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View metadata, citation and similar papers at core.ac.ukbrought to you byCOREprovided by Ayushdhara (E-Journal)AYUSHDHARAISSN: 2393-9583 (P)/ 2393-9591 (O)An International Journal of Research in AYUSH and Allied SystemsReview ArticleSHODHANA CHIKITSA AND STHANIK CHIKITSA IN STREE ROGAReshma Dattatraya Nangare1*, Vijay Nawale2, Salim Mulla3*1P.G.Scholar, 2Associate Professor and Guide, 3Professor and Head, Dept. of Stree Rog Avum Prasutitantra,S.M.B.T’s Ayurved College and Hospital, Nandi Hills, Dhamangaon Tal. Igatpuri, Dist. Nashik, MaharashtraState, India.KEYWORDS: Stree rog,Shoshana karma, Sthanikchikitsa.*Address for correspondenceDr Reshma Dattatraya NangareP.G.Scholar,Dept. of Stree Rog AvumPrasutitantra, S.M.B.T’s AyurvedCollege And Hospital, Nandi Hills,Dhamangaon Tal. Igatpuri, Dist.Nashik, Maharashtra State, India.Mobile: Healthy status of women is very much needed for society. In today's fastand competitive world, there is change in the lifestyle of women whichleads to their physical and mental stress, women mostly gets affected bythis environment and are prone to gynaecological problems. She alwaysface many more very common health problem or gynaecological problemlike white discharge, foul smell discharge, itching at vulval region,burning micturation etc., which are described detail in Stree rog vyadhi.As Ayurveda oldest system of health gives various Panchakarma andSthanik chikitsa for such gynecologic problems and it gives an excellentresult in above mentioned gynaecological problem. Sthanik chikitsa ischeap, easy, non surgical procedure.Anushastra Karma or parasurgical procedures means surgical procedureperformed by non-surgical items or in absence of surgical instruments.Acharya Sushruta has described 60 Upkarma, 25 Upyantra and 14Anushastra for the management of wound in different conditions. Shastiupkarma includes Kshara karma, Agni karma and Uttar basti etc., Ksharhas given utmost importance and it is included under Shasti Upkarmaupyantra and Anushastra, whereas Agnikarma is under Uyantra andAnushastra. Uttar basti is included under Shasti upkarma and Anushastra.Jaulaka is classified under Anushstra. Regarding Stree roga Yoni pichu,Yoni prakshalanam, Kshar karma, Uttar basti karma, are quite populardue to its excellent result and no adverse effect if followed properly.INTRODUCTIONWoman undergoes various physical andphysiological changes during her reproductiveperiod i.e., from menarche (onset of menstruation)to menopause. Awareness and management ofthese changes are necessary for a woman to remainhealthy. Most of the female related diseases belongsfrom the disturb functioning of genital tract.Diseases of women arise as a result of improperfood and regimen. This results in the arrangementof three Doshas Vata, Pitta and Kapha. Blood,situated in the reproductive organ is giving rise toseveral diseases. The most common symptoms ofgynaecological disorders include pelvic pain,vaginal itching, vaginal discharge, abnormal vaginalbleeding and breast pain and lumps. Dependingupon the combination of the Doshas involved A May - June 2018 Vol 5 Issue 3Management of Stree Roga is by Shoshanna karma(Vaman, Virechana, Basti) Sthanik karma(Yonidhawan, Yonipichu, Dhupan etc) purificationmethods. Panchakarma does Shuddhi of Sharir fromall vitiated Dosha. Ayurveda mentioned thatpurification therapy (Shodhana Karma) helps tomanage various Stree Rog related to unhygieniccondition. Shodhana Karma that helps to maintainclean condition and remove toxins and pacifyaggravated Doshas thus reduces pathologicalprogression of various Stree roga related tounhygienic condition of genital tract. Literary studyrevealed that Shodhana Karma along with Shamanand Sthanik Chikitsa significant improvement insymptoms of female disorders. This article want toemphasize the concept and contribution ofAyurveda such as Shoshana chikitsa, Sthanik1758
