A comparative clinical study to evaluate the effect of Indrayavadi Yoga and...

[Full title: A comparative clinical study to evaluate the effect of Indrayavadi Yoga and Bhoomyamalaki Choorna in the management of Asrigdara w.s.r. to Puberty Menorrhagia]

[Find the meaning and references behind the names: Raja, Patil, Sunita]

ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 31 A comparative clinical study to evaluate the effect of Indrayavadi Yoga and Bhoomyamalaki Choorna in the management of Asrigdara w.s.r. to Puberty Menorrhagia Dr. Patil Ashwini Shrimant 1 , Dr. P. K. Rawal 2 , Dr. Sunita Shiraguppi 3 , Dr. Shrishail. S. Pujeri 4 1 Post Graduate Scholar, 2 Professor & HOD, 3,4 Assistant Professor, Department of Prasooti Tantra and Stree Roga, SDM Trust’s Ayurvedic Medical College, Danigond Post Graduation Centre, Terdal, Bagalkot, Karnataka, INDIA. I NTRODUCTION Obesity Menarche is a hallmark event in the life of adolescent girls. It marks the transition from childhood to puberty. Although mechanism triggering puberty and menarche remain uncertain, they are Address for correspondence: Dr. Patil Ashwini Shrimant Post Graduate Scholar, Department of Prasooti Tantra and Stree Roga, SDM Trust’s Ayurvedic Medical College, Danigond Post Graduation Centre, Terdal, Bagalkot, Karnataka, INDIA. E-mail: drashwinipatil 544@gmail.com Submission Date: 12/09/2020 Accepted Date: 06/10/2020 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.5.5.4 dependent on nutrition, genetics, body weight and maturation of hypothalamic-pituitary-ovarian axis. The complete maturation of the axis may take up to 2- 3 year. During this time, it is common for adolescent to present with complaints of menstrual irregularities. Changes occurs during this period are physiological, physical, psychological, hormonal and metabolic in nature. Progression of this phase occurs through sequential changes described as Thelarche, Adrenarche, Peak growth spurt, Menarche and ovulation. The onset of menstruation is considered as climax of puberty and transitional step to motherhood. In 80% of cases puberty menorrhagia is caused by anovulatory cycles. There is an immaturity of the hypothalamus and inadequate positive feedback resulting in sustained high levels of estrogen [1] Due to Pradirana (excessive excessive) of Raja (menstrual blood), it is named as Pradara and A B S T R A C T A normal menstruation denotes a healthy state of female reproductive system. If the menstrual bleeding is abnormally excessive, prolonged and is associated with pain, it indicates some pathology. The abnormal menstrual cycle not only disturbs the general health, it also disturbs routine work schedule of the woman and her entire family. There is no direct reference of Puberty menorrhagia in classics. Puberty menorrhagia is defined as excessive bleeding occurring between menarche to 19 years of age. Anovulatory bleeding with irregular shedding of endometrium is the cause for puberty Menorrhagia which can be effectively tackled with the help of herbal drugs which contains hemostatic action. Asrigdara mainly due to vitiation of Vata and Pitta Doshas , hence the treatment should be based on use of drugs which are having predominance of Kashayarasa and Pitta - Vatashamaka properties and Stambhan action. Thus selected drugs are Indrayavadi Yoga and Bhoomyamalaki Choorna possess Vata-Pitta Shamaka and Raktastambhaka. This research work is comparative clinical study. 40 patients presenting with Pratyatma Lakshana of Asrigdara were randomly selected and divided into 2 groups of 20 patients each. Group A were given Indrayavadi Yoga and group B were given Bhoomyamalaki Choorna for a period of 2 menstrual cycle and two follow up during treatment and one follow up after treatment. After the completion of clinical trial, it was found that Bhoomyamalaki Choorna which was group B is more effective than group A. The overall effect in group A and Group B, both the groups shown excellent response, but when comparing all the parameters Bhoomyamalaki Choorna shown more significant response than Indrayavadi Yoga . Trial drug is a better remedy for Asrigdara . It has no side effect, cost effective. Key words: Asrigdara, Puberty Menorrhagia, Indrayava, Bhoomyamalaki Choorna.

