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Ayurvedic Gynecology Tirun Gopal MD.

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1 Ayurvedic Gynecology Tirun Gopal MD

2 Definitions Stri- comes from the word Stayi- which means making noise or movement- Sabda- i.e. one in whom the fetus or child makes movements. The concept is that fertilization and reproduction are some of the most important functions of the female without which the woman is considered incomplete.

3 Definitions Yoni comes from the joining of the word NI to the root Yu, which means mix and separate. It is the organs in which the woman and child are united and then separated, namely the Uterus

4 Definitions Stri or woman is an embodiment of Agni.
Agni is Fire. This is a portrayal of the natural luster that women possess. Stri or women are given a lot of respect in Indian tradition, and they are often spoken of as Laxmi and Saraswati, the two goddesses who are the embodiment of wealth and knowledge respectively. Although the woman is predominantly Kapha, the reproductive aspect is Pitta, since blood and menstrual fluid is Pitta.

5 Life cycle of women 1. Uvati (younger age group- menarche to reproductive age) 2. Elderly women (Praudha- 40 to 50 years) 3. Older women (Vriddha- over 50 years of age).

6 Definitions Although a male is predominantly Pitta, his reproductive system and the semen is basically Kapha. The opposing biological humors or Doshas attract each other and intercourse results in the balancing of the Doshas.

7 Differences between man and woman
This is not the only difference between male and female. There are 13 Srotas (channels) in the male. There are 15 in the female!! These channels or Srotas convey nourishment to the organ each of them serves. Each organ has its own Srotas or channel.

8 Chanels/Srotas Chanels or Srotas:
There are thirteen chanels in the human body; Three which bring nourishment to the body: Prana vaha srotas- intake of breath Anna vaha srotas- intake of food Ambu vaha srotas- intake of water. Three which are responsible for excretion of waste products: Sveda vaha srotas- excretion of sweat Purisha vaha srotas- excretion of feces Mutra vaha srotas- excretion of urine

9 Chanels/Srotas The seventh chanel is Manovaha srotas for the mind and thoughts. This is one of the areas where modern medicine and Ayurveda diverge since the mind is given equal , if not more importance in Ayurveda, in the make up of an individual as well as in disease. Seven chanels, one for each tissue: Rasa vaha srotas Rakta vaha srotas Mamsa vaha srotas Medovaha srotas Asthi vaha srotas Majja vaha srotas Sukra vaha srotas

10 Seven tissues Rasa and Rakta are Pitta Asthi is Vata and the rest:
Medas, Mamsa, Majja and Shukra are Kapha.

11 Chanels/Srotas Two separate channels for women:
Artava vaha srotas for menstruation Stanya vaha srotas for lactation. When one of the channels is being used as in lactation, menstruation seldom occurs. It has been documented by research that increase in the number of ovulations increases the incidence of ovarian and uterine cancers. This may one of the reasons for increase in risk for uterine, breast and ovarian cancers since more women postpone pregnancies or are infertile.

12 Modern medicine It is very common in modern medicine to advocate suppression of menses. Lot of young people these days are on Birth Control Pills. This artificially reduces the quantity and duration of bleeding. This is suppression of the natural and physiological processes in the female human body. When it is suppressed, there has to be adverse consequences. Prana Vayu is the downward moving force which is responsible for: Urination Defecation Menstruation and childbirth

13 Postponement of childbirth
When the physiological process of pregnancy is postponed in the pursuit of a career, again there will be adverse consequences. Eg: It has been established that the more the number of times a woman menstruates, the greater her risk of breast and ovarian cancer. Women who become pregnant and following childbirth breast feed, are at less risk for breast, ovarian and uterine cancers. Birth control pills are associated with depression, anxiety and loss of libido.

14 Channels Each of the tissue channels is responsible for feeding that particular tissue. It is separated from the tissue by what is called as a barrier or “Kala”. This is a membrane that is responsible for absorption and diffusion of the nutrients.

15 Dhatus or Tissues There are seven tissues in the human body:
Rasa- Plasma Rakta- Blood Mamsa- Flesh or muscle Medas- Fat Asti- Bone Majja- Bone marrow and reproductive tissue Sukra- Seminal fluid in the male and Ovum and reproductive juices in the female.

16 Channels Channels can be : 1. partially occluded- deficiency
2. Blocked- wasting 3. Wide open- healthy 4. Overflow – growth ( benign or malignant tumor). 5. Diversion- affliction of different parts, like joints where the muscles, tendons and bones come together.

