Endometriosis and its Ayurvedic perspective

ISSN: 2456-3110 REVIEW ARTICLE May-June 2017 Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 259 Endometriosis and its Ayurvedic perspective Vishwesh B.N Associate Professor, Department of Prasutitantra and Striroga, Shri Krishna Ayurvedic Medical College Cholapur, Varanasi, India. I NTRODUCTION Endometriosis is a gynecological condition that affects 1 out of every 10 women of reproductive age. This condition is traditionally defined as the development of endometrial glands and stroma outside of the uterine cavity, but this definition has broadened to include the development of any endometrial cell type (glands or stroma) outside of the uterine cavity. Laparoscopic evaluation followed by histological confirmation is the gold standard for diagnosis of endometriosis, but the accuracy of the diagnosis is highly dependent upon surgical and pathological expertise [1] Several reports have debated the effectiveness of either medical or surgical therapy for the treatment of infertility and chronic pain. Currently, there is no universally acceptable, standard treatment protocol for endometriosis. Although evidence has been presented that subtle Address for correspondence: Dr. Vishwesh B. N. Associate Professor, Department of Prasutitantra and Striroga, Shri Krishna Ayurvedic Medical College Cholapur, Varanasi, India. E-mail: vishweshbn@gmail.com Submission Date : 06/05/2017 Accepted Date: 22/05/2017 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 2 i 3.8240 endometriotic lesions are a normal physiologic condition occurring intermittently in all women, other data suggest that endometriosis is a progressive disease in about 50% of symptomatic women and non-human primates with a variable and unpredictable rate of progression. Defining endometriosis into a ‘disease’, ‘illness’ and or a ‘physiological phenomenon’ with a known cause has thus far eluded many scientists. Consequently, endometriosis remains a considerable challenge for those who attempt to understand the symptoms and signs of endometriosis that vary according to the location and severity of the disease/illness, as well as the impact on the general physical, mental and social well-being of a woman. The challenge of endometriosis accentuates the need to look at it as a persistent or chronic disease, at least in a subset of highly symptomatic women, as their symptoms may continue despite seemingly adequate medical or surgical treatment. This may affect their quality of life because of debilitating pain, the emotional impact of sub-fertility, anger and frustration about disease recurrence, and uncertainty about the future regarding repeated surgeries or long-term hit-andmiss medical therapies and their associated sideeffects which emphasized the complexity of the management and the necessity to offer all available treatments in a multi-disciplinary context [2] Hence in this background, it becomes important to study this phenomenon in detail. Ayurveda does not name A B S T R A C T Endometriosis defined as the presence of functioning endometrium, in sights other than uterus. It can be either the endometriosis externa or interna. Externa refers to endometriosis of any part of the body except the myometrium. In interna, the endometriosis is found in the muscle wall of the uterus. All though endometriosis is not considered as a life threatening disease, is a life altering disease that requires timely diagnosis and treatment. This paper intends to review on endometriosis and its Ayurvedic perspective in detail Key words: Endometrios, Nidana Panchaka, Paripluta, Vataja Pradara, Vatikiyonivyapat.

