{"paper_id":"5f999e48-97c1-4826-ae9c-9aa48dda7eec","body_text":"INTERNATIONAL JOURNAL OF PRECLINICAL AND\nCLINICAL RESEARCH\nCASE REPORT\n \n \nOPEN ACCESS\nReceived: 20.01.2022\nAccepted: 29.01.2022\nPublished: 04.02.2022\nCitation: Achuthan D, Nellikode S.\n(2021). Efficacy of S odhana chikista\nin the Management of\nEndometriosis — A Case Study.\nInternational Journal of Preclinical &\nClinical Research. 2(4): 103-107. http\ns://doi.org/10.51131/IJPCCR/v2i4.7\n\u0003\nCorresponding author.\nmail@drshabeernellikode.com\nFunding: None\nCompeting Interests: None\nCopyright: © 2021 Achuthan &\nNellikode. This is an open access\narticle distributed under the terms\nof the Creative Commons\nAttribution License, which permits\nunrestricted use, distribution, and\nreproduction in any medium,\nprovided the original author and\nsource are credited.\nPublished By Basaveshwara Medical\nCollege & Hospital, Chitradurga,\nKarnataka\nISSN\nPrint: XXXX-XXXX\nElectronic: 2583-0104\nEfficacy of S odhana chikista in the\nManagement of Endometriosis — A\nCase Study\nDeepa Achuthan1, Shabeer Nellikode 2\u0003\n1 Department of Sthree Roga, Rajah Beach Ayurveda Hospital, Akalad P.O, Thrissur, Kerala,\nIndia\n2 Consultant Neurologist and Internal Medicine, Universal Hospitals Group, U.A.E\nAbstract\nEndometriosis is one of the most common benign gynaecological diseases\ncharacterized by the implantation and growth of viable endometrial tissue\noutside the uterine cavity. The symptoms of endometriosis can be correlated\nto many of the Yoni vyapads described in our classics. In the present case,\na 37-year-old female (Swedish national) reported chief complaints of severe\nlower abdominal and pelvic pain and heavy bleeding during menstruation\nfrom the past 7 years, especially one day prior to menstruation and stops 1-\n2 days after the onset of bleeding. She was advised for a USG scan which\nshowed endometriosis, cyst in the left ovary. Sodhana chikitsa was followed,\nand the whole treatment period spanned for a total of 42 days. The patient was\nadvised to follow up after 6 months. After the treatment, there was a significant\nimprovement in the patient’s conditions, and in turn, the patient also expressed\ngreater satisfaction with the result.\nKeywords: Endometriosis; Yoni vyapad; Vatiki; Sodhana chikitsa\nIntroduction\nEndometriosis is the most common prob-\nlem encountered in Gynaecology. This is\na hormone-dependent gynecologic dis-\nease, with clinical manifestations of adhe-\nsion and progressive growth of endome-\ntrial cells in organs other than the\nuterus. (1) This disease affects a large\nportion of the population. Half of the\npatients with endometriosis display clin-\nical symptoms of pelvic pain and infertil-\nity, thereby reducing the quality of life of\nwomen. (2,3) Endometriosis is a relatively\ncommon and potentially debilitating con-\ndition affecting up to 10-15% of repro-\nductive age group women. It is seen in\n30-40% of women with infertility. Certain\nguidelines given in Samhitas are utilized\nfor understanding such diseases.\nAccording to Ayurveda classics,\nendometriosis cannot be codified under\na single disease entity. Our Acharya’ s\nhave emphasized Lakshanas (symptoms)\nlike Shula (pain) throughout the Striroga\nPrakarana (Gynaecology), among which\nVatiki yoni vyapad, Udavartini yoni vya-\npad bear close resemblance to the clinical\npicture of endometriosis,\nhttps://ijpccr.com/ 103\n\nAchuthan & Nellikode / International Journal of Preclinical & Clinical Research 2021;2(4):103–107\nwhich makes finding an effective, validated treatment proto-\ncol for the management of pain in endometriosis. (4)\nAcharya Charaka explains Vatiki - a woman of Vata\nprakriti, when consuming improper diet and indulges in\nother activities capable of aggravating Vata; thus, provoked\nVata reaches the reproductive system