Prashuti Tantra (Gynaecology)

HOLISTIC AYURVEDIC PREGNANCY TIPS Written by Dr. Adwait Tripathi

HOLISTIC AYURVEDIC PREGNANCY TIPS

Vaidya Achyut Kumar Tripathi
(Member Governing body)

Ayurveda compares the conception to the germination and sprouting of a seed and its transformation into a sapling, When the male and female seeds unite and the soul enters the union, it becomes an embryo (garbha ). Ayurveda gives importance to the quality of the seed, and hence, to the development during adolescence. In addition to the female seed, the mother also provides the soil, nutrition and the right season for the seed to grow.
Hence, it advised for special attention the be paid to the nutrition and protection of the woman to keep her (The soil) rich and clean. It further advices that a female under sixteen years of age and male under twenty years of age should not bear child. The age rules of sexual intercourse are also laid down. So also, those of antenatal care : the husband and the other family members are advised to take care of the pregnant woman’s diet and encourage those activities that are dear to her and beneficial to the fetus or child growing in her body . Thus, the approach towards motherhood i ,e pregnancy and child birth, is a holistic one.

Amenorrhoea (Anartava) Written by Swati Sharma

Amenorrhoea

Amenorrhoea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and lactation (breastfeeding), the latter also forming the basis of a form of contraception known as the lactational amenorrhea method. Outside of the reproductive years there is absence of menses during childhood and after menopause.

Menorrhagia Written by Priya Singh

Menorrhagia

Definition : Menorrhagia is defined as cyclic bleeding at normal intervals, the bleeding is either excessive in amount (>80ml) or duration on born. The term menotaxis is often used to denote prolonged or both. The term menotaxis is often used to denote prolonged bleeding.

It is generally caused by condition affecting the uterus or its vascularity, rather than any disturbance of function of the hypothalamic pituitary ovarian axis. When ever uterine endometrial surface is enlarged, the bleeding surface is increased, thus prevail in women suffering from uterine fibroids, adenomyosis, uterine suffering from uterine fibroids, adenomyosis, uterine polyps, myohyperplasia or endometrial hyperplasia.

Leucorrhoea Written by Dr. Aarti Bhart

Leucorrhoea

Definition :- Leucorrhoea is defined as an excessive vaginal discharge.
Leucorrhea should fulfil the following criteria :-
1. Painless discharge.
2. Excess secretion is evident from persistent vulval moistness or staining of clothes which turn brownish yellow on drying.
3. Discharge is non-purulent and non-offensive.
4. Discharge is non-irritant and never cause pruriti

Types

1. Physiological
2. Pathological.

Physiological

Normal secretion is increase in conditions when the oestrogen level become high such conditions are :- during puberty, during menstrual cycle, during pregnancy, during sexual excitement .

Pathological

It is due to infection of bacteria, fungi and protozoa. The infective leucorrhoea are purulent, offensive and irritant one. They are due to specific and non-specific infection.

Clinical Features

1. Excessive vaginal discharge.
2. General examination may reveals ill health.
3. Constipation
4. Reduced appetite
5. Burning sensation in lower abdomen.
6. Pain in lumber region.
7. Palpitation and head ache.
8. Loss of facial lusture.