17 Kalas One of the most important kalas of the body is that related to bones. This kala lines the Colon which is the seat of Vata. The Colon is where maximum absorption of nutrients takes place and the food and air are separated into what is to be retained and what is to be excreted. When this kala is functioning properly, Prana is absorbed from the food in the colon and goes to forming strong bones.

18 Kala When this Kala is not functioning properly, toxins accumulate in the colon, Prana is not properly absorbed and it weakens the bone or too much air is absorbed. Thus, Vata imbalance causes osteoporosis, which is a Vata problem. It is also associated with lack of Prana, as manifested by dementia, loss of memory

19 Kala Which brings home the important concept that proper nutrition, proper functioning of the channels, and the Kalas, proper digestion and nourishment, proper state of mind, are all necessary for maintaining balanced Health.

20 Health In Ayurveda, health is defined as:
Balance in all the three Doshas, Balance in all three excretions Proper balance of all the seven tissues Good state of digestion Existing in a body and mind that is abiding on the Self or Atman.

21 Health We know the three Doshas: Vata- Space and air
Pitta- Fire and Water Kapha- Earth and water.

22 Health We know the three excretory products: Sweda- sweat Mutra- Urine
Purisha- Feces

23 Health We know the seven Dhatus or tissues: Rasa- Plasma Rakta- Blood
Mamsa- Flesh Medas= Fat Asti- Bone Majja- Nerve tissue and bone marrow Sukra- Semen (male) and ovum and reproductive fluids (female).

24 Health A good state of digestion means that the Agni (the main Agni being the Jatharagni in the stomach) has to be burning brightly to receive and digest the food so that we can derive good nourishment from the food. It also means a balanced state of mind so that thoughts are also properly digested Since an undigested thought can be every bit as harmful as undigested food.

25 Health Finally, all of this is in a body and mind which are abiding in the Self or Atman. This is perhaps the most comprehensive definition of health But what is important to understand is that good food needs to be consumed and that the first step in the process of digestion is RASA. Ayurveda believes that each of these 7 stages of formation of tissues takes approximately 5 days, so that the Sukra is formed by the 35th day.

26 Shukra Dhatu Most hormonal disorders result from deficiency of the Shukra Dhatu in the female. But Shukra is formed from Rasa which is the first step in the metabolic process Rasa is formed from the food that we eat and digest. Thus the metabolic cascade of good nourishment, good digestion, including proper digestion of thoughts is responsible for Health.

27 Formation of Dhatus/tissues
Food is consumed In 5 days it is converted into Rasa It takes 5 further days at each conversion including: Rakta Mamsa Medas Asthi Majja and finally Shukra Thus a total of 35 days. Shukra us therefore the most dense and important of all the Dhatus and is not to be wasted!!!

28 Shukra Shukra dhatu is alternately called as Ojas
Mental disorders can affect the Ojas and hence the Shukra. Shukra is seminal fluid in the male. Shukra is the reproductive organs, their excretions (hormones )and vaginal secretions in the female.

29 Shukra Therefore, when Shukra dhatu is affected, it automatically affects the hormones and fertility, causing Anovulation (absence of ovulation) and infertility.

30 Rasa Dhatu Menstrual fluid and lactation are upa-dhatu of Rasa dhatu.
Therefore, anything that affects the Rasa dhatu will affect the menses and lactation.

31 Metabolic cascade In the metabolic cascade, food that we consume turns into Rasa dhatu It then goes through all the seven chanel, nourishing all the seven tissues, finally ending in the Shukra dhatu. This balances the hormones, which in turn leads to regular ovulation and menses. This results in a pregnancy.

32 Cascade Good, nourishing, freshly prepared food
Good digestion of food and thought Conversion into Rasa and other tissues Finally Shukra Regular production of hormones Regular menses and ovulation Combined with normal semen in male Reproduction

33 Physiology of menstruation
Has three phases: Vata phase is the proliferative cycle Kapha is the secretory phase and Pitta is the menstrual phase. The Apana Vayu is responsible for the proper flow of menstruation. When the Apana vayu is disrupted, the flow becomes irregular and menstrual irregularities result. Importantly, when menstruation is altered or suppressed as in modern times, it will result in other problems. Similar to the Rebellious Chi in Chinese. According to Ayurveda, menstruation is considered to be a time of cleansing and catabolism and this is the reason that in our culture, women are advised to rest and not participate in any activity that is physically or emotionally exacting.

34 PMS/ PMDD Is a condition which is characterized by: Irritability
Bloating Weight gain Crying spells Anxiety Depression etc. Starting approximately 7 days before the start of menses and abruptly ceasing with the onset of menstruation.

