Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara with special...

[Full title: Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara with special reference to Heavy Menstrual Bleeding]

[Find the meaning and references behind the names: Renu, Yadav, Prakash, Red, Preeti, Chaudhary]

REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 248 Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara with special reference to Heavy Menstrual Bleeding Renu Yadav 1 , Preeti 2 , Trapti Agarwal 3 , Aditaya Nath Tewari 4 1,2 Post Graduate Scholar, Dept. of Rog Nidan evum Vikruti Vigyan, Chaudhary Brahm Prakash Ayurved Charak Sansthan, New Delhi, Delhi, India. 3 Assistant Professor, Dept. of Prasuti Tantra and Stree Roga, Chaudhary Brahm Prakash Ayurved Charak Sansthan, New Delhi, Delhi, India. 4 Associate Professor, Dept. of Rog Nidan evum Vikruti Vigyan, Chaudhary Brahm Prakash Ayurved Charak Sansthan, New Delhi, Delhi, India. I NTRODUCTION Mensuration is a natural physiological process in females. Menstruation refers to the regular monthly cycle of bleeding from the uterus in women of reproductive age. The menstrual flow consists of whole blood containing red blood cells and white blood cells, along with tissue from the endometrium and a clear fluid called endometrial transudate. When menstruation Address for correspondence: Dr. Renu Yadav Post Graduate Scholar, Dept. of Rog Nidan evum Vikruti Vigyan, Chaudhary Brahm Prakash Ayurved Charak Sansthan, New Delhi, Delhi, India. E-mail: renuyadav 2736@gmail.com Submission Date: 17/05/2024 Accepted Date: 24/06/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.7.38 begins and tissue sheds and bleeding occurs, achieving local clotting depends on various factors. Local narrowing of blood vessels (vasoconstriction) primarily ensures early clotting. Substances such as thromboxane (produced by blood vessel linings and platelets), endothelin- 1, and PGF 2α each contr ibute to causing spasms in the spiral arteries of the endometrium. When menstruation occurs excessively, for a prolonged period, or outside the regular menstrual cycle (even if scanty and brief), and differs from normal menstrual blood characteristics, it is referred to as Asrugdara [1] In modern medical terms, it appears to correspond to Abnormal Uterine Bleeding (AUB). This condition involves uterine bleeding that deviates from the average in terms of volume (20-80 ml), duration (4-5 days), and frequency (21-35 days) [2] Asrugdara is a debilitating condition with significant direct and indirect costs. Irregular menstrual cycles can adversely affect female reproductive health. It is primarily responsible for iron-deficiency anemia, which can greatly impact quality of life and lead to symptoms A B S T R A C T Rakta is a crucial component of the human body and is considered vital. Sthambhana , a term from the Shadvidopakrama therapies, involves preventing mobility or obstruction, and is an integral part of Chaturvidha Chikitsa as described by Acharaya Susruta. Raktasthambhana specifically aims to arrest excessive blood flow, particularly in cases like Atyaadhika Raktasrava (excessive menstrual bleeding), which can be life-threatening and requires hemostatic interventions. Asrigdhara , defined as prolonged and heavy menstrual bleeding with or without bleeding between periods, is often caused by imbalances in Tridoshas affecting Garbhashaya Gata Siras and Artavavaha Srotas , leading to Artava Atipravrutti . Abnormal uterine bleeding, a common gynecological issue with diverse causes and pathophysiological origins, can significantly impact daily activities, well-being, and societal efficiency due to excessive menstrual bleeding. This condition can also lead to anemia due to continuous blood loss during menstrual and intermenstrual periods. Based on the aforementioned details, this article aims to investigate various studies to identify straightforward, safe, non-hormonal medications for patients suffering from Asrugdara . Additionally, it seeks to review the classical texts for insights into Asrugdara and compare these findings with modern literature on abnormal uterine bleeding. Key words: Rakta, Raktasthambhana, Asrigdhara, Abnormal uterine bleeding, Atyaadhika Raktasrava.

