A case study on effectiveness of bhavita churna of Asoka twak in Premenstrual Syndrome

Abstract

Premenstrual syndrome (PMS) is a disease characterised by manifestation of physical and psychological symptoms in females. It is a disorder of unknown etiology that recurs in the luteal phase of an ovulatory menstrual cycle. In Ayurvedic perspective, vitiation of tridoshas particularly vata can be observed in the pathogenesis of PMS. The Asoka - Saraca asoca (Roxb.) de Wilde has got vedanasthapana, pittakaphahara and sokanasana karma which implies that it can cure both somatic and affective symptoms. Bhavana includes processing of churna with liquid extracts to increase the potency. A clinical case of premenstrual syndrome has been selected to study the effectiveness of bhavita churna (processed powder) of stem bark of the drug. The treatment was conducted in the luteal phase (14 days prior to menstruation) for three menstrual cycles and a follow up was also carried out for another three consecutive menstrual cycles. There was significant reduction in symptoms as assessed through Premenstrual Syndrome Scale after 3 cycles of treatment when compared to before treatment. The effect sustained even after follow up. The Asoka - Saraca asoca (Roxb.) de Wilde stood as an effective drug for relieving physical and psychological symptoms observed in PMS. Key words: Asoka, Premenstrual Syndrome, bhavita churna, vedanasthapana, sokanasana

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International Journal of Ayurvedic Medicine, Vol 13 (1), 238-242
Published online in http://ijam.co.in
ISSN No: 0976-5921
Case Report
Key Words: Asoka, Premenstrual Syndrome, Bhavita churna, Vedanasthapana, Sokanasana.
Introduction
Premenstrual syndrome is a cluster of symptoms
appearing prior to the onset of menstruation. It is a
cyclical disorder of severe physical and emotional
distress. It appears specifically during the post-
ovulatory phase of female reproductive cycle and
disappears once menstruation begins. The reproductive
years of many women are punctuated with distressing
premenstrual symptoms that can disrupt their quality of
life and relationships. It is more common in women
aged 30-45 years.
The alteration in estrogen-progesterone ratio,
decrease in serotonin level, decreases in GABA level,
decrease in endorphin level during the luteal phase are
postulated theories for etiology of PMS. More than 150
symptoms are characterized in PMS. The symptoms are
mainly related to water retention like abdominal
blo a t ing, breast t ender n e ss, a bdomi n a l pain ,
neuropsychiatric symptoms including irritability,
depression, mood swings, tension and behavioral
symptoms consisting of fatigue and insomnia. (1)
The diagnostic methodology of Premenstrual
syndrome is still evolving. There is no physical
examination technique or laboratory test that currently
identifies PMS correctly. American College of
Obstetricians and Gynecologists (ACOG) has clearly
stated diagnostic criteria for PMS. Patient should report
1 of the following affective and somatic symptoms
during the 5 days before menses in each of 3 prior
me nstru al cycle s. Affec tive sym ptoms include
depression, angry outburst, irritability, anxiety,
confusion, social withdrawal. Somatic symptoms
incl ude b reast tend erness, ab dominal bl oating,
headache, swelling of extremities. (2)
Different questionnaires are accessible to
quantify the symptoms. The Premenstrual syndrome
scale is one among them intended to measure the
severity of premenstrual symptoms which was used in
the present study. The Premenstrual Syndrome Scale
(PMSS) consists of 40 questions with three sub-scales
(Ph ysio l ogic al, P sych olog i cal and Beha v iora l
symptoms). Physiological symptoms: Breast tenderness
and swelling, Abdominal bloating, Weight gain,
Headache, Dizziness/ Fainting, Fatigue, Palpitations,
Pelvic discomfort and pain, Abdominal cramps,
Ch ang es in b owe l h abits, Inc rea sed app eti te,
Generalized aches and Pains, Food cravings, Skin
changes, rashes and pimples, Nausea/ Vomiting,
Mu scl e/ Joi nt Pai n. Psy cho logical Symptoms:
A case study on effectiveness of bhavita churna of Asoka twak in
Premenstrual Syndrome
Ardra Ajayakumar1*, Shincymol V V2, Ansary P Y3, Sara Moncy Oommen4
1. PG Scholar, 2. Associate Professor, 3. Professor & HOD, Department of Dravyaguna Vijnana,
Government Ayurveda College, Tripunithura.