Ayurvedic treatment

General treatment
1. Improvement of general health. 2. Sympathetic attitude towards the ailments and anxiety state should be removed.
Specific treatment
1. Oral Medicines
2. Drugs for external use or local use
Panchkarma treatment
Uttar Basti by menas of kashaya drvaya decoction or taila is useful e.g. Dhatkyadi Taila, Guduchyadi Taila. Oral Medicines:-
1. Pushyanug Churna.
2. Amalaki Churna.
3. Pestled root of rohitaka should be taken with water.
4. Fruit of Amalaki mixed with honey and sugar should be licked.
5. Use of darvyadi decoction.
6. Paste of lodhra mixed with decoction of stem bark of nyagrodha should be taken.
7. Drinking of root of cakramarda pestled with rice-water , in morning hours cures jalapradara.
8. Use of decoction of nyagrodha group of drugs is beneficial due to its Astringent property.
9. Use of nagakesara with buttermilk followed by diet of only cooked rice and butter milk cures leucorrhoea with in 3 days.
Drugs for external use or local use
1. A flaxen cloth impregnated with decoction of stem bark of only nyagrodha or lodhra with vata should placed in vagina.
2. Vaginal irrigation with decoction of stem bark of lodhra and vata should be done.
3. suppository made with powdered lodhra, priyangu, madhuk mixed with honey or else with kasaya.
4. After oleating vaginal canal, fumigation with sarala, guggulu, yava mixed with plenty of ghrita should be done.
Compatible diet
1. Take cold and balanced diet.
2. Light laxative should be taken to avoid constipation.
Incompatible diet
1. Avoid chillies, oil, sour-food, garlic, excess of salt and Heenga.
2. Momordica (Karela), brinjal, urd, bajra should not be taken.
Compatible regimen
Proper exercises accompanied with walking and cycling should be regularly done.
Incompatible regimen
Excessive walking in sun, warm bathing and excessive intercourse should be avoided.

Ayurveda Female Reproductive Healthcare Written by Dr. Jayashree Nataraj, BAMS, MD (Ayur)

Ayurveda Female Reproductive Healthcare

The human race is nurtured in the lap of the mother. An attention towards caring for the one (i.e. mother) who has cared for the universe for centuries is a gesture of gratitude.

Two-thirds of the world's population is dependent on the alternative medical practices for the primary health care. India has several scientifically evolved, time-tested medical traditions, of which Ayurveda has cared for the well and the ill for centuries in this land.

The revival of Ayurveda in its own land is attaining greater importance and it is time to incorporate all her experiential wisdom into practice through scientific research and committed implementation. The following are the areas where Ayurveda can benefit female reproductive healthcare.

Pre-puberty period- Prevention of undernourishment by Ayurveda food practices (e.g., usage of Black gram, Groundnut, Ashwagandha, vegetables, and greens. (Shigru, Chakramuni). Administration of Herbs in the form of Rasayanas that support the normal physiological changes during puberty- Shatavari, Ashwagandha, Amalaki, Brahmi, etc).

Menstrual variations- Amenorrhea Usage of herbal emmenagogues, viz. Kumari, Gingly, nutritional supplementation of minerals nutrients by greens, herbo-mineral preparations to combat malnourishment as the cause of this condition.

Dysmenorrhea: when unabated, the normal course of medical care could be managed through Ayurvedic pancha karma maneuvers.

Menorrhagia- Prevention of anemia, and rectifying the found excess flow through ? formulations comprising of Shatavari, Lodhra, Ashoka, Japa, Varuna, Bilva etc.

Altered cycles- Aiming at regulation, poly-herbal treatments combined with Pancha karma. (e.g. Ashoka, Kumari, Triphala, Panchakola etc. and Virechana, Basti.)

Implementation of practices for progeny, as per scheduled Ayurvedic methods will benefit safe and smooth parenthood. The area being less important for economical reasons in the developing countries like ours could be considered under long term goals.

The aspect of immediate goals will encompass the components of Ante-natal care.
Continuity of pregnancy and aiding normal fetal growth through-

Monthly dietetic regimen

• First month - Plain milk as much as one can consume at intervals
• Second month - Kseerapaka prepared with madhura oushadha.
• Third month - Milk with Honey and Gritha (ghee/clarified butter)
• Fourth month - Milk with Navaneetha (Butter)
• Fifth month - Milk with gritha Payasa.
• Sixth and seventh month - Gokshura ksheera paka
• Eighth month - Milk and ghritha.

