Changes

|keywords=Menstrual disorders,  artava (menstruation),  asrugdara (menorrhagia), dysmenorrhoea, amenorrhoea, Ayurveda, Indian system of medicine, charak samhita.  

|keywords=Menstrual disorders,  artava (menstruation),  asrugdara (menorrhagia), dysmenorrhoea, amenorrhoea, Ayurveda, Indian system of medicine, charak samhita.  

|description=Sharira / Artava / Menstrual disorders

|description=Sharira / Artava / Menstrual disorders

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=charak samhita

|image_alt=charak samhita

|type=article

|type=article}}

}}

The physiology of menstruation can be understood by studying the concept of “artava” and its disorders. Fundamentally artava is originated from agni (fire) element. Therefore, menstrual blood is [[pitta]] [[dosha]] dominant. Menstruation and regulation of hypothalamo-pituitary-ovarian axis are important functions of [[vata]] [[dosha]]. Whereas the repair and restore functions in uterus after menstruation are carried out by [[kapha]] [[dosha]]. Hence all three [[dosha]] play role in physiology of menstruation. Therefore, the menstrual disorders need to be understood on the [[dosha]] axis and their abnormalities.  The duration of normal menstrual flow is generally 5 days, and the normal menstrual cycle typically lasts between 21 and 35 days.

The physiology of menstruation can be understood by studying the concept of “artava” and its disorders. Fundamentally artava is originated from agni (fire) element. Therefore, menstrual blood is [[pitta]] [[dosha]] dominant. Menstruation and regulation of hypothalamo-pituitary-ovarian axis are important functions of [[vata]] [[dosha]]. Whereas the repair and restore functions in uterus after menstruation are carried out by [[kapha]] [[dosha]]. Hence all three [[dosha]] play role in physiology of menstruation. Therefore, the menstrual disorders need to be understood on the [[dosha]] axis and their abnormalities.  The duration of normal menstrual flow is generally 5 days, and the normal menstrual cycle typically lasts between 21 and 35 days.

{{Infobox

{{Infobox

|label2 = Authors

|label2 = Authors

|data2 = Anagha S., Deole Y.S.

|data2 = Anagha S.¹, Deole Y.S.¹

|label3 = Reviewer and Editor  

|label3 = Reviewers and Editor  

|data3 = Basisht G.

|data3 = Basisht G.¹, Tandon S.²

|label4 = Affiliations

|label4 = Editor

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

|data4 = Basisht G.¹

|label5 = Correspondence email

|label5 = Affiliations

|data5 = carakasamhita@gmail.com

|data5 = ¹[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar,

|label6 = Date of first publication:

|label6 = Correspondence email

|data6 =July 31, 2020

 

|label7 = Date of first publication:

|data7 = July 31, 2020

}}

}}

== Age specific classification ==

== Age specific classification ==

 

Chronological age is an important factor of examination[Cha.Sa. [[Vimana Sthana]] 8/122]. Therefore, it is also considered in the diagnosis of menstrual disorders.  

Chronological age is an important factor of examination[Cha.Sa. [[Vimana Sthana]] 8/122]. Therefore, it is also considered in the diagnosis of menstrual disorders.  

'''b)Activities of the girl child(karma):''' Diet, life style, exercise, exposure to light,psychological state etc.

'''b)Activities of the girl child(karma):''' Diet, life style, exercise, exposure to light,psychological state etc.

Observational studies reveal the fact that menarcheal age is influenced by diverse variables such as genetics, geographic location, climate, psychological factors, socioeconomic status, body weight and height, nutrition, body fat and exercise, as well as the presence of chronic diseases.  <ref>Wang Z, Dang S, Xing Y, Li Q, Yan H. Correlation of body mass index levels with menarche in adolescent girls in Shaanxi, China: a cross sectional study. BMC Womens Health. 2016;16:61. Published 2016 Sep 6. doi:10.1186/s12905-016-0340-4</ref>, <ref>Laitinen J, Power C, Järvelin MR. Family social class, maternal body mass index, childhood body mass index, and age at menarche as predictors of adult obesity. Am J Clin Nutr. 2001;74:287–294. [PubMed] [Google Scholar]</ref>

