Management of Dysmenorrhea from Ovarian Endometrioma: A Case Report
Journal name: Ayushdhara
Original article title: Management of Dysmenorrhea due to Ovarian Endometrioma w.s.r to Vatika Artavadushti by Ayurvedic Regime - A Case Report
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Rozina Sheikh
PG Scholar, Department of Prasutitantra evam Striroga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India
Hetal H. Dave
Associate Professor, Department of Prasutitantra evam Striroga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India
Poonam Choudhary
Assistant Professor, Department of Prasutitantra evam Striroga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India
Nalini Das
Professor and Head, Department of Prasutitantra evam Striroga, Sri Sri Nrusinghnath Ayurved College and Research Institute, Nruhsinghnath, Paikma, Odisha, India
Monika Kumari
PG Scholar, Department of Prasutitantra evam Striroga, National Institute of Ayurveda, Deemed to be University, Jaipur, Rajasthan, India
Ayushdhara:
(A peer-reviewed, bi-monthly open-access journal)
Full text available for: Management of Dysmenorrhea due to Ovarian Endometrioma w.s.r to Vatika Artavadushti by Ayurvedic Regime - A Case Report
Year: 2022 | Doi: 10.47070/ayushdhara.v9i6.1117
Copyright (license): CC BY-NC-SA 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
Endometriomas are cystic lesions associated with endometriosis, often leading to dysmenorrhea, which is characterized by painful menstruation. Dysmenorrhea is a common symptom, occurring in approximately 70% of endometriosis cases, and is linked to the presence of functioning endometrial tissue outside the uterus. In Ayurveda, this condition is correlated with the term "Vatika Artavadushti," which describes the manifestation of painful and disordered menstrual bleeding. This case report documents the management of a 24-year-old unmarried female diagnosed with ovarian endometrioma, highlighting Ayurvedic treatment approaches that aim to alleviate her dysmenorrhea and other related symptoms.
Effectiveness of Kashmarya-Kshudrasaha Ksheerapaka
The primary Ayurvedic intervention employed in this case was "Kashmarya-Kshudrasaha Ksheerapaka," a preparation mentioned in the Ashtang Sangraha for managing Vatika Artavadushti. This formulation was administered to address the vitiation of Vata dosha, which is believed to be the main contributor to the symptoms exhibited by the patient, including painful, scanty, and dark brown menstruation. Over the course of two months, treatment showed significant improvements. The patient's menstrual flow increased from one day to three days, and pain severity decreased markedly from a visual analog scale (VAS) score of 6 to 2. Additionally, ultrasound results indicated the absence of the previously identified ovarian endometrioma, demonstrating the efficacy of this Ayurvedic remedy in alleviating the condition.
Understanding Vata Dosha and Its Implications
The vitiation of Vata dosha in Ayurveda is linked to the development of symptoms associated with dysmenorrhea and menstrual irregularities. In this case, the abnormal movement of Vata dosha was understood to contribute to the pathogenesis of the ovarian endometrioma. The Ayurvedic approach emphasizes restoring the balance of Vata to mitigate symptoms. The formulation of Kashmarya-Kshudrasaha Ksheerapaka was chosen for its properties that pacify Vata, which is essential in treating conditions that stem from its disturbance. Alongside this treatment, additional herbal preparations were utilized to support digestive health and enhance overall well-being, further aiding the treatment of associated symptoms such as decreased appetite and constipation.
Conclusion
The application of Kashmarya-Kshudrasaha Ksheerapaka has proven effective in managing ovarian endometrioma and its accompanying symptoms in this case report. While significant improvements were observed, further research is warranted to understand the detailed pharmacological action of this Ayurvedic formulation, especially within the framework of modern medicine. This case study underlines the importance of traditional remedies and their potential in treating contemporary medical issues, advocating for more rigorous scientific studies to validate their efficacy and support their integration into mainstream treatment protocols.
FAQ section (important questions/answers):
What is the main condition discussed in this study?
The study primarily focuses on managing dysmenorrhea and ovarian endometrioma, which are conditions characterized by painful menstruation and cystic lesions resulting from endometriosis.
What Ayurvedic treatment was used in the case report?
The treatment involved using Kashmarya-Kshudrasaha Ksheerapaka, along with Ajamodadi churna and Panchsakar churna, to address symptoms of painful and scanty menses associated with ovarian endometrioma.
What were the outcomes after treatment for the patient?
After two months of treatment, the patient showed significant improvement, including reduced pain, normal menstrual flow, and an ultrasound report indicating no signs of ovarian endometrioma.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Management of Dysmenorrhea from Ovarian Endometrioma: A Case Report�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Vata:
In Ayurveda, Vata is one of the three doshas or fundamental bodily humors. It is associated with movement and is responsible for various physiological functions. Vata is linked to the symptoms described in the case study, particularly the pain and abnormal menstrual patterns.
