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Line 216: − + − + − + − + − + − + − + + + + + + + + + + + + + + + + + + + − 4. Kunapagandhi Smell of dead tissue, excessive blood discharge, associated with features of pitta like burning sensation* Rakta* Early stage of endometrial carcinoma. − 5. Granthibhuta Clotted appearance, features of both kapha and vata.* Kapha-vata* Malignant disorders of reproductive system specially cervical carcinoma − 6. Puti-puya Putrid and purulent discharge.* associated with other features of pitta and kapha. Pitta-kapha*/ − Rakta- Pitta# − Acute infection of reproductive system especially acute endometritis leading to pyometra. − 7. Ksheena Delayed, scanty and associated with pain.* Vata-pitta* Hypoestrogenic oligomenorrhoea caused by nutritional deficiency. − 8. Mutra-purishagandhi Smell of urine and feces. Sannipata* Cervical carcinoma specially 3rd or 4th stage. − + − + − + + + + + + + − + + + Line 231:
Line 273: − • 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 an insect called red velvet mite(indragopa)[Cha. Sa. ChikitsaSthana 30/226]+ − • the color of blood of rabbit[Su. Sa. ShariraSthana 2/ 17 ]+ − • the color of solution Lacciferlacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17 ]+ − • blackish red[Su. Sa. Sharira Sthana 3/ 10]+ + + + + + + + − + + + + + + − + + + + +
Menstrual disorders (view source)
Revision as of 15:08, 11 September 2020
, 15:08, 11 September 2020no edit summary
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.
Symptoms of decrease of menstrual blood(artavakshaya)
{| class="wikitable"
*Symptoms of increase in menstrual blood (artavavriddhi)**
|-
primary or secondary amenorrhea, oligomenorrhea (yathochita kala adarshanam ) body aches (angamarda)
! Symptoms of decrease of menstrual blood(artavakshaya)
scanty menses/ hypomenorrhea (alpata) excessive menstrual bleeding (atipravrutti)
* !!Symptoms of increase in menstrual blood (artavavriddhi)**
pain in genital tract, dysmenorrhoea (yoni vedana) bad smell (daurgandhya)
|-
|primary or secondary amenorrhea, oligomenorrhea (yathochita kala adarshanam ) || body aches (angamarda)
|-
|scanty menses/ hypomenorrhea (alpata) || excessive menstrual bleeding (atipravrutti)
|-
|pain in genital tract, dysmenorrhoea (yoni vedana) ||bad smell (daurgandhya)
|}
*[Su. Sa. Sutra Sthana 15/12], **[Su. Sa. Sutra Sthana 15/16]
*[Su. Sa. Sutra Sthana 15/12], **[Su. Sa. Sutra Sthana 15/16]
A special condition characterized by excessive menstrual loss is explained in Ayurveda which is known as “Asrugdara”. It includes:
A special condition characterized by excessive menstrual loss is explained in Ayurveda which is known as “Asrugdara”.
It includes:
a)Menorrhagia: excessive bleeding in terms of quantityand duration(atiprasangena pravruttam). It is defined as menstrual blood loss greater than 80 ml.
a)Menorrhagia: excessive bleeding in terms of quantityand duration(atiprasangena pravruttam). It is defined as menstrual blood loss greater than 80 ml.
b)Metrorrhagia: intermenstrual bleeding(anrutavapi pravruttam)
b)Metrorrhagia: intermenstrual bleeding(anrutavapi pravruttam)
c)Menometrorrhagia: combination of the above two conditions
c)Menometrorrhagia: combination of the above two conditions
d)Polymenorrhea:decreased interval of cycles, bleeding occuring more ofen than every 21 days
d)Polymenorrhea:decreased interval of cycles, bleeding occurring more often than every 21 days
e)Other bleeding disorders(anyad raktalakshana)
e)Other bleeding disorders(anyad raktalakshana)
The specific features of different types of “asrugdara” are mentioned in the table.
The specific features of different types of “asrugdara” are mentioned in the table.
