{"paper_id":"1c603d55-21ab-4e2c-8ee3-d799e82ffcae","body_text":"International Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240424119 Volume 6, Issue 4, July-August 2024 1 \n \nAyurvedic Management of Endometriosis: A \nCase Study \n \nM.K. Sandhya1, Prof. S B Donga2 \n \n1PG scholar, Department of PTSR, ITRA, Jamnagar. \n2I/C HOD, Department of PTSR, ITRA, Jamnagar. \n \nABSTRACT \nIntroduction: Endometriosis is a benign gynaecological disorder defined by presence of endometrial \nglands and stroma outside the lining of uterine cavity. This ectopic endometrial tissue behaves as normal \nendometrial tissue and bleeds every month. This blood may become encysted and form endometrioma. \nThe exact prevalence is not known but estimates range from 10-15% within the woman reproductive age \ngroup.  \nMaterials and methods: A 26-year-old married patient came to the OPD of Prasutitantra evam Streeroga \non 10 September 2023 with the complains of failure to conceive since four and half years along with early \nand scanty menses since 3 years. A chocolate cyst of size 18*21*13mm in right ovary and a haemorrhagic \ncyst of size 42*36*41mm in left ovary  was detected by USG. She was given  Virechana Karma in first \ncycle, followed by Matra Basti with Dashamoola Trivruta Taila for 7 days in next consecutive cycle and \norally Saptasara Kashayam along with Purana Guggulu Choorna as Prakshepa and Goghruta as \nAnupana.  \nResult: After treatment her USG on 31/11/2023 relieved complete resolution of the chocolate cyst. The \nfollow-up was done for 1 month which showed no recurrence of the cyst. \nDiscussion: Virechana eliminates the Doshas and normalizes the ovarian functions. Dashamoola Trivruta \nTaila Matra Basti helps in Vaatanulomana and does Tridosha Shamana, in Saptasara Kashayam most of \nthe ingredients are having digestive, carminative, analgesic, anti -inflammatory, Stroto \nShodhana, Vatakaphashamana, laxative, and blood purifier properties. Guggulu when given with Saptasar \nKashayam will increase the efficiency of the formulation by its Yogavahi property thus helping in breaking \nthe pathogenesis. \n \nKeywords: Endometriosis, Virechana Karma, Dashamoola Trivruta Taila, Saptasara Kashayam, Purana \nGuggulu. \n \nINTRODUCTION \nPresence of functioning endometrium in the sites other than uterine mucosa is called endometriosis. i \nEndometriosis can occur at any site. The most common sites are the ovaries, cul-de-sac including the utero \nsacral ligaments, peritoneum overlying the bladder, sigmoid colon, back of the uterus, intestinal coils and \nappendix.ii This ectopic endometrial tissue behaves as normal endometrial tissue and bleeds every month. \nThis blood may become encysted and form endometrioma.  Endometrioma are cystic lesions that stem \nfrom endometriosis. Nearly 10 -15% of women of reproductive age suffer from endometriosis. iii These \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240424119 Volume 6, Issue 4, July-August 2024 2 \n \nlesions are commonly referred to as chocolate cyst due to thick dark brown appearance of the fluid that is \ncontained within them.iv \nAyurveda explains that it is not always possible to name a disease in a definite term. Endometriosis is not \nan exception for the same. Hence this disease has to be analysed according to the Nidana Panchaka theory \nof Ayurveda based on the concepts of Dosha, Dushya, S trotas, Samprapti and its management.  