Vishwesh B.N. Endometriosis and its Ayurvedic perspective ISSN: 2456-3110 REVIEW ARTICLE May-June 2017 Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 260 endometriosis as a separate disease entity. This paper is an attempt to identify the disease endometriosis from an Ayurvedic perspective. Etiology of Endometriosis The exact cause is still not clear; however, several theories are explained like the implantation theory, metaplasia theory, lymphatic theory, blood born spread theory, immune deficiency theory, genetic theory and so on. Pathology The endometrium stroma and glands in the ectopic site has got the potentiality to under go cyclical change. Proliferative changes are constantly evidenced, secretive changes are absent in ectopic endometrium. The periodical shed blood may remain encysted, the cyst becomes tense and ruptures. As the blood is irritant, there is dense tissue reaction surrounding the lesion with fibrosis. It produces adhesions and puckering of the peritoneum. There may be the formation of Chocolate Cyst. In spite of dense adhesion amongst the pelvic structure, fallopian tubes remain patent [3] Sites of endometriosis Endometriosis is reported in the ovaries, uterine ligaments, recto vaginal septum, pelvic peritoneum, laparotomy scars, vagina, umbilicus, hernia sacs, urinary tract, large and small intestine, appendix, umbilicus and rarely even in the pleura, diaphragm, arms, legs, kidneys etc. Clinical symptoms Dysmenorrhoea - The pain starts 5 - 7 days prior to menstruation and becomes maximum at the height of bleeding which persists during mensus and there after. Pelvic pain - Most patient complain of constant pelvic pain about 2 - 3 days prior to menstruation and remaining for 3 - 4 days after its occurrence. Dyspareunia, Back ache, Rectal Pain and Bleeding during menstruation, Dysurea, haemeturia, pyrexia, menstrual abnormalities like menorrhagea, epimenorrhoea, infertility etc. Differential diagnosis Endometriosis has to be differentially diagnosed from PID, Myomas, malignant diseases of the ovary, malignancy of cervix and vagina etc. Prognosis Endometriosis yet has no proper complete cure and all the therapies offer only relief in symptomatology. Any how surgical interventions seems to have lower recurrence rate than the available medical treatment. Management of Endometriosis The treatment may be of the following varities; Medical - In mild pelvic endometriosis diagnosed by laparoscopy in young women and in treatment residual and recurrent disease following conservative surgery. Surgical - Preferred in women with chronic severe pelvic pain or in moderate to severe endometriosis associated with infertility. Combined - Combined medical and surgical approach would be suitable to women who are not desirous of pregnancy. Medical management Expectant treatment In patients who have minimal symptoms, this is appropriate. The patient is encouraged to concieve under due observation of the lesion. If the size of the lesion increases, it is given up and hormonal or surgical treatment is initiated. Analgesic therapy In patients with minimal symptoms and having no desire for immediate fertility, NSAID or prostaglandin synthase inhibitory drugs are the choice. Hormonal methods Hormonal drugs to supress the cyclical ovarian function and menstruation is preferred. Since the lesions of endometriosis regress during pregnancy or menopause, pseudo pregnancy or pseudo menopause hormonal regimens are tried in patients.

Vishwesh B.N. Endometriosis and its Ayurvedic perspective ISSN: 2456-3110 REVIEW ARTICLE May-June 2017 Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 261 The surgical approach The surgical approach would either be conservative or radical. Conservative approach includes excision of a localized nodule, removal of the chocolate cyst or excision of the adhesions. The radical surgery involves removal of the uterus and the ovaries [4] The Ayurvedic perspective Ayurveda explains that it is not always possible to name a disease in a definate term. Endometeriosis is not an exception for the same. Hence this disease has to be analyzed according to the Nidana Panchaka theory of Ayurveda based on the concepts of Dosha , Dusya , Srotas , Samprapti and its management. Nidana A woman of Vataja Prakruti consuming Vatakara Ahara Vihara is more prone to have this disease. The Nidana can be classified as Aharaja , Viharaja and Manasika . Aharaja Nidana Katu and Laghu Ahara like dry leafy vegetable, Tikta and Ruksha Ahara like roasted meat and Kashaya Pradhana Dravya , pulses like Uddalaka and Mudga , overeating and irregular eating, fasting etc. form the Aharaja cause. Viharaja Nidana Excessive coitus, carrying heavy load, excessive journey, day sleep, suppression of natural urges, other causes which directly produce Dhatu Kshaya form the Viharaja causes. Apart from this Mityaacara , Pradushta Artava , Bijadosa and Daiva also contribute to the Nidana [5] Samprapti When Vatalaprukruti woman indulges in Vatakaraaharaviharas , it results in aggrevation of Vayu . This Prakupita Vayu in turn vitiates the Artava and carries the vitiated Artava situated in the Garbhashaya by Pratilomagati to sites other than Garbhashaya along with vitiated Vata by Ashayaapakarsha . Further the vitiated Vata causes vitiation in Rakta , Mamsa , Medha etc. Dhatus and implamnts the endometrial tissues in them. In due course of time, the dominant Vata Dosa involves the other two Dosas also producing various symptoms of the respective Dosas . Samprapthi Ghatakas Dosha: Vatavrudhi, Pittasama, Kaphakshaya Dushya: Rasa, Rakta. Srotas: Artavavaha Srotas. Srotodusti: Vimargagamana In a nut shell, the Samprapti can be explained as follows; 1 Vata dominant stage - implantation and cyst formation. 2 Vatakapha dominant stage - cystic and adhesion formation. 3 Kapha dominant stage - extensive adhesion. 4 Tridosa dominant stagemalignant changes [6] Roopa Symtoms like pricking pain in the Yoni , stiffness, sensation of creeping of ants, roughness, numbness, fatigue, lethargy and other generalised symptoms associated with painful menstruation along with sound, froathyness or vaginal flatus, thin and dry or scanty bleeding which have been explained for Vatala or Vatikiyoni Vyapat can be equated with endometriosis associated with laxity of perineum [7] To explain dyspareunia in endometriosis, one has to consider Paripluta Yonivyapat along with Vatala . According to the classics, Paripluta is the condition where Yoni gets swollen with pain, tenderness associated with bluish or yellowish menstrual discharge, severe pain during coitus etc [8] If menorrhagia is the presenting symptom, one has to consider Vataja Pradara to explain the same [9]