Sl no: Type Characteristic features Probable gynecological correlation
{| class="wikitable"
1. Vata dominant • Menstrual blood is frothy, thin, rough, blackish or reddish, resembling washings of flower of Butea monosperma (palasha).*
|-
|Sl no: || Type Characteristic features || Probable gynecological correlation
|-
|1. ||Vata dominant || • Menstrual blood is frothy, thin, rough, blackish or reddish, resembling washings of flower of Butea monosperma (palasha).*
• With or without pain*
• With or without pain*
• Flows quickly, does not clot**
• Flows quickly, does not clot**
• Smells like iron(lohagandhi), cold*** Severe pain and bleeding due to hyperemia of pelvic organs-pelvic congestion syndrome or pelvic sympathetic syndrome
• Smells like iron(lohagandhi), cold*** Severe pain and bleeding due to hyperemia of pelvic organs-pelvic congestion syndrome or pelvic sympathetic syndrome
2. Pitta dominant • Menstrual blood is blue, yellow or blackish in color, hot, comes in profuse amount repeatedly, and with pain*
|-
|2. ||Pitta dominant ||• Menstrual blood is blue, yellow or blackish in color, hot, comes in profuse amount repeatedly, and with pain*
• Associated with burning sensation, redness over body, thirst, mental confusion, fever and giddiness*
• Associated with burning sensation, redness over body, thirst, mental confusion, fever and giddiness*
• Resembles the water mixed with smoke or extract of Indian berberis(rasanjana) or cow urine in color, having musty or fishy smell***
• Resembles the water mixed with smoke or extract of Indian berberis(rasanjana) or cow urine in color, having musty or fishy smell***
• Not attracted by ants and flies, does not coagulate, hot*** Menometrorrhagia due to pelvic congestion caused by infection/inflammation
• Not attracted by ants and flies, does not coagulate, hot*** Menometrorrhagia due to pelvic congestion caused by infection/inflammation
3. Kapha dominant • Menstrual blood is slimy, pale, heavy, unctuous, cold, mixed with mucous and thick, discharged with mild pain*
|-
| 3. || Kapha dominant || • Menstrual blood is slimy, pale, heavy, unctuous, cold, mixed with mucous and thick, discharged with mild pain*
• Associated symptoms like vomiting, anorexia, nausea, dyspnea and cough*
• Associated symptoms like vomiting, anorexia, nausea, dyspnea and cough*
• Blood resembles the water mixed with red ochre, excreted very slowly, get clotted like a muscle**
• Blood resembles the water mixed with red ochre, excreted very slowly, get clotted like a muscle**
• Like flowers of Bauhinia variegata(kovidara), pale, gets clotted in the shape of fibers, smells like fat*** Menorrhagia due to early stage of tubercular endometritis or chronic endometritis due to other causes.
• Like flowers of Bauhinia variegata(kovidara), pale, gets clotted in the shape of fibers, smells like fat*** Menorrhagia due to early stage of tubercular endometritis or chronic endometritis due to other causes.
4. Sannipataja • Foul smelling, slimy, yellowish, resembling ghee, marrow, muscle fat etc.*
|-
| 4. || Sannipataja || • Foul smelling, slimy, yellowish, resembling ghee, marrow, muscle fat etc.*
• Continuously suffering from thirst, burning sensation, fever, anaemia, and weakness*
• Continuously suffering from thirst, burning sensation, fever, anaemia, and weakness*
• Resembles a sour liqid called “Kanji” prepared from rice and foul smelling.**
• Resembles a sour liqid called “Kanji” prepared from rice and foul smelling.**
or
or
Senile pyometra
Senile pyometra
|}
*[Cha. Sa. Chikitsa Sthana 30/211-224], **[ Su. Sa. Sutra Sthana 14/21]
*[Cha. Sa. Chikitsa Sthana 30/211-224], **[ Su. Sa. Sutra Sthana 14/21]
***[A. S. Sutra Sthana 36/16]
***[A. S. Sutra Sthana 36/16]
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.
Sl. No Type Characteristic features Vitiating factor Clinical gynecological disorders
{| class="wikitable"
1. Vataja Red, black or dark violet in color, thin, dry, frothy and scattered (very small clots mixed with liquid substance), excreted slowly with perforating or piercing type of pain* Vata* Oligomenorrhea with dysmenorrhea caused by nutritional deficiency
|-
2. Pittaja Yellowish or bluish in color, free from unctuousness, excreted blood is hot and associated with burning sensation*
!Sl. No !!Type !!Characteristic features !! Vitiating factor !! Clinical gynecological disorders
The color of blood resembles that of hibiscus (japa),or saffron, associated with dysuria ** Pitta* Inflammatory condition of reproductive organs due to infection especially chronic pelvic cellulitis associated with oligomenorrhoea.
|-
3. Kaphaja Whitish or slightly yellowish in color, appears as if mixed with bone marrow, too thick and slippery, unctuous and settles down if put in the water*
|1. ||Vataja || Red, black or dark violet in color, thin, dry, frothy and scattered (very small clots mixed with liquid substance), excreted slowly with perforating or piercing type of pain*|| Vata* || Oligomenorrhea with dysmenorrhea caused by nutritional deficiency
Retention of urine, body stiffness or idleness, lethargy, drowsiness, sleepiness**
|-
Kapha* Chronic endometritis, endocervicitis or cervicitis associated with oligomenorrhoea.
|2. ||Pittaja ||Yellowish or bluish in color, free from unctuousness, excreted blood is hot and associated with burning sensation*
The color of blood resembles that of hibiscus (japa),or saffron, associated with dysuria **|| Pitta* || Inflammatory condition of reproductive organs due to infection especially chronic pelvic cellulitis associated with oligomenorrhoea.
