An Ayurvedic approach on Bad Obstetric History w.s.r. to Putarghani Yonivyapad

[Full title: An Ayurvedic approach on Bad Obstetric History w.s.r. to Putarghani Yonivyapad: A Case Study]

CASE REPORT August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 230 An Ayurvedic approach on Bad Obstetric History w.s.r. to Putarghani Yonivyapad : A Case Study Manisha Kumari 1 , Jitesh Kumar Panda 2 , Suniti Tanwar 3 1 Post Graduate Scholar, Department of Prasuti Tantra Evum Stree Roga, Shri Krishna Govt. Ayurvedic College, Kurukshetra, Haryana, India. 2 Professor & HOD, Department of Prasuti Tantra Evum Stree Roga, Shri Krishna Govt. Ayurvedic College, Kurukshetra, Haryana, India. 3 Associate Professor, Department of Prasuti Tantra Evum Stree Roga, Shri Krishna Govt. Ayurvedic College, Kurukshetra, Haryana, India. I NTRODUCTION Repeated (or Habitual) abortion refers to a history of repeated miscarriage, defined as three or more successive pregnancy losses [1] Repeated miscarriage suggests the need for medical evaluation of a couple and ongoing care for what may be chronic problems (e.g., hormonal dysregulation, infection, etc.). The incidence of repeated miscarriage is 1% in India. The risk increases with each successive abortion reaching Address for correspondence: Dr. Manisha Kumari Post Graduate Scholar, Department of Prasuti Tantra Evum Stree Roga, Shri Krishna Govt. Ayurvedic College, Kurukshetra, Haryana, India. E-mail: manishakumari 16296@gmail.com Submission Date: 12/06/2023 Accepted Date: 25/07/2023 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.8.8.35 over 30% after 3 consecutive losses [2] In Ayurveda infertility is defined in detail based on its causative factors, and clinical presentations. Some such contexts are Jataharini, Putraghni and Asrijayonivyapad . According to Ayurveda classics, repeated miscarriage ( Putraghniyonivyapada ) is an inflammatory condition spelled "early pregnancy loss" [3] It is clear that maternal genital tract infection plays an important role in sporadic spontaneous abortion. Considering causes mentioned in the classics seems similar to modern science. Indulgence of Aharaja, Viharaja and Manasikanidana like stress-induced hormonal disturbances leads to Apanakshetradushti , Vataprakopa which causes disturbances in menstruation like painful menstruation and Garbha development. Considering Hetu , Sthana , and clinical symptoms Shodhana Chikitsa like Virechana, Basti and Uttarbasti holds promising results [4,5] Considering the need for Shodhana in this case, firstly patient showed a history of miscarriage [repeated], which shows Vatadushti, Srotas involved are Rasavaha and Artavavaha Srotas which are Matrijaavayav a. The A B S T R A C T Introduction: Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses. Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion , is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. Based on the incidence of sporadic pregnancy loss, the incidence of recurrent pregnancy loss should be approximately 1 in 300 pregnancies. In Ayurveda Putraghni Yonivyapad is described where repeated abortions or the early neonatal deaths are explained which are due to Artava Dosha, Rakta Dosha, Raktastrava and Raktakshaya . When we came across with descriptions given by different Acharyas we come to know that these all points came under the Bad Obstetric History described in modern science. As we all know that Ayurveda is a science of life. Methods: In the present case study, a 34 years old women patient consulted to the