Observational studies reveal the fact that menarcheal age is influenced by diverse variables such as genetics, geographic location, climate, psychological factors, socioeconomic status, body weight and height, nutrition, body fat and exercise, as well as the presence of chronic diseases.  <ref>Wang Z, Dang S, Xing Y, Li Q, Yan H. Correlation of body mass index levels with menarche in adolescent girls in Shaanxi, China: a cross sectional study. BMC Womens Health. 2016;16:61. Published 2016 Sep 6. doi:10.1186/s12905-016-0340-4</ref> <ref>Laitinen J, Power C, Järvelin MR. Family social class, maternal body mass index, childhood body mass index, and age at menarche as predictors of adult obesity. Am J Clin Nutr. 2001;74:287–294. [PubMed] [Google Scholar]</ref>

'''Disorders related to menarche are as below:'''

'''Disorders related to menarche are as below:'''

As all  the tissue components get depleted gradually during this age, menstruation also gets diminished naturally. But this transition stage of reproductive physiology may create many symptoms like excessive bleeding, irregularity in the cycle, psychological and vasomotor disturbances in the female.

As all  the tissue components get depleted gradually during this age, menstruation also gets diminished naturally. But this transition stage of reproductive physiology may create many symptoms like excessive bleeding, irregularity in the cycle, psychological and vasomotor disturbances in the female.

 

==Causes of menstrual disorders==

==Causes of menstrual disorders==

 

'''1. Dietary factors:'''  

'''1. Dietary factors:'''  

*Food and beverages that are excessively hot in potency cause disturbances in the physiology of menstruation especially in the growth and development of follicles/ovum. (andopachaya). [ Ka. Sa. Kalpa Sthana 7/32]

*Food and beverages that are excessively hot in potency cause disturbances in the physiology of menstruation especially in the growth and development of follicles/ovum. (andopachaya). [ Ka. Sa. Kalpa Sthana 7/32]

*Consumption of excessive salty, sour, heavy, pungent substances, those producing burning sensation(vidahi), excessive use of unctuous substances, meat of domestic, aquatic and fatty animals, mixture of cooked rice and pulses (krushara), curd, vinegar, curd-water(mastu) and wine leads to excessive menstrual bleeding. [Cha.Sa. Chikitsa Sthana 30/204]

*Consumption of excessive salty, sour, heavy, pungent substances, those producing burning sensation(vidahi), excessive use of unctuous substances, meat of domestic, aquatic and fatty animals, mixture of cooked rice and pulses (krushara), curd, vinegar, curd-water(mastu) and wine leads to excessive menstrual bleeding. [Cha.Sa. [[Chikitsa Sthana]] 30/204]

'''2. Lifestyle factors:'''

'''2. Lifestyle factors:'''

*The daily activities in general and those during menstruation influence reproductive health. [Cha. Sa. Chikitsa Sthana 30/7-8], [Su.Sa. Sharira Sthana 2/24-25]

*The daily activities in general and those during menstruation influence reproductive health. [Cha. Sa. [[Chikitsa Sthana]] 30/7-8], [Su.Sa. Sharira Sthana 2/24-25]

*Suppression of natural urges (vega dharana) of micturition, defecation etc. leading to aggravation of “apana vayu” cause menstrual disorders. [Cha. Sa. Chikitsa Sthana 30/25-26].

*Suppression of natural urges (vega dharana) of micturition, defecation etc. leading to aggravation of “apana vayu” cause menstrual disorders. [Cha. Sa. [[Chikitsa Sthana]] 30/25-26].

A case control study in 300 subjects has proven the association of suppression of urges of micturition and defaecation with primary dysmenorrhoea.<ref>Vrinda Roy(2011),A case-control study to evaluate the association between Mutra-purisha vegadharana and primary dysmenorrhoea,PG dissertation,department of Swasthavrutta, VPSV Ayurveda college, Kottakkal, Kerala.</ref>

A case control study in 300 subjects has proven the association of suppression of urges of micturition and defecation with primary dysmenorrhoea.<ref>Vrinda Roy(2011),A case-control study to evaluate the association between Mutra-purisha vegadharana and primary dysmenorrhoea,PG dissertation,department of Swasthavrutta, VPSV Ayurveda college, Kottakkal, Kerala.</ref>

*The specific activities like continuous travelling especially  in jerky vehicles,continuos sitting or standing in one position , excessive walking and exersion cause vitiation of “apana vayu” and lead to menstrual disorders. [A. Hr. Ni. 16/27]

