A Conceptual Co-relation of Endometriosis with Udavarta Yonivyapad

Endometriosis is one of the most mysterious benign gynecological disorder defined by implantation of functioning endometrial tissue outside the uterine cavity. The worldwide prevalence is about 10%. Women with endometriosis are usually confronted with one or more major problems like pain and infertility. Pain includes dysmenorrhea, dysperunia and chronic pelvic pain. It can be co-relate as it is one of the condition which consider under Udavarta yonivypad on the basis of dysmenorrhea and relief in pain just after the menstruation. As in Udavarta Yonivyapad vitiation of Apana and Vyana Vayu occurs. Further it causes alteration in Karma of Apana Yayu resulting retrograde menstruation with dysmenorrhea. Syndrome complex of Udavarta Yonivyapad resembles with End ometriosis. We can state that if pathology of Udavarta yonivypada continues for longer time, further it results into a condition of endometriosis. In Udavarta Yonivyapad Retrograde menstruation with painful menstruation occurs, as this continues for longer time due to vitiation of Apana and Vyana vayu, Strotovaigunya, Vimargagamana, Doshasanghat and Siragranthi type of Srotodusthi occurs accordingly. Also, we can relate this to the complication of untreated Udavarta due to which adhesion in uterus and pelvi s takes place, thereafter formation of Chocolate cyst which can relate to Granthi at Ovarian site.

Onset of Artava marks the starting of reproductive life of women and it should be devoid of Shoola, Daha, Paichhilya and should not be excessive or scanty in matra is considered as Shuddha Artavai. Abnormalities of Artava leads to many diseases like Yonivyapad, Artavavyapad, which may result in complications like infertility. Udavarta Yonivyapad is one such amongst the 20 Yonivyapad which are mentioned in Bruhatrayi as well as in Madhav Nidan and Yogaratnakar. According to Acharya Vagbhata, Prakruta Apana Vayu is responsible for excretion of Shukra, Artava, Mala, Mutra, Garbhaii. If natural urges are supressed, Vayu takes upwards course in the genital tract due to which the women suffer painful discharges of the menstrual blood with difficulty because of its upward tendency. After discharge of the menstrual blood, there will be relief instantly. Because of the upward course of menstrual blood, it is known by the wise as Udavartiniiii. In nut shell, the Vimargagamana in Artavavaha Srotas accounting to the Vaigunya in Apana Vayu results in displacement of Raja from its original place in altered form (Gunatah and Dravyatah), which corelates the condition of endometriosis. वेगोदावर्तन ाद्योनन मुदावर्तयर्ेऽनन लः| सारुगार्ात रजः कृ च्छ्रेणोदावृत्त ं नवमुञ्चनर्|| International Journal for Multidisciplinary Research (IJFMR) E-ISSN: 2582-2160 ● Website: www.ijfmr.com ● Email: [email protected] IJFMR240426064 Volume 6, Issue 4, July-August 2024 2 आर्तवे सा नवमुक्ते र्ु र्त्क्षणं लभर्े सुखम्| रजसो गमन ादूर्ध्वं ज्ञेयोदावनर्तनी बुध ः|| (cha.chi.30/25-26) According to the contemporary science, the syndrome complex of Endometriosis can be resemble with Udavarta yonivyapad and can be consider under Udavarta Yonivyapad. It means presence of endometrial tissue (gland and stroma) outside the uterus. Endometriosis presents in three different entities, which are frequently found together: peritoneal lesions, deep endometriosis and ovarian endometriotic cyst (endometriomas). Ovarian endometrioma is a benign oestrogen dependent cystic mass from ectopic endometrial tissue within the ovary. It contains thick, brown, tar like fluid which may referred as chocolate cyst. The pathogenesis of endomet riomas remains contentious, with a variety of theories proffered, including invagination and subsequent collection of menstrual debris from endometriotic implants, which are located on the ovarian surface and adherent peritoneum. Endometriosis is perceived as a chronic disease should be suspected with, Dysmenorrhea, Dyspareunia, subfertility, chronic pelvic pain and menstrual irregularity. Endometriosis can be associated with significant gastrointestinal symptoms (pain, nausea, vomiting, early satiety, bloating and distention, altered bowel habitsiv. Endometriosis is one of the most benign gynaecological conditions that affects 1 out of every 10 women of reproductive age and second to uterine fibroid needing major gynaecological surgery. Endometriosis prevalence ranged from 15.4% to 71.4% v, study has been taken to diagnose the disease in early stage, understanding the condition and corelating endometriosis with Udavarta yonivyapad to avoid further complications.