35 PMS/PMDD Modern Medicine has no explanation for this phenomenon except that it is related to the fall in the levels of Estrogen and Progesterone just before menses starts. Therefore, we used to give large amounts of hormones to these women in the hope that this would make them feel better. Some improved, most did not. Some improved even with sugar pills!!! We are no closing to understanding the problem. Now we recommend that during this time women should engage in strenuous physical activity since this would result in the release of endorphins and they would feel better

36 PMS/PMDD Ayurveda, on the other hand, believes that menses is a catabolic, depleting state and that it is important to rest physically and emotionally during this time That this is a time for spirituality and self introspection. The Chinese also call this period a Yin period, one of depletion and catabolism and therefore encourage women to rest.

37 PMS/PMDD Gynecologists these days administer birth control pills for this condition. The pills have side effects: Depression Loss of libido etc. The pills suppress the quantity and duration of bleeding. Thus Apana Vayu is restricted by these hormones. Therefore, Udana and Prana Vayu are affected which is why they have depression, anxiety and loss of sexual desire.

38 Treatment of PMS/PMDD in Ayurveda
IF Vata is imbalanced and the symptoms are predominantly Vata: Warming internally and externally Grounding (rest and grounding Yoga) Lubrication, internal and external. Abhyanga with warm sesame oil Calming – herbs Diet- predominantly Sweet, sour, salty

39 Treatment of PMS/PMDD If the symptoms are predominantly Pitta
Cooling (ghee, Shatavari) Take away deadlines Avoid caffeine and alcohol Abhyanaga with coconut oil and ghee Diet- Bitter, sweet and astringent

40 Treatment of PMS/PMDD If the symptoms are predominantly Kapha.
Warming but lightening Drying with pungent herbs and food Activity, physical and intellectual Fasting Tastes- Pungent and astringent. Ashwagandha. Dry massage with herbal powders.

41 Dysmenorrhea It is important to treat dysmenorrhea at the same time since it can substantially increase the intensity of the PMS symptoms. Vata dysmenorrhea is treated with Abhyanga with Nirgundi or Mahanarayan oil Followed by Svedana (fomentation) 2 weeks before the onset of period, take ½ tsf of herbal combination of Dashamoola 500mg, Ashwagandha 400 mg, Musta 300 mg., tagar 200 mg., and Yograj guggulu 200 mg

42 Dysmenorrhea Dashamoola vasti should also be given with half cup of sesame oil. Dasha- 10 and Moola- roots. This is a combination of ten herbs. Vata pacifying diet Yoga postures: Camel, cobra, cow Pawanamuktasanas (pelvic rest postures) Pranayama: Nadi shodana and anuloma viloma.

43 Dysmenorrhea Pitta dysmenorrhea is best treated with:
Abhyanga with coconut oil or sunflower oil Baking soda bath is good during painful periods. 2 weeks before periods, half tsf of combination of Shatavari 500mg., guduchi 300 mg., kama dudha 200mg., and Asoka 300 mg. This is taken with aloe vera gel before meals. Following the period, Virechana with one tsf of Bhumi amlaki at bedtime. Yoga: Boat, bow and bridge poses Shitali pranayama

44 Dysmenorrhea Kapha dysmenorrhea is best treated with:
Snehana with Visha garbha thailam Heating herbs like Trikatu and Chitrak. Chitrakadi thailam is very effective Dry heat with ginger paste Wet svedana with ginger bath 2 weeks before period, take the following combination, Punarnava 500mg., Kutki 200mg., Shilajit 200 mg., and Trikatu 200 mg. Three times a day with honey Asanas are lotus, lion, spinal twists. Bhastrika and Kapalabhati Pranayama.

45 Case History 48 yo white female who presents with the history that:
her menstrual periods are irregular She has symptoms of hot flashes, night sweats, she has vaginal dryness which is beginning to cause problems with painful intercourse she has loss of libido. she has palpitations, anxiety etc.

46 Premenopause In the perimenopausal period, Pitta peaks.
Estrogen is considered Agni Amsa (the most predominant female hormone responsible for menstruation and ovulation, along with other hormones) The transition from reproductive period to menopause is termed Vrudha avastha. The Gunas of Agni (Pitta) are gradually being transformed into Gunas of Vata (Air and Space). Manopause is therefore a transition from Pitta to Vata.

