Review on Raktapradara (menorrhagia) and its management

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

REVIEW ARTICLE Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 229 Review on Raktapradara (menorrhagia) and its management Dr. Samrajita Suhas Thorat 1 , Dr. Suhas Bajirao Thorat 2 1 Assistant Professor, Dept. of Stri Roga & Prasuti Tantra, 2 Associate Professor, Dept. of Kaumarabrutya, Maharashtra, INDIA. I NTRODUCTION Rakta Pradara is one among the Rakta Pradoshaja Vikara [1] and it is characterized by Artava Ati Pravrutti , Deerga Kala Pravrutti , Anruta Kala Pravrutti , Daha in Adho Vankshana Pradesha, Sroni, Prushta and Kukshi , Shoola in Garbhashaya Angamardha etc [2] It is a Pitta Pradhana Tridoshaja Vyadhi . By considering the symptoms mentioned above in account, it resembles with the condition Menometrorrhagia in modern literature. It is an irregular inter menstrual bleeding caused due to DUB, uterine polyp, cervical endometriosis and CA cervix [3] Address for correspondence: Dr. Samrajita Suhas Thorat Assistant Professor, Dept. of Stri Roga & Prasuti Tantra, Maharashtra, INDIA. E-mail: samrajita.thorat@gmail.com Submission Date: 13/01/2021 Accepted Date: 16/02/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA WHO has estimated that around 24% women ages 40 - 55 years are suffering from Menometrorrhagia. Menometrorrhagia is type of menstrual abnormality that causes extreme menstrual blood loss in women of various ages. It’s due to the imbalance in the estrogen and progesterone hormone results in excessive production of endometrium and irregular shedding of endometrium cause heavy menstrual bleeding and it also caused due to the any pathology in the uterus ovary like uterine fibriod, polyp, adenomyosis etc. By the above explanation Rakta Pradara seems to be a disease of Rakta Dhatu and Pitta Dosha and it is mentioned as a Raktapradoshaja Vikara involving Raktavaha Srotas . And it can be treated like that of Raktatisara , Raktapitta , Raktarsha and Garbha Srava [4] Raktapradara indicated by the excessive and irregularity of menses. In the female the reproductive system has a great importance and any disease in this system will seriously affect her health and happiness and also it proves to be a great discomfort. Raktapradara is one amongst the extensive range of occurrence. Any abnormality in Rutuchakra (menstrual rhythm) leads excessive and irregular A B S T R A C T Menorrhagia is cyclical bleeding at normal intervals which is excessive in amount or duration, Menorrhagia is generally caused by conditions affecting the uterus and its vascular apparatus, rather than by any ovarian disturbance. It occurs if the bleeding surface (that is the area of the endometrium) is increased. According to Ayurveda it can be correlated with Rakta Pradara . Rakta Pradara is one among the Rakta Pradoshaja Vikara and characterized by Artava Ati Pravrutti , Deerga Kala Pravrutti , Anruta Kala Pravrutti , Daha in Adho Vankshana Pradesha, Sroni, Prushta and Kukshi , Shoola in Garbhashaya Angamardha etc. Since Raktapradara is mainly due to Vata Pitta Dosha ; Kashaya Rasa and Pittashamaka Chikitsa may be adopted. Ayurvedic formulations help in breaking down the pathogeneses of Raktapradara and its recurrence. Key words: Raktapradara, Menorrhagia, Atyartava, Asrugdara

[Find the meaning and references behind the names: Raja, Dara, Indu, Heart]