Reshma Dattatraya Nangare et al. Shodhana Chikitsa and Sthanik Chikitsa in Stree RogaChikitsa (Yoni Pichu, Yoni Dhavan, Uttarbasti) etcthese are certain procedure mentioned inAyurvedic text to treat various medical and surgicalillnesses of female reproductive track.[1-3] Althoughit is more of local treatment but their effect issystemic and capable of preventing complicationsof diseases consequently these are parasurgicalbecause it doesn't involve the sharp instrument ithelps to avoid impending major surgeryconsequently to diseases. Anushastra karma (parasurgical procedure) can be performed with leastcomplication and enlist complicated facility.OBJECTIVES1. To study the literary view of Shodhan Chikitsafrom various Ayurvedic texts.2. To study the literary view of Sthanik Chikitsafrom various Ayurvedic texts.3. To study the probable mode of action ofShodhan Chikitsa.4. To study the probable mode of action of SthanikChikitsa.MATERIAL AND METHODSThis is a conceptual type of study. Textualmaterials are used for study from which variousreferences have been collected. Many Ayurvedictext used in this study are Charaka Samhita,Sushruta Samhita, Ashtanga sangraha, Ashtangahrudayam, commentaries also included in it, variousonline journals, research papers, articles have beensearched from PubMed etc., internet media tocollect the information.Ayurvedic Treatment for Gynecology Includes:Shodhana Chikitsa for StreerogVamanaVamana, therapeutic vomiting is amedicated emesis therapy. Vamana removes Kaphatoxins accumulated in the body, Kaphajpredominant Artava dushti may be treated withVaman Karma, Vamana also recommended forSoumya Dhatu nirharan and Agneya Dhatu vruddhidoes increases Artava matra.VirechanaVirechana therapy is medicated purificationtherapy, cleansing the body from excess Pittaaccumulation, purifying blood and clearing toxins.Vitiated Pitta dosha along with Dushan of Rakta andArtava are major factors associated with Yoni dosha.Virechana Karma helps to pacify these aggravatedfactors and thus reduce disease progression.Virechana Karma offers beneficial effect in PittajaYonidosha.AYUSHDHARA May - June 2018 Vol 5 Issue 3BastiMedicatedDravyagiventhroughAdhomarga i.e., enema, vitiated Vata dosha alongwith Dushan of Rakta and Artava are the majorfactors associated with Yoni dosha. Basti Karmahelps to pacify aggravated Vata and reduced diseaseprogression. Basti karma offers relief in vitiatedVata dosha associated with gynaecological disorder.Sthanik Chikitsa1) Yoni Pichu (tampons)‘Vatartanam cha yoninam sekabhyangapichu Kriya’.[4] This is one of the simplest SthanikKarma that gives the continuous drug delivery tothe target organ another advantage is that there isno need of sophisticated instruments and trainedexpert rather than patient can do itself after littleinstruction. Pichu is made up of cotton swabwrapped with gauze piece and tied with long threadit should be immersed in medicated oil or liquid oilare mostly prepared due to its retention abilitycircular and elongated Pichu is used for shallow anddeep insertion inside vagina respectively it shouldbe kept for 5 to 6 hours upto retention of urine.[5-6]Mode of action depending upon themedicine used as different medicines have differentmode of action. Pichu used in pregnancy AndLabour helps to soften the vaginal canal enablingeasy delivery and easy expulsion of placenta.Example1. Tampon soaked with Udambar or Triphalakwath is used in Kaphajayoniroga.2. Tampon soaked with Jatyadi Taila or Ghrita isused in Mahayoni.3. Tampon soaked with Dashmoolkwath or Ghritais used in Vataja yonivyapada.Indications1. Yonidaha, Yonikandu, Yonipaka.2. Vivrutta Yonivyapad [7]3. Yoni paicchilya and Yoni strava[8]4. Yoni karkashata[9]5. Vataj yonivyapad6. Pittaj yonivyapada7. Vamini, Upapluta yonivyapad[10]8. Nine months of pregnancy9. Retained placenta2) Yoni Dhawan/Parisheka- (Vaginal douche)It is a procedure in which the vagina, vaginalpassage, and mouth of uterus is washed withmedicated decoction or other liquids. Dhawanmeans cleaning or purification of wound with wateror other medicated material, Kwatha, Kshirapak,Siddha jala, Taila are have aseptic, wound healing,1759