[Find the meaning and references behind the names: Rasa, Padma]

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 32 since it is known as Asrigdara [2] In Ayurveda classics Raktapradara which affects woman physically and mentally. Ayurveda texts have described the variety treatment options in the management of Asrigdara . It is gynecological disorder. Asrigdara literally means excessive or acyclic bleeding from vagina during menses and intermenstrual period or cause due to riding, walking, weight lifting, trauma and day sleeping [3] Charaka and Chakrapani says that increased Rakta get mixed with Raja (menstrual blood) thus the quantity of Raja increased [4] Acharya Dalhana, while explaining general clinical features say that excessive and prolonged blood loss during menstruation or even scanty blood loss during intermenstrual period is known as Asrigdara [5] Acharya Vagbhata has mentioned excessive bleeding during menstrual or intermenstrual period. Length of Rutuchakra (menstrual cycle) is usually twenty-eight to thirty days [6] The duration of bleeding is about five days and estimated blood loss 20 to 30 ml. Acharya Sushruta says that, when menstruation is in excess amount of prolonged period or even without normal period of menstruation and different from features of normal menstrual blood is called Asrigdara . According to this definition the Asrigdara is analogs to menorrhagia. So here puberty menorrhagia is defined as excessive bleeding in amount i.e. >80 ml or in duration > 7 days between menarche and 19 years of age [7] According to classical text Hetu Sevan like excessive intake of Lavan, Amla, Katu, Vidahiaahar, Atibharvana, Divaswapna, Shoka, causes Asrigdara . So the present study is aimed for comparative study of Indrayavadi Yoga and Bhoomyamlaki Choorna in Asrigdara w.s.r. to puberty menorrhagia. Though there is no direct reference of Puberty menorrhagia in classics, there is need to adopt safe and alternate Ayurvedic medicine, as the growth and development of female is very important in pubertal age and menorrhagia. During this age may hamper physical growth as well as development. Anovulatory bleeding with irregular shedding of endometrium is the cause for puberty Menorrhagia which can be effectively tackled with the help of herbal drugs which contains hemostatic ( Raktastambhak action). In this way Asrigdara mainly due to vitiation of Vata and Pitta Dosha , hence the treatment should be based on uses of drugs which are having predominance of Kashaya Rasa and Pitta - Vatashamaka properties and Stambhan action [8] So, in the present study Indrayavadi Yoga has been selected as trial which contain Katu , Tikta and Kashaya Rasa and Sheeta Virya which may act as Raktastambhan , Dipana Karma which correct the Mandagni on Pitta Dosha [9] Bhoomyamalaki Choorna is reputed drug indicated in classical text which is used in the management of gynecological disorders. A IM AND O BJECTIVES 1 To evaluate the efficacy of Indrayavadi Yoga in the management of Asirgdara . 2 To evaluate the efficacy of Indrayavadi Yoga comparatively Bhoomyamlaki Choorna in the management of Asrigdara . M ATERIALS AND M ETHODS It is a comparative clinical study done at SDMT’S Ayurvedic Medical College, Danigond Post- Graduation Centre, and Padma Hospital and Research Centre, Terdal. In which 40 patients of Asrigdara were selected randomly divided into 2 groups as Group A - 20 Patients and Group B - 20 Patients. Group A was subjected to all the selected 20 patients with Indrayavadi Yoga . Group B was subjected to all the selected 20 patients with Bhoomyamalaki Choorna with Tandulodaka . The progress was assessed for all the patients and regular follow-up study was done for 3-cycles. Patients were ask to come on 1 st day of each cycle, Hence we have taken 2 follow up during treatment and 1 follow up after treatment. Thus observation and investigations were carried on registration of patients. Group - A 20 patients were taken for the study with trial drug Indrayavadi Yoga and dose was 20 ml twice a day before meal from 1 st day of cycle to 10 th day for 2 cycle.

[Find the meaning and references behind the names: Kalpana, Nil]

