A Clinical Case of Beejabhagavayava Dushti managed with Ayurvedic approach

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[Find the meaning and references behind the names: Sri, Vidya, Nidhi]

CASE REPORT May-June 2019 Journal of Ayurveda and Integrated Medical Sciences | May - June 2019 | Vol. 4 | Issue 3 141 A Clinical Case of Beejabhagavayava Dushti managed with Ayurvedic approach Dr. Nidhi Devidas Chickramane, 1 Dr. Vidya Ballal 2 1 Post Graduate Scholar, 2 Associate Professor, Department of Prasuti Tantra & Stri Roga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Kuthpady, Udupi, Karnataka, INDIA. I NTRODUCTION Concepts of anatomy, physiology and pathological considerations related to Stree Shareera can be traced in classics. Genetic and anatomical defects related to female body are explained in terms of Beeja, Beejabhaga and Beejabhagavayava [1] Swift increase of genetic abnormalities in present scenario can be attributed to several causes like Tulya Gotrata (consanguineous marriage), Ahita Ahara-Vihara (lifestyle changes), Prakriti (environmental factors) and Garbhopaghatakara Bhavas. Vandhyatwa, Trinapuli and Vaartadi Vyadhi are resultant of following such Nidana . Jataharini is one among various factors responsible Address for correspondence: Dr. Nidhi Devidas Chickramane Post Graduate Scholar, Department of Prasuti Tantra & Stri Roga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Kuthpady, Udupi, Karnataka, INDIA. E-mail: nidhidev 2012@gmail.com Submission Date: 27/04/2019 Accepted Date: 18/06/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.4.3.18 for Beejabhagavayava Dushti as per Kashyapa . Jataharini [2] can be correlated with the factors which produce anomalies in the progeny. It is known to affect the pregnant lady who shows negligence towards her pregnancy. Negligence can be, in not following Garbhini Paricharya [3] and Sadvritta Paripalana, [4] which play an important role in fetal development, increasing the life span and quality of life. A clinical case of young girl with presentation of congenital abnormality is selected and details are analyzed such as cause, signs and symptoms and treatment principles. Probable classical understanding and various management protocols that can be adopted are discussed here C ASE R EPORT A female patient aged 19 years hailing from Hyderabad, an engineering student, approached with chief complaint of primary amenorrhoea associated with excessive per vaginal white discharge and occasional lower abdominal pain. She was, k/c/o Mayer-Rokitansky-Kuster-Hauser syndrome. She had undergone vaginoplasty 1 Year ago. Post-surgery, she developed white discharge P/V and lower abdominal pain. The discharge was thick, white in colour, associated with foul smell, itching. She was regularly A B S T R A C T Present days, there is a rapid increase in number of genetic disorders due to various causes. Mayer- Rokitansky-Kuster-Hauser syndrome (MRKH syndrome) is a congenital condition due to mullerian agenesis. This can be correlated with Yonivyapats such as Suchimukhi, Shandi, Antarmukhi and Jataharinis like Shushkarevati, Katambhara. In this work, once such case of a female patient, aged 19 years, presenting with primary amenorrhea is discussed. Rationality in therapeutic approach by implementing the classical principles, along with the surgical aid is also presented which eventually succeeded in treating her. Key words: Congenital, MRKH syndrome, Jataharini, Yonivyapat.

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[Find the meaning and references behind the names: Low, Rasa, April, Kala]