[Find the meaning and references behind the names: Bala, Raja, Guna, Sara, Main, Guru, Rasa]

Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 249 such as fatigue, shortness of breath, and reduced work performance. Management typically involves appropriate iron supplementation. The main focus of this article is to review Asrugdara as described in Ayurvedic texts, along with clinical studies conducted to date on its management . A IMS AND O BJECTIVES 1 To analyze the efficacy of Shodhan Chikitsa in Asrugdara (Heavy Menstrual Bleeding). 2 To analyze the efficacy of Shaman Chikitsa in Asrugdara (Heavy Menstrual Bleeding). M ATERIALS AND M ETHODS Various Ayurvedic texts, databases such as PubMed, Scopus, DHARA, Google Scholar, and related research works were thoroughly searched and reviewed to establish an understanding of Asrugdara and its treatment protocols. R EVIEW OF L ITERATURE In Indian philosophy, women are revered for their role in creation, as they are seen as superior even to heaven due to their ability to conceive and nurture life within their womb. They play a crucial role in perpetuating the human race by bearing and nurturing children. The health and well-being of families, societies, and cultures are deeply intertwined with women's health. Ayurveda, which has eight branches, including Bala (Kaumarabhritya Tantra ) specifically focuses on the health of women and children [3] According to the fundamental principle of reproduction, known as Kshetra Beeja Nyaya, Kshetra (field) is one of the four essential factors necessary for Garbhotpatti (conception and pregnancy). The female body is considered Kshetra , emphasizing the importance of the reproductive system, particularly the Garbhashaya (uterus), which plays a crucial role in menstrual flow and the implantation of fertilized ova. For females, menstruation is a vital indicator of normal uterine function, and regularity in the monthly menstrual cycle is essential for achieving and maintaining fertility. The overall health of a woman is greatly influenced by the regularity and health of her menstrual cycle. Thus, in Indian philosophical and Ayurvedic perspectives, women are celebrated for their reproductive capabilities, which are central to the continuity of life and the health of communities. According to classical Ayurvedic texts, any disruption in the menstrual rhythm, known as Rutuchakra , can lead to excessive and irregular uterine bleeding, referred to as Asrugdara. Charaka Samhita explains that when there is excessive excretion of menstrual blood ( Raja ), it is termed as Pradara, and when there is excessive excretion of Asrik (menstrual blood), it is known as Asrugdara. [4] Sushruta mentions Asrugdara as menstruation that occurs excessively in amount, duration, and differs in characteristics from normal menstrual blood [5] Charaka describes Asrugdara as a Pittaavrita-Apana Vayu (a type of Vata associated with downward movement) and Rakta Pradoshaja Vikar . [6] Sushruta , on the other hand, associates Asrugdara with Pitta Yukta Apanvayu. [7] Astanga Sangraha [8] considers Asrugdara and Pradara as synonyms and describes Raktayoni as a related condition [8] According to Charak , After consumption of Pitta Prakopaka Nidan , aggravated Vayu, withholding the Rakta gets vitiated due to Nidan Sevan , increases its amount and then reaching raja carrying vessels of the uterus, increases immediately the amount of Raja . This increase in menstrual blood is due to relative more increase of Rasa, Because of increase in the amount of blood it is named as Asrugdara. [9] Charaka primarily identifies dietary factors contributing to pelvic congestion as the causative factors . Madhava Nidan, Bhava Prakash, and Yoga Ratnakara expand on Charaka's perspective by including dietary habits ( Aahara ), lifestyle ( Vihara ), and mental factors ( Manasika ) that can disturb the vasomotor functions, thereby contributing to the manifestation of Asrugdara. [10] The Ashraya-Ashrayi Bhava concept explains that Rakta (blood) and Pitta share similar properties, making Rakta Dhatu easily susceptible to vitiation by Pitta Dosha . The Chala Guna (mobile nature) of Vata Dosha , and the Sara (liquid) and Drava Guna (oily) properties of Pitta Dosha increase Rakta , while the Guru (heavy) and Picchila Guna (Slimy) qualities of Kapha Dosha lead to excessive proliferation of the endometrial lining, causing