4. Professor & HOD, Department of Dravyagunavijnana, Government Ayurveda College, Kannur.
Kerala University of Health Sciences, Thrissur, Kerala.
Abstract
Premenstrual syndrome (PMS) is a disease characterised by manifestation of physical and psychological
symptoms in females. It is a disorder of unknown etiology that recurs in the luteal phase of an ovulatory menstrual
cycle. In Ayurvedic perspective, vitiation of tridoshas particularly vata can be observed in the pathogenesis of PMS.
The Asoka - Saraca asoca (Roxb.) de Wilde has got vedanasthapana, pittakaphahara and sokanasana karma which
implies that it can cure both somatic and affective symptoms. Bhavana includes processing of churna with liquid
extracts to increase the potency. A clinical case of premenstrual syndrome has been selected to study the effectiveness
of bhavita churna (processed powder) of stem bark of the drug. The treatment was conducted in the luteal phase (14
days prior to menstruation) for three menstrual cycles and a follow up was also carried out for another three
consecutive menstrual cycles. There was significant reduction in symptoms as assessed through Premenstrual
Syndrome Scale after 3 cycles of treatment when compared to before treatment. The effect sustained even after
follow up. The Asoka - Saraca asoca (Roxb.) de Wilde stood as an effective drug for relieving physical and
psychological symptoms observed in PMS.
238
* Corresponding Author:
Ardra Ajayakumar
PG Scholar,
Department of Dravyagunavijnana,
Government Ayurveda College, Tripunithura.
Kerala. India
Email Id: ardraajayakumar@gmail.com

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Ardra Ajayakumar et.al., A case study on effectiveness of Bhavita churna of Asoka twak in Premenstrual Syndrome
Published online in http://ijam.co.in
ISSN No: 0976-5921
Irritability, Anxiety, Tension, Mood swings, Loss of
concentration, Depression, Forgetfulness, Easy crying/
crying spells, Sleep changes (Insomnia/ Hypersomnia),
Confusion, Aggression, Hopelessness Behavioral
symptoms: Social withdrawal, Restlessness, Lack of
self -control, Feeling guilty, Clumsiness, Lack of
interest in usual activities, Poor judgement, Impaired
work performance, Obsessional thoughts, Compulsive
behavior, Irrational thoughts, Being over sensitive. Each
symptom will be assessed and provided with scores as
follows. Never: 1, Rarely: 2, Sometimes: 3, Very often:
4, Always: 5. Rating of each item should be done from
1 (not present or no change from usual) to 5 (extreme
cha n g e , p e r h aps no t i c e a b le e ven to ca s u a l
acquaintances). In addition, the total score obtained
from the sub-scales forms the PMSS total score/ actual
score. (3)
Table 1: Premenstrual Syndrome Scale total score
On the basis of analysis of dosha involved in
symptom manifestation, predominantly vitiation of vata
and aggravation of pitta can be observed in the
pathogenesis with involvement of rasavaha, raktavaha
and manovaha srotases.
The Asoka - Saraca asoca (Roxb.) de Wilde is a
drug that exhibits its action especially in women. (4) It
directly pacifies pitta. (5) The drug can mitigate
unpleasant sensation and brings back body to normalcy
owing to its analgesic activity (vedanasthapana karma).
(6) It is described as one capable of relieving sorrow
(sokahara). (7) The drug has enough potential to
provide relief from physical and emotional symptoms
seen in Premenstrual syndrome. In Nighantu Adarsha
and in Ayurvedic Pharmacopoeia of India, the useful
part is specially mentioned as its stem bark. (8,9) So,
the stem bark of the drug was chosen for the study.
Bhavana is a process through which one can
potentiate the powder or decrease its toxicity. One can
increase the therapeutic efficacy of a drug and thereby
decrease the dose through bhavana. (10)
The analgesic and CNS depressant activity of
stem bark the drug has been observed from a previous
experimental study. Therefore, a study was conducted to
evaluate the effectiveness of bhavita churna (processed
powder) of stem bark of Asoka -Saraca asoca (Roxb.)
de Wilde clinically in a patient with Premenstrual
Syndrome.
