An Ayurvedic perspective of Endometriosis: A Review

The Name MAA (Mother) is the most precious blessing bestowed upon women by God. Consequently, women were designed with distinct anatomical and physiological traits that set them apart from men. As a result, women experience a variety of health issues primarily related to their reproductive systems, unlike men. Some of these conditions can disrupt their sense of womanhood, while others may pose serious risks to their health if not appropriately addressed. One such condition is endometriosis. This disorder occurs when endometrial tissue, typically found inside the uterus, is located outside of it. Patients suffering from this condition often endure intense pain that may progressively worsen. The misplaced endometrial tissue functions like normal tissue and sheds blood monthly. This blood can become trapped, leading to the formation of a chocolate cyst, which may also burst. At this point, surgical treatment becomes necessary to prevent potential life threatening situations for the patient. Therefore, it is crucial to have a treatment approach that not only addresses endometriosis but also prevents the formation of chocolate cysts. In Ayurveda, endometriosis is likened to "Vyana Avruta Apana Vata" and must be treated accordingly. Treatment strategies encompass Amachikitsa, Vyana Avruta Apana Vata Chikitsa, and Samanatherapies. Additionally, lifestyle and dietary changes should be emphasized, as their contribution to the development of diseases cannot be overlooked. This paper will explore various Ayurvedic medications that have these beneficial properties and are effective in managing endometriosis.

