A Literary Review of Artavakshaya in Ayurveda w.s.r. to Oligo Hypomenorrhea -...

[Full title: A Literary Review of Artavakshaya in Ayurveda w.s.r. to Oligo Hypomenorrhea - Review Based on Literary Study]

[Find the meaning and references behind the names: Kumar, Narendra, Meena, Sangeeta]

Review Article This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 5 (1),118-121, January, 2022 ISSN: 2581-785 X; https://irjay.com/ DOI: https://doi.org/10.47223/IRJAY.2022.5117 A Literary Review of Artavakshaya in Ayurveda w.s.r. to Oligo- Hypomenorrhea - Review Based on Literary Study Sangeeta, 1 Narendra Kumar Meena, 2 Diksha khathuria 3 1 PG Scholar , Prasuti Tantra and Stri Roga Vibhag, M.M.M. Govt. Ayurved College, Udaipur 2 Associate Professor, Prasuti Tantra and Stri Roga Vibhag, M.M.M. Govt. Ayurved College, Udaipur 3 Lecturer, Prasuti Tantra and Stri Roga Vibhag, M.M.M. Govt. Ayurved College, Udaipur INTRODUCTION Woman's health is the prime consent to be considered for well-being of family, society and culture. Any physical, physiological and psychological disorders can disturb her life. Physiological changes and development occurs right from birth but markedly during the age of puberty. Due to increased physical and emotional stress in routine lifestyle of women alters the physiology of "Hypothalamus- Pituitary-Ovarian-Uterine axis". This may lead to many gynecological problems. Among all gynecological problems, the most common menstrual problem is Artava Kshaya . Acharyas has mentioned the age of menarche with normal duration and interval of menstruation. Any deviation from these physiological parameters has been mentioned under different headings by different Acharyas like Artavadushtis , Yoni vyapadas , Artavakshaya etc. If we review our classics Artava kshaya has not been mentioned as a separate disease but it has been described as a symptom of many gynaecological disorders. Acharya Sushruta has explained the symptoms of Artava Kshaya 1 In this condition, menstruation is delayed, menstrual blood is scanty and associated with pain during menstruation. Article Info Article history: Received on: 15-11-2021 Accepted on: 25-12-2021 Available online: 31-01-2022 Corresponding author- Sangeeta, PG Scholar, Prasuti Tantra and Stri Roga Vibhag, M.M.M. Govt. Ayurved College, Udaipur Email: sangeetabishnoi 0505@gmail.com ABSTRACT: In Ayurveda classics, all Gynaecological problems are described in Yonivyapada and Artava Vikara . Due to changed lifestyle, the physical and emotional stress increases. This leads to many physiological changes that ends with the disruption of ‘H-P-O’ axis and may leads to various gynaecological disorders. Artavakshaya is one of amongst them. Ratio of Menstrual disorder is raising in gynaecological practice which is a precursor of infertility and other problems. Artavakshaya is also seen as one of the manifestation of the Yonivyapadas like Arajaska / Lohitkshaya Yonivyapada & Vatala Yonivyapada , along with ksheen artavadusti and jataharini . Modern science & Ayurveda both offer treatment for the Artavakshay , but in modern science very little options are there like hormonal therapy while Ayurveda describes various modalities like life style modification, correction of diet ,oral medication and Panchakarma procedures so this study is undertaken to through the light on classical reference of Artavakshaya with modern correlation & its Ayurvedic management. Keywords: Artavakshaya, Yonivyapada, diet