Dr. Samrajita Suhas Thorat et al. Review on Raktapradara (menorrhagia) and its management ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 230 uterine bleeding which is known as “ Raktapradara ” in classical text. Hence this present review article highlights the Raktapradara (menorrhagia) and its management. A IMS AND O BJECTIVES Review on Raktapradara (menorrhagia) and its management M ATERIALS AND M ETHODS Review of literature from Brihatrayee and other Ayurveda literatures related to Raktapradara , and from e-sources were compiled. R EVIEW OF L ITERATURE Raktapradara is a disease manifesting as excessive bleeding per vagina. This disease has been known to mankind since the age of Veda and Purana. Charaka explained Pradara as a separate disease with its management in Yoni Vyapat Chikitsa. He has also explained it as one of the Rakta Pradoshaja Vikara [5] and also under Pittavruta Apana Vayu [6] Acharya Sushruta explained it as a separate disease entity in Shukra Shonita Adhyaya in Sharirasthana . He also mentioned it under Pitta Samyukta Apana [7] He also mentioned it in Rakta Pradoshaja Vyadhi [8] Ashtanga Sangraha explained Raktayoni and said Asrigdara and Pradara as its synonyms [9],[10] Ashtanga Hridaya described Raktayoni , but nothing is mentioned about Asrigdara or Pradara [11] Yet it is explained under the synonym of Raktapradara in some places. The Terms ▪ Asrigdara is given by - Sushruta ▪ Pradara by - Charaka ▪ Raktapradara by - Sharangadhara Nirukti (Derivation) The derivation of word ‘ Asrigdara’ is derived from two words, That is - ▪ Asrik - Menstrual blood ▪ Dara - Excessive excretion Asrik + Dara → Asrigdara Asrika is essential Dhatu which is being present in the heart gets accumulated there and spreads all over the body. Excessive excretion of Rajah it is named as “ Pradara ” Excessive or prolonged flow of blood occurring in menstrual or inter menstrual period is Asrigdara . It is the condition in which the Rajorakta (menstrual blood) flows in abundant quantity. Charaka defined, due to Pradirana (excessive excretion) of Raja (menstrual blood) it is named as “ Pradara ” and since, there is Dirana (excessive excretion) of Asrik (menstrual blood) hence it is known as " Asrigdara ". Acharya Dalhana has described clinical feature of Asrigdara i.e., Excessive and prolonged or prolonged blood loss during menstruation or even scanty blood loss during intermenstrual period is ‘ Asrigdara’ . Synonyms A synonym means the word containing the same meaning as of the given word. In Ayurvedic Texts, many authors have used mainly the following terms for Asrigdara . Pradara, Dara. Rakta Pradara is the word stated in Sharangadhara Samhita. Ashtanga Sangraha (Indu) has also given various synonymous [12] like Pradara, Asrigdara, Atiraja, Raktapradara, Raktayoni etc. Nidana of Raktapradara All the Nidana of Raktapradara are grouped under four headings. 1) Aharaja 2) Viharaja 3) Manasika 4) Anya 1) Ahara Hetu The etiological factors related with dietary condition are known as dietary factors. In this class we can summarize the factors aggravating different Dosha

[Find the meaning and references behind the names: Guna, Sara, Guru, Rupa, Yana]

Dr. Samrajita Suhas Thorat et al. Review on Raktapradara (menorrhagia) and its management ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 231 such as over indulgence of Ruksha , Sheeta etc. diets provoke Vata; Amla, Ushna, Tikshna etc. provokes Pitta & Guru, Madhura, Snigdha etc. provokes Kapha Dosha . 2) Vihara Rupa Nidana ▪ Ati Maithuna ▪ Ati Yana ▪ Ati Marga Gamana ▪ Ati Bharavahana ▪ Divaswapna 3) Manasika Nidana ▪ Shoka 4) Anya Nidana ▪ Garbhapata ▪ Abhighata Samprapti Acharya Charaka has also enumerated Raktapradara amongst the diseases of vitiated Rakta and Pittavrita Apana Vayu . It can therefore be considered that Vayu can also be vitiated only due to being covered by Pitta . The Chala Guna of Vayu and Sara Guna and Drava Guna of Pitta plays an important role in forming the basic Samprapti of Asrigdara . Samprapti Ghataka ▪ Dosha : Tridosha ▪ Dushya : Rasa, Rakta, Artava ▪ Agni : Jathragnimandya ▪ Srotasa: Artavavaha, Rasavaha, Raktavaha, Mamsa ▪ Srotodushti : Atipravritti ▪ Adhisthana : Garbhashaya, Artavavaha Srotasa Classification of Raktapradara Raktapradara is classified in four groups i.e. ▪ Vataja ▪ Pittaja ▪ Kaphaja ▪ Sannipataja (Ch. Chi. 30/210) Lakshana (Symptoms) The Phase of Purvarupa of the Raktapradara is not mentioned in the texts. (Probably there may not be any premonitory Symptoms). Acharya Charaka has described the only one symptom i.e., presence of excessive bleeding during menstruation. According to Sushruta , when same menstruation comes in excess amount for prolonged period even without normal period of menstruation, different from the features of normal menstrual blood or denoting the features of specific Dosha known as Asrigdara . Chikitsa The general line of treatment of any disease is followed on the basic lines as ▪ Nidana Parivarjana ▪ Shodhana ▪ Shamana ▪ Rasayana chikitsa. ▪ Charaka explained the treatment to be like for Raktayoni i.e., Rakta Sthapana Aushadha after giving due consideration to the association of Doshas . ▪ Treatment prescribed for Vataladi Yonivyapat should be used in respective Raktapradara . It should be treated on the lines of Raktatisara , Raktarshas, [13] Guhyaroga, [14] and abortions [15] ▪ Treatment on the lines of Adhoga Raktapitta is to be applied [16] ▪ Use of Basti is beneficial [17] As Raktapradara is the Sharirika Roga , it needs Yuktivyapashraya Chikitsa . The Satvavajaya Chikitsa can also be done because of the involvement of the Shokadi Uttejakabhava will be there in Raktapradara . The Yuktivyapashraya Chikitsa is of two types. 1 Shodhana and