47 Symptoms of menopause Menopause is Pitta/Vata phase:
Hot flushes are caused by Pitta peaking Intermittent nature of the hot flushes are due to Vata which is usually unsteady, unpredictable and vascillating Mood changes between irritability (Pitta) and depression (Vata) Difficulty with concentration is Vata Insomnia is Vata Decreased sex drive is due to reduction in Pitta Decreased vaginal lubrication is due to Vata.

48 Hot flushes This is predominantly due to Pitta which is hot
It is also potentiated by Udana Vayu and Prana Vayu. Apana Vayu derangement also causes flatulence and constipation. Reduction in the Jatharagni creates problems with indigestion and constipation. Jatharagni is the Agni in the stomach which is primarily responsible for digestion of food.

49 Digestion of thought!! Digestion of thought is every bit as important as digestion of food. An undigested thought can be as problematic as undigested food. For digestion of thought to occur, the Vayu of Prana and Udana have to be functioning well. Disruption of this occurs in menopause leading to inability to concentrate, memory loss, and in worse cases, dementia.

50 Treatment Hot flushes: Nasyam with cow’s ghee or Anutailam.
Ayurveda believes that the gateway to the brain is through the nostrils. People who practice Nasyam on a daily basis, have better concentration, memory, and are less likely to develop sinus congestion, allergies etc.

51 Hot flushes Hot Flashes occur as a result of Pitta aggravation.
Seat of Pitta is in the small intestines. Purgation with Avipattikar churna. 3 to 5 gms of this powder is mixed with milk and administered before bedtime, so that the hot flashes do not keep the patient awake. Purgation is typically a Pitta reducing activity. Incidentally it also resolves the constipation they suffer from.

52 Hot flushes Pinda thailam: Abhyanga and Sneha, every 3 days
Abhyanga- is oil massage. It has the following beneficial effects: Lubricates skin and joints. Repairs tissue damage, muscle aches and pains Relaxing and helps induce sleep Soothes touch receptors on the skin and is therefore a satisfying experience. “From the time we graduate out of our parents laps, we become increasingly starved for touch”- MONTAGU

53 Hot flushes Ksheerabala thailam- thalam- for application to the crown of the head before shower daily. This has a stabilizing influence on the brain, especially on Prana and Udana vayu. Massage of the crown of the head should be done in a circular manner. Leave the oil on for a period of approx. twenty minutes and take a warm shower.

54 Treatment for digestion and calcium loss
Mahatiktaka Kashayam: One tbsful morning and night before meals. This is bitter in taste, and bitter taste is cooling. Ayurvedic nutrition is based on six tastes: Sweet, sour, salty, bitter, pungent and astringent. White sesame seeds: lightly roasted. 1 tsf morning and night. This is an excellent source of calcium. Pavala pishti (coral calcium): is another good source of calcium.

55 Treatment For excessive hot flushes and night sweats:
Shatavari grtm: one tsf twice daily, morning and bedtime. For vaginal lubrication: Pichu: vaginal douche with sesame oil.

56 Treatment For psychological problems: Brahmi grtm Kalyanaka grtm
Brahma rasayanam.

57 Treatment For loss of libido: Vasanthasukumara rasam. Kalyanaka grtm.

58 Suppressed menstruation
In modern times, several techniques are employed in suppressing ovulation and menstruation. The admonition in Ayurveda is that none of the natural urges or physiological occurrences are to be suppressed. When menstruation is suppressed with birth control pills, there has to be a side effect in some form or the other. It can be in the form of: Pre Menstrual syndrome characterized by: Moodiness Irritability Bloating and weight gain etc.

59 Disorders of menses Arthava Vyapath:
1.Excess: Athipravrti: Vata/ Pitta 2.Scanty: Aprvrti: Vata/ Kapha 1. Bleeding can be excessive and either infrequent or irregular (DUB) 2. Dark, thick and clotted blood, associated with heavy discharge in between

60 Kunapam Ghandi When the menstrual blood is dark, thick and has a strong odor, it is usually a Kapha disorder. Odor is associated with earth and water

61 Grandhi bhuta arthava vyapath
Malignant diseases/ or benign growths of the female genital organs. They are usually Kapha disorders since they involve unrestricted growth and require the earth element. Examples of this are fibroid tumors, ovarian cysts and tumors.

62 Ksheena arthavam Hypo-estrogen from exhaustion of the ovarian hormones as in menopause Therefore, this is different from Shushka which is a congenital state related to some chromosomal or genetic disorder.