[Find the meaning and references behind the names: Sita, Long, Nisha, Madhu]

Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 250 irregular shedding and ripening. Acharya Charaka mentioned ten Shonithasthapana Gana Dravyas as effective in managing Asrigdhara : Madhu , Madhuka, Nagakeshara, Mocharasa, Mritkapala, Lodhra, Gairika, Priyangu, Sharkara, and Laja. [11,12] According to Acharya Sushrutha , there are four types of therapies ( Upakramas ) for managing excessive blood loss: Sandhana (constriction), Skandana (ligation), Dahana (cauterization), and Pachana (digestion) [13] The fundamental principles of treatment described for conditions like Raktarsha (bleeding disorders), Raktatisara (bloody diarrhea), Raktapitta (bleeding disorders involving Pitta), Yonivyapat (gynecological disorders), and Garbhasrava (uterine bleeding in pregnancy) can all be applied effectively in the treatment of Asrigdhara. [14] Overall, Asrugdara in Ayurveda is understood as a disorder involving abnormal menstrual bleeding, influenced by disturbances in Doshas (especially Pitta and Vata ), Rakta , and factors affecting vasomotor functions. Heavy menstrual bleeding refers to menstrual periods that involve abnormally heavy bleeding (more than 80 ml) or prolonged bleeding (more than 7 days), which significantly impacts a woman's physical, emotional, social, and maternal quality of life [15] The International Federation of Gynecology and Obstetrics (FIGO), Menstrual Disorders Working Group suggested discontinuing the use of the term "Dysfunctional Uterine Bleeding," while endorsing the terms "Abnormal Uterine Bleeding" and "Heavy Menstrual Bleeding." [16] This system is called PALM-COEIN, where each letter represents a cause of uterine bleeding: Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The PALM-COEIN system is used once pregnancy-related causes of bleeding have been ruled out. This condition affects 20-30% of women during their reproductive years and can lead to complications such as anemia, increased costs related to sanitary products, and disruption of daily activities [17] Modern treatments such as hormonal therapy, prostaglandin inhibitors, and anti-fibrinolytic drugs offer temporary relief from symptoms but lack proven long-term effectiveness. Hormonal medications like oral progestogens can lead to irregular bleeding, headaches, and breast tenderness. Combined oral contraceptives may cause hypertension, reduced glucose tolerance, changes in lipid metabolism, and liver function impairment. Non-hormonal drugs such as tranexamic acid may result in gastrointestinal side effects like nausea, vomiting, diarrhea, dyspepsia, and color vision disturbances. Therefore, there is a necessity to explore effective and safe alternative medicines for Asrugdara through comprehensive clinical research and trials conducted to date. As a final option, some women resort to surgical procedures like hysterectomy, which are expensive and result in complete loss of fertility. R ESULTS Table 1: Role of Shaman Chikitsa in Asrugdara Drugs No. of patients Duration Type of study Result Group A: Patrangasava - 20 ml and Nisha Lauha 500 mg BD Group B: Jeerakavaleha - 10 gm and Nisha Lauha 500 mg BD [18] Group A - 16 patients Group B - 14 patients 90 days Randomized comparative clinical study Group A patients showed more improvement than group B but intergroup comparison was non-significant Group A Shatavarigopakanyadi Kashaya - 50 ml BD with Anupana of Sita and Madhu Total 40 -20 in each group Two Consecutive menstrual Cycle Randomized comparative clinical study Both the groups showed statistically significant results for all assessment criteria.