|-
|3. || Kaphaja || Whitish or slightly yellowish in color, appears as if mixed with bone marrow, too thick and slippery, unctuous and settles down if put in the water*
Retention of urine, body stiffness or idleness, lethargy, drowsiness, sleepiness** ||
Kapha* ||Chronic endometritis, endocervicitis or cervicitis associated with oligomenorrhoea.
|-
|4. || Kunapagandhi|| Smell of dead tissue, excessive blood discharge, associated with features of pitta like burning sensation* ||Rakta*|| Early stage of endometrial carcinoma.
|-
|5. || Granthibhuta || Clotted appearance, features of both kapha and vata.* || Kapha-vata* ||Malignant disorders of reproductive system specially cervical carcinoma
|-
|6. || Puti-puya || Putrid and purulent discharge.* associated with other features of pitta and kapha. || Pitta-kapha*/
Rakta- Pitta#||
Acute infection of reproductive system especially acute endometritis leading to pyometra.
|-
|7. || Ksheena || Delayed, scanty and associated with pain.* || Vata-pitta* || Hypoestrogenic oligomenorrhoea caused by nutritional deficiency.
|-
|8. || Mutra-purishagandhi || Smell of urine and feces. ||Sannipata* ||Cervical carcinoma specially 3rd or 4th stage.
|}
*[Su. Sa. Sharira Sthana 2/4], [A.S. Sharira Sthana 1/24]
*[Su. Sa. Sharira Sthana 2/4], [A.S. Sharira Sthana 1/24]
**[Ha.Sa. Trutiya Sthana 48/19,22, 23]
**[Ha.Sa. Trutiya Sthana 48/19,22, 23]
#[A. Hr. ShariraSthana 1/11]
#[A. Hr. ShariraSthana 1/11]
Prognosis of abnormal menstrual blood(artavadushti):
Curable Incurable
Vata dominant, pitta dominant, Kapha dominant Kunapagandhi, granthibhuta,putipuya,ksheena, mutra-purishagandhi
'''Prognosis of abnormal menstrual blood(artavadushti):'''
{| class="wikitable"
|-
!Curable !!Incurable
|-
|Vata dominant, pitta dominant, Kapha dominant || Kunapagandhi, granthibhuta,putipuya,ksheena, mutra-purishagandhi
|}
In the opinion of Vagbhata, the condition of mutra-purishagandhi in incurable and all other disorders are difficult to cure.[Su.Sa.Sharira Sthana 2/5] [A.Hr. Sharira Sthana 1/ 12]
In the opinion of Vagbhata, the condition of mutra-purishagandhi in incurable and all other disorders are difficult to cure.[Su.Sa.Sharira Sthana 2/5] [A.Hr. Sharira Sthana 1/ 12]
Currently, apart from the three types of vitiations 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 focussing on the diagnosis and treatment aspects of abnormal variations in the characterestic 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) ===
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 red lotus flower[Cha. Sa. Chikitsa Sthana 30/ 226]
*the color of an insect called red velvet mite(indragopa)[Cha. Sa. ChikitsaSthana 30/226]
*the color of blood of rabbit[Su. Sa. ShariraSthana 2/ 17 ]
*the color of solution Lacciferlacca(laksha rasa)[Su. Sa. Sharira Sthana 2/17]
*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 bi-manual examination of uterus and adnexa is important in the diagnosis of menstrual disorders.
Tenderness (sparshasahatva) indicates the involvement of [[pitta]] along with [[vata]]. The secondary pelvic pathologies like uterine fibroid (garbhashaya arbuda), ovarian cyst(beejakoshagranthi), tubo-ovarian(TO) mass, adenomyosis,endometriosis, uterine polyps etc. which can cause menstrual abnormalities are kept in mind during palpation.
Tenderness (sparshasahatva) indicates the involvement of [[pitta]] along with [[vata]]. The secondary pelvic pathologies like uterine fibroid (garbhashaya arbuda), ovarian cyst(beejakoshagranthi), tubo-ovarian(TO) mass, adenomyosis,endometriosis, uterine polyps etc. which can cause menstrual abnormalities are kept in mind during palpation.
===Interrogation (prashna) ===
===Interrogation (prashna) ===
The associated symptoms with menstruation especially in case of dysmenorrhea, premenstrual syndrome, menopausal syndrome etc. are elicited through interrogation.
The associated symptoms with menstruation especially in case of dysmenorrhea, premenstrual syndrome, menopausal syndrome etc. are elicited through 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]
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]
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.
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.
==Laboratory investigations==
==Laboratory investigations==
===In decreased state of menstrual blood (artavakshaya)===
===In decreased state of menstrual blood (artavakshaya)===