For the study the literary materials which include the reference of Udav arta Yonivyapad through the available ayurvedic text and for endometriosis, available modern texts and articles has been collected. CONCEPTUAL REVIEW UDA V ARTA YONIVYAPAD It is one of the Vishmati Yonivyapdas told by all acharyas. Vata is causative dosha of udavarta yonivyapad by all the acharyas. NIRUKTI-The act of going up. In udavarta, Gati of Vayu turns into upward direction. DEFINITION-Udavarta is the Urdhvagamana of Raja due to Vata vitiation. In Madhukosha teeka, Udavarta is defined as the condition where vitiated Vata takes the Raja upward and then discharges painfully. There will be painful menstruation and pain gets relieved immediately following discharge of menstrual blood. NIDANA-It can be classified into two types for convenience i,e Samanya and Vishesha. Samanya nidana- Mithyachara: It includes both mithya ahara and mithya vihara Mithya aahara • Anashana • Alpashana • Atyashana • Vishmashana • Katu, tikta, kashaya rasa aahara sevana International Journal for Multidisciplinary Research (IJFMR) E-ISSN: 2582-2160 ● Website: www.ijfmr.com ● Email: [email protected] IJFMR240426064 Volume 6, Issue 4, July-August 2024 3 • Ruksha, laghu, sheeta aahara sevana Mithya Vihara • Excessive coitus, coitus in abnormal body posture. • Vishama sthana shayana • Ratrijagarana • Bhaya, Shoka etc. • Apadravya sevana: Introducing artificial objects into the vagina in an Unhygienic way which leads to local resistance and facilitate the Invasion of the organisms, precipitating infection. These leads to vitiation of Vata specifically Apana Vata which then moves upward instead of moving downwards thereby causing movement of Raja in reverse diversion and fails to expel the Raja. Pradushta artava When the Artava does not possess Shuddha Artava lakshanas, it is pradushta Artava. And is the cause of Ashta Artava Dushti. These Dushti occurs due to the vitiation of Tridosha which affects not only the quantity and quality of the Artava but also causes painful menstruation. According to modern perspective it resembles Hormonal imbalance as hormones are responsible for the normal and abnormal flow of menstrual blood. Beeja dosha Beeja dosha refers to abnormalities in Artava and Shukra, which results into abnormal formation of genital tract of the female foetus like Suchimukhi causing Kricchrartava. In modern correl ation, congenital anomalies in the women like pin hole Os of cervix, septate uterus, imperforate hymen etc. are the causes of painful menstruation due to difficulty in escaping of menstrual blood. Daiva When the cause is not known, the disease is said to develop due to Adharma done by the women and also due to Purvajanma kruta papa karma. Vishesha nidana- Vegadharana is the vishesha nidana told by Acharya Charaka and Vagbhatavi. SAMPRAPTI- Nidan sevana Dhatu kshay and strotovaigunya, Vyan and Apan vayu prakopa (kapha Anubandha) Marga Avrodh evam avaran, Vimargagamana Doshasangata Artava urdhwagamana Kasthartawa,Yonishoola Udavarta Yonivyapada International Journal for Multidisciplinary Research (IJFMR) E-ISSN: 2582-2160 ● Website: www.ijfmr.com ● Email: [email protected] IJFMR240426064 Volume 6, Issue 4, July-August 2024 4 SAMPRAPTI GHATAKA Table 1: Samprapti ghataka of Udavarta yonivyapad Samprapti ghataka Details Dosha Vayu Pradhana Tridosha Udbhavsthana Garbhashaya /yoni Sanchara Shroni, Yoni, Udar, Stana, Shira, Adhokaya, Sarwasharir Avayava Garbhashaya /yoni Ashraya Pakwashaya Ashrita Rogmarga Abhyantar roga marga Strotas Artavavaha Srotas, Rasavaha, Raktavaha Sroto vikruti Sanga, Vimarga gamana Dhatu /Mala Rasa mansa Artava Anubandha Kapha and pitta Anubandhya Vayu SYMPTOMS Table 2: symptoms of Udavarta yonivyapad Charaka Sushruta Madhava nidana Vagbhata Yogratnakara Kricchartava Artava vimukshesukham Ruka Kricchartava Phenilata Kricchartava Phenilata Kricchartava Phenilata Yonipradeepana badhha artava Kricchartava Phenilata Kaphanivam artvam vii ENDOMETRIOSIS It means presence of endometrial tissue [gland and stroma] outside the uterus . Endometriosis present in three different entities, which are frequently found together: peritoneal lesions, deep endometriosis and ovarian endometriotic cyst (endometriomas)viii. It contains thick, brown, tar like fluid which may referred as chocolate cyst ix. The pathogenesis of endometriomas remains continues, with a variety of theories proferred, including invagination and subsequent collection of menstrual debris from endometriotic implants, which are located on the ovarian surface and adherent peritoneum. COMMON CAUSES -Retrograde Menstruation , Coelomic Metaplasia , Direct implantation theory , Lymphatic and vascular theory, Genetic and immunological factors. PATHOGENESIS Retrograde menstruation Endometrial fragments get implanted in peritonial surface Outflow tract obstruction in genital tract International Journal for Multidisciplinary Research (IJFMR) E-ISSN: 2582-2160 ● Website: www.ijfmr.com ● Email: [email protected] IJFMR240426064 Volume 6, Issue 4, July-August 2024 5 Adhesions in pelvic region Patient suffers from Dysmenorrhea,Pelvic pain(Endometriosis) COMMON SITES-Ovaries, Pelvic peritoneum, Pouch of Douglas, Uterosacral ligaments, Rectovaginal septum, Appendix, Fallopian tubes.x SYMPTOMS-Leading symptoms are Dysmenorrhea, Dyspareunia, subfertility, chronic pelvic pain, menstrual irregularity. Endometriosis can be associated with significant gastrointestinal symptoms (pain, nausea, vomiting, early satiety, bloating and distention, altered bowel habits).