Cyst. Maa, Endometriosis, Yonivyapad, Vata

Endometriosis is considered one of the most enigmatic and intriguing non-cancerous gynecological conditions, characterized by the presence of functional endometrial tissue outside the uterus. Its occurrence rate is around ten percent. Nevertheless, this rate elevates among women experiencing infertility, reaching 30 to 40 percent according to findings from diagnostic procedures such as laparoscopy and laparotomy1. Endometriosis can manifest in various locations. The most frequently affected areas include the ovaries, the cul-de-sac with the Uterosacral ligaments, the peritoneum that covers the bladder, the sigmoid colon, the posterior part of the uterus, and areas of the intestine and appendix [2]. The precise origin of this condition remains unclear, though multiple theories have been proposed, including the implantation theory, metaplasia theory, lymphatic spread theory, blood spread theory, immune deficiency theory, and genetic theory, among others. Ectopic endometrial stroma and glands are capable of undergoing cyclical changes. While proliferative changes are routinely observed, secretory changes are not present in the ectopic tissue. Blood that is shed periodically may become encapsulated, causing the cyst to tense and eventually rupture. This blood acts as an irritant, resulting in a strong tissue reaction around the area that leads to fibrosis. As a consequence, adhesions and puckered areas of the peritoneum may develop. Chocolate Cysts might form. Despite the significant adhesions within the pelvic region, the fallopian tubes usually remain unobstructed [3]. Endometriosis has been noted in various locations such as the ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, scars from laparotomy, vagina, umbilicus, hernia sacs, urinary tract, large and small intestines, appendix, and occasionally, even in areas like the pleura, diaphragm, arms, legs, and kidneys. Symptoms may include nausea or vomiting, abdominal bloating, painful menstruation, painful intercourse, painful urination, painful bowel movements, lower abdominal discomfort, heavy menstrual bleeding, irregular periods, and chocolate cysts in advanced stages [4]. Journal of Ayurvedic Maulik Siddhant 2025; 2(2): 50 -53 ~ 51 ~ Journal of Ayurvedic Maulik Siddhant https://www.maulikjournal.com While it is mainly accepted that there is no definitive cure for endometriosis, Ayurveda offers insights about the underlying causes, contributing factors for triggering the condition, and potential treatments for recovery. Endometriosis In the lens of Ayurveda, this condition is seen as disturbance of the Tridoshas in various situations. An excessive growth of cells signifies a Kapha disturbance. Given the uterus's position and the role of hormones along with blood flow, this also points to a Pitta disturbance. Moreover, since the menstrual cycle involves movement, it can be viewed as a Vata issue. The disturbance of all three Doshas contributes to endometriosis, suggesting a state of imbalance in the Tridoshas. The role of the Tridoshas in the development of endometriosis is outlined in the table below. Perspective of Endometriosis in Ayurveda Ayurveda is a healing system that emphasizes the significance of Nidana, Doshas, Dushyas, and Udbhavastana in effectively treating illnesses in a clinical context. Therefore, Ayurveda scholars assert that a doctor can successfully address a condition even if they are unable to identify it by considering all these elements. The manifestations of endometriosis can be linked to various Yoni Vyapads mentioned in ancient texts. However, not all symptoms associated with endometriosis can be classified under one specific Yoni Vyapad. Thus, accurate diagnosis is crucial at this time. This approach aids in developing treatment strategies and managing the condition effectively, which in turn helps avoid potential complications. Samprapti Incorrect diet and lifestyle choices disturb the three doshas, particularly affecting the Vata dosha in cases of endometriosis. Among the five types of Vata, it is the Vyana vata that becomes predominantly imbalanced. This imbalanced Vyana vata moves to the location of the Apana vata, causing a disturbance in the function of Apana vata. Apana vata plays a crucial role in the processes of menstruation, urination, excretion, semen production, and childbirth5. Therefore, disturbances related to menstruation, urination, and excretion are observed in endometriosis6. The Vyan Vayu facilitates movement within the body. When Vyana vata reaches the site of Apana vata, it hinders the usual functions of Apana vata and pushes it in the wrong direction, leading to a reversal of the menstrual flow. Midhyahara Vihara Tridoshic Vitiation Mainly Vata Vyanavata Obstruction of Apana Vata Disturbed Function of Apana Vata Viloma Gati of Artava Artava and Mutra Purisha Vikaras Vikarasas Udavarta, Kastartava, Arti, Asrigdara, Gulma, Maithuna Ashishnuta, Vandhya, Mutrakricchra, Parikartikacan arise due to the disturbed function of Apana vata. As it is a Pakwasaya Gata Sthana Vyadhi Adhmanacan also be encountered. Ayurveda Diagnosis Depending on the samprapti described in Ayurveda and symptoms of endometriosis in Ayurveda can be diagnosed as “Vyana Avruta Apana Vata”. Symptoms of Vyana Avruta Apana Vata [7] Vami, Adhmana, Udavarta, Gulma, Aarti, Parikartika. When Vata is the main Dosha, the key characteristics include adhmana, Udavarta, and Aarti. In this situation, the patient often reports various types of pain, such as dysmenorrhea, dyspareunia, dysuria, low back discomfort, or abdominal pain, along with a retrograde flow of menstrual fluid. If Vyana avruta apana vata interacts with Pitta, the patient may face Gulma (Artava) and Asrugdhara. In this instance, Gulma pertains to Artava Gulma, reflecting the buildup of normal Artava. In this scenario, the patient might experience menorrhagia and chocolate cysts [8]. Since chocolate cysts arise from the buildup of menstrual debris, they are classified as ArtavaGulma. When Vyana avruta apana vata is linked with Kapha, it can result in adhesions. Table 1: Types of Endometriosis and its comparison with Ayurved Samhita S.N. Endometriosis Vyana Avruta Apana Vata 1 Nausea / vomiting Vami 2 Bloating Adhmann 3 Retrograde movement of the menstrual blood Udavarta 4 Chocolate cyst Gulm 5 Pain Arti (Includes Dysmenorrhoea, Dysperunia and Dysuria) 6 Dyschezia Parikartika Contemporary Medical Science view of Endometriosis Almost 10 to 15% of women in their reproductive years are primarily impacted by endometriosis. Among women facing infertility, approximately 25 to 50% have endometriosis, and between 30 to 50% of those with endometriosis experience infertility [9]. The three predominant forms of endometriosis commonly seen in our clinical setting are as follows 1. Peritoneal endometriosis, where endometrial-like growths are present on the pelvic peritoneum and ovaries. 