All the \nailments of female reproductive system (gynaecological disorders) which are considered in Ayurveda, can \nbe classified under Artava Dushti and Yonivyapada After thoroughly analyzing the modern perspective of \nendometriosis & different Samhitas in Ayurveda, we can relate it with Beejakosha Granthi , Vatika \nYonivyapath, Udavarta Yonivyapath, Granthi. Due to various causes, Vata gets vitiated. This vitiated Vata \nin turn vitiates the Artava (endometrium) and carries the vitiated Artava from the  Garbhashaya by \nPratilomagati to sites other than Garbhashaya along with vitiated Vata by Ashayapakarsha. Further the \nvitiated Vata Dosha vitiates Rakta, Mamsa and Medo Dhatu’ sv. By time, the dominant Vata Dosha involves \nthe other two Doshas and produces various symptoms. The general treatment principles can be laid down \nby going through the treatment principles of Artavadushti, Pradara, Yonivyapada, Raktapitta, Gulma and \nGranthi.  \n \nCASE REPORT \nPresenting Concerns \nA 26-year-old Vata Pradhana Pitta Prakruti  married patient with a married life of five and half years  \nvisited the OPD on 10/09/2023, with the complains of failure to conceive since four and half years along \nwith early and scanty menses in the past 3 years.  \nClinical findings \nThe patient attained menarche at 14 years of age and had severe dysmenorrhea with a score of 6 in visual \nanalogue scale. Since childhood patient was habituated to taking Katu, Amla Rasa Pradhana Ahara along \nwith physical work. Patient did not take any medication and after marriage her condition improved. She \nis married for five and half  years. Since the past 3 years she is having early and scanty menses, and is \nunable to conceive. Her current menstrual history showed a cycle of 20-23 days interval and a duration of \n1-2 days with partially soaked one pad and pain in abdomen during menses with a score of 3 in the visual \nanalogue scale. She has never conceived and had no history of dyspareunia. She had no history of any \nsystemic disorder, DM, HTN, thyroid dysfunction, leukorrhea or any significant illness. There was no \nfamily history of any ovarian cyst or tumour. \n \nCLINICAL FINDINGS \nPhysical Examination \nPatient’s general condition was good with Pulse rate of 88/min, respiratory rate was 16/min and blood \npressure 110/70mmHg. She had a BMI of 18.72 kg/m2. No abnormality was noted after a detailed systemic \nexamination. Appetite, sleep, micturition and bowel were normal. The patient was of lean body built and \nhad Vata- Pitta Prakruti.  \nLocal Examination \nOn per speculum examination, the vulva was healthy with no any local lesion or growth. The vaginal canal \nwas healthy with no secretions. The cervix was of normal size, with no discharge and or lesions. On per \nvaginal examination, the cervix was found to be  smooth, firm, with no cervical motion tenderness. The \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240424119 Volume 6, Issue 4, July-August 2024 3 \n \nuterus was found to be retroverted with normal size, freely mobile with no associated tenderness. Bilateral \nadnexa was clear with no tenderness.  \n \nINVESTIAGTIONS – as in table 1 to 2. \nTherapeutic intervention  \nAfter thoroughly examining the patient, Nidana were found in patient related to diet and lifestyle are \nmorning breakfast was chai –parataha’s, bhakri, roti ma de of bajra , Viruddhashana (also like milk and \nsalty or pungent things ) , Katu, Amla Rasa Pradhana Ahara.  Dinner time was around 9 pm or 9:30 pm, \nMala -Mutra Vega Dharana, according to which treatment protocol was planned. She was advised to \nfollow Nidana Parivarjan as well as Pathya Palana. In the first cycle, after stoppage of menses, she was \ngiven Virechana Karmavi as shown in Table 03. After that orally Saptasara Kashayam vii and Purana \nGuggulu Choornaviii was given for 2 months as shown in Table 04. The next two consecutive cycles after \nVrechana, she was administered Matra Basti with Dashamoola Trivruta Taila for 7 days as shown in Table \n05.    \nFollow-up and Outcome \nWithin 2 months of treatment, her menstrual interval was of 25-26 days and pain in abdomen reduced to \na Score of 2 in the visual analogue scale. Her sonography on 21/11/23 showed complete resolution of cyst \nin both ovaries.  \n \nDISCUSSION \nVirechana: Indriya get clarified, Dhatu also gets cleaned and seed becomes efficacious by Virechana.ix \nAshtanga Sangraha  clearly mentioned the role of Virechana Karma x in Granthi Chikitsa.  Doshas \neliminated through Samshodhana Chikitsa are eradicated entirely (Apunarbhava)xi. Virechana also has \nRaktaprasadana Karma (blood purifying action) xii. It normalizes the ovarian functions by its purifying \naction (Bio cleansing property). \nBasti Karma: Yoni (female reproductive tract) is clarified by Basti, it provides fortune and child even to \ninfertile women. Yoni Rogas are inevitable without Vata and Basti is the main treatment for Vata Dosha.xiii \nDashamoola Trivruta Taila: In endometriosis, due to Vata Kopa, there is change in normal Anuloma Gati \n(normal movemen t) of Artava (menstrual blood) . For treatment of Vata Dosha, Taila Kalpana is \nconsidered the best treatment. xiv Here Dashamoola Trivruta Taila Matra Basti xv has Madhura, Tiktha, \nKashaya Rasa; Snigdha Guna, Ushna Virya, Madhura Katu Vipaka and Tridosha Shamana Guna thus \nhelping in Vatanulomana.   \nSaptasara Kashayam: Saptasara Kashayamxvi is indicated in Vidbandha (severe constipation), Mandagni \n( diminution of Agni), Atimahati Ruja (excessive pain) and pain in Yoni (pelvis), Hrudaya (cardiac region), \nKukshi (abdomen), Prushta  (back), Shroni Pradesha along with Jatara, Ashteela  (Benign Prostatic \nHyperplasia), Pleha(splenic diseases) and Gulma Roga (cyst).  \nMost of the ingredients are having digestive, carminative, analgesic, anti -inflammatory, channel \ncleansing, Vatakaphasamana (alleviation of  Vata and Kapha), laxative, and blood purifier properties. \nThus, the formulation help s in breaking the pathogenesis by normalizing the functions of  Apana Vayu, \ncleansing the channels as well as removing the obstacles related to menses. \nGuggulu is called Yogavahi (carrier/catalyst), as it can penetrate the minute parts of the body, thereby \nremoving the deep-rooted toxins from the bodily tissues. Guggulu when given with Saptasara Kashayam \nwill increase the efficiency of the formulation by its Yogavahi property.   \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240424119 Volume 6, Issue 4, July-August 2024 4 \n \nPurana Guggulu is having properties of Apakarshana (removal of cause of disease), Tridosha Shamaka, \nAnala Deepana (increasing the digestive fire) and is indicated in Gulma, Antar Vidradhi. \n \nCONCLUSION \nAyurveda has a great scope in this area of concern as a wide range of Ayurvedic Drugs are having the \npotential to treat the symptoms associated with endometriosis.  So, from this study, we can conclude that \nabove mentioned Ayurvedic medicines are effective in treating secondary dysmenorrhea due to \nendometriosis. \n \nPATIENT PERSCEPTIVE \nThe patient was satisfied with the treatment. \n \nPATIENT CONSENT \nThe patient provided written consent for publication of this case report. \n \nTable 01: Lab Investigations: 10/10/23 \nHematological :  \nHb 11.0gms% \nBGRH B positive \nHIV , HCV , HbsAg, VDRL Negative \nBT 1min 35 sec \nCT 3 min 30 sec \nCA-125 4.3U/mL \nUrine routine and micro Normal study \n \nTable 02: USG-TVS: \n BT (20/09/23) AT (21/11/23) \n Right ovary Left ovary Right ovary Left ovary \nSize of \ncyst \n18*21*13mm \nchocolate cyst  \n42*36*41mm \nhemorrhagic cyst \nComplete resolution of cyst \nVolume of \ncyst \n19cc 34cc \nOvarian \nvolume \n24cc 38cc \n \nTable 03 Schedule of Virechana Karma \nDate Karma Medicine name Posology Duration \n23/09/23 to \n26/09/23  \nDeepeana \nPachana \nTrikatu \nChoorna \n1gm, twice a \nday, with \nlukewarm water \n4 days \n27/09/23 to \n02/10/23 \nSnehapana Gogrita 1st day – 30ml \n2nd day – 60ml \n6 days \n \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240424119 Volume 