*The specific activities like continuous travelling especially  in jerky vehicles,continuos sitting or standing in one position , excessive walking and exersion cause vitiation of “apana vayu” and lead to menstrual disorders. [A. Hr. Nidana thana 16/27]

*Use of artificial objects for sexual pleasure are considered as risk factors for menstrual disorders. [Cha. Sa. Chikitsa Sthana 30/7-8] [A. Hr. Uttara Sthana 33/27-28]  

*Use of artificial objects for sexual pleasure are considered as risk factors for menstrual disorders. [Cha. Sa. [[Chikitsa Sthana]] 30/7-8] [A. Hr. Uttara Sthana 33/27-28]  

'''3. Psychological factors:'''  

'''3. Psychological factors:'''  

*Mental stress, anxiety and excessive thinking causes vitiation of channels of transportation of [[rasa dhatu]] and lead to disturbances in the physiology of menstruation. [Cha. Sa. Vimana Sthana 5/13] Stress is a major cause for hormonal disturbance in HPO axis leading to menstrual abnormalities.

*Mental stress, anxiety and excessive thinking causes vitiation of channels of transportation of [[rasa dhatu]] and lead to disturbances in the physiology of menstruation. [Cha. Sa. [[Vimana Sthana]] 5/13] Stress is a major cause for hormonal disturbance in HPO axis leading to menstrual abnormalities.

'''4. Improper use of therapeutic interventions:'''

'''4. Improper use of therapeutic interventions:'''

'''5. Congenital factors:'''  

'''5. Congenital factors:'''  

*The defects in gametes (beejadosha), especially in the ovum of mother can cause congenital anomalies related to female reproductive system. [Cha. Sa. Sharira Sthana 4/ 30].

*The defects in gametes (beejadosha), especially in the ovum of mother can cause congenital anomalies related to female reproductive system. [Cha. Sa. [[Sharira Sthana]] 4/ 30].

 

===Pathophysiology===

===Pathophysiology===

'''Functions of 5 types of vata  in reproductive physiology''' [A.S. Sutra Sthana 20/2]

'''Functions of 5 types of vata  in reproductive physiology''' [A.S. Sutra Sthana 20/2]

!Type of Vayu !!Related Functions !! Physiological functions

!Type of Vayu !!Related Functions !! Physiological functions

|-

|-

|'''Prana vayu''' ||Maintanance and control of intellect(buddhi), sense organs (indriya),mind, vasomotor activities. || Neural regulation at  hypothalamo-pitutary level

|'''Prana vayu''' ||Maintenance and control of intellect(buddhi), sense organs (indriya),mind, vasomotor activities. || Neural regulation at  hypothalamo-pitutary level

|-

|-

|'''Udana vayu''' ||Production of strength(bala), energy(urja), memory(smriti), nourishing channels of body tissues(srota preenana)||Neural regulation at  hypothalamo-pitutary level

|'''Udana vayu''' ||Production of strength(bala), energy(urja), memory(smriti), nourishing channels of body tissues(srota preenana)||Neural regulation at  hypothalamo-pitutary level

|'''Apana vayu'''|| Elimination of menstrual blood(artava nishkramana) || Shedding of superficial functional layer of endometrium along with blood from the uterine cavity.

|'''Apana vayu'''|| Elimination of menstrual blood(artava nishkramana) || Shedding of superficial functional layer of endometrium along with blood from the uterine cavity.

|}

|}

 

*The vitiation of vata occurs in two ways:

*The vitiation of vata occurs in two ways:

1)Primary vitiation: Due to degenration of body components(dhatukshaya)

1)Primary vitiation: Due to degeneration of body components(dhatukshaya)

2)Secondary vitiation: Obtructive pathology (avarodha)

2)Secondary vitiation: Obtructive pathology (avarodha)

*The pathology of excessive menstrual bleeding (asrugdara) is explained as the occlusion of apana vayu with [[pitta]] (pittavruta apana).[Su. Sa. Nidana Sthana 1/37]

*The pathology of excessive menstrual bleeding (asrugdara) is explained as the occlusion of apana vayu with [[pitta]] (pittavruta apana).[Su. Sa. Nidana Sthana 1/37]

*Heavy menstrual bleeding is also included in the disorders of blood (raktapradoshaja vikara).[ Cha. Sa. Sutra Sthana 28/11]

*Heavy menstrual bleeding is also included in the disorders of blood (raktapradoshaja vikara).[ Cha. Sa.[[Sutra Sthana]] 28/11]