[Find the meaning and references behind the names: Ashok, Pushpa, Kala, Ras]

Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 251 Group B Vasaadi Kashaya 50 ml BD with Anupana of Sita and Ghrit [19] Kutajashtakaleha - 10 gm BD with Goghrita. [20] 01 Two Menstrual Cycle Case Report Pbac score reduced from 400 to 222 and quality of life score improved from 53 to 75. Ashoka Valkala Kshirapaka - 50 ml BD Musthamruthadi Kashaya - 50 ml TDS [21] 01 2 months Case Report Significant decrease in bleeding volume and duration of menstruation without clotting . Group A Chandrakala Ras - 250 mg BD Ashoka Ksheera Paka - 48 ml BD Group B Progesterone - 5 mg BD [22] Total 20 -10 in each group 30 days Single Blind control clinical study Patients in group A showed noticeable enhancement in symptoms and daily functioning compared to those in group B. Group A Amalaki Rasanjana Haritaki Choorna - 5 GM BD Group B Ashok Twak Choorna - 5 GM BD [23] Total 60 - 30 in each group 12 months Randomized control trial Amalaki-Rasanjana-Haritaki Choorna and Ashoka Twak Choorna both were equally effective Durva Swarasa 30 ml BD [24] 01 7 days Case Report The bleeding decreased from 6 pads per day to 2 pads per day within 3 days, and after 7 days, it ceased completely. Khanda kushmanda Avleha – 12 gm OD [25] 40 30 days Clinical Trial Greater relief was noted in main complaints such as heavy bleeding, body aches, and overall weakness. Kadali Pushpa Churna – 4 gm OD [26] 20 3 Menstrual cycle Clinical Trial There was a gradual reduction in menstrual bleeding from cycle 1 to 3, with a t-value of 0.1525. Group A Yashtimadhu Sita Churna - 5 gm BD Group B Ashok Twak Churna - 5 gm BD [27] Total 60 -30 in each group 10 months Randomized comparative clinical study Both medications effectively reduced Rajasrava Pramana, Rajasrava Kala, Angamarda, Adho Udara Shula, and Katishula in patients with Asrugdara. Group A Bharangi – Shunthi Churna 3 gm BD Group B Total 60 -30 in each group 90 days Comparative clinical trial Pushyanuga Churna has significant results as compared to Bharangi- Shunthi.

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

Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 252 Pushyanuga Churna 3 gm BD [28] Group A Dandotpaladi yoga 3 gm BD Group B Pushyanuga Churna 3 gm BD [29] Total 40 - 20 in each group 3 months Randomized comparative clinical study Group A has significant result as compared to Group B Table 2: Role of Shodhan Chikitsa in Asrugdara Drug and therapy No. of patients Duration Type of study Result Virechana Karma With Trivit Modak [30] 01 One month Case Report The menstrual duration decreased from 8-10 days to 4-5 days without clots, and the patient remained asymptomatic throughout this period . Group 1 Kushadi Asthapana Basti - 1200 ml once a day for two consecutive days on the third day Kashmarya Kutaj Uttar Basti - was given in dose of 4 ml for three consecutive cycles after two days of clearance of menses Group 2 Tab Ovral-L -(Levonorgestrel 0.15 mg + Ethinylestradiol 0.03 mg) [31] Total 40 - 20 in each group Three consecutive Menstrual cycle Comparative clinical trial After a three-month drug-free follow-up period, it was observed that in Group 1, relief in assessment criteria and associated symptoms persisted in the majority of patients even after discontinuing the drug. However, in Group 2, relief in assessment criteria and associated symptoms did not persist after discontinuation of the drug in the majority of patients Sadyovamana conducted with Ksheera, Yastimadhu Phanta and Saindhava Lavana Jala followed by Dhumpana, Kavala Gandusha [32] 10 Patients 10 days Single blind study Out of the selected patients, 80% experienced complete cessation of vaginal bleeding on the second day of Sadyovamana , while 20% achieved cessation by the fourth day. Group A: Virechana with Sansarjan Karma during intermenstrual period & Ashok Twak Ksheerpaka 40 ml BD for 7 days during the menstrual period Group B: Ashok Twak Ksheerpaka 40 ml BD for 7 days during the menstrual period [33] Total 60 - 30 in each group 3 Consecutive menstrual cycle Comparative clinical trial The combination of Virechana karma and Ashoka Twak Kseerpaka therapy is more effective for treating Asrigdara compared to solely administering Shamana therapy with Ashoka Twak Kseerapaka . Group A: Virechana karma with Aragvadha Phala Majja Kashaya Group B: Total 30 -15 in each group 3 months Comparative clinical trial The use of Virechana karma with Aragwadha Kashaya helps in alleviating symptoms and demonstrated moderate improvement.