OPD with the complaints of recurrent pregnancy loss in first trimester [5 Abortions]. Her hematological and sonographic reports were normal. Diagnosis was unexplained. She was supposed to be treated with Ayurvedic Shodhan and Shaman therapy. Result: Only Ayurvedic protocol were used during the course of the treatment. After this, patient conceived after 3 months of treatment, and no evidence of abortion was found. She delivered a healthy baby. Discussion: The present study shows the role of Ayurveda in bringing a positive result in the management of Putraghni Yonivayapad. Key words: Recurrent Abortion, Putraghni Yonivyapad, Ayurveda, Shodhan, Shaman

Manisha Kumari et al. An Ayurvedic approach on Bad Obstetric History ISSN: 2456-3110 CASE REPORT August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 231 second one is Kshetra involvement which is Apanavatakshetra . Mentioning the above symptoms is Bahudoshavastha , hence, needs Shodhana . Thorough examination, investigations, and sonological examinations were done. Shamanaushadhis like Phalaghrita and Chandraprabhavati, Grabhpalrasa have been given, and periodically follow-up were taken. C ASE S TUDY Age -34 yrs female Occupation - Housewife Socio-economic Status - Middle Chief complaint - Came to OPD with complaint of unable to convince along with stress and fear of previous 5 abortions. History of present illness - A 34-year female patient, came in OPD with complaints of recurrent abortion losses in first trimester [5 Abortions]. Her hematological and sonographic reports were normal. Patient was managed conservatively. Past History N/K/C/O - Diabetes /Hypothyroidism/ HTN PCOD/ no specific history of pelvic infections; no h/o D&C Familial history - not specific Menstrual history Menstrual cycle - regular, lasts for 4 days, pain in lower abdomen on first 2 days of menstruation. Interval - 30-32 days Blood flow - normal in first 2 days Clinical findings Built - normal Height - 5.2 ft Weight - 60 kg Gait - normal Blood pressure - 120/70 mmHg Pulse - 68/min Temp - 98.3°F Systemic examination Cardiovascular - normal rhythm, no added sounds Respiratory - normal vesicular breathing sounds Central nervous system - normal. Urogenital system - healthy cervix with no discharges, and tenderness. Per vaginal - normal size, bilateral free fornix Ashtavidha Pareeksha Nadi - VK Jihva - Sama Mala - twice in a day Mutra - Samyak Shabda - Samyak Sparsh - Anushnsheeta Drika - Samyak Aakrti - Madhyam Dasavidha Pareeksha Prakrti - VK Sara- Maansasaar Samhanan - Madhyam Pramaan - Madhyam Satmya - Sarva Rasa Satva - Madhyam Aahar Shakti - Madhyam Vyayaam Shakti - Madhyam Vaya - Yuva Desha - Aanupa Investigations All hematological and sonographical investigations were normal.

Manisha Kumari et al. An Ayurvedic approach on Bad Obstetric History ISSN: 2456-3110 CASE REPORT August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 232 Treatment Protocol 1. Shodana Karma Deepan Pachana Chitrakadivati - 1 tds x 5 days [before meal] Avipattikar Churna -1/2 tsp-tds x 5 days [before meal] Snehpana Phalaghrita x 5 days 2. Shaman Aushada Phalaghrita Pana 10 ml with 200 ml milk (empty stomach) Chandraprabha Vati 2 bd (for one cycle) Grabhpalrasa 1 tds (For 3 cycle) Dashmoola Kwatha 15 ml bd after meal (for 3 cycles) Ajmodaadi Churna 5 gm with warm water (HS) Shodana Karma 1 st Virechana Plan Deepana Pachana for 5 days Chitrakadi Vati - 1 tds Avipattikar Churna - ½ tsp tds Snehapana with Phalaghrita for 5 days (till Samyak Lakshana of Snehapana achieved) 