*The obstructive pathology due to kapha usually leads to decrease in the fuction due increase in the properties like coldness[[sheeta]], dullness/slowness[[manda]] and immobility[[sthiratva]]. While explaining the pathology of secondary amenorrhoea(artava nasha), it is clarified that the [[dosha]] causing the occlusion of [[vata]] here is either [[kapha]] or another form of [[vata]] itself, but not [[pitta]].[Dalhana commentary on  Su. Sa. Sharira Sthana 2/21]

*The obstructive pathology due to [[kapha]] usually leads to decrease in the function due increase in the properties like coldness (sheeta), dullness/slowness (manda) and immobility (sthiratva). While explaining the pathology of secondary amenorrhoea(artava nasha), it is clarified that the [[dosha]] causing the occlusion of [[vata]] here is either [[kapha]] or another form of [[vata]] itself, but not [[pitta]].[Dalhana commentary on  Su. Sa. Sharira Sthana 2/21]

===General features===

===General features===

 

The increase or decrease in quality and/or quantity of menstrual blood(artava)can lead to various abnormal conditions. The states can be assessed by following clinical features.

The increase or decrease in quality and/or quantity of menstrual blood(artava)can lead to various abnormal conditions. The states can be assessed by following clinical features.

{| class="wikitable"

{| class="wikitable"

e)Other bleeding disorders(anyad raktalakshana)

e)Other bleeding disorders(anyad raktalakshana)

===Special features===

===Special features===

|}

|}

* *[Cha. Sa. Chikitsa Sthana 30/211-224], **[ Su. Sa. Sutra Sthana 14/21], ***[A. S. Sutra Sthana 36/16]

* *[Cha. Sa. [[Chikitsa Sthana]] 30/211-224], **[ Su. Sa. Sutra Sthana 14/21], ***[A. S. Sutra Sthana 36/16]

==== Types of vitiation of menstrual blood (artava) ====

==== Types of vitiation of menstrual blood (artava) ====

 

There are eight types of deviated/abnormal states of menstrual blood (artavadushti) as mentioned in the table.

There are eight types of deviated/abnormal states of menstrual blood (artavadushti) as mentioned in the table.

{| class="wikitable"

{| class="wikitable"

Currently, apart from the three types of vitiation due to vata-pitta-kapha, clotted appearance(grandhibuta) as well as scanty menstruation(ksheena) are also treated with good efficacy by Ayurvedic treatment modalities. More research studies focusing on the diagnosis and treatment aspects of abnormal variations in the characteristic features of menstrual blood(artava dushti) are needed.

Currently, apart from the three types of vitiation due to vata-pitta-kapha, clotted appearance(grandhibuta) as well as scanty menstruation(ksheena) are also treated with good efficacy by Ayurvedic treatment modalities. More research studies focusing on the diagnosis and treatment aspects of abnormal variations in the characteristic features of menstrual blood(artava dushti) are needed.

== Examination of patients ==

== Examination of patients ==

=== Observation (darshana) ===

=== Observation (darshana) ===

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.[[Chikitsa Sthana]] 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. Chikitsa Sthana 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 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. Chikitsa Sthana 30/ 226]

*the color of red lotus flower[Cha. Sa. [[Chikitsa Sthana]] 30/ 226]

*the color of an insect called red velvet mite(indragopa)[Cha. Sa. Chikitsa Sthana 30/226]

*the color of an insect called red velvet mite(indragopa)[Cha. Sa. [[Chikitsa Sthana]] 30/226]

*the color of blood of rabbit[Su. Sa. ShariraSthana 2/ 17 ]

*the color of blood of rabbit[Su. Sa. Sharira Sthana 2/ 17 ]

*the color of solution Laccifer lacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17]

*the color of solution Laccifer lacca(laksha rasa)[Su. Sa. Sharira Sthana 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 bi-manual examination of uterus and adnexa is important in the diagnosis of menstrual disorders.

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

The typical feature suggestive of a particular pathology can be reveled through proper interrogation.  

The typical feature suggestive of a particular pathology can be reveled through proper interrogation.  

Ex- immediate relief of pain after proper establishment of bleeding in primary/spasmodic dysmenorrhea (udavartini yoni vyapad).[ Cha. Sa. Chikitsa Sthana 30/25-26]

Ex- immediate relief of pain after proper establishment of bleeding in primary/spasmodic dysmenorrhea (udavartini yoni vyapad).[ Cha. Sa.[[Chikitsa Sthana]] 30/25-26]

The etiological factors should be traced out through proper history taking which helps in both diagnosis as well as treatment.