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 33 Method of preparation of Indrayavadi Yoga It contains two procedures. First one is preparation of the Indrayava Choorna and next is the preparation of the Hima . The required drug Indrayava Choorna was prepared by standard method given in Sharangdhar Samhita , in the form of Sthula Choorna , at the Pharmacy of Rasa Shastra and Bhaishajya Kalpana. Indrayavadi Yoga - it is one type of Hima Kalpana . In this Yoga Indrayava Choorna and Sharkara is used. Here Yogratnakara has mentioned it is as Indrayavadi Yoga [10] Practical method of preparation of Indrayavadi Yoga guided to patient Indrayavadi yoga was prepared as per mentioned in Yogratnakara . 3 gm (one Nishka ) of Indrayava Churna was taken and added 6 times of water i.e. 20 ml and kept for 12 hours and then drained the water. And in this drained water 6 gms (2 Nishka ) of Sharkara is mixed. This procedure is done in twice a day following morning and night according to reference. Group - B 20 patients were taken for the study with control drug Bhoomyamalaki Churna and dose was 3 gm twice a day before meal from 1 st day of cycle to 10 th day for 2 cycle. Bhoomyamalaki Choorna [11] Method of preparation of Bhoomyamalaki Choorna The required drug Bhoomyamalaki Churna was prepared at Rasa Shastra and Bhaishajya Kalpana Department of our College in standard method given in Sharangdhara Samhita. Anupana : Tandulodaka Practical method of preparation of Tandulodaka guided to patient Tandulodaka was prepared as per Hima Kalpana by taking 10 gm of Tandula and adding 8 times water i.e. 80 ml and keeping it for 12 hour at night and then drain Tandula and water is used as Tandulodaka . Inclusion criteria 1 Age 13 to 19 2 Patients with irregular or prolonged cycles and excessive bleeding p/v during menstruation. 3 Hb % 8 grams% and above 4 Polymenorrhagia Exclusion criteria 1 K/c/o Endocrinal disorders 2 K/c/o Bleeding dyscrasias 3 K/c/o Structural abnormality in genital organs 4 Any other systemic illness 5 Married females 6 Diagnosed cases of PCOD 7 Hb< 8 gm% Criteria for assessment of results A case record form was designed including various examinations. The efficacy of therapy was measured from subjective and objective parameters based on Ayurvedic and modern text. Reduction in amount of menstrual flow (i.e. degree in use of soiled pads/day) total stoppage of passage of clots, reduction in menstrual bleeding & period to 7 days or less, relief in associated symptoms etc. Subjective Parameters Table 1: Duration of bleeding Duration Score Grade Upto 5 days 0 Nil 6 days 1 Mild 7 days 2 Moderate >7 days 3 Severe

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 34 Table 2: Associated symptoms: ( Katishul, Adhodharshul, Angamarda ) Katishula Adhodarshul Angamarda Symptoms Score Grade No associated symptoms 0 nill Associated symptoms cured by taking rest 1 Mild Associated symptoms not cured by taking rest 1 Moderate Associated disturbing routine work 2 Severe Table 3: Character of bleeding Character Score Clotted 1 Without clot 0 Objective Parameter Table 4: Amount of blood loss Amount of blood loss during menstruation Score Grade 1-2 pads /day 0 Nil 3-4 pads /day 1 Mild 5-6 pads/ day 2 Moderate >6 pads /day 3 Severe Final Assessment For assessment, all parameters were used. Table 5: Overall effect Overall effect (patient wise) Criteria Marked improvement >75 % relief in signs and symptoms Moderate Improvement >50 % to 75 % relief in sings & symptoms Mild improvement >25% & 50% relief in sings & symptoms Unchanged Up to 25% relief in sings & symptoms O BSERVATIONS 1) Effect on amount of blood loss within the group Grou p Statist ic B. T 1 st cycl e 2 nd cycl e A. T d. f Friedma n chisquared Pvalu e Grou p A Media n 2 0 2.00 1.00 1 0 3 52.51 < 0.00 1 Mean 2 1 1.85 1.00 0 9 Grou p B Media n 2 0 1.00 1.00 1 0 3 50.373 < 0.00 1 Mean 2 0 1.50 0.75 0 7 Post hoc Analysis - Group A B.T. 1 st cycle 2 nd cycle 1 st cycle 0.037 NA NA 2 nd cycle < 0.001 < 0.001 NA A.T. < 0.001 < 0.001 0.346

[Find the meaning and references behind the names: Mann]