Co-relation between Endometriosis and Udavarta Yonivyapad-As there dysmenorrhea, Chronic pelvic pain and relief in pain just after the menstruation are the common symptom in both . Thus, we can state that if pathology of Udavarta yonivypada continues for longer time, further it results into a condition of endometriosis. In Udavarta Yonivyapad Retrograde menstruation with Painful discharge occurs, as this continues for longer time due to vitiation of Apana and Vyana vayu, Strotovaigunya, Vimargagamana, Doshasanghat and Siragranthi type of Srotodusthi occurs accordingly. Also, we can relate this to the complication of untreated Udavarta due to which adhesion in uterus and pelvis takes place, thereafter formation Chocolate cyst which can relate to Granthi at Ovarian site. In contemporary science, the primary management of this conditions includes NSAIDs, OCPs and hormonal therapy which have long list of side effects and do not provide long lasting relief. Ayurveda can provide a radical treatment of this disease by normalisi ng the function of Apana Vayu, for that proper diagnosis should done to avoid further complications in future.

Symptoms of both the diseases can be resembles that is why we can Correlate them as endometriosis is one of the conditions which can consider under the Udavarta Yonivyapad. Financial support and sponsorship-Nil Conflicts of interest-There are no conflicts of interest.

1. Agnivesh, Charak Samhita of Aacharya Charaka,Dridhbalakrit, Edited by Pandit Kashinatha Shahtri and Dr. gorakhanatha Chaturvedi, Chikitsa sthana, cha.30, ver-226, Chaukhambha Bharati academy, Varanasi, Reprint 2019, pg. 870 2. Aacharya Vagbhatt, Ashtanghruday, Dr. bramhananda Tripathi, Edited with ‘NIramala’ Hindi commentary, Sutra Sthana, cha. 12, ver-9, Chaukhambha Sanskrit Prakashana, Delhi, pg. 172 3. Premavati Tiwari, Ayurvediy prasuti tantra evum stree rog part2, Adhyay 1 Yonivyapada ,Chaukhamba Orientalia Varanasi, pg no.34 4. Berek & Novak’s Gynaecology, fourteenth edition, Published by Wolters Kluwer(India) pvt.ltd,new delhi, reprint-ISBN- 13:978-81-89836-11-5, section-7, cha.29, pg.1137& 1143 5. https://www.researchgate.net International Journal for Multidisciplinary Research (IJFMR) E-ISSN: 2582-2160 ● Website: www.ijfmr.com ● Email: [email protected] IJFMR240426064 Volume 6, Issue 4, July-August 2024 6 6. Vagbhata,Asthanghruday with commentaries of Arundatta and Hemadri. Edited by PL Harisadashiva shastriparadkar,Chaukhamba Sanskrit sansthana, Varanasi , edition reprint 2010 7. http;/www.wjpmr.com/article/view/ISSN 2455-3301 8. Sajeewani, H., and Parera, M.S.(2021, January 1). Ayurvedic management of Udavartini Yonivyapad(Ovarian Endometrioma) - A case report. International journal of AYUSH case reports,4(4),226-232.Retrived from https:www.ijacare.in/index.php/ijcare/article/view/180 9. Berek & Novak’s Gynaecology, fourteenth edition, Published by Wolters Kluwer (India) pvt.ltd,new delhi, reprint-ISBN- 13:978-81-89836-11-5, section-7, cha.29, pg.1137& 1143