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Dr. Samrajita Suhas Thorat et al. Review on Raktapradara (menorrhagia) and its management ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 232 2 Shamana In Shodhana , Panchakarma can be done according to the Dosha involved. Vamana Vamana may help to normalize the Gati of Vayu ( Apana ), thus helping to cure it. However, there is no direct reference of either its indication or contraindication. Virechana Virechana has been indicated where in Charaka has suggested the use of Mahatiktaka Ghrita for Virechana in Pittaja type of Raktapradara [18] The predominant Dosha being Pitta , Virechana serves as the best Shodhana therapy. According to Kashyapa , Raktapradara should be treated by Virechana . Basti It is a well-known fact that none of the Yoni Roga is caused without the vitiation of Vata Dosha . Hence, the pacification and regulation of the vitiated Vata becomes necessary. Classics have mentioned the use of both Niruha and Anuvasana Basti in Raktapradara to pacify Vata (especially Apana Vayu ). Another type of Basti explained is the Uttara Basti . Acharya have recommended the efficacy and importance of Uttarabasti in the treatment of Artava Vyapat . A brief review of the drugs and Yoga indicated in Raktapradara; For Asthapana Basti (a) Chandanadi or Rasnadi Niruha Basti (Ch. Si. 3, A. H. Kal. 4) (b) Kushadi Asthapana (Su. Chi. 37) (c) Lodhradi Asthapana (Su. Chi. 38) (d) Mustadi Yapana Basti (A. S. Kal. 5) For Anuvasana (a) Madhukoshiradi (Su. Chi. 37) (b) Shatapushpa Taila (Ka. S. Kal. 24, 25) For Virechana (a) Mahatiktaka Ghrita especially in Pittaja Raktapradara. Internal Medicines Various medications in the form of powders, pastes, medicated milk, Modaka , Avaleha etc. have been mentioned in the classics. SN Name of Preparation Name of Yoga Reference 1. Kwatha -Decoction of flowers of Dhataki and Pungi. -Decoction of Ela, Lajjalu, Salmali, Haritaki Andmagadhika -Decoction prepared with Nyagrodhadi group -Yo. Ra. Pradar Roga Chi. -Harita Samhita. -Sha. S.M.Kh.2/113 2. Kalka & Churna -Tanduliyaka moola kalka with honey -Rasanjana with Laksha Churna -Bala Moola Kalka with milk -Indrayava Churna -Pushyanuga Churna -Yo. Ra.Pradar Roga Chi. -Yo. Ra.Pradar Roga Chi. -B. P.Chi- 68 -Yo. Ra.Pradar Roga Chi. -Ch.Chi.30/90, A.S.Ut.39/61,A.H.Ut- 34, 3. Gutika -Gokshuradi Guggulu -Chandraprabha Gutika -Sha.S.M.- 7,Yo.Ra.Prameha Chi. - Yo. Ra.Pradar Roga Chi. 4. Modaka -Alabu phala Modaka -Malaya phala Modaka -B.P.Chi-68 - Yo. Ra.Pradar Roga Chi. 5. Ghrita - Brihatshatavari Ghrita -Ch.Chi.-30, A.S.Ut.39, A.H.Ut-34

