Kulkarni Shilpa A.

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA
KASHAYA AND LASUNADI VATI IN ARTAVA KSHAYA”
BY
Dr. Shilpa A. Kulkarni. B.A.M.S.
Dissertation submitted to the Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka
In partial fulfillment of the requirements for the degree of
MASTER OF SURGERY (Ayu)

In
“PRASOOTI TANTRA AND STREE ROGA”
UNDER THE GUIDANCE OF
Dr. RAMADEVI G. M.D. (AYU)

Asst. Professor
P. G Studies Dept of Prasooti Tantra and Stree Roga .
DEPARTMENT OF POST GRADUATE STUDIES IN

PRASOOTI TANTR AND STREE ROGA
S.D.M. COLLEGE OF AYURVEDA, UDUPI – 574118
2009 -2010

Dedicated To My Parents

With Lots
Of
Love & Respect.

ACKNOWLEDGEMENT
First and foremost I pray to the almighty God, who is omnipresent,

omniscient and omnipotent. This unforgettable moment of contentment on the successful
completion of this dissertation work which is a milestone, I bow my head at the feet of the Almighty
Lord Ganesha, Yallamma devi & Renukadevi.
My deep sense of gratification is due to my parents Dr. Ashok Kulkarni &

Dr.(Mrs).Jyoti Kulkarni who are the architects of my career. I am highly indebted to my
parents who have played a valuable role in molding my thoughts towards higher studies with a
constant showering of affectionate blessings which are the driving forces behind my work. With lots
of love and regards the boundless encouragement of my brother Mr.Amit Kulkarni.
Who has motivated me towards this course.
I am grateful to my maternal aunt Mrs Neeta Tambolkar for her valuable support & always
encouraging me.
It is indeed my fortune to have carried out this dissertation work at Sri Dharmasthala
Manjunatheshwara College of Ayurveda, Udupi. In this regard, I would like to express my heart felt
gratitude to Honorable Dr. D. Veerendra Heggde Dharmadhikari Sri Kshetra Dharmasthala,
President of Sri Dharmasthala Manjunatheshwara Educational Society (Regd) for his courtesy, grace
and blessing to carry out this work .
I feel myself very lucky to carry out this dissertation work under the
valuable guidance of Dr.G.Ramadevi, Asst. Professor who has helped me in each &
every step in all respects. Her prompt suggestions, optimistic view & motherly
affection showered on me during this whole period & inspired me to accomplish
this work in all respect.
I am deeply thankful to Dr. Usha V.N.K. Prof. & HOD, Department of Prasuti Tantra and
Streeroga, of SDM College of Ayurveda, for her concern and generosity towards the dissertation work.
I sincerely express my deep sense of gratitude to Dr. Mamatha K.V. Professor Department of
Prasuti Tantra & Streeroga for support towards my work, providing me valuable knowledge and
giving exposure to practical aspects of the subject.
I extend my heartful thanks to Dr. Suchetha and Dr. Vidya Ballal Department of Prasuti
Tantra & Streeroga for the support & concerned towards my work.
I express gratitude to Dr. Veena Mayya.and Dr. Krishna Bai. for their guidance towards the
subject.
I am grateful to Dr. U. N. Prasad, Principal, S.D.M. College of Ayurveda, Udupi invaluable
support & guidance for completion of my work.
I sincerely thank Dr. Shrikanth U. Dean of PG Studies and Dr. U. Govind Raju Co-Dean of
PG Studies for the support throughout my work.
My gratitude to Dr. Y. N. Shetty, Superintendent SDM Ayurveda Hospital, Udupi for
support.
I sincerely thank Dr. Jonah. Asst Professor Department of Kayachikitsa for valuable support
and guidance during my work.
My thanks to Mr. Harish Bhat librarian, & other library staff for there generous help during
the course of the study.
I express my indebted gratitude towards my friends Dr. Vijayalakshmi, Dr. Sujata, Dr.
Sukanya, Dr. Kavya, Dr. Shubha. for there timely valuable support & suggestions.
I am thankful to my friends Dr. Keertan, Dr. Rathod, Dr. Vijayashankar for their support &
timely help.
I cannot move further before thanking my roommates Varsha, Deepti &
Shruthi who not only helped me but stood by me during hours of stress and
dejection.
Last but not least I am grateful to all my classmates and friends who have directly or
indirectly supported and helped me through out the work.
I am thankful to all my patients for their cooperation through out the study, who are
pillars of my research work.
Dr. Shilpa.
LIST OF ABBREVIATIONS –
1. Ca.S- CARAKA SAMHITHA
2. Su.S - SUSHRUTA SAMHITHA
3. A.S - ASTANGA SANGRAHA
4. A.H - ASTANGA HRUDAYA
5. Dh.N - DHANWANTARI NIGHANTU
6. Bp.N - BHAVAPRAKASHA NIGHANTU
7. Rj.Ni - RAJA NIGHANTU
8. Ma.Ni - MADANAPALA NIGHANTU
9. Sh.S.Ma. Kh - SHARANGADARA SAMHITA
MADHYAMA KHANDA.
10. Kai.N- KAIYADEVA NIGHANTU
11. Y.R- YOGA RATNAKARA
12. Sa.N- SALIGRAMA NIGHANTU
13. BT- BEFORE TREATMENT
14. AT- AFTER TREATMENT
15. &- AND
16. %- PERCENTAGE
17. SD STANDARD DEVIATION
18. SE STANDARD ERROR
19. df DEGREE OF FREEDOM
20. d DIFFERENCE

ABSTRACT
Title -“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA AND
LASUNADI VATI IN ARTAVA KSHAYA”
Woman is symbol of beauty. ‘Beauty must not be skin deep’. It should be maintained
internally also. There are many physiological changes takes place in women’s body which is
markedly seen in the reproductive life. Menstrual cycle is such a unique phenomenon in the body
which includes dramatical monthly change in the hormones, which ends finally with the shedding
of endometrium.
If there is any alter in this phenomenon leads to menstrual irregularities which holds
attention of all research institutes to address the problem with new formulation of drugs. Thus to
make awareness about this condition with its side effects is very important.
Though, ‘Artavakshaya’ is described as a symptom in classics, but in present study it

appears like a disease. The people have come to know the importance of the reproductive health.
Thus the line of treatment selected for this study is shamana Chikitsa.
The drugs selected are agneya dravyas i:e Krishna Tila Kashaya & Lasunadi vati possess
pittavardhaka & vatakapha shamaka property.
Objectives : A conceptual study of Artava Kshaya.

To evaluate the efficacy of Krishna Tila Kashaya with Guda
To evaluate the efficacy of Lasunadi vati.
To compare the efficacy of Krishna Tila kashaya with Guda & Lasunadi vati
Study design: This research work is a single blind comparative clinical study with pre test and
post test design. 30 women presenting with pratyma lakshanas of Artava kshaya were randomly
selected and categorized into 2 groups of 15 patients each. Group A were given Krishna Tila
Kashaya and Group B were given Lasunadi vati for a period of 3 menstrual cycle & follow up for
further 3cycles
Result: These drugs showed good improvement in duration of flow, intermenstrual period,
amount of flow, changes in the pain& weight.
Key words- Reproductive life, Menstrual cycle, shedding of endometrium, Artava Kshaya,
hormonal treatment, shamana Chikitsa, agneya dravyas, Krishna Tila Kashaya, Lasunadi vati.
CONTENTS
CHAPTER NO. PAGE NO.

PART 1 INTRODUCTION 1-2
PART 2 OBJECTIVES OF THE STUDY 3
PART 3 CONCEPTUAL STUDY
3.1 Historical Review 4-5
3.2 Previous work done 6
3.3 Conceptual Study
3.3.1 Artava 7-12
3.3.2 Menstruation 13-22
3.3.3 Disease review
Artava Kshaya
9 Ayurvedic view 23-34
9 Modern view 35-42
3.4 Drug Review 43-50
PART 4 CLINICAL STUDY
4.1 Materials and Methods 51-53
4.2 Observations 54-79
4.3 Results 80-89
4.4 Discussion 90-105
PART 5 CONCLUSION 106-107
PART 6 SUMMARY 108-109
PART 7 ANNEXURE
7.1 Bibliography 110-125
7.2 Case proforma 126-130
LIST OF TABLES
Table No. List of Tables Page No.
CONCEPTUAL STUDY
1 Aharaja Hetu 25
2 Viharaja Hetu 26
3 Manasika Hetu 26
4 Anya hetu 26
DRUGS
5 Lasuna 43
6 Jeeraka 44
7 Hingu 45
8 Pipalli 46
9 Marica 47
10 Nagara 48
11 Saindhava 49
12 Jambira 49
13 Krishna Tila 50
14 Guda 50
OBSERVATION TABLES
15 Incidence According to Age 54
16 Incidence According to Marital Status 55
17 Incidence According to Habitat 55
18 Incidence According to Religion 56
19 Incidence According to Education 57
20 Distribution According to Occupation 58
21 Incidence According to Socio- Economic Status 59
22 Incidence According to Duration of Illness 60
23 Incidence According to Duration of Blood Loss 61
24 Incidence according to Intermenstrual Period 62
25 Incidence according to Amount of Blood Loss 63

26 Incidence according to Pain 64
27 Incidence according to Anubandha Vedana 65
28 Incidence according to Diet 66
29 Incidence according to Rasa Sambhandhi 67
30 Incidence according to Diet Habit 68
31 Incidence According to Mental Stress 68
32 Incidence According to Mala 69
33 Incidence According to Weight 69
34 Incidence According to Habits 70
35 Incidence According to Rajo Pravrutti 71
36 Incidence According to Varna of Artava 71
37 Incidence According to Gandha of Artava 72
38 Incidence According to Akruti 72
39 Incidence According to PallorSamhanana and Pramana 73
40 Incidence According to Shabda, Sparsha, Druk 73
41 Incidence According to Prakruti 74
42 Incidence according to Vikruti 74
43 Incidence according to Sara 75
44 Incidence according to Satva 76
45 Incidence according to Ahara Shaktikti 77
46 Incidence according to Vyayama Shakti 77
47 Incidence according to Srothas Affected 78
48 Incidence according to Tenderness in Vagina 79
49 Incidence according to Condition of Cervix 79
RESULTS TABLES
R1 Duration of flow
50 Effect within the Group A & Group B 80
51 Effect in between the Groups 81
R2 Interval between two menstrual cycle
R3 Amount of Blood loss
R4 Change in Pain
R5 Change in Weight
LIST OF GRAPHS
OBSERVATION GRAPHS
1 Incidence According to Age 54
2 Incidence According to Marital Status 55
3 Incidence According to Habitat 55
4 Incidence According to Religion 56
5 Incidence According to Education 57
6 Distribution According to Occupation 58
7 Incidence According to Socio- Economic Status 59
8 Incidence According to Duration of Illness 60
9 Incidence According to Duration of Blood Loss 61
10 Incidence according to Intermenstrual Period 62
11 Incidence according to Amount of Blood Los 63
12 Incidence according to Pain 64

13 Incidence according to Anubandha Vedana 65
14 Incidence according to Diet 66
15 Incidence according to Rasa Sambhandhi 67
16 Incidence according to Diet Habit 68
17 Incidence According to Mental Stress 68
18 Incidence According to Mala 69
19 Incidence According to Weight 69
20 Incidence According to Habits 70
21 Incidence According to Rajo Pravrutti 71
22 Incidence According to Varna of Artava 71
23 Incidence According to Gandha of Artava 72
24 Incidence According to Akruti 72
25 Incidence According to PallorSamhanana & Pramana 73
26 Incidence According to Shabda, Sparsha, Druk 73
27 Incidence According to Prakruti 74
28 Incidence according to Vikruti 74
29 Incidence according to Sara 75
30 Incidence according to Satva 76
31 Incidence according to Ahara Shaktikti 77
32 Incidence according to Vyayama Shakti 77
33 Incidence according to Srothas Affected 78
34 Incidence according to Tenderness in Vagina 79
35 Incidence according to Condition of Cervix 79
RESULTS GRAPHS
R1 Duration of flow
R2 Interval between two menstrual cycle
R3 Amount of Blood loss
R4 Change in Pain
R5 Change in Weight
Sr.no LIST OF FIGURES
1 Lasuna
2 Jeeraka
3 Hingu
4 Pipalli
5 Marica
6 Nagara
7 Saindhava
8 Gandhaka
9 Jambira
10 Lasunadi Vati
11 Krishna Tila
12 Guda
13 Krishna Tila Kashaya
Introduction

INTRODUCTION
Ayurveda, a medical system of world which is serving the ailing humanity since
the creation of life is not behind in recognizing the most pragmatic feature of a woman
viz. women are the roots of progeny. Women are considered as one of the most essential
factors of the continuity of human race. God has given this magnanimous gift only to the
women. Mother is the most sacred and beautiful word in the world but the tragedy is that
all women are not Mother. But the root of the importance of women lies in their capacity
of creation. This is the reason why the question of fertility is most important for women.
All hazards that hamper the capacity of fertility attract unique attention for cure.
For the same human being are trying to develop newer resources as well as trying
to improve the quality of life by acquiring sound health. This health can be achieved only
when all of the processes in the body are in equilibrium. The normalcy of the physical &
emotional factors also counts.
There are many normal physiological phenomenons taking place in the body
which is carried out in a cyclic manner. If there is any alteration in this will give rise to
the pathological conditions. Among all these physiological changes, menstrual cycle is
one of them. Menstrual cycle is a beautiful hormonal change that takes place every month
in women life. There is a well coordination between the hormones & the shedding of the
endometrium that takes place every month indicating the normal menstruation.
Geographical conditions, racial factors, nutritional standards, environmental

influences and indulgence in strenuous physical activity can affect hormonal status and
menstrual cycles of woman. Even on completing her family, having irregular and scanty
menstruation is continuous stress denoting hormonal aberrations. There is a sharp
increase in the incidence of same in modern age hence requires solution. A slight
deviation in the menstrual cycle which may be excessive or low is filled with fear of
some serious pathology of internal genital organs.
In the modern world, the Life style, food habit and just for unnecessary desires
have increased stress, strain and restlessness which have resultantly increased menstrual
disorders. Artava dusti is very important among gynaecological problems. Ratio of
“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

AND LASUNADI VATI IN ARTAVA KSHAYA” 2

Introduction

menstrual disorder is rising in gynaecological practice which is precursor of infertility
and other problems, so it requires more attention. Menstrual disorder affect on mental
state of women. Many Menstrual disorder i.e secondary amenorrhoea, oligomenorrhoea,
require counselling with appropriate treatment. There is an altered physiology in the
H-P-O-U axis. Hence this requires attention that can answer the rising question.
In Modern medical science Hormonal Treatment which has a good therapeutic
utility is used for menstrual disorders but this is not devoid of side effect.
So, in contemporary era it is very important to provide a particular etiopathology
and treatment for “Artavakshaya”. There are many processes and Methods available in
Ayurvedic classics to alleviate Artavakshya. But it is yet, the on going research to find
out a method of treatment, which is more near to procurance of permanent cure without
side effects. It must be easier for administration and warmly acceptable by all class of
patients.
In the classics treatment is mentioned to keep the doshas in equilibrium. It can be
achieved by
• Samshodhana – Cleansing process which is in form of Panchakarma.

• Samshamana – Palliative measures which is in form of Agneya dravyas.
Hence for the present study shamana line of treatment is selected as the medicines are
easily available, are palatable & cost effective.
For the treatment of Artavakshaya many drugs are available. In such recipes, we have
selected “Krishna Tila Kashaya ” & “Lasunadi Vati” for oral administration.


Objective of study
OBJECTIVE OF STUDY
1. A conceptual study of Artava Kshaya.

2. To evaluate the efficacy of Krishna Tila Kashaya with Guda.
3. To evaluate the efficacy of Lasunadi vati.
4. To compare the efficacy of Krishna Tila kashaya with Guda & Lasunadi vati.

Historical review
Historical review
Kaumara bhrtya is one of the Astangas of Ayurveda, Prasooti tantra & Stree roga
is included under it. But today Prasooti tantra & Stree roga is dealt as distinct specialty.
Vedic Samhita
Vedas the first written records of Indian literature contains innumerable references in
relation to stree roga.
Rigveda
Scattered reference for the treatment of anartava is found.1
Yajurveda
The reference for tila & Krishna Tila to be the uttama Tila is available.2
Athrava veda
The different drugs for the treatment of artava kshaya is available , Krishna Tila to be the
uttama Tila. 1,2
Manu smruti
The reference for rutumati is available.3 further specifies the Tila & Lasuna are useful in
production of beeja.4
Samhita period
Caraka Samhita
The reference for lasuna, jeeraka, hingu, trikatu & tila is available.
Sushruta samhita 5
About the artava kshaya its lakshana with chikitsa is available.
Acharya Dalhana explains the use of Krishna tila in artava kshaya.
The explainations for lasuna, jeeraka, trikatu & tila is found.

Historical review
Vagbhata I & II 6,7

The clinical features of artava kshaya is explained. The Astanga Hrudaya the reference
for nagara is found.
Kashyapa samhita 8
Use of lasuna is explained in Kalpastana for Pushpadusti.
Yoga Ratanakara 9
The use of Krishna tila kwath with Guda is found.
Baishaya Ratnavali
The use of Krishna tila kwatha for artava kshaya is found.
Vaidya Jeevan10
The method of preparation of lasunadivati is found.
Nighantu
Bhavaprakasha Nighantu11
A short description of Artava kshaya & use of Krishna tila along with guda is explained.
Dhanvantari Nighantu, Shodala Nighantu, Kaiyadeva Nighantu, Raja Nighantu,

Bhavaprakasha Nighantu explains about lasuna12 jeeraka13 trikatu15,16,17, hingu14, tila19.
Reference for guda is available in Raja valbha, Raja Nighantu & Nighantu Ratnakar
Reference for saindhava is available in Bhavapraksha Nighantu & nighantu Ratnakar
Reference for Jambira18 is available in Dhanvantari Nighantu, Kaiyadeva Nighantu,
Bhavaprakasha Nighantu.
Modern20
The reference for oligomenorrhoea & Hypomenorrhoea is available in almost all the text.

Previous work done
PREVIOUS WORK DONE
• A comparative clinical study on Shatapushpadi vati and Krishna Tila kwatha in artava
kshaya by Dr. Der C in G.A.U. Jamnagar in 2002.
• Management of artava kshaya with Shatapushpa curna by Dr. Archana Ghose in

Gopabandhu Ayurvedic Mahavidyalaya, Puri, Utkal University Bhubaneshwar in 2004.
• Role of Krishna Tila and Arkapushpa taila uttara basti in management of artava kshaya
by Dr. Trivedi Rujuta in G.A.U. Jamnagar in 2005.
• Effect of Satapushpa taila nasya in artava kshaya with reference to hypo and
oligomenorrhoea, Dr Nikita Sirigere in S.D.M.College of Ayurveda,Udupi, RGUHS,
Banglore in 2006.