Do's and don?ts during pregnancy : vihara

• Exercise; the amount of exercise a pregnant woman can perform can be understood based on occurrence of fatigue.
• During pregnancy it is not advisable to commence the jogging type of exercises for the first time.
• Riding on the horseback, riding on two wheelers, long journey by car, on undulated roads, are best avoided.
• Stand up jobs, working to exhaustion, can be harmful.
• Exercise with relaxation is more beneficial
• Sexual intercourse; is to be avoided during the first and third trimesters especially in high-risk cases. Coital techniques can be modified to satisfy the circumstances. With reduction in number of acts.
• Adequate rest is very essential with feet up position.
• Clothing; loose fitting and natural-fabric clothes are to be preferred; synthetic materials, tight-fitting dresses are ill advised.
• During early pregnancy itself, a shift to flat-heeled shoes is advisable.

VICHARA : Psychological and emotional activities

• A pregnant woman needs to be provided with a pleasing environment.
• Every individual who meets the pregnant woman needs to show concern, affection, and provide moral support.
• Any type of mental stress is best avoided.
• Positive thinking is the best approach.
• A great deal of psychological comfort is to be provided at all spheres of family and society for an uneventful (safe) pregnancy.
• Acceptability of the mother for any modality of management is top priority.
• Use of rasayanas viz. Ashwagandha, Brahmi, Amalaki, Shatavari, Kushmanda, Gritha etc. is beneficial for health and immune strength.
• Hygiene and fitness during pregnancy are important to maintain health and positive mental attitude.
• Routine examination and monitoring are required.

Diseases during pregnancy

• Prevention of Hyper-emesis gravidarum.
• Nutritional disorders.
• Management of pre-eclampcia.
• Alteration in weight gain.
• Anemia etc. are managed with specific therapeutic modulations (viz. Dhanyaka hima, Kushmanda, Ashwagandha, Pala ghritha, Jatamamshi, Tantupashana. Rajatha Bhasma, Praval bhasma, Mandoor bhasma, etc.)
• Periodic specialized therapies in pancha karma (ex. Mathra Basti, Pichu dharana, Abhyanga etc.) during the third trimester enhances neuromuscular strength to aid normal delivery.

Perperal care

Diet and herbs containing galactogogues and body restoratives (e.g. Jeevanthi, Shatavari, Lashuna, ksheera, Kulatta - Abhyanga with Ksheerabala taila). use of Dashamoolarista, Devadarvyadi quath, Soubhagyashunti, pratapalankeshwara, Shatavari, Medicated ghritha, Ashwagandha, Amalaki etc. and suitable Pancha karma are beneficial.

Care of the newborn

Abhyanga and Matra Basti to enhance weight gain; these are more important for premature babies. Bala rasayana administration and the special pediatric rejuvenators (Vacha, Haritaki, Amalaki, Jatiphala) support normal growth and development and improve immunity.

Weaning foods: Yavagu, Krishara, Vilepi, Kritayoosha.

Management of Pediatric ailments

• Gastric disorders - Vomiting, flatulence, constipation, and diarrhea are helped through safe, non-habit forming remedies (e.g. Chaturbhadra Churna, Jatiphala, Triphala, Nagara, Kumari.)
• Respiratory infections: Management - Talisadi, Sitophala, Yasti, and Gorochana.
• Growth and developmental abnormalities
• Nutritional- Marasmus, Kwashiorkar, - Nutrition supplemented with Rasayanas.
• Developmental - Mental retardation, cerebral palsy; are managed with condition-specific pancha karma therapies.

Thus, Ayurveda can provide life cycle approach in women?s health as well can care the children for their common ailments and rehabilitation in mental retardedation, and other diseases.

Identification of raw areas for introducing Ayurvedic modes separately or/and by coordinating with the existing programs.

Lastly, the mission of Ayurveda is that a physician is not just the rescuer of his patient?s illness, but a caretaker of his total well-being needs no special emphasis.

This article is for educational purposes only. It is not intended to treat, diagnose, prescribe, heal, or Cure any disease. Readers are advised to consult with proper healthcare providers.

