Habbitual Abortion and Ayurved A Case study BY Dr.Sachin M.Bhor

AN AYURVEDIC MANAGEMENT OF PUTRAGHNI YONIVYAPADA W.S.R. DASHANGA AGADA 

A CASE STUDY

Sachin M. Bhor  

BAMS Pune. Maharashtra.                               

Email: -  Dr.sachin_bhor@yahoo.com 

Introduction- Miscarriage is a personal and emotional loss for a young couple trying to start a family. Recurrent miscarriage is a common problem during childbearing years. Many factors are responsible for recurrent pregnancy loss in which some hetu like eating virudhanna or Kitalutadansha and history of Pandu roga, Kamala in early ages which affects the Rasa, Rakta dhatu. Putraghni is a condition where repeated pregnancy loss occurs because of Artava, Rakta dosha dusthi and Aartava is updhatu of Rasa dhatu.

Main observations: A case of Putraghni yoni vyapada in a 24-year-old female patient with complaint of irregular menses along with stress and fear of previous 2 abortions. 

Result: Ayurvedic remedies were used to treat the patient for 4 months. This case study demonstrates the efficacy of Ayurvedic treatment for Putraghani yoni vyapada 

Conclusions: In this article, a case history kamala 5 yrs. back and 3 yrs. back dengue fever and habbits of eating virudhanaa with repeated pregnancy loss treated successfully with Ayurvedic medications like Rakta Pachaka and Dashanaga agada and Panchakarma treatment including Uttarbasti before conception and after conceived throughout pregnancy shamana chikitsa is continued. Antenatal visits and Ultrasonography observations gave positive outcomes with healthy foetal growth. Patient delivered a full term single live male baby vaginally on 19/02/2020 with 2.750 kg and on 3.42PM. No birth anomalies were detected. The selected treatment protocol i.e., Shamana aushada of dashanga agada and rakta Pachaka and panchakarma prior conception are found very effective in the management of Putraghni Yonivyapada .

Keywords:-  Virudhanna, Kitalutadansha ,Putraghni yoni vyapada ,Dashanga agada , Panchakarma.

According to Ayurveda, four healthy pillars require for conception and healthy outcome. That are Ritu (healthy menstrual cycle, fertile period), Kshetra (healthy endometrium or implantation bed or uterus), Ambu (proper nutrition), Beeja (healthy ova and sperm)1. Deviations of these factors lead to miscarriage and fetal abnormalities lead to infertility. According to Ayurveda classics, recurrent miscarriage (Putraghni yonivyapada) is an inflammatory condition spelled "early pregnancy loss".

It may occur due to genetic abnormality, immune factors, improper eating habbits ovarian factors, stress and various infections.3History of kamala or panduta4 and kitalutadansha4 like dengue or malarial fever, improper eating habbits like virudhanna5

According to Ayurveda : Putraghni yoniyapada 

Raukshaayad vayu yada garbham jatam jatam vinashayet Dusthta shonitajam naryaha putraghni nama sa mata ||6

Acharya Charaka states that Vayu gets aggravated due to predominance of Rooksha properties (Vata kara Ahara Vihara) which destroys foetus repeatedly due to vitiated Shonita because of vitiated vayu. Putraghni also called as jataghni yonivyapada.In first trimester pregnancy loss can be due to  abnormality of shonita or aartava (abnormality of ovum) and in 2nd and 3rd trimester pregnancy loss can be due to abnormality of shonita (Placenta) leads to many congenital abnormalities of the fetus and abnormality of blood can be consider as Rh incompatibility also or rakta dhatu kshaya due to vayu.7

1.To understand an ayurvedic treatment including shamana and panchakarma treatment in Putraghni yonivyapada.

2.To understand the role of dashanga agada in putraghni yonivyapada with respect to kitalutadansha chikitsa.