The etiological factors should be traced out through proper history taking which helps in both diagnosis as well as treatment.

In cases where direct observation of characters of menstrual blood is not feasible, it can be understood by proper interrogation. Detailed history regarding diet, life style and sexual activity is necessary for the successful treatment of menstrual disorders.

In cases where direct observation of characters of menstrual blood is not feasible, it can be understood by proper interrogation. Detailed history regarding diet, life style and sexual activity is necessary for the successful treatment of menstrual disorders.

==Laboratory investigations==

==Laboratory investigations==

'''Purification therapy(shodhana chikitsa):'''

'''Purification therapy(shodhana chikitsa):'''

 

Purification therapy is the first line of treatment in quantitative or qualitative decrease of menstrual blood due to obstructive/occlusion pathology(avarodha). Here, therapeutic emesis([[Vamana]]) has major role as the condition is predominantly due to [[kapha]].

Purification therapy is the first line of treatment in quantitative or qualitative decrease of menstrual blood due to obstructive/occlusion pathology(avarodha). Here, therapeutic emesis([[Vamana]]) has major role as the condition is predominantly due to [[kapha]].

Substances promoting the properties of pitta (agneya dravya) like sesame oil (tila tail), black gram(masha)are advised to be taken regularly by the women. But in case of extreme decrease of endometrial thickness, ghee(ghrita) is having greater role than oil(taila)for promoting the endometrial proliferation and maintenance of preferred level of growth.[A.S. Sharira Sthana 1/64]

Substances promoting the properties of pitta (agneya dravya) like sesame oil (tila tail), black gram(masha)are advised to be taken regularly by the women. But in case of extreme decrease of endometrial thickness, ghee(ghrita) is having greater role than oil(taila)for promoting the endometrial proliferation and maintenance of preferred level of growth.[A.S. Sharira Sthana 1/64]

===Treatment for increased state of menstrual blood ===  

===Treatment for increased state of menstrual blood ===  

 

'''Purification therapy:'''

'''Purification therapy:'''

'''Pacification therapy:'''

'''Pacification therapy:'''

*Hemostatic drugs (rakta stambhaka) are given only if the strength of patient is low and the vital parameters are disturbed. In this case, the medicines used for stopping blood as indicated in treatment of diarrhea with blood(raktatisara),bleeding disorders (raktapitta) and bleeding piles(raktarsha).[Ch.Sa.Chikitsa Sthana 30/228]

*Hemostatic drugs (rakta stambhaka) are given only if the strength of patient is low and the vital parameters are disturbed. In this case, the medicines used for stopping blood as indicated in treatment of diarrhea with blood(raktatisara),bleeding disorders (raktapitta) and bleeding piles(raktarsha).[Ch.Sa.[[Chikitsa Sthana]] 30/228]

*If the vital parameters are normal and strenghth of patient is normal, then no medicine is advised to stop bleeding in the initial stage. Hemostasis treatment of vitiated blood leads to complications. [Ch.Sa. Chikitsa Sthana 30/228]

*If the vital parameters are normal and strenghth of patient is normal, then no medicine is advised to stop bleeding in the initial stage. Hemostasis treatment of vitiated blood leads to complications. [Ch.Sa. [[Chikitsa Sthana]] 30/228]

*By considering the association of [[doshas]] diagnosed on the basis of color and smell of blood,haemostatic drugs should be given to arrest the bleeding.[Ch. Sa Chikitsa Sthana 30/86]

*By considering the association of [[doshas]] diagnosed on the basis of color and smell of blood,haemostatic drugs should be given to arrest the bleeding.[Cha. Sa [[Chikitsa Sthana]] 30/86]

===Treatment for abnormal state of menstrual blood: ===  

===Treatment for abnormal state of menstrual blood: ===  

 

'''Purification therapy :'''

'''Purification therapy :'''

In abnormalities of menstrual blood (artava dushti), oleation(snehana),sudation(swedana), purification therapies(vamana, virechana, basti) as well as local therapies including intra uterine drug administration(uttarabasti) is advised.[Su. Sa. Sharira Sthana 2/12]