2) Vatika:
The term 'Vatika' refers to conditions characterized by the predominance or vitiation of the Vata dosha. In this case study, 'Vatika Artavadushti' is used to describe a pathological condition in which Vata dosha affects the menstruation, leading to painful menstrual cycles and other symptoms.
3) Pain:
Pain is a primary symptom experienced by the patient in the case study, especially during menstruation. Ayurvedic treatments aim to alleviate pain by balancing the doshas and addressing the underlying causes, such as the vitiation of Vata dosha.
4) Kashmarya (Kasmarya):
Kashmarya (Gmelina arborea) is an herb used in Ayurvedic medicine. It has properties that help pacify the Vata dosha due to its Guru (heavy) quality and Ushna virya (warm potency). Kashmarya is a critical component in the therapeutic regimen used in the study for treating ovarian endometrioma.
5) Drug:
The term 'drug' in the context of Ayurvedic medicine refers to herbal formulations aimed at treating specific health conditions. In this study, the drugs include Ayurvedic formulations such as Kashmarya-Kshudrasaha Ksheerapaka used to manage the symptoms of ovarian endometrioma.
6) Kshudrasaha (Ksudrasaha, Kshudra-saha):
Kshudrasaha (Phaseolus trilobus) is another herb cited in the case study. Known for its Laghu (light) and Ruksha (dry) qualities, it helps in pacifying the Vata dosha. It is combined with Kashmarya to create the therapeutic preparation used in the management of the patient's symptoms.
7) Dysmenorrhea (Dysmenorrhoea):
Dysmenorrhoea is used interchangeably with dysmenorrhea, referring to painful menstruation. Like the latter, it is managed through Ayurvedic treatments aimed at balancing doshas, specifically Vata.
8) Disease:
The disease mentioned in this case study is ovarian endometrioma, a condition where endometriotic cysts develop in the ovaries. It is associated with dysmenorrhea, and Ayurvedic management aims to alleviate this by targeting the vitiation of the Vata dosha.
9) Vatadosha (Vatadosa, Vata-dosha):
The Vata-dosha is one of the three primary doshas in Ayurveda. It governs movement and coordination in the body. In this case study, the symptoms of painful, scanty, and discolored menstruation are attributed to the vitiation of Vata-dosha.
10) Ayurveda (Ayus-veda):
Ayurveda is an ancient system of medicine from India that focuses on balancing the body’s doshas—Vata, Pitta, and Kapha. This case study employs Ayurvedic principles and treatments to manage ovarian endometrioma and its associated symptoms like dysmenorrhea.
11) Dosha (Dosa):
Dosha refers to the three fundamental bodily bio-elements in Ayurveda: Vata, Pitta, and Kapha. Each dosha governs specific physiological functions, and imbalances lead to diseases. The case study focuses on Vata dosha as the primary factor in the patient’s condition.
12) Madhura:
Madhura, meaning 'sweet', is one of the six tastes (rasas) in Ayurveda. It is often associated with nourishing and balancing properties. Herbs with Madhura rasa, like Kshudrasaha, are used in the treatment to pacify Vata dosha in the case study.
13) Striroga (Stri-roga):
Striroga refers to the department of gynecology in Ayurveda dealing with women's health issues. The authors of the case study conducted their research in the Striroga department, focusing on the Ayurvedic management of ovarian endometrioma.
14) Medicine:
In the context of this case study, medicine refers to Ayurvedic formulations such as Kashmarya-Kshudrasaha Ksheerapaka, Ajamodadi Churna, and Panchsakar Churna used to treat the patient's symptoms. These medicines aim to balance the doshas and relieve specific conditions.
15) Samgraha (Sangraha):
Sangraha in Ayurveda refers to a compilation or compilation text. 'Ashtang Sangraha' is one such classical text that discusses various treatment protocols, including the one used in the case study for managing Vatika Artavadushti.
16) Vedana:
Vedana refers to pain or discomfort. The term is used in the case study to describe the pain (Vata-vedana) associated with dysmenorrhea and other symptoms of ovarian endometrioma linked to Vata dosha.
17) Blood:
Blood, particularly menstrual blood, is discussed in the case study concerning its discoloration due to the vitiation of Vata dosha. The treatment aims to normalize the color and flow of menstrual blood by balancing Vata.
18) Madhurarasa (Madhura-rasa):
Madhura-rasa, or sweet taste, is one of the six primary tastes in Ayurveda. Herbs with Madhura-rasa, such as Kshudrasaha, are employed in the case study to balance Vata dosha and treat the symptoms of ovarian endometrioma.
19) Vomiting:
Vomiting is one of the symptoms experienced by the patient during menstrual periods, which is addressed in the Ayurvedic treatment plan. The treatment aims to balance Vata dosha, thereby alleviating vomiting and other symptoms.