Conceptual Study
Artava
GiÉÉæ pÉuÉqÉÉiÉïuÉqÉç, x§ÉÏhÉÉÇ rÉSmÉirÉqÉÉaÉÉïiÉç vÉÑkSqÉÏwÉiÉç
M×üwhÉÇ ÌuÉaÉlkÉÇ uÉÉrÉÑmÉëãËUiÉÇ sÉÉãÌWûiÉÇ mÉëuÉiÉïiÉã
iÉSÉiÉïuÉqÉÑcrÉiÉã || A. WØû.vÉÉ 1/1 AÂhÉ S¨É OûÏMü
Artava which is to be considered as menstrual blood is clearly explained by commentary

Arunadatta.21
Synonyms of Artava 22
Shonita,23 Asruk ,24 Raja,25 Rakta,26 Lohita,27 Rudhira,28 Pushpa 29
Artava nirmana
Artava is considered as upadhatu of rasa dhatu by all the acharyas,30,31,32,33 except
Acharya Bhavaprakasha & Sharangadhara who consider artava as upadhatu of rakta, 34,35
but no further description is available. So to consider the artava as upadhatu of rasa dhatu
holds good.
It is important to understand the utpatti of rasa dhatu according to “Dhatu Poshana

Siddhanata.”
The ahara which enters into the amasaya, gets converted into ahara rasa by the
action of Pachaka pitta, Kledaka kapha & Jataragni from which rasa dhatu is formed. By
the action of Rasa dhatvagni, Prasada bhaga & Kitta bhaga is formed. The Kitta bhaga
forms the rasa mala i:e Kapha. The Prasada bhaga again divides into Stula bhaga which
remains as rasadhatu & Sushkma bhaga helps in the formation of Uttarottara dhatu &
Upadhatu i:e artava & stanya.
Astanga Samgraha states the opinion that the blood gets collected in the
garbhasaya as artava & is expelled out every month for 3days.36
Vishvamitra’s opinion coated by Dalhana in his commentary as there are some

small capillaries present in the uterus which fill the uterus with rakta/artava for the whole
month & is expelled out every month if the conception does not occur37.


Conceptual Study
Ahara
Enters
Amasaya
Jataragni
Pachaka pitta
Kledaka kapha
Ahara rasa Kitta
Rasadhatu Mutra & Mala

Rasadhatvagni
Prasada bhaga Kitta bhaga

(Kapha)
Stula bhaga Sukshma bhaga

Remains as
Rasa dhatu Upadhatu Uttarottra dhatu
(Artava, Stnaya) (Raktadi dhatus)
Artava swarupa 38,39,40

AÉiÉïuÉqÉÉalÉãrÉqÉç | xÉÑ.vÉÉ.3/3
Colour & lakshana of rakta is similar to that of artava i:e Gunjaphala,41 Padmalakta,41
Indragopha,41 Shashasruka, 42,44 Laksharasa, 42,43 etc.


Conceptual Study
Pitta is the predominant dosha in rakta dhatu & responsible for the agneyatva of
it. Since the artava has similarities with rakta36,39 it also gains agneyatva. But as we know
that artava is formed from the rasa dhatu which has soumya guna. So artava is soumya at
the time of formation. But at time of expulsion, it will gains agneya guna. To make it
easy to understand, Acharyas have given the simile of the Parthiva substance which
combines with the Tejas & turns as dhuma. The Ikshu rasa which initially vitiates kapha
but when it turns as phanita it becomes Tridoshakari (Su.Su.14/7 Cakrapani Tika). In the
same way, the guna of Artava changes & it gets agneyatva at the time of expulsion.
Artava pramana
The pramana of artava is 4anjali.45,46
Suddha artava lakshana 41,42,43,44

o Colour of artava resembles gunjaphala, padmalakta, indragopha, shashasruka
o Flow of artava is for 3- 5 days
o Na atibahula naatyalpa
o Character of artava – comes through the yoni every month, which is not picchila
in nature, does not cause daha & vedana, does not stains the cloth.
Prathama atrava darshana & artava nivrutti
The age or prathama rajodarshana is mentioned as 12yrears,47,48,49 16years 50
&
47,48,49
age of artava nivrutti is 50 years.
The artava is present from garbhakala,112 but it is visible only after certain time.
Jara avastha & pakwa shareera causes artava nivrutti. While explaining about the same
acharyas explain that like a bud, dry fruit & dry flower does not have fragrance in either
of a young plant or old tree, in the same way the way the artava is present in the hidden
form before prathama rajodarshana & after the rajonivrutti respectively. The fire is
present in the wood but it is generated only after certain time & efforts.50,44
The concept of Dhatuparipuranta51,52 is explained by the acharyas which will

further clear the concept of prathama rajodarshana.

Conceptual Study
WûÏlÉrÉÉãlrÉÉxiÉÑ oÉÉsÉÉrÉÉ: MüÉrÉÇ aÉcNûÌiÉ vÉÉãÍhÉiÉqÉç |

AjÉ mÉÔhÉïxuÉpÉÉuÉÉrÉÉ: MüÉrÉÇ rÉÉãÌlÉ cÉ aÉcNûÌiÉ || MüÉ. xÉÇ. ÎZÉ. 9/19
As per above reference by Kashyapa,51 as the Shukra is present from the
childhood similarly the Artava (Shonita) is also present, which is not visible due to very
minute quantity. It is be visible in Yoni after the maturation of all organs.
Here the word ‘hina yoni’ may point towards the developing female genital organ
and ‘purnaswabhavaya’ means attainment of maturity, feminine figure with formation of
menstrual blood & ovum
Acharya Bhela also believes that Dhatuparipurnata is one causative factor of
Artavapravritti.52
Artava chakra
The artava chakra is for one masa –i:e one lunar month (Chandra masa)-28days. The
entire masa is divided into 3phases.
• Rajasrava kala- 3-5days

• Rutukala- 12-16days
• Rutuvyatitakala- 9-13days
Rajasrava kala
There are different opinion regarding the time duration of rajasrava, 3days,33,48
5days,53 7days.52 Acharya Bhavamishra has added scanty flow for 16days. In this phase
there is predominance of vayu. The vayu is required for expulsion of artava from
garbhasaya54,55,56. As garbhasaya is a pelvic organ apana vata is considered to play a
major role in this regard. The artava is carried by the dhamanis to garbhasaya for the
whole month. This collected artava is carried by vayu to yoni mukha & is excreted out as
rajasrava.52,54,56
There is presence of rajovaha siras which carries the raja & expels it out every
month51.


Conceptual Study
Paricharya 42,55,57,58
9 From the first day of menstruation the rajaswala stree must follow Brahmacharya.
9 She should use bed made of darbha spread over the ground.
9 She should eat in palm leaf or unbroken utensils made up of clay.
9 She should eat little quantity of food to maintain the agni.
9 She must always use havisya 42 & yavaka.55,57
9 She must avoid diwaswapana, anjana, asrupata, snana, abhyanga, lepa,
nakhachedana, excessive laughing, talking, work or exercise, use of ornaments,
excess consumption of teekshana, katu, lavana ahara.
9 The use of nasya, vamana, swedana is contraindicated in this period.
9 On 4th day, she must bath over head, dress herself in new cloths or white coloured
dress wearing ornaments & garlands, indulge herself in pious hymns.
9 She must 1st see her husband’s face.
Rutukala
It is for the period of 12days54,59, 16 days56or it is considered for the whole month
if yoni garbhasaya is shuddha56 .
Acharya Kashayapa60 explains the kala for Brahmana’s as 12days, Ksatriya’s as

10days, Vaisaya’s 10days, Sudra’s 9days. The different opinion of rutukala from
12-16days is clarified by Acharya Dalhana by saying that the first 3 days & last one day
there is yoni sankocha, So this kala is not favorable for conception. Hence rutukala can
be considered for 12days.54
Paricharya
As explained earlier, on 4th day the woman must take bath & dress herself
beautifully & approach her husband happily & joyfully. The sexual contact must be on
even or odd days for male & female child respectively.


Conceptual Study
Rutumati stree lakshana 54,55,56,61

When the purana raja is expelled out & collection of new raja takes place which
indicates new rutuchakra. After taking bath on 4th day woman is considered shuddha. The
yoni, garbhasaya & shonita is considered as shuddha i:e free from disease this lady is
termed as rutumati.
The woman’s face looks prasanna, kledata is seen on mukha, danta, who is
interested in reading priya katha & anxious to have sexual relation. Shithilata over
kukshi, eyes & hairs is seen.
She has twitching over arms, breast, pelvis, umbilicus, thighs & hips, who is
happy & excited is termed as rutumati.
Predominance of dosha
This can be interpreted with changes in proliferative phase in which endometrium
increases in thickness. The regeneration of endometrium can be considered due to prithivi
& jalamahabhuta, which are the bhoutika component of kapha.
Acharya vagbhatta says that the use of ghrita & ksheera56 or use of taila &
masha60 which are brumhana in nature, nourishes the endometrium & further helps to
maintain the pregnancy.
Rutuvyatitakala
After sunset as the lotus closes, similarly the constriction of yoni is seen after
rutukala, so the yoni does not accept shukra for conception.54,55,56 This stage can be
compared to secretary phase of menstruatal cycle, where there is increase in production
of progesterone which has thermogenic effect, makes cervical mucus hostile & hampers
the sperm motility. In this phase the basal body temperature is increases by 0.80F. Since
the temperature & progesterone levels are increased, we can say that, this phase is
dominated by pitta.


Conceptual study
Menstruation 62,63,64,65
The menstruation is the cyclic physiological uterine bleeding out of shedding of
the endometrium due to invisible interplay of the hormones mainly through
Hypothalamus – Pituitary –Ovarian- Uterine axis. For this phenomenon to occur in
normalcy, the axis must be actively coordinated, positive response of the endometrium
towards the ovarian hormones i:e estrogen and progesterone with patent outflow tract.
• In a normal healthy woman menarche occurs at the age of 10-16yrs, 12.5yrs being
the mean.
• Cyclic menstruation persists throughout the reproductive era of life with an
average rhythm of 28±7 days, bleeding for 4-6 days.
• Normal blood loss 20-80ml, average being 35ml.
• Menstrual blood contains- endometrial debris, dark altered blood, mucus, vaginal
epithelial cells, PG enzymes and bacteria.
Physiology- 66,67,68,69
With vast hormonal interaction Neuro endocrinology is responsible for menstrual
cycle & reproductive functions in a woman.
The well established knowledge of normal menstruation, clearly states the
importance of cyclic ovarian steroid secretions which inturn is controlled by
Hypothalamus-Pituitary-Ovarian-Uterine axis in treating various gynecological disorders.
Hypothalamus-
Hypothalamus with its several nuclei & extrinsic normal connections is the
regulating factor in the chain of Hypothalamus-Pituitary-Ovarian-Uterine axis. Schally &
Guillemin in 1971 discovered a decapeptide called gonadotropin releasing factor(GnRH).
GnRH factor is secreted by median eminence & the arcuate nucleus which mediate the
neural control of gonadotropin secretion of pituitary. GnRH is released into the
hypophysial portal vessels & thus reaches pituitary.

Conceptual study
GnRH is released at the nerve endings near tuber cinereum. GnRH has a half life
of 2-4 mins. It is released in pulsatile manner into portal vessels & reaches the anterior
pituitary gland. The pulsatility & amplitude of its release varies with the various phases
of menstrual cycle.
In preovulatory phase, it pulses once in every 60 mins but slows down to one in
3hrs in luteal phase with increased amplitude of each pulse.
Higher center like temporal lobe influences the hypothalamus. Emotional upset
are known to stimulate or depress the H-P-O axis & causes menstrual irregularities.
The factors that stimulate GnRH are epinephrine estrogen & endogenous opiods
& that which inhibits are dopamine & serotonin.
Pituitary glands-
Ant.pituitary glands is located at the base of brain in a bony cavity called sella turcica
consist of 3 cells-
• Chromophobe or parent cell.
• Chromophil cells as esonophil or alpha cells.
• Basophil or beta cells.
The β cells secrete gonadotropins that control the ovarian function & menstrual cycle.
Gonadotrophins are FSH & LH.
Gonadotrophins-
These are water soluble glycoprotein of higher molecular wt. β cells secrete FSH
& LH in pulsatile manner in responsible to pulsatile GnRH. It has 2 subunit α & β. In
which α subunit is concerned with FSH, LH & hCG.
Functions of FSH
• Controls the ripening of the primordial follicle in conjunction with the LH.
• Activates the secretion of estrogen.

Conceptual study
• Activates- after cessation of menstruation.

• Peaks at 7th day of cycle.
• Declines to disappear at 18th day.
• Half life of FSH is 4 hrs.
• Estrogen suppresses FSH secretion through negative feed back mechanism.
Functions of LH-
• It activates the secretion of estrogen.
• Helps in ovulation.
• Following ovulation helps in secretion of progesterone with the help of granulose
& theca cells.
• LH surge- 24-36 hrs prior to ovulation at 75ng/ml.
Prolactin-
• Prolactin is alcoholic soluble protein (polypeptide).
• Half life is 30 mins.
• Secreted by α cells.
• Main action is lactation.
• Suppressive action on pituitary ovarian axis, hence hyper prolactinaemia causes
amenorrhoea or oligomenorhoea.
• Normal prolactin level is 25ng/ml.
Ovarian steroids-
The ovarian steroid hormones are derived from cholesterol, which include
estrogen, progesterone, testosterone & androstenedione.
Oestrogen-
C18 steroid are natural estrogen, granulose cells of graafian follicles & theca cells
being the main source & adrenal cortex the secondary source of supply.

Conceptual study
Action- Thorough binding to cytoplasmic receptor in the cells.

Conjugates as- oestrogen, oestradiol & oestriol.
Rise in level- 6-7days prior to ovulation oestradiol level rises & peaks 2 days before
ovulation.
Normal value- 50ug.
Peak level-300ug.
Progesterone-
• Source- Corpus luteum & some small amount from adrenal glands.
• Peak level in mid luteal phase about 15ng/ml with degeneration of corpus luteum
its level falls inducing menstruation.
• In anovulatory cycles progesterone is absent or is in less amount which is from
extra ovarian source.
• Excreted through- urine as sodium pregnandiol, 3-glucuronide.
• Daily production from Corpus luteum- 20-30mg.
• Excreted through urine 3-6mg/daily.
• Mid luteal phase level less than 15ng/ml suggests luteal phase defect & ovulatory
dysfunction.
Inhibin-
• It is non steroidal water soluble protein (peptide).
• Secreted by graafian follicle which suppresses pituitary FSH.
• Inhibin consist of 2 peptides A(α) & B(β).
• In graafian follicle, estrogen is responsible for secretion of inhibin which
suppresses FSH & stimulates LH secretion.
Sex hormone binding proteins (SHBP)-

Estrogen & androgen are bound to SHBP secreted by the liver & remain inactive.

Conceptual study
Thyroid hormone-
• Numerous acini & follicle are present in thyroid glands.
• TSH released from anterior pituitary stimulates the follicles to synthesis iodine
containing Thyroxine (T4) & Tri-iodothyronine (T3) these hormones are related to
body growth & metabolic needs.
• Thyroid activity has a good influence on ovarian function which alters with
thyroid dysfunction leading to menstrual disorders.
Prostaglandins
Prostaglandins are unsaturated fatty acids which are a cyclopentane ring with 20
carbon atoms.
Types
The active forms of prostaglandins are PGD2, PGE2, PGF2 .
Functions
• Elevates intracellular concentration of Ca. ions in uterine muscles.
• Prostaglandins play an important role in regulating the reproductive cycle. These
hormones also cause degeneration of carpus luteum (luteolysis). Prostaglandins
increase the receptive capacity of cervical mucosa for sperms and cause reverse
peristaltic movements of uterus and fallopian tube during coitus. This increases
the velocity of sperm transport in female genital tract.
Physiology of menstruation 66,68,70,71
It can be made easy to understand by dividing it into
• Ovarian cycle
• Endometrial cycle

Conceptual study
Ovarian cycle
It consist of
¾ Development & maturation of follicles
¾ Ovulation
¾ Formation & degeneration of corpus luteum
I. Development of follicle –Preantral phase

9 The cohort of growing follicle undergoes a process of development &
differentiation which takes place in 85days & lasts for the ovarian cycle.
9 Initial recruitment & growth of primordial follicles are not under the control of
any hormones.
9 The action of FSH over the primordial follicle starts at the follicular size of
2.5mm otherwise there is atresia. The granulose cells require FSH receptor &
grow faster than the theca cells.
9 Dominant follicle is formed by day 5-7, which contains maximum FSH receptors
& high antral concentration.
9 FSH induces LH receptors on granulosa cell of dominant cell follicle which is
necessary for LH surge to induce ovulation, lutenisation of granulose cells to form
corpus luteum & secretion of progesterone.
II. Ovulation
It is possible in following factors
Endocrine
9 LH surge-
o Peak level of estrogen 24-48hrs in late follicular phase results in LH surge
giving +ve feedback mechanism to anterior pituitary. LH surge persist for
24hrs.

Conceptual study
9 FSH surge
o 17 alpha hydroxy progesterone facilitates the +ve feedback action on
estrogen to induce FSH surge giving rise to plasminogen activator
producing plaminogen then plasmin which helps in lysis of the wall of the
follicles.
o Thus the combined effect of LH/FSH is required for maturation, rupture of
follicle & expulsion of oocyte.
Stretching factor- Passive stretching cause’s necrobiosis of the overlying tissue.
Contraction of the micro muscles due to increased local prostaglandin secretion.
III. Formation & degeneration of corpus luteum
It is divided into 4 stages.
a. Stage of proliferation
b. Stage of vascularisation
c. Stage of maturation
d. Stage of regression
After ovulation the ruptured graffian follicle develops into corpus luteum
Hormonal changes
i. LH receptor in granulosa cells in dominant follicle is induced by FSH in presence
of high levels of estrogens which leads to mid cycle LH surge to cause
luteinisation of granulosa cells & secretion of progesterone.
ii. In preovulatory phase, with increased secretion of oestradiol & 17α hydroxy
progesterone is a prerequisite for adequate corpus luteum formation.
iii. Low level of prolactin.
iv. Life span of corpus luteum is 12-14days
v. The progesterone along with estrogen secrets relaxin & inhibin.
vi. Progesterone along with estrogen from corpus luteum, maintains the growth of
fertilized ovum.

Conceptual study
Endometrial cycle
Endometrium is the lining epithelium of uterine cavity above the level of internal
os. It consist of surface epithelium, glands, stroma & blood vessels.
2 distinct division are established
1. Basal zone- stratum basalis
2. Superficial function zone
This cycle includes

i. Regeneration
ii. Proliferation
iii. Secretary
iv. Menstruation
Stage of Regeneration
Starts before menstruation & completes 2-3days after menstruation.
Stage of Proliferation
From 5-6th day of cycle upto ovulation (14th day) & is dominated by ovarian
estrogen.
Stage of Secretory
Corpus luteum liberates the combined effect of estrogen & progesterone.
Progesterone receptors are now present in endometrium which is introduced by estrogen.
This phase begin from day 15th of the cycle & ceases 5-6days prior to menstruation. The
action of the progesterone is mainly on estrogen primed endometrium.
Stage of Menstruation
The retrogressive changes in the endometrium are due to withdrawal of support of
ovarian hormone estrogen & progesterone. The regression of corpus luteum is an

Conceptual study
invariable preceding feature which with withdrawal of hormone leads to degeneration &
casting of endometrium causing bleeding.
Menstruation
The uterus is under the influence of estrogen in the initial stage and later under
combined action of estrogen & progesterone of ovarian cycle.
Menstruation occurs with the withdrawal of both estrogen & progesterone along
with the degeneration of corpus luteum. Level of the hormones fall to & below the
bleeding threshold which initiates the menstruation.
The degeneration of corpus luteum occur when the ovum is not fertilized which is
the fundamental of menstruation.
Menstruation represents breaking down & casting off of an endometrium prepared
for a pregnancy which does not materialize & so is sometimes called as ‘weeping of
disappointed uterus’.
Endometrial ischemia is due to spiral artery vascular spasm which is the effect of
withdrawal of the steroid hormones (estrogen & progesterone).
Simultaneously there is a breakdown of lysosomes & a release of proteolytic
enzymes which further promotes local tissue destruction. This layer of endometrium is
than shed leaving the deciduas basalis as the source of subsequent endometrial growth.
Prostaglandin F2α is a potent vasoconstrictor causing vasospasm & endometrial
ischemia & it produces myometrial contraction that decreases the local uterine wall blood
flow & may serve to physically expel sloughing endometrial tissue from the uterus.
Mechanism of bleeding from endometrium66,68,70,71
The degenerative changes are predominantly of vascular origin. Damage to the

arteriolar wall is due to stasis of the blood & spasm of arterioles. Phase of relaxation
leads to escape of blood out of the vessels through the damaged walls.