[Find the meaning and references behind the names: Mala, Prithvi, Good]

Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 253 Oral contraceptive pills 1 tab for 21 days [34] DISCUSSION Ayurvedic drugs with properties like Raktastambhaka, Vata-Pitta Nashaka, Sravarodhaka, Raktashodhana used along with preparations of Lauha provide a good relief in patients of Asrigdara. Many substances such as Patranga, Khadira, Vasa, Shalmali, Japa, Amrasthi, Dhataki, Vanshaja, and Lodhra acted as blood purifiers and astringents, promoting purification of contaminated pitta and blood, thereby aiding in hemostasis. Their anti-inflammatory, wound-healing, and tissue-strengthening properties reduced uterine congestion and the vulnerability of uterine blood vessels, contributing to their strengthening. Their digestive and metabolism-correcting properties rectified digestive sluggishness and menstrual irregularities. Additionally, the rejuvenating, strengthening, blood-enhancing, and anemiacorrecting effects of these remedies improved overall health, replenished blood loss, and addressed anemia . [18] Kutajashtakavleha having Deepan, Pachan, Raktasthambhana, Raktasangrahi, Raktaprasadana Balya Activites is an effective formulation in Asrugdara. [20] Ashoka Valkala Kshirapaka and Musthamruthadi Kashaya aid in strengthening the uterine muscles, addressing excessive bleeding, irregular shedding, and abnormal ripening of the endometrium during menstruation, owing to their astringent properties (which cause vasoconstriction) [21] Chandrakala rasa and Ashoka have properties that contract the uterus, stop bleeding, and nourish tissues. The liquid extract from Ashoka bark is highly astringent, contains betasitosterol, and directly affects uterine muscle fibers, stimulating the endometrium and ovarian tissue [22] Aamalaki Rasanjana Churna is also effective in Asrugdara by reducing excessive menstrual flow and its duration, as well as alleviating body pain, lower abdominal and lower back pain, weakness, and thereby increasing hemoglobin levels [23] Durvaswarasa acts as a detoxifier, is alkaline, readily absorbed into the bloodstream, coagulant, and strengthens the uterus due to its Madhur Ras . It acts as a Garbhayashodhaka due to its Tikta and Kashaya Rasa and reduces endometrial hyperplasi [24] Kushmanda is a very good Brimhana Dravya, helps in subsiding Pitta and elevates the Rakta Dhatu. [25] Yashtimadhu Sita Choorn is Raktastambhaka, Vata-Pittanashak, Rakta- Pittanashak, Jivaniya hence reduces the Rajasrava Pramana. Rajsravakala and Angamarda. [27] Pushyanug Churna having Tikta and Kashaya Ras acts as Grahi, Sravahar and Stambhaka , due to Sheeta veerya it acts as Pittahara and due to its Laghuruksha Guna it acts as Kaphanashak . It has some ingredients which are Yonidoshahara, Rakta Shodhak, Asragdushtihar, Dipana . Presence of Garbhasthapaniya, Raktasthapaka , Shothahara Dravya , improves Uterine condition and reduce inflammation [28] Dandotpaladi Yoga has anti-inflammatory and decongestant properties. It aids in halting bleeding by narrowing blood vessels and encouraging clot formation. The Udumbara's Dahaprashmana quality assists in alleviating symptoms resulting from blood loss such as burning sensation, weakness, dizziness, fainting, and thirst [29] Virechan Karma helps in Asrugdara by clearing blockages ( Margavarodha ) and expelling excessive toxic substances ( Kledamsha) downwards, primarily due to the predominance of Prithvi and Jala Mahabhuta , leading to pacification of Pitta and Kapha , and facilitation of Vata movement [30] Basti generally oversees nervous control, while Uttar Basti specifically regulates the autonomic nervous system that governs pelvic organs [35] This process provides accurate feedback to the hypothalamus, which controls the H-P- O axis. By doing so, it aids in regulating both the follicular and secretory phases and eliminates hormonal imbalances, a key cause of abnormal uterine bleeding (AUB). Additionally, it helps balance vitiated Dosha, Malas, and Apanavayu. [31] The line of treatment in Asrugdara is same as Raktapitta and since Asrugdara can be considered as a Adhogataktapitta Vyadhi being Kapha Pradhan Vyadhi Sadyovaman is advised [32]