NIDANA CAUSATIVE FACTORS FOR PUTRAGHNI YONIVYAPADA

 Vayu aggravated due to predominance of ruksha properties (due to consumption of dry diet) and rakta dhatu affected by Virudhanna and kitalutadansha in Garbhashaya so repeatedly destroys the fetuses conceived .

SAMPRAPTI

SAMPRAPTI	TREATMENT BEFORE CONCEIVE	AFTER CONCEIVE
Vatadi dosha prakopa (Tridosha)-aacharya charaka	Deepana -Pachana drugs mainly Tridoshgna	Garbhasthapaka chikitsa
Pitta predominance – Acharya sushruta	According to hetu treatment like Kitalutadansha -Dashanga agada-Tridoshghna	Madhura, Sheeta, Balya, Jeevaniya and Rasayana dravyas are helpful in preventing Garbhasrava and maintaining pregnancy
Sthana -garbhashaya	Shodhana : Panchakarma  Vamana,Virechana,yapana basti,Uttarbasti,shirodhara.	Garbhasthapaka gritam for nine months.
Roopa : Sthitam Sthitam Hanti Garbham8 repeated foetal loss	Rasayana chikitsa

CASE REPORT

A 24 year-old Indian, married, female consulted in Sulbhas Shree Sainath Ayurved and Panchkarma Clinic Ravet Pune in 23/11/2018  for a complaint of Irreguler Menses and malavasthabha.

History of Kamala 5 years back and Dengue fever 3 year back in February 2015

Virudhanna – Daily eating of Tea and Wheat roti. (Milk and salt)

G1 miscarriage happened in 2015 July in 7 Week

G2  baby died in april 2017 at 9th Month with spontaneous labour 

Married 4 year back.

CLINICAL FINDINGS ;-

Rasa dhatu	Jivha Niram. Aartav -Menses irregular(30 to 40 day cycle) .Normal flow with four days with sometime clots but mild pain in abdomen while menses. Menarch ;14yr.
Rakta Dhatu	Mild Kanduta all over body
Mansa Dhatu	Pidikodwsthen shoola
Meda dhatu	Normal Mutra pravrutti
Asthi Dhatu	No pain at Joints.
Majja dhatu	No giddiness but weakness
Vata dosha	Prana vayu,Samana vayu, Vyana vayu, Apan vayu
Pitta dosha	Pachaka pitta
Kapha dosha	No swelling, whitish vaginal discharge.
Nidra	Alpa nidra and stress
Mala purisha         Mutra         Sweda	Aniyamita Samyaka Samyaka
Prakriti	Vata pradhana pitta
Awastha	Vat kaphaj (Avrodha awastha)
Sarata	Mansasarata
Aahar shakti	Madhyam

BP- 120/90 mm of hg    Weight-62 kg 

Temperature- 98.6 f       Body build -average

LMP :21/11/2018

Modern investigation finding :

ULTRASONOGRAPHY -28TH JUNE 2018	PCOD WITH BULKY UTERUS.
TSH	2.404MLIU/ML
HB	12.9
PROLACTIN	4.44
LH	15.60
Foliculer study done   8/1/2019	On 15th day ovulation done by left ovary.

TREATMENT GIVEN BEFORE CONCEIVE :