Conceptual study
The degenerative process is rapid & involves the compounds of functional

damaged layer. Breakdown of lysosomes causes release of proteolytic enzymes which
leads into local tissue distruction.
The bleeding occurs from broken arteries, veins & capillaries & also from the
stromal hematoma. The blood along with superficial functional layer is shed into the
uterine cavity. The blood coagulates in uterine cavity but is soon liquefied by
thrombolysins released from endometrium. Proactivators of plasminogen is present in the
endometrial tissue all the time & at the time of menstruation it is converted into activator,
probably as a result of anoxia or breakdown of tissue. As a result of fibrinolysis the
effluent from the uterus consist of altered blood, rich of calcium but deficient in
prothrombin & fibrinogen.
The expulsion of this together with fragments of endometrium is brought about by
uterine contraction.
The spasm of straight stems of endometrial arterioles is very important which may
be due to action of PGF2α released from degenerating endometrium.
The current concept of spasm, is to limit the amount of bleeding from arteriole
than the ischemic necrosis. The amount of the loss may be controlled by muscular
compression of larger arteries as they pass through the myometrium.
Endothelium & Platelet Activating Factor (PAF) are the potent vasoconstrictor.
When the endometrium breaks down, the basal layers are not involved because they are
supplied by blood vessels which come off the main arterioles proximal to the part
affected by the coiling & spasm.
Post menstrually, new arterioles grow from the old stumps just as the
endometrium grows from its basal layer. This is result of estrogen stimulus from next
ripening graafian follicle.

Disease Review
Artava kshaya
Most of the menstrual disorders have been described under the heading of asta
artava dusti, asrgdhara, artava kshaya in our classics.
The word kshaya is derived from ‘¤ÉÏ’ dhatu which means ‘to get reduced’ or ‘to cease’.
As per Acharya Caraka ‘kshaya’ means ‘hrasa’ or ‘nyunata’.72
¤ÉÏhÉÉ eÉWûÌiÉ ÍsÉXaÉÇ xuÉÇ | cÉ.xÉÔ17/62
¤ÉÏhÉÉiÉïuÉlÉÉqÉ AÉiÉïuÉxrÉ xuÉmÉëqÉÉhÉ WûÉÌlÉ | vÉoS MüÉãwÉ
When artava is reduced in quantity from its normal flow it is called as
kshinartava.
Shabad kalpadruma the meaning of ‘Alpa’ has been written as ‘kshrudra
pramana’ which is suggestive of lesser in quantity.
Artava kshaya is not explained as a disease moreover it is a symptom in some
diseases. Acharya Sushruta explains artava kshaya lakshanas under dosa dhatu mala
kshaya vriddhi vignanam in sutrastana. He explains same lakshanas under nastartava74 in
sharirastana, & anaratava49 explained according to Vagbhatta.
Acharya Caraka has not mentioned artava kshaya separately but has mentioned as
symptom of many disease.
Nidana panchaka are required for formation of vyadhi. In artava kshaya, nidana
sevana, khavaigunya, srotorodha, dosha dushya dusti & sammurchana all are seen.
All these play key role in vyadhi utpatti. Thus artava kshaya can be considered as
a disease.
Nidana
Every action in this universe is not without any cause. For production of diseases
the nidanas play a very important role.
Nidana can be divided into samanya & vishesha nidana.
Samanya nidana
•
Nidana of vinshanti yonivyapad can also be considered as nidana of artava
dusti75,75.77.
Disease Review
• mÉÔuÉÉãï uÉ×kS: mÉUÇ MÑürÉÉïSè uÉ×kSÇ ¤ÉÏhÉ¶É iÉÌ²kÉqÉç ||

A.WØû.xÉÔ11/34
Acharya Vagbhata mentions that the vruddhi & kshaya of uttaradhatu depends
upon vruddhi & kshaya of purvadhatu78.
• mÉÔuÉï: mÉÔuÉÉãïÅÌiÉuÉ×kSiuÉÉ²kÉïrÉãÎkS mÉUÇ mÉUqÉç |
iÉxqÉÉSÌiÉmÉëuÉ×kSÉlÉÉÇ kÉÉiÉÔlÉÉÇ ¾ûÉxÉlÉÇ ÌWûiÉqÉç ||
xÉÑ.xÉÔ.15/18
Acharya Sushruta in sutrastana mentioned that the rasa dhatu kshaya is one of the
causative factor for dhatu kshaya79.
• Artava is upadhatu of rasa dhatu
• urÉÉrÉÉqÉÉãÅlÉvÉlÉÇ ÍcÉliÉÉ Â¤ÉÉsmÉmÉÍqÉiÉÉvÉlÉqÉç |

uÉÉiÉÉiÉmÉÉæ pÉrÉÇ vÉÉãMüÉã Â¤ÉmÉÉlÉÇ mÉëeÉÉaÉU:||
MüTüvÉÉãÍhÉiÉ vÉÑ¢üÉhÉÉÇ qÉsÉÉlÉÉÇ cÉÉÌiÉuÉiÉïlÉqÉç |
MüÉsÉÉã pÉÔiÉÉãmÉbÉÉiÉ¶É ¥ÉÉiÉurÉÉ: ¤ÉrÉ WãûiÉuÉ: || cÉ.xÉÔ.17/76,77
Acharya Caraka explained the samanya nidana of kshaya, the same nidanas play a
very good role in artava kshaya80.
Vishesha nidana
Acharya Kashyapa while explaining about beejopaghata & pushpopaghata says
that, use of nasya during menstruation, consumption of teekshna dravya for panchakarma
procedure & use of ushna annapana by a woman with mrudukosta having received
snehana & swedana causes pushpopaghata81.
¤ÉÏhÉÇ uÉÉiÉÌmÉ¨ÉÉprÉÉqÉç | A.xÉÇ. vÉÉ.1/24
Vitiation of vata & pitta dosha causes kshina Artava82.
SÉæwÉæUÉuÉ×¨ÉqÉÉaÉïiuÉSÉiÉïuÉÇ lÉvrÉÌiÉ Îx§ÉrÉÉ: || xÉÑ.vÉÉ. 2/22
The margavarana is done by vata & kapha, thus hampering the physiological
production of artava leading to artava kshaya83.
As we know that artava is agneya in nature i:e pitta dosha pradhana. Hence the
vishesha nidana for artava kshaya can be considered as vata kapha prakopaka nidana &
pitta kshaya nidana.

Disease Review
So for proper understanding this nidana84,85 is divided into

• Aharaja
• Viharaja
• Manasika
• Abhighataja
• Anya
Aharaja hetu 84,85

Table no: 1
Vataja vitiating Pittaja vitiating Kaphaja vitiating

hetu hetu hetu
According to Atikatu, Tikta, Atikatu, Amla, Atimadhura, Lavana,

rasa Kashaya Lavana, Amla
predominant
According to Excessive Excessive Excessive

guna consumption of consumption of consumption of
Sheeta, Laghu, Ushna & Vidahi Abhishandi, Guru,
Ruksha ahara ahara Picchila ahara
According to Abhojana, ------------------- Atibhojana,

pramana of laghubhojana Adhyasana, Ajirna
ahara.
According to Excessive intake of Excessive intake of Excessive intake of

dravya Koddalaka, Mudga, Kshara, Dadhi, Pisti, Ishu, Masha,
Shyamaka, Takra, Kanji Anupa mamsa
Atishushka shaka
Viharaja hetu 84,85

Table no: 2

Disease Review
Vataja vitiating hetu Pittaja vitiating hetu Kaphaja vitiating hetu
Atiprajagarana Atapasevana Diwaswapana

Vegadharana Agni-Dhuma sevana
Ativyavaya
Ativyayama
Manasika hetu 84,85

Table no: 3
Shoka, Chinta, Bhaya Irsha, Krodha Harsha
Anya hetu 84,85

Table no: 4
Dhatukshaya, Atiraktastrava Atisantarpana,Virechana

Rogatikarshana ayoga
Abhighataja hetu 86
AÉiÉïuÉWãû ²ã iÉrÉÉãqÉÔïsÉÇ aÉpÉÉïvÉrÉ AÉiÉïuÉuÉÉÌWûlrÉ¶É kÉqÉlrÉ: |
iÉ§É ÌuÉkSÉrÉÉ uÉlkrÉÉiuÉÇ qÉæjÉÑlÉÉxÉÌWûwhÉÑiuÉqÉÉiÉïuÉlÉÉvÉ¶É ||
xÉÑ.vÉÉ. 9/12
The mula of artavavaha srothas being garbhasaya & artavavahi dhamani where
injury causes infertility, dyspareunia & amenorrhoea.
Poorvaroopa
Specific reference for the poorvaroopa is not present in the classics
Roopa73

Disease Review
AÉiÉïuÉ¤ÉrÉã rÉjÉÉãÍcÉ¨É MüÉsÉÉSvÉïlÉqÉç AsmÉiÉÉ uÉÉ rÉÉãÌlÉuÉãSlÉÉ ||

xÉÑ.xÉÔ. 15/12
The 3 cardinal features mentioned by acharya Sushruta
• Yathochittakala adarshana- Delayed menstruation
• Alpata – scanty menstrual flow
• Yoni vedana- pain in vaginal region.
Yathochittakala adarshana73-
Normal interval between 2 menstrual cycles is one month.
As explained in the classics
qÉÉÍxÉ qÉÉÍxÉ UeÉ: x§ÉÏhÉÉÇ | A.WØû.vÉÉ. 1/7
If menstrustion fails to occur by one month showing irregularity in the cycle & increased
intermenstrual period can be termed as Yathochittakala adarshana.
Alapata73
The meaning of alpa is kshudra pramana. This may be considered as reduced in
menstrual flow.
In artava kshaya both pramana & avadhi are altered from the normal i:e. 3-5days with 4
anjali pramana (35ml according to modern).
Yoni vedana73
Vitiation of vata causes yoni vedana. The vata mainly affected is apana vata. As there is
partial filling of the garbhasaya for the whole month by the sukshma keshikas due to
srothorodha. This little quantity of artava is excreted out with great difficulty causing
yoni vedana.

Disease Review
Samprapti
SÉãwÉæUÉuÉ×iÉqÉÉaÉÉïiuÉÉSÉiÉïuÉÇ lÉvrÉÌiÉ Îx§ÉrÉÉ: || xÉÑ. vÉÉ. 2/21

SÉãwÉæËUirÉÉÌS- | A§É SÉãwÉÉ: MüTüÉã uÉÉrÉÑuÉÉïiÉMüTüÉæ cÉ; lÉ iÉÑ
ÌmÉ¨ÉÇ, ÌmÉ¨ÉuÉ×®Éæ iÉxrÉÉÌiÉmÉëuÉ×Í¨ÉuÉ×k±ÉãÂ£üiuÉÉiÉç ,
MÑüsÉijÉÉÌSuÉÉiÉMüTüWûUSìurÉÉuÉcÉUhÉÉgcÉ |
lÉvrÉiÉÏÌiÉ mÉëuÉiÉïqÉÉlÉÇ lÉ SØvrÉiÉã, lÉ iÉÑ xÉuÉïjÉÉ ¤ÉrÉÇ rÉÉÌiÉ || xÉÑ.
vÉÉ. 2/21 QûsWû. OûÏMüÉ
Acharya Sushruta while explaining about nastaratava says that, the vitiation of vata &
kapha does avarana to the marga of artava leading to srothorodha of artavavaha srothas
74
causing artava kshaya. Hence the above samprapti can be understood in the following
way.
• The nidanas mentioned in artava kshaya vitiates the vata mainly apana vata & the
kapha. The kapha does the avarana of apana vata & this kaphavritta apana vata
does margavarodha in artavavaha srothas resulting in reduction in flow of artava
leading to artava kshaya74.
•
Vitiated apana vata causes khavaigunya in artavavaha siras that fills the uterus for
the whole month. This leads to partial filling of menstrual blood in the uterus
causing reduced flow resulting in artava kshaya.73
• The nidanas of vata & kapha prakopaka ahara vihara leads to jataragni mandya
not only produces ama but also vitiates samana vata, pachaka pitta, kledaka
kapha, which have good role in digestion. Thus the production of ahara rasa is
hampered which ultimately affects the formation of rasa dhatu by causing
dhatavagni mandya. Artava being the upadhatu of rasa dhatu its utpatti is also
affected. Finally leading to artava kshaya.
Acharya Kashyapa while explaining the causes for beejopaghata &

pushpopaghata explains that in the mrudu kosta woman after proper snehana & swedana,
intake of excessive & teekshana dravyas, ushna annapana, there is jeevarakta skalana
causing puspopaghata finally causes artava dusti.81

Disease Review
Acharya Vagbhatta explains that the vata & kapha does the avarodha of rakta &
causes nastartava33.
As explained acharya Sushruta
iÉrÉÉãqÉÑïsÉÇ aÉpÉÉïvÉrÉ AÉiÉïuÉuÉÉÌWûlrÉ¶É kÉqÉlrÉ; iÉ§É ÌuÉ®ÉrÉÉ
uÉlkrÉÉiuÉÇ qÉæjÉÑlÉÉxÉÌWûwhÉÑiuÉqÉÉiÉïuÉlÉÉvÉ¶É ||
xÉÑ. vÉÉ. 9/12
The mula of artavavaha srothas is garbhasaya & artava vahini dhamani. If any
trauma to this may lead to artava nasha86.
While describing about nastaartava, Acharya Dalhana explains that the kapha &
vata obstructs the artava vaha srothas resulting into nastartava. Here the meaning of
nastartava does not mean that the artava is destroyed completely, but there is suppression
of artava which causes irregularity in menstruation74.
Nidana sevana Intake of teekshana oushadha Abhighata
Vata kapha prakopa by
Vata dusti-apana vata Mrudu kosta woman artvavaha

Kaphadusti srothas
Increase in sthanika kledata After proper Artavanasha

Produces avarana to apana vata Snehana & Swedana
Kaphavrita apana vata Causes jeeva rakta skalana
Artava vaha srothas Pushpopaghata
ARTAVA KSHAYA

Disease Review
Samprapti Ghataka
9 Dosha-
o Vata – Apana vata, Samana vata
o Pitta –Pachaka pitta
o Kapha –Kledaka kapha
9 Dushya- Rasa, Rakta
9 Upadhatu- Artava
9 Agni –Jataragni, Dhatavagni
9 Srotas-Rasavaha, Raktavaha
9 Srotodusti- Sanga
9 Udbhvastana -Amasaya
9 Adhisthana- Garbhsaya
9 Sancharasthana- Sarvashareera
9 Vyakta sthana – Yoni, Garbhasaya.

Disease Review
Chikitsa
xÉqmÉëÉÎmiÉ ÌuÉbÉOûlÉqÉãuÉ ÍcÉÌMüixÉÉ ||

The main objective of chikitsa is samprapti vighatana. This mainly can be
achieved in 2ways
9 Samshodhana
9 Samshamana
o Samshodhana includes Panchakarma which can be defined as therapeutic

measures applicable to cleanse excessively accumulated dosha from the body.
This is for bahu dosha avastha.
o Samshamana includes oral medication which pacifies the disease. This is advised
for madhyam dosha avastha.
o In alpa dosha avastha, langhana chikitsa can be done86.
Hence different mode of chikitsa works on vitiated dosha & dhatu at different
avastha.
Acharya Sushruta while explaining about the chikitsa of artava kshaya says that,
the chikitsa can be adopted according to vitiation of the dosha.
iÉ§É xÉÇvÉÉãkÉlÉqÉÉalÉãrÉÉlÉÉÇ cÉ SìurÉÉhÉÉÇ ÌuÉÍkÉuÉSÒmÉrÉÉãaÉ: ||
xÉÑ.xÉÔ.15/12
Here both shodhana & shamana chikitsa which is in form of agneya dravyas can
be given. But the selection of the chikitsa should be done wisely73.
Acharya Dalhana commenting on the same says only vamana karma must be done
not the virechana. Due to virechana the pitta dosha is reduced which in turn decreases
artava, as we know that AÉiÉïuÉqÉÉalÉãrÉqÉç | while vamana removes the soumya

Disease Review
dhatu, resulting into relative increase in agneya constituents of the body & finally causes
increase in artava. So he advised vamana73.
Charakapani explains that both vamana & virechana are used to clear urdhva &
adho srothas respectively. Hence both the measures must be adopted considering the
dosage of drugs used for shodhana & the bala of the woman undergoing the procedure.
Acharya Sushruta explains few of the agneya dravyas74 which increases artava
iÉ§É qÉixrÉMÑüijÉÉqsÉÌiÉsÉqÉÉwÉxÉÑUÉ ÌWûiÉÉ: |
mÉÉlÉã qÉÔ§ÉqÉÑS¶ÉÑccÉ SÍkÉ vÉÑ£üÇ cÉ pÉÉãeÉlÉã || xÉÑ.vÉÉ.1/22
Matsya, kulattha, amla(kanji), tila, masha, sura, gomutra, udashevta, dadhi, sukta,
all these are agneya dravyas which helps to improve the quality & quantity of artava74.
As mentioned in Astanga Samghara

ÌmÉ¨ÉsÉæÂmÉÉcÉÉUæxiÉimÉëuÉiÉïqÉÉlÉqÉç | A.xÉÇ vÉÉ. 1/13
Acharya Vagbhata explains that the use of pittavardhaka dravyas also helps in
increasing the artava49.
Acharya Bhava Prakasha & Yogaratnakara have given the list of dravyas that can be
used in artava kshaya. (Bp.N. Chi. 70/22-24, Y.R. Yonivyapad Chi.)
o Matsya, kanji, tila, masha, udashveta, dadhi, are given orally.
o Ishvakubeeja, danti, Chapala, guda, madana phala, yava, sukta, snuhi ksheera,
varti is prepared from this & is kept in yoni. This helps to remove out the
obstructed artava.
o Jyotishmati, swarji kshara, rajika, lasuna all these drugs are mixed & given with
cold water to drink for three days.
Acharya Kashyapa explains in kalpastana, drugs like Lasuna,88 shatapuspa &

satavari89 are beneficial in treating artava kshaya.
The disease artava kshaya has vitiation of vata pitta & obstruction of vata kapha
in artava vaha srothas.
Acharya Caraka describes in all yoni vyapad as vata is the prime factor.
lÉ ÌWû uÉÉiÉÉSØiÉã rÉÉãÌlÉlÉÉïUÏhÉÉÇ xÉÇmÉëSÒwrÉÌiÉ | cÉ.ÍcÉ. 30/115

Disease Review
So he has advised to treat vata dosha first which normalizes other all doshas90.
As explained by Acharya Vagbhata
oÉÎxiÉËUwrÉiÉã……UeÉÉãlÉvÉÉlÉç | A.WØû.xÉÔ 19/1-3
Artava kshaya is basti sadhya vyadhi91
This is further supported by Acharya Kashyapa
AsmÉmÉÑwmÉÇ AlÉÑuÉÉxrÉ CÌiÉ | MüÉ. xÉÇ ÍxÉ. 7/11
In alpa pushpa i:e artava kshaya anuvasana basti is beneficial92.
Hence the above can be summarized as follows

o Shodhana & shaman both line of treatment can be adopted.
o The use of agneya dravya is strongly recommended.
o The drugs capable of increasing pitta which helps in increasing artava must be
used.
Sadhyasadhyata –Prognosis
As seen in the classics there is no description about the prognosis of the disease.
The dosha involvement & the lakshanas of ksheena artava are one & the same. Hence the
sadhyasaadhyata mentioned for ksheena artava can be considered.
As explained by Acharya Sushruta, it is asadhya vyadhi.93
In A.S. Acharya Vagbhata has not clearly mentioned about it. But commentator
Indu has quoted vÉãwÉ xÉuÉï xÉÉkrÉÇ | A.xÉÇ vÉÉ. 1/25 ClSÒ OûÏMüÉ. This
probably indicates it to be sadhya82. Acharya Vagbhata in A.H. explains it to be
kastasadhya vyadhi94
Sapeeksha Nidana - Differential Diagnosis

Artava kshaya can be noted in the following
Vatala Yonivypad
TãüÌlÉsÉÉÂhÉM×üwhÉÉsmÉiÉlÉÑÂ¤ÉÉiÉïuÉxÉëÑÌiÉqÉç | A.xÉÇ.E 38/33
As there is alpa artava darshana, it can be considered as artava kshaya. But
presence of ayama, suptata in vatala yonivyapad which is absent in artava kshaya95.