Dr. Nidhi Devidas Chickramane et.al. A Clinical Case of Beejabhagavayava Dushti ISSN: 2456-3110 CASE REPORT May-June 2019 Journal of Ayurveda and Integrated Medical Sciences | May - June 2019 | Vol. 4 | Issue 3 142 using vaginal dilators. She did not have breast development and no pubic and axillary hair growth. For these complaints, she approached us for further management. (on 05/06/2015 ) Her family history revealed consanguineous marriage among parents. Mother has a history of having excessive Katu and Ruksha Ahara during the period of pregnancy. She does not have siblings and all other family members are said to be healthy. Her general examination revealed, height: 5 feet, weight: 37 kg, BMI: 16.4 Kg/m 2 , rest examinations were normal. Local examination revealed, Tanners chart - Breast development : Stage 1; Pubic hair : Stage 2 Investigation: On 13/4/2015, AMH - 1.11 ng/ml (Low fertility), USG : Uterus - 2.43 x 1.25 cm, ET - cannot be visualized, right Ovary - 3.5 x 3.6 cm simple cyst, left ovary - 1.2 x 1.09 cm, Impression: Hypoplastic uterus and right ovarian simple cyst. Treatment Protocol Date Treatment Given Duration 05/06/2015 Nashtapushpantaka Rasa 1-1-1, Chitrakadi Vati 1-0-1, Kumaryasava 3-3-3 tsf, Shatavari Rasayana + Ashwagandhavaleha 1-0-1 tsf 1 month 9/09/2015 Abhyanga with Ksheerabala Taila, Balamoola Kwatha Parisheka, Rajayapana Basti and Matrabasti with Mahanarayana Taila Kala Basti pattern. 7 days 25/03/2016 Abhyanga and Parisheka, Rajayapana Basti and Matrabasti with Dhanvantara Taila. Nasya Karma with Phala Ghrita followed by Dhumpana and Kavalaghriha. 7 days 06/05/2016 Abhyanga and Parisheka , Rajayapana Basti and Matrabasti with Dhanvantara Taila. Nasya Karma with Phala Ghrita 7 days followed by Dhumpana and Kavalaghriha. 02/01/2017 Abhyanga with Ksheerabala Taila, Bashpasweda with Dashamoola Kwatha, Rajayapana Basti and Anuvasana Basti with Ksheerabala Taila, Yoni Basti with Shatavari Ghrita. 7 days 09/01/2017 Ashokarishta + Abhayarishta 20 ml TID, Shatavari Ghrita 2 tsf BD, Gomutra Arka 2 tsf BD 1 month Patient developed improvement in the secondary sexual characters after 3 rd course of admission and she continued the oral medications as she was unable to come for admission due to her academic work schedule. Investigations done during treatment Date Investigation 12/09/2016 USG: Uterus: 3.1 x 1.1 x 2.4 cm, Hypoplastic Uterus, ET- 2.5 mm, Normal echo texture, No free fluid. Rest NAD 13/12/2017 MRI: Upper half of vagina not visualized suggestive of aplasia, Lower vagina seen, past vaginoplasty and it does not show. Normal uterus not seen, Two small rudimentary horn/ uterine buds are seen measuring 2.8*1.8 cm on right 1.8*1.2 cm in left. Functional endometrium seen. Right ovary: 2.6*2.4*1.7 cm left ovary: 2.9*2.2*1.6 cm. Multiple follicles are seen in both ovaries. Patient underwent vaginoplasty again on 13/4/2018. She got her menstruation as spotting on April 2018. Since then, she is on regular menstrual cycle but bleeding occurs in the form of spotting. DISCUSSION Beejabhagavayava Dushti lead to Putipraja in the female progeny. In other words, the female is unable to produce the progeny. This is supported with modern genetic parameters. Genetic mutation in the

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[Find the meaning and references behind the names: Bala, Jana, Shad]

Dr. Nidhi Devidas Chickramane et.al. A Clinical Case of Beejabhagavayava Dushti ISSN: 2456-3110 CASE REPORT May-June 2019 Journal of Ayurveda and Integrated Medical Sciences | May - June 2019 | Vol. 4 | Issue 3 143 form of deletion or change in the structure of the chromosome causes structural anomaly in the foetus. Consanguineous marriage can lead to deletion of genes and bring about congenital malformation or structural anomaly in the foetus. Mayer Rokitansky Kuster Hauser syndrome [5] is a condition with under developed vagina, uterus, however the external genitalia is normal. This condition of mullerian agenesis and primary amenorrhoea, can be correlated with Yonivyapats such as Suchimukhi, Vandhya, Shandi and Jataharinis such as Shuskarevati and Katambhara. Cause for both Yonivyapat and Jataharini is Mithya Ahara and Vihara . Adharma is considered as an important cause for the Jataharini. Tulya Gotra Vivaha or consanguineous marriage is one among them and it causes Beejadosha . Improper Garbhini Paricharya and Sadvritta Palana , being Prajnaparadha, cause Tridosha Dushti . Thus, affecting the growing foetus . Line of management in such cases is preconception genetic counselling to prevent the congenital malformation in the foetus and Beeja Samskara for getting Shreyasi Praja. Garbhini Paricharya is of special consideration as Matrajadi Shad Bhava play an important role in development of the foetus. In the present case, Shushkarevati Jataharini and Shandi Yonivyapat are taken into consideration and treatment was planned. Balya and Artava Jana Dravyas were used for the treatment. Probable mode of action of the medications can be explained as follows, ▪ Rajayapana Basti is Balya and helps in the Dhatu Vardhana and Agni Vardhaka. The patient had under developed secondary sexual characters and low BMI. This can be attributed to Dhatvagni and Jataragni Mandya . ▪ Apana Vata Dushti is seen in the patient, thus Basti Karma, being Vatahara is ideal treatment. Basti Karma helps in increasing the blood flow to the pelvic organ and there by enhancing their growth. ▪ Along with Basti, Nasya Karma was combined in the later visits. HPO axis has a prime role in maintaining menstrual cycle [6] Nasya Karma has a direct action on this axis by regularising the GnRH hormone and restoring the normalcy of the pituitary gland. ▪ In this case of primary amenorrhoea, underdeveloped secondary sexual characters indicate hormonal misbalance, Nasya Karma helps in regulating the hormones and helped in improvement of the secondary sexual characters. ▪ Yoni Basti was adopted in further course of treatment; Yoni Basti has a local action on the uterus and vagina. Vaginal wall has high efficacy for the lipid soluble molecules. Shatavari Ghrita was used for the Yonibasti Karma, Shatavari is considered as Streedoshaghna according to Dhanvantari Nighantu, [7] it is also Balya thus help in strengthening the uterus and other reproductive organs. Shatavari is also a rich source of phytoestrogen, thus it helps in improving the secondary sexual characters and also improving the endometrial thickness. ▪ In this case the patient did not have functional endometrium, but after the Yonibasti she developed functional endometrium. ▪ Oral medications Nashtapushpantaka Rasa, Kumarysava are Artavajanaka , they act at the hormonal level thereby synchronising the menstrual cycle. Ashwagandhavaleha, Shatavari Avaleha are Balya and helps in increasing the Bala of the patient. CONCLUSION Shuskarevati and Shandhi are considered as Kricchrasadhya and Vatahara line of treatment is indicated. Though complete cure is not possible through medication, a combined medico surgical approach can be taken into consideration. MRKH syndrome is due to mullerian agenesis, surgical approach was necessary in order to have an established path between the uterus and vagina. Medical management was successful in establishing