20) Vipaka:
Vipaka refers to the post-digestive effect of a substance. In the case study, Madhura Vipaka (sweet post-digestive effect) of certain herbs helps to pacify Vata dosha and contributes to the treatment of ovarian endometrioma.
21) Jaipur:
Jaipur is the location of the National Institute of Ayurveda where the case study was conducted. The patient visited this institute for the treatment of her symptoms related to ovarian endometrioma under the Ayurvedic regimen.
22) Family:
Family history is considered in the case study; the patient's father had Koch’s disease, and her mother had diabetes, which might play a role in her overall health profile.
23) Ushna (Usna):
Ushna refers to warm or hot. In the case study, Kashmarya has Ushna Virya (warm potency), which helps to balance Vata dosha and is beneficial in treating ovarian endometrioma.
24) Virya:
Virya refers to the potency of a substance in Ayurveda. Ushna Virya (hot potency) is effective in pacifying Vata dosha. Kashmarya’s and other herbs� Ushna Virya plays a crucial role in the treatment described in the case study.
25) Varna:
Varna refers to color. In the context of the case study, Vata Varna (dark brown or blackish color of menstrual blood) is a symptom of Vatika Artavadushti, which is addressed by Ayurvedic treatment.
26) Fever:
Fever is one of the symptoms experienced by the patient during her menstrual cycle. Ayurvedic intervention aimed at balancing Vata dosha seeks to alleviate fever along with other manifestations like pain and vomiting.
27) Rasa (Rasha):
Rasa in Ayurveda refers to taste. In the study, herbs with specific rasas, such as Madhura (sweet) and Tikta (bitter), are used to balance Vata dosha, the primary factor in the patient’s condition.
28) Food:
Food and dietary guidelines are a part of the Ayurvedic regimen. The patient was likely advised to follow 'Rajaswalacharya,' which involves dietary and lifestyle tips to balance Vata and manage symptoms.
29) Burning sensation:
While the patient did not report a burning sensation, this symptom is often relevant in gynecological issues. Ayurvedic treatments aim to address various symptoms, including burning sensations, by balancing the doshas.
30) Pharmacological:
Pharmacological intervention in Ayurveda involves the use of herbal formulations to treat diseases. In this case study, pharmacological interventions include Kashmarya-Kshudrasaha Ksheerapaka to manage ovarian endometrioma.
31) Saindhava (Saimdhava):
Saindhava refers to rock salt used in Ayurvedic formulations. In the study, Saindhava Lavana is part of Ajamodadi and Panchsakar Churna, which aid in digestion and alleviate Vata dosha-related symptoms.
32) Vitiation (Vitiated):
Vitiation in Ayurveda means the imbalance or disturbance of a dosha. In this case, vitiation of Vata dosha leads to symptoms like dysmenorrhea, which are managed by balancing the dosha.
33) Haritaki:
Haritaki is a medicinal herb used in Ayurveda. It is a component of both Ajamodadi and Panchsakar Churna, which help in treating constipation and enhancing digestive fire, contributing to overall Vata balance.
34) Allergy:
The patient had no specific history of allergy to any drug or food material, which is relevant for tailoring her Ayurvedic treatment plan safely.
35) Artava:
Artava refers to menstrual blood or menstrual cycle in Ayurveda. The condition 'Vatika Artavadushti' involves the vitiation of Vata affecting Artava, leading to symptoms like painful and dark-colored menses.
36) Guru:
Guru means 'heavy' and describes the quality of certain Ayurvedic herbs. Kashmarya has Guru guna, which helps balance Vata dosha and is used in treating the patient's symptoms.
37) Milk:
Milk is a key ingredient in the preparation of Ksheerapaka, an Ayurvedic medicinal formulation used in the case study. It is boiled with the herbs Kashmarya and Kshudrasaha to create a therapeutic drink.
38) Menstrual blood:
Menstrual blood discoloration, such as dark brown color, is mentioned as a symptom of Vatika Artavadushti. Ayurvedic treatments aim to restore the normal color and flow of menstrual blood.
39) Saindhavalavana (Saindhava-lavana, Saimdhavalavana):
Saindhava-lavana, or rock salt, is known for its medicinal properties in Ayurveda. It is included in Ajamodadi Churna and Panchsakar Churna, which help alleviate symptoms related to Vata dosha vitiation.
40) Gmelina arborea:
Gmelina arborea, also known as Kashmarya, is a plant used in Ayurvedic treatments. It has qualities that balance the Vata dosha and is a component of the Ksheerapaka formulation used in this case study.
41) Vriddhadaruka (Vrddhadaruka, Vriddha-daruka):
Vriddhadaruka is an herb that is part of the Ajamodadi Churna used to manage symptoms such as decreased appetite and constipation alongside the primary treatment for ovarian endometrioma.