Disease Review
Lohitakshaya Yonivyapad
uÉÉiÉÌmÉ¨ÉÉprÉÉÇ ¤ÉÏrÉiÉã UeÉ: |
xÉ SÉWû MüÉvrÉïuÉæuÉhrÉï rÉxrÉÉÇ xÉÉ sÉÉãÌWûiÉ¤ÉrÉÉ || A.WØû.E.33/45
It is different from artava kshaya because of its other features like daha, karshya,
vaivarnya95.
Arajaska Yonivyapad
rÉÉãÌlÉaÉpÉÉïvÉrÉxjÉÇ cÉãiÉç ÌmÉ¨ÉÇ xÉÇSÕwÉrÉãSxÉ×Mç |
xÉÉÅUeÉxMüÉ qÉiÉÉ MüÉvrÉïuÉæuÉhrÉïeÉlÉlÉÏ pÉ×vÉqÉç ||cÉ.ÍcÉ.30/17
In this yonivypad the pitta is the vitiated dosha. But Acharya Caraka has not
explained any symptom of anartava. Commentator Chakrapani explains anartava as
symptom. But it cannot be considered as artava kshaya because it includes other
symptoms like karshya, vaivarnya which are not seen in artava kshaya75.
Vandhya Yonivyapad
uÉlkrÉÉ lÉ¹ÉiÉïuÉÉÇ ÌuÉ±ÉiÉç | xÉÑ.E. 38/10
Nastarva is a symptom in vandhya yoni vypad i:e absence of menstruation. But it
is also associated with other symptoms96.
Shandhi Yonivyapad
AlÉÉiÉïuÉÉxiÉlÉÉ wÉhQûÏ ZÉUxmÉvÉÉï cÉ qÉæjÉÑlÉã | xÉÑ E. 38/18
Here anartava & astana features are seen which is congenitally present. But
artava kshaya as explained in classics is not a congenital disease96.

Disease review

Oligomenorrhoea 97,98,99
It can be defined arbitrarily as one in which the cycle lasts longer than 35days
with only 4-9 cycles in a year.
Menstruation may be both infrequent & irregular or may be regularly infrequent.
Infrequent menstruation & amenorrhea are essentially similar symptoms with

identical causes the difference is only one degree.
Aetiology 100,101,102
Oligomenorrhoea can be caused by a hormonal imbalance. Menarche to

menopause the length, regularity & menstrual flow is under the hormonal control of
hypothalamus –pituitary-ovarian–uterine axis. Adrenal gland also takes part in production
of steroid hormones. Thus the causes & be divided into
• Physiological
• Pathology
Physiological factors
It is quite common for women at the beginning & end of their reproductive lives
to miss or have irregular cycles. This is normal & is usually the result of imperfect co-
ordination between the hypothalamus –pituitary-ovarian axis.
o Pregnancy
o Lactation
Pathological
Uterine factor
Tubercular endometrisis- There is destruction of the endometrium or inhibition of
ovarian function by tubercular toxins
Post radiation- There will be destruction of endometrium.
Synechiae- Intra uterine adhesions viscero-cortical reflex leads to amenorrhoea


Disease review

Surgical removal of endometrium i:e Ablation of endometrium by laser,
resectoscope.
Due to absence of FSH receptors.
Ovarian factors
Autoimmune disease
PCOD – Tonically elevated LH increased androgen production from theca cell
& stroma of the ovaries decrease SHBG increased unbound estrogens &
androgens pituitary sensitivity to GnRH is increased preferential increased
production of LH, decreased production of FSH due to inhibin. Disturbed adrenal
function is also implicated in androgen excess.
Resistance ovarian syndrome (savage syndrome)- defect in FSH receptors,
follicles are present but are resistant to gonadotropins.
Hypoestrogenic state
Radiotherapy- Makes the ovaries unresponsive to gonadotropins
Surgical extirpation- Removal of site of production of estrogen.
Pituitary factors
Tumors like Prolactinoma, Chromophobe adenoma, Cushing disease.
In all the above conditions there is microadenoma associated with
hyperprolactinaemia. This inhibits steriodogenesis of ovary directly & inhibits
pituitary release of LH & FSH.
Simmond’s disease
Sheehan’s syndrome
In above 2 conditions there is partial or complete destruction of pituitary by
ischemia caused by venous thrombosis. The principle hormones affected are
growth hormone, LH, FSH, TSH, adreno-corticotrophins & prolactin.
Hyperprolactinaema


Disease review

Hypothalamus causes
GnRH deficiency
Vigorous exercise
Pseudocyesis
Brain tumors
Psychogenic shock stress
Anorexia nervosa-
Release of GnRH is inhibited. There is low level of esterogen & LH, but FSH
level remains normal. There may be hyerprolactinemia due to altered dopamine
inhibition. Tumours of hypothalamus & pituitary need surgical excision.
Adrenal causes
Cushing syndrome
Suprarenal tumours or hyperplasia
The effect of estrogen on the endometrium is opposed by excess androgen.
Thyroid factors
Hypothyroidism
Graves disease
Raised TSH & hyperprolactinaemia by direct action of TRH on galactophere cells
in the pituitary.
Drugs
Contraceptive pills- This leads to ‘post pill syndrome’ due to suppression of
GnRH release
Anti depressants, Dopamine blockers- These agents raises the prolactin levels
Anti hypertensive- These are dopamine depleting agents & raises the prolactin
levels.


Disease review

Nutritional factors
Extreme obesity
Excessive weight loss in the athletes & ballet dancer
Severe anemia
Malnutrition
Chromosomal factors
An underlying sex chromosome abnormality such as an XXX arrangement.
Other factors
Diabetes
Renal disease
Probably all these factors will be affecting the hypothalamus –pituitary- ovarian –
uterine axis
Many women are obese, hirsuite with poorly developed secondary sexual
characters, genital hypoplasia, ovarian subfunction.
Hypomenorrhoea 103,104,105
Uterine bleeding may be slight in amount, short in duration or both. Bleeding

which lasts 2 days or less is unusual & this pathology is termed as Hypomenorrhoea.
Causes
Constitutional causes
Constitutional scanty menstruation is perhaps best explained by assuming the
presence of an unusual arrangement, or relative insensitivity of endometrial
vascular apparatus.
Uterine causes
Scanty loss sometimes means that the bleeding surface is smaller than the normal.
The endometrial cavity will be reduced to much-
During myomectomy,


Disease review

Due to intra uterine adhesions
Due to chronic endometritis
Hormonal causes
Disturbances in endocrine system do not ordinarily lead to scanty menstruation
without altering the cycle at the same time.
Scanty menstruation is however occasionally seen as forerunner to amenorrhoea
& oligomenorrhoea & thus has the same causes.
Use of low dose oral contraceptives results in endometrial atrophy that causes
hypomenorrhoea.
Nervous & Emotional causes

Ovarian –Uterine axis are sometimes suppressed by the psychological factor &
sometimes succeed only in reducing the amount of flow.
E.g.-Pseudocysis which is frequently characterized by scanty period rather than
amenorrhoea.
Approach towards both hypomenorrhoea & oligomenorrhoea 106,107,108
There is altered co-ordinate function of Hypothalamus-pituitary-ovarian-uterine

axis by some pathology.
Hence a thorough history taking has a prime importance & all clinical
examination is mandatory.
Laboratory investigation are required either for the diagnosis or to confirm the
clinical diagnosis.
Detail history taking also plays an important role which further helps to decide
line of treatment.


Disease review

This includes
i. Mode of onset of menses

ii. Sudden change in environment, emotional stress, or any mental upset.
i. Sudden change in weight – may be loss or gain.
ii. Intake of psychotropic or anti hypertensive drugs.
iii. History of-
a. Radiotherapy or chemotherapy
b. Acne, hirsute, change in voice.
c. Inappropriate galactorrhoea.
d. Headache or visual disturbance.
e. Hot flushes & vaginal dryness.
f. Curettage leading to synechae, post partum or post abortal infection.
iv. Labor and puperial events –PPH, shock, lactation.
v. Medical history of tuberculosis, diabetes, chronic nephritis or overt hypothyroid
state, duration of use of OCPs.
vi. Family history- if anything to be enquired.
vii. General examinations-

a. Nutritional status
b. Extreme emaciation or marked obesity.
c. Presence of acne or hirsute.
d. Breast discharges.
viii. Pelvic examination

a. Examination of external genitalia along with development of secondary
sexual characters.
b. Enlargement of clitoris
c. Adnexal mass suggestive of tubercular T-O mass.
d. Per-vaginal examination


Disease review

ix. Special investigations
a. Urine Pregnancy Test- To exclude pregnancy in woman with active
reproductive period.
b. Radiology- radiological of pituitary gland. CT scan to detect pituitary
adenomas.
c. Ophthalmology- Examination of retina & visual field should be done if
pituitary tumor is suspected.
d. Hormonal assays-
FSH, LH, Serum Prolactin, Testosterone levels
TSH, T3, T4 levels
Increased in gonadotrophin indicates primary ovarian failure.
Decrease in gonadotrophin indicates Hypothalamus- Pituitary defect.
e. Ultrasound- to document status of uterus, ovaries.
Thickness of endometrium.
Endometrial thickness < 4mm indicates anorexia nervosa.
f. Chromosomal studies for excluding
Turner’s Syndrome (XO)
Super female (Trisomy X or XXX)
x. Laparoscopy-
xi. Treatment 109,110,111

a. Reassurance plays a major role.
b. Therapeutic tests
o When investigations leave doubt as to with link of H-P-O-U axis is
primarily at fault, therapeutic tests is of great value.
o The first of these is to assess uterine sensitivity to ovarian hormones.
o After excluding pregnancy, hpyerprolactinaemia & hypothyroidism, a
Progesterone Challenge Test is administered.
9 If the patient has withdrawal bleeding it indicates the presence of a
functional outflow tract, & also presence of sufficient circulating


Disease review

endogenous estrogens which has primed the endometrium & the diagnosis
is anovulation.
9 If on the other hand, the patient does not have withdrawal bleeding in
response to the progesterone challenge, a combination of both estrogen &
progesterone is given.
9 If negative response indicates a defect in the outflow tract i:e uterine
amenorrhea.
9 If bleeding does occur it points to a defect in production of both estrogen
& progesterone.
9 Serum FSH & LH levels are measured. If these are raised, the cause is
ovarian failure where as if they are low or normal, the cause is
hypothalamic.
o GnRH Dynamic Test- If with GnRH administration, there is rise of
pituitary gonadotrophins, it is probably a cause of hypothalamic
dysfunction.
o Laparoscopy-
- This is done to exclude the presence of streak gonads & small
ovarian tumors,
- To recognize PCOD in which ovarian drilling can be done.
- Abnormal gonads may be removed at the same sitting.


Drug Review
Lasuna –
Botanical name- Allium sativum
Family – LILIACEAE
Table no: 5
Rasa Guna Viryaa Vipaka Doshakarma
Caraka Katu Guru Ushna Katu Vataghna

Snigdha
Sushrut Madhura Snigdha Ushna Katu Kaphaghna
a Teekshana
Picchila
Sara.
Dh. Ni. Madhura Guru, Ushna Katu Kaphaghna
Snigdha
Teekshana
Picchila
Sh. Ni. Katu Snigdha Ushna Katu Kaphaghna
Teekshana
sara guru
Kai. Ni. Katu, Snigdha Ushna Katu Vatakaphahara
Madhura Teekshana
Guru
Sara.
BP. Ni. Amla Snigdha Ushna Katu Pittakara,
vargita Teekshana vatakaphahara
pancharasa Guru, Sara.
Ushna
R. Ni. Amla Ushna Ushna Katu Kaphavatanut
vargita
pancharasa
Ni. Ad. Madhura, Snigdha Ushna Katu Kaphavatanut
Katu Ushna,
Guru,
Chemical constitution-
Alliin; carbohydrate (arabinose, galactose etc); vitamins (folic acid, niacin, riboflavin,
thiamine, vit.c); amino acids (arginine,asparagic acid, methionine etc.); enzymes
(allinase); volatile compounds (allylalcohol, allylthiol, allylpropyl disulphide etc.);
thioglycosides(scordine, scordinine A1, A2 & B etc,); prostaglandins A2, D2, E2 and F2;
allylmethylselenide, ajoene, proteoruboside B.

Drug Review
Jeeraka
Botanical name- Cuminum cyminum
Family – UMBELLIFERAE
Table no: 6
Rasa Guna Virya Vipaka Doshgnata
Sushrut Katu Teekshna Ushna Katu Pittavardhaka,

a Ushna Kaphavatahara
Dh.Ni Katu Ruksha Ushna Katu Vataghna
Sh. Ni. Katu Teekshna, Ushna Katu Kaphavatahara
Ushna Pittakruta
Kai. Ni. Katu, Laghu, Ushna Katu Pittala,
Tikta Ruksha Kaphavatapaha
BP. Ni Katu Laghu, Ushna Katu Kaphavatahara
Ruksha Pittakara
R. Ni. Katu Ushna Ushna Katu Vataghna
Ni. Rt. Madhura Laghu, Ushna Katu Vataghna
Ruksha,
Ushna
Ciminin, diacyl glycerol, imperatorin, isoimperatorin, isoimpinellin, oxypeucedanin;
apigenin & apiin; oxalic, cuminaldehyde, p-cymene etc.

Drug Review
Hingu
Botanical name-– Ferula northax
Family – UMBELLIFERAE
Table no: 7
Rasa Guna Virya Vipaka Doshgnata
Caraka Ushna Katu Kaphavata

shamaka
Dh. Ni. Katu Sara Ushna Katu Vatakaphapham
Sh. Ni. Katu Laghu, Ushna Katu Vatakaphagna
Snidgha Pittakopaka
Kai. Ni. Tikta,Katu Laghu Ushna Katu Vatakaphanashaka
BP. Ni. Teekshna Ushna Katu Vataghna,
Pittavardhaka
R. Ni Katu Ushna Katu Vatakaphapaha
Chemical constitution- Gum-a- pinene, phllandrene, see.butyl propenyldisulphide, a

trisulfide, asaresinotanol, farnesiferol A, gummosin, kamolonol, mogoltadone,
polyanthinin, polyanthin, undecylsulfonyl acetic acid; umbelliferone, root- foetidin,
luteolin, Whole plant- assafoetidin, ferocolicin.

Drug Review
Pipalli
Botanical name – Piper longum
Family – PIPERACEA
Table no: 8
Rasa Guna Virya Vipaka Dosakarma
Caraka Madhura Guru, Ushna Madhura Kaphavataghna,

Katu Snidgha, Pittakara
Shuska,
Yogavahi
Susruta Swadu Guru, Ushna Katu Kaphavataghna
Pittavishodhini
Dh. Ni. Madhura Teekshna Ushna Katu Tridoshajeet
, katu Hima,
Snigdha
Sh. Ni.
Sushka- Katu Teekshna, Ushna Katu Vatakaphahara
Snigdha,
Laghu
Adra Madhura Snigdha, Sheeta Kaphakara
Guru
Kai. Ni.
Sushka- Hima Sheeta Madhura Kaphaprada
Guru
Snigdha
Adra - Sara, Ushna Madhura Kaphavatahara
Snigdha,T
eekshna
BP Laghu, Anush Madhura Vatakaphahara
Snigdha na Pittaprakopaka
R.N. Teekshna Ushna Madhura Kaphavatahara
Laghu,
Snigdha,
Ushna
Essential oil, mono- and sesquiterpenes, caryophyllene(mainly), piperine,piplarine,
piplartine, piperlongumine, piperlonguminine, pipernonaline, piperundecalidine,
pipercide, sesamin, beta-sitosterol; four aristolactams (cepharonone B, aristolactum All,
piperlactumA and piperolactam B); five 4,5-dioxoaporphines etc.

Drug Review
Marica
Botanical name – Piper nigrum
Family – PIPERACEAE
Table no: 9

Caraka Katu Laghu Ushna Madhura Kaphavatahara,
Susruta Katu Guru, Nati Madhura Kaphavatajit
Ushna,
nati
sheeta
Dh. Ni. Tikta, Ushna Ushna Madhura Kaphanashak,
Katu Vataghna,
Pittakara
Sh. Ni. Katu Tikshna, Ushna Madhura Kaphakara
Guru, Pittakara
Suskma,
Sushka
Kai. Ni. Katu Teekshna Ushna Madhura Kaphavatahara

Ushna, Pittakara
laghu
BP Katu Guru, Ushna Madhura Kaphavatajit

Tikshna Pittaprakopaka
Ruksha
R.N. Katu Laghu , Ushna Katu Kaphavatahara
Tikta Ruksha
Piperene, piperethine, piperolein A & B, feruperine, dihydrofeuperine, citronellol,
cryptone, dihydrocarveeol, alpha-&beta- pinene, piperonal, camphene, beta-caryophene,
beta-caryophyllene, beta-alanine,pipecolic acid, carotene, ascorbic acid, pipercide etc.

Drug Review
Nagara
Botanical name – Zingiber officinale
Family – SCITAMINAE
Table no: 10
Rasa Guna Virya Vipaka Doshakarma
Caraka Kaphavatanashaka,
Susruta Katu Laghu Ushna Madhura Kaphavataghna

Snigdha
A.H. Katu Kaphavataghna
Dh. Ni. Katu Snigdha Ushna Madhura Kaphavataghna
Ushna
Sh. Ni.
Sushka- Katu Snigdha, Ushna Madhura KaphaVatajit
Laghu
Adra - Katu Snigdha, Ushna Madhura Kaphavatanut
Kai. Ni. Katu Snigdha. Ushna Madhura Kaphavatahara

Teekshna Pittalam
Laghu
Bhedana
BP
Sushka- Katu Laghu, Ushna Madhura Vatakaphahara
Snigdha
Adra- Katu Laghu, Ushna Madhura Kaphavatapaha

Teekshana
Ruksha
R.N. Katu Snigdha, Ushna Madhura Kaphavatahanti
Ushna
Alpha-curcumene, beta-bourbornene, d-borneal, citral, d-camphene, citronellol, geraniol,
gingerol, alpha-&beta-zingiberenes, zingiberol, zingerone, gingerols, paradol,
gingerenone A, ginger glycolipids A, B, & C; [6]gingerdiol; gingerone B & C etc.