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Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 254 CONCLUSION Raktasthambhana plays a crucial role in preventing excessive menstrual blood flow and the complications that arise from it. Untreated, excessive menstrual bleeding with irregularity can significantly impact a woman's quality of life and, if severe, may even become life-threatening, potentially necessitating a hysterectomy. The substances involved primarily exhibit Kashaya and Tikta tastes, are characterized by Laghu (light) and Ruksha (dry) qualities, and possess Sheeta (cooling) potency. These properties aid in blood coagulation ( Shonithasthapana ), while also enhancing the quality ( Raktashodhana ) and quantity ( Raktavardhaka ) of blood, all without causing any side effects. Based on the comprehensive literature and data reviewed regarding the treatment of Asrugdara , it can be concluded that Ayurvedic management offers a superior alternative to conventional hormonal therapy. Ayurvedic treatments demonstrate significant improvements in both the primary symptoms and associated manifestations of Asrugdara . Moreover, Ayurvedic management is perceived as safer compared to modern medical approaches because herbal formulations are free from side effects and have the potential to cure the condition with minimal chances of recurrence. REFERENCES 1 Tewari Premvati, Ayurvediya Prasutitantra Evam Striroga, Part 2 Striroga, Artavavyapad Ch. 2, Chaukhambha Orientalia Varanasi; Reprint 2016, p 181. 2 Dutta DC. Konar Hiralal, Editor. DC Dutta’s Textbook of Gynecology. Abnormal uterine bleeding (AUB). 7 th ed. Jaypee: The Health Sciences Publisher; 2016. p 152. 3 Tripathi Brahmanand, Ed reprint, Nirmala Hindi Commentary on Astanga Hrdayam of Srimadvagbhat, Sutra Sthan; Ayushkamiya Adhyaya: Chapter 1,5. Delhi: Chaukhamba Sanskrit Pratishthan, 2009; pg 5. 4 Sastri Kasinatha, Chaturvedi Natha Gorakha, Ed reprint, Vidyotini Hindi Commentary on Caraka Samhita of Agnivesh, Chikitsa Sthan; Yonivyapadachikitsa Adhyaya: Chapter 30,209. Varanasi: Chaukhamba Bharati Academy, 2018; pg 868. 5 Shastri Ambikadutta Kaviraja, Ed reprint, Ayurveda Tattva Sandipika Hindi Commentary on Susruta Samhita of Maharsi Susruta, Sharir Sthan; SukraShonitasudhi sharir Adhyaya: Chapter 2,20. Varanasi: Chaukhambha Sanskrit Sansthan, 2018; pg 15. 6 Sastri Kasinatha, Chaturvedi Natha Gorakha, Ed reprint, Vidyotini Hindi Commentary on Caraka Samhita of Agnivesh, Chikitsa Sthan; Vatavyadhichikitsa Adhyaya: Chapter 28,229. Varanasi: Chaukhamba Bharati Academy, 2018; pg 815. 7 Shastri Ambikadutta Kaviraja, Ed reprint, Ayurveda Tattva Sandipika Hindi Commentary on Susruta Samhita of Maharsi Susruta, Nidan Sthan; Vatavyadhinidan Adhyaya: Chapter 1,37. Varanasi: Chaukhambha Sanskrit Sansthan, 2018; pg 299. 8 Acharya Vriddha Vagbhat, Astanga Samgrah (Sutra sthana), Jeevan Hindi Commentary by Dr Shailaja Srivastawa, Chaukhambha Orientalia, 2006, p.328. 9 Sastri Kasinatha, Chaturvedi Natha Gorakha, Ed reprint, Vidyotini Hindi Commentary on Caraka Samhita of Agnivesh, Chikitsa Sthan; Yonivyapadachikitsa Adhyaya: Chapter 30,205- 209. Varanasi: Chaukhamba Bharati Academy, 2018; pg 868. 10 Tewari Premvati, Ayurvediya Prasutitantra Evam Striroga, Part 2 Striroga, Artavavyapad Vimarsh Ch.2, Chaukhambha Orientalia Varanasi; Reprint 2016, p 176. 11 Agnivesha, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani Dutta, edited by Yadavji Trikamjiacharya: Varanasi, Choukhambha Publications, 2013, 3 rd edition, Sutra sthana, 4/46, p 34. 12 Geeta K. Jadhav, Priyanka M. Kurde, D. V. Kulkarni: A review on Charakokta Shonitasthapaka mahakashaya in Ayurvedic and Modern perspective. Ayurline: International Journal of Research in Indian Medicine 2021; 5(3): 01-11. 13 Susrutha, Susrutha Samhita with Nibandha Sangraha commentary by Sri Dalhanachaarya, edited by Vaidya Yadavji Trikamji Acharya: Varanasi, Chowkhambha Orientalia, 2012, 9 th edition, Sutra sthana, 14 /39, p-66. 14 Agnivesha, Charaka Samhita with Ayurveda Deepika commentary by Chakrapani Dutta, edited by Yadavji Trikamjiacharya: Varanasi, Choukhambha Publications, 2013, 3 rd edition, Chikitsa sthana, 30 chapter, verse 227, 228, p- 643. 15 Edmonds D. keith, Lees Christoph, Bourne Tom, et al. Dewhurst’s Textbook of Obstetrics & Gynaecology, Ninth Edition. Wiley Blackwell; 2018, Pg 653. 16 Edmonds D. keith, Lees Christoph, Bourne Tom, et al. Dewhurst’s Textbook of Obstetrics & Gynaecology, Ninth Edition.Wiley Blackwell; 2018, Pg 653. 17 Kumar Suresh, Padubidri VG, Daftary N Shirish, et al. Howkins & Bourne Shaw’s Textbook of Gynaecology, 17 th Edition. Elsevier; 2018, pg 123.