6, Issue 4, July-August 2024 5 \n \n3rd day – 90ml \n4th day – 120ml \n5th day – 150ml \n6th day – 180ml \n \n03/10/23 to \n04/10/23 \nIntermenstrual bleeding \n06/10/23 Snehapana Gogrita 7th day – 210ml 1 day \n07/10/23 to \n10/10/23 \nSarvanga \nAbhyanga \nSwedana \nAbhyanga with \nBala taila \nSwedana with \nDashamoola \nNadi Swedana \n- 4 days \n10/10/23 Virechana \nVega - 14  \nTrivruta \nAvaleha \n(65gm)+ \nDraksha Jala \n(Q.S) \n- 1 day \n10/10/23 to \n14/10/23 \nSamsarjana \nKrama \n- - 5 days \n \nTable 04 Shamana Aushadhi \n \nTable 05 Schedule of Dashamoola Trivruta Taila Matra Basti \n \nFigure 1  USG Report before and after treatment \n \nDrug   Dose  Anupana Prakshepa Route  Time Duration  \nSaptasara \nKashayam \n50 ml \ntwice a day \nGo-Ghrita \n(5ml)  \nPurana \nGuggulu \nChoorna \n(1gm) \nOral  Morning and \nevening, empty \nstomach \n  \nFor 2 months \nDate  Drug  Dose Route Time Duration \n03/11/23 to \n09/11/23 \nDashamoola \nTrivruta Taila  \n60ml Rectal At morning 8:30am to \n10:00am; after light diet \n7 days  \n\n \nInternational Journal for Multidisciplinary Research (IJFMR) \n \nE-ISSN: 2582-2160   ●   Website: www.ijfmr.com       ●   Email: editor@ijfmr.com \n \nIJFMR240424119 Volume 6, Issue 4, July-August 2024 6 \n \nREFERENCES \n \n1. DC Dutta’s text book of Gynecology including  contraception edited by Hiralal Konar published by \nJaypee Brothers Medical Publishers (P) Ltd, Seventh edition, 2016; 22nd: 248. \n2. Howkins and Bourne Shaw’s text book of Gynaecology edited by V .Padubidri and Shirish N. Daftary, \nPublished by B.I. Churchill Livingstone Pvt Ltd, Eleventh edition, 1994; 32: 526. \n3. Counsellor VS. Endometriosis. A clinical and surgical review. Am J Obstet Gynecol, 1938; 36: 877 \n4. Exacoustos C, De Felice G, Pizzo A, Morosetti G, Lazzeri L, Centini G, Piccione E, Zupi E. Isolated \nOvarian Endometrioma: A History Between Myth and Reality. J Minim Invasive Gynecol, 2018 Jul - \nAug; 25(5): 884-891. \n5. P.K, Jyothi. (2022). Endometriosis an Ayurvedic View. International Research Journal of Ayurveda & \nYoga. 05. 117-123. 10.47223/IRJAY .2022.5921 \n6. Nepal Rajguru Pan. Hemraj Sharma, Kashyap Samhita of Vruddhajivaka, Chaukhambha Sankrita \nSamsthan, Varanasi, Siddhi Sthan, TRilakshana Siddhiadhyay/6 Page no. 225 \n7. Sahasrayogam , Kendriya Ayurved Evam Anusandan Parishad, new Delhi, page no. 112 \n8. Sushruta,    SushrutaSamhita.Kaviraj    Ambika Dutta Shastri, Editor.; Chiktsa sthana, 05/40-45, \nChaukhambha Sanskrit Sansthan, Varanasi, Reprint 2012. \n9. Nepal Rajguru Pan. Hemraj Sharma, Kashyap Samhita of Vruddhajivaka, Chaukhambha Sankrita \nSamsthan, Varanasi, Siddhi Sthan, TRilakshana Siddhiadhyay, Page no. 225 \n10. Shree nandkishorsharma, Astangsamgraha of vagbhatta, uttartantra, granthichikitsaadhyay. Cha 34, ver \n26. Reprint edition, varanasiChaukhambhaoriantalia, 2015. page no 412 \n11. R.K. Sharma and Bhagavan Das editors, Agnivesha's Caraka Samhita based on Chakrapani Datta's \nAyurveda deepika, volume 1, Published by Choukhamba Sanskrit Series office, Varanasi, Sutrasthan, \nvidhishonitiyaadhyay Shloka no.18, page no;406 \n12. R.K. Sharma and Bhagavan Das editors, Agnivesha's Caraka Samhita based on Chakrapani Datta's \nAyurveda deepika, volume 1, Published by Choukhamba Sanskrit Series office, Varanasi, Sutrasthan, \nChikitsaprabhruteeya, Shloka no.20-21.  \n13. R.K. Sharma and Bhagavan Das editors, Agnivesha's Caraka Samhita based on Chakrapani Datta's \nAyurveda deepika, volume 1, Published by Choukhamba Sanskrit Series office, Varanasi, Sutrasthan, \nYajjah purushiyaadhyaya, Shloka no.40, page no;425. \n14. Dr. T. Sreekumar, Ashtanga Hrdaya, English translation & commentary, Harisree hospital publication \ndepartment, June 2005, Sutrasthana-1, Ayushkamiyam, shloka no. 25, page no. 54.","source_license":"CC0","license_restricted":false}