AYUSHDHARA, 2018;5(3):1758-1762pain alleviating, and bactericidal action. Theyprevent growth of bacterial organism and restorethe altered pH of vaginal cavity. It gives quality tovaginal muscles. This is general purifying measuresof genital organs to maintain a strategic distancefrom parasitic or yeast diseases. Absorption of drugthrough the mucus and blood circulation also helpsto have beneficial effect on the uterus it shouldperformed in Ritukala from 6th day of menses for 8day and duration is 1-1.5min.[11]Example1. With decoction of Lodhra and Trikatu is used inKaphaja artavadushti.2. With decoction of Triphala[11] is used inKunapgandhi artavadushti.Indications1. Yonikandu2. Kunapgandhi Artava dushti3. Kaphaj Artava dushti4. Yoni paicchilya and yoni strava5. Yoni arsha6. Leucorrhea[12]3) Yoni Varti[13] (pessary)Varti is prolonged and long lasting worthycan be used effectively in infections and dealingwith their recurrence, University helps to clearvagina and also provides the opportunity torecreate the optimum vaginal health.ExamplePessary prepared with powdered Yava(barley) and Masa (a type of bean) is used inKaphaja yonivyapada.IndicationsYoni paicchilya, Kaphaj Yonivyapada, ViplutaYonivyapada, Karnini Yonivyapada, Anartava.4) Yoni Dhupan[14] - (fumigation of vagina withmedicated smokes)Medicines which are used in the form ofsmoke by burning are called as Dhupana.Fumigation is done on wound, a part of the body oron the whole body depending on the need.Fumigation is the exposure till the action of smokeor of fumes of any kind as a means of disinfection oreradication. The fumigation carried out using finepowder of selected drugs with the intention ofNirjantukaran (disinfection) is called as Dhupana.Dhupana is process explained from timeimmemorial from the period of Samhita. It is widelyused not just in Ayurveda pharmaceutics fromdisinfecting drug stores to prevent degradation ofraw drug, but also as pre-processing in variousKalpana. Different Dhupakalpas are explained inAYUSHDHARA May - June 2018 Vol 5 Issue 3treatises that are used in various elements forcurative purpose and also Dhupas are employed forprevention of disease.Yoni Dhupan is also used for local disinfection ofgenital organs.ExampleFumigation with Haridra and Brahti is used in Yonikadu.Fumigation with Kustha, Guggalu, Agara mixed withGhrita is used in a,Garbhsanga,Aparasanga, Sutika paricharya.5) Yoni Lepan (vaginal painting)In Lepan the drug penetration is higher onthe vagina, the efficacy of Lepana relates to both itsinherent potency and the ability of the drug topenetrate the skin, muscle and mucosa.ExampleWith powder of burnt broken earthan pots andTriphala mixed with Ghrita is used in Yoni Arsha.Indications: Vivrutta yoni, Yoni arsha etc.6) Yoni Purana (vaginal packing)Yonipurana involves feeling of vaginal cavityusing Churna, Kalka and medicated oil. It offers localtherapeutic action. This therapy employed whenlarge amount of drug needs to be employed forlonger duration of time.ExampleWith Vesawara (minced meat or oleo mixed withdrug) is used in Prasansini yoni.IndicationsMahayoni, Prasansini yoni etc7) Uttara BastiUttarbasti is an important para surgicalprocedure among the 60 Karma as told by AcharyaSushruta, Vagabhatt has mentioned Basti as Ardhachikitsa. Basti chikitsa is best for Vata dosha.Insertion of medicated oil decoction intoUttarmarga i.e., true the passage located above or infront part of anus that is vagina or urethra is knownas Uttar Basti. Entire technique used in Uttar Bastichikitsa is more or less similar to the Hysterosalphingography (HSG) and cystourethrographydone now days as important investigation of femaleinfertility. It is important to treat previousinfections completely before giving Uttarbasti. It isadministered during Ritukala (after menstrualbleeding stops). Because during this period themouth of uterus is open and it readily receives thefluid injected. It is usually carried out under aseptic1760
