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Dysmenorrhoea (Kashtartava): An Ayurvedic Perspective

Authors:
  • Bharati Vidyapeeth Deemed University College of Ayured

Abstract

In present day life women are effectively facing challenges encountered by stressful life resulting in Mithya Ahar, vihar, over exertion & malnutrition this may direct to vikruti in " Rutuchakra'' leading to various vyadhi allied to menstruation. Ayurveda recommends rutucharya and dinacharya, diet modulation and yoga in the form of asanas, pranayam and meditation on a regular basis so as to alleviate dysmenorrhoea effectively. Similarly, Uttarbasti, Garbhashaya balyaaushadhi, anuvasan or matrabasti can also be administered if necessary.
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International Journal of Herbal Medicine 2015; 3(3): 33-35
E-ISSN: 2321-2187
P-ISSN: 2394-0514
IJHM 2015; 3(3): 33-35
Received: 15-06-2015
Accepted: 17-07-2015
Bhagyashri Patil
PG Scholar, Department of
Swasthavritta, Bharati,
Vidyapeeth Deemed University,
College of Ayurved, Pune,
Maharashtra, India.
Rahul Kamde
Assist. Prof Department, of
Prasutitantra & Strirog KVTR
Ayurved College Boradi.
Vijay Bhalsing
Prof, Department of
Swasthavritta, Bharati
Vidyapeeth Deemed University,
College of Ayurved, Pune,
Maharashtra, India.
Kirti Bhati
Assist. Prof, Department of,
Swasthavritta, Bharati
Vidyapeeth Deemed University,
College of Ayurved, Pune,
Maharashtra, India.
Correspondence:
Bhagyashri Patil
PG Scholar, Department of
Swasthavritta, Bharati
Vidyapeeth Deemed University,
College of Ayurved, Pune,
Maharashtra, India.
Dysmenorrhoea (Kashtartava): An Ayurvedic Perspective
Bhagyashri Patil, Rahul Kamde, Vijay Bhalsing, Kirti Bhati
Abstract
In present day life women are effectively facing challenges encountered by stressful life resulting in
Mithya Ahar, vihar, over exertion & malnutrition this may direct to vikruti in “Rutuchakra’’ leading to
various vyadhi allied to menstruation. Ayurveda recommends rutucharya and dinacharya, diet
modulation and yoga in the form of asanas, pranayam and meditation on a regular basis so as to alleviate
dysmenorrhoea effectively. Similarly, Uttarbasti, Garbhashaya balyaaushadhi, anuvasan or matrabasti
can also be administered if necessary.
Keywords: Ayurveda, Kashtartava, Menstruation, Dysmenorrhoea
1. Introduction
Today stress is becoming an inescapable part of modern life. In the incessant quest for material
comforts, a woman has been losing her health. The basic reason why women are reeling under
myriad problems is because she has not been following the codes of healthy living. She has
disregarded the codes for the bodily health as well as healthy mind also.
Menstruation is a natural event as a part of the normal process of reproductive life in females.
Due to today’s sedentary lifestyle and lack of exercise, dysmenorrhoea is becoming today’s
burning problem throughout the world which causes discomfort for women’s daily ensuing
day to day activities and may result in missing work or school, inability to participate in sports
or other activities. A systematic review of studies in developing countries performed by
Harlow and Campbell (2002) has revealed that about 25-50% of adult women and about 75%
of adolescents experience pain during menstruation, with 05-20% reporting severe
dysmenorrhoea or pain [1].
In the treatment of dysmenorrhea, no addictive, analgesic, antispasmodics are prescribed
which are not good for health for longer use. During menstruation, many women experience
gastrointestinal upsets which are increased by analgesics and anti-inflammatory drugs, which
also produce headache, dizziness, drowsiness and blurred vision.
In Ayurvedic classics Kashtartava (dysmenorrhoea) is not described as a separate disease
because women were not suffering much from this problem in that era because of pin pointed
Ritucharya & Rajasvalacharya. According to Ayurvedic text there are many other diseases in
which Kashtartava is considered and is described as a symptom. Hence, this study is particular
about the description regarding Kashtartava on the basis of scattered classical references.
