Chikitsa SUTRA OF PRADARA:

1.?rasayana? chikitsa? and? adhogata raktapitta? hara chikitsa? is adopted
2.?Asthapana? vasti with? nyagrodadi kashaya? is given
3.?Uttara vasti with? satavari ghruta is given for 7 days
4.?Kushmanda avalehya? 5gm?? twice daily? with milk? after uttara vasti
5.?Chandraprabhavati - two tabs, twice daily with milk

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Analysis:

Basing on the description of endometriosis and different yoni vyapad and the arthava vyapad conditions the Ayurvedic concept of endometriosis can be explained. As it is not possible to relate any single disease explained in the classics can be taken as endometriosis, the disease like udavarthini, vandhya, apraja and raktha yoni, vamini, paripluta yoni vyapad? and Asrigdara arthava vyapad can be taken in a group as endometriosis and it can be termed as vata pittaja disorder of arthava vaha srotos.

The udavarthini yoni vyapad which is vataja yoni vyapad satisfies not only symptomology with the classical features of dysmenorrhoea (kastarthava) which is one of the important symptom of endometriosis, but also the theory of retrograde menstrual flow which is one of the aetiological theory can be seen in the explanation of udavarthini.

The cause of udavarthini that has been explained by Charaka i.e, the aggrevated apana vayu moving in upward direction or reverse direction fills the yoni and the yoni seized with pain pushes the raja upwards i.e, the retrograde flow of menstrual blood. This point clearly states the possibility of retrograde menstrual flow which is one of the cause of endometriosis. Basing on this explanation udavarthini yoni can be considered one among the vataja vyapads that simulates endometriosis.

The yoni vyapads like apraja, vandhya, vamini are related to the conditions of failure of conception as well as implantation defects, which is caused due to the anovulatory cycles, leutinized unerupted follicleand corpus luteum insufficiency etc.

The term vandhya is used buy Charaka to denote the beeja dosha i.e, congenital abnormality and Sushrutha’s explanation suggests amennorhoea i.e, nastarthava. But in Charaka’s explanation he says apraja and sapraja are the curable conditions of childlessness i.e, primary and secondary infertility. According to Haritha vandhya word denotes six types of conditions that lead to childlessness.

The conditions apraja and sapraja i.e, primary and secondary infertility respectively pushpagnijataharani given by Kashyapa and the conditions of Kakavandhya (one child sterility), anapathya (primary infertility) satisfies the condition of primary and secondary infertility caused due to endometriosis. These conditions fall under the category of anovulatory cycles except sapraja vandhya, and kakavandhya which denotes the conditions of secondary infertility caused due to the endometriosis because of which tubal motility is altered and the capacity of sperm transport is decreased because of the affected uterine endometrium.

The conditions of vamini and apraja or asraja denote the condition of luteal phase defect and early embryo reduction which are the probable causes of infertility caused due to endometriosis.

Paripluta yoni vyapad which is characterized with dyspareunia according to Sushrutha and dysmenorrhoea according to Charaka can be taken as the condition caused due to the deposits of endometriosis present in the ligaments and vatala yoni vyapad or vatika yoni vyapad to some extent suggests with the explanation of Charaka i.e, pricking pain, stiffness, roughness, numbness etc, in yoni. The deposition of the endometrial tissue in the pelvis causes pain and roughness. Chakrapani’s version of inter-menstrual bleeding in the vatala yoni vyapad is one of the important features which is suggestive of relation with endometriosis.

The condition of chocolate cyst that is one of the features of pelvic endometriosis can be considered as the condition of vataja grandhi explained in classics. In the explanation of granthi, the points of production of knotty swelling, features of pain like stretching, pricking, cutting etc and discharge of blood after bursting are suggestive of the feature of the chocolate cyst.

The description of Asrigdara suggests the involvement of endometriosis in the myometrium that is the adenomyosis condition which is characterized by menorrhagia (Asrigdara) and dysmenorrohea as suggested?? by Dalhana .

Considering the points in critical analysis, the disease endometriosis can be taken in Ayurvedic concept as vata pitta arthava vaha sroto dusti.

It has been taken as vata pittaja because the yoni vyapads like udavarthini, vandhya, vatala, vamini etc are mainly vataja vyadhis. The condition paripluta and asraja are pittaja yoni vyapads. So the doshas can be taken as vata pitta and the dushya is artavavaha srotos.

Artavavaha srotos is taken as dushya because the moola for arthavavaha
srotos is garbhashaya and arthava vahini dhamani.