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Sangeeta et al “A Literary Review of Artavakshaya in Ayurveda w.s.r. to Oligo-Hypomenorrhea - Review Based on Literary Study” : 2022; 5 (1):118-121 119 Artava Kshaya has also been mentioned in Astha Artava dushtis as Ksheen Artava 2 In modern science Lakshana of Artava Kshaya can be correlated with certain menstrual disorders that are as follows: • Uchitakala adarshanam as delayed menses or Oligomenorrhea • Alpata as Hypomenorrhea • Yonivedana as painful menses So when we compare the disease Artava Kshaya with the modern medical science Oligomenorrhea and Hypomenorrhea can be correlated on the basis of its signs and symptoms. Oligomenorrhea 3 is defined as menstrual bleeding occurring more than 35 days apart and which remains constant at that frequency. Hypomenorrhea 4 is defined as when the menstrual bleeding is unduly scanty and lasts for less than 2 days. Prevalence of Oligomenorrhea is 13.5% in general population 5 Many causes has been described in modern science for Oligomenorrhoea and hypomenorrhea that includes hormonal factors, ill health of patient, poor nutrition, may be constitutional in origin, may be related to uterine or endometrial origin. Treatment modalities in modern science includes reassurance, improving the general health of patient, hormonal therapy and various other modalities based on the underlying etiology for treating these condition. Nirukti of artavkshaya – “ Raktasya pramanahani”Rakta – raja/ artava Pramanhani- decrease in amount 6 Praman of artava – 4 anjali (In a healthy person) References of Artavashaya in Ayurvedic text - Yonivyapadas related to Artavakshaya : a) Lohitakshaya : Acharya Vagbhata opined that due to vitiation of vata and pitta the raja is decreased and the woman suffers from burning, emaciation and changes in complexion. This condition known as lohitakshaya 7 b) Arajaska : Acharya Charaka says that pitta situated in yoni and uterus vitiates rakta then a woman becomes extremely emaciated and her complexion gets changed. This condition is known as arajaska 8 Chakrapani in his teeka described amenorrhoea as a symptom. c. Vatala Yonivyapada : Charaka writes that a woman of vata prakriti, when consumes Vatapradhan diet and indulges in other activities capable of aggravating vayu , then provoked vayu reaching reproductive system, produces pricking and other pain, stiffness, sensation as if creeping of ants, roughness, numbness etc . local symptoms and fatigue or lethargy etc. other disorders of vata . Due to vata the menstruation starts with sound and pain, and menses is frothy, thin and dry 9 Artava dushti related to artava kshaya : " Ksheena artavadushti" means reduced quantity of artava from its normal measurement due to vitiation of doshas 10 [scanty menses] This condition merely co-related with the " Artava kshaya ". Jataharini 11 related to Artavakshaya Kashyapa has mentioned certain menstrual disorders, as Shushka revati, Katambhara, Vikuta jataharini and these are the result of jataharini graha badha . These three menstrual disorders can be considered as primary amenorrhea, because the following lakshanas are found in these jataharini graha badhas a) Shushka Revati: When a woman is 16 years old even then the menstrual phenomena does not take place and her sphikapradesha is emaciated then she is considered to be suffering from Shushkarevati graha . b) Katambhara : The woman who does not menstruate in the uchita kala (appropriate time) and becomes krisha, heenabala, kruddha and ultimately dies is known as Katambhara . c) Vikuta : When the menstrual discharge is vishama in kala (time), varna (colour) and pramana (quantity) from the very beginning and there is balahani and glani in the woman then she can be considered as suffering from Vikuta jataharini. From above description one can say that first two can be considered as primary amenorrhoea and last one as oligomenorrhoea. Nidana of Artavakshaya : - The mula of artavavah srotas being garbhashaya and artava vahi dhamani where injury causes infertility, dyspareunia and amenorrhoea 12 Different authors have explained their own views regarding the manifestation of menstrual disorder. According to kasyapa view, after proper snehna and swedan in a mrudokosta vyakti adhika aushadha sevana , atiusna annapana sevana jivarakta skalana occurs. There by causing vata prakopa leading to pralapa, unmade, hikka , bejoupghata and pushpopaghat ( artava dusti ) 13 Dalhana , the commentator of Sushruta has described the various etiological factors responsible for this condition, they are