2. Artava
A substance of the body which flows out at the specific period of time is called as Artava [2]. A
substance which flows out from Apaty amarga without pain, burning and sliminess is known
as Artava [3]. Apana Vayu and Vyana Vayuis mainly responsible for Artava Utpatti [4].
3. Kashtartava
Kashtartava (dysmenorrhea) is not separately described as a disease. But there are many
diseases in which Kashtartava is considered and described as a symptom.
3.1. Nirukti
The term Kashtartava is made of two words- Kashta and Artava
Kashta: Painful, Difficult, troublesome, ill, forced, wrong, unnatural, a bad state of
Thing.
Artava: Belonging to reasons, period of time, menstruation.
Kashtena - with great difficulty [5].
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International Journal of Herbal Medicine
Thus the word Kashtartava can be expressed as-
Kashthenamuchyatiiti kashtartava” i.e. the condition where
Artava is shaded with great difficulty and pain istermed as
Kashtartava”.
4. Sampraptighataka
Dosha Vata Pradhana Tridosha
Vata Vyana, Apana
Pitta Ranjaka, Pachaka
Kapha as AnubandhitaDosa
Dhatu Rasa, Rakta, Artava
Upadhatu Artava
Agni Jatharagni, Rasagni, Raktagni
Srotasa Rasa, Rakta and ArtavavahaSrotasa
Srotodushti Sanga and Vimargagamana
Udbhavasthana Amapakvashaya
Rogamarga Abyantara
SthanaSamshraya Garbhashaya
VyaktiSthana Garbhashaya
5. Ayurvedic concept of pain related to Kashtartava
Acharya Charaka [6] has mentioned none of the gynecological
disease can be arise without affliction of aggravated Vata.
Vata is the main responsible factor, though other doshas only
be present as Anubandhi to it. So pain is produced due to
vitiation of only vatadosha or in combination with other
Doshas.
Modern Review
6. Definitions of Menstruation
Menstruation is a function peculiar to women and the higher
apes. It may be define as a “periodic and cyclic shedding of
progestational endometrium accompanied by loss of blood”. It
takes place at approximately 28-days interval between the
menarche and menopause [11]. Menstruation is the visible
manifestation of cyclic physiologic uterine bleeding due to
shedding of the endometrium following invisible interplay of
hormones mainly through hypothalamo-pitutary-ovarian-
endometrial axis [12].
7. Dysmenhorrhoea
7.1 Defination
The term dysmenorrhea refers to painful menstruation.
Dysmenorrhea is a cramp labor-like pain in the lower abdomen
that radiates to upper abdomen, waist and thighs and is
sometimes accompanied by systemic symptoms like nausea,
vomiting, diarrhea, headache and dizziness [17, 18].
7.2. Etymology
The word „dysmenorrhoea has a Greek origin. Dis-men-o-
reah
Dis: Prefix meaning difficult, bad, painfulmen: Monthrein: To
flow
Thus, Dysmenorrhoea-means painful or difficult menses [13].
7.3. Types of dysmenorrhea
There are two types of Dysmenorrhoea.
7.3.1. Primary dysmenorrhoea-
Primary dysmenorrhoea is the pain associated to ovulation
cycles, without demonstrable lesions that affect the
reproductive organs. Primary dysmenorrhea is related to
myometrial contractions induced by prostaglandins (Pgs)
originating in secretory endometrium, which result in uterine
ischemia and pain [14,15] In addition to the physiologic
perspective, various psychologic theories have also been
proposed, emphasizing the role of personality factors and
attitudes about menstruation [16].
7.3.2. Secondary dysmenorrhoea-
Secondary dysmenorrhoea is the pain associated with
ovulatory cycles caused by a demonstrable pathology.
8. Differential diagnosis
A. The most important differential diagnosis of primary
dysmenorrhoea is secondary dysmenorrhoea.