and produces pricking\nand other pains, stiffness, sensation as if creeping of ants,\nroughness and numbness, local symptoms and fatigue or\nlethargy etc. Due toVata Vaigunyamenstruation appears with\nirregularity and is painful. Vata gets aggravated due to Vega\ndharana and moves in the reverse direction, then settles in\nyoni and produces the pain, initially pushesraja in an upward\ndirection, then discharges it with difficulty. The woman feels\nrelief immediately after the discharge of menstrual blood in\nUdavartini. (5)\nThe Gynaecological reasons for chronic pelvic pain\nare diverse. This diversity ends in the clinical diagnosis\nof endometriosis in about one-third of the cases during\ntheir reproductive period. After a definitive diagnosis of\nendometriosis has been made out for those suffering from\nchronic pelvic pain, the patients are forced to travel through\nthe traumatic paths of long-term medication leading to\nfrustration and depression. This case study describes Sod-\nhana chikitsa and its effectiveness in the management of\nendometriosis.\nPatient Information\nA 37-year-old female (Swedish national) visited the Outpa-\ntient Department (OPD) of Ayurveda Hospital in December\n2020 for the management of 7 years of chronic pelvic pain\nwith chief complaints of severe lower abdominal and pelvic\npain and heavy bleeding during menstruation. The patient\nreported that the pelvic pain starts one day prior to menstru-\nation and stops 1-2 days after the onset of bleeding. The pain\nis most severe on the first day of the menstrual cycle, associ-\nated with heavy bleeding with clots. History of painful periods\nsince menarche.\nShe was advised to take Oral Contraceptive pills (OC\npills) in the year 2000, which she continued for 8 years. On\nmedication, she got temporary relief from the symptoms,\nwhich reappeared on the stoppage of OC pills. She denied\ntaking OC pills and resorted to oestrogen pills for the\nmanagement of pain from 2008 to 2012. Stopped oestrogen\npills when side effects- abnormal facial hair growth noted.\nFrom 2013 again, the pain and bleeding became worse. The\npain aggravated, and she was advised for a USG scan in April\n2015, which showed endometriosis, cyst in the left ovary.\nAfter which, she was advised by the Gynaecologist to have\nOC pills again. But she resorted to herbal medicine. She\nwas unmarried but a non-virgin without having any habits\nor addictions. Her family history- Nothing specific revealed.\nHer personal history revealed a constipated bowel habit,\noccasional acidity and disturbed sleep. She attained menarche\nat the age of 12 years, a menstrual period with a duration of\n3-4 days and an interval of 24-26 days. Her Last Menstrual\nPeriod (LMP) was on 03/11/2020. The amount of bleeding\nwas excessive on the second day, evident from the usage of\nfour to five heavily soaked pads. No history of hypertension,\ndiabetes, thyrotoxosis, no surgical history was obtained. No\nhistory of any drug Allergy.\nClinical Findings\nPatient was found to be average built and weighing 60.7\nkg. Her blood pressure was 120/80 mmHg, pulse rate was\n70/minutes, and BMI was 24.7 kg/m2. Ashta sthana pareeksha\ndetails are given in the diagnostic assessment. She is of\nKapha-vata prakriti (~constitution based on bodily humour)\nwith Madhyama satva(~mental constitution).Dasavidha rogi\npareeksha details are mentioned in the diagnostic assessment.\nExamination of external genitalia didn’t reveal any abnormal\nfindings. Per speculum examination showed a normal cervix\nwithout any significant abnormality. Bimanual examination\nrevealed a bulky uterus; no tenderness was detected. Her\nbowel and bladder habits were normal.