Drug Review
Saindhva
Table no: 11

B.P. Madhura Snigdha Sheeta Madhura Tridoshanashaka
Lavana Sheeta
Suksma
Laghu
Ni. R Madhura Snigdha Sheeta Madhura Tridoshanashaka
Lavana Suksma
Laghu
Gandhaka
Sulphar [ S ]
Rasa – Katu, Tikta, Kashaya
Guna – Snigdha, Guru, Sara
Virya – Ushna
Vipaka –Madhura
Doshakarma –Vatakaphahara, pittakara
Jambira
Botanical name – Citrus limon
Family – RUTACEAE
Table no: 12
Dh.Ni. Amla Guru Ushna Amla Vatashlemghna
Pittala
Kai. Ni. Amla Guru Ushna Amla Vatakaphaghna
Usna
B.P. Amla Laghu Ushna Amla Vatakaphanuta
Usna
Teekshna
Abscisic acid, abscisin II, auxin, limonin, limonene, poncirin from fruits.
Preparation of vati.-. Curna of jeeraka, trikatu, suddha gandhaka, saindhava lavana, is

prepared. Suddha hingu, lasuana are taken. All these ingredients are mixed together &
bhavana of jambira swarasa is given. Then the vati is prepared of 500mg each.

Drug Review
Krishna Tila
Botanical name – Sesamum indicum
Family – PEDALICEAE
Table no: 13
Caraka Madhura, Tikta SnigdhaUshn Ushna Katu Vataghna
Kashaya a, suksma Kaphapittakrut
Vyavai
Susruta Madhura, Tikta Snigdha Ushna Madhura Pittakara
Kashaya Sangrahi
Guru
A.S. Katu Kaphakara
Dh.Ni. Katu, Madhura Snigdha Ushna Madhura Vataghna
Tikta Suksma Pittakara
Vyavai
Guru
BP Katu, Madhura Guru, Ushna Ushna Madhura Kaphapittakruta
Tikta Snigdha
R.N. Madhura, Tikta Snigdha, Ushna Katu Vataghna

Kashaya Guru Pittakara
N.A. Madhura,Tikta Snigdha Ushna Katu Kaphapittaghna
Kashaya Katu
S. N. Madhura, Tikta Guru,Snigdha Ushna Katu Vatanashaka
Kashaya, Katu Tikshna Kaphapittaghna
Ushna
Neutral lipids, glycolipids & phospholipids, sesamose, sesamolin, sesamolinol, sesamol,
pinoresinol etc.
Guda
English name - Jaggery
Table no: 14
R.Va. Madhura Guru, Snigdha Sheeta Madhura Vatanashaka
Kaphapittakara
R.N Madhura Snigdha, Laghu Sheeta Madhura Tridoshanashaka
Preparation of Kashaya- Preparation of Krishna Tila Kashaya, is done as per samanya
kwatha preparation method mentioned in Sharangadhara samhita. According to
Sharangadhara (Sh.Ma.Kh 2/1), kashaya is prepared by boiling 1pala (48gms) Krishna
Tila with 16 parts of water & reduced to 1/8th part. It is given with Guda
Clinical Study
MATERIALS AND METHODS
The current study “A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA

KASHAYA AND LASUNADI VATI IN ARTAVA KSHAYA” was carried out on 30
patients attending the OPD and IPD sections of Prasuti Tantra and Stree Roga department
SDM Ayurveda hospital Udupi.
Source of data:
Minimum 30 patients complaining of scanty menstruation, prolonged interval in
between menstruation (irregular menses), were selected from OPD and IPD section of
SDM Ayurvedic hospital Kuthpady Udupi.
Method of data collection:

It is single blind comparative clinical study.
30 selected patients were divided into 2 groups of 15 patients each.
a. Group A- Patients were given Krishna Tila Kashaya with Guda orally for 3 cycles.
b. Group B-Patients were given Lasunadi Vati orally along with Ushna Jala for 3 cycles.
A special Proforma was prepared with all history taking, physical examination, as
mentioned in our classics and allied sciences to confirm the diagnosis.
The parameters of signs and symptoms will be scored on the basis of standard method
of statistical analysis.
Inclusion criteria:
• Patients age between 18-35 years.
• Both married and unmarried women.
• Bleeding, spotting less then 2 days.
• Pad used 1 per day.
• Infrequent menses at interval longer then 35 days.
• Patients presenting with the pratyatma lakshana of artava kshaya.

Clinical Study
Exclusion criteria:
• Patient with systemic disorder like DM, HTN, TB, Asthma, Congenital
abnormalities.
• Patient with malnutrition, severe anemia (Hb < 8gm %)
• Lactating women.
• OCP using women.
Intervention:
Dose-Group A Patients were given Krishna Tila Kashaya with Guda 90ml thrice a day
before the meals.
Group B Patients were given Lasunadi Vati, 1 vati (500mg) thrice a day before meals
with ushna jala.
Duration of treatment will be for 3 cycles and then follow up once after each cycle for 3
cycles.
Assessment criteria:
• Duration of flow.
• Interval between 2 cycles
• Amount of blood loss.
• Grade of pain
• Reduction in weight
Criteria of Assessment
The changes in the symptoms after the medication were scored as follows
1. DURATION OF FLOW SCORE
[in days ]
1-2 days 1
3-4 days 2
More than 4 days 3

Clinical Study
2. INTERVAL BETWEEN TWO CYCLES

26-35 days 0
36-45 days 1
46-55days 2
More 55days 3
3. AMOUNT OF BLOOD LOSS

Only spotting 0
½ -1pad per day 1
2 pads per day 2
More than 2pads per day 3
4. PAIN
No pain 0
Mild 1
Moderate 2
Severe 3
5. Reduction in the weight- was assessed directly. No scoring was given.

Final assessment:
• No relief
o No change
• Improved
o Increased in amount of bleeding
o Reduction in length of cycle.
o Reduction of pain.
• Cured
o Regularization of menstruation
o Regularization in amount of flow using 1-2 pads per day.
o Absence of pain.

OBSERVATIONS
OBSERVATIONS
Incidence according to Age:

Table No:15
Age group Group A Group B Total %
18 – 23yrs 5 6 11 36.66
24 – 29yrs 5 6 11 36.66
30 – 35yrs 5 3 8 26.66
Graph no: 1
40
35
30
25
18 – 23yrs
20
24 – 29yrs
15
30 – 35yrs
10
5
0
Gr A Gr B Total %
The incidence of age showed 36.66% each in the age group of 18-23yrs & 24-29yrs,
26.66% were in the age group of 30-35yrs

OBSERVATIONS
Incidence according to Marital status

Table no: 16
Marital status Group A Group B Total %
Married 10 8 18 60
Unmarried 5 7 12 40
Graph No: 2
60
50
40
30 Married
20 Unm arried
10
0
Gr A Gr B Total %
Among the group of patients 60% were married & remaining 40% were unmarried.
Incidence of Habitat
Table no: 17
Habitat Group A Group B Total %
Rural 6 6 12 40
Urban 9 9 18 60
Graph no: 3
60
50
40
30 Rural
20 Urban
10
0
Gr A Gr B Total %
Maximum numbers 60% of patients reported in this study were residing in

urban area and remaining 40% patients were belonged to rural habitat.

OBSERVATIONS
Incidence according to Religion

Table no: 18
Religion Group A Group B Total %
Hindu 14 12 26 86.67
Muslim 0 1 1 3.33
Christian. 1 2 3 10
Graph No: 4
90
80
70
60
50 Hindu
40 Muslim
30 Christian.
20
10
0
Gr A Gr B Total %
Among the patients maximum patients 86.67% were belonged to the Hindu
community, whereas 3.33% patients were belonged Muslim community &
remaining 10% where belonging to Christian community.

OBSERVATIONS
Incidence according to Education:

Table No: 19
Education GroupA GroupB Total %

P 3 1 4 13.33
S 2 2 4 13.33
HS 2 4 6 20
G 5 6 11 36.67
PG 1 2 3 6.67
Nil 2 0 2 6.67
Graph No: 5
40
35
30 P
25 S
20 HS
15 G
10 PG
5 Nil
0
Gr A Gr B Total %
The sample group had a mixed dispersion of subjects belonging to various educational
backgrounds. Among them 6.67% subjects were illiterates, 13.33% of the population had
been educated up to the primary & secondary level, 20% were educated upto High
secondary level. 36.67 % of the subjects were graduates level. 6.67% of the subjects were
post graduates.

OBSERVATIONS
Incidence of Occupation
Table no: 20
Occupation Group A Group B Total %

Student 4 5 9 30
Housewife 6 8 14 46.67
Service 5 2 7 23.33
Graph no: 6
50
40
30 Student
Housewife
20
Service
10
0
Gr A Gr B Total %
Among the subjects registered for the study maximum of 46.67% were housewives, 30%
were students & remaining 23.33% were working women.

OBSERVATIONS
Distribution according to Socio Economic status

Table no: 21
Socio economic Group A Group B Total %

status
Upper class 0 0 0 0
Upper middle class 7 10 17 56.67
Lower middle class 8 5 13 43.33
Lower class 0 0 0 0
Graph no: 7
60
50
40
Upper class
30 Upper middle class
Lower middle class
20
Lower class
10
0
Gr A Gr B Total %
None of the patients in this study group belonged to upper or lower class, 56.67% were of
upper middle class, 43.33% were of lower middle class.

OBSERVATIONS
Incidence according to Duration of illness
Table no: 22
Duration of illness Group A Group B Total %
Below 6months 7 5 12 40
7months-1yr 2 4 6 20
1yr-2yrs 3 1 4 13.33
Above 2yrs 3 5 8 26.67
Graph no: 8
40
35
30
25 Below 6months
20 7months-1yr
15 1yr-2yrs
10 Above 2yrs
5
0
Gr A Gr B Total %
In the sample size, 40% of subjects showed duration of illness below 6months, 20% of
them were between 7months-1year, 13.33% were from 1yr- 2yrs & remaining 26.67%
were in group of more than 2years.

OBSERVATIONS
Incidence according to Duration of blood loss:

Table no: 23
Duration of Group A Group B Total %

blood loss
1-2days 8 3 11 36.67
3-4days 6 8 14 46.67
Above 4days 1 4 5 16.66
Graph no: 9
50
40
30 1-2days
3-4days
20
Above 4days
10
0
Gr A Gr B Total %
Among 30 patients, 36.67% of patients had the flow between 1 – 2 days, 46.67% had the
flow between 3 – 4 days and 16.66% had the flow more than 4 days

OBSERVATIONS
Incidence according to Intermenstrual period:
Table no: 24
Inter Group A Group B Total %

menstrual
period
35-45days 11 5 16 53.33
46-60days 1 4 5 16.67
Above 60days 3 6 9 30
Graph no: 10
60
50
40
35-45days
30
46-60days
20 Above 60days
10
0
Gr A Gr B Total %
In this sample, the Inter menstrual period was 53.33% in between 35-45days, 16.67% in
between 46-60days, 30% people were more than 60days.

OBSERVATIONS
Incidence according to Amount of menstrual flow:
Table no: 25
Amount of Group A Group B Total %

menstrual
flow
½-1pad 10 13 23 76.67
1-2pad 5 2 7 23.33
More than 0 0 0 0
2pads
Graph no: 11
80
70
60
50
½-1pad
40
1-2pad
30
More than 2pads
20
10
0
Gr A Gr B Total %
76.67% of registered patients used ½ -1pad, 23.33% used 1-2pads & none of them used
more than 2pads.

OBSERVATIONS
Incidence according to Pain:
Table no: 26
Pain Group A Group B Total %

No 1 3 4 13.33
Mild 1 3 4 13.33
Moderate 10 9 19 63.33
Severe 3 0 3 10
Graph no: 12
70
60
50
No
40
Mild
30
Moderate
20 Severe
10
0
Gr A Gr B Total %
Pain with different grades were registered in which 13.33% had no pain & mild pain
each, maximum of 63.33% had moderate pain, & 10% of them had severe pain.

OBSERVATIONS
Incidence according to Anubandha Vedana
Table no: 27
Anubandha Group A Group B Total %

vedana
Weakness 6 5 11 36.67
Low backache 11 12 23 76.66
Vomiting 1 0 1 3.33
Giddiness 0 2 2 6.66
Headache 1 0 1 3.33
Loose motions 0 1 1 3.33
Constipation 2 2 4 13.33
Nausea 1 0 1 3.33
Lower limb 1 0 1 3.33
pain
Pain in vaginal 0 1 1 3.33
region
Nothing 0 1 1 3.33
Graph no: 13
Weakness
80
Low backache
70
Vomiting
60
Giddiness
50
Headache
40
Loose motions
30 Constipation
20 Nausea
10 Lower limb pain
0 Pain in vaginal region
Gr A Gr B Total %
Nothing
Among 30 subjects, 36.67% of had complaint of weakness, maximum of 76.66% had low
backache, 13.33% of them had constipation, 6.66% had giddiness, 3.33% of each of
them had vomiting, headache, loose motion, nausea, pain in lower limbs, pain in vaginal
region.

OBSERVATIONS
Incidence according to Diet

Table no: 28
Diet Group A Group B Total %

Veg 2 5 7 23.33
Mixed 13 10 23 76.67
Graph no: 14
80
70
60
50
40 Veg
30 Mixed
20
10
0
Gr A Gr B Total %
Maximum of 76.67% of the sample has mixed dietary habit; remaining 23.33% were
strictly vegetarian.

OBSERVATIONS
Incidence according to Rasa sambhandhi
Table no: 29
Rasa Group A Group B Total %

sambhandhi
Madhura 15 15 30 100
Amla 5 4 9 30
Lavana 0 0 0 0
Katu 13 15 28 93.33
Tikta 0 0 0 0
Kashaya 0 0 0 0
Graph no: 15
100
90
80
Madhura
70
60 Amla
50 Lavana
40 Katu
30 Tikta
20
Kashaya
10
0
Gr A Gr B Total %
Among the 30 patients, all of them i:e 100% consumed madhura ahara, 93.33% were
used to take katu ahara, 30% of them were consuming amla ahara.

OBSERVATIONS
Incidence according to Diet Habit

Table no: 30
Diet habit Group A Group B Total %

Kalabhojana 5 4 9 30
Akalabhojana 10 11 21 70
Graph no: 16
70
60
50
40
Kalabhojana
30
Akalabhojana
20
10
0
Gr A Gr B Total %
Dietary habit of 70% of the subjects was of akalabhojana, & 30% of the subjects had
kalabhjana.
Incidence according to Mental Stress

Table no: 31
Mental stress Group A Group B Total %

Yes 9 10 19 63.33
No 6 5 11 36.67
Graph no: 17
70
60
50
40
Yes
30
No
20
10
0
Gr A Gr B Total %
63.33% of the sample had mental stress, & remaining 36.67% of the sample was free
from stress.

OBSERVATIONS
Incidence according to Mala

Table no: 32
Mala Group A Group B Total %

Regular 10 11 21 70
Irregular 5 4 9 30
Graph no: 18
70
60
50
40
Regular
30
Irregular
20
10
0
Gr A Gr B Total %
70% of the population had regular bowel habits & 30% of them were suffering from
irregular bowel habits.
Incidence according to Weight

Table no: 33
Weight Group A Group B Total %
43.5-50.5kgs 2 2 4 13.33
50.6-57.5kgs 11 6 17 56.67
57.6-64.5kgs 2 5 7 23.33
64.6kgs & above 0 2 2 6.67
Graph no: 19
60
50
40 43.5-50.5kgs
30 50.6-57.5kgs
20 57.6-64.5kgs
64.6kgs & above
10
0
Gr A Gr B Total %
In the sample size of 30 patients, 13.33% were of weight between 43.5-50.5kgs, 56.67%
were in between 50.6-57.5kgs, 23.33% were in between 57.6-64.5kgs, remaining 6.67%
were above 64.6kgs.

OBSERVATIONS
Incidence according to Habits
Table no: 34
Habit Group A Group B Total %

Ice-cream 0 1 1 3.33
Tea 3 6 9 30
Coffee 11 4 15 50
Tobacco 0 0 0 0
Smoking 0 0 0 0
Drinking 0 0 0 0
Fast food 1 3 4 13.33
Milk 1 1 2 6.66
Nothing 0 1 1 3.33
Graph no: 20
50
Ice-cream
40 Tea
Coffee
30 Tobacco
Smoking
20
Drinking
10 Fast food
Milk
0
Gr A Gr B Total % Nothing
In the sample size take 50% of the subjects had the habit of drinking coffee, about
13.33% of them were addicted to fast food, 6.66% of them used to drink milk, 3.33% of
them used to have ice cream & remaining 3.33% of them had no habit.

OBSERVATIONS
Incidence according to Rajoprvrutti

Table no: 35
Rajoprvrutti Group A Group B Total %

Niyamitta 2 0 2 6.66
Aniyamitta 13 15 28 93.33
Graph no: 21
100
80
60
Niyam itta
40 Aniyam itta
20
0
Gr A Gr B Total %
Maximum of 93.33% had aniyamitta rajo pravrutti, & 6.66% had niyamitta rajo pravrutti.
Incidence according to Varna of Artava

Table no: 36
Varna Group A Group B Total %

Blackish red 7 10 17 56.66
Red 8 5 13 43.33
Graph no: 22
60
50
40
30 Blackish red
Red
20
10
0
Gr A Gr B Total %
The varna of artava of 56.66% was blackish red, & 43.33% has red color flow.

OBSERVATIONS
Incidence according to Gandha of Artava

Table no: 37
Gandha Group A Group B Total %

Yes 2 5 7 23.33
No 13 10 23 76.67
Graph no: 23
80
60
40 Yes
No
20
0
Gr A Gr B Total %
76.67% of population had no smell to the menstrual blood, 23.33% of population has
some smell to menstrual blood.
Incidence according to Akruti

Table no: 38
Akruti Group A Group B Total %

Krusha 3 3 6 20
Madhyama 6 9 15 50
Stula 6 3 9 30
Graph no: 24
50
40
30 Krusha
20 Madhyama
Stula
10
0
Gr A Gr B Total %
The akruti differed in the population as 20% were krusha, 50% were madhyama, 30%
were stula.

OBSERVATIONS
Incidence according to Pallor

Table no: 39
Pallor Group A Group B Total %

Absent 14 12 26 86.67
Present 1 3 4 13.33
Graph no: 25
100
80
60
Absent
40 Present
20
0
Gr A Gr B Total %
Among the 30 patients, 86.67% pallor was absent, & 13.33% pallor was present.
Incidence according to Shabda, Sparsha, Druk

Table no: 40
Shabda, Group A Group B Total %

Sparsha, Druk
Prakruta 15 15 30 100
Aprakruta 0 0 0 0
Graph no: 26
100
80
60
Prakruta
40
Aprakruta
20
0
Gr A Gr B Total %
All 100% population had prakruta Shabda, sparsha, druk.

OBSERVATIONS
Incidence according to Prakruti

Table no: 41
Prakruti Group A Group B Total %

VK 10 9 19 63.33
PK 3 3 6 20
VP 2 3 5 16.67
Graph no: 27
70
60
50
40 VK
30 PK
20 VP
10
0
Gr A Gr B Total %
Maximum of 63.33% were of vatakapha prakruti, 20% were pittakapha prakruti, &
16.67% were vatapitta prakrutti.
Incidence according to Vikruti
Table no: 42
Vikruti Group A Group B Total %

VK 2 4 6 20
PK 4 6 10 33.33
VP 9 5 14 46.67
Graph no: 28
50
40
30 VK
20 PK
VP
10
0
Gr A Gr B Total %
Vatapitta vikrutti was observed in 46.67%, pittakapha vikruti was observed in 30% &
20% had vatakapha vikrutti.