Secondary dysmenorrhoea
1. Endometriosis
2. Adenomyosis
3. Uterine myoma
4. Endometrial polyps
5. Obstructive malformations of the genital tract
B. Other causes of pain
Chronic pelvic inflammatory disease
Pelvic adhesions
Irritable bowel syndrome
Inflammatory bowel disease
Interstitial cystitis
C. Sudden onset of dysmenorrhoea
Pelvic inflammatory disease
Unrecognized ectopic pregnancy
Spontaneous abortion
9. Treatment as Per Ayurvedic Classics
1. These disorders (gynecological disorders) do not occur
without vitiation of Vata, thus first of all Vata should be
normalized, and only then treatment for other doshas
should be done [7].
2. In all these gynecologic disorders, after proper oleation
and sudation, emesis etc. all five purifying measures
should be used. Only after proper cleansing of dosas
though upper and lower passages, other medicines should
be given. These emesis etc. cleansing measures cure
gynecologic disorders in the same way as they cure the
diseases of other systems [8].
3. In menstrual disorders caused by Vata Dosha, the specific
treatment prescribed for suppressing that particular Dosha
should be used. Recipes prescribed for Yoni Rogas and
Uttarbasti etc. should also be used after giving due
consideration to the vitiated Doshā. [9].
4. Unctuous, hot, sour and salty articles should be used for
the relief from menstrual disorders due to Vata. Sweet,
cold and astringent substances for the purification of Pitta
and hot, dry and astringent for Kapha [9].
5. For Avrita Apana Vayu, treatment should be Agnideepaka,
Grahi, Vāta, Anulomana and Pakvashaya Shuddhikara
[10].
9.1 Treatment
Life-style changes
Exercise regularly-minimum thrice a week
Ensure sound sleep of at least 6-8 hours
Avoid smoking and alcohol
Reduce caffeine
Diet
Eat healthy, warm and fresh foods
Eat 5-6 small meals
Have fresh fruits like plums, dark grapes, apples,
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International Journal of Herbal Medicine
pomegranates.
Eat more leafy vegetables
Regularly use ginger in food preparations
Avoid high fat and sugar
Take supplements like calcium, magnesium, vitamin E, B6,
B12
Yoga: Yoga activities can help to reduce and prevent the
severity of many ailments that specifically women’s health and
give strength, stability, and suppleness. Yogasanas are
considered as the most convenient, drugless, and inexpensive
method. Yoga is also found to have encouraging effect on
increasing the pain threshold capacity in individuals. In Yoga,
various types of Asanas have been mentioned. Among them
Ushtrasana, Bhadrasana, Gomukhasana, and Vajrasana have
a pain relieving effect.
Ayurvedic Treatment: According to Ayurveda menstruation
is guarded by vata dosha. Derangement or aggravation of vata
dosha gives rise to this symptom. The treatment, which
alleviates vata, gives excellent results in this disease.
Panchakarma treatments like Uttarbasti, anuvasa or
matrabasti are the treatments which will specifically target
derangement of vata in menstrual problems. Garbhashaya
balya aushadhi will also reduce associated symptoms.
10. Discussion
Culturally, the abbreviation Primary Dysmenorrhea is widely
understood in the world to refer to difficulties associated with
menses, and the abbreviation is used frequently even in casual
and conversational settings, without regard to medical rigor. In
these contexts, the syndrome is rarely referred to without
abbreviation, and the intensions of the reference are frequently
broader than the clinical definition. The misery is going on
endlessly. Thanks we have the solution.
11. Conclusion
Ayurveda views Primary Dysmenorrhea as a doshic imbalance
that can potentially be impacted through balanced living that is
characterized by dosha appropriate diet, herbal supplements,
exercise, routine, yoga, meditation, as well as nourishing
inputs through all five senses.
12. Reference
1. Rao KA. Textbook of Gynaecology. Vol. II Elsevier, a
division of reed Elsevier India Pvt. Limited, India, 2008,
37.
2. Srikantha Murthy KB. Astanga Hrdayam, Krishnadas
Academy, Varanasi, 2001, 357.
3. Sharma RK, Dash B, Caraka Samhita, Chowkhamba
Sanskrit Series Office, Varanasi 2003; 5:185.