63 Stri Rogam/ Prasudi tantra Gynecology/ Obstetrics
1. Yoni vyapath 2. Asrg dhara 3. Anapatyatha Yoni: reproductive tract organs of pelvis 20 types of basic gyn disorders

64 Vulvar disorders Vulvar swelling: Yoni Shoth or Yoni Virashi.
May be caused by: Due to pressure in the veins or lymphatics. Allergy Cyst or abscess of Bartholin’s glands.

65 Swelling in vulva Usually associated with pain and tenderness
Painful intercourse Inability to have intercourse.

66 Swelling in vulva Ointment of Hot fomentation with Dashamoola and ghee
Sarsap (Brassica compestris) Lashuna (garlic). Hingu (asafoetida) Vacha (Acorus calamus) Hot fomentation with Dashamoola and ghee

67 Swelling in vulva For relief of pain:
Guggul (Commiphora mukul) 1gm Add this to a decoction of Punarnava (Boerrhiva diffusa), Devadaru (Cedrus deodara) Shunti (ginger, Zingiber officinale) and Dashamoola In a dose of 50 ml three times daily.

68 Pruritus vulvae (itching)
Yoni Kandu Causes: Infection Allergy

69 Itching of vulva Symptoms: Itching Burning sensation Redness of area

70 Itching of vulva Treatment:
Local washing with decoction of Guduchi (Tinospora cardifolia) Triphala And Danti (Baliospermum montanum) Purified Gandhaka (sulfur powder) mixed in coconut oil applied locally. Sandalwood powder (Santalum album) mixed in coconut oil.

71 Diseases of vagina vaginitis
Kaphaja Yoni Vyapad Causes: Infections such as Candida, Trichomonas or Bacterial vaginosis. Symptoms: Yellow Discharge Itching and/or burning Odor Blood stained discharge

72 Treatment For excess secretions:
Vaginal insertion of powder of Palash (Butea monosperma), Dhataki (woodfordia fruticosa) and Jambu (Syzygium cumini) twice daily. Paste of five barks, Vata (Ficus bengalensis) Udumbar (Ficus glomerata), Asvatha (Ficus religiosa), Plasha (Ficus lacor) and Vatasaz (Salix caprea) Between insufflations. Vagina should be douched with unripe fruit of Udumbar (Ficus glomerata) mixed with sugar.

73 Treatment (contd.) Ointment made from kernel of Jambu (Syzygium cumini), kernel of Amra (Mangifera indica) and powder of Dhataki (woodfordia fructicosa) mixed with honey should be applied. Application of Trivit paste (Operculina terpethum) Oral Triphala guggulu, 2 tablets three times daily.

74 Dryness of the vagina Shushka yoni vyapad Cause: Estrogen deficiency.
Symptoms and signs: Dryness of the vagina, feeling of irritation and burning sensation, painful intercourse, appearance of inflammation of the vagina and cervix, narrowing of the vagina etc.

75 Dryness of the vagina Vagina should be douched with Triphala decoction. Application of Udumbar bark (Ficus glomerata) for 10 to 15 days at a time. Since this is a chronic and progressive condition, this application of Udumbar bark paste should be done on a frequent basis. Bala oil (Sida cardifolia) tampon.

76 Vaginal dryness Treatment: Dhanwantaram thailam pichu
Sesame oil lubrication Any vegetable oil

77 PID Treatment: Paste of Hardra (Curcuma longa0 and Daruharidra (Berberis aristata) should be applied to the vagina three times daily and at bedtime. Sveda (hot fomentation) to the lower abdomen with Dashamoola group of herbs. Uttar vasti: Vaginal and uterine irrigation of Bala oil (Sida cardifolia). Milk medicated with powder of Rasna (Pluchea lanceolata) and Ashwagandha (Withenia somnifera) consumed, 8oz. Three times daily. Triphala guggulu (2 tabs three times daily for pain and inflammation.

78 PID Abhayarishtam 40ml twice daily after meals, will help with pain and inflammation. Decoction of Bala (Sida cardifolia), Eranda (Ricinus cuminis), Punarnava (Boerhaavia diffusa) and chole kateri (Solanum surattense) taken orally before meals 50ml three times daily

79 Ovarian cysts Fall under the general term of Gulma Causes: Congenital
Sex hormone imbalance Symptoms: No symptoms, incidental finding Pelvic pain, usually unilateral Dyspareunia Painful and irregular menstrual periods. Swelling of the abdomen.