Materials and methods
Preparation of medicine
The bhavita churna (processed powder) of stem
bark of the drug was prepared according to the bhavana
procedure told in Bhaishajya ratnavali. As per the
reference, fine powder of the drug should be soaked in a
suitable liquid at night and then dried in the sunlight
during day time. This process has to be repeated for 7
days. (11) In the present study, the churna (powder) of
dried stem barks of Asoka -Saraca asoca (Roxb.) de
Wilde was soaked in kashaya (decoction) prepared of
its own stem bark, kept undisturbed (without trituration)
for a whole night and dried under sunlight the next day.
After properly dried, it was then finely powdered to
remove lumps. The next day the processed churna was
immersed in freshly prepared kashaya and the whole
procedure was repeated. The entire procedure was
conducted for 7 times and powdering of drug was done
after each bhavana. The finely powdered bhavita
churna (processed powder) were then filled in capsules
with 500 mg in each.
Methodology of study
The patient was included based on ACOG
diagnostic criteria for PMS. (2) The severity of
symptoms was assessed before initiating treatment
using Premenstrual Syndrome Scale (PMSS). (3)
Treatment was provided during luteal phase /post-
ovulatory phase, ie, 14 days prior to onset of menstrual
bleeding in continuous 3 menstrual cycles. The
assessment using PMSS was conducted after 3
consecutive cycles of treatment. A follow up of patient
was conducted for next consecutive 3 menstrual cycles
and assessment was also taken using PMSS. No specific
dietary or lifestyle restrictions were advised to the
patient.
Case report
A 32 years old married women attended Out
Patien t D e p artment o f Dravyagun a Vi j n a n a,
Govern m e n t Ay u r veda C o l l e g e , Tripunith u r a
complaining of fatigue, pelvic pain radiating to legs,
abdominal cramps, change in bowel habits, increased
cravings for sour and cold food items, appearance of
skin rashes, irritability, anxiety, tension, mood swings,
loss of concentration, depression, tendency to cry for
small causes, aggression, hopelessness, tendency to sit
alone, restlessness, lack of self-control, guilty feeling,
carelessness, lack of interest in usual activities,
impaired work performance, obsessional and irrational
thoughts, compulsive behavior and being over sensitive
during 5 days prior to the onset of menses since 2012.
There was no history of any hormone ingestion, intake
of nutritional and herbal supplements, drug or alcohol
abuse or any severe relationship problem. The
appearance of symptoms was confined to the late luteal
phase and diminished with the onset of menstrual
Premenstrual Syndrome Scale (PMSS)
Level of symptoms
Actual
scores
Percentage
of scores
No
symptoms
-
1-40
< 20
Mild
Only slightly
apparent
41-80
21-40
Moderate
Aware of
symptoms, but it
doesn’t affect daily
activity at all
81-120
41-60
Severe
symptoms
Continuously
bothered by
symptoms
121-160
61-80
Very severe
symptoms
Symptom is
overwhelming and/
or interferes with
daily activity
161-200
> 80
239

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International Journal of Ayurvedic Medicine, Vol 13 (1), 238-242
Published online in http://ijam.co.in
ISSN No: 0976-5921
bleeding. She took medicine for the above complaints 1
year before and got no improvement. She did not have
any gynecological, psychological, thyroid disorders.
She had neither undergone any surgical interventions.
She also reported similar symptoms especially change
in bowel habits and pelvic pain for her sister. Menstrual
history revealed that the patient attained menarche at
the age of 13 years. The menstrual cycles appeared
regularly every 28 days and bleeding was observed for
5-7 days. The patient was having moderate amount of
blood loss along with clots. She experienced severe pain
both during premenstrual and initial 1-2 days of
menstrual period. She reported the obstetric history with
two normal vaginal delivery and one miscarriage. No
abnormality was detected following general, physical
and systemic examinations except for presence of
pallor. The Dasavidha pareeksha and Ashtastana
pareeksha revealed normal findings except for
involvement of vitiated vata, pitta and rasa dhatu. Poor
abhyavaharana sakti (inability to consume adequate
amount of food) was also reported by patient. The
patient was diagnosed with Premenstrual syndrome
based on ACOG diagnostic criteria for PMS. Informed
consent was obtained from the patient prior to inclusion
in the present study.
Treatment
The patient was provided with capsules filled with 500
mg of bhavita churna (processed powder) of stem bark
of Asoka – Saraca asoca (Roxb.) de Wilde and advised
to take 2 capsules thrice daily after food along with 1
glass of luke warm water during 14 days prior to the
onset of menstrual bleeding. The medicine was
provided for 3 consecutive menstrual cycles and a
follow up was conducted for next consecutive 3
menstrual cycles.