SR.NO	DATE	MEDICINE	DOSE	ANUPANAM
1	24/11/2018	Laghumanjisthadi kashayam	15ml morning after food	Warm water with same quantity.
	TO	Dashang agada	2.5 gm daily morning empty stomach	With ghee and honey visham matra
	10/12/2018	Chandraprabha vati	250gm two time after food	Warm water
		Varunadi kashayam	15ml two time after food	Warm water
		Gandharva haritaki vati	250gm at night after food	Warm water
2.	12/12/2018 17/12/2018 -vamana karma 19/12/2018	Vamana karma  17 to 21/12/2018  Sansarjana karma	Snehapanam aabhyanter  Tikitam gritam for 4 day (50/80/110/130ml) Bahyantara by Chandan bala tailam Vamana karma done at 5th day	With milk. Uttam shudhi done with 7 to 8 vega
3.	19/12/2018	Virechana karma	Falagritam Sneha aabhyantara panam for 3 day 50/80/110/130 ml Bahyanter Narayana tailam	With milk
	23/12/2018	Virechana done with trivrutta aaragvadh kashayam 250ml 23 to25/12/2018  Sansarjan karma	Around 12 vega  Madhyam sudhi	Draksha kashyam
	Menses started	25/12/2018	Normal flow with no clots and no pain four day.
4.	Basti karma	From 6th day of Menses  Mustadi Yapana basti	6th ,7th and 8th day	500ml Mustadi yapanam
	Uttarbasti 2nd session Uttarbasti	Dhanvantaram tailam  Falgritam	9th 11th 14th day Same as last month followed with yapana basti	2ml. 2ml
5	Every 15 day	Shirodhara	Aamalaki +Brungraj +Musta tailama	800ml
6.	Rasyana Chikitsa Given for 1 month	Kushmanda rasayana	10gm daily rasayana kal	With milk
	1/1/2019 to 15/2/2019.	Garbhasthapana grita (garbhasthapak gana dravya )	10ml daily in morning before food.

Male semen analysis report : Normal with good motility

Male : Virechana karma done and Mustadi Yapana basti and  Dhanavantaram tail matra basti given .

Medicine : kaucha Paka .

ROLE OF DASHANGA AGADA

Dashanga Agada with Ayurveda point of view shows that among all the contents 10% are Sheeta Veerya, 20% are Anushnasheeta, and 20% are having Madhura Rasa. All these properties shows the Tridoshgna and mainly all dravya are deepana, pachana, raktapachaka activities.

table given below9,10,11,12,13,14,15,16,17

Ingredient of  Dashanga Agada	A.H.U (37/28)	Rasa	Guna	Virya	Vipaka	Karma	Doshghnata
Vacha9	Acorus calamus Linn	Katu, Tiktha	Laghu Tikshna	Ushna	Katu	Vedanasthapan, Sanjnasthapana, Jwaragna, Krimigna Deepana ,pachana	Medhya Kapha vataghna
Hingu10	Ferula narthex Boiss	Katu Laghu, snigdha, Ushna Katu Vedanasthapana, Sanjnasthapan	Snigdha Laghu	Ushna	Katu	Vedanasthapana Sadnyasthapana Deepana ,pachana Stripushpajana.	Kapha vataghna
Vidanga11	Embelia ribes Burm	Katu,kasaya	Laghu Ruksha	Ushna	Katu	Rakta shodhaka Vedanasthapana,Krimighna,udarshool, kustha,aadhamana	Kapha vataghna
Saindhav12	Rock salt	Lavana	Shita, Ruksha	Shita	Madhura	Rochana, deepana,mootrala	Tridosha ghna
Gajapippali13	Scindapsus Officinalis	Katu	Laghu  snigdha	Anush ‘n’sita	Katu	Deepana,pachana, Shothahara	Kapha vataghna
Patha14	Cyclea peltate	Tikta	Laghu teekshna	Ushna	Katu	Vishaghna,Daha prashamana,Deepana, pachana,mootrala	Tridosha ghna
Ativisha15	Aconitum heterophylum Wall.	Tikta katu	Laghu  ruksha	Ushna	Katu	Deepana ,pachana,shothahara,raktashodhaka	Tridosha ghna
Shunthi16	Zingiber officinale Rosc.	Katu	Laghu snigdha	Ushna	Madhura	Rakta Pachaka,raktashodhaka,aamapachaka	Kapha vataghna
Maricha17	Piper nigrum Linn	Katu	Laghu teekshna	Ushna	Katu	Deepana,pachana,vatanulomana,sothahara	Vata kaphghna
Pippali18	Piper longum Linn.	Katu	Laghu teekshna	Anush ‘n’sita	Katu	Krimighna,vedanasthapana,jwarahara best use in kamala,pleehavridhi, yogavahi,rasayana	Kapha vataghna