80 Ovarian cysts Treatment:
Sandhava salt added to powder of Pippali (Piper longum), Chitrak (Plumbago zeylanica) and black Jeera (Carum carvi), should be taken with Dashamoola decoction. Drakshasava improves immunity Draksharishtam with powder of Ajvayan (Tachyspermum ammi), Hingu (Asafoetida), Sandhav salt, and Haritaki (Terminalia chebula) Gokshuradi guggulu 2 tablets three times daily.

81 Yoni Rogas 1. Vatala Yoni rogam- In this Vata type of Yoni roga, there is pain (cramps), menstrual flow is diminished. This is comparable to oligomenorrhea or Spasmodic dysmenorrhea

82 Pittala Yoni Rogam Asscoiated with: Inflammatory disorders, like PID
Heavy and prolonged bleeding.

83 Kaphaja Yoni rogam There is usually formation of clots, more than heavy bleeding Thick and dark blood Enlargement of uterus or ovary as in fibroids and cysts.

84 Lohita Kshara Condition associated with : Erosion Cervical polyps
Chronic cervicitis

85 Lohita Kshaya Scanty menses without pain:
Nutritional deficiencies like anorexia, TB and other chronic disorders This is differentiated from Vata type of menstrual disorders by the fact that there is no pain and the bleeding is scanty.

86 Acharana When ability to have an orgasm is affected.
Occurs with menopause as a physiological event or Psychological disorders Due to medications like anti-depressants Ojas is affected. Pt is lacking in Prana

87 Paripluta Dyspareunia
Vaginismus, unrelated to deeper causes like endometriosis Could be psychological Dryness and lack of lubrication- Vata Vestibulitis- Pitta

88 Pudha varta yoni Pain and discharge of blood or other liquids PID
Cervicitis Endometritis STDs

89 Karnini Karna means ring: Polyps Cervical fibroids
Any growth on the cervix which causes obstruction

90 Putragni Habitual abortion
Athulya Ghotria: or consanguinity was admonished by Caraka Rh incompatibility

91 Anthar mukhi Retroverted uterus: Cause dyspareunia Painful menses
Thought to cause infertility Could be responsible for backache

92 Suchi mukhi Pinhole os:
Obstruction to free passage of blood and discharge. Hematometra Pyometra

93 Sushka Congenital estrogen deficiency:
Leading to underdevelopment of organs as in Turner’s syndrome Puberty is delayed or does not occur. Amenorrhea

94 Shandi Amenorrhea:/ oligomenorrhea
With or without underdevelopment of the genital organs. PCO

95 Maha yoni Different degrees of prolapse of the uterus and the other organs. Pelvic organ prolapse Vault prolapse

96 Vandhya Secondary amenorrhea Infertility anovulation

97 Athyanandha Nymphomaniac
It is important to understand that the formation and use and preservation of the Shukra is considered extremely important in Ayurveda. Psychological disorders leading to too much sex or too little and abnormal sex is prohibited.

98 Mutra-Purish arthava vyapath
When there is communication of the genital tract with other pelvic organs like bladder and bowels as in: VVF RVF and Any other type of abnormal communication

99 Treatment Treatment is based on the following principles:
Vata is cold, dry, light and mobile. Therefore, treatment will essentially consist of warming, lubricating and stabilizing or grounding

100 Treatment Spasmodic dysmenorrhea, deep dyspareunia, scanty and irregular menstrual periods: Diet: warming foods. Sour, salty and some pungent. Pungent should be in moderate quantities. Some sweet also since it is heavy and grounding and calming but it is cold.

101 Treatment Internally lubricating should be warm ghee with hot water.
All beverages should be warm or hot. Stay away from bitter foods like raw lettuce, endives, kale, romaine lettuce. Stay away from astringent tastes like strawberry, pomegranate, cranberry. The only berry which is good is chaste berry

102 Treatment Chasteberry: Agnus castus vitex. Which relieves not only dysmenorrhea but also some of the PM symptoms. Warm massage to the abdominal wall with warm sesame oil or castor oil, place a heating pad to the abdomen.Counterclockwise massage on the back.

103 Treatment Abhyanga; warm body massage with sesame or castor oil, especially to the crown of the head and feet. Vasti: Dasamoola powder boiled in water for about three minutes, add 1 oz of sesame oil and instill as an enema. This is a nutritive enema and therefore can be used daily.

104 Treatment Internal herbal treatments can be of four types:
Tablets- Gulika Kashayam Grtm Arishtam

105 Kashayam Ratio: 1 part of herb to 16 parts of water Reduced to 1/8th.
Take 1 Pala (50gms of powdered herb, add 800ml of water and boil slowly with lid of container closed. Boil until the quantity is 1/8th of original volume Strain and administer 50ml bid.