Observations
There was significant reduction in symptoms as
the total PMS score decreased after treatment when
compared to before treatment. There was further
reduction in severity of symptoms after follow up when
compared to after treatment. The level of symptom was
severe as reported by patient before treatment which
changed to mild after treatment which even sustained
after follow up.
Table 2: Change in actual score of PMSS in patient
Discussion
The drug Asoka - Saraca asoca (Roxb.) de Wilde
is indicated in vedanasthapana dasemani by Acharya
Caraka which means the drug is capable of pacifying
vedana (painful sensation) of sareera (body). (6) In a
previous research work conducted by Dr. Asha S Raj on
analgesic activity of stem bark of the drug, spasmodic
pain similar to dysmenorrhea had been achieved by
imparting peritoneal irritation using acetic acid solution
in female Wistar-albino rats and the study came up with
dose dependent significant analgesic activity. The
analgesic property can be attributed to alkaloids,
flavonoids, sterols, catechol and salicylates present in
bark. Inhibition of prostaglandin synthesis by synergic
action of these phytoconstituents were also postulated in
the above study. (12) The analgesic property of the drug
can be applied in physical symptoms such as pelvic
discomfort and pain, abdominal cramps, headache,
muscle/ joint pain and generalized aches and pains
experienced by the patient.
The drug Asoka - Saraca asoca (Roxb.) de Wilde
is a potent source of phytoestrogens which exhibits
estrogen-mimicking action. The stem bark of the drug
was evaluated for estrogenic activity in bilaterally
ovariectomized Swiss albino rats and revealed
estrogenic activity on account of restoration of estrous
cycle as well as restoration of endometrial lining and
glands. (13) The estrogen is considered as nature’s
psychoprotectant. In a research review on estrogen
control of central neurotransmission, it is mentioned
that low levels of estrogen in women are associated
with premenstrual syndrome, postnatal depression and
post-menopausal depression. (14) Estrogen stimulates
increase in dopamine receptors in the striatum and also
effects in significant increase in density of serotonin
binding sites in areas of brain concerned with the
control of mood, mental state, cognition, emotion and
behavior. In the luteal phase of women with PMS, a
decrease in serotonin level has been reported in
association with a drop in estrogen level. By restoring
estrogen levels by providing the drug, serotonin level
might have increased and pacified symptoms like
depression, hopelessness, anxiety. (15)
The stem bark of Asoka - Saraca asoca (Roxb.)
de Wilde has minerals like calcium which has shown
benefits in relieving symptoms like irritability, anxiety
and cramps. (16) Exposure to stressful life events is an
im porta nt risk factor for the de velop ment of
psychological and behavioral symptoms of PMS. In an
experimental study, rats were submitted to chronic
stress through corticosterone injections and chronic
administration of catechin, a phytoconstituent is present
in stem bark of Saraca asoca (Roxb.) de Wilde could
decrease depression and anxiety-like behaviors. (17)
These properties might have resulted in reduction of
symptoms in patient.
The pharmacological actions of a drug can be
explained through the pharmacological properties
(rasapanchaka) of the drug. The drug Asoka - Saraca
asoca (Roxb.) de Wilde has kashaya -tikta rasa, laghu-
ruksha guna, seeta veerya and katu vipaka according to
Ayurvedic classics. The kashaya rasa purifies rakta
(asra visodhanam) by its deepana (increases digestive
fire) and pachana (corrects digestion) property. (18)
Based on these, the drug may cure skin changes, rashes
and pimples seen during premenstrual phase. Kashaya
rasa pacifies aggravated pitta dosha by its ruksha and
seeta guna. Kashaya rasa has grahi (constipating)
Premenstrual
Syndrome Scale
Score
Level of
symptoms
Actual
scores
Percentage
of scores
Before treatment
Severe
135
67.5
After treatment
Mild
51
25.5
After follow up
Mild
46
23.0
240

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Ardra Ajayakumar et.al., A case study on effectiveness of Bhavita churna of Asoka twak in Premenstrual Syndrome
Published online in http://ijam.co.in
ISSN No: 0976-5921
property by which it may cure the increased laxity of
bowel during premenstrual phase. (19)
Tikta rasa is also mentioned as raktagadapaha
(pacifies diseases of blood origin). (20) It is medhya
which accounts for its action on brain which possesses
r e c e pt o r s o f s t e r o i d h o rm o n e s a s w e l l a s
neurotransmitters. The medhya property helped to get
relief from loss of concentration, obsessional and
irrational thoughts, lack of self-control, feeling guilty
seen in PMS. Tikta rasa pacifies aggravated pitta dosha
by its ruksha guna and seeta veerya. (21)
The laghu guna of the drug helps for easy
digestion (ama pachana) and kindling of digestive fire
(agni deepana). The laghu guna accounts for normal
functioning of pachaka pitta and samana vata in koshta.