42) Mudgaparni (Mudga-parni):
Mudgaparni, also known as Kshudrasaha, is an herb with properties that help in pacifying Vata dosha. It is used in the therapeutic formulation in the case study to manage ovarian endometrioma.
43) Bhaishajya (Bhaisajya):
Bhaishajya refers to medicine or pharmacology in Ayurveda. The case study uses various Bhaishajya Churnas and preparations like Kashmarya-Kshudrasaha Ksheerapaka to treat the patient’s symptoms.
44) Discussion:
The Discussion section of the case study elaborates on the treatment’s effectiveness and Ayurvedic principles underlying the therapy. It emphasizes that balancing Vata dosha is crucial for managing ovarian endometrioma.
45) Science (Scientific):
Scientific methods and modern diagnostic tools, such as ultrasonography and hormonal assays, were used alongside Ayurvedic principles to evaluate the effectiveness of the treatment in the case study.
46) Rajasthan:
Rajasthan is the Indian state where the National Institute of Ayurveda is located. This institute in Jaipur conducted the case study on the Ayurvedic management of ovarian endometrioma.
47) Anulomana:
Anulomana refers to promoting the normal downward movement of bodily functions. In Ayurveda, this is essential for clearing obstructions and balancing Vata dosha, which helps in treating constipation and related symptoms in the patient.
48) Flavonoid:
Flavonoids are compounds found in certain herbs, contributing to their therapeutic effects. Kshudrasaha contains flavonoids, which offer antioxidant and other medicinal benefits that aid in the treatment of ovarian endometrioma.
49) Vibandha:
Vibandha refers to constipation. Panchsakar Churna, used in this study, is indicated for Vibandha due to its properties that aid in relieving constipation and promoting digestive health.
50) Devadaru (Deva-daru):
Devadaru is one of the ingredients in Ajamodadi Churna. It has properties that enhance Agni (digestive fire) and is used in the treatment to improve appetite and relieve constipation.
51) Gambhari:
Gambhari is another name for Kashmarya (Gmelina arborea). This herb has specific qualities like Guru guna and Ushna Virya, used in the case study to pacify Vata dosha and manage ovarian endometrioma.
52) Pariksha (Pariksa):
Pariksha means examination or assessment in Ayurveda. The patient underwent Ashtavidh Pariksha and other examinations to diagnose her condition and assess the effectiveness of the treatment.
53) Rasayana (Rasa-ayana):
Rasayana refers to rejuvenation and health-promoting therapies in Ayurveda. Kshudrasaha has Rasayana properties due to the presence of beneficial compounds like flavonoids and phenols, contributing to the treatment’s effectiveness.
54) Vidanga (Vidamga):
Vidanga is one of the ingredients in Ajamodadi Churna. It is used for its digestive and anti-microbial properties, helping to manage symptoms like decreased appetite and constipation in the patient.
55) Pippali (Pippalin):
Pippali is a medicinal herb included in Ajamodadi Churna. It aids in enhancing Agni (digestive fire) and alleviating digestive issues, which were part of the patient's symptoms.
56) Shunthi (Sunthi, Sumthi, Shumthi):
Shunthi, or dried ginger, is used both in Ajamodadi Churna and Panchsakar Churna to improve digestion and balance Vata dosha, addressing symptoms like decreased appetite and constipation.
57) Ajamoda (Aja-moda):
Ajamoda is one of the ingredients in Ajamodadi Churna, known for its carminative and digestive properties, helping relieve symptoms of decreased appetite and improve digestion in the patient.
58) Anushna (Anusna):
Anushna means not hot. In the Ashtavidh Pariksha, examining Anushna Sparsha (not hot touch) helps in assessing the thermal characteristics of the patient's skin and other factors relevant to diagnosis.
59) Sparsha (Sparsa):
Sparsha refers to touch. In the case study, Anushna Sparsha (cold touch) is noted during the Ashtavidh Pariksha, helping to assess the patient's condition related to her Vata dosha.
60) Spashta (Spasta):
Spashta means clear or distinct. In the Ashtavidh Pariksha, Spashta Shabda (clear speech) is one of the criteria noted for the patient's examination, aiding in the overall diagnosis.
61) Kashaya (Kasaya):
Kashaya or astringent taste is one of the six tastes in Ayurveda. Kashmarya has Kashaya rasa, which aids in pacifying Vata dosha and is used in the treatment regimen in the case study.
62) Siddha:
Siddha refers to accomplished or perfected in Ayurveda. The Siddha-bhaishajya-manimala is a text where Panchsakar Churna is mentioned, providing traditional formulations for various conditions.
[Note: The above list is limited to 75. Total glossary definitions available: 88]
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