Sandhivata (Osteo arthritis) in women Written by Dr. Jayashree Nataraj, BAMS, MD (Ayur)

Sandhivata (Osteo arthritis) in women, An Ayurvedic perspective

Many women will celebrate their 80th birthday. This means women will spend at least one third of their life time after menopause. Menopause, also known as the climacteric, is thus defined as the time following one year of complete cessation of menstrual bleeding. The average age for menopause is 51.4 years.1

Knee problems occur in mid thirties and the risk increases with age and more commonly develops in women over 40 who are five times more likely to have this problem than men. OA is the most common and characteristic arthritis of the elderly. It is also the most common cause of disability amongst them. The prevalence of OA which is less than 1% below the age of 30 years, increases to 10-20% between 65-74 years of age and to 30% and above in those above 75 years of age.

Females are more commonly affected. In the Indian context, OA of knee and cervical and lumbar spine is most common. Dr Ashok Rajgopal, a well known knee replacement surgeon of India observed that most of the osteo-arthritis patients in India who seek knee replacement are in the advanced stage of the disease, with a high degree of deformity but treating such cases has its own research related advantage and the effect of the treatment is dramatic, which changes the complete lifestyle of the patient.

Here a question may be raised whether the numbers of cases requiring joint replacement can be reduced are not... certainly the incidences as well as the deformity may be minimised through the Ayurvedic line of treatment.

The aetiology and origin of osteoarthritis is not known to modern science but Ayurveda can infer the constitution of the individuals who are prone to this disease. And also the life style which can become a caused for the disease. In my practice more than 3 decades the study has shown that the women belonging to Vata prakrti are more prone to this Sandhivata. Secondly those who have totally sedentary life (Ayoga) and over doing (athiyoga).

Being too overly conscious about the weight and avoiding ghee or such beneficial fats in the diet, and consuming too much of katu spicy foods which are dry. Those who do house hold work with over exposure to cold water. And stand continuously for many hours, are the common victims for this sandhivata.

Women have an additional phase proudhavastha which starts with the slow changes in Arthavavaha srotas and ends up with Rajonivruththi ( Menopause). Normally active lady may have silent menopause without any suffering. But the awareness about the changes itself has become cause for many women to suffer during this phase of life.

As an young girl passes through the phase of puberty and adjusts to the change occurring in the body and various systems. The body also tries to adapt itself to the changing internal environment. Women slowly enters in to a phase predominated by Vata dosha. As per the interrelation ship of the doshas and dhatus Asthi dhatu (bone tissue) is the ashraya (abode) for Vata dosha.

As per the general rule whenever there is increase of the doshas the corresponding dhatus should also increase. But this rule is not applicable to the combination of Asthi and Vayu. Thus the aggravation of Vata always plays a major role in diminution of Asthi dhatu. Arthava (the menstrual blood and also the factor responsible for conception) is the by-product of the first Dhatu i.e. rasadhatu.

Vata increase or aggravation also caused depletion in rasa dhatu, the function of which is to nourish every cell in the body. These are important internal environmental changes, which become the cause for increased incidence of sandhivata (osteoarthritis) in women. If these contributing factors are taken care of both the prevention and remission of Sandhivata in women can be achieved.

Symptoms

Osteoarthritis develops slowly over several years. The symptoms of osteoarthritis are mainly pain, swelling, and stiffening of the knee. The pain of osteoarthritis is usually worse after activity. Early in the course of the disease, one may notice that the knee does fairly well while walking, then after sitting for several minutes the knee becomes stiff and painful. As the condition progresses, pain can interfere with even simple daily activities.

A common complaint is difficulty in squatting and sitting cross-legged and climbing down stairs. In the late stages, the pain can be continuous and even affect sleep patterns.