In abnormalities of menstrual blood (artava dushti), oleation (snehana),sudation(swedana), purification therapies(vamana, virechana, basti) as well as local therapies including intra uterine drug administration(uttarabasti) is advised.[Su. Sa. Sharira Sthana 2/12]

In the management of dysmenorrhoea (udavartini) also, oleation(snehana), sudation (swedana), enema therapy (both unctuous as well as decoction like dashamoola and milk) especially unctuous enema(anuvasanabasti) and intra uterine oil administration(uttara basti) are recommended.[Ch. Sa. ChikitsaSthana 30/228]

In the management of dysmenorrhoea (udavartini) also, oleation(snehana), sudation (swedana), enema therapy (both unctuous as well as decoction like dashamoola and milk) especially unctuous enema(anuvasana basti) and intra uterine oil administration(uttara basti) are recommended.[Ch. Sa. [[Chikitsa Sthana]] 30/228]

'''Pacification therapy:'''

'''Pacification therapy:'''

!Type of abnormality !!Drugs

!Type of abnormality !!Drugs

|-

|-

|Vataja ||| •Unctuous,hot,sour and salty substances*

|'''Vataja''' ||| •Unctuous,hot,sour and salty substances*

Internal:

'''Internal:'''

•Ghee processed with Clerodendrum serratum (bharangi) ,Madhuca longifolia(madhuka), Cedrus deodara ( bhadradaru)**

•Ghee processed with Clerodendrum serratum (bharangi) ,Madhuca longifolia(madhuka), Cedrus deodara ( bhadradaru)**

•Milk processed with Gmelina arborea(kashmari), Phaseolus trilobus(kshudrasaha)**

•Milk processed with Gmelina arborea(kashmari), Phaseolus trilobus(kshudrasaha)**

External:

'''External:'''

•Paste of Callicarpa macrophylla(priyangu) and sesame oil-applied in vagina**

•Paste of Callicarpa macrophylla(priyangu) and sesame oil-applied in vagina**

|-

|-

|Pittaja || •Sweet, cold and astringent substances*

|'''Pittaja''' || •Sweet, cold and astringent substances*

Internal:

'''Internal:'''

•Decoction of Lilium polyphyllum (kakoli)/ root of Pueraria tuberose(vidarimula)/ Nymphaea alba(utpala)/ Madhucalongifolia (madhuka)/ Gmelina arborea (kashmari) mixed with sugar.**

•Decoction of Lilium polyphyllum (kakoli)/ root of Pueraria tuberose(vidarimula)/ Nymphaea alba(utpala)/ Madhucalongifolia (madhuka)/ Gmelina arborea (kashmari) mixed with sugar.**

•Paste of Anogeissuslatifolia (dhava) and Woodfordiafruticosa  (dhataki) flowers mixed with ghee**

•Paste of Anogeissuslatifolia (dhava) and Woodfordiafruticosa  (dhataki) flowers mixed with ghee**

External:

'''External:'''

•Vaginal application of paste of Santalum album (chandana)and Ipomoea digitata(payasya)**

•Vaginal application of paste of Santalum album (chandana)and Ipomoea digitata(payasya)**

•Vaginal douche with decoction of red ochre(gairika) and neem.**

•Vaginal douche with decoction of red ochre(gairika) and neem.**

|-

|-

|Kaphaja || •Hot,dry and astringent substances*

|'''Kaphaja''' || •Hot,dry and astringent substances*

Internal:

'''Internal:'''

•Decoction of Holarrhena antidysenterica (kutaja), Picrorhiza kurrooa (katuka)and Withania somnifera (ashwagandha)**

•Decoction of Holarrhena antidysenterica (kutaja), Picrorhiza kurrooa (katuka)and Withania somnifera (ashwagandha)**

•Decoction of tender leaves of latex yielding trees mixed with honey**

•Decoction of tender leaves of latex yielding trees mixed with honey**

External:

'''External:'''

•Vaginal application of paste of Randia dumetorum (madanaphala)**

•Vaginal application of paste of Randia dumetorum (madanaphala)**

•Decoction of Cissampelospareira (patha),Tribulus terrestris(trikandaka), Holarrhenaantidysenterica(vrukshaka)**

•Decoction of Cissampelospareira (patha),Tribulus terrestris(trikandaka), Holarrhenaantidysenterica(vrukshaka)**

|-

|-

|Kunapagandhi(foul smelling) , Puti-puya(pus like appearance)|| For removing bad smell-

|'''Kunapagandhi(foul smelling) , Puti-puya(pus like appearance)'''|| For removing bad smell-