On account of this, proper rasa dhatu is formed from
ahara rasa. As artava is considered as an upadhatu of
rasa dhatu, proper dhatu parinama is an inevitable
factor for formation of sudha artava (normal menstrual
blood). The ruksha guna helps in stasis and spasm of
endometrial arterioles at the late luteal phase and
thereby causing normal anulomana of apana vata and
expulsion of artava (artava nishkramana). The normal
functioning of doshas helps in normal occurrence of
menstrual cycle (rtuchakra) and provides relief from
symptoms of Premenstrual Syndrome.
The seeta veerya is cooling and gives happiness
and comfort to mind (prahladana). It also does rakta
prasadana (makes blood pure and devoid of toxins). It
pacifies aggravated pitta dosha and helps to pacify
anger (krodha). It has sthireekarana (stabilizing) and
jeevana (enlivening) property by which it stabilizes
mental thoughts and provides relief from anxiety,
tensions, irritability and mood swings. It can reduce
neuronal excitability by virtue of its sthambana
(arresting) property and gives relief from restlessness,
lack of self-control and compulsive behavior. The katu
vipaka helps to pacify aggravated kapha dosha seen in
symptom like social withdrawal.
As a whole, on analyzing the physiological,
psychological and behavioral symptoms of PMS, an
involvement of tridoshas can be considered with a
predominance of vatika and paittika symptoms over
kaphaja symptoms. Among all, vitiated vata plays the
crucial role in a majority of symptoms in Premenstrual
syndrome. The symptoms mostly relate to vitiated vata
and aggravated pitta dosha. The drug pacifies
symptoms caused by pitta on account of its kashaya,
tikta rasa and seeta veerya. The drug Asoka [Saraca
asoca (Roxb.) de Wilde] also normalizes symptoms
caused by vitiated vata by its vedasthapana property.
Conclusion
The bhavita churna of Asoka – Saraca asoca
(Roxb.) d e Wilde w a s c a p able o f r e d u c ing
physiological, psychological and behavioral symptoms
experienced by the patient. The drug might have been
reduced the symptoms owing to its vedanasthapana
property as well as sokahara karma. Currently there is
scarcity of an effective medicine with minimal side-
effects that corrects physical and psychological
symptoms in one hand. Asoka - Saraca asoca (Roxb.)
de Wilde is a promising drug that possesses action at
different levels, in somatic functions and in higher
mental functions. There was significant reduction in
symptoms after treatment and the effect of treatment
sustained even after follow up.
Acknowledgement
I express my whole-hearted gratitude to Dr.
Shincymol V V MD (Ay), Associate Professor,
Department of Dravyaguna Vijnana, Government
Ayurveda College, Tripunithura for her support and
guidance in completing this work. My deep respect to
Dr. P Y Ansary MD (Ay) PhD, Professor and HOD,
Department of Dravyaguna Vijnana, Government
Ayurveda College, Tripunithura for his meticulous
guidance. I am grateful to Dr. Sara Moncy Oommen
MD(Ay), Professor & HOD, Department of Dravyaguna
Vijnana, Government Ayurveda College, Kannur for her
timely advice and suggestions. I would like to express
my sincere gratitude to Dr. Sethu R MD (Ay), Assistant
Professor, Departm ent of Dravyaguna Vijna na,
Government Ayurveda College, Tripunithura and Dr.
Mridula M K MD (Ay), Assistant Professor, Department
of Dravyaguna Vijnana, Government Ayurveda College,
Tripunithura, Dr. Ashima K Sasidharan, Former
Assistant Professor, Department of Dravyaguna
Vijnana, Government Ayurveda College, Tripunithura
for their constant support and help in completing this
work. I would also like express my gratitude to the
statutory authority of the Kerala University of Health
Sciences, Thrissur, Kerala for the valuable support and
facilities provided for the completion of the work.
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