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Sangeeta et al “A Literary Review of Artavakshaya in Ayurveda w.s.r. to Oligo-Hypomenorrhea - Review Based on Literary Study” : 2022; 5 (1):118-121 120 a) Atisamshodhana b) Atisamshamana c) Vega dharana d) Asat manna e) Manastaapa f) Vyayama g) Anshan Samprapti The samprapti (Etiopathogenesis) of artava kshaya involves two mechanisms. 1) Marga avarodha janya 2) Dhatu kshaya janya In marga avarodha janya artava kshaya , involvement of doshas is vata and kapha . According to Charaka the vitiation of artava vaha srotas occurs by means of sanga (obstruction) . This avarodha (obstruction) is caused either by kapha or vata alone or vata kapha together.According to Sushruta , vata kapha are the factors causing avarana to artava vaha srotas . Pitta is not included because it causes artava vriddhi . Sushruta has also explained that the trauma or injury to artava vaha srotas causes vandhyatwa (infertility), maithuna asahishnuta (dyspareunia) artava nasha 14 The aim of treatment here is to relieve the obstruction caused by kapha or/& vata to the artava vaha srotas . After performing Snehana & Swedana karmas . Vamana karma in case of kapha vitiation can be done. Niruha & anuvasana basti are indicated in vata vitiation. Uttarabasti can be indicated in obstruction caused by kapha & vata . In dhatu kshaya janya Artavakshaya , the vitiation of doshas occurs by their respective vitiated ahara & vihara . These vitiated doshas effect rasadhatu & its dhatwagni . So there is rakta dhatu kshaya which is an anuloma kshaya. When there is rakta dhatu kshaya due to anemic condition, all prasadansha of rasa dhatu goes to rakta dhatu alone and not to other dhatus . So there is decrease in the other dhatus . Due to same reason artava upadhtwagni doesn’t get poshak ansha of rasa leading to artava kshaya. There is ashraya - ashryee bhava between rakta and pitta . As there is kshaya of rakta dhatu , ultimately pitta kshaya also occurs resulting in artava kshaya . Sushruta has considered rakta as dosha and mentioned it also as a vitiating factor of artava kshaya . So by its own vitiating ahara & vihara , rakta also gets vitiated and in turns vitiates artava . Chikitsa (treatment) Nidan parivarjan : -Eradication of the causative factor is the basic treatment of all disorders. “ Tatra samshodhanameva ca agneyanaam dravayanaam vidhiyat upayogah” ( su. su. 15/12) Artavakshaya should be treated by use of purifying measures & Agneya Dravyas 15 The Pittavardhaka and vata kapha shamak, ushna, tikshna, dipan, pachan, dravyas are used and these dravyas can remove Srotoavarodha of artavaha srotas and brings up the normal menstrual flow. “ Samshodhanamih vamanam na virekah etyapare” Dalhana says that for purification, only Vamana karma should be used, no Virechana , because it reduces pitta which in turn decreases Agneya nature in body. Consequently artava also decreases. Agneya substances i.e. tila, masha, & sukta can be used 16 Mahrishi kashyap consider artavakshaya as anuvasna yogya vyadhi . Sitakalyana ghrita is also beneficial which is described under pradar chikitsa of yogratnakara . Abhyantara Chikitsa (Oral Treatment) Kwatha 1 Tila, Karvi, Guda in form of decoction. 2 Krishna Tila Kwath with Guda , Mishreya Methika, muli, Gajara, Shatpushpa etc. in form of Decoction. Churna 1. Shatapushpa Kalpa . 2. Malkangni flower, Swarjiksharan, Vacha, Peeta shal flower with cold water Vati 1. Rajah pravartini vati 2. Nastapushpantaka ras Modaka 1. Aswathamuladi modaka 2. Agasti Haritaki modaka Taila shatapushpa taila Ghrita Phala Ghrita,brihat shatavari ghrita,kumar kalyana ghrita,kalyanaka ghrita , shitakalyana ghrita,mahakalyanaka ghrita Sthanika Chikitsa (Local Treatment) Varti Ikswaku-beeja, Danti, Chapala,Madanaphala, Guda, Surabeeja,Yavashuka Snuhikshira in form of Varti Lepa Intra vaginal use of langali and rasa preparations. Basti chikitsa (Enema or Uterine instillations) 1. Anuvasana Basti – Shatavaryadi