[Find the meaning and references behind the names: Singh, Long]

Dr. Samrajita Suhas Thorat et al. Review on Raktapradara (menorrhagia) and its management ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 233 -Shalmali Ghrita -Sheetakalyanaka Ghrita -Shatavari Ghrita -Mahatiktaka Ghrita - Yo. Ra.Pradar Roga Chi. -Yo. Ra.Pradar Roga Chi. -Ka.S.Kal.5 -Sha.S.M.-9 6. Avaleha -Kushmandavaleha -Jeerakavaleha -B.P.Chi-68 - Yo. Ra. Pradar Roga Chi. 7. Rashoushadhi -Pradararipurasa -Bola Parpati Rasa - Yo. Ra. Pradar Roga Chi. - Yo. Ra.Pradar Roga Chi. 8. Kshiraprayoga -Ashoka Valkala Siddha Kshirapaka - B.P.Chi.-68 9. Taila -Shatavari Taila -Shatpushpa Taila -Sha.S.M.-9 -Ka.S.Kal.-5 DISCUSSION Raktapradara manifesting as excessive bleeding per vagina is seen to be an age-old disease known to mankind since the era of Veda and Purana . Excessive and irregular menstrual bleeding condition is similar to Raktapradara a gynaecological condition mentioned in Ayurvedic classics. Active or passive congestion causes hypertrophy of myometrium and endometrium so that uterus enlarges 2 – 6 times from its normal size. A similar vascular upset which involves the ovaries may make them cystic causing polymenorrhea. This aspect can be correlated to the Nidana of Bhela i.e., Shonita goes into Dushta Marga Pratipadyate . Emotional influence such as changes in environment, nervous tension, anxiety states, unsatisfied sex urge, marital upset, stress situations, etc. can cause excessive menstrual blood loss. (These factors operate through the endocrine system which is influenced by the hypothalamus, more probably through the autonomic nervous system which controls the blood vessels supplying the pelvic organs. This can be corelated to the Nidana i.e., Chintyanam Cha Atichintanat. One such study shows that patients suffering from mild to moderate depression had menorrhagia. (Greenberg M. J. Psychosom Res. 1983) Acharya Charaka has mentioned Raktapradara is a one of the Upadrava of all Yoni Vyapada. Charaka and Kashyapa considered the Raktapradara as a Rakta Doshaja Vikara. Before the description of Raktapradara , Sushruta has described the Shuddha Artava Lakshana then he said that Raktapradara . Sushruta described its symptoms and complication but he has not mentioned any types of Raktapradara . In Su. Su. 15, he has also described the “Artava Vriddhi Lakshana ” which is also like Pradara. Sometimes it is a diseased condition or a symptom of other diseases or/is the complication of the disease. Raktapradara is one of the complications of Dushprajata . (Ka. S. Chi. Dushprajata - 8) As the disease is characterized by excess flow of blood out of the body and Rakta is known to be a vital substance of the body ( Jivana Karma ), hence, Rakta Stambhaka Chikitsa becomes important. Charaka explained the treatment to be as for Rakta Yoni i.e., Rakta Sthapana after giving due consideration to the association of the Dosha . He said it to be treated on the lines of Raktatisara , Raktapitta and Rakta Arsha. CONCLUSION Raktapradara is a disorder which plagues many women at some time or other of their life time. It may be a result of some psychomotor disturbances acting through the Autonomic Nervous System or may be the manifestation of some other underlying disorder. Excessive amount of blood loss or long duration of blood loss or short inter menstrual period. As well as presence of any two or three are also cardinal symptoms of Raktapradara . REFERENCES 1 Vd. Harischandra singh Kushwaha, Charaka Samhita Vimana Sthana, Ayushi Hindi commentary 28 th Chapter verses 11, Varanasi: Choukambha orienntalia; first edition 2005, p.475.