AFTER CONCEIVE TREATMENT

SR NO	MEDICINE	Dose	ANUPANA
1	Garbhasthapak grita19 for 9 month	Daily 10gm in morning empty stomach	with milk
2	First trimester laghumalini vasanta tab	Morning 1 and evening 1 after food	With water
3	Second trimester madhumalini vasanta tab	Morning 1 and evening 1 after food	With water
4	Third trimester  suvarnamalini vasanata tab	Morning 1 and evening 1 after food	With water
5	15 days  matra basti 50 ml bala tailam	7 th and 8th Month
6	Full term baby delivered vaginaly.	( Gynaecologist consultation continue for 9 month )

RESULT 

Patient delivered a full term single live male baby vaginally on 19/02/2020 at 3:42PM with 2.725 kg. No any birth anomalies were detected

The selected treatment protocol i.e., Shamana aushada of dashang agada and rakta Pachaka and panchakarma prior conception are found very effective in the management of Putraghni Yonivyapada .

Becoming mother is the most cherished dream of all women. In Putraghni Yonivyapada Kshetra and Beeja plays major role. Putraghni yonivyapada takes place due to Ruksha Aahara and Vihara, thus leads to Vata Prakopa which in turn causes Shonita and Artava Dushti results in Garbha Vinasha .So for Garbhashaya kshetra and beej dusthi (Rakta dhatu) Dashanga Agada used for agnidipan and raktapachana.Its works Tridoshaghna and by prabhava works  Vishghna, Pittaghna and Daha shamana along with raktapachaka laghumanjisthadi kashayam also used for kanduta and for kleda pachana and mutarechana chandraprabha vati and varunadi kashayam used which regular the menses.  

Vamandi panchakarma shodhana karma are told by acharya charaka for all yoniroga20 ,it removes extra increase dustha dosha and helps in  beej (ovum)and kshetra(Garbhashaya) shudhi.Vamana karma and Virechana karma helps removes excessive kapha dosha and pitta dosha respectively and basti works on Vata Sthana so Mustadi yapana basti are balya ,tridoshgna and helps to develop endometrium and for ovulation.thus increase balyata of garbhashaya antakala for garbhasthapana.Uttarbasti done with Dhanvantaram tail removes excessive vata in yoni and then with falagrita gives balyata to garbhashaya. 

Dashanga agada contains Hingu possess Stripushpajana21, vacha helps in ovulation22, Patha  is also useful for managing menstrual problems like pain or cramps during periods due to its Vata balancing property,Trikatu has deepan and pachana activity.

Thus medicines used in post conception mainly Garbhasthapaka Gana are Madhura, Sheeta, Balya, Jeevaniya and Rasayana thus helps in preventing Garbhasrava and maintaining pregnancy. Garbhasthapak grita made of garbhasthapaniya gana helps the woman to achieve conception and cures female genital tract disorder. It is Vatahara, Balya, Brimhaniya, Garbhasthapaka and Rasayana thus helps in nourishment of reproductive organs and baby later.It works as Prajasthapaka and Yonipradosha Shamaka properties. It also helps in proper development of endometrium, follicles results in healthy progeny. Malini kalpa are used for balya and for well development of fetus.

Putraghni yonivyapada is increased due to modern stressful lifestyle,food habits and sometime aagantuj hetu like kitalutadansha. Here in present case study, Putraghni yonivyapada is treated successfully by Ayurvedic Herbal and Panchakarma treatment only. Pregnancy is successfully carried as it crossed that critical period of first and second trimester. The medicines used are Tridoshaghna,Dahashamna and having Garbhasthapaka, Rasayana, Balya and jivaniya Guna. Thus, it helps to maintain pregnancy & promotes the growth of fetus.

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Before treatment

After treat