OBSERVATIONS
Incidence according to Sara

Table no: 43
Sara Group A Group B Total %

Rasa 0 0 0 0
Rakta 0 0 0 0
Mamsa 6 4 10 33.33
Meda 7 7 14 46.67
Asthi 2 4 6 20
Majja 0 0 0 0
Sukra 0 0 0 0
Graph no: 29
50
40 Rasa
Rakta
30 Mamsa
Meda
20
Asthi
10 Majja
Sukra
0
Gr A Gr B Total %
33.33% of the subjects were of mamsa sara, 46.67% were of meda sara, & remaining
20% were of asthi sara.

OBSERVATIONS
Incidence according to Satva

Table no: 44
Satva Group A Group B Total %

Pravara 0 0 0 0
Madhyama 12 13 25 83.33
Avara 3 2 5 16.67
Graph no: 30
90
80
70
60
50 Pravara
40 Madhyama
30 Avara
20
10
0
Gr A Gr B Total %
Satva of 83.33% is madhyama, & 16.67% is of avara satva.

OBSERVATIONS
Incidence according to Ahara shakti

Table no: 45
Ahara shakti Group A Group B Total %

Pravara 5 4 9 20
Madhyama 7 9 16 53.33
Avara 3 2 5 16.67
Graph no: 31
60
50
40
Pravara
30
Madhyam a
20 Avara
10
0
Gr A Gr B Total %
Ahara shakti of 20% was pravara, 53.33% was madhyam, 16.67% was avara.
Incidence according to Vyayama shakti

Table no: 46
Vyayama Group A Group B Total %

shakti
Pravara 4 2 6 20
Madhyama 7 9 16 53.33
Avara 4 4 8 26.67
Graph no: 32
60
50
40
Pravara
30
Madhyam a
20
Avara
10
0
Gr A Gr B Total %
Vyayama shakti of 53.33% was madhyam, 26.67% was avara & 20% was pravara.

OBSERVATIONS
Incidence according to Srothas affected
Table no: 47
Srothas Group A Group B Total %

Pranavaha 0 0 0 0
Annavaha 8 4 12 40
Rasavaha 15 15 30 100
Raktavaha 7 11 18 60
Artavavaha 15 15 30 100
Graph no: 33
100
80
Prana
60 Anna
Rasa
40
Rakta
20 Artava
0
Gr A Gr B Total %
Annavaha srothas was affected in 40% of population, 60% of raktavaha srothas was
affected, rasavaha & artavavaha srothas was affected in 100% of population.

OBSERVATIONS
Pelvic examination P/S

Incidence according to Tenderness in vaginal region
Table no: 48
Tenderness in Group A Group B Total %

vaginal region
Present 0 1 1 5.5
Absent 10 7 17 94.44
Graph no: 44
100
80
60
Present
40
Absent
20
0
Group A Group B Total Percentage
Tenderness in vaginal region was found in 5.5% of patients, remaining 94.44% of them
had no complaints
Incidence according to Condition of Cervix

Table no: 49
Condition of cervix Group A Group B Total %
Normal 6 5 11 61.11
Congestion 2 0 2 11.11
Hypertrophied 2 3 5 27.77
Graph no: 35
70
60
50
40 Normal
30 Congestion
20 Hypertrophied
10
0
Gr A Gr B Total %
Condition of cervix was normal in 61.11% of patients, congestion was found in about
11.11% of patients, hypertrophied cervix was seen in 27.77% of patients.
Results
RESULTS
Duration of flow
Effect within the Group
Table no: 50
Groups Mean Mean of AT d % Paired ‘t’ test

of BT
S.D S.E t P df
Group 1.467 AT 2.600 -1.133 77.23 0.507 0.507 -6.859 <0.001 14

A
1.467 AT1 2.733 -1.267 86.36 0.458 0.118 -8.264 <0.001 14
1.467 AT2 2.667 -1.200 81.79 0.488 0.126 -6.874 <0.001 14
1.467 AT3 2.733 -1.267 86.36 0.458 0.118 -6.971 <0.001 14
Group 1.733 AT 2.800 -1.067 61.56 0.414 0.107 -5.172 <0.001 14
B
1.733 AT1 2.667 -0.933 53.83 0.488 0.126 -4.090 <0.001 14
1.733 AT2 2.800 -1.067 61.56 0.414 0.107 -4.675 <0.001 14
1.733 AT3 2.867 -1.133 65.37 0.352 0.0909 -5.906 <0.001 14
Graph no: 36
3.5
3
2.5
2 GROUP A
1.5 GROUP B
1
0.5
0
BT AT AT1 AT2 AT3
Effect within the Group:

Group A:
The mean score of the symptom which was 1.467 before treatment increased to
2.600 after 3 cycles of treatment, increased to 2.733 in first follow up, further reduced to
2.667 in the second follow up and further to 2.733 after third follow up.

Results
When these values were analyzed statistically the change that occurred with the
treatment is greater than would be expected by chance; there is a statistically significant
change (P = <0.001)
Group B:
2.800 after 3 cycles of treatment, further reduced to 2.667 in first follow up, than
increased to 2.800 in the second follow up and further to 2.867 after third follow up.
change (P = <0.001).
Effect between two Groups

Table No: 51
Groups Mean d ‘t’ test

S.D S.E M t P df
Group A 2.733 -0.133 0.458 0.118 0.894 0.379 28
Group B 2.867 0.352 0.0909
Graph no. 37
2.9
2.85
2.8 Duration
of flow
2.75
2.7
2.65
Group A Group B
The difference in the mean values of the two groups is not great enough to reject
the possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 0.379).

Results
Interval between two menstrual cycles
Effect within the groups

Table no: 52

of BT
S.D S.E t P df
Group 1.933 AT 0.800 1.133 58.6 0.561 0.145 5.906 <0.001 14

A
1.933 AT1 0.200 1.733 89.6 0.414 0.107 9.539 <0.001 14
1.933 AT2 0.133 1.800 94.7 0.352 0.0909 9.000 <0.001 14
1.933 AT3 0.0667 1.867 96.5 0.258 0.0667 7.897 <0.001 14
Group 2.200 AT 0.733 1.467 66.6 0.458 0.118 7.643 <0.001 14
B
2.200 AT1 0.733 1.467 66.6 0.458 0.118 7.643 <0.001 14
2.200 AT2 0.667 1.533 69.6 0.488 0.126 9.280 <0.001 14
2.200 AT3 0.133 2.067 93.8 0.352 0.0909 7.750 <0.001 14
Graph no: 38
2.5
1.5
GROUP A
1 GROUP B
0.5
0
BT AT AT1 AT2 AT3

Group A:
The mean score of the symptom which was 1.933 before treatment reduced to
0.800 after 3 cycles of treatment, further reduced to 0.200 in first follow up, further
reduced to 0.133 in the second follow up and further to 0.0667 after third follow up.

Results
change (P = <0.001).
Group B:
0.733 after 3 cycles of treatment, which remained stable after first follow up i:e 0.733,
than further reduced to 0.667 in the second follow up and further to 0.133 after third
follow up.
change (P = <0.001).
Effect in between two Groups

Table no: 53

S.D S.E M t P df
Group A 0.0667 -0.0667 0.258 0.0667 0.592 0.559 28
Group B 0.133 0.352 0.0909
Graph no: 39
0.14
0.12
0.1
0.08 interm en
0.06 strual
0.04
0.02
0
Group A Group B

Results
Amount of blood loss

Effect within then Group
Table no: 54
Groups Mean Mean of AT d Paired ‘t’ test

of BT
S.D S.E t P df
Group 1.200 AT 2.133 -0.933 0.352 0.0909 -7.897 <0.001 14
A 1.200 AT1 2.333 -1.133 0.488 0.126 -8.500 <0.001 14
1.200 AT2 2.267 -1.067 0.458 0.118 -9.020. <0.001 14
1.200 AT3 2.533 -1.333 0.516 0.133 -10.583 <0.001 14
Group 0.800 AT 2.000 -1.200 0.000 0.000 -8.290 <0.001 14
B 0.800 AT1 2.000 -1.200 0.000 0.000 -8.290 <0.001 14
0.800 AT2 2.333 -1.533 0.488 0.126 -9.280 <0.001 14
0.800 AT3 2.333 -1.533 0.488 0.126 -11.500 <0.001 14
Graph no: 40
2.5
2
GROUP A
1.5
GROUP B
1
0.5
0
BT AT AT1 AT2 AT3

Group A:
2.133 after 3 cycles of treatment, further increased to 2.333 in first follow up, further
increased to 2.267 in the second follow up and reduced to 2.533 after third follow up.

Results
change (P = <0.001).
Group B:
2.000 after 3 cycles of treatment, which remained stable after first follow up i:e 2.000,
than further increased to 2.333 in the second follow up and further remain stable at 2.333
after third follow up.
change (P = <0.001).
Effect in between the Groups

Table no: 55
S.D S.E M t P df
Group A 2.533 0.200 0.516 0.133 1.090 0.285 28
Group B 2.333 0.488 0.126
Graph no: 41
2.55
2.5
2.45
2.4 am ount
of blood
2.35
2.3
2.25
2.2
Group A Group B

Results
Change in Pain
Table no: 56

of BT
S.D S.E t P df
Group 1.133 AT 0.400 0.733 64.6 0.507 0.131 4.036 <0.001 14

A 1.133 AT1 0.400 0.733 64.6 0.507 0.131 4.036 <0.001 14
1.133 AT2 0.0667 1.067 94.1 0.258 0.0667 4.298 <0.001 14
1.133 AT3 0.000 1.133 100 0.000 0.000 4.432 <0.001 14
Group 2.000 AT 0.867 1.133 56.6 0.640 0.165 5.264 <0.001 14
B 2.000 AT1 0.533 1.467 73.3 0.516 0.133 6.205 <0.001 14
2.000 AT2 0.333 1.667 83.3 0.488 0.232 7.714 <0.001 14
2.000 AT3 0.0667 1.933 96.65 0.258 0.0667 8.473 <0.001 14
Graph no: 42
2.5
1.5
GROUP A
1 GROUP B
0.5
0
BT AT AT1 AT2 AT3

Group A:
0.400 after 3 cycles of treatment, remained stable at 0.400 after first follow up, further

Results
change (P = <0.001).
Group B:
0.867 after 3 cycles of treatment, which further reduced to 0.533 after first follow up,
follow up.
change (P = <0.001).

Table no: 57

S.D S.E M t P df
Group A 0.000 -0.0667 0.000 0.000 -1.000 0.326 28
Group B 0.0667 0.258 0.0667
Graph no: 43
0.07
0.06
0.05
0.04 pain
0.03
0.02
0.01
0
Group A Group B
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a

Results
Change in Weight
Table no 58
of BT
S.D S.E t P df
Group 54.533 AT 53.433 1.100 2 4.031 1.041 5.016 <0.001 14

A 54.533 AT1 53.333 1.200 2.2 4.126 1.065 5.392 <0.001 14
54.533 AT2 53.133 1.400 2.5 4.015 1.037 4.979 <0.001 14
54.533 AT3 52.900 1.633 2.9 4.214 1.088 7.587 <0.001 14
Group 59.033 AT 57.600 1.433 2.4 12.557 3.242 8.911 <0.001 14
B 59.033 AT1 57.733 1.300 2.2 12.747 3.291 7.172 <0.001 14
59.033 AT2 57.267 1.767 2.9 13.060 3.372 6.315 <0.001 14
59.033 AT3 57.067 1.967 3.3 12.941 3.341 9.932 <0.001 14
Graph no 44
60
59
58
57
56
55 GROUP A
54 GROUP B
53
52
51
50
49
BT AT AT1 AT2 AT3

Group A:
53.433 after 3 cycles of treatment, further reduced at 53.333 after first follow up, further

Results
change (P = <0.001).
Group B:
57.600 after 3 cycles of treatment, which was increased to 57.733 after first follow up,
follow up.
change (P = <0.001).
Effect of weight in between the Groups
Table no: 59

S.D S.E M t P df
Group A 52.900 -4.167 4.214 1.088 -1.186 0.246 28
Group B 57.067 12.941 3.341
Graph no 45
58
57
56
55
w eight
54
53
52
51
50
Group A Group B

Discussion

Discussion
God has empowered women with special gift of the capacity of giving birth to
living being. This special gift of God has given women the status of visible creator. To
effectively fulfill the above aim, nature has conferred special anatomical and
physiological characteristics in the woman which are collectively referred to as
‘Streetwa’. One among them is the ‘Concept of menstruation’. As human life is
constantly influenced by the rhythmic phenomenon operating in this universe, the female
menstrual cycle which involves dramatic monthly hormonal changes affects a woman’s
physical and emotional state. The menstrual cycle which involves the shedding of
endometrium which was prepared in the anticipation of providing a bed for the fertilized
gamete, when fails, result into the manifestation of menstruation. If the above mechanism
fails, ends with change in menstrual cycle.
All these menstrual disorders have become a challenging problem for today’s
women. There are certain rapid physiological changes occurring from the puberty which
are markedly seen during reproductive period. This physiology gets altered due to
changed life style of the women, as there is increased physical & emotional, stress &
strain, which disrupts the H-P-O-U axis, leading to many gynecological problems.
Menstrual irregularity is one among them.
Among the menstrual irregularities, scanty and infrequent menses creates anxiety
of not getting pregnancy, guilt, especially questioning the fertility of women and
feminine outlook. This affects her physical and emotional activities disturbing the family
& social life. Many treatment regimens are prescribed for this. However a promising
therapy is still needed. Hence the present study is undertaken.
In the present study, a detail description of Artava kshaya is done with all its
nidana, lakshanas samprapti, samprapti ghatakas, etc. Artava kshaya can be correlated to
some extent with Oligomenorrhoea & Hypomenorrhoea. The effects of drugs as
evidenced in the clinical trials were recorded along with detailed case history.


Discussion

As in our classics we don’t find Artava kshaya as a separate disease, but it appears
as a symptom for many of the disorder. Acharya Sushruta explains Artava kshaya in
dosha dhatu mala kshaya vruddhi vignanam in Sutrastana, but later on explains the same
lakshanas under the heading of Nastartava in Shareerastana. Acharaya Vagbhata explains
Anartava with same pathology as that of Nastartava. Acharya Caraka has mentioned
Artava kshaya as a symptom of many yoni vyapad.
The direct reference for the nidana of Artava kshaya is not found in the classics.
The samanya nidana that causes kshaya of the dosha & dhatu is considered & the
vishesha nidana that vitiates the doshas are considered in the study. Thus all these nidana
sevana contribute to cause Artava Kshaya.
To understand the samprapti of Artava kshaya it is important to know about the

formation of Rasa dhatu. As Artava is the upadhatu of rasa dhatu, the kshaya of rasa
dhatu finally leads to kshaya of Artava. Formation of rasa dhatu is affected when there is
jataragni mandhya along with the vitiation of samana vata, pachaka pitta & kledaka
kapha. This mandagni with vitiated doshas hamper the formation of ahara rasa by
producing ama. Hence utpatti of rasa dhatu is affected as it is formed from ahara rasa.
Since the ‘Samprapti vighatana’ is the main aim for the proper Artava utpatti, which
can be achieved by maintaining the normalcy of the agni.
Normalcy of apana vata helps in expulsion of Artava. Garbhasaya & artavavahini

dhamani are mula for artavavaha srothas. If there is any injury to this, leads to nastartava.
Aratavavaha srothas are obstructed by the vikruti of apana vata & kapha, results in
Artava kshaya.
To maintain normalcy of agni & vata, removing the kapha is the basic line of
treatment. In the classics both Shodhana & Shamana chikitsa has been explained for
Artava kshaya. Shodhana chikitsa as explained by Acharya Dalhana includes only
vamana karma, as this removes only the soumya dhatu and maintains the pitta which is
required for utpatti of Artava. Acharya Cakrapani explains that both vamana & virechana


Discussion

karma can be administered. Acharya Kashyapa has mentioned basti to be the best
treatment. Shamana chikitsa is explained in the form of ‘Agneya dravyas’.
Agneya dravyas are used as they are Pittavardhaka. By this the agni will be
stimulated which helps in digestion of ama, formation of ahara rasa, which later on forms
the Rasa dhatu from which the Artava is formed. These Agneya dravyas helps in
increasing the quantity of Artava, as the Artava is also pitta pradhana. As the basic
concept of ‘xÉÉqÉÉlrÉÉãuÉ×ÎkS MüÉUhÉqÉç’ intake of samana guna causes the
increase of same guna. Hence the agneya dravyas are given prime importance in
producing Artava.
Use of Agneya dravyas not only relieves the kapha which does avarana to apana
vata but also increases the quantity of Artava. As agneya dravyas have ushna virya, it
maintains the normalcy of ruksha & sheeta guna of vata, snigdha & pichhila guna of
kapha.
There are many agneya dravyas mentioned in the classics which are having
Artavajanana property.
The drugs taken for the study i:e Krishna Tila Kshaya with guda & Lasunadi Vati,
possess ushna veerya & vatakapha shamaka properties.
Probable mode of action of Krishna Tila Kashaya:

With its Madhura Rasa, madhura Vipaka ,Guru, Snighdha Guna, Ushna Veerya
properties helps in Vata Shamana. Thus regularizing the Artava.
Tikta katu rasa, Ushna Veerya & Artavajanana Karma of Krishna Tila helps in increasing
the pitta, results in production of artava.
Katu rasa, Ushna Veerya of Krishna Tila relieves the avarana of kapha, enhances
the flow of Artava.
As the Krishna Tila Kashaya contains madhura rasa and madhura vipaka, it
nourishes and gives strength to Rasa Dhatu & its upadhatus. So it increases secretions
and helps in regeneration of endometrium. As madhura Rasa contains Carbohydrates in


Discussion

abundance which is very important constituent of endometrium, results in Artava
vruddhi.
The ushna veerya of the Krishna Tila helps in digestion of ama, results in proper
formation of Rasa Dhatu, ultimately ends in production of Artava.
Probable mode of action of guda:

The properties of Guda help in enhancing the quality of Krishna Tila Kashaya.
Though it is having madhura rasa, madhura vipaka, guru guna & sheeta veerya, it is
pittavardhaka as per Nighantu Ratnakara. It is having special qualities like ruchikara,
raktakara, rasayana, vrushya which not only helps in dhatu vruddhi, but also makes the
kashaya palatable.
Probable mode of action according to modern science 115,116

Krishna Tila known as sesamum-is an important source of Thiamine & niacin,
riboflavin, nicotinic acid, pantothenic acid, folic acid pyridoxine, ascorbic acid,
nourishing Lactagogue, diuretic, sugars such as glucose, sucrose, galactose. They have a
high magnesium content to help steady nerves and are used in laxatives as an emollient,
hence regulate the bowel & relieves from constipation.
Some studies show that sesamin, a lignan found only in sesame seeds, has
remarkable antioxidant effect which can inhibit the absorption of cholesterol and the
production of cholesterol in the liver. The seeds are also rich in Vitamin A, E and protein.
An old folk remedy recommends thoroughly chewing and swallowing one tablespoon of
sesame seeds per day to regulate the menses.
Lignan are plant phenolics converted in the intestines to a type of phytoestrogen
with antioxident properties. Lignans are a type of phytoestrogen that can influence
hormonal metabolism and are also anticarcinogenic. Lignans are found in outer part,
when a food containing a plant lignan is eaten, the friendly flora in the bowel converts
this to a ‘mammalian Lignan’ that has a therapeutic action in the body.
The phytoestrogens contained in Lignans have relatively weak hormonal activity
in comparison to the body’s own hormone levels. Lignan phytoestrogens do not stimulate


Discussion

reproductive tissue but may help to regulate stronger oestrogens in the body. Lignans
help to regulate the body’s oestrogen production. Lignans are capable of binding to
oestrogen receptor.
Probable mode of action of Lasunadi vati

Almost all the dravyas contains guru, snigdha, teekshna guna, ushna virya, katu
vipaka, so vatakaphashamaka, & enhances the pitta properties in the body.
These drugs possess six rasas and deepana, pachana, rasayana, ruchikara,
vatanulomana qualities helps in amapachana, agnideepana results in dhatu vruddhi.
Pittakara properties of these dravyas increasing the agneyatva of the body helps in
the production of Artava.
Finally we can conclude that the drugs present in Lasunadi Vati are vatakapha
shamaka, pitta vardhaka & artavajanana.
Probable mode of action in modern view113,114,116

Almost all the drugs acts as antibiotic, bacteriostatic, fungicidal, anthelmintic,
antithrombobic, hypotensive, hypoglacaemic, hypocholesolaemic, laxative, anti
spasmodic, anti inflammatory & diuretic.
Several studies showed that supplementation with lasuna extract inhibited
vascular calcification in patients with high blood cholesterol. Allium sativum has been
found to reduce platelet aggregation and hyperlipidemia. Garlic cloves are high in
sulphur containing amino acids known as allin, which is converted into enzyme allinase.
Allinase breakdown into ajoene, vinydithin, diallyldisulfide & trisulfide.
Ajoene inactivates human gastric lipase which is involved in digestion &
absorption of dietary fat. This factor may prove effective in preventing obstruction in
srothas.
Diallyltetra, penta & hexa hepta sulphides are potential antioxidants.
Jeeraka consist of EOH extract of the fruit exhibits spasmolytic activity. Fennol is
considered superior carminative.