4. Sharma PV, Sushruta Samhita. Chaukhambha
Visvabharati, Varanasi 2000; l.2:6.
5. Williams MA. A Sanskrit English Dictonary, Bharatiya
Granth Niketana, New Delhi, 2007, 266.
6. Sharma RK, Dash B, Charaka Samhita, Chowkhamba
Sanskrit Series Office, Varanasi 2001; 5:158.
7. Srikantamurthy KB. Bhavaprakasa, Krishnadas Academy,
Varanasi 1998; 2:782.
8. Sharma RK, Dash B, Charaka Samhita. Chowkhamba
Sanskrit Series Office, Varanasi, 2003; 5:135.
9. Srikanthamurthy KB, Ashtanga Hrdayam. Krishnadas
Academy, Varanasi 2001; l.1:361
10. Sharma RK, Dash B, Charaka Samhita. Chowkhamba
Sanskrit Series Office, Varanasi 2004; 5:84.
11. Kumar P, Malhotra N. Jeffcoate’s Principles of
Gynaecology., Jaypee Brother Medical Publishers (P) Ltd,
New Delhi, 2008, 79
12. Dutta DC. The text book of Gynecology, New central
book Agency (P) LTD, Kolkata, 2007, 74.
13. Dorland’s illustrated Medical Dictionary.
14. Speroff L, Glass RH, Kase NG. Menopause and the
perimenopausal transition. In:. Clinical Gynecologic
Endocrinology and Infertility, 6thed Baltimore: Lippincott
Williams & Wilkins, 1999, 643-724.
15. Harel ZA. Contemporary approach to dysmenorrhea
inadolescents. Paediatr Drugs 2002; 4:797-805.
16. Lewis RJ, Wasserman E, Denney NW, Gerrard M. The
etiology and treatment of primary dysmenorrhea: A
review. Clin Psychol Rev 1983; 3:371-389.
17. Beckman CR. Obstetrics and Gynecology. 4th ed.
Lippincott Williams and Wilkins, Philadelphia 2004, 234.
18. Drife J, Magowan B. Clinical Obstetrics and Gynecology.
4th ed. Edinburgh Sounder, London, 2004, 203-215.
... The oleo-gum-resin extracted from Ferula assfoetida contains about 40-64% resin, 25% endogenous gum, 10-17% volatile oil and 1.5-10% ash. Its resin fraction consists of ferulic acid esters, free feruli acid, umbelliferone and coumarin derivatives such as foetidin and kamolonol, farnesiferoles A, B, and C. The compositions of its gum fraction are known to be glucose, galactose, L-arabinose, rhamnose and gluronic acid (6). ...
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Dysmenorrhea is one of the most common clinical problems observed in regular practice and it is a medical condition of pain during menstruation that interferes with daily activities. Dysmenorrhea can be correlated with Karppa vayu in Siddha Medicine. An attempt has been made to treat the dysmenorrhea with Siddha system of medicine. A single blind comparative clinical study was conducted to evaluate the efficacy of Ferula asafoetida resin powder on Karppa vayu (Primary dysmenorrhea) in comparison with standard drug (mefenamic acid). Forty patients with Karppa vayu disease were selected systematically. The Selected patients were divided into 4 groups of 10 each. The groups A and B were treated with Ferula asafetida resin powder, orally, thrice a day 650mg and 500mg respectively with the onset of pain, for 3 continuous menstrual cycles. The group C and D were treated by standard drug of 500mg of mefenamic acid, orally, thrice a day from onset of pain for 3 continuous menstrual cycles. Encouraging results were observed with the trial drug and when comparing Ferula asafetida resin powder and mefenamic acid for severe pain, the 650mg of Ferula asafetida resin power and 500mg of mefenamic acid both are statistically significant relief the pain because the P values <0.005. The P-value of 650mg of Ferula asafetida resin powder and 500mg of mefenamic acid was 0.000 and 0.001, respectively. When comparing Ferula asafetida resin powder and mefenamic acid for moderate pain, the 500mg of Ferula asafetida resin powder and 500mg of mefenamic acid both are statistically significant relief the pain because of the P-value <0.005. The p-value of both groups is 0.000. In the present study, Ferula asafetida resin powder can be used as a highly effective internal administrative medicine for Karppa vayu.