2. Endometriomas, which are ovarian cysts that are covered by endometrial-like tissue. 3. Rectovaginal endometriosis, characterized by endometrial-like tissue intertwined with fat and connective muscle tissue located between the rectum and vagina [10]. Risk factors The pathology of endometriosis is not clear even to this day and is full of theories. Yet the risk factors of this disease are identified. They include low parity, delayed child bearing, familial history, genital tract obstruction, environmental toxins (Dioxins) and molecular defects of cytokines, TNF, macrophages, MMPs and the like [11]. Clinical symptoms The clinical symptoms include nausea or vomiting and bloating [12], dysmenorrhea, dyspareunia, dysuria, dyschezia, lower abdominal pain, menorrhagia, irregular bleeding and chocolate cyst in later stages [13]. Pathology Numerous theories have been suggested to clarify the development of endometriosis. ~ 52 ~ Journal of Ayurvedic Maulik Siddhant https://www.maulikjournal.com They consist of 1. Retrograde Menstruation (Sampson’s Theory): This theory suggests that during the menstrual cycle, blood can flow backward through the fallopian tubes into the pelvic region [14]. 2. Coelemic Metaplasia Theory: This concept asserts that the origin of endometriosis comes from the transformation of the mesothelial lining cells within the abdominal and visceral peritoneum [15]. 3. Hormone Theory: This theory indicates that the abnormal endometrial tissue reacts to ovarian steroid hormones. Estrogens promote the growth of endometrial cells, causing the ectopic tissue to respond similarly, which heightens the likelihood of endometriosis occurring [16]. 4. Immune Dysfunction: The presence of ectopic endometrial tissue in the peritoneum triggers inflammatory responses. This situation leads to the local activation of macrophages [17] and leukocytes, resulting in a compromised immune response that hampers the clearance of menstrual debris and supports the implantation and proliferation of endometrial cells in non-typical areas. 5. Genetics: A hereditary tendency raises the likelihood of cellular damage. Genetic mutations that induce cell impairment can drive the advancement of endometriosis. Ayurvedic Management Endometriosis cannot be correlated to any single disease in Ayurveda. As discussed earlier the diagnosis, hence has to be based on the Ayurvedic pathogenesis and balancing of Tridosha’s and symptomatic. So, treatment approach can be Ampachana & correction of Agni, Vaatanulomana, Mridu Virechana, Vatashamaka, Raktasravarodhaka, Granthihar and Lekhan Chikitsa. S.N. Mode of Chiktsa(Treatment) Vyakhya (Description) 1 Aampachana and Agni Chikitsa (Imrove Digestion and correction of Agni) Deepan-Pachan drug like Panchkol Churna, Ampachakvati, Chitrakadi Vati Agnitundi Vati, Sankh Vati, Vaishwanara Churna, Jirakadyarishta etc. can be used to promote Agni and for eleminatig Ama from Artavahasrotas i.e., removal of obstruction in the Srotas. 2 Vatanuloman (regulation of Vaat) Vatanulomak drug like Hingwastaka Vati, Hingwadi Churna, Avipattikara Churna, Abhayarista, Triphala Churna, Haritaki Churna, Trivrit Churna, etc. drugs which helps in decreasing Pratiloma Gati of vitiated Vata 3 Virechana (Purgation) Mridu Virechana can be given to correct the Vatadosha Vimarggaman and to balance Pitta Dosha if there is any liver pathology involvement. 4 Vatshaman (Pacification of Vaat) External oil massage with Vata pacifying oil like Bala Taila, Dhanwanthara Tailam, Sesame oil, etc. Yoga Basti procedure eliminate the Ama Doshas from body and balances the Vata Dosha. Drug formulation for Niruha Basti - (Dashmool Kwatha, Erandmuladi Kwatha etc.) and Anuvasana Basti - (Sahchar Taila Dashmool Taila etc.) can be given. 5 Raktasravavrodhak (Controll the Excess Bleeding) Pradarantaka Rasa, Bolabaddha Rasa, Pradarari Rasa, Pushyanuga Choorna, Puskaraleha, Asokarishta, Lodhrasava, Patrangasava etc. which help in stopping bleeding and prevent formations of cyst. 6 Granthihar Kanchnara Guggul having Antitumor activity. Varunadi Kashaya 7 Lekhana Collection of Kapha removed by Bhedana Shigru leaf powder. Kumari - Bhedan, Kaphshamak and act on Liver. Manjishtha - Antitumor activity (Pitta Dosha) Gokshurdi Guggul - Anti tumour activity (if Kanchanar not work) Other drugs having antitumor activity like Sariva, Methika can be used. 8 Vedanasthapan (Analgesic) Dashmoolarishta, Dashmool Kwatha, Ashokarishta, Maharashnadi Kashaya, Kumariasav, etc. can be used for pain relief 9 Pathya-Apathya Favour warm, light and slightly oily, fresh home-cooked meals. Avoid dry, cold, excessively heating and fermented foods. Particularly avoid alcohol, caffeine (especially coffee), carbonated drinks, red meat and refined sugar or flour. Red wine, chili, coffee and red meat (all very heating) should be the first things to go. As mentioned, women should avoid exercise during menstruation and should keep their exercise relatively moderate throughout the month. 10 Yog  Supta Matsyendrasana  Ananda Balasana  Balasana  Supta Baddha Konasana  Malasana  Yoga Nidra

The condition characterized by the existence of endometrial- like tissue outside the uterine cavity is known as endometriosis. It is a disorder that is explained by various theories. The disruption of Vata Dosha, particularly the Apana and Vyana Vata, leads to the backward flow of menstrual blood and the distribution of endometrial tissues through the bloodstream. The ectopic endometrial implants may increase in size with each menstrual cycle. Endometriosis can be managed through methods such as Ampachana, improving Agni, Vaatanulomana, gentle purging (Mridu Virechana), reducing Vata (Vatashamaka), preventing blood loss (Raktasravarodhaka), addressing cysts (Granthihar), and tissue scraping (Lekhan Chikitsa). Additionally, adopting changes in lifestyle and diet can aid in the treatment of this condition.

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