Discussion

Pipalli shows the action like digestive, appetizer, carminative, haematonic. The
essential oil is antimicrobial and anthelmintic. Piperine is hypotensive, antipyretic,
analeptic, and nerve stimulant.
Marica acts as stimulant, carminative, diuretic, anticholerin. Used in the
flatulence, indigestion, GI stimulant.
Ginger is a classic tonic for the digestive tract. Classified as an aromatic bitter, it
stimulates digestion. It also keeps the intestinal muscles toned. This action eases the
transport of substances through the digestive tract, lessening irritation to the intestinal
walls. Ginger may protect the stomach from the damaging effect of alcohol and non
steroidal anti-inflammatory drugs and may help prevent ulcers. Ginger contains lot of
minerals and vitamins to boost adrenal glands.
Hingu, olea gum resin stimulates the intestinal & respiratory tract, used in simple
digestive problems such as indigestion & constipation.
Sulphur – it increases bile, acts as a laxative & alternative, used in skin disorders
enlarged spleen.
Jambira – this is used for the bhavana purpose. It mainly contains vitamin C
(ascorbic acid), which enhances the absorption of the drug. Jambira swarasa contains
coumarins & bioflavonoids. These acids contents once digested, provide alkaline effect
within the body & are found useful in all gastric conditions. The bioflavonoid strengthens
the inner lining of blood vessels especially veins & capillaries & helps counter varicose
vein, circulatory disorder & infection of liver, stomach & intestine.
PLAN OF STUDY:
This is single blind comparative clinical study of pretest and post test design.
Patients between age group of 18-35 years, who presented with pratyatma lakshanas of
artava kshaya were taken for study from OPD of SDM Ayurvedic Hospital. These 30
patients were categorized randomly into 2 groups. 15 patients in Group A were treated
with Krishna Tila Kashaya with Guda and 15 patients of Group B were treated with
Lasunadi vati for a period of 3 menstrual cycle & follow up every cycle for 3cycles.


Discussion

General Data
Age:
`In the present study 30 patients were registered, among them 36.66% were in the
age group of 18-23yrs & 24-29 yrs each. This period of reproductive life is mainly
concerned with child bearing, there is increase in family burden & changing trend of
personal career development. Hence the woman is unable to concentrate more on her
personal health. Therefore there might be increase incidence of artava kshaya in this age
group.
Marital status:
The study showed that maximum women suffering from artava kshaya in married
group i:e 60%. This may be due to the concerned towards the fertility & any disturbance
in the menstrual cycle may have been made the woman anxious & hence rushed for the
treatment.
Habitat:
Maximum of 60% of the women were from urban habitat. The reason for the
increase in women from urban area may be that, in urban area there is more awareness
towards the Ayurvedic Medicines & the women are having the knowledge of side effects
of continuous use of hormonal treatment. Secondly the problem of menstrual
irregularities is more in this area, as they are more prone to physical & emotional stress,
with changing lifestyles.
Religion:
About 86.67% of women were Hindus. As population in & around Udupi is
dominated by Hindus.
Education:
Graduates about 36.67% followed by 20% of higher secondary educated women
were registered for the study. As there is increase in stress during the education period &


Discussion

later on to built up there career which also includes irregular dietary habits. A slight
alteration in the menstrual flow & length of the cycle might have made the women alert
of the forth coming infertility problems. Hence incidence of artava kshaya is more seen in
this group of patients.
Occupation:
46.67% of the women were housewives. This may be due to increase in emotional
stress which leads to psychological disturbance affecting the H-P-O-U axis & sedentary
life style leads to increase in kapha & meda in the body, causing artava kshaya. About
30% of registered patients were students. Because of competitive era maximum time they
are exposed to stress & strain which alters the H-P-O-U axis, results in Artava kshaya.
Socio-economic status:
About 56.67% patients were registered of upper middle class followed by 43.33%
of lower middle class. The reason for this may be that of improper diet leading to
malnutrition.
Anubandhi vedana:
In the 30 patients, most of the women had low backache about 76.67%. As there
is vikruti of apana vata which is mainly located in the pelvic region, hence this might be
the reason for low backache. Secondly weakness was seen in 36.67% of patients which
may be due the reason of malnutrition.
Diet habit
Dietary habit of 76.67% of patients was of mixed. As this area is in coastal belt,
maximum patient are prone to mixed dietary habit. Akalabhojana is in about 70% of
patients this may be due to increasing stress & physical strain. The shortage of time, rapid
& altered lifestyle has made the changes in the dietary habits as the women has to adjust
herself to her personal & family life. Hence all these factors contribute in formation in
ama, resulting in Artava ks


Discussion

Rasa sambhandhi
The patients registered for the study used madhura rasa in100% of cases. Due to
this there is vitiation of kapha, 93.33% of patients were used katu rasa, leads to vitiation
of vata kapha dosha, results in Artava kshaya.
Mental stress
In about 63.33% of women the mental stress is present. As today’s women herself
or her family members are concentrating on her career, increases the rate of stress,
influences the H-P-O-U axis results in reduced flow of Artava.
It can be said that due to atichinta, krodha rajoguna vruddhi cause vata vruddhi
and this leads to Dhatu Kshaya. Due to Dhatu Kshaya, less quantity of Artava will be
formed leading to Artavakshaya. Psychological factor fail to suppress a stable ovarian
and uterine cycle completely and some time succeed only in reducing the amount of flow.
Emotional stress, strain etc. affect hypothalamus thus inhibiting the release of
GnRH. Low level of Oestrogen and LH, also suppresses menstruation.
Habit
About 50% of the people of the population are addicted to coffee. This incidence
may be more due to the people of south India mainly of coastal belt are more addicted to
drink coffee. Fast food is taken by 13.33%. The altered life style of women has forced the
women to addict herself to fast food. The preservatives used in that influences the
menstrual cycle.
Rajo Pravrutti
In 93.33% of women the rajo Pravrutti is aniyamitta. As it fulfills inclusion
criteria & is also the pratyatma lakshana of Artava kshaya. 6.66% of women showed
niyamitta rajo Pravrutti even then they were included in the study as they had scanty
flow.


Discussion

Duration of illness
40% of subjects showed duration of illness below 6months, followed by 26.67%
were in more than 2years, 20% of them were between 7months-1year, 13.33% were from
1yr- 2yrs. This shows the awareness of the women towards the menstrual irregularities.
Duration of blood loss:
Among 30 patients, 46.67% had the flow between 3 – 4 days, 36.67% of patients
had the flow between 1 – 2 days and 16.66% had the flow more than 4 days. Even though
the flow of menstruation was more in days, the patients complained of scanty bleeding
with prolonged intermenstrual period.
Inter menstrual period:
The Inter menstrual period was 53.33% in between 35-45days, 30% people were
more than 60days, 16.67% in between 46-60days. This shows increased intermenstrual
period in maximum patients.
Amount of menstrual flow
76.67% of registered patients used ½ -1pad, 23.33% used 1-2pads & none of them
used more than 2pads. This incidence showed that there was reduce in amount of
menstrual flow. This shows that change in the dietary habits, quality of the food,
excessive use of bakery items, lack of time for herself effects the menstruation.
Pain
Pain with different grades were registered in which maximum of 63.33% had
moderate pain, 13.33% had no pain & mild pain each, & 10% of them had severe pain.
This incidence showed the vikruti of vata which causes pain.


Discussion

Varna
In 56.66% of the women the colour of menstruation is blackish red. This may be
due to the Artava dusti. Hence we can conclude that the women suffering from Artava
kshaya does not have shuddha Artava lakshana.
Gandha
About 76.67% of the women have no smell to the menstrual blood.
Akruti
Madhyama akruti is maximum in the study group. Second highest is stula akruti
patients, the incidence of this is 30%. The reason for this may be the increase in medo
dhatu results in kapha vruddhi which obstructs the flow of the Artava. This shows that
obesity influencing the menstruation.
Prakruti
The incidence of vata kapha prakruti patients is more. The vata is more prone to
vitiate and due to this, Artava Srava becomes alpa in pramana and is also the cause for
the yoni vedana. The kapha which is vitiated will do the avarana, finally leading to
Artava kshaya.
Vikruti
About 46.67% of the patients showed vata pitta vikruti. This shows apana vata
vikruti, which reduces flow of the Artava. There is pitta vikruti in the form of kshaya,
agneyatva in the body is reduced, results in less production of Artava.
Sara
The maximum of the women were of medo sara. There will be teekshanagni in
them. Hence excessive consumption of ahara goes in production of meda instead of rasa
dhatu, effects the Artava formation.


Discussion

Satva
83.33% of women had madhyama satva. But direct correlation of Artava kshaya
& satva could not be established.
Ahara Shakti and Vyayam Shakti:

In the present study, maximum no. of patients 53.33% had madhyama vyayama
shakti, madhyama ahara shakti. It is very difficult to establish the relation between
disease and above findings.
Srothas
In 100% of women rasavaha & Artavavaha srothas were affected. This affected
srothas was diagnosed by asking a set of questions to the patients. Thus the affected
srothas have caused Artava kshaya, either by less formation of rasa dhatu or less Artava
utpatti, or avarodha in Artavavaha srothas.
Per Speculum (P/S) Examination :

Per speculum examination was restricted only to the married women. Among the
30 patients 60% were married & remaining 40% were unmarried.
Tenderness in vaginal region was seen in 5.5% of the women which does not show any
relation with the study.
Condition of cervix
Condition of cervix was normal in 61.11% of patients, congestion was found in
about 11.11% of patients, hypertrophied cervix was seen in 27.77% of patients. Hence
this finding also had no effect on the present study


Discussion

Results of the study
Duration of flow
Group A:
2.733 after treatment. The change that occurred with the treatment is greater than would
be expected by chance; there is a statistically significant change (P = <0.001). As Krishna
Tila is Vatakapha shamaka, & Artavajanana, this showed good effect on the duration of
flow.
Group B:
The mean score of the symptom which was 1.733 before treatment increased and
increased to 2.867 after treatment. The change that occurred with the treatment is greater
than would be expected by chance; there is a statistically significant change (P = <0.001).
The change seen in group was because all the drugs are deepana, pachana, vatakaphahara
& pittavarddhaka, due to this there will be amapachana which finally results in artava
utpatti.
Effect in between two groups
The effect of Krishna Tila Kashaya 86.36% was & Lasunadi Vati was 65.37%.
statistically significant difference between the input groups (P = 0.379). The
improvement in both the groups was seen as drugs possess vatakapha shamaka & pitta
vardhaka property.
Interval between 2 menstrual cycles

Group A:

Discussion

be expected by chance; there is a statistically significant change (P = <0.001). As the
drug possess artavajanana property along with Vatakapha Shamaka & Pittavardhaka
quality. In one of the patients the quantity of Kashaya was increased. This shows that the
increase in quantity of kashaya may give effective result in some chronic cases.
Group B:
be expected by chance; there is a statistically significant change (P = <0.001). This
change is due to amapachana which leads to proper formation of rasa dhatu, which helps
in artava utapatti.
The effect of Krishna Tila Kashaya was 96.5% & Lasunadi Vati was 93.9%. The
difference in the mean values of the two groups is not great enough to reject the
statistically significant difference between the input groups (P = 0.559). As the drugs are
ama pachana & Artavajanana.
Amount of blood loss

Group A:
The mean score of the symptom which was 1.200 before treatment increased to 2.533
after treatment. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001). As Krishna
Tila is agneya dravya which enhances the pitta, & helps in increase in production of
Artava.
Group B:
The mean score of the symptom which was 0.800 before treatment increased to 2.333
after treatment. The change that occurred with the treatment is greater than would be

Discussion

expected by chance; there is a statistically significant change (P = <0.001). As maximum
of the drugs are of ushna veerya pitta varddhaka, vatakapha shamaka does amapachana.
Thus helps in proper formation of rasa dhatu then Artava utapatti. In Group B patient, 3
patients showed excess of bleeding hence the treatment was stopped for them. This shows
that the drugs are more potent & are having Artavajanaka property.
Effect in between the Groups

The effect of Krishna Tila Kashaya & Lasunadi Vati on amount of flow it is more
than expected in both the groups but lasunadi vati prove to be more effective.
statistically significant difference between the input groups (P = 0.285). As both the
groups contain agneya dravya which helps for Artava utapatti.
Change in Pain
Group A:
be expected by chance; there is a statistically significant change (P = <0.001). The
reduction in pain was seen as the drug contains vatashamaka property, which helps in
controlling the vikrut apana vata.
Group B:
be expected by chance; there is a statistically significant change (P = <0.001). All the
drugs are vatashamaka, hence helps in reliving the pain.


Discussion

The effect of Krishna Tila Kashaya is100% & Lasunadi Vati is 96.6%. The
group contains drugs which have vatashamaka properties.
Change in Weight
Group A:
be expected by chance; there is a statistically significant change (P = <0.001). As the
drugs possess kaphashamaka property which helps in reduction of weight.
Group B:
be expected by chance; there is a statistically significant change (P = <0.001). The drugs
contain ushna veerya which helps in kapha shamaka. Thus helps in weight reduction.
Effect of weight in between the Groups
The effect of Krishna Tila Kashaya was 2.9% & Lasunadi Vati was 3.3%. The
groups showed kapha shamaka property. It was proved that irregular menstruation
women showed increase in weight due to hormonal changes which leads to retention of
fluid. The study showed that reduction in the weight gives an interesting finding, that the
drugs may be having the capacity to remove excessive fluid from the body.


Conclusion

CONCLUSION
Conclusion is the total extort that is obtains from the work done to complete the
study.
Whatever was explained earlier are the particular facts and reasons that are supported
by the obtained evidences/data as well as textual references. Now whatever the
conclusions are coming at by that scientific discussion are presented here.
• Though, ‘Artavakshaya’ is described as a symptom in classics, but in present
study it appears like a disease by Nidana, Lakshana and Chikitsa base.
• The main principles of management of Artavakshaya are Agnivardhaka and
Vatanulomaka chikitsa.
Conceptual study
o ‘Artavakshaya’ in present study it appears like a disease on the basis of Nidana,
Lakshana and Chikitsa.
o Shodhana & shamana both line of treatment can be adopted.
o Shodhana includes pancha karma & shamana includes use of agneya dravyas.
Modern view
o This disease can be compared with Oligomenorrhoea & Hypomenorrhoea.
o There is altered physiology in H-P-O-U axis which leads to symptoms like
infrequent menstruation & scanty flow.
o Assurance & hormonal therapy is the accepted line of treatment.
From current study we obtained the following result with the help of required
assessment criteria.
o The effect of Krishna Tila Kashaya & Lasunadi Vati on the duration of flow was
86.36% & 65.37% respectively. Hence Krishna tila kashaya proved to be more
effective.


Conclusion

o The effect of Krishna Tila Kashaya & Lasunadi Vati on the inter menstrual period
is 96.5% &93.9% respectively. Thus Krishna Tila kashaya proved to be more
effective.
o The effect of Krishna Tila Kashaya & Lasunadi Vati on amount of flow it is more
than expected in both the groups but lasunadi vati prove to be more effective.
o The effect of Krishna Tila Kashaya & Lasunadi Vati on changes in pain is 100%
& 96.6% respectively. The patients taking Krishna Tila Kashaya had relieved
from pain after the treatment course. Hence it proved to be more effective.
o The effect of Krishna Tila Kashaya & Lasunadi Vati on change in weight 2.9% &
3.3% respectively. Thus there was more weight reduction in patients of Lasunadi
vati. Hence it proved to be more effective.
Hence by the clinical trial on 30 patients with 15 patients each in Group A-Krishna
Tila Kashaya & Group B – Lasunadi vati, the results in Group A was more effective
in duration of flow, intermenstrual period, and pain. Group B was more effective in
amount of flow & in reduction of weight. But there is not a statistically significant
difference between the two groups.


Summary

SUMMARY
The present dissertation study entitled as “A COMPARATIVE CLINICAL
STUDY OF KRISHNA TILA KASHAYA AND LASUNADI VATI IN ARTAVA
KSHAYA” is planned with the following aim and objectives
1. A conceptual study of Artava Kshaya.
2. To evaluate the efficacy of Krishna Tila Kashaya with Guda
3. To evaluate the efficacy of Lasunadi vati
4. To compare the efficacy of Krishna Tila kashaya with Guda & Lasunadi vati.
The whole study was elaborated in 5 parts are namely.
o Review of literature.
o Clinical study
o Discussion
o Conclusion
o Summary
Review of literature
It contains of 2sections, first section comprises of historical review of Artava,

Artava kshaya, all the drugs that are included in the study.
The second section contains – Artava nirmana, Artava chakra with paricharya,
Artava Kshaya with its chikitsa with the drug review of the concerned drugs.
It also includes the modern view of menstruation & its physiology, disease review
of Oligomenorrhoea & Hypomenorrhoea.

Summary

Clinical study
With the Aim of addressing the increased menstrual disorder, Artava kshaya was
select for the study. 30 patients with pratyatma lakshana of Artava Kshaya were
randomly selected and divided in to 2 groups. Criteria of inclusion, exclusion and
assessment with parameters are given. The data recorded from the observations and
results obtained at the end of therapy are represented in tabular and graphical form. The
results of statistical analysis by applying paired‘t’ test and unpaired‘t’ test are mentioned.
Discussion
In this part, discussion is done on the concept of disease from references collected
and compiled from Ayurvedic and modern texts. Discussion on the data of observations
obtained from patients along with the effect of therapy is done.
A probable mode of action of Krishna Tila Kshaya and Lasunadi Vati on the
basis of it’s ‘Rasapanchaka’, active chemical constituents is drawn on the basis of
discussion on the whole study:
Conclusion
• Significant results were seen in all the criteria i:e duration of flow, intermenstrual
period, amount of flow, changes in pain & weight.
• Further studies should be carried out with large sample size with all hematological
investigation including hormonal assay.