[Find the meaning and references behind the names: Manoj Kumar, Surya, Sharma, Singh, Anil, Manoj, Murthy, Patil, Joshi, Arun, Sonu, Santhosh, Kavitha, Swapna, Kapil, Anusha, Prem, Rashmi, Nil, Chandan, Med, Gayathri, Bharathi, Nikita, Asha, Soni]

Renu Yadav et al. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara ISSN: 2456-3110 REVIEW ARTICLE July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 255 18 Khare C.P. Indian Medicinal Plants an Illustrated Dictionary [Internet]. New Delhi: Springer; 2007 [cited 1 March 2021]. Available from: http:// www.gbpihedenvis.nic.in. 19 Priyanka Prem & Kavitha B.K: A Comparative Clinical Study of Shatavarigopakanyadi Kashaya and Vasadi Kashaya In Asrigdara. International Ayurvedic Medical Journal {online} 2020 {cited September, 2020} Available from: http://www. iamj.in/posts/ images/upload/4391_4396.pdf. 20 Khushboo Jha, K. Bharathi, & Sonu. (2020). A Case Report on Effective Management of Asrigdara. International Journal of Ayurveda and Pharma Research, 8(Supply 2), 106-111. https://doi.org/10.47070/ijapr.v 8 iSupply 2.1700. 21 Surya Santhosh C, Gayathri Bhat N.V. Ayurvedic management of Asrigdaraa case report. World journal of pharmacy and pharmaceutical sciences. 2018; 7(7): 1152-1157. 22 Hosur Asha F, A clinical evaluation of effect of Chandrakala rasa and Ashoka kheerapaka in asrigdara w.s.r to dub, International Ayurvedic Medical Journal, 2014, 2(4), 659-664. 23 Mehetre KD, Bhalgat MS - Randomized Controlled Study to evaluate efficacy of ‘Amalaki Rasanjana Haritaki Choorna’ in Asrigdara. International Journal of Research in Ayurveda and Medical Sciences 2018; 1 (1): 27-35. 24 Gaikwad Manoj Vitthal Et Al:Role Of Durva Swarasa in the management of Puberty Menorrhagia - A Case Study. International AyurvedicMedical Journal {online} 2017 {cited March, 2017. 25 Swapna Tadasad, Dr. B. H. Katti, Dr. M. R. Sajjanshetti, Dr. G. N Kannolli. Clinical evaluation of the effect of Khanda Kushmanda Avaleha in Rakta Pradara (Abnormal uterine bleeding). J Ayurveda Integr Med Sci 2018; 5: 36-44. http://dx.doi.org/10.21760/jaims.v 3 i 5.13817. 26 National Arogya Fair, 2018: International Conference On Conglomeration of Health Traditions In Bharatvarsha, December: 2018, Bengaluru. 27 Jarange MB, Shirsath AD. Randomized Controlled Study to evaluate efficacy of ‘Yashtimadhu -Sita Choorna with Tandulodak’ in Asrigdara. International Journal of Research in Ayurveda and Medical Sciences 2018; 1(2): 98-104. 