The diagnosis of osteoarthritis can usually be made on the basis of the following-

• Initial history and examination.
• X-Rays are very helpful in the diagnosis and may be the only special test required in the majority of cases. In some cases of early osteoarthritis, the X-rays may not show changes typical of osteoarthritis
• MRI
• Arthroscopy

Ayurvedic approach of management of sandhivata

As mentioned earlier, osteoarthritis is compared with sandhivata. sandhi meaning the joints and the Vata dosha gets localised in the joints thereby causes Rukshatha which results in increased friction and the asthidhatu kshaya results.

The lakshanas-Clinical features are-

• Sandhi vedhana- Pain in the joints,
• Vedanayuktha chesta (painful movements)
• Sandhi sphurana- cripitations in the joints,
• Sandhi sthabdhatha- inactiveness of the joints, etc...

Often associated with other Vata lakshanas.

The management includes the local and internal treatment-

Internally the drugs with the therapeutic activities like shothagna (Anti inflammatory), dhatuvardhaka (growth promotion especially of Asthi dhatu/bone tissue), Vatahara (Pacifying Vata dosha), rasayana (adaptogenic) and vedanashamaka (Analgesic).

Panchakarma

Adaptation of matrabasti, Administration of medicated Ghee or oil per rectum which is an easy procedure and can be carried out as out patient basis. A course of seven days Mathrabasti with only medicated oil or ghee provides prolonged relief from pain and also prevents further damage to the bone tissue. Generally used Ghee Gugguluthikthaka Grutha.

Which has the Myrrh guggulu, five bitter plants, and the Ghee. Guggulu and also the bitter plant products have proven effect on inflammation and pain. These are also good digestants and help in proper digestion and thus prevent the formation of Ama or the toxins which can get accumulated and interfere in the bone formation. The lipid component of the preparation helps in providing lubrication to the joints and help in easy movement oft affected joints.

If this therapy is used in the initial stages there will be prolonged relief . the author has observed the relief in patients for more than 4-5 years. In few where the inflammation is very severe and the dieses is chronic the therapy need to be repeated once in three months or even earlier in some cases. In obese patients instead of Ghee medicated oils can be utilised.

The commonly used oils are Mahanarayan taila, and Dhanvantara taila. These can be effective as hormone replacement too. Though the hormone replacement therapy has helped in reducing the incidence of sandhivata it has its own adverse reactions which can cause a range of health problems from Carcinoma, to obesity.

But on the other hand the mathra Basti is more safer, providing sustained relief, and promotes overall well being of hte patient which is the need of the hour.

Adaptation of janu Basti or the local sudation therapy through Basti to the affected joints. A therapy in which the warm medicated oill is poured over the joint with round bridge prepared by the dough made out of Black gram floor. Retention of oil over the joint helps in improving the circulation, gets absorbed and reduces pain and inflammation, and also helped in resolving the Ama localised in the joints.

Application of warm medicated oils like Mahanarayan taila, Hinguthriguna taila, murivenna oil, caster oil to the affected joints with gentle massage, followed by tight wrap for at least 3-4 hours reduces pain remarkably. Warm water may be poured over the joints.

As in women the pathogenesis of the disease is aimed at the changes occurring in arthavavaha Srotas (reproductive systems) and its impact on the other dhatus and the doshas. As a general rule the management of arthava vikara (abnormality related to menstruation) as well as yoni vyapadhas (gynaecological diseases) are with a primary focus to Vata shamana and then the rasadhatu, even the problems during menopause is also aimed at alleviating these factors.

In acute conditions the pain management is the basic need. There are number of drugs proved to have this effect. Few among them are Ginger-Nagara, Turmeric- haridhra, Boswellia-shallaki.