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[Find the meaning and references behind the names: Williams, Nepal, Sharma, Hiralal, Deepika, Nil, Med]

Dr. Nidhi Devidas Chickramane et.al. A Clinical Case of Beejabhagavayava Dushti ISSN: 2456-3110 CASE REPORT May-June 2019 Journal of Ayurveda and Integrated Medical Sciences | May - June 2019 | Vol. 4 | Issue 3 144 the secondary sexual characters and bringing about the menstrual cycle. REFERENCES 1 Agnivesha, Charaka Samhita revised by Charaka and Dridabala with Ayurveda Deepika commentary by Chakrapani Dutta edited by Acharya Yadavji Trikumji, Chaukhambha Surabharathi Prakashana, Varanasi, 2013, Pp-738, pg no.-321-322 2 Vriddhajivaka, Kashyapa Samhita or Vriddhajivaka Tantra by Vriddhajivaka revised by Vatsya with Sanskrit introduction by Nepal Rajguru Pandit Hemaraj Sharma with Vidyodini hini commentary and hindi translation of Sanskrit introduction by Ayurvedadalnkar Sri Satyapala Bhishagacharya, Varansi: Chaukhambha Sanskrit Sansthan, 2016, pp-578. 3 Sushruta, Sushruta Samhita with Nimbandha Sangraha commentary by Dalhana, foreword by Acharya Jadavji Trikamji. Varanasi: Chaukhambha Sanskrit Sansthan; 2010, Reprint. Pp-824. 4 Agnivesha, Charaka Samhita revised by Charaka and Dridabala with Ayurveda Deepika commentary by Chakrapani Dutta edited by Acharya Yadavji Trikumji, Chaukhambha Surabharathi Prakashana, Varanasi, 2013, Pp-738, pg no.- 5 Hoffman, Schorge, Bradshaw, Halvorson, Schaffer,Corton. Williams Gynecology, 3 rd edition, New Delhi: Mc Graw Hill Education, 2016, Pp-1270, Pg.no.- 420 6 Hiralal Konar, D.C.Dutta, D.C.Dutta’s Textbook of Gynaecology including contraception, 6 th edition, Kolkata: New Central Book Agency (p) Ltd; 2004. Pp 686, pg no-80 7 Kamat S.D., Studies on medicinal plant and drugs in Dhanvantari Nighantu, 1 st edition, Delhi: Chaukhambha Sanskrit Pratishthan, 2002, Pp-858, pg no.-110 ******************************* How to cite this article: Dr. Nidhi Devidas Chickramane, Dr. Vidya Ballal. A Clinical Case of Beejabhagavayava Dushti managed with Ayurvedic approach. J Ayurveda Integr Med Sci 2019;3:141-144. http://dx.doi.org/10.21760/jaims.4.3.18 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2019 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Balya, Abhyanga, Shushkarevati, Vandhya, Agnivardhaka, Dhanvantarinighantu, Parisheka, Mithyahara, Vatahara, Nasyakarman, Jataharini, Phalaghrita, Anuvasanabasti, Prajnaparadha, Amtarmukhi, Abhayarishta, Foetus, Shatavarighrita, Shandi, Chitrakadi Vati, Garbhini Paricharya, Phytoestrogen, Congenital malformation, Rajayapana Basti, Kumaryasava, Endometrial thickness, Ksheerabala taila, Matrabasti, Beejadosha, Oral medication, Ashokarishta, Dashamoola Kwatha, Surgical approach, Sadvritta Palana, Mithya Ahara-Vihara, Medical management, Gomutra arka, Secondary sexual characters, Tridosha Dushti, HPO Axis, Genetic abnormalities, Hypoplastic Uterus, Garbhopaghatakara Bhava, Mithya Vihara, Dhatvagni mandya, Consanguineous marriage, Dhanvantara taila, Primary amenorrhoea, Mithya ahara and vihara, Congenital abnormality, Balya Dravya.