Reshma Dattatraya Nangare et al. Shodhana Chikitsa and Sthanik Chikitsa in Stree Rogaprecaution in minor OT, no need of any anaestheticagent or analgesic during and after the procedure.ExampleBasti with oil medicated with Jivaniya groupof drug. (Shushka yoni, Acharanayoni, Aticharana,karnini yonivyapada).IndicationsTubal Blockage[15]For conception, for pacifying Vata, diseasesof urinary bladder, prolapse uterus, severe pelvicpain, Asrugdara, menstrual disorders, pathologicalamenorrhea, for all reproductive tract disorders, all20 types of Yonivyapada.ContraindicationsCervical cancer, virginity vesico vaginalfistula hypersensitivity disorder.8) Kshara karmaKshara Karma is said to be superior to anyother surgical or parasurgical measures due to itsfunction like Chedan, Bhedan, Lekhan, PatanKarma[16]. It can be applied in the narrowest placeand internally where surgical procedure cannot beperformed. Kshara acts as a corrosive or causticagent and generates healthy base for healing.Application of Kshara in case of cervical erosion isan effective form of herbal cauterization (incisionand excision). This therapy clears the erosion withminimal recurrence and complications. Kshara is oftwo types namely Paniya kshara and PratisaraneeyaKshara.Kshara karma is considered as satisfactoryapproach to treat cervical erosion instead of electrocauterization in which chances of recurrence andcomplicationsaremore,likesecondaryhemorrhage, infertility, cervical stenosis etc.[17]ExampleDepending upon its origin they are Khanija(mineral origin) e.g., Tankana kshara, Sarja kshara,etc., Pranija (animal origin) e.g., Shankha, Kapardikaetc., Vrukshaja (plant origin) e.g., Apamarga kshara,Yavakshara etc.IndicationGenital warts, cervical erosion, cervicalpolyp, Nabothian follicle, Chronic non healingcervical ulcer.DISCUSSIONPoverty, illiteracy, poor hygiene, social andreligious factors imposes more challenges to thereproductive health of females in developingcountries. Today the increasing burden of cost onHealthcare sector demand to search simple costeffective, non recurrent, with no adverse HARA May - June 2018 Vol 5 Issue 3parasurgical procedure are safe and effective,reduce hospital stay. Vaman Virechana, Basti, Yonipichu, Yoni dhawan /Prakshalan, Kshara karma,Agnikarma, Uttarbasti are the importantparasurgical procedure of Ayurveda to treat variousreproductive tract diseases of female. Multicenteredclinical trial and Proper training to present humanresources of healthcare sector can produce lot ofchanges in present situation. The vagina is apotential space that connects the lower portion ofthe uterus cervix to the outside environment. it isone of the Bahya Strotas in women. Drug transportacross the vaginal membrane may occur bytranscellular route or intercellular route. Thevaginal wall is well suited for the absorption of drugfor systemic use, since it contains a vast network ofblood vessels. Moreover the automaticallybackward position of the vagina may help in selfcontaining of drug thereby holding it in situ for alonger duration. Uttarbasti helps in endometrialconditions by improving thickness of endometrium,improve the quality of endometrium, helps incuring endometriosis etc., absorption is very fastgives quicker result.CONCLUSIONShoshana karma, Sthanik karma Chikitsa arecheap, safe, effective and with no adverse effect.This can be helpful to prove like a boon toStree rog in Ayurveda when the Vaidya supply thistherapies in there gynaecological practice logicallyand carefully and under aseptic precautions. EachShodhan karma, Sthanik