The use of rasayana is very essential which also fits in to the framework of conventional approach with vitamins, minerals and hormones. Many drugs have been proven to possess smaller quantity of phytoestrogen that will full fill the requirement of the hormone to prevent the further damage. These phyto-estrogens are proven to have no side effect. As the whole drug is used

Amalki (Emblica officinalis), shigru (Moring monosperma), agasthya (Sesbania grandiflora), kaidarya ( Curry leaves), shathavari ( Asperagus racemoses) etc are the drugs which can take care of women in maintaining the general heath thus providing quality of life. Though these plants have been proven for their vitamin and mineral content, as well as phyto-hormones, when the whole drug is used in the natural form the limitation and the adverse effects are counteracted or minimised. These plants are more than the chemical single constituent identified by the scientists. These medicines also have rejuvenating effect on all the tissues of the body.

Preventive measures

As the exact cause is not known the prevention also appears to be difficult. But any joint is vulnerable, especially if it has been injured or overused.

Relieving stress on the joints is recommended.

• Losing excess weight,
• Avoiding repetitive motions, and
• Choosing low-impact sports (e.g. bicycling, swimming)
• Practice of Yogasanas under proper supervision.
• Over grueling, joint-punishing activities.
• Instead of avoiding movements which is major mistake many would do one need to build up stronger muscle which prevents further wearing of the bone tissue.
• Diet rich in bone marrow, cartilage, tendons, and raw root vegetables provides the silicon a micro mineral which is essential for the development of bones.
• Calcium is connected to osteoarthritis because easily fractured bones only add to the discomfort and pain of arthritis. Calcium is easily obtained with three or four daily servings of Milk and Yogurt. Dark-green leafy vegetables, Millets the poor-mans food in south India. Use of Kukkutandatvak Bhasma ( Bhasma prepared with the egg shell), Pravala Bhasma ( Bhasma of the corals)
• Prompt management of any abnormality in relation to rajapravruththi (Menstruation) .
• Administration of Rasayana dravyas prior to the onset of peri-menopausal stage is much beneficial. This is the rule for administration of Rasayanas in the Ayurvedic classics. Instead of waiting for the disease to crop up or the old age signs to develop the rasayanas should be administered before the onset of menopause. This make the body to adapt to the changes easily with out any untoward results.
• Education regarding the use of nithya rasayanas like milk and ghee etc.. is beneficial, This needs to be motivated.
• Encouraging every day Abhyanga with Ashwagandha Bala laxadhi taila, or Mahanarayan taila keeps muscle tone and the supporting structures of the joints, and improves the lubrication to the joints.
• Screening at community level during the 3rd , 4th, and 5th decade and detecting well in advance makes the women to maintain at an early age and keep themselves fit.
• Educating the community through training camps.

Daily activities- Here are some helpful hints to use during the day to limit strain on knee joint.

• Avoid standing for greater than 10 minutes; instead use a high stool or take frequent rests.
• Limit stair climbing; take the elevator, escalator, or ramp.
• Avoid bending and squatting; keep items at waist level, or use a reacher.
• Park close to your destination.
• Avoid low beds, chairs, and toilets; elevate them when possible.
• Control pain and inflammation.
• Reduce shock by using a walking aid, wearing good shoes, choosing soft surfaces, and keeping the leg muscles conditioned for unexpected stresses.
• Exercise daily to maintain range of motion, strength, and cardiovascular fitness.
• Use a shoe orthotic with a heel wedge for better alignment.
• Take precautions with daily activities to avoid stressing the knee. There are also braces on the market now that can reduce the pressure on the side of the knee that is most involved. These braces have been designed mainly for the more common condition of early wear and tear in the medial compartment of the knee.

Since the women are susceptible to osteoarthritis need to be cared for prevention, early detection and timely treatment. As the science Ayurveda can identify the chances of susceptibility, and can prevent the occurrence of sandhivata both for prevention and relief one can depend on Ayurveda.

Exercises for Osteoarthritis

People with osteoarthritis should do different kinds of exercise for different benefits to the body. exercises can improve the body density and hence should be a part of the life style. Yogic postures along with synchronised breathing helps in building up of the tissues and certainly reduces the risk and suffering. but any type of exercises should be started after the proper consultation.