\nDiagnostic Assessments\nAs part of initial assessment Ashta sthana pareeksha &\nDasavidha Pareeksha was done. Nadi (Pulse) was regular\nwith 72 beats per minute, Mutram (Urine) was clear and\nflow and quantity was normal (Frequency of urination: 3-4\ntimes during morning and 1-2 times at night), Malam (Stool)\nwas formed with nomal toilet once daily early morning, No\ncoating was noted on Jihva (T ongue) and the shape of tongue\nwas normal, Sabda (Sound) was normal, Sparsa (Skin) was\nnormal to touch, Drik (Vision) was normal. She was of young\nvaya: (age) and of moderate built and heightAkruthi (General\nappearance and built). Her (Basic constitution) Prakruthi\nwas assessed as Kapha- Vata. Vikruthi (Imbalances): Vata,\nKapha and Pitta was assessed to be vitiated on tridosha\nlevel, and Dhushya (vitiation of tissues): Dhatus (Tissue level)\nRasa, Rakta and Mamsa was found to be vitiated. (Quality\nand quantity of tissues) Sara, Samhanana (Compactness),\nSatva (Mental strength and tolerance) were found to be\nnormal, with moderate Vyayama sakthi (Exercise tolerance)\nand (Compatabilities) Satmya.\nCBC-WNL, Urine –WNL Laboratory tests were unre-\nmarkable. Previous specialized evaluations included Radi-\nological ultrasound revealed (abdominal ultrasonography),\nbulky uterus with adenomyosis. The left endometriotic cyst\n5 X 2.3 cm was seen adherent to the uterus. A probable\ndiagnosis, Vatiki yonivyapat (~gynaecological conditions in\nAyurveda which includes painful menstruation), was drawn\nout from the presenting complaints and the previous medical\nreports produced by the patient during the OPD visit on 11th\nDecember 2020. She was advised for admission the same day.\nhttps://ijpccr.com/ 104\n\nAchuthan & Nellikode / International Journal of Preclinical & Clinical Research 2021;2(4):103–107\nTherapeutic Interventions\nThe treatment given was Amapachana (~digestion of undi-\ngested food), Agnideepana (~increase digestive fire), Sroto-\nsodhaka (~clear channel) and Vata anulomana (~downward\nmovement of Vata), and finally Pitta pacifying. The therapeu-\ntic plan was to perform Shodhana Karma (~cleansing thera-\npies) after correcting herAgni (~digestive fire) byPurvakarma\n(~preparatory therapies). Initially,Hinguvachadi churna(6 g)\nwas given for improving the digestive fire prior to cleansing\ntherapy for three days. The sequence of treatment was as fol-\nlows:\nPreparatory therapy\nThe initial treatment was with Agni vishamya (Aama) which\nis the main root cause of all diseases. Hence the medication\ngiven focused on Agni deepana, Aama pachana, Vata anulo-\nmana. After that 15ml of Sapthasaram kwatha (Ref: Sahas-\nrayogam) two times a day, followed by 6g of Hinguvachadi\nchurna (Ref: Sahasrayogam) with warm water.\nAlong with the above-mentioned treatment, 15 ml ofSuku-\nmaram kashayam (Ref: Ashtangahrudayam) two times a day,\n15 ml of Thrayanthyadi kashayam(Ref: Ashtangahrudayam)\ntwo times a day, followed by 2 tablets of Krimighna vati (Ref:\nCharakasamhita) daily, 30 ml of Asokarishtam (Ref: Sahas-\nrayogam) after lunch and 10g of Manibadra gula (Ref: Sahas-\nrayogam) at bedtime was given. The detailed schedule of treat-\nment is tabulated in Table 1.\nAsanas, Pranayama\nUshtrasana, Bhadrasana, Gomukhasana, and Vajrasanawere\nadvised. Ustrasana also known as Camel Pose is a deep back-\nward bending pose. Bhadrasna or the Gracious Pose is good\nfor activating the Mooladhara chakra. In Sanskrit ‘Bhadra’\nmeans ‘auspicious’ and ‘asana’ means ‘pose’ .Gomukhasana A\nSanskrit word, Gomukhasana literally translates into a cow\nface posture (go – cow, mukha – face, asana – pose). A\nseated yoga posture, Gomukhasana can be performed along\nwith a set of different seated Asanas. It helps stretch the\narms, triceps, shoulders, and chest. Vajrasana-vajra’ means\ndiamond-shaped or thunderbolt; ‘ Asana’ means posture or\npose. Vajrasana has been named after the shape it takes – a\ndiamond or thunderbolt.\nTreatment was given for a duration of 42 days. Diet &\nBehavioural changes advised.