chikitsa holds its ownimportance and show tremendous results whenapplied with proper indications, strict asepticprecaution and extreme carefulness.REFERENCES1. Sushrut, Sushruta Samhita with commentaryNibandh Sangrah commentary of DulhanAcharya, edited by Vaidya Yadav ji trikamji andNarayanRamKavyatirtha,ChaukhambaSanskrut Sansthan, Varanasi, reprint - edition Vi.Sa. 2067, Sutra sthan chapter- 7/16 Page No 34.2. Sushrut, Sushruta Samhita with commentaryNibandh Sangrah commentary of DulhanAcharya, edited by Vaidya Yadav ji trikamji andNarayanRamKavyatirtha,ChaukhambaSanskrut Sansthan, Varanasi, reprint - edition Vi.Sa. 2067, Sutra sthan chapter- 8/15. Page No 41.3. Sushrut, Sushruta Samhita with commentaryNibandh Sangrah commentary of DulhanAcharya, edited by Vaidya Yadav ji trikamji andNarayanRamKavyatirtha,ChaukhambaSanskrut Sansthan, Varanasi, reprint - edition Vi.Sa. 2067, Sutra sthan chapter- 1/8 Page No 397.1761
AYUSHDHARA, 2018;5(3):1758-17624. Charaka Samhita, chikitsa sthana edited byYadavji trikamji Acharya chaukhamba surbharatiPrakashan, Varanasi, 3rd edition, chapter-30/61,P-637.5. Jaymala Shirke, editor Ayurvediya Stree rogvigyana, Edition- 1st, Pune tathagat Prakashan2003, p- 164.6. Dhanashree H Mahajan et al. a critical review ofsainik chikitsa local therapies adapted in 3 RoverInt.J. Ayu. alt. med, 2014,2(3) :28 -35.7. Yogaratnakar edited by Shastri Brahma Shankar,5th edition, chaukhamba Sanskrit Sansthan,Varanasi, 1993, p- 426.8. Charaka Samhita, chikitsa sthana edited byYadavji trikamji Acharya chaukhamba surbharatiPrakashan, Varanasi, 3rd edition, 1941.p-638.9. Sushruta Samhita Uttara tantra edited by Yadavjitrikamji Acharya and Narayan Ram Acharya, 7thedition, chaukhamba Orientalia, 2002, p- 669.10. Astanga sangraha, Uttarasthana, edited byLalchand Shastri Vaidya, 2nd Edition, Nagpur,Baidyanath Ayurved Bhawan Limited 1981,verse 39/ 49 p- 680.11. Dhanashri H Mahajan, Manish S. Bhoyar. Efficacyof Triphala Kwath Yoni Dhavan with Triphalasiddha ghrita pratisaran. IJRAP April 2013 4(2):249-252.12. Dr Shamal Pote, Role of Ayurvedic Treatment inLeucorrhea. www.boloji.com, 28 Feb 2016.13. Jaymala Shirke, editor Ayurvediya Stree rogvigyana, Edition- 1st, Pune tathagat Prakashan2003, p- 159.14. Ayurveda Prasuti Tantra evam Street Rog by P.Tiwari, Chaukhamba orientalia, 2007, Vol – 2.15. Kamayani Shukla, Kaumadi Karungoda. Effect ofKumari Taila Uttar Basti On fallopian tubeblockage, Ayu. 2010 Oct-Dec; 31(4):424-429.16. Sushrut, sushruta Samhita with commentaryNibandh Sangrah commentary of DulhanAcharya, edited by Vaidya Yadav ji trikamji andNarayanRamKavyatirtha,ChaukhambaSanskrut Sansthan, Varanasi, reprint - edition Vi.Sa. 2067, Sutra sthan chapter-11/3 Page No 432.17. Parmar Meena, Parmar Gaurav. Role ofksharakarma in recurrent cervical erosion: acase study. J of Ayurveda and Hol Med (JAHM);2014; 2(6):60-63.Cite this article as:Reshma Dattatraya Nangare, Vijay Nawale, Salim Mulla. Shodhana Chikitsa and Sthanik Chikitsain Stree Roga. AYUSHDHARA, 2018;5(3):1758-1762.Source of support: Nil, Conflict of interest: None DeclaredDisclaimer: AYUSHDHARA is solely owned by Mahadev Publications - A non-profit publications, dedicated to publish qualityresearch, while every effort has been taken to verify the accuracy of the content published in our Journal. AYUSHDHARA cannotaccept any responsibility or liability for the articles content which are published. The views expressed in articles by our contributingauthors are not necessarily those of AYUSHDHARA editor or editorial board members.AYUSHDHARA May - June 2018 Vol 5 Issue 31762
Yoni paicchilya and Yoni strava[8] 4. Yoni karkashata[9] 5. Vataj yonivyapad 6. Pittaj yonivyapada 7. Vamini, Upapluta yonivyapad[10] 8. Nine months of pregnancy 9. Retained placenta 2) Yoni Dhawan/Parisheka-(Vaginal douche) It is a procedure in which the vagina, vaginal passage, and mouth of uterus is washed with