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Sangeeta et al “A Literary Review of Artavakshaya in Ayurveda w.s.r. to Oligo-Hypomenorrhea - Review Based on Literary Study” : 2022; 5 (1):118-121 121 2. Uttar Basti-Taila of Jivaniygana dravyas shatapushpa taila Pathyapathya : Pathya: 1 madya, mamsam capable of increasing pitta are Beneficial 17 2 Fish, kulattha, kanji (sour substances), takra, sura etc. Be used in diet 18 3 Lasuna(Garlic) is beneficial 19 4. Tila,masha, sura, sukta, etc. 20 5. Fish, kanji, tila, udaswihcha, curd. 21 Apathya: • Ahara capable of aggravating nidanas are contraindicated • Diwaswpna, ratri jagarana etc 22 CONCLUSION Artava kshaya occurs due to involvement of vata and kapha , which can be attributed to marga avarodha of artava vaha strotas .In Ayurvedic classical texts, treatment is mentioned to keep the doshas in equilibrium. It can be achieved by Samsodhana ( vaman and basti ) and Samshamana (in form of Agneya dravyas ).Use of Agneya dravyas not only relieves the kapha which does avarana to apanavata but also increases the quantity of artava Acknowledgements: - Nil Conflict of Interest – None Source of Finance & Support - Nil REFERENCES 1 Shastri A.D; Edited Susruta Samhita Sutra Sthana 15/12, Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-59 2 Shastri A.D Susruta Samhita Ayurveda tatva sandipika Hindi Commentary Sharir Sthan Chapter 2, Slok No. 5 Published By Chaukhamha Sanskrit Sansthan Varanasi 2007. 3 DC Duttas Textbook Of Gynaecology Including Contraception 6 th Edition Edited By Hiralal Konar Page No.180 4 DC Duttas Textbook Of Gynaecology Including Contraception 6 th Edition Edited By Hiralal Konar Page No.180 5 The Ayurvedic Pharmacopoeia Of India. Part-1 Vol. II, 1 st Edition, Govt. Of India, Department Of Indian System Of Medicin And Homeopathy, New Delhi;1999. 6 Gupta A; Edited Astanga Hrudayam Uttara Sthana 33/45. Varanasi: Chaukambha Prakashan;2009. pp-777. 7 Sastri K Edited Caraka Samhita Cikitsa Sthana 30/17, Varanasi: Chaukhambha Bharati Academy: 2009.pp-842. 8 Acharya YT, Edited Chakrapani Commentary Of Charaka Samhita Cikitsa Sthana 30, 5 th Edition Varanasi: Chaukambha Sanskrit Samsthana: 2008.pp.635. 9 Shastri AD; Edited Susruta Samhita Sarira Sthana 2/5. Varanasi: Chaukhamha Sanskrit Sansthan Reprint 2007.pp.9. 10 Vriddha J; Edited Kashayapa Samhita Kalpa Sthana 6/31,32,34; Varanasi Aukh: Anskrit Sansthan: 2006.pp- 192. 61. 11 Shastri AD; Edited Susruta Samhita Sutra Sthana 15/16, Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-59 12 Shastri AD; Edited Susruta Samhita Sutra Sthana 15/16, Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-59 13 Vriddha J; Edited Kashayapa Samhita Sidhi Sthana 3/21, Varanasi: Chaukhambha Sanskrit Sansthan; 2006.pp-157. 14 Vriddha J; Edited Kashayapa Samhita Sidhi Sthana 7/32. Varanasi: Chaukhambha Sanskrit Sansthan; 2006.pp-205. 15 Shastri AD; Edited Susruta Samhita Sharir Sthana 9/12, Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-13 16 Shastri AD; Edited Susruta Samhita Sutra Sthana 15/12, Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-59 17 Sharma P; Edited Dalhan Commentary Of Susruta Samhita Sutra Sthana 15/12, Vol-1, Varanasi: Chaukambha Vishvabharti: 2004.pp-162. 18 Shastri AD, Edited Susruta Samhita Sharira Sthana 2/18, Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-12 19 Shastri A; Edited Susruta Samhita Sharira Sthana 2/14. Varanasi: Chaukhamha Sanskrit Sansthan; 2007.pp-11. 20 Vriddha J: Edited Kashayapa Samhita Sharira Sthana 2/22, Varanasi: Chaukhambha Sanskrit Sansthan: 2006.pp-175. 21 Sharma P; Edited Dalhan Commentary Of Susruta Samhita Sutra Sthana 15/12, Vol-1, Varanasi: Chaukambha Vishvabharti: 2004.pp-162. 22 Shree B; Edited Bhavaprakash Samhita 70/22, Part-2, Varanasi: Chaukhambha Sanskrit Sansthan:2008.pp-767. How to cite this article: Sangeeta, Meena N.K, Khathuria D “A Literary Review Of Artavakshaya In Ayurveda W.S.R. To Oligo-Hypomenorrhea - Review Based On Literary Study” IRJAY.[online]2022;5(1);118-121 Available from: https://irjay.com ; Doi: : https://doi.org/10.47223/IRJAY.2022.5117