2 days Sarvanga Abhyanga and Swedana done. Virechana with Trivrut Avaleha with warm water was done under observation. Total Vega - 17-18 Noted. Madhyam Suddhi Lakshana observed. After that Samsarjana Karma followed for 5 days. Shamana Aushada prescribed for 15 days ▪ Phalaghrita Pana - 10 ml followed by 200 ml Godugda [early morning] ▪ Chandraprabha Vati - 2 bd ▪ Garbhapala Rasa - 1 tds ▪ Dashmoola Kwatha - 15 ml with equal amount of water ▪ Ajamodaadi Churna - 5 gm HS R ESULT After three sitting of Uttarbasti for three consecutive cycles, along with Shaman Aushadi, she reported with amenorrhea and found urine pregnancy test positive. Confirmed the pregnancy by USG, as single live intrauterine fetus. Patient regular came for ANC Checkup. She delivered a healthy baby. DISCUSSION Becoming mother is the most cherished dream of all women. Ritu, Kshetra, Ambu and Beeja are the four essential factor for fertility [6] Defect in any of these result in miscarriages (infertility). Vata is prime cause of Abortion. In Putraghni Yonivyapada (Repeated Abortion) Kshetra and Ambu plays major role. Repeated Abortion take place due to Ruksha Ahara and Vihara thus lead to Vataprakop which in turns causes Shonita and Artava Dushti result in Garbha Vinasha (Foetal loss) [7,8] Thus, the medicine used in this study have Garbhasthapaka Gana . Mode of action Acharya Kashyapa has mentioned that Virechana is the best line of management in Beeja and Artavadushti . After proper administration of Virechana , only these results are going to be achieved [9] Virechana Karma has a direct effect on Agnisthana (hampered Agni is one of the initiating factors information of vitiated Raja ). यथा दोषं विशोधयेत्।..... अग्निः प्रजाश्च.....॥ विरेचन.....बीजं भितत कार्मुकर््....गभाुशयासृजी॥ विरेक.....॥ ( का.सं.सस 2/5-7,13) It pacifies the vitiated Kapha and Vatadosha and removes only Vaikarika Pitta only & thus does Raktashodhana . It does the quality of Srotovishodhana , so it will help in eliminating the disease from its root ( Rasavaha and Raktavaha Srotas ) rather than temporary relief from Artava Vikaras (menstrual disorders). Phalaghrita helps the women to achieve the conception and cures the females genital tract

Manisha Kumari et al. An Ayurvedic approach on Bad Obstetric History ISSN: 2456-3110 CASE REPORT August 2023 Journal of Ayurveda and Integrated Medical Sciences | August 2023 | Vol. 8 | Issue 8 233 disorder [10] It is Vatahara, Balya, Deepan, Pachana, Vataanulomna and Shothahara. Krimighna, Bruhaniya, Garbhada and Rasayana thus helps in nourishment of reproductive organs and baby later. It helps in proper development of endometrium and follicles, so result in healthy progeny. Chandraprabha Vati has properties like Vata-Pitta- Kaphahar , Balya, Vrushya and Rasayana . It helps in correcting an anovulatory cycle. Garbhapala Rasa gives sustaining effect by preventing foetal loss. It also helps in disorders during pregnancy such as Shiroshula (headache), Chhardi (vomiting), Atisara (diarrhoea) and Unmada (hysteria), Eclampsia etc Dashmool Kwatha - Collective properties of Dashmool Kwath are Katu Rasa, Katuvipaka , Laghu- Ruksha Guna and Ushna Veerya . By virtue of this properties Dashmoola act as Aamapachana and remove the Avarana of Kaphadi Doshas. As Dashmool is Ushnaveerya and other properties associating to that are acting on Vata Dosha also. It has potent antiinflammatory and uterine tonic action. CONCLUSION Ayurvedic medicine, an ancient holistic healing system, has gained attention in the context