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 35 Post hoc Analysis - Group B B.T. 1 st cycle 2 nd cycle 1 st cycle 0.002 NA NA 2 nd cycle < 0.001 < 0.001 NA A.T. < 0.001 < 0.001 1 Comparative Analysis between the Groups Grou p Median Differenc e (bef – aft) Mean of differenc e (bef-aft) IQR of differenc e (bef-aft) Mann- Whitne y U statistic P- Valu e Group A 1.00 1.20 0 176.00 0.415 Group B 1.00 1.30 1 2) Effect on the duration of bleeding within the group Grou p Statist ic B.T 1 st cycl e 2 nd cycl e A.T d. f Friedm an chisquare d Pvalu e Grou p A Media n 2.0 0 1.0 0 1.0 0 0.0 0 3 50.025 < 0.00 1 Mean 1.9 5 1.4 5 0.7 5 0.5 0 Grou p B Media n 1.5 0 1.0 0 0.0 0 0.0 0 3 39.646 < 0.00 1 Mean 1.5 0 0.9 5 0.4 5 0.1 5 Post hoc Analysis - Group A B.T. 1 st cycle 2 nd cycle 1 st cycle 0.002 NA NA 2 nd cycle < 0.001 < 0.001 NA A.T. < 0.001 < 0.001 0.037 Post hoc Analysis - Group B B.T. 1 st cycle 2 nd cycle 1 st cycle 0.003 NA NA 2 nd cycle < 0.001 0.002 NA A.T. < 0.001 0.001 0.02 Comparative Analysis between the Groups Grou p Median Differenc e (bef – aft) Mean of differenc e (bef-aft) IQR of differenc e (bef-aft) Mann- Whitne y U statistic P- Valu e Group A 1.5 1.45 1 214.5 0.683 Group B 1.0 1.35 1 3) Effect on the associated symptoms within the groups Grou p Statist ic B.T 1 st cycl e 2 nd cycl e A.T d. f Friedm an chisquare d Pvalu e Grou p A Media n 2.0 0 2.0 0 1.0 1.0 0 3 24.846 < 0.00 1 Mean 1.6 0 1.4 0 1.1 1.0 5 Grou p B Media n 1.0 0 1.0 0 1.0 1.0 0 3 28.924 < 0.00 1 Mean 1.5 5 1.1 5 0.9 0.7 5 Post hoc Analysis - Group A B.T. 1 st cycle 2 nd cycle 1 st cycle 0.072 NA NA 2 nd cycle 0.002 0.020 NA A.T. 0.001 < 0.001 1

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 36 Post hoc Analysis - Group B B.T. 1 st cycle 2 nd cycle 1 st cycle 0.006 NA NA 2 nd cycle 0.001 0.037 NA A.T. 0.002 0.006 0.149 Comparative Analysis between the Groups Grou p Median Differenc e (bef – aft) Mean of differenc e (bef-aft) IQR of differenc e (bef-aft) Mann- Whitne y U statistic P- Valu e Group A 1.00 0.55 1 168 0.345 Group B 1.00 0.80 1 4) Effect on Character of bleeding within the groups Group A Before treatment After treatment d.f Chi squared (McNemar) pvalue Without clot With clot Without clot 6 0 1 9.091 0.003 With clot 11 3 Group B Before treatment After treatment d.f. Chi squared (McNemar) pvalue Without clot With clot Without clot 9 0 1 8.1 0.004 With clot 10 1 Comparative Analysis between the groups Grou p Number of Patients having bleeding with clot d.f Chi-square test of independenc e pvalue B. T 1 st cycl e 2 nd cycl e A. T Group A 14 11 4 3 3 1.617 0.65 6 Group B 11 5 1 1 Overall % mean reduction Parameter % mean reduction % mean reduction Group A Group B Amount of blood loss 59.65% 68.33% Duration of bleeding 76.67% 92.71% Associated symptoms 36.84% 48.33% Character of bleeding 78.57% 90.91% Overall % mean reduction 62.93% 75.07% DISCUSSION The present study was conducted to compare and evaluate the effect of Indrayavadi Yoga and Bhoomyamalaki Choorna in the management of Asrigdara w.s.r. to puberty menorrhagia. In this work literary review of Asrigdara , puberty menorrhagia, Choorna Kalpana, Hima Kalpana, as described in Ayurvedic and modern medical sciences are also dealt. The probable mode of the action Indrayavadi Yoga Indrayavadi Yoga contains Indrayava Churna and Sharkara . The properties of are as follows - The Indrayava having Katu Vipak, Sheeta Veerya, Tikta,

[Find the meaning and references behind the names: Guna]