•Oral intake of decoction of Santalum album(chandana)*

•Oral intake of decoction of Santalum album(chandana)*

•Vaginal irrigation with decoction of Emblicaofficinalis ,Terminalia bellirica,Terminalia chebula (triphala)**

•Vaginal irrigation with decoction of Emblicaofficinalis ,Terminalia bellirica,Terminalia chebula (triphala)**

|-

|-

|Ksheena(scanty) || Same as artavakashaya**

|'''Ksheena(scanty)''' || Same as artavakashaya**

|}

|}

*[A.Hr. Sharira Sthana 1], **[A.S. Sharira Sthana 1]

*[A.Hr. Sharira Sthana 1], **[A.S. Sharira Sthana 1]

===Diet and lifestyle modification for prevention of menstrual disorders ===

===Diet and lifestyle modification for prevention of menstrual disorders ===

 

In general, cereals like rice(shali), barley(yava), alcoholic preparations (madya),meat preparations capable of increasing [[pitta]] are beneficial for promoting the female reproductive health.[Su.Sa. Sharira Sthana 2/16]

In general, cereals like rice(shali), barley(yava), alcoholic preparations (madya),meat preparations capable of increasing [[pitta]] are beneficial for promoting the female reproductive health.[Su.Sa. Sharira Sthana 2/16]

All these activities are likely to cause physical strain for the woman and their adverse effects are reflected even in her future progeny.[Su. Sa. Sharira Sthana 2/24-25]

All these activities are likely to cause physical strain for the woman and their adverse effects are reflected even in her future progeny.[Su. Sa. Sharira Sthana 2/24-25]

==Menstrual Hygiene ==

==Menstrual Hygiene ==

==Current Researches==

==Current Researches==

 

*PCOS is diagnosed as per the standard Rotterdam criteria<ref>Rui Wang, Ben Willem J. Mol, The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria?, Human Reproduction, Volume 32, Issue 2, 1 February 2017, Pages 261–264, https://doi.org/10.1093/humrep/dew287</ref>. Recent studies suggest the incorporation of raised level of Anti mullerian Hormone (AMH) along with the sonography findings to define polycystic ovarian morphology (PCOM).<ref>Fraissinet A, Robin G, Pigny P, Lefebvre T, Catteau-Jonard S, Dewailly D. Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. Hum Reprod. 2017;32(8):1716-1722. doi:10.1093/humrep/dex239</ref>

*PCOS is diagnosed as per the standard Rotterdam criteria<ref>Rui Wang, Ben Willem J. Mol, The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria?, Human Reproduction, Volume 32, Issue 2, 1 February 2017, Pages 261–264, https://doi.org/10.1093/humrep/dew287</ref>. Recent studies suggest the incorporation of raised level of Anti mullerian Hormone (AMH) along with the sonography findings to define polycystic ovarian morphology (PCOM).<ref>Fraissinet A, Robin G, Pigny P, Lefebvre T, Catteau-Jonard S, Dewailly D. Use of the serum anti-Müllerian hormone assay as a surrogate for polycystic ovarian morphology: impact on diagnosis and phenotypic classification of polycystic ovary syndrome. Hum Reprod. 2017;32(8):1716-1722. doi:10.1093/humrep/dex239</ref>

PCOS is considered as Vata- kapha dominant vitiation (artava dushti) in Ayurveda and many clinical trials are being conducted on Ayurvedic management of PCOS.  

PCOS is considered as [[Vata]]- [[kapha]] dominant vitiation (artava dushti) in Ayurveda and many clinical trials are being conducted on Ayurvedic management of PCOS.  