106 Arishtam (alcohol preparation)
Ratio: Prakshepa 500gms, jaggery 1kg and liquid 13 liters. Powder herb and prepare decoction Strain decoction and place in an earthen pot Add sugar, molasses or honey Add the herbal preservatives Keep in a cool environment for 30 days Decant, strain and bottle in a dark bottle

107 Grtm (Ghee) Ratio: 1 part of kalka, 4 parts sneha and 16 parts Drava dravya Make a paste of herb and add it to the ghee Place this in the Kalka and boil until a good paste is produced. This is taken 1 tsf bid.

108 Churnam (powder) Pushyanugam:
This is a herbal mixture which contains Arjuna, Bilva, Shundi, Raktachandanam, Yastimadhu, Ananta, Jambu etc. It is excellent for the treatment of DUB and spasmodic dysmenorrhea. It is good in the treatment of endometriosis.

109 Treatment Kashayam: is a decoction of the main herb along with other supplementary herbs. It is mainly made by boiling the herb for several minutes. Kashayam is mainly used for Vata and Kapha conditions. The usual dosage of Kashayam is 50ml bid.

110 Grtm Grtm is any ghee containing preparation. The herb is cooked with ghee. Grtm preparations are most suitable for Vata and Pitta. Vata because they need lubrication, being dry. Pitta because ghee has a cooling effect.

111 Arishtam/Fermentation
This is a process of fermentation which produces natural alcoholic preparation of the her. It is suitable mostly for Kapha and Vata. It is not suitable for Pitta because it is heating in quality. Such preparations are to be given carefully to Vatas.

112 Menstrual disorders Artava Aprvrti: When the quantity and duration of bleeding is increased as in menorrhagia and polymenorrhea. This is considered Vata/Pitta Treatment is with Vidari, Shatavari, Asoka If painful: Sukumara and Lashunadi kashayam

113 Lashunadi Garlic: Allium sativum Bulb.
Crushed bulb, wrapped in muslin cloth can be introduced into the vagina, in resistant cases of leucorrhea and vaginits. Antibacterial and anti-viral properties As Lashunadi kashayam, good for Vata/Kapha menstrual disorders.

114 Shatavari Asparagus racemosus. Reduces p and v and increases K.
Traditional Ayurvedic herb which is known to promote: Fertility Breast milk production “strengthens” female reproductive system

115 Asoka Saraca Indica: Astringent herb which is excellent for all the menstrual disorders associated with excess bleeding It is said to be soothing to the Uterus and ovaries (harmonizing). Cab be used in heavy bleeding, effective quickly, as Ashokarishtam

116 Sukumaram Dasamoolam with Trina Panchamoolam (5 types of grass) are the main ingredients of Sukumaram kashayam. Dasamoola:

117 Artava anaprvrti This is a menstrual disorder characterized by scanty and irregular bleeding. This is a Vata/Kapha disorder Treatment usually consists of Hingu and Chitrak which can be taken in the form of Kashayam

118 Hingu Asafoetida: Ferula asafoetida Spicy, bitter and hot herb- resin
Used as a famous Ayurvedic formula called Hingvastak- for bloating, gas, indigestion. It is excellent also for Candida of the bowels and vagina It is usually taken as a powder 1tsf one hour before meals, three times daily.

119 Raspberry leaves Excellent hemostatic agent and therefore used in heavy and prolonged bleedings. It is used in the form of powder, 6-15gms which is made into a decoction. Another indication is PPH It is also considered to be good parturient, facilitating vaginal delivery.

120 Dhanwantaram guliga Another agent that enhances the apana vayu and helps with parturition is Dhanwantaram guliga. To be taken 2 tablets three times daily in the 3rd trimester. This is usually given with Dadimadi churnam (Pomegranate) in the third trimester.

121 Other treatments Other treatments for Vata/Pitta include,
Virechana- purgation. This is based on the principle that the small intestines is the seat of Pitta. Purgation relieves and passifies Pitta. It also increases the downward moving force of Apana Vayu, thus facilitating the treatment of excess and irregular bleeding (Acute disc prolapse)!!!

122 Kapha discharge Use Asokarishtam, either orally or Asoka as a douche.
This is pitta increasing and Kapha reducing Therefore it is not to be used for inflammatory disorders.