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 37 Kashaya Rasatmaka properties like Tridoshahara, Deepana, Grahi, Raktastambhana. Rasa - Indrayavadi Yoga has predominantly Tikta Kashaya . Kashaya Rasa possess Sthambhan Grahi , Sleshmahara and Raktapittahara property and thus it helps reduce the duration and amount of bleeding. Tiktarasa is Pittakapha Shamaka and it act like Dhatu Shodhana properties. It is also having Raktapittahara property, so it helps to reduce the duration and amount of bleeding in Asrigdara . Guna - Laghuguna - have srotoshodhana property, does Raktshodhana . Rukshaguna - possess Sthambhana and shodhana property, so reduce the duration and amount of bleeding. Virya - Sheeta which is Raktapittashamak and Sthambhan properties which helps in relieving symptoms of Asrigdara . Vipaka - Katu Vipaka which helps in relieving symptoms by Laghu and Kaphapitta Shamaka Guna. So it helps in Asrigdara . Karma - The drug having properties like Tridoshashamak , Raktahara, Pradarhara, Grahisthambhaka, Deepana. All these properties helps in reducing symptoms of Asrigdara . Sharkara - It is Sheetavirya, Madhura Rasa, Madhurvipaka, Laghuguna, so it also helps in Asrigdara . Indrayavadi Yoga has antispasmodic activity. In this disease Modern science use non-steroidal antiinflammatory drugs which block myometrial PGE 2 receptors and maintain prostaglandin and help to reduce menstrual blood so it helped in reduces Asrigdara symptoms. It helps in reducing bleeding but it does not regulize the menstrual cycle. It has also astringent property. It also noted that Indrayava Yoga was well tolerated by the patients. In this way this Indrayavadi Yoga act by hemostatic, restorative and specific Prabhava etc. The probable mode of the action of Bhumyamalaki Choorna It contain Bhoomyamalaki Moola Choorna and Tandulodaka as Anupana Rasa - Bhoomyamalaki Choorna has predominantly Madhur, Tikta, Kashaya. Madhura Rasa possess Vatapitta Shamaka property so it helps in deduction of amount of blood loss and reduction in Angamarda etc. Kashaya Rasa possess Sthambhan Grahi, Sleshmahara and Raktapittahara property and thus it helps reduce the duration and amount of bleeding. Tiktaras a is Pittakaphshamak and it act like Dhatushodhana properties. It is also having Raktapittahara property so it helps to reduce the duration and amount of bleeding in Asrigdara . Guna - Laghuguna - have Srotoshodhana propertydoes Raktshodhana . Rukshaguna - possess Sthambhana and Shodhana property - so reduce the duration and amount of bleeding. Virya - Sheeta is Raktapitta Shamak and Sthambhan properties which helps in relieving symptoms of Asrigdara Vipaka - Madhur Vipaka which helps in relieving symptoms by Laghu and Vatapittashamakguna . So it helps in Asrigdara . Karma - the drug having properties like Pittahara, Raktahara, Pradarhara, Grahisthambhaka, Deepana. All these properties helps in reducing symptoms of Asrigdara . In this way all the properties of Bhoomyamalaki Churna acted on uterine blood vessles and not only that, it has Deepana and Pachana property correct the metabolic disorders of body and balance hormonal disturbances. General health of patients improve because it also has Raktashodhak quality. Bhoomyamalaki has a astringent property, which gives tonicity to the uterine muscles. Here Tandulodaka is Sheetavirya Madhura Vipaka, Madhura Rasa so helped in Asrigdara .

[Find the meaning and references behind the names: Sri, Sharma, Ratna, Tika, Krishnadas, Med, Sha]