A series of clinical trials on effect of a classical formulation of Cissampelos pareira (patha),  Piper longum Linn, Zingiber officinale, Piper nigrum Linn (trikatu), Holarrhena antidysenterica, (vrukshaka) mentioned for clotted type presentation (vata-kapha predominant granthibhuta artava dushti) was carried out. Oral administration of the formulation, therapeutic purgation(virechana), medicated enema(basti) showed good results in 170 patients of PCOS. The efficacy in terms of symptomatic relief, correction of hormonal levels and improvement in the quality of life was observed.<ref>Dr. krupa D. Patel (2011) A clinical study on Polycystic Ovarian Disease (PCOD) & it’s management by Shatpushpa tail matra basti & Pathadi Kwatha ,PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Ashokan (2014) ,Clinical study on Ayurvedic treatment modalities in the management  Vata – Kaphaja Artavadushti (w.s.r.to PCOS), PhD thesis ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Pravin Dhote (2015),Clinical study on Vata Kaphaja Artavdushti (w.s.r. to PCOS) and it’s management by Ayurvedic treatment Modalities” , PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Ashiya (2018), Managementof Artava Dushti w.s.r to Polycystic Ovarian Syndrome with Virechana and Pathadi kwatha – a randomized controlled clinical trial, PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Archana S. (2019),Management of ArtavaDushti w.s.r to polycystic ovarian syndrome by PalashadiBasti and PathadiChoorna : A randomized controlled clinical trial , PhD thesis ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref>   

A series of clinical trials on effect of a classical formulation of Cissampelos pareira (patha),  Piper longum Linn, Zingiber officinale, Piper nigrum Linn (trikatu), Holarrhena antidysenterica, (vrukshaka) mentioned for clotted type presentation (vata-kapha predominant granthibhuta artava dushti) was carried out. Oral administration of the formulation, therapeutic purgation(virechana), medicated enema(basti) showed good results in 170 patients of PCOS. The efficacy in terms of symptomatic relief, correction of hormonal levels and improvement in the quality of life was observed.<ref>Dr. krupa D. Patel (2011) A clinical study on Polycystic Ovarian Disease (PCOD) & it’s management by Shatpushpa tail matra basti & Pathadi Kwatha ,PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Ashokan (2014) ,Clinical study on Ayurvedic treatment modalities in the management  Vata – Kaphaja Artavadushti (w.s.r.to PCOS), PhD thesis ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Pravin Dhote (2015),Clinical study on Vata Kaphaja Artavdushti (w.s.r. to PCOS) and it’s management by Ayurvedic treatment Modalities” , PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Dr. Ashiya (2018), Managementof Artava Dushti w.s.r to Polycystic Ovarian Syndrome with Virechana and Pathadi kwatha – a randomized controlled clinical trial, PG dissertation ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref> <ref>Archana S. (2019),Management of ArtavaDushti w.s.r to polycystic ovarian syndrome by PalashadiBasti and PathadiChoorna : A randomized controlled clinical trial , PhD thesis ,Dept of Prasutitantra and Stree Roga, IPGT&RA, Jamnagar.</ref>   

*Menstrual blood-derived stem cells (MenSCs) are a novel source of mesenchymal stem cells (MSCs). They are found to be having therapeutic effects in various diseases, including liver disease, diabetes, stroke, Duchenne muscular dystrophy, ovarian-related disease, myocardial infarction, Asherman syndrome, Alzheimer's disease, acute lung injury, cutaneous wound, endometriosis, and neurodegenerative diseases.<ref>Chen L, Qu J, Xiang C. The multi-functional roles of menstrual blood-derived stem cells in regenerative medicine. Stem Cell Res Ther. 2019;10(1):1. Published 2019 Jan 3. doi:10.1186/s13287-018-1105-9</ref>

*Menstrual blood-derived stem cells (MenSCs) are a novel source of mesenchymal stem cells (MSCs). They are found to be having therapeutic effects in various diseases, including liver disease, diabetes, stroke, Duchenne muscular dystrophy, ovarian-related disease, myocardial infarction, Asherman syndrome, Alzheimer's disease, acute lung injury, cutaneous wound, endometriosis, and neurodegenerative diseases.<ref>Chen L, Qu J, Xiang C. The multi-functional roles of menstrual blood-derived stem cells in regenerative medicine. Stem Cell Res Ther. 2019;10(1):1. Published 2019 Jan 3. doi:10.1186/s13287-018-1105-9</ref>

===Abbreviations ===

===Abbreviations ===

 

Sa. = Samhita, Cha. = Charak, Su. = Sushruta, Ka. = Kashyapa, Sha. =Sharangadhara, A. = Ashtanga, Hr. = Hridaya, S. = Sangraha,  

Sa. = Samhita, Cha. = Charak, Su. = Sushruta, Ka. = Kashyapa, Sha. =Sharangadhara, A. = Ashtanga, Hr. = Hridaya, S. = Sangraha,  

Ha. = Harita

Ha. = Harita

==References==

==References==