of modern medicine and In Vitro Fertilization (IVF). While Ayurveda offers a unique approach to health and wellness, its role in conjunction with modern medicine and IVF is a subject of debate. The incidence of repeated abortions is increased due to modern stressful lifestyle & food habits. While treating the patients of bad obstetric history one should go thoroughly examination of patient followed by the proper line of treatment only then we will get the fruitful outcome. When we came across the causes of bad obstetric history, we come to know that the integrative approach is helpful rather the individual Ayurvedic or modern approach in treatment. Here in present case study of repeated abortions is treated by Ayurvedic treatment only. REFERENCES 1 Ford, Holly B; Schust, Danny J (2009). "Recurrent Pregnancy Loss: Etiology, Diagnosis, and Therapy". Reviews in Obstetrics and Gynecology . 2 (2): 76 – 83. ISSN 1941-2797. PMC 2709325. PMID 19609401. 2 Dutta D.C., Textbook of Gynecology, 5 th edn., Jaypee Brothers Medical publishers (P) Ltd., New Delhi, 2013, p. 222 -247. 3 Acharya Charka. Charak Samhita (ChikitshaSthan) by Acharya Vidyadhar Shukla and Prof.Ravi Dutt Tripathi foreword by Acharya Priyvrata Sharma, Chaukambha Sanskrit Pratishthan, Delhi ch,chi,30/28. 4 Bhramanand Tripathi, Charak Samhita Vol.II, Edition 2011, Varanasi; Chaukhamba Surbharati Prakashan, 2011, Adhyay 30/28-29, Page no. 1019. 5 Kaviraj Ambika Datta Shashtri, Sushruta Virachit Sushruta Samhita, Ayurvedtatvsandipika Hindi Vyakhya Part 2, Edition & Reprint 2011, Varanasi; Chaukhamba Sanskrit Sansthan, 2011, Page no. 210-211. 6 Sushruta. Sushruta Samhita, Vol.1 sharir sthana,2/35 Mudhagarbhanidana Adhyaya,8/3 edited by Kaviraj Kunjalal, Published By Author, Culcutta 1911. 7 Vagbhata, Ashtanga Sangraha, with Sasilekha Sanskrit Commentary by In-du,Edited by Dr. Shivprasad Sharma, Chaukhamba Sanskrit Series Publication, Varanasi, 2008; 38(37): 965 8 Vagbhata, Astanga Hrudaya, Sarvanga Sundara Commentary of Arunadatta andAyurveda Rasayana Commentary of Hemadri, Edited by; Pandit Hari Sadasiva Sastri Paradakara Bhisagacharya, Chaukhambha Surabharati Prakashan, Varanasi, Reprint-2010; 33(34): 956 9 Vriddhajivaka, Kashyapa Samhita, Siddhisthana, Trilkshanaiyaadhyaya, Choukhambha Sanskrit Series, 7 th edition 2000. 10 Kaviraj Atreya Gupta, Vagbhatvirachit Ashtang Sangrah Hindi Vayakhya Edited by Pandit. Shri Nandkishor Sharama Reprinted in 1993, Varanasi; Krishnadas Academy 1993, Page no. 340. How to cite this article: Manisha Kumari, Jitesh Kumar Panda, Suniti Tanwar. An Ayurvedic approach on Bad Obstetric History w.s.r. to Putarghani Yonivyapad: A Case Study. J Ayurveda Integr Med Sci 2023;08:230-233. http://dx.doi.org/10.21760/jaims.8.8.35 Source of Support: Nil, Conflict of Interest: None declared.

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Vihara, Shodhana, Ayurveda, Kshetra, Ambu, Ritu, Raktakshaya, Virechana, Vatahara, Vataprakopa, Snehapana, Phalaghrita, Garbhavinasha, Katurasa, Amenorrhea, Garbha development, Shodhana Karma, Virechana Karma, Shamana Therapy, Ayurvedic approach, Case study, Shodhana Chikitsa, Uttarbasti, Ruksha ahara, Ushna veerya, Artavavaha srotas, Shodhan Chikitsa, Shaman therapy, Beeja, Chandraprabha vati, Aamapachana, Raktashodhana, Artava dosha, Rakta Dosha, Recurrent pregnancy loss, Garbhasthapaka Gana, Pregnancy Loss, Bad obstetric history, Dashmoola kwatha, Aharaja Viharaja, Rasavaha Srota, Kaphadi Dosha, Artava Vikara, Foetal loss, Deepan Pachana, Recurrent Abortion.