Dr. Patil Ashwini Shrimant et al. A comparative clinical study on Asrigdara w.s.r. to Puberty Menorrhagia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2020 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2020 | Vol. 5 | Issue 5 38 In overall effect of treatment of Indrayavadi Yoga and Bhoomyamalaki Churna in both groups: In group A, 6 patients (30%) maximum improvement, 8 patients (40%) were moderately improved while 6 patients (30%) were seen with mild improvement. In group B, 8 patients (40%) maximum improvement, 11 patients (55%) were moderately improved while 1 patient (5%) was seen with mild improvement. Thus total result in Bhoomyamalaki Choorna is 75.07% and in Indrayavadi Yoga is 62.93%. CONCLUSION Aim of present study to evaluate the efficacy of Indrayavadi Yoga comparatively Bhoomyamalaki Choorna in the management of Asrigdara . Based on above clinical statistical data it may be concluded as follows: in Group A , Indrayavadi Yoga and in Group B, Bhoomyamalaki Choorna both are having significant effect on the management on the Asrigdara . There was comparatively more improvement in amount of blood loss, duration of bleeding, associated symptoms and character of bleeding in the treated group B as compaired to group A. at the end of this clinical trial it was found that both groups are efficient in the management of Asrigdara, but while considering statistical analysis Bhoomyamalaki Choorna is more effective than Indrayavadi Yoga . Indrayavadi Yoga is well tolerated by the patient. REFERENCES 1 Hiralalkonar; D.C. Duttas textbook of Gynaecology, Jaypee, 6 th edition; (2013); (page no. 48, 80, and 178) 2 Dr. Kashinath shashtri and Priyavat Sharma; Charaka Samhita; Chaukhamba Sanskrit series office Varanasi; reprint 2005. Ch. Chi 30/209, page no.776. 3 BhishagratnaPandit Sri Brahma Sankaramisra; Bhavaprakashof Sri Bhavamishra; Chaukhamba Sanskrit Sansthan, Varanasi; part 2; 9 th edition 2005. bha. Chi. 68/3 page no.757. 4 Dr. Kashinath Shashtri and Priyavat Sharma; Charak Samhita; Chaukhamba Sanskrit series office Varanasi; reprint 2005. ch. Chi 30/204, page no. 180, 181. 5 Prof. K.R. Shrikanthamurthy; Sushruta Samhita text English translation volume 1; Chaukhamba Orientalia Varanasi; edition 3 rd 2007. su. Sha. 2/18, page no.21. 6 Atridevgupta, Astanga Sangraha with hindi commentary, volume I, published by Chaukhamba Krishnadas academy, Varanasi, reprint in 2005, sha. Tika 6 7 Kaviraj Ambikadutta Shashtri; Sushruta Samhita; part 1; Chaukhamba Sanskrit Sansthana Varanasi; edition reprint, 2014, Su. Chi. 7/38, page no.57. 8 Prof. Premavati Tiwari, Ayurvediya Striroga, part 2, Chaukhamba Orientaliya, Varanasi, chapter 2, page no.174,175. 9 Acharya P. V. Sharma – Dravyaguna Vijnyan volume 2, Chaukhamba Bharati Academy, Varanasi, chapter- 5 page no.463. 10 Yogratnakara with Vidyotini Hindi commentary by Vaidya Shastri, edited by Bhishag Ratna Shankara Shastri, Chaukhamba Sanskrit Samsthan, Varanasi,5 th edition 1933,PN-400. 11 Yogratnakara with Vidyotini Hindi commentary by Vaidya Shastri, edited by Bhishag Ratna Shankara Shastri, Chaukhamba Sanskrit Samsthan, Varanasi, 5 th edition 1933 PN-400. ****************************** How to cite this article: Dr. Patil Ashwini Shrimant, Dr. P. K. Rawal, Dr. Sunita Shiraguppi, Dr.Shrishail. S. Pujeri. A comparative clinical study to evaluate the effect of Indrayavadi Yoga and Bhoomyamalaki Choorna in the management of Asrigdara w.s.r. to Puberty Menorrhagia. J Ayurveda Integr Med Sci 2020;5:31-38. http://dx.doi.org/10.21760/jaims.5.5.4 Source of Support: Nil, Conflict of Interest: None declared.

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Raja, Asrigdara, Sharkara, Prabhava, Tandulodaka, Katuvipaka, Madhuravipaka, Madhurarasa, Bleeding, Menstrual blood, Modern science, Ayurvedic medicine, Associated symptoms, Comparative analysis, Tikta Rasa, Kashaya Rasa, Menstrual cycle, Menstrual flow, Statistical analysis, Group A, Menstruation, Adolescent girl, Literary review, Inclusion criteria, Exclusion criteria, Clinical study, Clinical trial, Moderately improved, Comparative clinical study, Acharya Sushruta, Blood loss, Trial Drug, Astringent property, Menstrual irregularities, Anovulatory cycle, Mild improvement, Metabolic disorder, Subjective parameter, Objective parameter, Classical text, Menarche, Overall effect, Gynecological disorder, Maximum improvement, Ovulation, Vata and Pitta Dosha, General health, Duration of Bleeding, Overall Effect of Treatment, Herbal drug, Laghuguna, Puberty Menorrhagia, Madhur Vipaka, Tridoshashamak, Sheeta virya, Amount of blood loss, Menstrual bleeding, Rukshaguna, Antispasmodic activity, Ayurveda Classic, Hormonal Disturbance, Assessment of Result, Group B, Probable mode, Uterine muscle.