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Dysmenorrhoea is the most common problem experienced by many women which have signs and symptoms like mild to severe abdominal pain along with vomiting, diarrhoea, giddiness which disturbs day-today activities. Suppression of natural urges (vegadharana) is one of the leading causes of dysmenorrhoea. There is a high need to educate women about the importance of food, nutrition, attending natural urges, daily regimen (dinacharya) for the maintenance of gynaecological health. The study aims to evaluate the effect of the suppression of natural urges (vegaavarodha) and its role in causing dysmenorrhoea (udavartini). The secondary objective was to study the effect of ayurvedic uterine drugs like dashamoolaksheerapaka with latakaranja masi in dysmenorrhoea. This was a single-blind clinical trial on 110 patients diagnosed with primary dysmenorrhoea. This study included counselling of patients, education about menstrual hygiene, food habits, non-suppression of natural urges, and use of ayurvedic treatment i.e. dashamoolaksheerapaka 100 ml twice daily for 3 months and latakaranjamasi (Caesalpinia crista) 300 mg twice daily for 10 days before menstruation. The study showed, overall moderate improvement in subjective parameters of the dysmenorrhoea which were abdominal pain (60.91%), decrease in the duration of pain (59.37%) and quantity of menstrual flow (60.01%), improvement in consistency of menstrual flow with reduced clots (69.11%). Counseling and education about the non-suppression of natural urges play a significant role in the prevention of dysmenorrhoea (udavartini). The study drug Dashamoolaksheerapaka along with Latakaranja masi showed moderate improvement in subjective parameters of dysmenorrhoea.
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This paper is a review of the literature regarding the etiology and treatment of primary dysmenorrhea. The review is organized around the four basic theoretical approaches that have guided research in the area: the anatomical approach, the psychological approach, the biochemical approach, and an interactive (psychological and physiological) approach. A critical analysis of the research on both etiology and treatment is presented, and methodological problems and issues in research on dysmenorrhea are examined. Suggestions for future research are also presented
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Dysmenorrhea is the most common gynecologic complaint among adolescent girls. Despite progress in understanding the physiology of dysmenorrhea and the availability of effective treatments, many adolescent girls do not seek medical advice or are undertreated. Dysmenorrhea in adolescents is usually primary (functional), and is associated with normal ovulatory cycles and no pelvic pathology. In approximately 10% of adolescents with severe dysmenorrhea, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins from the second series and potent leukotrienes from the fourth series play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea in adolescents followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered combined estrogen/ progestin oral contraceptive pills for three menstrual cycles. Adolescents with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. Adolescent care providers have the important roles of educating adolescent girls about menstruation-associated symptoms, as well as evaluating and effectively treating patients with dysmenorrhea.
  • K B Srikantha Murthy
Srikantha Murthy KB. Astanga Hrdayam, Krishnadas Academy, Varanasi, 2001, 357.
Jeffcoate's Principles of Gynaecology
  • P Kumar
  • N Malhotra
Kumar P, Malhotra N. Jeffcoate's Principles of Gynaecology., Jaypee Brother Medical Publishers (P) Ltd, New Delhi, 2008, 79
The text book of Gynecology
  • D C Dutta
Dutta DC. The text book of Gynecology, New central book Agency (P) LTD, Kolkata, 2007, 74.
  • K A Rao
Rao KA. Textbook of Gynaecology. Vol. II Elsevier, a division of reed Elsevier India Pvt. Limited, India, 2008, 37.
  • R K Sharma
  • B Dash
  • Caraka Samhita
Sharma RK, Dash B, Caraka Samhita, Chowkhamba Sanskrit Series Office, Varanasi 2003; 5:185.
  • R K Sharma
  • B Dash
  • Charaka Samhita
Sharma RK, Dash B, Charaka Samhita, Chowkhamba Sanskrit Series Office, Varanasi 2001; 5:158.