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Dr. Samrajita Suhas Thorat et al. Review on Raktapradara (menorrhagia) and its management ISSN: 2456-3110 REVIEW ARTICLE Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 234 2 Prof P.V Tiwari, Ayurvediya Prasooti Tantra evam Stree Roga 2 nd part Chapter 2 nd Artava vyapad, Chaukambha orientalia, second edition reprinted on 2005, Varanasi – , p. 180 3 D. C Datta, Text book of gynaecology edited by Hiralal Konar, chapter no 14 th , abnormal uterine bleeding, new Delhi, New Central Book agency 5 th edition revised reprint 2009, p.182. 4 Prof P.V Tiwari, Ayurvediya Prasooti Tantra evam Stree Roga 2 nd part Chapter 2 nd Artava vyapad, Chaukambha orientalia, second edition reprinted on 2005, Varanasi,p.196. 5 Agnivesha. “Charaka Samhita” Revised by Charaka and Dridhabala with the Ayurveda Dipika commentary of Chakrapanidatta, edited by Acharya Yadhavji Trikamaji. Varanasi: Chaukhambha Sanskrit Sansthan, Ed. Reprint, 2006,p.179 6 Agnivesha. “Charaka Samhita” Revised by Charaka and Dridhabala with the Ayurveda Dipika commentary of Chakrapanidatta, edited by Acharya Yadhavji Trikamaji. Varanasi: Chaukhambha Sanskrit Sansthan, Ed. Reprint, 2006,p.635 7 Sushrutha, Sushrutha samhita with Nibandha Samgraha Commentary of Dalhana and Nyayachandrika of Gayadasa on Nidanasthana, Edited by Acharya Yadhavji Trikamaji, Varanasi: Chaukhambha Krishnadas Academy, Ed. Reprint, 2004, Su. Ni. 1/37 p.263 8 Sushrutha, Sushrutha samhita with Nibandha Samgraha Commentary of Dalhana and Nyayachandrika of Gayadasa on Nidanasthana, Edited by Acharya Yadhavji Trikamaji, Varanasi: Chaukhambha Krishnadas Academy, Ed. Reprint, 2004, p.114 9 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012, A. S. 1 1/11 p.5 10 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012,A. S. Ut. – 38/45,p.830 11 Vagbhata. Ashtanga Hridaya, with commentaries of Arunadutta and Hemadri, edited by Pt. Hari Sadasiva Sastri Paradakara: Chaukhambha Surbharati Prakashan, Ed. Reprint 2010, A. H. Ut. – 33/43,p.896 12 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012,A. S. Ut. – 39/58- Indu,p.841 13 Agn ivesha. “Charaka Samhita” Revised by Charaka and Dridhabala with the Ayurveda Dipika commentary of Chakrapanidatta, edited by Acharya Yadhavji Trikamaji. Varanasi: Chaukhambha Sanskrit Sansthan, Ed. Reprint, 2006, Ch. Chi. -30/86,p.639 14 Agnivesha. “Charaka Samhita” Revised by Charaka and Dridhabala with the Ayurveda Dipika commentary of Chakrapanidatta, edited by Acharya Yadhavji Trikamaji. Varanasi: Chaukhambha Sanskrit Sansthan, Ed. Reprint, 2006, Ch. Chi. – 30/227-228.p.643 15 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012,A. S. Sha. 1/12.,p.267 16 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012,A. S. Ut. -39/62.,p.840 17 Sushrutha, Sushrutha samhita with Nibandha Samgraha Commentary of Dalhana and Nyayachandrika of Gayadasa on Nidanasthana, Edited by Acharya Yadhavji Trikamaji, Varanasi: Chaukhambha Krishnadas Academy, Ed. Reprint, 2004, Su. Ut. – 45/44,p.738 18 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012,A. S. Chi. -3/78,79,p.446 ******************************* How to cite this article: Dr. Samrajita Suhas Thorat, Dr. Suhas Bajirao Thorat. Review on Raktapradara (menorrhagia) and its management. J Ayurveda Integr Med Sci 2021;1:229-234. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 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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