123 Inflammatory vaginal disorders
Kumariasavam Chandanadi vati Pushyanuka churnam: in the handout This is best done in harmony with the lunar cycle, in women who have unexplained infertility. Ayurveda states that it harmonizes the genital organs and enhances fertility. Balances hormones

124 Male infertility Causes:
Somatic causes- congenital, sperm count and motility and impotence Dietary causes Behavioral- excessive sex, excess exercise, suppression of natural urges etc.

125 Treatment Poorva karma- Snehana, Svedana and Virechana
Pratama karma: Sneha vasti (oil enemas) and Yapana Vasti (rejuvenating enemas) And Uttara vasti (urethral enemas) Pascat Karma: management after main treatment (as follows)

126 Treatmement Grtms: Lehyams: Tonics: Dasamoolarishtam, Draksharishtam
Ashwagandhadi grtm, Sukumara grtm, Palasarpis Lehyams: Satavari lehyam, Chyavanaprasam Tonics: Dasamoolarishtam, Draksharishtam

127 Female infertility Kshetra: organ like uterus, ovaries etc
Ambu: Hormonal problems Beeja; Ovum problems Maithuna: disorders of intercourse, like frigidity, dyspareunia, vaginismus, loss of libido.

128 Menopause Menses is calculated in Chandra Masa. One masa is 28 days
Bleeding phase is Pitta dominant, raja kala 12 days of kapha pradhanya kala (proliferative) 14 days of mrtu vatita kala (secretory phase).

129 Menopause When Pitta becomes depleted and Vata becomes predominant
Pitta represents hot flushes, night sweats Vata causes, insomnia, irritability, difficulty with mentation, dryness of the skin, constipation and brittling of the bones.

130 Menopause Bone is the ashraya or host in which Vata is situated.
Bone is primarily made of earth element and when Vata predominates, it becomes more space and air. Osteoporosis is asthya kshaya Another feature of vata is pain and therefore bone and joint pains

131 Menopause symptoms Hot flushes and night sweats:
Pitta –hot, vata-intermittent Irritability, anxiety, depression- vata No menses or irreg menses- Pitta/ Vata Vaginal dryness and dyspareunia- Vata Decreased libido- decreased Pitta Loss of memory, confusion etc- Vata

132 Manopause treatment 1st treat Pitta- Hot flushes/irritability
Abhyanga with Ksheerabala thailam or coconut oil.- cooling to the head and body Use same oils as Nasya or cow’s ghee Shatavari lehyam or Kumari lehyam 1tsf bid Sm. Int is seat of Pitta and therefore purgation with Avipattikar churna or milk and trvrth churna Mahatiktaka kashayam

133 Night sweats Shatavari grtm Ashwagandha.
Both of these can also be calming and help with restful sleep.

134 Mood changes Brahmi (Gotu kola) Manasamitram Brahma rasayanam Mentat
Mental clarity

135 Menopause treatment Pravala pishti- 500 mg bid
Black, lightly roasted sesame seeds- 1 tsf bid Both are excellent sources of calcium Pan and Chuna Kamaduga rasam is excellent for hot flushes

136 Menopause treatment Mood changes: Manasamitram vatakam Mentat
Brahmi (gotu kola) churnam

137 Libido Vasantha kusumara rasam Kalyanaka grtm

138 Lactation Sthanya is the upadhatu of Rasa dhatu
Therefore as long as Rasa is well made, the lactation will do well. This is why, PP women in India are well fed, given a lot of rest and are kept away from a lot of stress. Milk, Fruits, ghee, dates, raisins and a lot of well cooked vegetables like asparagus etc.

139 Hyperemesis Cumin, lemon, pomegranate plus ginger.(matulanga rasayanam) 1 tsf 1 hour before meals Jeeraka vilvadi lehyam: root of vilva- make paste, make syrup, add coriander, cumin, cinnamon, cardamom, saffron, ginger, pepper, pippali; make paste Cool and add honey (!!!)

140 Ashta churnam Excellent for IBS, indigestion, constipation, spamodic dysmenorrhea, abdominal pain of unknown etiology. Ashta means 8 Ginger, Pepper, pippali, cumin, rock salt, bl. Cumin, celery, hing.

141 Herpes Pitta disorder (inflammation) Sudarshanam churnam Tiktaka grtm
Locally- triphala grtm Madhusnuhi 5gm bid

142 Menopause paste Fennel, sesame seeds, aloe vera, satavari, pravala pishti, jeeraka, arjuna for the heart or chandraprabha, or dashamoola haritaki

143 Recurrent ovarian cysts
Sapthasaram kashayam with hingu Sukumaram lehyam Varunadhi guggulu kumariasavam

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