28 Belhekar P, Nimase J. A Comparative Study of Bharangi-Sunthi Churna and Pushyanuga Churna in Asrigdara. International Journal of Research in Ayurveda and Medical Sciences. 2019; 2(4): 214- 219. 29 Nikita Panwar, Chandan Singh, Manoj Kumar Adlakha. Pharmacotherapeutic Study Of ‘Dandotpaladi Yog’ (Kalpita Yog) in the Management of ‘Raktapradara’ w.s.r. to Menorrhagia. World Journal of Pharmacy and Pharmaceutical Sciences. 2021; 10(4): 1139-1150). 30 Apurva Joshi, Rashmi Sharma. A Case Study in Asrigdara with Shodhana and Shamana Chikitsa. J Ayurveda Integr Med Sci 2023;07:213-217. http://dx.doi.org/10.21760/jaims.8.7.41. 31 Kaminey, Soni Kapil, Anil Bhardawaj. A Clinical Study to Evaluate the Efficacy of Asthapana Basti and Uttar Basti in Asrigdara w.s.r to Abnormal Uterine Bleeding. AYUSHDHARA, 2021;8(5):3482-3489 https://doi.org/10.47070/ayushdhara.v 8 i 5.810. 32 Arun B.Jainer &Anusha M: Role Of Sadyovamana In Cases Of Asrigdara. International Ayurvedic Medical Journal {online} 2018 {cited November, 2018} Available from: http://www.iamj.in/posts/images/upload/1435_1438.pdf. 33 Pashte Sayali & Gaikwad Rutuja: A Comparative Study of Ashok Twak Ksheerapaka With Virechana Karma In Asrigdara W.S.R. To Dysfunctional Uterine Bleeding (DUB). International Ayurvedic Medical Journal {online} 2019{cited March 2019} Available from: http://www.iamj.in/posts/ images /upload/1609_1616.pdf, retrieved on 8/10/2021. 34 Murthy S, Arawatti S, TS Manjunatha, Bhatted S, Ratnakar LV. Role of Virechana in Asrigdara. International journal of ayurvedic & herbal medicine, 2012;2(5):907-920 http://interscience.org.uk/v 2-i 5/16%20 ijahm.pdf, retrieved on 16/10/2021. 35 Vasant C. Patil, Essentials of Practical Panchakarma therapy (A complete practical guide on classical and Keraliya panchakarma), Chaukhambha Publication New Delhi, chapter 12. ******************************* How to cite this article: Renu Yadav, Preeti, Trapti Agarwal, Aditaya Nath Tewari. Analysis on action of Shaman and Shodhan Chikitsa in Asrugdara with special reference to Heavy Menstrual Bleeding. J Ayurveda Integr Med Sci 2024;7:248-255. http://dx.doi.org/10.21760/jaims.9.7.38 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 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 (https://creativecommons.org/licenses/by/4.0/unported [CC BY 4.0]), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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