\nFollow-up and outcome\nThe patient recovered significantly from pain lower abdomen;\nbleeding was normal. The menstrual cycle was regular and at\nnormal intervals without any complications. After six months\nof follow-up, there have been no further episodes of pelvic\npain and the assessment was repeated at six menstrual cycles\n(at 4 th, 5 th, 6 th,7th, 8 th, and 9 th menstrual cycles without\nmedicines).\nDiscussion\nEndometriosis is one of the challenging clinical entities for the\npractitioners of Ayurveda. The complicated clinical scenario\ndemands accurate diagnosis and management to prevent\nsurgical intervention. This present case report emphasized\nthe importance of an Ayurvedic treatment protocol for the\nmanagement of pelvic pain connected with endometriosis.\nThe patient was treated on the line of management of\nVatiki yonivyapad. Treatment focused onAgni deepana, Aama\npachana with Shodhana in order to remove the Aama and get\nthe Doshas back into normal. The treatment protocol aims\nfor the pacification of Vata dosha and correction of digestive\nfire, thereby abolishing the chronic pelvic pain associated\nwith endometriosis. Due to the unavoidable role of Vata\ndosha in the present disease entity, cleansing therapies like\npurgation and enema procedures hold prime importance for\nthe pacification of Vata dosha.\nA course of medicated enema with intrauterine instillation\nof medicated formulation has been selected after purgation,\ngiving due importance to the analgesic properties of the\ndrugs. Same time Pitta pacifying medicines were given at the\ntime of discharge. Follow up USG was advised, which was\npolitely refused by the patient. However, she was constantly in\ntouch with proper follow up of oral medicines. For the last two\nyears, no follow up possibly due to a reduction of symptoms.\nPrevious studies have proved the efficacy of Sodhana\nand Samana therapy in the management of chronic pelvic\npain in endometriosis (6) and infertility as a consequence of\nendometriosis. (7) This study results were also in agreement\nwith the previously reported studies. When the treatment\nprinciples are individualized and applied clinically, it yields\nexcellent results to patient satisfaction. Ayurveda blesses\nthe feminine world with numerous drugs, which helps to\nmaintain their health in a natural way. Hence Ayurveda plays\na major role in treating endometriosis and thereby prevent\ncomplications.\nConclusion\nThis case study showed that if the plan of treatment is\nselected according to principles of Ayurveda along with\nproper drug, dose, duration, Anupana, Pathya and Apathya\nthere is an assertion of progress in treatment. The Ayurvedic\nmanagement protocol - Sodhana chikitsa is highly effective\nand recommended in managing the chronic pelvic pain\nassociated with endometriosis.\nhttps://ijpccr.com/ 105\n\nAchuthan & Nellikode / International Journal of Preclinical & Clinical Research 2021;2(4):103–107\nTable 1. The treatment schedule given to the patient\nTreatment procedure Method of administration Remarks\nDipana, Pachana with H\ninguvachadi churna\n3 days\n5g daily before food with warm water Appetite-Good\nBowel-Cleared once\nMicturition-Normal\nSleep-Sound\nSnehapana\nwith D adimadi ghritham\n7 days\nArohana krama after assessing Agni and K oshtha, maximum dose was 150 mL\nDays 1 2 3 4 5 6 7\nGhritha 30 60 75 80 90 110 150\nml ml ml ml ml ml ml\nAppetite- Good\nBowel- Cleared once\nMicturition- Normal\nSleep- Sound\nBahya nehana with S\nwedana\n3 days\nSarvanga abhyanga with Dhanvanthara taila for 45 minutes followed by N adi\nveda swedana with Dasamula kwatha for 15 min.