthana 30/ 226]

• the color of solution Lacciferlacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17  ]

• the color of solution Lacciferlacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17  ]

• blackish red[Su. Sa. Sharira Sthana 3/ 10]

• blackish red[Su. Sa. Sharira Sthana 3/ 10]

The abnormal range of color shades are mentioned as the clinical features of different types of abnormal states of menstrual blood(artavadushti) as well the features of different types of excessive bleeding(asrugdara).

The abnormal range of color shades are mentioned as the clinical features of different types of abnormal states of menstrual blood(artavadushti) as well the features of different types of excessive bleeding(asrugdara).

Apart from the color, the smell and consistency also should be noted. The peculiar nature of menstrual blood as it does not stain the cloth is particularly observed. [Su. Sa. ShariraSthana 2/ 17]

Apart from the color, the smell and consistency also should be noted. The peculiar nature of menstrual blood as it does not stain the cloth is particularly observed. [Su. Sa. ShariraSthana 2/ 17]

All these are supposed to be noted in direct observation in clinically practice even though it is not always feasible in regular set up. But, per speculum examination of vaginal tract reveals many hidden diagnoses.  

All these are supposed to be noted in direct observation in clinically practice even though it is not always feasible in regular set up. But, per speculum examination of vaginal tract reveals many hidden diagnoses.

 

===Palpation(sparshana) ===

===Palpation(sparshana) ===

Per abdominal examination by palpation as well as bimanual examination of uterus and adnexa is important in the diagnosis of menstrual disorders.

Per abdominal examination by palpation as well as bimanual examination of uterus and adnexa is important in the diagnosis of menstrual disorders.