Bibliography

1. Vedo me Ayurveda by Dr. Kapildev Dvivedi and Dr. Bharatendu Dvivedi, Reprint 2001
Vishwabharati Anusandhana Parishada, Jnanapur Pp266 Pgno. 108
2. Vedo me Ayurveda by Dr. Kapildev Dvivedi and Dr. Bharatendu Dvivedi, Reprint 2001
Vishwabharati Anusandhana Parishada, Jnanapur Pp266 Pgno. 252
3. Manusmriti edited with maniprabha hindi commentary by Pt. Haragovinda Sastri 1965
Published by Chowkhambha Sanskrit series office Pp 716 Pg no. 501
4. Manusmriti edited with maniprabha hindi commentary by Pt. Haragovinda Sastri 1965
Published by Chowkhambha Sanskrit series office Pp 716 Pg no. 487
5. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited by
Vaidya Jadavaji Trikamjiacharya . Introduced by Prof. P.V. Sharma, 9th edition 2007,
published by, Chaukhambha orientalia Varanasi. Pp 824, Pg no 70
6. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
Arunadutta. Introduced by Prof. P. V. Sharma. Reprint 9th edition 2005, Published by
Chaukhambha Orientalia Pp. 956, page no. 364
7. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
commentary by Indu, by Prof. Jyotir Mitra. Edited by Dr. Shivaprasad Sharma, Published
by Choukhambha Sanskrit series office Varanasi Pp. 965, pg no. 267
8. Kasyapa Samhita or Vruddha Jivakiya tantra by Vruddha Jivaka revised by Vatsy with
Sanskrit introduction by Nepal Rajaguru Pandit Hemaraja Sarma with Vidyotini hindi
commentary and hindi translation of sanskrit introduction by Ayurvedalankar Sri
th
Satyapala Bhisagacharya , edition 7 2000. Published by Chaukhambha Sankrit Sansthan
Varanasi. Pp364, Pg no. 287
9. Yogaratanakar with vidyotini hindi commentary by Vaidya Laksmipati Sastri edited by
Bhisagratha Brahmasankar Sastri, 6th edition 1997, published by Chaukhambha Sanskrit
Santhan Varanasi. Uttaradham, Pp 504, Pg no 406
10. Vaidyajivanam by Loliambaraja with vidyotini hindi commentary by Dr Indradeva
Tripathi, 3rd edition. 1998. Published by Chaukhambha orientalia Varanasi. Pp100, Page
no.50.
th
11. Bhavaprakash of sribhava Misra , 11 Edition 2007 Published by Chaukhambha Sanskrit
Bhawan Varanasi 1st volume Pp 959 pg no


Bibliography

nd
12. Dravyaguna vignana, volume II by Dr.J.L.N. Sastry edition 2 2005 Published by
Chaukhambha orientalia Varanasi Pp 1134 Pg no 535
nd
Chaukhambha orientalia Varanasi Pp 1134 Pg no 274,276
nd
nd
Chaukhambha orientalia Varanasi Pp 1134 Pg no 457-458
nd
nd
Chaukhambha orientalia Varanasi Pp 1134 Pg no 525,526
nd
nd
20.
a. Jeffcoate’s principles of Gynaecology Revised and updated by Pratap Kumar, Narendra
Malhotra 7th Edition 2008, Published by Jaypee Brother Medical Publishers (P) LTD Pp
964 pg no.595
b. Howkin’s and Bourne Shaw’s Textbook of Gynaecology, Edited by VG Padubidri, and
Shirish N Daftary, 14th Edition 2008, Published by Elsevier, a division of Reed Elsevier
India Private limited Pp 483 pg no.50
c. Text Book of Gynaecology including Contraception D.C. Dutta Edited by Hiralal Konar
3rd edition 2001, Published by NEW CENTRAL BOOK AGENCY (P) LTD Pp 604 pg
no.76
21. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of



Bibliography

22.
a. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
by Vaidya Jadavaji Trikamjiacharya . Introduced by Prof. P.V. Sharma, 9th edition
2007, published by, Chaukhambha orientalia Varanasi. Pp 824, Pg no 275.
b. Caraka Samhita by Agnivesha Revised by Charaka & Dridhabala with the Ayurveda
Dipika commentary of chakrapani datta, Edited by Vaidya Jadavaji Trikamji
Acharya, reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg
no. 210
c. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
2007, published by, Chaukhambha orientalia Varanasi. Pp 824, Pg no 351
d. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
e. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda
no. 643
f. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
g. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
h. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda
no. 635
i. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya and the
Nyayacandrika Panijka of Sri Gayadasacharya on Nidanastana edited by Vaidya


Bibliography

Jadavaji Trikamjiacharya . Introduced by Prof. P.V. Sharma, 9th edition 2007,
j. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
k. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
l. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited
m. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
n. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
commentary by Indu, by Prof. Jyotir Mitra. Edited by Dr. Shivaprasad Sharma,
Published by Choukhambha Sanskrit series office Varanasi Pp. 965, pg no. 266
o. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
Arunadutta Introduced by Prof. P. V. Sharma. Reprint 9th edition 2005, Published by
Chaukhambha Orientalia Pp. 956 pg no. 511
p. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
q. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
Published by Choukhambha Sanskrit series office Varanasi Pp. 965 pg no. 267
r. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit


Bibliography

s. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
Published by Choukhambha Sanskrit series office Varanasi Pp. 965 pg no. 270
t. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
Published by Choukhambha Sanskrit series office Varanasi Pp. 965 pg no 276
u. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
23.
a. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited by
b. Kasyapa Samhita or Vruddha Jivakiya tantra by Vruddha Jivaka revised by Vatsy with
Satyapala Bhisagacharya , edition 7th 2000. Published by Chaukhambha Sankrit Sansthan
Varanasi. Pp364, Pg no.79
c. Kasyapa Samhita or Vruddha Jivakiya tantra by Vruddha Jivaka revised by Vatsy with
24.
a. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda
Dipika commentary of chakrapani datta, Edited by Vaidya Jadavaji Trikamji Acharya,
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no. 643
b. Sushruta Samhita with nibandhasangraha commentary of Sri Dalhanacharya edited by


Bibliography

c. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda
25.
b. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no. 316-317
c. Kasyapa Samhita or Vruddha Jivakiya tantra by Vruddha Jivaka revised by Vatsy with
th
d. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
e. Kasyapa Samhita or Vruddha Jivakiya tantra by Vruddha Jivaka revised by Vatsy with
f. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
g. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit


Bibliography

h. Astangahrdayam composed by Vagbhata with the Commentaries (Sarvangasundari ) of
26.
a. Astangahrdayam composed by Vagbhata with the Commentaries (Sarvangasundari ) of
published by, Chaukhambha orientalia Varanasi. Pp 824, Pg no. 347
27.
b. Astangahrdayam composed by Vagbhata with the Commentary (Sarvangasundari ) of
28.
Kasyapa Samhita or Vruddha Jivakiya tantra by Vruddha Jivaka revised by Vatsy with
29.
a. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda

Bibliography

c. Astangahrdayam composed by Vagbhata with the Commentaries (Sarvangasundari ) of
d. Astanga Samgraha of Vahata or Vruddha Vagabhata with the Sasilekha Sanskrit
by Choukhambha Sanskrit series office Varanasi Pp. 965, pg no.271
30. Caraka Samhita by Agnivesha Revisedby Charaka & Dridhabala with the Ayurveda
32. Astangahrdayam composed by Vagbhata with the Commentaries (Sarvangasundari ) of
Chaukhambha Orientalia Varanasi Pp. 956 pg no. 363
th
34. Bhavaprakash of sribhava Misra , 11 Edition 2007 Published by Chaukhambha Sanskrit
Bhawan Varanasi 1st volume Pp 959 pg no 64
th
35. Sarngadhara Samhita by Pt. Sarngadharacharya, edition 5 2002 Published by
Chaukhambha Orientalia Varanasi Pp 398 pg no. 46
published by, Chaukhambha orientalia Varanasi. Pp 824, Pg no59

Bibliography



Bibliography

by Choukhambha Sanskrit series office Varanasi Pp. 965, pg no.267
52. Bhela Samhita edited by Girijadayalu Suklah reprinted 1999, Published by Choukhambha
Academy Varanasi Pp 285, pg no 93


Bibliography

th
Chaukhambha Orientalia Varanasi Pp. 956 pg no.367
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no. 316-317
62. Jeffcoate’s principles of Gynaecology Revised & updated by Pratap Kumar, Narendra
Malhotra 7thEdition 2008, Published by Jaypee Brother Medical Publishers (P) LTD Pp
964 pg no 79
63. Howkin’s and Bourne Shaw’s Textbook of Gynaecology, Edited by VG Padubidri, and
India Private limited Pp 483 pg no. 41
64. Text Book of Gynaecology including Contraception D.C. Dutta Edited by Hiralal Konar
no. 74
th
65. Text book of Medical physiology by Arthur C. Guyton 11 edition reprint 2006
published by Saunders An imprint of Elsevier Pp 1116 pg no.1019
th
66. Text book of Medical physiology by Arthur C. Guyton 11 edition reprint 2006
published by Saunders An imprint of Elsevier Pp 1116 pg no.1011-1021


Bibliography

964 pg no 56-78
India Private limited Pp 483 pg no. 35-43
no. 59-73
964 pg no 79-87
no. 76-86
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no.102
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no.634


Bibliography

Chaukhambha Orientalia Varanasi Pp. 956 pg no.188
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no 617


Bibliography

th
th
Varanasi. Pp364, Pg no.185-187
Chaukhambha Orientalia Varanasi Pp. 956 pg no 270-271
Varanasi. Pp364, Pg no 167


Bibliography

Chaukhambha Orientalia Varanasi Pp. 956 pg no 364
Chaukhambha Orientalia Varanasi Pp. 956 pg no 896
964 pg no 596
3rd edition 2001, Published by NEW CENTRAL BOOK AGENCY (P) LTD Pp 604
pg no. 176
964 pg no 579-590
102. Book of Gynaecology including Contraception D.C. Dutta Edited by Hiralal Konar 3rd
edition 2001, Published by NEW CENTRAL BOOK AGENCY (P) LTD Pp 604 pg no
419-428
964 pg no 595-596


Bibliography

177
106.Book of Gynaecology including Contraception D.C. Dutta Edited by Hiralal Konar 3rd
428-430
964 pg no 590-592
964 pg no 592-595
edition 2001, Published by NEW CENTRAL BOOK AGENCY (P) LTD Pp 604
pg no 431-432
reprint in 2007 Published by Choukhambha Orientalia, Varanasi Pp 738, pg no.321-322
113. http://www.scs.leeds.ac.uk/pfaf/onions.html
114. http://www.Herbs.html
115. http://www. Sesamum_Benne.html
116. WHO monograph

Annexure
CASE PROFORMA
S.D.M. College of Ayurveda –Udupi
Department of Prasooti Tantra and Stree Roga

2007-2010
“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA

KASHAYA AND LASUNADI VATI IN ARTAVA KSHAYA”
ATURA VIVARA:
Name: Serial No.:
Age: Years OPD No.:
Religion: IPD No.:
Education: DOA:
Occupation: DOD:
Socioeconomic Status: Diagnosis:
Address: Results: Comfertable relief /Moderate Relief

/Unchanged
PRADHANA VEDANA:
ARTAVA SAMBANDHA / MENSTRUAL FLOW:
a. Duration of illness: Months / Years
b. L.M.P.:
c. Duration of blood loss:
d. Interval of blood loss:
e. Amount of menstrual flow:
VEDANA SAMBANDHI
Pain: No Pain – (0)
Mild (1)
Moderate (2)
Severe (3)
Annexure
ANUBANDHA VEDANA
a. Weakness d. Giddiness g. other if any
b. Low back ache e. Headache
c. Vomiting f. loose motion
POORVA VYADHI VRITTANTA

Specific: white discharge / infection / infertility / abortion
General: if any
Treatment history:
Medical :
Surgical treatment:
KOUTUMBIKA VRITTANA:
Family: HTn/DM/TB/ASTHMA/SYPHILIS/AIDS
VAIYAKTIKA VRITTANTA:
AAHARA SAMBANDHI:
Ahara : Veg / Non-Veg / Mixed
Rasa Sambandhi : M / A / L / K / T / K
Diet Habit: Akalabhojana / Kalabhojana/Abhojana / Samasana/Adhyasana / Vishamasana
NIDRA: Sound / Disturbed
If Disturbed: Mental Stress Yes / No
Jagarana Yes / No
MALA: Regular / Irregular
MUTRA:
Habit: Coffee / Tea / Tobacco chewing/smoking/ drinking/others if any
RAJO VRITTANTA:
Prathama Rajo Pravritti Kala:
Rajo Pravritti: Niyamita / Aniyamita
Srava Kala: Days / Scanty Varna
Antima Rajo Pravritti Dinanka: Gandha
Associated with Pain: Yes / No

Annexure
PRASAVA VRITTANTA:
Vaivahika Kala:
G / P /A/ L / D
FAMILY PLANNING:
Safe Method/Contraceptive Pills/IUCD/Permanent Sterilisation:
General Examination:
Built: Well / Moderate / Poor
Pallor: Conjunctiva – Present / Absent
Nail Bed
Tongue
Ictrus: Present / Absent
Nourishment: Well / Moderate / Poor
BP: / mm of Hg Pulse: / Min
Heart Rate: / Min Temperature:
Height: Respiratory Rate:
Weight:
Ashta Vidha Pariksha:
Nadi Mala Mutra Jihva Shabda Sparsha Druk Akruti
Dashavidha Pariksha:
Prakriti: V / P / K / VP / PK / VK / SAMA
Vikriti: V / P/ K
Sara: Rasa / Rakta / Mamsa / Meda / Asti / Majja / Shukra / Sarva.. P/M/A
Samhanana: P / M / A
Satmya: Ekarasa / Sarvarasa / Mishra Rasa. P/M/A
Pramana: Heena / Madhyama / Uttama
Satva: Pravara / Madhyama / Avara
Ahara Shakti: Pravara / Madhyama / Avara
VyayamaShakti: P / M / A
Vaya: Madhyama / Vriddha

Annexure
Srotas Pariksha: Affected Not affected

Prana Vaha Srotas:
Rasa Vaha Srotas:
Rakta Vaha Srotas:
Anna Vaha Srotas:
Artava Vaha Srotas
Systemic Examination:
Respiratory System:
Cardiovascular System:
Gastro intestinal system
Central nervous System
Examination of Reproduction System:

Vulvae inspection: Hair distribution
Labia Majora Well Developed / Undeveloped
Labia Minora
P/S- Vagina: Tenderness – Present / Absent
Cervix: Size: Normal / Atrophied / Hypertrophied
P/V- Direction: Anterior / Posterior
OS: Nulliparous / Parous
Uterus: Position: Anteverted / Retroverted
Mobility: Mobile / Fixed
Consistency: Soft / Hard
Fornices: Free / Tender
Investigations:
1. Hb%
2. TC, DC,ESR
3. USG, Hormonal assay – if needed

Annexure
Treatment
Assessment Criteria
Criteria BT AT FOLLOW UP
1st 2nd 3rd
1. Duration
of flow
2. Interval between
Two menstrual cycles
3. Amount of menstrual
Blood loss
4. Changes in associated
Symptoms
5. Weight
Signature of the Guide Signature of the PG Scholar
(Dr. Ramadevi. G.) (Dr. Shilpa A. Kulkarni)


Figure:1 Lasuna Figure:2 Jeeraka Figure:3 Hingu

Figure:4 Pippalli Figure:5 Marica Figure:6 Nagara

Figure:7 Saindhava Lavana Figure:8 Gandhaka Figure:9 Jambira

Figure: 10 Lasunadi Vati

Figure:11 Krishna Tila Figure:12 Guda

Figure:13 Krishna Tila Kashaya

Kulkarni Shilpa A.

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Kulkarni Shilpa A.

Încărcat de

Drepturi de autor:

Formate disponibile

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA

KASHAYA AND LASUNADI VATI IN ARTAVA KSHAYA”

Dissertation submitted to the Rajiv Gandhi University of Health Sciences,

MASTER OF SURGERY (Ayu)

UNDER THE GUIDANCE OF

Dr. RAMADEVI G. M.D. (AYU)

DEPARTMENT OF POST GRADUATE STUDIES IN

First and foremost I pray to the almighty God, who is omnipresent,

My deep sense of gratification is due to my parents Dr. Ashok Kulkarni &

1. Ca.S- CARAKA SAMHITHA

2. Su.S - SUSHRUTA SAMHITHA

3. A.S - ASTANGA SANGRAHA

4. A.H - ASTANGA HRUDAYA

5. Dh.N - DHANWANTARI NIGHANTU

6. Bp.N - BHAVAPRAKASHA NIGHANTU

7. Rj.Ni - RAJA NIGHANTU

8. Ma.Ni - MADANAPALA NIGHANTU

9. Sh.S.Ma. Kh - SHARANGADARA SAMHITA

10. Kai.N- KAIYADEVA NIGHANTU

11. Y.R- YOGA RATNAKARA

12. Sa.N- SALIGRAMA NIGHANTU

13. BT- BEFORE TREATMENT

14. AT- AFTER TREATMENT

15. &- AND

17. SD STANDARD DEVIATION

18. SE STANDARD ERROR

19. df DEGREE OF FREEDOM

Though, ‘Artavakshaya’ is described as a symptom in classics, but in present study it

Objectives : A conceptual study of Artava Kshaya.

CHAPTER NO. PAGE NO.

25 Incidence according to Amount of Blood Loss 63

11 Incidence according to Amount of Blood Los 63

12 Incidence according to Pain 64

Geographical conditions, racial factors, nutritional standards, environmental

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

• Samshodhana – Cleansing process which is in form of Panchakarma.

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

1. A conceptual study of Artava Kshaya.

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

Vagbhata I & II 6,7

Dhanvantari Nighantu, Shodala Nighantu, Kaiyadeva Nighantu, Raja Nighantu,

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

PREVIOUS WORK DONE

• Management of artava kshaya with Shatapushpa curna by Dr. Archana Ghose in

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

Artava which is to be considered as menstrual blood is clearly explained by commentary

Shonita,23 Asruk ,24 Raja,25 Rakta,26 Lohita,27 Rudhira,28 Pushpa 29

It is important to understand the utpatti of rasa dhatu according to “Dhatu Poshana

Vishvamitra’s opinion coated by Dalhana in his commentary as there are some

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

Ahara rasa Kitta

Rasadhatu Mutra & Mala

Prasada bhaga Kitta bhaga

Stula bhaga Sukshma bhaga

Artava swarupa 38,39,40

“A COMPARATIVE CLINICAL STUDY OF KRISHNA TILA KASHAYA

Suddha artava lakshana 41,42,43,44

o Flow of artava is for 3- 5 days

The concept of Dhatuparipuranta51,52 is explained by the acharyas which will

WûÏlÉrÉÉãlrÉÉxiÉÑ oÉÉsÉÉrÉÉ: MüÉrÉÇ aÉcNûÌiÉ vÉÉãÍhÉiÉqÉç |

• Rajasrava kala- 3-5days

Acharya Kashayapa60 explains the kala for Brahmana’s as 12days, Ksatriya’s as