Vishwesh B.N. Endometriosis and its Ayurvedic perspective ISSN: 2456-3110 REVIEW ARTICLE May-June 2017 Journal of Ayurveda and Integrated Medical Sciences | May - June 2017 | Vol. 2 | Issue 3 262 Ayurvedic management Endometriosis cannot be correlated to any single disease in Ayurveda. As discussed earlier the diagnosis, hence has to be based on the Nidana Panchaka theory. The treatment therefore should be opposite to the causative factors. As the Dosa involved is Vatapradhana , Kaphaanubandha , the treatment should be both Vata and Kaphahara . The modalities mainly involved include; Shodhana - After proper Poorvakarma , one should go for Vamana , Virechana , Asthapana , Anuvasana or Uttaravasti as per the condition required. Shamana - Internally any of the following may be used as per the condition. Raktasravarodhaka drugs - like Chandrakala Rasa , Pradarantaka Rasa , Bolabaddha Rasa , Pradarari Rasa , Pushyanuga Choorna , Puskaraleha , Asokarishta , Lodhrasava , Patrangasava etc. Raktavardhaka drugs - like Svarnavasantamalati Rasa , Pravalapisti , Godantibhasma , Vangabhasma etc. Other combinations like Phalaghrita , Phalakalyanaka Ghrita , etc. as and when required. Grantihara combinations also may be prescribed as per requirement like Punarnava Mandura , Shilajatu , Arogyavardini , Gandhaka Rasayana , Dasamularishta , Abhayarishta etc. CONCLUSION Endometriosis is a condition which has no complete cure in any system of medicine. It usually affects the progeny in younger female and in elderly causes lots of discomfort and pain requiring chronic medical attension. The number of cases of endometriosis being reported is increasing day by day. Hence, understanding this disease from Ayurvedic point of view and planning out a complete treatment modality is the need of the hour. REFERENCES 1 D’Hooghe TM, Bambra CS , Raeymaekers BM, Koninckx PR. Serial laparoscopies over 30 months show that endometriosis in captive baboons (Papioanubis, Papio cynocephalus) is a progressive disease, Fertil Steril , 1996:65;p.645-649. 2 D’HoogheTM, Debrock S. Future directions in endometriosis research, Obstet Gynecol Clin North Am, 2003:30;p.221-244. 3 Endometriosis . womenshealth.gov. 13 February 2017 . Retrieved 20 May 2017 . 4 Endometriosis : Overview. www.nichd.nih.gov. Retrieved 20 May 2017. 5 Acharya YT Charaka Samhita of Agnivesa with Ayurveda Dipika Commentary of Chakrapani Datta. Reprinted. Varanasi: Choukambha Orientalia; 2001;Cha.Chi 30/22. 6 P.K.Ushakumari, G.Nagabhushanam. Endometriosis. Kottakkal; Aryavaidyasala; Jan 2005. 7 Acharya YT. Charaka Samhita of Agnivesa with Ayurveda Dipika Commentary of Chakrapani Datta. Reprinted. Varanasi: Choukambha Orientalia; 2001;Cha.Chi 30/22. 8 Acharya YT. Charaka Samhita of Agnivesa with Ayurveda Dipika Commentary of Chakrapani Datta. Reprinted. Varanasi: Choukambha Orientalia; 2001;Cha.Chi 30/24. 9 Acharya YT. Charaka Samhita of Agnivesa with Ayurveda Dipika Commentary of Chakrapani Datta. Reprinted. Varanasi: Choukambha Orientalia; 2001;Cha.Chi 30/205-209. ******************************** How to cite this article: Vishwesh B.N. Endometriosis and its Ayurvedic perspective. J Ayurveda Integr Med Sci 2017;3:259-262. http://dx.doi.org/10.21760/jaims.v 2 i 3.8240 Source of Support: Nil, Conflict of Interest: None declared.

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