\nAppetite-Good\nBowel-Cleared once\nMicturition-Normal\nSleep-Sound\nV irechana Pradana karma -Virechana\nVirechana dravya\nThrivrt churna -5 g + A vipathi choorna- 15 g mixed with luke warm water given\nat 7 am\n14 Vegas\nSansarjana karma\n3 days\nM anda eya vilepi Advised rest\nSn ehana\n7 days\nSarvanga abayanga– Dhannwantharam taila45 minutes for 7 days followed by\nN adi veda swedana with Dasamula kwatha for 15 min.\nOral medication continued\nAppetite-Good\nBowel-Cleared once\nMicturition-Normal\nSleep-Sound\nY oga vasti\n8 days\nY oga vasti\n1st Day- Matra vasti\nAfter taking lunch\nPoorva karma – Abhyanga with Sarsapa taila in the lower abdomen and lower\nback followed by Swedana karma\nPradana karma – Matra vasti dhanwantharam Mezhupakam thailam-90ml\nPaschat karma –Lying supine position\n2nd day, 4th day, 6th Day- Kashayavasti was given\n7 am Before food\nPoorva karma – Abayanga with Dhanwantharam taila in the lower abdomen\nand lower back followed by Swedana karma\nPradana karma – Kashaya vasti (Niruha vasti).\nPaschat karma –Lying supine position\niruha vasti with:\nMadanaphala, Musthadi, Laghupanchamula kwatha-320 ml\naindhava lavana-15 g, Madhu (~Honey)-120 ml ahacharadi thailam7 Avarthi\n120 ml Kalka- 30 g (Madhuka, Sathahwa, Pippali, Rasanjana, Thrivrut )\nAnuvasana vasti with 90 ml D hanvantara taila Mezhukupakam\nAdvised rest\nSansarjana karma\n3 days\nM anda eya vilepi Advised rest\n7 days T hakradhara\nOral medication continued\nAppetite-Good\nBowel-Cleared once\nMicturition-Normal\nSleep-Sound\nPatient was discharged Oral Medicines on discharge for 3 months\nPradaroushadhi - 15 ml twice a day\nSukumaram kashayam- 15 ml twice a day\nBala thailam - 10 drops early morning with warm water\nhttps://ijpccr.com/ 106\n\nAchuthan & Nellikode / International Journal of Preclinical & Clinical Research 2021;2(4):103–107\nDeclaration of patient consent\nAuthors certify that they have obtained patient consent\nform, where the patient/caregiver has given his/her consent\nfor reporting the case along with the images and other\nclinical information in the journal. The patient/ caregiver\nunderstands that his/her name and initials will not be\npublished and due efforts will be made to conceal his/her\nidentity, but anonymity cannot be guaranteed.\nTable 2. Scheduled Diet Plan\n6:30 am Herbal tea/ Barley water\n8:00 am Broken wheat porridge/ Poha upma/ Idli with veg\n11:00 am T ender coconut water/Herbal tea/ green tea\n1:00 pm Kicchadi /steamed veg\n4:00 pm Herbal tea\n7:00 pm Mixed veg Soup, Chappathi, Mint chutney\nTable 3. Results after the treatment\nSymptoms Before\nTreatment\nAfter\nTreatment\nResults\nPelvic, low\nabdominal pain\nPelvic low\nabdominal pain\nReduced Up to\n90 %\nDysmenorrhoea Dysmenorrhoea Relieved Up to\n90 %\nHeavy bleeding Heavy bleeding Reduced Up to\n80 %\nReferences\n1) Giudice LC, Kao LC. Endometriosis. The Lancet. 2004;364(9447):1789–\n1799. Available from: https://dx.doi.org/10.1016/s0140-6736(04)17403-\n5.\n2) Moradi M, Parker M, Sneddon A, Lopez V , Ellwood D. Impact of\nendometriosis on women’ s lives: a qualitative study.BMC Women’s Health.\n2014;14(1):123. Available from: https://dx.doi.org/10.1186/1472-6874-\n14-123.\n3) Ozkan S, Murk W , Arici A. Endometriosis and infertility: epidemiology\nand evidence-based treatments. Ann N Y Acad Sci. 2008;1127:92–100.\n4) Acharya YT , editor. Charaka Samhita of Agnivesha. V aranasi:\nChaukhambha Surabharati Prakashana. 2004.\n5) T ewari P , editor. Ayurvediya Prasuti-Tantra Evam Stri-Roga Part-II. 2007.\n6) Muraleedharan A, Unnikrishnan P , Narayan P , Bhatt HSK. Ayurvedic\nTreatment Protocol for Chronic Pelvic Pain in Endometriosis. Journal\nof Clinical and Diagnostic Research . 2018;12(12):1–3. Available from:\nhttps://dx.doi.org/10.7860/jcdr/2018/37364.12369.\n7) Sindhu A. OA01.02. Management of infertility subsequent to en-\ndometriosis -A study. Ancient Science of Life . 2013;32(5):2. Available\nfrom: https://dx.doi.org/10.4103/0257-7941.123814.\nhttps://ijpccr.com/ 107","source_license":"CC0","license_restricted":false}